2 out of 3 maternal deaths were due to maternal obesity :(

This is a sad article on obesity, moms and babies. Now it’s time to talk to people about how they can maintain a healthy weight.

http://www.nytimes.com/2010/06/06/health/06obese.html

As Americans have grown fatter over the last generation, inviting more heart disease, diabetes and premature deaths, all that extra weight has also become a burden in the maternity ward, where babies take their first breath of life.

About one in five women are obese when they become pregnant, meaning they have a body mass index of at least 30, as would a 5-foot-5 woman weighing 180 pounds, according to researchers with the federal Centers for Disease Control and Prevention. And medical evidence suggests thatobesity might be contributing to record-high rates of Caesarean sections and leading to more birth defects and deaths for mothers and babies.

Hospitals, especially in poor neighborhoods, have been forced to adjust. They are buying longer surgical instruments, more sophisticated fetal testing machines and bigger beds. They are holding sensitivity training for staff members and counseling women about losing weight, or even having bariatric surgery, before they become pregnant.

At Maimonides Medical Center in Brooklyn, where 38 percent of women giving birth are obese, Patricia Garcia had to be admitted after she had a stroke, part of a constellation of illnesses related to her weight, including diabetes and weak kidneys.

At seven months pregnant, she should have been feeling the thump of tiny feet against her belly. But as she lay flat in her hospital bed, doctors buzzing about, trying to stretch out her pregnancy day by precious day, Ms. Garcia, who had recently weighed in at 261 pounds, said she was too numb from water retention to feel anything.

On May 5, 11 weeks shy of her due date, a sonogram showed that the baby’s growth was lagging, and an emergency Caesarean was ordered.

She was given general anesthesia because her bulk made it hard to feel her spine to place a local anesthetic. Dr. Betsy Lantner, the obstetrician on call, stood on a stool so she could reach over Ms. Garcia’s belly. A flap of fat covered her bikini line, so the doctor had to make a higher incision. In an operation where every minute counted, it took four or five minutes, rather than the usual one or two, to pull out a 1-pound 11-ounce baby boy.

Studies have shown that babies born to obese women are nearly three times as likely to die within the first month of birth than women of normal weight, and that obese women are almost twice as likely to have a stillbirth.

About two out of three maternal deaths in New York State from 2003 to 2005 were associated with maternal obesity, according to the state-sponsored Safe Motherhood Initiative, which is analyzing more recent data.

Obese women are also more likely to have high blood pressure, diabetes, anesthesia complications, hemorrhage, blood clots and strokes during pregnancy and childbirth, data shows.

The problem has become so acute that five New York City hospitals — Beth Israel Medical Center and Mount Sinai Medical Center in Manhattan, Maimonides in Brooklyn andMontefiore Medical Center and Bronx-Lebanon Hospital Center in the Bronx — have formed a consortium to figure out how to handle it. They are supported by their malpractice insurer and the United Hospital Fund, a research group.

One possibility is to create specialized centers for obese women. The centers would counsel them on nutrition and weight loss, and would be staffed to provide emergency Caesarean sections and intensive care for newborns, said Dr. Adam P. Buckley, an obstetrician and patient safety expert at Beth Israel Hospital North who is leading the group.

Very obese women, or those with a B.M.I. of 35 or higher, are three to four times as likely to deliver their first baby by Caesarean section as first-time mothers of normal weight, according to a study by the Consortium on Safe Labor of the National Institutes of Health.

While doctors are often on the defensive about whether Caesarean sections, which carry all the risks of surgery, are justified, Dr. Howard L. Minkoff, the chairman of obstetrics at Maimonides, said doctors must weigh those concerns against the potential complications from vaginal delivery in obese women. Typically, these include failing to progress in labor; diabetes in the mother, which can lead to birth complications; and difficulty monitoring fetal distress. “With obese women we are stuck between Scylla and Charybdis,” Dr. Minkoff said.

But even routine care, like finding a vein to take blood, can be harder through layers of fatty tissue.

And equipment can be a problem. Dr. Janice Henderson, an obstetrician for high-risk pregnancies at Johns Hopkins in Baltimore, described a recent meeting where doctors worried that the delivery room table might collapse under the weight of an obese patient.

