How
Strong Are Your Bones?
Osteoporosis is a disease in which bones become weak
and thin and are susceptible to fractures. Eight million
women and two million men in the United States are
at high risk for osteoporosis and fractures because
of low bone density. One of every two women over age
50 and one in four men over age 60 have fractures due
to osteoporosis. Often called a "silent disease" because
you cannot feel or see the bone loss, osteoporosis
causes bones to become weaker and more fragile. In
fact, there are no symptoms at all until a bone breaks,
often with only a simple fall or jolt. The most common
sites for fractures are the bones of the spine, hip
and wrist. These fractures often lead to loss of height,
back pain, disability and premature death if osteoporosis
is not treated.
The good news is that osteoporosis is preventable
and treatable, particularly if bone loss is caught
early. Despite this fact, 77 percent of women and most
men with osteoporosis are still undiagnosed. Without
a diagnosis and treatment, bone loss continues unchecked.
The diagnosis of osteoporosis begins with a thorough
medical history and examination by a physician. After
determining your risk factors for osteoporosis, the
physician may order a bone mineral density test (BMD).
Who Should Have a Bone Mineral Density Test?
Your physician may advise you to have a BMD if you
are:
- a postmenopausal woman under the age of 65 not
on hormone replacement, who has one or more additional
risk factors for osteoporosis (besides menopause).
- a woman age 65 or older regardless of other risk
factors.
- a man or postmenopausal woman with a history
of hip, spine or other fractures which occurred
from a fall from no more than one step above the
ground.
- anyone on cortisone therapy.
- a woman or man being treated for osteoporosis
to monitor that treatment.
Major Risk Factors For Osteoporosis
- Early menopause (before age 45) or removal of
ovaries
- Prolonged absence of menses for more than one
year (before menopause)
- Long-term cortisone therapy
- Personal history of fractures as an adult
- History of fracture in a first-degree relative
- Current cigarette smoking
- Weight less than 127 lbs.
- Use of certain medications, such as cortisone
or prednisone, seizure medication, chemotherapy,
blood thinners, prostate cancer treatments and
high doses of thyroid hormone.
- Other illnesses, such as Crohn's Disease, malabsorption,
partial gastrectomy, anorexia, chronic liver disease,
low levels of estrogen or testosterone or rheumatoid
arthritis.
What is a Bone Mineral Density Test?
A BMD test is a fast, safe, noninvasive and painless
way for your physician to determine the health of
your bones and to diagnose osteoporosis. Several
types of tests are available which measure bone density
at a variety of skeletal areas of the body, for example,
the spine, hip, wrist, heel or finger. The dual-energy
absorptiometry, or DXA, of the hip and spine is considered
to be the "gold standard" of bone density measurements
because of its low radiation, high accuracy and superior
ability to monitor treatment. In addition, the current
criteria used to diagnose osteoporosis were developed
specifically for DXA measurements and may not apply
to other techniques. DXA machines use very low dose
x-ray technology to assess bone density. For a DXA
measurement, you lie on an open table, usually in
your own clothes, and the arm of the machine moves
around the table without touching you.
The test is completed in about 15 minutes. The BMD
results guide your physician in determining your risk
of fracture in critical areas.
What Do The BMD Results Mean?
The density of your bones is compared to the bone density
of healthy young adults (approximately age 30). The
results are reported as a score, called a "T-score," which
shows how your bones compare to what is considered
normal bone mass.
The T-scores fall into one of three categories:
Normal . . . . . . . -1.0 or higher
Low bone mass . . Between -1.0 and -2.5 (osteopenia)
Osteoporosis . . . . Less than -2.5
Another result, called a "Z-score," compares your
bone density to your age- matched peers. If the Z-score
is between -1 and +1 it means that your bone density
is approximately average for your age. If it is less
than -2, it suggests that you are outside the usual
range for your age group and indicates the need for
other laboratory tests. Because fracture risk increases
as bone density declines from young normal levels,
only the T-score is used to diagnose osteoporosis and
determine the need for treatment. In general, if you
have osteoporosis, your risk for fractures is very
high and medication is usually recommended. Osteopenia
means that your risk for broken bones is higher than
desirable, but the need for medication will be individualized
based on your full medical history and other risk factors
for bone loss and fractures.
