March 2022 Newsletter - Featuring Meg Wolitzer

Welcome to Medicine, Mountains & More, combining medical news with inspiration from art and nature.

Medical Updates: 

Bone density is something people of all ages, genders and races should be aware of, even though problems with low bone density and fractures occur in older people, and more often in women. In the U.S. one in two women over the age of 50 will experience a fracture due to osteoporosis, and although many should be started on treatment when that occurs, only 24% of those over 60 are.

Preventing osteoporotic fractures is a major reason to motivate yourself to do exercise when you’re young. “Physical activity early in life stimulates bone remodeling, which leads to increased bone density and contributes to higher peak bone mass. Although the ideal physical activity for strengthening bone has not been established, resistance and high-impact or weight-bearing exercises (e.g., free weights or resistance bands, jogging, stepping, and jumping rope) appear to show the most benefit.” (ACOG guidelines). This applies to postmenopausal women too – doing these exercises prevents bone loss as well as builds bone when women people are most vulnerable.

It may surprise you to know that taking calcium and vitamin D supplements does not reduce your risk of fracture but is recommended for overall health, and to reduce vitamin deficiency.

It is recommended that postmenopausal folks get bone mineral density screening by age 65 if they are of average risk, and younger if they have risk factors for osteoporosis.

As Texas restricts abortion, a new initiative in Dallas is expanding access to contraception. The “Trust Her” team is working to ensure that every woman has access to same day initiation of all birth control methods regardless of ability to pay. There are currently eight clinics involved in the mission, funded by the Dallas Foundation, as part of the Child Poverty action Lab whose goal is to cut child poverty in Dallas County in half over the next 20 years. We know, from the large Turnaway study, that the children of women turned away from abortions live in poverty longer than children of women who obtained abortions.

Amid abortion threats, the OBGYN community is more actively supporting access. The American College of OBGYNs filed a brief with the Supreme Court against the Mississippi abortion law that is predicted to overturn Roe v Wade, calling it “fundamentally at odds with the provision of safe and essential healthcare.” One outcome of the restrictions sweeping the country is mobilization of those that support access to abortion.

You’ve probably heard about the importance of the microbiome over the past few years. Attention has turned to what role our bacterial co-habitants, that influence out metabolic and endocrine function, play in our health. A recent small study is an example of the type of studies being done to understand our gut’s role in our health. Investigators studied the contents of the upper intestine, or duodenum, in reproductive age women (10 women), postmenopausal women on hormone therapy (13 women), and those not taking hormones (12). They found that the contents of the duodenum in older women on hormones was similar to the younger women and was associated with lower cardiovascular risk. This is a small study showing a potential benefit to postmenopausal hormone therapy.

The downside of telehealth may be less ability for clinicians to show empathy, but the upside of convenience may outweigh this. Although the majority of clinicians worldwide (63%) expect most consultations to become remote in the next decade, 54% recognize how the screen adversely affects conveying emotion. Unfortunately the report on the future of healthcare also predicts that 39% of initial medical consultations will be through chatbots.

Inserting IUDs immediately after birth. One of the studies I initiated at Emory was the first pilot study of Mirena IUD insertion immediately after delivery. It was standard in many developing countries to insert IUDs after delivery of the placenta, but hadn’t been done yet in the U.S. Now, it is a widespread practice that increases convenience for the mother but has the downside of a higher rate of expulsion of the IUD. We found increased expulsion in our small study and it has been confirmed in larger studies since then. The latest study of > 300,000 U.S. IUD users, examining electronic health records found a 5-year cumulative expulsion rate of ~ 10% for insertions done within three days postpartum with most expulsions discovered within 12 weeks of insertion. This compares to a cumulative five-year rate ~5% for IUDs inserted later, not right after delivery.

Latest Ask DR. Z. Question
How long is the copper IUD effective for? 10 or 12 years?

Mountains

The Mountains section of this newsletter highlights inspiration from nature or art. Naturally I'm selecting pictures of flowers to welcome spring!

More: book quote of the month - straight from the author herself!

This month I asked one of my favorite authors, Meg Wolitzer, to share a quote from one of her books that relates to the theme of feminism and she chose one from The Female Persuasion. I loved this book which highlights young idealistic women and a seasoned, famous, feminist mentor. Meg said, "This quote... is near the end from Zee, the main character Greer’s best friend:"  

"I think there are two kinds of feminists, the famous ones and everyone else, all the people who quietly do what they are supposed to do."

This makes me think of so many people who work quietly in the background getting things done. It also reminds me of Meg's gorgeously written book - The Wife.

I also asked Meg, "What are you doing for fun these days? Or can you share a source of inspiration that has helped during these uncertain times?" 

Meg's response: 

 I am playing a lot of online Scrabble, which I adore. It keeps words front and center, and I enjoy the competition, and it’s really fast-moving. For me, I think it’s a great idea these days to find something like this that I love to do, and which I don’t need to discuss with other people very much. Something that I incorporate into my day when I choose, and which gives me a burst of pleasure whenever I require one.

I get this! My online game of choice these days in Mahjongg. Do you have any?

Don't miss the amazing podcast hosted by Meg, Selected Shorts, which features actors reading short fiction stories. https://www.npr.org/podcasts/381443486/pri-selected-shorts

More: Save the Date

If you're in Atlanta on April 28th, don't miss the award wining premiere of a French film co-sponsored by National Council of Jewish Women and Planned Parenthood Southeast followed by a panel discussion on what to expect in a post-Roe world featuring the director - Audrey Diwan, Sean Youn of the ACLU, and Dr. Michelle Au a state senator. I'll post how to get tickets when available -I look forward to moderating.

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Thanks for reading!

Wishing you the best of mountains,

Mimi