At Maimonides, the perinatal unit threw away its old examining tables and replaced them with wider, sturdier ones. It bought ultrasound machines that make lifelike three-dimensional images early in pregnancy, when the fetus is still low in the uterus and less obscured by fat, but also less developed and thus harder to diagnose clearly. “You really need to use the best equipment, which is more expensive,” said Dr. Shoshana Haberman, the director of perinatal services.

Many experienced obstetricians complain that as Americans have grown larger, the perception of what constitutes obesity has shifted, leading to some complacency among doctors. At UMass Memorial Medical Center in Worcester, Mass., Dr. Tiffany A. Moore Simas, the associate director of the residency program in obstetrics, demands that residents calculate B.M.I. as a routine part of prenatal treatment. “It’s one of my siren songs,” Dr. Moore Simas said, “because we are very bad at eyeballing people.”

Dr. Haberman said there was obesity in her own family, and she had seen how hurtful even professionals could be. “We as a society have issues with the perception of obesity; anatomically, you get turned off,” she said.

So she was sympathetic to Ms. Garcia, making sure she got a room with a window, and calling to check on her after hours.

Ms. Garcia, 38, a former school bus dispatcher, is 5 feet tall. She said she had tried diets, weight-watching groups and joining a gym. She was 195 pounds before her pregnancy (B.M.I., 38) and ballooned to 261 pounds, which she attributed to water weight and inactivity.

“I’m the smallest one in my family,” she said. Her older brother weighed more than 700 pounds before having gastric bypass surgery.

She wiped tears away as she confessed that she worried that she might die and leave her baby without a mother.

At Ms. Garcia’s stage of pregnancy, every day in the womb was good for the baby but bad for the mother, Dr. Minkoff said. “She’s making a heroic decision to put her own self in peril for the sake of the child,” he said.

She survived, but was dismayed by the size of her son, Josiah Patrick, who had to be put on a breathing machine. At first she could see him only by remote video. But after a month, Josiah was off the ventilator, taking 15 milliliters of formula and had smiled at his mother, and doctors said he was where he should be developmentally for a preemie his age.

The hospital estimated that the cost of caring for the mother and baby would be more than $200,000, compared with $13,000 for a normal delivery.

Ms. Garcia promised Dr. Minkoff that she would lose weight and see her baby graduate from college. “I’m going on a strict, strict, strict diet,” she said. “I’m not going through this again.”

Shanghai

China in the airport and Shanghai!

Breakfast on Delta

Delayed flight over 24 hours

At the airport day 2 waiting to get on the airplane. We had $12 in Delta voucher for breakfast and considering we had already eaten breakfast at the hotel for free, we decided to just get something else to eat. So for two fruit cups and a bottle of water at Starbucks, it costed $11.40 on Delta. Whoohoo!!

The Bund in Shanghai

The Bund in Shanghai

We arrived in Shanghai on Sunday, August 28 around 6:40pm and got onto the Line 2 subway by 7:18pm. It took 1 hour (8:18pm) to get to Nanjing East Rd subway stop. The best part was it took about 2 minutes to walk to the Nanjing Hotel!!!We then took some time to relax and change into something more comfortable to look around Shanghai.At 9pm, we walked east toward the Bund, and looked at the city life. First, we got the ‘pan fried’ bun – 4 for 8 yuan. And Yes, I saw the thing that Sunny got for me. I don’t know if I’ll be able to roll like them but it has inspired me a little bit — especially since it lights up!

The Bund 2

The Bund 2

We walked really slowly so we didn’t arrive at the Bund until 9:40ish. In a way, I was surprised by the number of people there!! Many Chinese tourists and foreign tourists alike. Of course, there were some smokers there but since I read about it, I was more indifferent to them. Also, there isn’t such thing as ‘personal space’ either. And staring is ok! haha.The Bund is really nicely lit up at night.

Xintiandi -- “New Paradise”

Xintiandi -- “New Paradise”

We then decided to taxi it over to Xintiandi — “New Paradise” (16 yuan before 11pm). It’s full of foreigners and many young people dressed up! There were many cafes that were so full of energy on this Sunday evening.

