Thursday, November 27, 2008

Post-natal Depression Misdiagnosis




Joanne Morgan was initially diagnosed with post-natal depression following the birth of her first child Thomas. But tests later revealed she had a rare pituitary gland disorder called Cushing’s disease.
I tucked my baby Thomas into his cot and dabbed my eyes – maybe I was being weak, but I’d been feeling so bad lately that I could hardly cope.
“I had no strength in my legs, no energy to carry my baby upstairs or to even bend down for anything.
“By 11am I was ready to go back to sleep, I couldn’t keep my eyes open.”
Joanne Morgan had started to feel exhausted halfway through her pregnancy with Thomas. Her blood pressure had risen and she was advised by doctors to rest.
In her 20th week she was told that she may have pre-eclampsia.
She said: “I was a first-time mum – it was no beautiful experience, but I was sure that I’d pick up after the birth.
“But after Thomas was born I wasn’t feeling any better – worse if anything. I felt totally washed out.
“Some days I was so tired that I’d fall into a deep sleep, not even waking when Thomas cried.
“And there were some odd changes in me too. I had acquired a lot of facial hair and a ‘buffalo hump’ at the top of my spine. I’d shot up from a size 12 to 20.
“The weight had settled around my middle, face and shoulders. I looked flushed and had big red stretch marks. I felt a mess.”
After seeing her GP, who took blood tests, Joanne, who lived in Llandrindod Wells, was told that she was probably suffering from post-natal depression and was given a prescription for the anti-depressant Prozac.
“I wasn’t convinced, but I had been feeling very down for quite a while,” Joanne, now 39, said.
“I didn’t know what was wrong with me.
“I couldn’t cope with Thomas and I felt that my life was falling apart.”
The turning point for Joanne came when her mother suggested she speak to her former employer Kate who worked as a doctor in London – Joanne had previously worked as a nanny for her family.
She was referred to see a private gynaecologist who asked whether she had pronounced stretch marks and said he was certain Joanne had Cushing’s disease, which is caused by a tumour on the pituitary gland.
The disease can cause increased weight gain, heavy stretch marks, fatigue, anxiety and depression. In people with Cushing’s disease, the pituitary gland, which is situated at the base of the brain, produces excessive and often dangerous amounts of the hormone cortisol, which regulates metabolism.
The pituitary gland is about the size of a pea and is situated behind the nose.
Joanne, who now has a daughter Cerys after undergoing IVF treatment, said: “I was so relieved that someone believed I was ill, I wasn’t upset about the illness.
“Tests found 10 times the normal amount of cortisol in my system. If the condition had been left unchecked. I could have had a stroke or a heart attack.”
Joanne was later admitted to the University Hospital of Wales, in Cardiff, for further tests to determine whether the excess cortisol was being caused by a tumour on the pituitary gland. They revealed a non-cancerous tumour and decided to operate.
The mother-of-two, who now lives near Newark, in Nottinghamshire, was in theatre for three hours and was kept in hospital for three weeks. Despite feeling “very poorly” for the first week after surgery, her flushed face began to calm down and steadily she recovered.
“Three months later I was feeling far more lively. I went back to work part-time and I could at least give Thomas the attention he needed.
“Part of my pituitary gland had been cut away so I then had to take replacement hormones.
“If only someone had recognised the symptoms earlier before my self-confidence took such a battering.”
Pituitary gland The pituitary gland is in the bony hollow beneath the brain and behind the bridge of the nose.
The pea-sized gland is also known as the master gland as it controls all the body’s hormones.
The world’s tallest man, Ukrainian vet Leonid Stadnik who is 2.57m tall, reportedly started growing at the age of 14, after undergoing brain surgery, which stimulated his pituitary gland.
But most pituitary disorders are caused by a benign tumour on the gland and can cause a vast range of symptoms, including infertility, raging thirst, growth of hands, feet and facial bones, abnormal weight gain and even fragile skin and visual problems.
But because pituitary disorders are relatively rare and many of their symptoms are non-specific, such as constant headaches and weight gain, diagnosis can be slow and many patients can find themselves isolated and distressed as their quality of life diminishes.
Once diagnosed, treatment often involves surgery and radiotherapy and patients may have to take hormone replacement drugs for the rest of their lives.
The Pituitary Foundation has found that the hormonal changes can also cause psychological and psychiatric problems.
And because many patients know no one else with the same problem, it can be traumatic to cope with.

Wednesday, November 26, 2008

Shrinking Economy Puts Baby on Hold

The Last Four U.S. Recessions Have Been Followed by Declines in the Country's Fertility Rate. Maternity wards may get a bit quieter in about nine months.

