Penn Elm Medical Group
488 E. Valley Parkway
Suite 411
Escondido, CA 92025
(760) 745-2000

NEWSLETTER:
October 2005

VISIT NEWSLETTER ARCHIVE

NEWS YOU CAN USE
Post Partum Depression Frequently Missed by Patients and Doctors
MEDPAGE TODAY: Courtney Cox, star of the hit television series “Friends” isn't surprised by the latest thinking in postpartum depression, which extends the window for onset to many months after the birth of a new baby. The actress says depression didn't strike until six months after her first child was born, well within the new window.

Clinically, a wider diagnostic window presents problems because many women have a final visit with their ob-gyn at six weeks and then fall off the medical radar for a year or longer. "The problem is that within a few months after having the baby, many women essentially have no doctor," said Nada Stotland, M.D., vice president of the American Psychiatric Association and a professor of psychiatry and obstetrics and gynecology at Rush Medical College here. For some women who may suffer from delayed postpartum depression, the only doctor they see regularly is a pediatrician. Yet the pediatrician is trained to be the baby's doctor, not the mother's.

It is not as if obstetrician-gynecologists are unaware of delayed postpartum depression. The American College of Obstetricians and Gynecologists has said that postpartum depression can arise anytime during the year after childbirth. In the past it was generally accepted that the risk period for developing postpartum depression extended from birth to four to six weeks postpartum, a dictum that's reflected in the American Psychiatric Association's text, which states that symptoms typically appear within four weeks of delivery. Moreover, there are no data on the number of postpartum depression cases that occur after the six-week checkup. Because the problem is under-reported, it is difficult to track accurately, Dr. Stotland said.

Many physicians who treat new mothers are aware that postpartum depression is not a short-term problem, but few have the opportunity to screen women for later onset because routine obstetric care stops with the six-week checkup. However, as Dr. Stotland noted, it makes sense that postpartum symptoms would surface after six weeks, when women are alone and often overwhelmed by the demands of new motherhood. She points out that women receive a great deal of medical attention when they're pregnant, but once the baby is born, it's the baby who becomes the center of medical attention.

"I went through a really hard time—not right after the baby but when Coco [her daughter] turned six months," the 41-year-old Cox told USA Today. "I couldn't sleep. My heart was racing. And I got really depressed. I went to a doctor and found out my hormones had been pummeled."

Hard data on postpartum depression are scant but most estimates are that up to 10% of women have some symptoms of baby blues, and the condition varies in both severity and duration. A six- to 12-month duration is not uncommon. Risk is greater for women with a history of depression before or during pregnancy, although the condition can occur to any new mother regardless of history, said Dr. Stotland. Symptoms can include exhaustion, sadness, and thoughts about hurting the baby, or a lack of interest in the baby.

But while celebrities and prominent figures may be willing to go public with their symptoms, most women are unlikely to be forthcoming about such feelings, said Yvonne S. Thornton, M.D., a professor of clinical obstetrics and gynecology at Cornell Weill Medical College in New York. That reticence combined with the time restraints faced by most practicing physicians often means that physicians fail to diagnose postpartum depression, Dr. Thornton said. Physicians need to ask more than just the old standby, "How is everything at home?" question, said Dr. Thornton. She said questions need to be more probing because postpartum depression can be so subtle. In addition to better assessment questions, Dr. Thornton said that "it's incumbent upon physicians to have a six-month checkup. Six months is a better yard stick."

When postpartum depression is diagnosed, the treatments often include antidepressants and psychotherapy. Some patients, like Cox, report improvement from hormonal therapy, but this is a controversial therapeutic choice. One concern is that "progesterone has been blamed hormonally for related depressions for a long time, including premenstrual syndrome," said Dr. Stotland. "And every time there's been a controlled study, it hasn't held up." Dr. Dell also questioned progesterone for postpartum depression. "I'm a little wary of progesterone, because for women it causes depressive symptoms," she said.

