Postpartum depression is a condition in which mothers who have just given birth to their newborn suffer from a form of clinical depression. Symptoms and signs include excessive crying and emotional instability, fatigue, irritability, anxiety, and/or an inability to care for their new baby. It can last for up to a year or so and is best treated with therapy and medications.
Pregnancy is the time in which a woman carries her unborn baby in her uterus for nine months before delivering him or her into the world. Pregnancy can be complicated or high-risk, or it can be relatively uneventful, because every woman is different. Pregnant women should eat right, get appropriate exercise, and be well rested to prepare for the birth.
One of AME’s pregnancy expert witnesses has written an exclusive medical malpractice article that we have provided, for your interest, below. Missed Diagnosis of Pre-Eclampsia
If the patient starts out her pregnancy with 130/70 blood pressure and the 70 changes to 80, it must be looked at, not necessarily treated, but looked at. If the 80 goes up to 85, then you have to be concerned about the possibility of early pre-eclampsia, a high blood pressure condition in pregnancy which can cause damage to the mother and the baby. When there is high blood pressure in the mother, blood flow to the placenta, which nourishes the baby, is impaired and there is a higher risk of the placenta separating from the lining of the uterus (abruptio placenta).
Patients suspected of having possible pre-eclampsia are also given urine tests. Protein appear in the urine abnormally; we call it “spill out”.
Actually, the protein leaks through the filtering system of the mother’s kidneys into the urine. The mother’s kidneys filter her blood to remove her impurities and those she absorbs into her blood from the baby through the placenta. With high blood pressure, the filtering mechanism is damaged.
In pre-eclampsia, protein which is in the blood and which should stay in the blood and not go in the urine will go into the mother’s urine where it can be picked up with these simple, inexpensive tests. It’s standard to check the urine for protein at every obstetrical visit. If any protein is found and if the level of protein in the urine rises, and/or if the blood pressure is rising, the doctor must be concerned about pre-eclampsia.
Reflexes (knee jerk, ankle, elbow) are tested at each office visit. In pre-eclampsia, these responses become more active (brisker) and are another indicator of potential problems.
If the blood pressure starts rising, the woman must be placed at absolute bedrest (other than going to the bathroom) and a low salt diet prescribed to treat and prevent progression of pre-eclampsia. Often this works. If that doesn’t work, then you give the mother tranquilizing medications such as the barbiturate Phenobarbital or a sedative. If that doesn’t work, you begin some of the mild antihypertensive agents which reduce blood pressure.
If this office and home treatment for pre-eclampaia is ineffective, the woman must be hospitalized quickly. This is a clinical judgment; however, it can also be poor judgment, which is negligence. If the diastolic pressure starts to rise to 90 or 95, then she must be hospitalized, regardless of the week of pregnancy. She must be kept in a hospital environment, under treatment, so the blood pressure stays down in a range safe enough to protect the mother and baby. Then the mother can carry the baby as close to term as possible; as close to the forty weeks the baby would normally go. If the blood pressure continues to rise however, at that point the obstetrician must intervene to deliver the baby. This can be done either by induction with the hormone-like medication Pitocin which stimulates the uterus to contract down so the mother can deliver the baby vaginally or, if that’s not successful, and the blood pressure continues to rise, then by a Caesarean section operation.
The mother is given either general or spinal anesthesia which paralyzes and numbs the abdominal muscles. The abdomen is cut and opened between the umbilicus (the belly button) and the pubic bone. The bladder is separated from the lower third of the uterus. The uterus is opened, the baby taken out and the placenta (afterbirth) removed.
Then everything is sewn back up again. The only definitive treatment for pre-eclampsia is to deliver the baby without delay.
Pain medications are prescribed according to a “pain ladder.” This means that the patient must describe his pain and other symptoms along a numeric scale (ranging from mild to moderate to severe) and then the doctor prescribes the appropriate drug. Pain medicine administering must be properly monitored so the patient does not become addicted or
Pressure ulcers, also known as bedsores, are spots on the skin that are caused by unrelieved pressure or friction. So if a patient remains in one position for too long, then he or she will suffer from pressure ulcers. In a hospital facility, the nurses and physicians will turn the patient frequently to avoid them.
Preventative medicine is any course of treatment that aims to preemptively prevent the patient from contracting a disease. Therefore, preventative medications and therapies are not palliative or curative; instead, they focus on stopping the patient from ever suffering in the first place.
A primary care physician is a general practitioner who is knowledgeable about all the different aspects of human anatomy and disease. Therefore, he or she can handle any primary concerns the patient has; if necessary, the primary care physician will make a referral to a specialist.