If I Have Low Bone Density,
What Are My Options?
If you have osteoporosis or are at risk it, you and
your physician can determine whether lifestyle changes
and/or additional treatment measures are necessary.
Some things you can do right now are:
Eat a diet rich in calcium and make sure you get enough
Vitamin D.
Get plenty of exercise, both weight bearing (walking,
low impact aerobics, etc.) and muscle strengthening
(light, progressive weight lifting).
Discuss with your physician the need for prescription
medication to halt bone loss.
Remember, it is never too late to treat never too
early to prevent osteoporosis! The BMD test is typically
repeated at two-year intervals to help monitor your
response to treatment. Keep in mind that for accurate
comparisons, all of BMD tests should be performed at
the same facility using the same machine. For reliable
results, it is also critical that the measurements
be performed Unfortunately, not all technicians and
physicians have had the training or experience needed
to perform or interpret bone density tests correctly.
To choose the right facility, ask if the technicians
and physicians are certified by the ISCD (International
Society of Clinical Density) and ask how many DXA's
are performed each year.
For more information about osteoporosis, to schedule
a bone mineral density test or to schedule an appointment
with one of our physicians, call the Saint Barnabas
Osteoporosis and Metabolic Bone Disease Center at the
Ambulatory Care Center at (973) 322-7430.
The Saint Barnabas Osteoporosis Center is the leader
in bone densitometry testing in New Jersey since 1995,
performing approximately 6,000 DXA measurements per
year. Under the leadership of Marjorie M. Luckey, M.D.,
a world-renowned expert and teacher of densitometry
techniques, the Osteoporosis Center is equipped with
the most scientifically advanced DXA machines and staffed
by highly trained and ISCD certified technicians and
physicians.
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The
Sandwich Generation - Caregivers of the 21st Century
" The Sandwich Generation" emerged in the last decade
of the 20th century and has become a buzzword to describe
those individuals who are caught in the middle of providing
for the needs of the many. This growing number of adults
is often faced with the challenges of balancing a job
along with the responsibilities of children and the
care of an elderly parent or relative. Eighty percent
of middle-aged couples have at least one living parent,
as compared with less than 50 percent a hundred years
ago.
What caused this change to occur? Although there are
many factors, several trends are developing that stand
out. First, people are living longer. Those over the
age of 85 comprise the fastest growing population group
in our country. In 1956, there were only 2,500 people
over the age of 100. In 1986, this number had risen
to 25,000. Today, that number is a staggering 268,000.
But of this group, more than half suffer from some
disability.
Because of this, many people are learning to adjust
to the role reversal that takes place between parent
and child; to confront the demands of having to care
for those who once took care of them. But we also have
to remind ourselves that because we might be caring
for our parents, role reversal does not mean they become
our children. Parents remain our parents no matter
how dependent they become upon us.
The Caregivers
We become caregivers to our parents or elderly loved
ones for a whole host of reasons: love, dedication,
devotion, but also out of a sense of obligation,
duty, or simply because there is no one else to do
it - either because of circumstances such as being
an only child, or because someone else is unable
or unwilling. Unless you are a paid caregiver, then
you are an "informal" caregiver -providing care for
one of the reasons previously mentioned. But even
under the best of circumstances, the role of caregiver
can take its toll. You do not have to be providing
24-hour care in your own home to feel this way. Many
people who provide only a few hours of care per week
can grow to have many negative feelings about their
role.
It is always impressive to hear the tasks people take
on for their care recipients. Things like washing,
cooking, cleaning, shopping, banking, helping with
personal care, making appointments, transporting the
person to appointments and providing entertainment
and companionship. Some people have essentially taken
on the daily and long-term responsibilities of another
entire life. These tasks can generate feelings of anger,
resentment, hurt, guilt, jealousy, fatigue, frustration,
burden, loss, fear, confusion, denial, discouragement,
anxiety, depression and grief, and ultimately lead
to caregiver burnout.
