It is a simple decision for a pregnant woman to forgo things like cold medicine, caffeine or alcohol in order to protect their baby from potentially harmful substances. The effects of those decisions are short term and not harmful to either mother or child. However, almost 20% of pregnant woman experience clinical depression. Left untreated clinical depression can be deadly. There are several options available to treat depression, including psychotherapy, medications, bright light therapy and combinations of these.**[see note]
A study published in the April issue of Pharmacotherapy analyzes the choices available to patients and their doctors. This particular study evaluated the results of several other studies that focused on newer antidepressants; selective serotonin reuptake inhibitors (SSRIs) and seratonin norepinephiren reuptake inhibitors. While “information is available on the safety of antidepressant use during pregnancy it is limited by the small size of most trials and by trial designs that often did not use mothers with depression as control subjects and could not, for ethical reasons, be randomized and double blinded.” That paucity makes the decision whether or not to use medication to treat depression during pregnancy that much more difficult. Pregnant women “are subject to the same adverse consequences of depression as are non-pregnant women, including social withdrawal and even suicide.”
Untreated clinical depression during pregnancy has been associated with preeclampsia, miscarriages, and premature labor. “In addition, pregnant women with depression are less likely to attend regular obstetric visits and may have lower than normal weight gain, may lack compliance with prenatal care, and may be more likely to smoke, drink alcohol, or use cocaine.”
While data about the gestational pharmacotherapy is sparce, most of the data is encouraging. For example, “preliminary evidence suggests that SSRI exposure in utero does not have significant long-term effects on cognition or behavior.” Doctors and women should weigh several factors to decide on a treatment plan including the severity of the depression and the preferences of the mother.
**Electoconvulsive therapy is another option, however, it is only used when other therapies have failed to provide relief.
Thursday, July 5, 2007
Tuesday, July 3, 2007
Visiting The Emergency Room
No one likes to go to the emergency room. That’s understandable. For one thing, the fact that you are there means that you have a problem that you cannot deal with on your own. Not only that, but you get to pay someone else an exorbitant amount of money at the same time. It is also irritating waiting centuries for your turn, I mean, hours for your turn. I have figured something out; when the staff take you straight back to an exam room instead of making you wait 4 hours, this is NOT a sign of good service. Customer service is not a high priority for emergency room personnel. That doesn’t mean that they will go out of their way to inconvenience you. It means that they have bigger fish to fry. Let me reiterate, going straight back to an exam room is BAD.
Almost 10 years ago, my six year old son had a chest cold. All of the sudden, he started complaining about stomach pain. My internal “Red Alert” lights started flashing, so I took him down to the ER. It wasn’t a busy night, and we made it to the triage nurse within 10 minutes. She took his pulse and blood pressure and also tested his O2sats (blood oxygen saturation levels) which turned out to be 87. She said, “Why don’t you two come on back?” Then the ER staff were all doing something for my son. It wasn’t dramatic like on TV, but they were definitely scurrying. I was confused because I didn’t think it was all that bad. After all, an 87 is a B+, right? In a word, no. But I’m still not a doctor, so I don’t know why and don’t care all that much. I do know that my son had actually pneumonia, not just a head cold.
Two years ago, my other son was getting his nightly (high blood pressure) medicine ready when he spilled the bottle. So, he picked all the pills up. After he picked them all up, because he had been in the process of taking his medicine to begin with, he proceeded to swallow the entire handful. Over doses are nothing to trifle with, so we headed straight to the ER. Thank God that he told me right away! When we got to the hospital, I told the nurse what we were there for, and we headed straight back to an exam room. We spent the next two nights in the hospital.
Last June, I fell at work and broke my left elbow, badly. Or, depending on your point of view, I did a very good job breaking it. I arrived at the hospital in an ambulance. Once I got there, my wheelchair was parked in the waiting room and I waited over an hour and a half to be seen. That is not a long wait, all things considered, but it is far from a straight shot to the doctor! I was definitely injured, but the fact that I was waiting to go back told me that I was not in imminent danger.
I am not talking about the aberrational situations where people have died because they should have been seen earlier. That is a whole other topic. For the average Joe, waiting in the ER for treatment can be torture. You depend on the staff to end the interminable wait and so you analyze them, like a hunter stalking prey. From your point of view they flirt, fight, and gossip instead of discernibly treating patients. At times like this, remember waiting is good.