East Nanjing Pedestrian Street

East Nanjing Pedestrian Street

At 11pm, we got tired and headed back to the East Nanjing Pedestrian Street but starting from the west side (where the People’s Square is) walking west. The lights were still on (as shown in the picture) and much less people were around. The homeless were settling in onto their benches.
We headed over to the McDonald’s nearby to try out the internet. It didn’t work! And my phone didn’t work either. Anyway, we tried to order food the ‘proper’ way and was immediately called out as a “old outsider” or foreigner. Haha, just because I used the proper name for the food… and even though I ordered a cheeseburger and a 10 piece chicken nugget, none were available. Only a tiny two piece chicken wing (the size of your pinky!!) and a 5 piece chicken nugget were available. Too bad it didn’t taste that great.
At night, we plugged everything in and hopped on the internet.

Xiao Long Bao - Soup Buns

Xiao Long Bao - Soup Buns

NEXT DAY on Monday, August 29, 2011, we both woke up at 5:45am, despite going to sleep at 2am. We didn’t get up until 7:20am and got ready and left by 8am. At first, we were going to go eat at a ‘little eat’ place two blocks away but…Instead, we were stopped by good soup bun prices! 8 for 12 yuan. And yes, we only took about 4 steps out of the hotel and stopped right in front of the restaurant in front of us. Yes, it is a little bit sad but we did it anyway. And the soup in the picture was 8 yuan – and just as yummy! I like how the food in Shanghai is not as oily as they make it in the US so good food, good prices — hooray!

Mei Long Zhen Restaurant

Mei Long Zhen Restaurant

On the right is a picture of an expensive but historic restaurant: Mei Long Zhen Restaurant (1038 Nanjing Rd W). Simple and tasty, we ordered a specialty dish with just shrimp, Ma Po tofu (best one I’ve had!), vegetables (sad to say that we found HAIR but they quickly replaced it… still scary to see though), and hot and sour soup with sea cucumber, roast pork and other expensive ingredients.Apparently we ‘bought’ the hair towels too and the tea was 12 yuan. At least the bathrooms were western with toilet paper and the decor of the place was amazing!It came out to be 302 yuan — not cheap but we probably won’t go to these really nice places often haha. Honestly, I prefer the cheap but good tasting food!! Better for stomach and ‘piece of mind’.

Past People’s Square

Past People’s Square

We did make stop at Shen Da Cheng (636 Nanjing Rd E) and bought this warm red bean and other bean cup of food (3.5 yuan) and a meat mooncake. YUMMYAnd we went to McDonalds and got free wifi for 30 minutes! YAY Unfortunately, I also got bite 10 times! BUT at least we went to the drug store to buy anti-itch for 5.6 yuan.We walked past People’s Square, ate a 85 degree (mango thing), and went to ICBC to exchange the travellers’ cheque. NEVER AGAIN. It took over 30 minutes and they charged $11.25 US.

Also, since the phone card was bought in Beijing, Shanghai people can’t get access to info there. Retarded.

We also shopped around and I got a nice blue and white dress for 139 yuan. Thanks mom!!

Reel Kitchen

Reel Kitchen

On the way over to the Jiag’an Temple, the Reel Kitchen ad stopped us in our feet! So many tasty desserts appeared on this ad. Look at mom — she looks happy. Hehehe. Especially about the Taiwanese ice!

Jing'an Temple

Jing'an Temple

We are inside the Jing’an Temple in this picture. People are praying with incests in a ‘north, south, east, and west’ direction. Many statues are made of gold and we walked into the temple to see Buddha of the past, present, and future. It’s neat how the temple has survived from World War I and II and the drum tower and clock (bell) tower really do have a drum and a bell inside!The girl standing in front — well, I was surprised that even women dressed in high heels, and old and young men, and of course more, all come to say their prayers.And if you throw money into the pot, you shall be protected. But I’m not sure if I believe that.