The Risk of Caregiver Burnout
Caregiver burnout is defined as "a state of emotional
exhaustion that results from too many demands on one's
energy, strength or resources." (*Haigler, et al.,
1998) It is a process with stages. The good thing about
that is that once you recognize that you are on that
slippery slope, you can get off of it. Symptoms of
burnout include depression, withdrawal, feelings of
helplessness and hopelessness, negative emotions and
physical fatigue. It is not uncommon to see the primary
caregiver of an elderly relative become so overwhelmed
with these symptoms that his or her own health suffers
and ultimately compromises the care of the relative
- exactly what the caregiver was trying to avoid! It
is imperative that caregivers recognize and deal with
burnout before this scenario occurs.
So, how do you prevent burnout? First, realize that
you cannot be all things to this person and that a
caregiver that cares for himself/herself first is the
best caregiver. We like to use the example of a parent
and child on an airplane. When providing instructions
about what to do in the event of a loss of cabin pressure,
the flight attendants always instruct the parent to
put the oxygen mask on themselves first, then their
child. The reasoning behind this is that a parent will
be of no use to a child if he or she becomes incapacitated.
For caregivers, this means taking time for yourself,
getting others involved, attending a support group
and being attentive to your own health problems.
The next thing to do to prevent burnout is to recognize
and cope with negative emotions. If you feel angry
or used, recognize that and talk to someone about it.
Get validation of your feelings or at least give it
to yourself. Then let go; it will only eat away at
you. Another way to cope is to learn to laugh. Sometimes
even the seemingly unfunniest things can be less stressful
if you learn to laugh at them. Finally, let others
help you. Do not turn anyone away. Pride will get you
nowhere when you are exhausted.
But what about when you seek help from others and
can't get it? In their book, I'll Take Care of You,
authors Joseph Illardo and Carole Rothman report that
in general there are three sources where people look
for help and are sometimes turned down: their own families,
specifically amongst siblings; their workplace; and "the
system."
Help Within the Family
Let's start with families. Why don't families share
equally in the care of the ill person? Here are a few
reasons: 1.) "I'm not good at taking care of sick people." Maybe,
but that does not mean that that person should have
no role. Perhaps your brother who cannot deal with
your sick parent can do the weekly grocery shopping,
take over the financial management or even pick up
your kids from school. 2.) "Mom always liked you better." This
person's unwillingness to help is clearly tied to his/her
feelings of being second best. But mom's illness is
everyone's problem and the responsibilities need to
be shared even if the adult child feels the parent's
love was not always equally distributed.
On the other hand, here is a reason that some supposedly "unhelpful" siblings
have given when asked why they are not helpful, "I'm
tired of having my offers of help rejected." As the
primary caregiver, you have to look at the offers of
help and decide, as objectively as possible, if they
are timely and legitimate. If they are, ask yourself, "Why
am I not accepting this offer?" "Is my own anger making
me try to inflict guilt on others?" "Am I unwilling
to give up control?" "Am I falling into that 'nobody
can do it as well as I can trap?'" Look carefully at
your answers.
So, how do you obtain cooperation from a family member?
Do four things:
1. Acknowledge the existence of the problem.
2. Talk about how it came about and what might be
done to solve it.
3. Create a plan for solving it.
4. Periodically evaluate the progress.
To effectively achieve these four steps, however,
there are some guidelines.
1. Don't blame.
2. Don't speak for others.
3. Don't interrupt.
4. Everyone should be privy to all dialogue - no secret
arrangements or ganging up.
5. Don't be afraid to express feelings but make sure
to use "I" statements.
Workplace Problems
The Family and Medical Leave Act of 1993 guarantees
12 weeks of unpaid leave annually for every employee
in the United States in order to provide care for a
family member or other reasons (like maternity leave).
The law specifies that the time may be taken in a block
or a few days at a time. Regardless of how the time
is used, the employer must continue paying for the
employee's health insurance and other benefits,
and the employee is guaranteed his or her job back.
It may help to keep in mind some things when requesting
this to enable everyone involved to be in a "win-win" situation.
1. Be sensitive to your employer's needs and make
it easy for them to give you what you want. 2. Be clear
about your goals and keep your employer updated. 3.
When the time off is over, be grateful to employers
and coworkers alike - you never know when you are going
to need this or some other type of concession again.