Almost 10 years ago, my six year old son had a chest cold. All of the sudden, he started complaining about stomach pain. My internal “Red Alert” lights started flashing, so I took him down to the ER. It wasn’t a busy night, and we made it to the triage nurse within 10 minutes. She took his pulse and blood pressure and also tested his O2sats (blood oxygen saturation levels) which turned out to be 87. She said, “Why don’t you two come on back?” Then the ER staff were all doing something for my son. It wasn’t dramatic like on TV, but they were definitely scurrying. I was confused because I didn’t think it was all that bad. After all, an 87 is a B+, right? In a word, no. But I’m still not a doctor, so I don’t know why and don’t care all that much. I do know that my son had actually pneumonia, not just a head cold.
Two years ago, my other son was getting his nightly (high blood pressure) medicine ready when he spilled the bottle. So, he picked all the pills up. After he picked them all up, because he had been in the process of taking his medicine to begin with, he proceeded to swallow the entire handful. Over doses are nothing to trifle with, so we headed straight to the ER. Thank God that he told me right away! When we got to the hospital, I told the nurse what we were there for, and we headed straight back to an exam room. We spent the next two nights in the hospital.
Last June, I fell at work and broke my left elbow, badly. Or, depending on your point of view, I did a very good job breaking it. I arrived at the hospital in an ambulance. Once I got there, my wheelchair was parked in the waiting room and I waited over an hour and a half to be seen. That is not a long wait, all things considered, but it is far from a straight shot to the doctor! I was definitely injured, but the fact that I was waiting to go back told me that I was not in imminent danger.
I am not talking about the aberrational situations where people have died because they should have been seen earlier. That is a whole other topic. For the average Joe, waiting in the ER for treatment can be torture. You depend on the staff to end the interminable wait and so you analyze them, like a hunter stalking prey. From your point of view they flirt, fight, and gossip instead of discernibly treating patients. At times like this, remember waiting is good.
Ethanol Fuel May Pose Health Risks
Ethanol is a renewable alcohol fuel hyped as environmentally friendly solution to air pollution. Proponents claim that ethanol burns cleanly and produces less toxic emissions. It is a linchpin in President Bush's plan to reduce gasoline consumption in the United States by 20% with 10 years. The president announced the plan during the State of the Union address in January 2007.
The most common form is ethanol currently available in the US is E10, a mixture of 90% gasoline and 10% ethanol. E10 is used primarily in urban areas that do not meet clean air standards. All vehicles that use gasoline can run on E10 without a modified engine. The California Air Resources Board (CARB) has been considering the impact of ethanol on air quality. So far, CARB seems ambivalent toward ethanol. It recently applied for a waiver from the U.S. Environmental Protection Agency's rule requiring the use of E10 during the winter months.
That is a valid concern according to Dr. Mark Jacobson, an atmospheric chemist at Stanford University. In the 1970s, Brazil heavily promoted ethanol fuel. At the same time, for reasons that are still unclear, air quality deteriorated. Using that knowledge, a NASA research grant for computational development, and a sophisticated atmospheric computer model, he compared two air quality scenarios for the year 2020: a vehicle fleet fueled entirely by gasoline versus a fuel flexible vehicle (FFV) fleet, which should be common by then. FFVs are vehicles that can run on 100% unleaded gasoline or a mixture of gasoline and up to 85% ethanol. The next generation of ethanol is E85, a blend of 85% ethanol and 15% gasoline. It contains approximately 80% less contaminants than gasoline. The National Ethanol Vehicle Coalition (NEVR) maintains that E85 will reduce greenhouse gas emissions as much as 46%, is non-toxic, water soluble and biodegradable. They claim that the cleaner exhaust will mean less smog and fewer respiratory illnesses. The American Lung Association of the Upper Midwest also endorses E85 as a CleanAirChoice.
However, Dr. Jacobson's study, "Effects of Ethanol (E85) Versus Gasoline Vehicles on Cancer and Mortality in the United States", produced results that contradict NEVR's assertions. This is the first study that examined not just tailpipe emissions, but also "chemical reactions, temperatures, sunlight, clouds, wind and precipitation." He found that E85 emissions did reduce atmospheric levels of two carcinogens, benzene and butadiene. Unfortunately, the atmospheric levels of two other carcinogens, formaldehyde and acetaldehyde, actually increased. Dr. Jacobson adds that "we have found that using E85 will cause at least as much health damage as gasoline, which already causes about 10,000 U.S. premature deaths annually from ozone and particulate matter."
The Renewable Fuels Association published a review** that challenged these results. It was written by Dr. Gary Z. Whitten, who has worked in the field of gas-phase photochemistry since the 1960s. He has testified as an expert witness before Congress, State Legislatures, and the U.S. EPA as an expert witness on the subject of various emission sources and the impact on air quality. While both scientists agree that the future is uncertain with regard to emission technology, regulations and other fuel formulations, they reach entirely different conclusions. Dr. Whitten's primary objection to this study centers on the data Dr. Jacobson entered into the computer model. "The methodology used to assemble existing data... is not described in sufficient detail to assess... that methodology or the range of data variability." He also believes that rapidly developing technology make long-term projections unreliable.