Meetfresh

Meetfresh - Ice

So we headed back to the B2 Reel Kitchen to get the specialty dessert “Meetfresh.” Black grass jelly and that kind of ice (yes, the ice was black), and taro jelly. With condensed milk on top. YUMMMMMY

Fruit on Chopsticks

Fruit on Chopsticks

Thankfully, by this time, we were tired and the B2 was connected to the Line 2 subway. We paid 3 yuan each for a stop only 3 stops away and headed back to the hotel. We saw a couple eating fruit so we couldn’t resist and had to get some too! The melon and watermelon on a chopstick were 2 yuan each. How fun!!!We then took a nap from 4:30pm to 9pm. Oopss. By the time we got ready and left our room, it was 3 minutes to 10pm so we ate at the place we ate for breakfast. More siao long bao!! Eggplant over rice and small shrimp wonton soup. Total cost 30 yuan.We then went to get a message about 1 block away for 88 yuan 1.5 hours foot and body message. Mom kept asking them questions while I closed my eyes and just relaxed. Once mom told them that she will tip them more, they stopped trying to sell us products, haha.

It ended at 12:10am and we headed home and got on the internet. And now it’s almost 3am so time to go sleep and go to Nanjing tomorrow!!!

Addiction

My mom is addicted to YouTube. After coming back from Hong Kong to China, she said the worst part about China is that they banned YouTube. Yes, I suggested to her that she should try YouKu, China’s version of YouTube. She said she did but couldn’t find the show that she wanted to watch.

Now that she’s back home, she glued to her iPad. Even as of right now.

My dad is addicted to the stock market. He watches it go up and down. He watches YouTube videos of ‘experts’ predicting the next day’s outcome at 10pm and in the morning before the market opens. He keeps reading about what will happen. He then goes on to StockCharts.com and reads the charts hourly to determine what he will do next with his stocks. He gets the most excited when he makes $$.

Maybe the only thing that will take him away from the computer is Miki – a Japanese Restaurant that my parents enjoy eating at.

Yesterday, he said that my mom and I should go out for lunch alone because he still had taxes to do (he had them delayed, I guess). I went over to tell my mom and when my dad came by, she said that we were going to Miki. When he heard that, he instantly changed his mind and said he’ll go eat with us.

Pills Prevent H.I.V. Infection in 2 New Studies – NYTimes.com

As it becomes ever clearer that modern antiretroviral drugs can not only treat the disease but prevent it, pressure is likely to increase on donors to find more money to supply them in places like Africa and on pharmaceutical manufacturers to either sell them cheaply or release their patents to companies that can.

“This is an extremely exciting day for H.I.V. prevention,” said Dr. Kevin Fenton, director of AIDS prevention at the Centers for Disease Control and Prevention in Atlanta. “It’s clear we’re not going to find a magic pill that prevents it, but this is adding more to the tool kit.”

Until a few years ago, condoms and abstinence were alone in that tool kit. Recent studies have added circumcision, vaginal microbicides, a daily pill for the uninfected (known as pre-exposure prophylaxis, or PrEP) and early treatment for the infected (known as “treatment as prevention”).

via Pills Prevent H.I.V. Infection in 2 New Studies – NYTimes.com.

Wait to Restart Birth Control Pills, C.D.C. Says – NYTimes.com

Women who have just given birth should wait at least three weeks before they start using birth control pills because of the risk of serious, potentially fatal blood clots, public health officials announced last week. Women who deliver by Caesarean section or have other risk factors for blood clots — like obesity or a history of previous blood clots — should wait at least six weeks before using these medications, they said.

via Wait to Restart Birth Control Pills, C.D.C. Says – NYTimes.com.

API Medical Traditions

Asian medical tradition centers on a belief in the interconnectedness of the mind, body, and spirit and the need for balance and a holistic approach to the treatment of illness. In this session, you will look at some of the traditional beliefs that shape Asian medicine. Understanding and acknowledging these beliefs can help you provide a better foundation for helping your patients make intelligent health care decisions.

Many Asian patients must reconcile traditional beliefs with Western concepts of health and illness. Patients subscribe more firmly to traditional or western beliefs based on their age, education, language proficiency, length of time in the US, and general assimilation into Western culture. An awareness of AAPI medical tradition will permit you to ask appropriate questions regarding health beliefs, demonstrate respect and sensitivity for your patient’s culture, and ultimately strengthen your relationships with your AAPI patients.

via Providers Guide.

STUDENT SPOTLIGHT
Saturday, October 13, 2007

A feature on area youth who are leaders and volunteers in their communities. The teens featured were nominated for The Ann Arbor News’ Young Citizen of the Year award.