The System
The system is that group of organizations or community
resources that provides assistance and is responsible
for the delivery of services. When attempting to access
help through the system, remember these six points.
1. Be clear about your needs.
2. Insist that your rights be respected
3. If you are dissatisfied, tell your health care
provider or other official.
4. Write things down - dates, names, places.
5. Speak with a supervisor.
6. Utilize resources to help you (the hospital social
worker, the physician etc.).
In Conclusion
If you follow the guidelines described above, you
may find that caregiving, although at times emotionally
and physically difficult, can also be productive and
even rewarding.
For more information about caregiver support groups
in your area, call the Self-Help Clearinghouse at 1-800-FOR-MASH.
They can provide referrals to groups throughout the
state as well as national organizations.
Saint Barnabas Medical Center offers a service called
Geriatric Assessment Program (GAP) that can help
families address these problems. The GAP team includes
a board-certified Geriatrician, a Gerontological
Nurse Practitioner and a Social Worker, all with
training and expertise in the care of older adults.
GAP offers consultative outpatient evaluations designed
to assist older persons, their families and primary
care physicians in addressing special health care
needs and providing optimal individualized solutions
for conditions like Alzheimer's disease. To learn
more, please call (973) 322-7988.
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Could
It Be My Hormones
What are hormones? How do they affect my health? How
can I tell if I have a hormonal problem? Who should
I see if I think I am having a problem?
Hormones are substances made by different organs of
the body to regulate or affect other parts of the body.
They are an important form of communication that keeps
your body running smoothly. For women, the most obvious
bodily function under hormonal control is the menstrual
cycle. The cycle is a result of a complex interplay
of hormones of the brain and the ovaries that prepare
the uterus for pregnancy, produce eggs, and maintain
health in many other parts of the body. The hypothalamus
in the brain, produces a hormone that signals another
organ, the pituitary, to produce hormones that signal
the ovaries to produce eggs and the steroid hormones,
estrogen and progesterone. Estrogen and progesterone
then act upon the uterus to prepare the lining for
pregnancy. When pregnancy does not occur, the menstrual
period begins.
Meanwhile, estrogen acts on multiple parts of the
body, maintaining normal bone density, lowering cholesterol,
maintaining normal vaginal and skin tone, relaxing
coronary arteries, perhaps improving brain function.
There are many other hormone systems in the body that
work in a similar way.
In this article, we will discuss some common hormonal
disorders that affect women This article will not cover
all hormonal problems, so if you suspect something
is wrong, speak with your physician or internist about
your concerns.
Thyroid Disorders
The thyroid gland is a small organ in front of the
windpipe that produces thyroid hormone. Thyroid hormone
can affect almost every organ in the body. It helps
regulate the body's metabolism. Problems with inadequate
production of thyroid hormone (hypothyroidism) are
extremely common in women and become more common with
increasing age. Between 4-17 percent of women have
evidence of hypothyroidism on laboratory testing, while
only 2-7 percent of men have this disorder.
Hypothyroidism usually worsens over time and may cause
problems such as hypercholesterolemia, cardiac problems,
high blood pressure, neurological disorders, anemia
and in very severe cases, coma. Symptoms of hypothyroidism
can be very vague and non-specific. In early, mild
cases, there may be no symptoms at all. Some common
symptoms include menstrual irregularities, constipation,
cold intolerance, carpal tunnel syndrome, decreased
exercise tolerance, fatigue, lack of energy and infertility.
For women over 40, it may be reasonable to test for
thyroid dysfunction even if no symptoms are present.
The best screening test is a blood TSH (Thyroid Stimulating
Hormone) level. This is another hormone produced by
the brain that causes the thyroid to produce thyroid
hormone. It is the most sensitive indicator of thyroid
dysfunction. If the TSH is normal it should be repeated
every 1-2 years. If the TSH level indicates hypothyroidism,
your physician may simply place you on a low dose of
thyroid hormone in the form of a daily pill. Retesting
of TSH should be performed periodically.