In accordance with the laws and codes of HIPPA, the Health Insurance Portability and Accountability Act, all patient health info and records must remain private and confidential. This allows patients to feel safe in the knowledge that their medical history will never be used against them in a discriminative manner.
Proctology is a field of medicine whose physicians study, diagnose, and treat conditions of the colon and anus. The most common procedure they perform is a colonscopy, a type of diagnostic measure in which they explore the patient’s colon to screen for cancerous polyps.
A prognosis is a term used in medicine to describe the typical outcome of a diagnosis. Cancer prognoses are not generally optimistic, because they describe the short period of time that the patient has left to live.
The prostate is the exocrine gland of the male reproductive system; it creates, stores, and dispenses a whitish fluid that is included in the male’s ejaculatory fluid. Prostates need male hormones, like testosterone, to remain stable and productive.
One of AME’s prostate expert witnesses has written an exclusive medical malpractice article that we have provided, for your interest, below.Prostate Cancer- delay in diagnosis, failed follow-up strategy
Attorneys are often consulted by patients who feel that they have not been properly followed after cancer had been treated and that a recurrence could have been diagnosed earlier but was missed. Different cancers have different follow-up recommendations. For prostate cancer,
PSA is the mainstay of the follow-up strategy.
One consequence of the routine adoption of PSA monitoring after treatment of early stage prostate cancer is the identification of men with a PSA-only recurrence. In this situation, increases in serum PSA over the pretreatment baseline are often not accompanied by signs or symptoms of progressive disease. When PSA rises, the physician is often faced with a quandary. The longer one waits to perform an imaging study, the greater the chance that a recurrence can be confirmed and treatment started. On the other hand, imaging too early in the course of PSA rising, might result in a negative study, frustrated patient, avoidable expense and the need to repeat imaging at a future time. If the rise in the PSA is slow and occurs after a prolonged period, the site of relapse is generally at the site of the original tumor. Since a significant number of these men are relatively young and otherwise healthy and can still be cured, intense interest has been focused upon their treatment, with particular attention to survival, and the impact of therapy on quality of life.
Treatment options for men with a PSA-only recurrence after radical prostatectomy include external beam radiation therapy (RT) to the prostatic bed with or without treatment of the pelvic lymph nodes (salvage RT), androgen deprivation therapy (ADT), a combination of salvage RT plus ADT, or observation. Most of the available data regarding these approaches has come from observational series. Long-term results of randomized clinical trials will be required to define the optimal approach.
After prostatectomy, PSA should be 0.0 or close to zero. Rising PSA suggests recurrence even if the absolute PSA values is low. When this fact is not appreciated, a recurrence can be missed because the PSA, although higher, is still within the “normal” range. There is some controversy on whether any PSA rise warrants re-treatment or whether the PSA Velocity (rate of PSA rise over time) should be used to predict when to intervene.
Wiegel T, Lohm G, Bottke D, et al. Achieving an undetectable PSA after radiotherapy for biochemical progression after radical prostatectomy is an independent predictor of biochemical outcome–results of a retrospective study. Int J Radiat Oncol Biol Phys 2009; 73:1009.
Trock BJ, Han M, Freedland SJ, et al. Prostate cancer-specific survival following salvage radiotherapy vs observation in men with biochemical recurrence after radical prostatectomy. JAMA 2008; 299:2760.
Boorjian SA, Karnes RJ, Crispen PL, et al. Radiation therapy after radical prostatectomy: impact on metastasis and survival. J Urol 2009; 182:2708.
Andrew J. Stephenson, Salvage Radiotherapy for Recurrent Prostate Cancer After Radical Prostatectomy , JAMA. 2004;291:1325-1332
Biography
The Hematologist/Oncologist who wrote this article had been Associate Professor of Medicine while a full-time attending at the University Hospital of a Medical School until 2009. Prior to 2004 had been an Associate Clinical Professor of Medicine. He is currently in private practice. He is first author of over thirty academic articles, chapters and several books. Over the past two decades he held the positions of Interim Chief of Hematology and Oncology, Director of the Cancer Center, Chief of Hematology and Oncology and Chief of Service and concurrently Director of the Cancer Center Network of the Health and Hospitals Corporation and Co-Director of Oncology at a University Hospital and Medical Center. He developed and ran two clinical research programs as well as a community advocacy group, a consulting group, and a non-profit educational institution. In addition to Internal Medicine and Oncology. He is Board Certified in Quality Assurance and Utilization Review and holds an MBA. He was listed several times as the best in his specialty by the Castle Connolly Guide to America’s Top Doctors.
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