Jessica Chang

High school: Pioneer High School in Ann Arbor.

Grade: Graduated.

Parents: Jimmy and Theresa Chang.

School activities: President of Asian Student Union, webmaster of Rotary’s Interact Club, lead team member of Leap the Gap project from Youth Senate.

Community activities: Taught English to young children, created brochures for the Caregiver’s Day conference, raised money for tsunami relief in southeast Asia and earthquake aid in Pakistan. Also donated blood.

Post high school plans: Will attend the New York Institute of Technology as part of a seven-year bachelor of science/doctor of osteopathic medicine program.

Why is community service an important part of your life?

“The community has provided a lot for me, and I believe that it is important to give back even more. It brings people together to make the town a better place and generates new ideas.”

What do you wish to tell other students about the value of community service?

“What you do will make a big impact on someone else’s life, no matter how small or insignificant you think the service is. People appreciate those who help. Thus, in turn, you will receive help when you need it.”

http://www.mlive.com/annarbor/stories/index.ssf?/base/news-1/1192255838208480.xml&coll=2&thispage=2

I’m back at school

wow, it’s already been 4 weeks of school and it doesn’t really seem like it. Until now.

It’s hard to believe that I haven’t typed in this thing in forever. It wasn’t until I saw Sunny on it that I checked mine out again.

Life has been alright. I know a few people on campus, but I haven’t been really close to any of them except Justine. And that’s only because one, we’re both orientals and we’re in three classes together (and have similar classes). I hope to make more friends, but my first concern is testing. And doing well. And not failing biology lab. I really don’t want that to happen. As long as I study for the labs and type up lab reports, right??! Well, it’s kinda annoying because he’s not very clear about what he wants in his lab report.

Introduction, Hypothesis, Procedure, Data, Conclusion.

Okay, intro, procedure, and data I got. But what kind of hypothesis do we come up with on our own? Uh, we expect the potato juice to turn black in the iodine test because that tests for starch… but what about when you have unknowns???!

Anyway, life is good so far.

I studied with Justine and Pearl at the Flushing Library today. I thought I was really behind (I have one more chapter to go), but they are only half way through the first chapter… I guess they should probably start earlier next time (me too).

Calc… I hope I got 20/20 on my quiz again. I didn’t know how to show something so I wrote a long paragraph describing why something was the way it was.

Chem, review session on Tuesday on all the hw and test on Thursday. I am soo freaked out. 20 questions, 5 points each!?????! OMG, that is so crazy!! If you get one wrong, you’re down 5 percent. I have to get everything right… it should be a piece of pie.

3 tests. First one Tuesday. Wish me luck.

I’m working on getting my study habits down. Preview text + write down definitions (if poss, understand concepts), take notes in class, review notes, reread text + fill in the gaps w/ more detail, do hw/questions, and formulate test questions. Review class notes and text notes daily. Ask questions to myself daily. Repeat for every lecture.

Can I do it??

Yes I can (wow, I feel like bob the builder).

Well, I need to revamp this site so I like it more so I’ll type here more. I have this amazing travel blog going up so once it’s up and running, I’ll link it.

I ate a lot today.
I chatted with Dan this morning, went to Farmer’s Market, ate a large green paper and pepperoni pizza and a carne sampler (3 huge meatballs and 3 sausages) at Arigero’s.

I went home, chatted with dad, read something about orientation for NYIT (I’m supposed to sign up for a date but I’ll be in Europe on those three days… I had already contacted them about this issue way back in May, but I guess I just have to tell them again… I can already tell that the administration at NYIT is probably not the greatest), getting a student loan……

http://newyork.craigslist.org/que/sha/355385569.html

http://newyork.craigslist.org/que/sha/352256593.html
$550 Room for Couple (no kids)
Reply to: hous-352256593@craigslist.org
Date: 2007-06-14, 5:38PM EDT

We need 2 ($550 each) mid size rooms for 2 couple no kids. Bathroom and kitchen sharing is okey. With or without living room is ok too. Willing to pay advance and deposit. We are quiet,very clean and reserve people. We work all week. Just need a place to stay and rest during days off. We always pay rent on time and we clean after ourselves.

Only no broker fee please.

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