Penn Medicine News Blog Posts by Olivia Fermano

I remember the first time I heard of preeclampsia . Despite the fact that I’ve worked my whole adult career in hospitals and health care, I didn’t first learn about preeclampsia on the job. In truth, I read about it years ago – and rather graphically – in the John Irving  novel, The Cider House Rules. (FYI, readers:  you will not find a scene about preeclampsia in the movie version starring Toby Maguire and Charlize Theron. That, along with much more, was edited out of the book for the screenplay.)

Preeclampsia is a form of high blood pressure brought on by pregnancy and occurs after the 20^th week of pregnancy. It is also known as toxemia. In some women, a more severe form of the illness, eclampsia    develop, causing seizures or convulsions. It’s a leading cause of premature births, and the only sure treatment is delivery of the baby. If that doesn’t happen, the condition can take the life of both mother and her unborn child.

That’s what the pregnant woman at the orphanage giving birth in The Cider House Rules had. In the story, she was in labor, flailing and jack-knifing on the table in the midst of a full-blown seizure. It freaked me out. And I remember thinking after the lead character Homer saves the day – and thus the eclampsic woman’s life, “Geez…bad enough the poor woman had to sneak off to give birth to an unwanted child whom she was going to abandon at the orphanage. Did she really need to have such an emotionally gut-wrenching experience made all the worse by this, this “preeclampsia?” At the time, it seemed like “down-on-one’s-luck overkill” for a lone character. I would come to learn later, though, that Irving didn’t really add any unnecessary drama to the story. Pre-eclampsia was and reemains actually quite common with consequences quite dramatic. No creative literary license was taken. Irving was apparently right on the money with the realism.

I didn’t hear a thing about preeclampsia until almost ten years later – and at that time is was through work, when I began working with obstetricians. But how come I hadn’t heard about preeclampsia for a whole decade, a time when I’d been surrounded by pregnant relatives, friends and co-workers? I remember some of them having to have emergency c-sections because of high blood pressure…but was this preeclampsia?

Why wasn’t anyone talking about this?

To celebrate February as American Heart Month, the News Blog is highlighting some of the latest heart-centric news and stories from all parts of Penn Medicine.

Hot flashes. Night sweats. Sleep disturbances. Mood swings. Irregular and racing hearts. These are all signs of menopause setting in, the time in a woman’s life when her ovaries cease to function signaling the end her fertility years, her menstrual cycle and a drop in naturally produced hormones.

Often aptly referred to as “the change of life,” the period during which some women suffer the many unpleasant symptoms associated with menopause is actually a transitional phase called perimenopause, which can begin from as young as 40 and last until a woman’s early 60s. A woman is considered perimenopausal until one full year after her last menstrual period. After this year has passed, a women can then declare herself as “gone through menopause” and is considered postmenopausal the rest of her life. 

 As if the possibility of menopausal symptoms setting in as early as age 40 isn’t unsettling enough, check out these disturbing facts: a woman’s risk for heart disease automatically increases at age 40, and heart disease is the leading cause of death in women over 40, particularly those in the midst of menopause. Why? Because the decrease in estrogen caused by menopause has multiple negative effects on the female cardiovascular system including: changes in the walls of arteries and blood vessels which makes plaque and blood clots more likely to form; increased fibrinogen levels which make blood clots more likely to form and narrow the arteries; a decrease in HDL – or “good cholesterol” – and an increase in LDL or “bad cholesterol.”

To celebrate February as American Heart Month, the News Blog is highlighting some of the latest heart-centric news and stories from all parts of Penn Medicine.

The flowers and cards have all been delivered. The chocolates were devoured and Cupid can now take his annual break. But just because Valentine’s Day has come and gone doesn’t mean the time for hearts is over. There’s still some days left of American Heart Month and while the public is bombarded with commercials and news stories about the topic, no one – especially women – should think they’ve heard all there is to know about heart disease.

Heart disease is the number one killer of women. Yet after scores of public education programs and public service campaigns the message still hasn’t sunk in. “For decades, heart disease was considered a man’s disease,” said Nazanin Moghbeli, MD, MPH, FACC, the director of the Women's Cardiovascular Center at Pennsylvania Hospital. “Previous heart disease research and public awareness efforts only focused on cardiovascular disease in men. But we know differently today. Today we’re faced with the sobering fact that a woman suffers a heart attack every minute in the United States. Not only do we need further research and continuing education, we must focus on teaching women the important differences in the symptoms and risk factors of heart disease.”