If physical examination of the thyroid gland reveals
any abnormalities, a thyroid ultrasound should be performed
to look for any abnormal growths. If there are abnormalities
on ultrasound, you will need further evaluation by
a medical endocrinologist. Glucocorticoid Disorders
Glucocorticoids are steroid hormones that are produced
by the adrenal glands, triangular organs on top of
the kidneys. These hormones affect multiple body systems.
Adrenal abnormalities are much less common than other
hormone disorders and can be life-threatening in severe
cases.
Over production of glucocorticoids can cause Cushing's
syndrome. Signs and symptoms include progressive central
obesity, muscle weakness, increased skin and blood
vessel fragility, moon-shaped face, high blood pressure,
and diabetes. Because Cushing's syndrome is rare, a
good history and physical exam by your internist can
tell you whether or not to suspect this problem. If
the problem is suspected, a 24-hour urine collection
to test for free urinary cortisol is the first step.
Full evaluation requires a medical endocrinologist.
Underproduction of glucocorticoids or Addison's disease,
leads to loss of appetite, nausea, vomiting, abdominal
pain, dizziness upon standing, low blood pressure,
diarrhea, darkening of the skin, weight loss and inability
to fight infection. Theses symptoms are non-specific
and Addison's is not the most common cause, but it
may be reasonable to consider if other causes have
been ruled out. Testing starts with an ACTH (adrenocorticotropic
hormone) stimulation test. A fasting blood cortisol
level is drawn in the morning. An injection of synthetic
ACTH is given, and cortisol is measured again one hour
later. Initial evaluation is with your primary care
physician, who can determine if testing and/or referral
to a medical endocrinologist is indicated.
Sex Hormone Disorders
These disorders involve abnormalities of estrogen,
progesterone and testosterone and the hormones that regulate
them. The most common symptoms are menstrual irregularities.
The lack of estrogen and progesterone are what cause
the symptoms and physical effects of menopause. Your
gynecologist should evaluate menstrual abnormalities.
One of the most common causes of abnormal bleeding,
or the lack of bleeding, is pregnancy. Bleeding can
occur during normal pregnancies, but can also be a
sign of a problem such as
miscarriage or tubal pregnancy. Once pregnancy is ruled
out, the gynecologist can evaluate for non-hormonal
causes of bleeding such as uterine fibroids, polyps,
uterine or cervical cancer, vaginal infections, etc.
One of the most common hormonal causes of irregular
menstrual periods is an ovulation or the failure to
ovulate. Common hormonal disorders that can cause irregular
menses include thyroid disorders discussed above, and
conditions that lead to sex hormone abnormalities such
as polycystic ovarian syndrome, hypothalamic amenorrhea
and premature ovarian failure.
Polycystic ovarian syndrome (PCOS) is one of the most
common hormonal causes of irregular periods. The cause
of PCOS is unknown. Common symptoms include lack of
menses or infrequent menses (more than 35 days apart),
infertility, overweight, acne and excess facial hair.
Women with PCOS are at increased risk for developing
uterine cancer. They also have elevated insulin levels
that can lead to diabetes, high blood pressure, high
cholesterol and heart disease.
Many women with PCOS seek care from a gynecologist
to help regulate their menses and to obtain clomiphene
citrate (Clomid, Serophene) to help them ovulate and
conceive. If clomiphene does not work, women with PCOS
should consult with a reproductive endocrinologist
for more advanced fertility therapy. Researchers are
also looking at some oral diabetic drugs such as metformin
(Glucophage) to normalize insulin levels in PCOS, alleviate
symptoms and perhaps reduce long-term health risks.
Therapy with metformin may be discussed with a reproductive
endocrinologist.
Hypothalamic amenorrhea and premature ovarian failure
(POF) may have similar symptoms: a lack of menses and
hot flashes. This is due to a lack of estrogen in both
conditions. Hypothalamic amenorrhea is due to failure
of the brain (the hypothalamus) or pituitary gland
to stimulate the ovaries to produce estrogen. In POF,
the brain and pituitary work, but the ovaries do not
respond. POF is similar to menopause, which is the
natural end of estrogen and egg production by the ovaries,
but POF occurs prior to age 40.
In Review
If you suspect that you have one of these conditions,
you should review your symptoms with your gynecologist.
Your doctor will examine you and run some blood hormonal
tests. The FSH (follicle stimulating hormone) level
is the key to differentiating between these conditions.