Responding to the review, Dr. Jacobson says, "Dr. Whitten did not realize that simulations were done for present day conditions as well, as reported in the paper. Almost his entire argument centered around uncertainties in future emissions when, in fact, simulations indicated an even greater effect under current emission conditions, which are extremely reliable. Further, four sensitivity tests were run examining different possible future (2020) emission scenarios, and regardless of the uncertainty, the future results held. Dr. Whitten did not realize these results were also stated in the paper. He hypothesized incorrectly that conclusions would change if emissions changed."
This article is based on information from an article entitled "Clearing the Air On Ethanol" published in the April 18 online edition of the journal Environmental Science & Technology (ES&T) and input directly from Dr. Mark Jacobson.
The most common form is ethanol currently available in the US is E10, a mixture of 90% gasoline and 10% ethanol. E10 is used primarily in urban areas that do not meet clean air standards. All vehicles that use gasoline can run on E10 without a modified engine. The California Air Resources Board (CARB) has been considering the impact of ethanol on air quality. So far, CARB seems ambivalent toward ethanol. It recently applied for a waiver from the U.S. Environmental Protection Agency's rule requiring the use of E10 during the winter months.
That is a valid concern according to Dr. Mark Jacobson, an atmospheric chemist at Stanford University. In the 1970s, Brazil heavily promoted ethanol fuel. At the same time, for reasons that are still unclear, air quality deteriorated. Using that knowledge, a NASA research grant for computational development, and a sophisticated atmospheric computer model, he compared two air quality scenarios for the year 2020: a vehicle fleet fueled entirely by gasoline versus a fuel flexible vehicle (FFV) fleet, which should be common by then. FFVs are vehicles that can run on 100% unleaded gasoline or a mixture of gasoline and up to 85% ethanol. The next generation of ethanol is E85, a blend of 85% ethanol and 15% gasoline. It contains approximately 80% less contaminants than gasoline. The National Ethanol Vehicle Coalition (NEVR) maintains that E85 will reduce greenhouse gas emissions as much as 46%, is non-toxic, water soluble and biodegradable. They claim that the cleaner exhaust will mean less smog and fewer respiratory illnesses. The American Lung Association of the Upper Midwest also endorses E85 as a CleanAirChoice.
However, Dr. Jacobson's study, "Effects of Ethanol (E85) Versus Gasoline Vehicles on Cancer and Mortality in the United States", produced results that contradict NEVR's assertions. This is the first study that examined not just tailpipe emissions, but also "chemical reactions, temperatures, sunlight, clouds, wind and precipitation." He found that E85 emissions did reduce atmospheric levels of two carcinogens, benzene and butadiene. Unfortunately, the atmospheric levels of two other carcinogens, formaldehyde and acetaldehyde, actually increased. Dr. Jacobson adds that "we have found that using E85 will cause at least as much health damage as gasoline, which already causes about 10,000 U.S. premature deaths annually from ozone and particulate matter."
The Renewable Fuels Association published a review** that challenged these results. It was written by Dr. Gary Z. Whitten, who has worked in the field of gas-phase photochemistry since the 1960s. He has testified as an expert witness before Congress, State Legislatures, and the U.S. EPA as an expert witness on the subject of various emission sources and the impact on air quality. While both scientists agree that the future is uncertain with regard to emission technology, regulations and other fuel formulations, they reach entirely different conclusions. Dr. Whitten's primary objection to this study centers on the data Dr. Jacobson entered into the computer model. "The methodology used to assemble existing data... is not described in sufficient detail to assess... that methodology or the range of data variability." He also believes that rapidly developing technology make long-term projections unreliable.
Responding to the review, Dr. Jacobson says, "Dr. Whitten did not realize that simulations were done for present day conditions as well, as reported in the paper. Almost his entire argument centered around uncertainties in future emissions when, in fact, simulations indicated an even greater effect under current emission conditions, which are extremely reliable. Further, four sensitivity tests were run examining different possible future (2020) emission scenarios, and regardless of the uncertainty, the future results held. Dr. Whitten did not realize these results were also stated in the paper. He hypothesized incorrectly that conclusions would change if emissions changed."
This article is based on information from an article entitled "Clearing the Air On Ethanol" published in the April 18 online edition of the journal Environmental Science & Technology (ES&T) and input directly from Dr. Mark Jacobson.
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