Inauguration Day Thoughts
Tuesday, January 20, 2009
Kenneth F. Trofatter, Jr., MD, PhD
The proceedings did not disappoint. Ella Fitzgerald’s rendition of “My Country Tis of Thee” was moving and endearing and I will never forget the new President’s smile when she sang the last note. The quartet’s performance of the John Williams’ arrangement was nothing less than stunning – four of the world’s greatest artists, each from very different backgrounds, performing together with uncontained joy and enthusiasm. When Itzhak Perlman hit the first cord on the violin, tears instantly welled-up in my eyes and streamed down my cheeks (at that point I was quite content to be alone), something that had happened to me only once before when the violins began the opening movement of Handel’s “Messiah” while I was a member of the chapel choir at Duke University too many years ago. When the time came for the actual swearing in of the new President and everyone was asked to stand, I found myself rising to my own feet, in respect for the moment and with great sense of awe in my heart for having the opportunity to be a witness to the event.
But regardless of all that transpired before, there is no doubt in my mind that the highlight of the ceremony was the Presidential address which followed. Fully aware that the world would be focusing on every word, listening to the messages, spoken and implied, assessing his demeanor, sincerity, integrity, and forcefulness of the presentation, President Obama rose to the occasion and delivered a speech that will surely be recorded as a defining moment of his presidency and the history of the United States. He did not mince words. In a few short minutes, he reminded us of our past, where we have come from, what we have been through, what that has cost us, and what that has given us as a great nation. It was a message of challenge, it was a message of hope, and it was a message that stressed the necessity of working together, not just as a country, but as a world to preserve that same world for the generations that will follow. To me, one of the most memorable quotes came early in the speech: “…we have chosen hope over fear, unity of purpose over conflict and discord…the time has come to set aside childish things…to reaffirm our enduring spirit...to choose our better history.” The message allows for people to continue believing what they want, but the hard decisions we make moving forward as a nation need to be based on critical evaluation and evidence rather than simple emotion.
I find a special hope in the President’s message and in the months of oratory that preceded the election – and that is a hope for a new emphasis on the health of women and children in this country. During the last 8 years, short-sighted policies in health care and the economic down turn have led to reduced access to care, the highest teen pregnancy rates in years, an epidemic of obesity that will affect generations to come, and great disparities in morbidity and mortality that fall clearly along socioeconomic and ethnic lines. We must invest in the health and well-being of our youngest citizens and our pregnant women if we are ever to address the containment of health care costs in the future. Untold millions of dollars wasted on “abstinence only” education programs must be redirected to early and ongoing educational efforts that emphasize the importance of responsible family planning and means of pregnancy prevention before an individual is prepared to be a good parent. Regular physical, health, and nutritional education need to be brought back into our schools. Such an approach will lay the foundation for a healthier America; a country with citizens who feel better about themselves will also feel more confident and better about the future of their country and will be in a much better position to contribute to its success. I may be an idealist, but these things are possible and I think we have a new President who has the foresight and aptitude to give us a fresh start on our future.
12 Comments:
At Thu Jan 22, 10:22:00 PM 2009,
Anonymous said…
Dear Dr. Tfofatter;
I have posted a comment on your blog on PAI-1 Role in adverse pregnancy outcomes - 6. Regarding my homozygous Pai-1 result. I don'tknow if that particular blog is still active, but I was wondering if you would be so kind as to respond to my comment. I would truly appreciate a response as I am unable to get any answers elsewhere.
Thank you.