Women with hypothalamic amenorrhea will have normal
or low FSH levels, while women with POF or menopause
will have elevated FSH levels. Women with hypothalamic
amenorrhea should be referred to a reproductive endocrinologist
for evaluation and treatment. Hypothalamic amenorrhea
may be caused by excessive dieting,
weight loss and exercise. Rarely, a brain tumor can
cause this condition and many cases are unexplained.
The underlying condition needs to be treated and hormone
replacement given or ovulation induced in women who
are trying to conceive.
Women with POF and menopause will need hormone replacement
therapy, which should be managed by a gynecologist.
Women with POF that is not caused by ovarian surgery,
chemotherapy or radiation are at increased risk for
developing other endocrine problems such as thyroid
disorders and diabetes. They should be monitored yearly
for these conditions. POF significantly increases the
risk for developing osteoporosis and women with POF
should discuss with their doctor whether or not to
consider baseline bone density testing. Women with
POF can conceive using donor eggs and in vitro fertilization.
Menopause
Menopause is not a disorder, but the dramatic drop
in the level of sex hormones during menopause can
cause very disruptive and uncomfortable symptoms
including hot flashes, insomnia, vaginitis, vaginal
dryness, irregular vaginal bleeding, depression,
moodiness and poor memory. Long-term risks of estrogen
deprivation include osteoporosis, heart disease and
perhaps an increased risk of Alzheimer's disease.
A gynecologist can help evaluate a women for signs
of menopause and help her find a regimen of hormone
replacement that will prevent disease and alleviate
her symptoms. This may be an ongoing process as there
are individual differences in symptoms and responses
and many different ways to given estrogen replacement.
Summary
Hormones play a very important role in a woman's health.
Hormonal disorders can cause a wide range of symptoms
and affect multiple body systems. Some of the more
common hormonal disorders have been discussed in
this article. In general, if you suspect that you
may have a hormonal disorder, speak with your physician.
For further evaluation, a consultation with a medical
or reproductive endocrinologist may be helpful.
For an appointment with The Institute of Reproductive
Medicine and Science at Saint Barnabas Medical Center,
please call (973) 322-8286.
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Research
Suggests Modified Le Fort Procedure Is Sound Alternative
for Elderly Women with Pelvic Organ Prolapse
The Administration on Aging predicts that by the year
2030, 20 percent of the nation's population will be
over age 65. As Americans gray, medical professionals
are challenged to reduce the risk of age-related diseases
and provide alternative treatments that improve the
quality of life.
With more women reaching their 8th and 9th decades,
physicians are seeing an increased number of patients
with pelvic organ prolapse. Surgeons at Saint Barnabas
Medical Center's Division of Gynecologic Oncology and
Reconstructive Pelvic Surgery offer a less invasive
surgery for the long-term treatment of vaginal and
uterine prolapse in women whose advanced age or medical
condition prevent standard vaginal hysterectomy.
Thad R. Denehy, M.D., Associate Director of the Division
of Gynecology Oncology and Reconstructive Pelvic Surgery
at Saint Barnabas, and a team of colleagues conducted
a retrospective study that compared the clinical outcomes
of 42 women suffering from prolapse who had undergone
vaginal hysterectomy with 21 elderly women treated
with a modified Le Fort colpocleisis procedure. After
two years 95 percent of the women who underwent the
modified Le Fort procedure continued to have good results
with long-term pelvic support. Since their research
was published in the American Journal of Obstetrics
and Gynecology in 1995, the team has performed another
35 procedures with good outcomes and is in the process
of publishing the most recent phase of research.
"With an aging population in this country, physicians
are seeing more elderly women who suffer from pelvic
organ prolapse. Aside from being very uncomfortable,
a prolapse raises hygiene issues for the patient and
the caregivers," explains Dr. Denehy. "We were looking
for a procedure that would offer long-term pelvic support
for a narrowly defined population of elderly and medically
frail women who fail management with a pessary." A
pessary is a medical devise worn in the vagina that
prevents the uterus from dropping.
The minimally invasive surgery takes approximately
half the time of a complete hysterectomy. Small portions
of the surface layer of the protruding vagina are removed.
