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Category Archives: RHBill

In The Nick Of Time

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(photo: http://www.moondragon.org)

A first time mother was well into the third trimester of her pregnancy. She never got sick, currently with no pregnancy-induced illness like hypertension or diabetes. She was regular on her prenatal visits, compliant. Unremarkable.

During the wee hours in the morning, she began to feel some abdominal cramps. She thought it was hunger pangs, so she had something eaten. However, after few minutes, in contrast to the relief she was expecting, the abdominal cramps continued, intermittently.

She then went to consult her OB-Gyne and have the problem assessed. On internal exam, her cervix was already 1.5 cm dilated. Her abdominal contractions were intermittent. What was unusual was that she was screaming as if in in severe pain, which was incongruent to the degree of the abdominal contraction she was experiencing. She was thus advised admission.

Upon arrival at the emergency room, it was noted that the abdomen was a little harder than the usual premature contractions, with her screaming still as if in severe pain. A tracing taken from the abdomen to assess the contractions of the uterus and heart beat of the baby (cardiotocography, CTG) showed abnormal uterine contractions and variable fetal heart rate pattern. Quick thinking by the OB-Gyne lead to the consideration of impending abruptio placenta (premature detachment of placenta from the uterine wall).

Normally, the baby gets delivered first, before placenta separates from the uterus. When the placenta prematurely detaches from the uterine wall, ahead of the delivery of the baby, this can lead to exsanguination (massive hemorrhage). On the maternal part, she can have anemia, or worse, hypovolemic shock, due to the blood loss. On the fetal side, since the placenta (which serves as the baby’s siphon for blood from the mother, delivering nutrients and oxygen supply to the baby) prematurely detached, baby can also have hypovolemia, anemia and shock. And since baby gets deprived of oxygen, baby is in a similar situation to that who is drowning or strangulated, resulting to asphyxia, and worse, death. It is then crucial that this condition (abruptio placenta) be diagnosed and managed very early on to prevent the occurrence of such adverse effects on both the mother and the baby.

Mother had to undergo emergency cesarean section. While the obstetrician was doing her job, I went to peek on the complete blood count of the mother. It showed that the mother was already having anemia. This means that she was losing significant amount of blood. (This could then explain why the uterus was unusually hard, and her unusual screaming, characteristic of one in severe pain.) On opening up of the uterus, there was a huge blood clot between the uterine wall and placenta, with about 30-40% of the placenta detached from the uterus.

When baby came out one minute after opening of the uterus, baby had difficulty of initiating his first breaths. I had to stimulate and provide bag-mask ventilation until baby began to cry. We did uninterrupted skin-to-skin contact for that chance to acquire maternal bacterial flora that will eventually help protect baby from infections. As soon as baby began to grunt (which began at about 10 minutes after skin-to-skin), we took him to the NICU for care.

When the result of the complete blood count of the baby came in, it showed that per 100 of white blood cells (WBC), 45 of which were nucleated red blood cells (NRBC). RBCs are produced in the bone marrow. While still undergoing development, the immature forms are still nucleated. Once they mature and before they are released to the peripheral circulation, the nucleus is extruded. This now allows the RBC to be pliable in the peripheral circulation, with an increased carrying capacity for oxygen. If however, in cases where baby becomes deprived of oxygen such as in massive bleeding as was the case for this baby, immature RBCs, the nucleated ones, are then thrown out into the peripheral circulation, in an attempt to increase the oxygen-carrying capacity of the RBCs — to protect the brain, heart and adrenal glands from the devastating effect of hypoxemia and hypoxia.

The urgency of the cesarean delivery has just saved the mother from massive hemorrhage and the baby from being asphyxiated. A few minutes of delay perhaps would have resulted otherwise… In the nick of time.

IMAGINE this happening to a mother, who is living in a far-flung area, with no access to obstetrics care; where hospital is 2-days travel away; where there are no barangay health workers that can be called, or even if there are, but no nearby health care facilities… would we have saved the mother? the baby? How many perinatal deaths would have to occur before the reproductive law be enacted? Do we need to have a national dumping site of dead mothers and babies (similar to that of the “Killing Fields” of Cambodia), which our leaders will personally inspect, or perhaps do a skull count, before they believe there is a need for the immediate enactment of the reproductive law? Well, one senator wanted to have maternal death certificates as an evidence before he could believe high perinatal mortality is happening.

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Posted by on June 17, 2013 in Pregnancy, Prematurity, RHBill

 

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Foul: SC SQAOs RH LAW

(photo courtesy of www.pogsinc.org)

(photo courtesy of http://www.pogsinc.org)

UN resident representative described the Philippines as the “worst performer” in Asia as far as achievement of Millenium Development Goals (MDG) are concerned. This, as far as lowering of child mortality, decreasing maternal morbidity and mortality as well as HIV prevention are concerned.

These three are included in the Responsible Parenthood and Reproductive Law that was already signed, implementing rules and regulations signed as well, but put on hold by the “status quo ante order” issued by the Supreme Court on March 19, 2013.