That's because recessions and babies apparently don't mix. It's been true for the last four recessions, and experts are predicting a similar downturn now. There's plenty of bad economic news out there: the crisis on Wall Street, record foreclosures, high prices for gas and food. A recent study by the American Psychological Association showed that 80% of Americans are stressed about the economy.

At times like this, demographers say, Americans postpone starting a family and think twice about adding a baby to a family that is already struggling.

Tony Marks, a mortgage broker in Florida, and his wife, a schoolteacher, have been married for just over two years. "We honestly thought we'd have kids by now, but have put it on hold because of financial issues," says Marks, who is 31.

His industry has been hit hard, and the couple have lost a lot in their retirement accounts because of the stock market slide. Also, they are helping his wife's sister, who is struggling to pay her mortgage and can't sell her home because she owes more than it is worth.

"The economy has definitely affected our plans for starting a family," he says.

It's no surprise couples may be thinking twice: The annual cost of raising a child is between $10,930 and $12,030, according to the most recent estimates from the United States Department of Agriculture. These estimates are for a child living in a middle-income family with two kids and two adults.

In current times, many couples also must evaluate the cost of fertility treatments. In vitro fertilization costs on average more than $12,000.

Although some doctors say they haven't yet seen a change in patient load, demographers stress that the results won't be apparent for a while -- pregnancy after all lasts on average 38 weeks. Couples report that money concerns are an increasingly big part of family planning discussions.

Although a number of factors, including demographic and social trends, contribute to the fertility rate (the number of babies born per year per 1,000 women between the ages of 15 and 44), the economy also appears to affect the numbers.

The last four recessions in the United States have been followed by a dip in the fertility rate, according to economic data from the National Bureau of Economic Research and fertility data from the National Center for Health Statistics, a division of the CDC.

In the early 1970s, a recession lasted from November 1973 until March 1975. The fertility rate, 68.8 in 1973, fell for the next three years, bottoming out at 65 in 1976, the year after the recession ended. It climbed again the next year.
The early '80s brought more tough times. The economy was officially in a recession from January 1980 to July 1980 and again from July 1981 until November 1982. The fertility rate was 68.4 in 1980 and fell for the next four years to 65.5 in 1984. It increased again in 1985.

In July 1990, the country fell into a recession that lasted until March 1991. The fertility rate, which had been climbing throughout the late '80s, hit 70.9 in 1990, the highest rate in nearly two decades. However, the next year, following the recession, it started falling again and declined to 63.6 in 1997. After the dot-com bust, the country was in a recession from March 2001 until November 2001. Again, fertility rates dipped the next year, falling from 65.3 in 2001 to 64.8 in 2002.
Recession and Babies: The Current Economic Crisis

The NCHS data cannot provide any insight into the current economy's effect on the fertility rate. In addition to the length of pregnancy, it takes a while for the NCHS to compile data. The most recent birth rate information available is from 2005.

But using history as a lesson, Carl Haub, demographer at the Population Reference Bureau, says he expects to see a slight drop in the fertility rate in the United States. If the economy gets worse -- and people become as scared as they were in the mid-'70s amid the oil crisis -- the drop may be more dramatic, he says.

The shifts typically are not sudden -- in either direction. "There is a certain amount of lag time," Haub says. "When the economy improves, it is not like people rush out and say, 'Let's have a baby.'"

Khalil Tabsh, chief of obstetrics at UCLA, says he expects to see fewer families having third and fourth children, especially among the middle class. "If you have two kids and you aren't sure if you are going to lose your job, you are going to think twice about having another baby," he says. He has not yet seen a decrease in his patient load.

Hilton Kort, a fertility doctor and the founder of Reproductive Biology Associates in Atlanta, also says he has not seen a shift so far. Since he began practicing in vitro fertilization in 1983, he has not seen his business fluctuate with economy.

After Sept. 11, he even saw an increase as people worried less about material things and more "about what is really important, and that's having a family," he says.

In good and bad times, most of his patients are concerned about finances because many insurance companies do not cover fertility treatments. His firm puts patients in touch with companies that offer low-interest loans, and so far, those companies have not tightened requirements for credit.

The only economic impact he's seen so far? More patients are saying they'd like to have twins, a relatively common result of fertility treatments. Though he and other doctors have worked to reduce multiple births because of potential pregnancy complications, some couples want twins because they can only afford to complete the process once and they want two children, Kort says.

Jennifer Gniadecki, 33, and her husband also reconsidered their plans. Already the parents of two young girls, the couple wanted to try for a boy. Gniadecki, who does freelance writing for companies including Wal-Mart, is busy with work now but never knows how much she will have a few months down the road. If the economy gets worse, she fears she might lose her income.