“It’s obvious that women should be aware of the risks of heart disease and recognize the signs of a heart attack. Yet women also need to realize they can take action. If they know the risks factors of heart disease and can minimize or eliminate them, they can greatly improve their chances of preventing cardiovascular disease,” Dr. Moghbeli says “When it comes to risk factors of heart disease for women, I like to break them down into two categories:  the usual suspects and the not-so-usual suspects.”

To celebrate February as American Heart Month, the News Blog is highlighting some of the latest heart-centric news and stories from all parts of Penn Medicine.

February is all about hearts…from Valentine’s Day to American Heart Month. However, while one is a reference to a romantic and commercial holiday, the other is a more serious matter. One that women in particular need to pay close attention to: the prevention, causes, symptoms and treatment of heart disease.

Heart disease remains the number one cause of death in the US for both men and women. Heart disease, in all its forms, is responsible for over 400,000 deaths a year among women – more than all forms of cancer combined. And although new research on the importance of heart-healthy diets, exercise and quitting smoking have decreased heart disease rates among men in the past 30 years, the rate for women hasn’t budged, according to a new report from the National Insitute of Nursing.

Helping to battle such depressing statistics and improve the heart health of women in the greater Philadelphia region is Nazanin Moghbeli, MD, MPH, FACC, the director of the Women’s Cardiovascular Center at Pennsylvania Hospital. In a series of posts this month, Dr. Moghbeli will address the most important questions and issues to help women become more  heart smart.

Funny thing how celebrities and sport stars can dictate what’s considered fashionable in everything from wardrobes to medical treatments. Over the past year, there has been debate on whether or not platelet-rich-plasma-therapy (PRPT) is an effective, viable treatment for orthopaedic injuries, a topic most recently voiced in the New York Times Well Blog, “Does Platelet Rich Plasma Therapy Really work?” PRPT has made the news and put the bug in many-an-ear as a viable successful sports injury-buster when professional athletes like Philadelphia Eagle and NFC pro-bowler Jon Dorenbos and Troy Polamalu from the Pittsburgh Steelers are reported as receiving the somewhat experimental treatments. But now, in the words of The New York Times, “rather belatedly, science is showing up to spoil the fun.”

Well, where the science is showing that PRPT is losing in the sports arena, it’s also showing where it’s winning in operating room. Samir Mehta, MD, chief of the the Orthopaedic Trauma and Fracture Service at the Hospital of the University of Pennsylvania and assistant professor of Orthopaedic Surgery at the University of Pennsylvania School of Medicine has been successfully using PRPT to treat traumatic bone loss – and some very severe cases - by augmenting commercially available bone grafts in patients like a tri-athlete, veteran competitor of Iron-women competitions whose shoulder was completely shattered after being hit by an automobile, and a motorcycle policeman who, after losing control of his bike completely shattered his tibia, and a mother of two who was struck by a truck resulting in massive bone loss in both her femurs.

The treatment involves injecting portions of the patient’s own specially processed blood directly into the injured areas with bone grafting. The injection acts like a catalyst in the body to get it to instinctively repair bone and surrounding tissue.

So why do we hear so little about the demonstrated successes of PRPT for healing bones and only its failures for other sports injuries? The facts are generally unclear to the public so to help shed some light on the issue Dr. Mehta outlines the following fast facts:

• PRPT is only FDA-approved as a bone graft extender – all other uses, including those touted in the media being used by pro athletes – is “off-label” use.
• As the science has shown so far, there is limited anecdotal success in off label use.
• Many basic science (animal) studies so far are supportive of fracture healing with PRP. 
• There has been anecdotal success in using PRPT in recalcitrant (long-bone) fracture healing and used judiciously, especially in patients who have failed other biologic augments, to incite fracture healing.

To read more about Dr. Mehta - who just recently was announced as one of the 2011 "Top 40 Under 40" award winners by the Philadelphia Business Journal - and his successful use of PRPT, check him out in a recent issue of SJ Magazine:  SJ Magazine.net/2011