This law went through hurdles for about 16 years before being finally passed by the 15th Congress. It aims to empower people by making them a responsible parent. By this, it will allow parents to determine the number of their offspring they can responsibly have – those that they can feed, vaccinate, send to school and be a responsible citizens of the country. This can be achieved through sexuality education, which will be taught while the children are young, and employment of safe and acceptable contraceptive methods, depending on the couple’s choice, heightened HIV education and awareness especially to population at risk.

Recently, there was a scandal about an adolescent college student who claimed her life after, bottom line, cannot afford to pay her tuition. They are 4 siblings and yet the father cannot afford her tuition fee. And how does this relate to the RH Law? I am not saying the father is irresponsible. BUT, had he considered that he could only afford to rear one or two children, providing all their needs, then his daughter wouldn’t have suffered this problem at such a young and tender age. He could still have his brilliant daughter this very minute with him.

I am the eldest of 4 children. My parents used pills and condoms. We don’t own a house and we had been renting up to this date. When I was about to enter the school of medicine, the 4 of us were already simultaneously going to college. With my father’s income, he couldn’t afford to send us altogether. He talked to me that he cannot afford my tuition. If he would, my other siblings wont be able to enrol. I on the other hand has graduated from college already, so perhaps I could already work and save up for my tuition. I was heartbroken as my aspiration of being a physician was imperiled. I won’t be graduating with my batch mates. I felt it was so unfair for me. I was selfish as I didn’t want to trash my dreams to happen at the right time that I want it to, and without considering my other siblings’ welfare too. But my selfishness was my motivation and determination to find myself a scholarship that can fuel my ambition. My youngest sister as well was able to secure a scholarship for her. So basically, my father was only supporting two of my other siblings as far as tuition and miscellaneous fees are concerned. It was very very difficult time. Sometimes we have to make do with our meager allowance. But one thing I salute my parents for was that we were never delayed in paying our tuition. My parents didn’t want as much as possible for us to be delayed from graduating. They didn’t want as much as possible for us to be working scholars in order for us to afford college. As much as possible, they wanted to shoulder the entire burden of sending us to college as it is their obligation to do so. They believed it was was their duty and responsibility. My parents admitted that they won’t be able to give us land, house or any property for inheritance but our education that will help us build our own future. Now, if my parents who practiced family planning were still hard up to give us good and quality education, how much more for those who had not?

I am aware of that it will be a long time before the concrete effects of RH Law will be experienced by our fellowmen. But delaying it or even preventing it from being implemented, considering our country’s situation right now, is a violation of our rights to access to reproductive health care. We need an immediate tangible effect such as in the following case.

Small for Gestational Infant

A mother conceived, she was hypertensive even at the early stages of her pregnancy. After reaching 20 weeks, her blood pressure all the more shoot up. Even with medical care from a private obstetrician, still the blood pressure wasn’t adequately controlled. At 36 weeks, she came to the hospital in active labor. The baby’s heart beat was erratic and had to be delivered immediately, or else we will lose the baby.

The baby came out without spontaneous breath and crying, and the heart beat was very slow. He had to be resuscitated, a tube was inserted into his trachea to assist him breathing. He was small for his age of 36 weeks, with respect to his weight, length and head circumference (an indirect indicator of brain growth). This only means that the baby was chronically “undernourished” inside the mother’s uterus that’s why all of his anthropometric measurements were below normal.

Adequate blood glucose and oxygen supply from the placenta to the baby is necessary for optimum brain and body growth. Normal or good glucose level stimulates the production of more insulin-like growth factor 2, which is responsible for increasing the number of neurons and oligodendrocytes, and increasing the communications between neurons through dendrites and axon. An increased communication between these two parts of neurons leads to faster transmission of signals. Bottom line, intelligent kid. The opposite, “bobo.” I am not saying this is always the case but the risk, a very high risk at that, to being one is undeniably there.

So this baby already suffered an injury biochemically and physiologically inside the womb, even if he was born alive. So it’s true no mother died in this case. It’s true, no baby died in this case. But the impact of the chronic uncontrolled hypertension to the baby’s brain, IS permanent, and may be debilitating. This thing is still happening among our pregnant mothers, even if they are under the care of able obstetricians. But what about those who have no access to obstetricians? And mind you, this is just one aspect of issues surrounding a pregnant woman. There are more other pressing equally important concerns.

One anti-RH bill argues that there is no more need for RH law as there is already an existing Magna Carta Law for Women. Let me throw back the question to you. With the MCW in place, how come, we still have this high incidence of maternal morbidity and death? With the MCW in place, how come we are not achieving the millenium development goals? And what about HIV which is not included in the MCW, neonates? With the SQAO against implementation of the RH Law, aren’t we not endangering further our poor constituents? Is it right to issue this SQAO at this time?

 

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Why I Support Reproductive Health and Responsible Parenthood Bill

One time, I received an SMS from my mentor saying “why are you so passionate about RH Bill. Dont think about politics, think about lives.” My mentor is one of the highly regarded authorities in our field and him saying such to me made me rethink. Am I fighting a wrong battle with my support to the reproductive health bill? What politics am I doing or violating with such stance?