These sites are sutured together as the vagina is repositioned.
Scarring occurs, joining the walls of the vagina and
preventing future prolapse. Due to the anatomical proximity
of the rectum and the urinary bladder, these organs
are often drawn out when the vagina and/or uterus prolapse.
These are also repositioned and supported during the
procedure.
Dr. Denehy emphasizes that a few disadvantages of
the modified Le Fort procedure require that patients
considered for this surgery be carefully selected.
One drawback is the inaccessibility of the cervix and
uterus after surgery. "We recommend that an endometrial
biopsy be performed before surgery to rule out the
presence of cancer." The procedure also restricts sexual
intercourse.
"The original Le Fort procedure fell out of favor
with advances in vaginal hysterectomy. Now we are seeing
a resurgence in the use of modified Le Fort partial
colpocleisis as a sound alternative for medically compromised
elderly women," concludes Dr. Denehy.
For information, call (973) 322-5250.
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Bibi and Hirohisa Hayakawa of Maplewood, N.J., had
been trying to have a baby for three years. Eventually,
with the assistance of in vitro fertilization, Mrs.
Hayakawa became pregnant. When the Hayakawa's learned
they would be having twins, due in early summer 2001,
the couple was ecstatic. But on January 30, an unanticipated
turn of events turned their dream of having a family
into a nightmare.
In late January, Mrs. Hayakawa, then at 17 weeks gestation,
experienced unexpected bleeding and had to be rushed
to Saint Barnabas Medical Center. In the throws of
a miscarriage, Mrs. Hayakawa lost the first fetus en
route to obstetric surgery before she could be stabilized
and attempts were made to prevent the second fetus
from miscarriage.
According to Dom Terrone, M.D., perinatologist at
the Division of Maternal-Fetal Medicine, Mrs. Hayakawa's
miscarriage was caused by cervical incompetence, a
condition in which the cervix dilates prematurely,
leading to miscarriage or premature delivery. "Even
aggressive intervention would provide less than a five
percent chance of survival for the remaining twin," he
said.
For Dr. Terrone, there were serious risks to consider
with any efforts to save the remaining fetus. Attempts
to delay the birth of a second twin are called a "delayed
interval delivery," and represent a relatively new
area of medical research. Health risks for mother and
baby alike are increased dramatically due to the chance
of infection caused by the rupture of the membrane
from the loss of the first fetus. Likewise, according
to the medical literature, treatment tends to hold
off the birth of the second fetus for only a matter
of days, sometimes four weeks at most. Since a full-term
baby is 37-40 weeks gestation, and the youngest surviving
infants have been born at 23 weeks gestation, Baby
Hayakawa would need at the very least a minimum of
another six and a half weeks in his mother's uterus
to survive. Another five weeks above and beyond that
benchmark would increase his health and survivability
significantly. But the odds were not in his favor.
For the Hayakawa's, the decision was more personal.
Despite the devastation of losing her first twin, a
boy, whom she and her husband, a software engineer,
named Nosomu, which is Japanese for "hope," she steadfastly
followed strict guidelines and spent time both at home
and in Saint Barnabas' high-risk maternal-fetal medicine
department, waiting and hoping.
Treatment included tocolysis (medicine to prevent
labor); antibiotics to prevent infection; a cerclage,
or stitches to prevent premature delivery; as well
as bed rest. "Dr. Terrone and his colleagues, particularly
Dr. Richard C. Miller, as well as Dr. Kalavathi Ayyagari,
my OB/GYN, were very cautious in managing the remainder
of my pregnancy," said Mrs. Hayakawa. "I knew Dr. Terrone
had done all that he could do and that our chances
were very slim. But after all we had been through,
we were more than willing to take those chances."
"We are delighted the Hayakawa Baby reached this gestational
age with no ill effects for Mrs. Hayakawa," said Dr.
Terrone. "We have used this technique before, as have
our colleagues around the world, but it is rare for
a delayed interval delivery to achieve an additional
19 gestational weeks. There is no question that the
first twin could not have been saved given the quick
manner in which Mrs. Hayakawa miscarried; the vast
majority of women, unfortunately, lose both babies.