Finally, postpartum depression is not to be confused with postpartum psychosis, a condition that hit center stage in 2000 when Andrea Yates, a mother in a suburb of Houston, was found guilty of drowning her five young children in a bathtub. Yates, experts testified, suffered from postpartum psychosis. "Postpartum psychosis is usually associated with confusion and agitation, not just feeling exhausted and hopeless," said Dr. Stotland. "It's a different disease." According to the APA, it occurs from 1 in 500 to 1 in 1,000 deliveries. Whereas symptoms of postpartum depression can take months to appear, postpartum psychosis appears "within days to a few weeks," she said.

Study Shows Foods Rich in Folate Reduce Alzheimer’s Disease Risk
BALTIMORE, Aug. 12: Folate-rich foods may be good for the brain, suggest findings from the Baltimore Longitudinal Study of Aging. According to data from the long-running study of aging, eating foods rich in folate—or even adding the B vitamin to the diet with supplements—appears to reduce the risk of Alzheimer's disease.

Participants in the study who typically ate at least the recommended dietary allowance of folate had a 55% reduction in the risk of Alzheimer's, María Corrada, Sc.D., of the University of California at Irvine reported in the July issue of Alzheimer's & Dementia, the inaugural edition of the journal. Other nutrients thought to be beneficial for Alzheimer's—vitamins E and B6—did not appear to reduce risk, she said. Foods rich in folate include fruits such as oranges and bananas, leafy green vegetables, some peas and beans, and liver. More research is needed to confirm the results, said William Thies, Ph.D., of the Alzheimer's Association, but the study appears to support recommendations for a "brain-healthy" diet low in fat and cholesterol and high in fruits and vegetables.

Participants had no trouble reaching recommended allowances of the other vitamins by diet alone without the use of additional vitamin supplements. In the U.S., grains are now fortified with folate in an attempt to reduce the rate of neural-tube defects. The program began after the data in this study were taken, but the researchers estimate it would have meant an additional 18% of the study participants would have reached the recommended dietary allowance. However, that would still have left 47% of the participants below the recommended levels.

Dr. Corrada said the study implies that a diet rich in folate is good for the brain, but she added that it's impossible to rule out other possibilities. The bottom line is that people who want to reduce their risk of Alzheimer's should "live a healthy life," she said.

Big Study Links Red Meat to Colorectal Cancer
In a study that observed nearly half a million people, the European Prospective Investigation into Cancer and Nutrition reported that eating 160 grams or more of red and processed meat daily led to a 35% increased risk for colorectal cancer when compared with eating 20 grams or less per day. This study suggests that you should limit your intake of red meat intake, particularly processed meat. The results also suggest that a diet high in fish may be beneficial, as people who consumed a greater quantity of fish had a significantly lower risk for colon cancer.

Even though it is not known which red meats are the most harmful and which fish are the most beneficial, the researchers said the findings clearly point a finger at the modern Western diet. "It has been recently estimated that approximately 70% of colorectal cancer could be avoided by changes in lifestyle in Western countries." they concluded.

MedPage Today offers physicians real-time coverage of breaking medical news and the top stories in health and medicine. MedPage Today is the only medical news service for physicians that links consumer medical news and the professional medical analysis needed by clinicians. All content is reviewed and approved by physicians under the direction of the University of Pennsylvania School of Medicine. There is no cost to use the service and you can sign up for daily email headline alerts. Visit http://www.medpagetoday.com.

IMPORTANT ANNOUNCEMENTS
Dr. Sheffey Has Moved
This is another reminder that Dr. Sheffey has moved into the main building at 488 E. Valley Parkway, Suite 411, joining the remaining Penn Elm physicians. When you make an appointment to see Dr. Sheffey, please ask the receptionist for directions to his new office, or see map.

Should You Be Tested For Osteoporosis?
Women who are going through menopause or are post-menopausal; have had surgery to remove their ovaries; are on chemotherapy or chronic steroids such as Prednisone; or are Caucasian, Asian, or Hispanic have an increased risk of Osteoporosis—a weakening of the bones—resulting in potential fracture of the spine, hip, or other bones. Penn Elm offers screening for Osteoporosis and recommends that these women be checked every 2-3 years. Please call our office to speak with your doctor’s nurse to determine if you should be screened.

WHAT’S NEW AT PENN ELM?
New Receptionists
Several new receptionists have joined us recently! Please be patient as they undergo training in our computer system and processes. If you have any difficulties, please leave a message for our Operations Manager, Judy Shaw.

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