Her husband works in online advertising, "but we can't trust he will keep that full-time job if there is a recession," she says.

The Chicago-area couple ultimately decided to cut back on spending but still try to conceive another baby. "It is knowing what's important," she says.

With a laugh, she adds: "The more children we have, the more likely it is that one of them will take care of us when we're old."

Tuesday, November 25, 2008

Couple Celebrate Their Miracle Baby

A mother has become the first in Britain to have a successful pregnancy after receiving a double organ transplant.

Emma Smith, 37, from Little Wymondley gave birth to healthy 6lb baby Oliver at the end of last month despite having a donor pancreas and kidney.

It is extremely rare because anti-rejection drugs, which must be taken for life, can cause infertility or complications during pregnancy.

Ms Smith, who lives with her boyfriend Steve, said: "After my transplants I did wonder if I would ever be able to have kids. When I found out it was a complete surprise. The suppressants lower fertility and it is very rare to get pregnant and to go on to have a birth without complications.

"They didn't have any data about being pregnant on the drugs I was on, but they didn't want to take the risk of changing them and damaging my organs so they kept me on the same drugs and monitored me very carefully.

"I'm thinking of having another baby now. This one has gone so well, I'm quite reassured about it.

"I hope it shows other people who have had a transplant that they can have children - if it gives them hope then that's great."

Emma was diagnosed with type 1 diabetes when she was 11 and had to have daily injections of insulin. Because of the disease her organs deteriorated until it was necessary to have the transplants five years ago.

She gave birth at St Mary's Hospital, London, under the care of leading surgeon Professor Nadey Hakim.

Prof Hakim said: "It's special because the fact of having had a transplant you need to be on anti-rejection therapy. Any medication could be detrimental to the foetus and these are very potent drugs.

"With this little small baby we had to be very careful to have just enough medication on board so the baby doesn't get damaged.

"It should encourage patients who've had transplants to have a normal life - people will not say 'I've had a transplant I can't get pregnant'.

Monday, November 24, 2008

2 Brothers from Sperm Donor traced

They were born 1,000 miles apart, in Britain and Finland. Now two four-year-old boys have discovered they share a sperm-donor father.

When Sally, 43, gave birth to her son Alex, she knew only that his father was Danish and was a good footballer with blue eyes and a talent for jazz piano.

He was identified by the alias “Jens” and by his sperm sample number, 3001, from the Cryos clinic in Denmark.
Alex has become the first British child to be put in touch with a half-brother or half- sister by a US-based website, the Donor Sibling Registry.

After posting details on the site, Sally was contacted by Riikka Turunen, a graphic designer from Helsinki, Finland. Turunen had used sperm from the same donor to conceive her baby boy, Kasper, who was born in August 2004, just six weeks after Alex.

The mothers now regularly chat by email and swap photographs of the boys, and they are planning to meet.
The case raises questions in Britain about whether children should have the right from birth to know they have been conceived with donor eggs or sperm and to be told the identity of their genetic parents. Children born since April 1, 2005, are entitled to be told the identities of their genetic parents when they reach the age of 18, although without the consent of those bringing them up, it is hard to insist on. The rule also applies to foreign sperm used in British clinics.

Alex was born in Warwick before the law came into force, and recipients of donated sperm such as Sally have no right to know who the donor is.

Sally, a marketing manager who does not wish to disclose her surname, set out to trace her son’s brothers and sisters through the Donor Sibling Registry website because she wanted Alex to know more about his genetic background. Fourteen British children conceived via donors have so far contacted each other through the registry and 111 British families are using it to look for relations.

Sally, who has dual British and Australian nationality and has moved to Melbourne, said: “Out of the blue, I got an email from this person in Finland saying ‘I have just noticed your information on the website. Are
you absolutely sure your donor was number 3001 from Cryos because we have a son born from the same donor?’”

Sally underwent IVF treatment, using donated sperm, at the private Midland Fertility Services clinic at the age of 38. Gillian Lockwood, medical director of the Midland clinic, believes the rules in Britain should change so children can be told the identity of their donor parent before they are 18.

Although Sally was living in Britain, she bought the sperm through the US office of the Danish sperm bank, because more details of the donor could be disclosed in America. “If my son became a good pianist, I could
say: ‘You don’t get that from me; you get that from your donor father.’ I wanted to be forearmed,” she said.

Sally has examined photos of her son’s half-brother for traits inherited from their father. “I think there are similarities in the mouth and chin,” she said. She insists it will be up to the boys how much contact they have with their half-brothers. “Alex is interested in football and I told him his donor father was good at it,” she said. sunday times, london