It is gratifying for our team (including the perinatologists,
residents, our high-risk maternal nursing staff, and
other support personnel) that our efforts were so successful.
I have nothing but praise for the Hayakawa's, particularly
Mrs. Hayakawa, for demonstrating such a commitment
to this pregnancy despite the many obstacles."
On June 15, Mrs. Hayakawa gave birth to 4 lb., 10
oz. Hikaru Wakeel with the assistance of her obstetrician/gynecologist
Dr. Ayyagari of Maplewood; Albert Franco, M.D.; Jennifer
Malabre, R.N.; and Galina Gendelman, R.N. The labor
and delivery took place naturally at just over 36 weeks
gestation.
"Hikaru No Genji or 'the shining Genji' is the main
character from The Tale of Genji, a Japanese novel
written by Murasaki Shikibu in approximately 1000 A.D.
Shikibu is a woman writer and her book is the first
novel ever written," explains Mrs. Hayakawa, who has
an M.A. in Spanish literature and is learning Japanese. "So
it is a significant piece of literature for several
reasons." Hikaru along with Wakeel, which means guardian
in Urdu and Arabic, can loosely be translated as the
Hayakawa's "Shining Guardian." "For us, it is such
a miracle and a blessing to have him. Throughout the
last four and a half months, Hikaru has been a glimmer
of hope for my husband and I and now that we can actually
hold him in our arms, we are overwhelmed by the happiness
and light he has brought to our lives."
Hikaru Wakeel, born June 15, is shown here with his
parents Bibi and Hirohisa Hayakawa and Dom Terrone,
M.D., perinatologist in Saint Barnabas Medical Center's
Division of Maternal-Fetal Medicine.
[ top ]
Women's
Health Educartion Program
The Women's Health Education Program encompasses all
prenatal childbirth preparation classes. In addition,
seminars on women's health issues are offered. Under
the direction of Susan Weinstein, R.N., B.S., F.A.C.C.E.,
this department has an extensive array of programs
to meet community needs.
The following courses and services are currently offered:
Prepared Childbirth Series-First-time parents are
prepared for pregnancy, labor and delivery and provided
with instruction in baby care. A tour of the maternity
unit is included. Specialty populations, including
pregnant women over 35 and parents expecting multiples,
have separate curriculums. Condensed weekend series
is available.
Lamaze Refresher Series-A review for couples who previously
attended a prepared childbirth series during their
first pregnancy. Women preparing for a VBAC delivery
are encouraged to attend and are grouped together.
Sibling Preparation Class-Designed to reduce children's
anxieties when separating from their mothers during
delivery. This class promotes a good feeling about
the hospital and realistic expectations of newborn
babies. Breast-feeding Basics-Breast-feeding information
and techniques are taught prenatally.
Breast Pump Rental Service-Electric pumps may be rented
or purchased through this office. Breast-feeding accessories
may also be purchased.
Infant and Child CPR-An overview of infant CPR and
guidelines. This program is under the direction of
the CPR Training Center. For more information, please
call (973) 926-7407.
Postpartum Depression Support Group-This active support
group meets on a weekly basis at the Saint Barnabas
Ambulatory Care Center at 200 South Orange Avenue in
Livingston and is facilitated by a member of the psychiatric
support staff. For more information, please call 1-800-300-0628.
Grandparenting Seminar-This program familiarizes grandparents
with new trends in OB management and childcare practices.
Adoptive Parents Baby Care Consultations-Service available
for parents who want one-on-one demonstrations and
discussion of baby care techniques. Women's Health
Seminars-Programs are offered on or off site to educate
and promote women's wellness. Topics include: "Women,
Weight and Wellness," "Preparing for Menopause" and "The
Mind/Body Connection with Women and Wellness." Women's
Resource Library-This consumer library is housed in
the Medical Center's Health Sciences Library. Videos
and information on women's health-related issues are
available on a free loan basis. Pets and Babies-This
informative seminar offers tips on introducing the
family pet to the new baby. Guest speakers discuss
pet/baby interactions.
Unless a different phone number is listed above, information
about registration for classes is available by calling
The Women's Health/Parent Education Department at (973)
322-5360. |