Karen
kbolduc@netscape.ca
At Thu Jan 29, 06:12:00 AM 2009,
Anonymous said…
Hi Dr. T, this is my first time seeking advice from you. I hope I am posting in the correct spot. I am 38 yrs. old., 5 ft. 6 in. and 125 lbs. 1st pregnancy; diagnosed w/ gestational diabetes @ 28 wks. It was controlled by diet, and 09/2004 delivered a healthy 7 lb. daughter. Miscarriage 07/07 and 03/08. Both times started spotting @ 10 1/2 wks - ultrasound showed the baby stopped growing 6 1/2 wks. gestational ly. April 2008 had a panel of blood tests, the only thing that showed up out of the ordinary: my cholesterol: HDL 65 and LDL 176. 5 hour glucose tolerance test: Fasting 71; 1hr. 158; 2hr. 135; 3hr. 98; 4hr. 40 (out of range); 5 hr. 60 (out of range). I was in a hypoglycemic state. I have since changed my diet and eliminated all refined carbohydrates. However, I have a tendency to feel tired after I eat - do you know why? My general dr. sent me to: endocrinolgist (performed Cortisol Free 24 urine and other blood tests that came back normal), rheumotologist (physical exam - said I seemed fine) and cardiologist (echocardiogram and ultrasound of heart checked out fine). Jan. 2009 went to a perinatologist: ultrasound showed uterus fine. Right ovary had 1 simple cyst. Left ovary had multiple simple cysts. The Dr. mentioned polycystic ovarian syndrome:
• Multiple ovarian cysts *yes
• Irregular or absent menses *no
• Infertility *no, not getting pregnant, but maintaining pregnancy
• Acne *yes
• Obesity or inability to lose weight *no
• Excessive body or facial hair (hirsutism) *no
• Insulin resistance and possibly diabetes *gestational diabetes, hypoglycemia
• Thinning of scalp hair *no
• Velvety, hyperpigmented skin folds (acanthosis nigricans) *NO
• High blood pressure *no
He also sent me for blood work for: antithrombin III activity, protein c and s activity, TPA, EIA, antiphospholipid antibody surgery, factor V, prothrombin factor II, methylenetetrahydrofolate reductase, ANA, full thyroid panel and urine. All of the above were normal. The Dr. also tested for Plasminogen Activator Inhibitor (PAI-1) which came back less than 2.0. He wants me to repeat that test.
There seems to be some sort of link w/: PCOS, elevated cholesterol, gestational diabetes/ hypoglycemia and PAI – 1 inefficiency. Dr. T., with the info. I gave you I wanted to ask your opinion about my case. Do you think I could have PCOS? Thank you for taking the time to read this – I appreciate it, KJ
At Fri Jan 30, 07:28:00 AM 2009,
Anonymous said…
Hello Dr Trottafer
Will you be revisiting your CMV post anytime soon? I lost my baby in October 2008 and a primary CMV infection was suspected. I have some questions my consultant is unable to answer and I was wondering if you could help?
Thank you for your time.
Regards
Louise
At Tue Feb 03, 12:54:00 AM 2009,
denise said…
I've never posted anything on a site before. I am 37 and very confused and a bit afraid.
In late Aug 2008 I received a positive preganancy test following my first month of clomid. In Sept I was told it would not be viable (blighted ovum). I thought I miscarried in October and shortly thereafter, I left the country.
I was actually in South Africa on election day (an unbelievable day, to be sure) and a couple of days earlier I went to a doctor about some allergy symptoms. He asked if I was pregnant before prescribing a particular drug. When I told him I was but that I believe I miscarried, he did a quick ultrasound and said, "something doesn't look right. please have this checked out when you get home." I did, and was told after a pelvic exam that I found to be very painful that "everything seemed fine."
Now, all these months later (it is now February 2009) I went to another doctor and was shocked to learn I have a positive pregnancy test with an hcg level of only 36. This level is not increasing.
Through a pelvic ultrasound, they found something round and unusual attached to blood vessels. My uterus is a normal size. I have not had any bleeding, besides the brown discharge I had back in October that I thought was a miscarriage.
Can this definitely be a molar pregnancy? If so, does this sound right, given how much time has elapsed and how low my hcg count is?
What else can this possibly be?
I am going in on Wed. to have it removed through D and C.
I would really like to know your thoughts. This is very scary for me.
At Wed Feb 04, 08:49:00 PM 2009,
Anonymous said…
dr., i am 28 yo and pregnant(22w4d) for the third time(i have two normal, healthy daughters) and have never had a miscarraige or aboortion. i am in excellent health-never smoked, did any(including pot) and really do not like alcohol. i had the first tri scan and corresponding bloodwork and my tri 21 results were reported 1>10,000. at 18 w i took the quad screen and results were all normal. then at my 20w scan(20w5d) the periontologist discovered eif and a left pleural effusion. i was referred to a genetic counselor and my risk was quoted as1:20. i feel like this risk is very high given my other test results as well as my age. the dr.(he is in the very high risk mfm group) that wants me to have an amnio says he has performed about 400 of them with just one ending in miscarraige. he is also the dr. that is experienced with pleural effusions and says the effusion is not that large and the lung appears to be developing normally-the baby is directly on target for weight and gestational age. my questions are:what is your experience with pleural effusions connected to tri 21, doesn't my newly calculated risk seem unreasonabbly high with all of my other results being so good, how accurate are fish results for down's, and finally do you feel that a baby with down's can look normal on an ultrasound? i have had 6 ultrasounds already and this last on was in 4d-the baby looks perfect-in fact he looks very similar to my 2yo daughter-nice femur, humerous and nasal bone-and everything else checks out. i am now 21w4d and if i am going to have an amnio now is the time-what do you think? thank you for your time
At Mon Mar 02, 09:02:00 AM 2009,
samantha said…
Hi,
I have been going through a hellish time with this ectopic pregnancy. At first I had a lot of pain and cramping in my abdominal area but my pregnacy blood count was pretty low... The doctors at the hospital thought it would be best for me to have surgery since my pain was so severe. They could not find the ectopic pregnancy but instead found a large sist on my right ovary that had ruptured. They were able to drain it, but left my tubes alone because they were not sure where exactly this thing was. I had a shot of MTX the day after my surgery and found out that I was still pregnant a week later, so I just had my second shot six days ago. I went back into my doctor four days after my second shot and he did an ultrasound and it appeared that the ectopic was more distint and very clear to see. I looked at my past ultrasounds and it looked to me as this ectopic pregnancy had actually grown. My dr. scheduled surgery on Day 7, which is tomorrow, just in case. Last night I started to bleed a little bit and today I am bleeding more. I am not in any sort of pain, however. What does this mean? Does this mean that the second shot has worked? I know it is normal to "spot" during these pregnancies, but doesn't that come along with pain as well? I am not in any pain anymore, and I seem to be bleeding like a somewhat heavy period. Is this a good sign? Please let me know. I do not want to have to wait in the emergency room again for six hours when I don't have to! Thank you very much
At Sat Mar 07, 02:59:00 PM 2009,
Tab said…
DR
I really hope you can be a help me. I was told I had an ecotpic pregnancy and given methorexate sodium. A week later my Dr found a fetus in my uterus. now i'm bleeding and was told that 1 out 4 pragnancies are miscarried. I really need to know if the methorexate is the reason i lost my child. Please help me understand! Thank you
At Sat Mar 07, 03:05:00 PM 2009,
Tab said…
I hope you can help me. I was told I had a ectopic pregnancy and was given methotrexate sodium. A week later my Dr found a uterus pregnancy. I need to know what will the methotrexatevdo to my fetus?
At Wed Apr 15, 07:55:00 PM 2009,
Marie said…
its nice to read your comments... at my office we did stop work and 35 of us crammed around the tv to watch - republicans and democrats... since then we have gone back to political bickering but it was nice for a day... im glad to hear of a doctor that likes obama usually i hear skepticism about his health policies... thanks for you blog
At Thu Apr 30, 08:32:00 PM 2009,
Anonymous said…
my daughter is 27 has one miscarriage is now 5 - 6 weeks pregnant. 2 weeks ago had blood work done hcg levels very high progesterone levels very low doc put her on supplements goes monday for ultrasound. should i be concerned.
At Sat Jun 06, 01:33:00 PM 2009,
robin said…
my blood screen came back 1:10 for trisomy 18 but sonogram showed no signs of defects for such diagnosis what are the chances that the baby will be fine
At Sun Jun 21, 04:57:00 PM 2009,
Kenneth F. Trofatter, Jr., MD, PhD said…
Robin June 6: What lab results drove that risk for trisomy 18. A 'level 2' ultrasound will rule out about 90% (but NOT all) of trisomy 18 babies because they usually have multiple abnormalities and if none are found that is very reassuring. If your risk was driven by a low PAPP-A result in first trimester, you may still be at risk for complications related to a small or poorly grown placenta. Such complications include intrauterine growth restriction, preeclampsia, early delivery, and cesraen section (among others). I have discussed this in several other blogs so use the search engine to find these. Best of luck. Dr T
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