Being a pediatrician and a neonatologist, I am faced with women giving birth… mostly women with complicated pregnancies. Often than not, most of my referrals are emergency cesarian deliveries where either or both of the mother and babies is/are in peril; delay of delivering by few minutes might just lead to the death of the baby or the mother. These are the lives I am dealing with often… Rethinking my mentor’s statement, are these lives the only one I should fight for?

Being in a private practice, the mothers and babies referred to me are under the care of obstetricians. BUT, the statistics have keep on repeating that only half of the mothers in the Philippines deliver in the hospital. And not all of those who deliver in the hospital have been adequately cared for by obstetricians. Some may have had a visit to a health center, midwives, nurses or even obstetricians, but not frequently enough for thorough monitoring of their pregnancies. Now, what about those who have no access to health services at all? Are they not the ones I fight for too by supporting the reproductive health and responsible parenthood bill? Shouldn’t they matter to me, even if I am a privately practicing neonatologist who won’t earn income from them?

The provisions of the bill mention, among other else, include providing options for couples to plan for their family, providing age-appropriate sexuality education, prohibiting abortion, providing access to health care to all mothers. With such provisions, who would not be glad to support such measure, especially for someone who know the actual health status of our young children and mothers? In reality, we as a country, and at the current status we are in, will not be able to meet the millenium development goals by 2015, specifically on child health, maternal deaths and HIV. In fact, those millenium development goals should have been achieved by 2000, when I was still a student. But the deadline kept on being postponed as they have never been met universally. Seeing this bill addressing such concerns really merits support, especially if you are a rational being.

It is bothersome to learn that not all infants receive adequate and proper care, and thus ending among those who do not reach their 5th birthday. In the latest global data, WHO listed the top causes of mortalities among children less than 5 years old as follows: pneumonia (18%), preterm birth complications (14%), diarrhea (11%), birth asphyxia (9%), malaria (7%), and others (41%). (Reference: http://www.who.int/mediacentre/factsheets/fs178/en/index.html). The four leading causes of mortalities are PREVENTABLE, by adequate prenatal care and vaccination. In our country where our geography limits gathering of complete and actual data, the figures may be more. It is a fact that there is underreporting especially from our fellow countrymen in the farflung areas without access to information.

As of October 2012, the Department of Health have posted that there were 295 confirmed new cases of HIV-AIDS infection, 60 out of 295 are under the 15-24 years old age bracket. Among the OFWs, who Senator Enrile boasts of as our large export, 31 of 295 or more than 10% new infections were confirmed. While it is true that still men who have sex with men are the bracket with the highest proportion, our OFWs are another factors who contract the disease from their country of work and vectors it into our country. If only these persons have been educated well enough, have access to protective barriers, then probably we can also join the rank of those countries with decreasing prevalence. On the contrary, we are among the few remaining countries with consistently increasing number of cases. (Reference: http://www.doh.gov.ph/sites/default/files/NEC_HIV_Oct-AIDSreg2012.pdf).

Teenage (or Early) pregnancy is very high in the Philippines, in fact it increased significantly few years ago that we are now among the top countries in Asia with the highest number. Out of fear, teenage moms usually end up hiding their pregnancies (and thus not visiting an obstetricians) or worse, decide to abort them. Again, I recall that story of a colleague of mine who admitted a baby born outside the hospital. The mother is teenage, from a conservative Catholic family who never knew she was pregnant. She went to a department store at the time she was due to deliver, locked herself in a storage room and delivered the baby there. She abandoned the baby at the storage room, went out as if nothing happened. Good thing a saleslady heard the baby cry and thus was brought to the hospital. If only these young people are well aware about their body, their sexuality, then these unwanted pregnancies may be reduced to minimal to nil, nor would they end up criminal by aborting their own offsprings.

Maternal deaths do happen, and the average is 11 mothers dying everyday due to pregnancy-related causes. Maternal morbidity doesn’t only encompass death during giving birth, but it is also due to complications that arise from pregnancy – including pre-eclampsia/eclampsia, puerperal sepsis, abortion-related complications and deaths. What is so stupid and an insult to the honor of those mother who died was when a senator demanded for their death certificate as he thinks the statistics was just made up. It is not a joke for a motherless family. The father will all the more strive to work to provide for his large litter; whom are left under the care of anyone convenient to do so. (In retrospect, I wonder if this senator’s neurons are still discharging electrical impulses, or if he has neurons in his brain at all.)

I do not agree with the accusations by those opposing the bill where among other else, RH Bill is a population control measure. And because it is so, then it will lead to extinction of our race (ethnic cleansing – Bishop Arguelles) or there will be decline of our labor force, hence lesser Filipinos would be working as overseas contract workers (Senator Enrile). So senator, our overseas contract workers are milking cows? If you notice, many countries have long existing reproductive health law. And contrary to the prejudiced fear of our legislators, their race remains and have never been extinguished by their reproductive health law. Another argument hurled into me before was, there will be lesser kids, and I will have fewer to none patients. I was really dumbfounded by this comment from a devote Catholic anti-rh bill fan. While it is true that I earn my keep from my pediatric patients, I do not equate them to churchgoers whom I will amass monetary collections from every time I celebrate a mass.

One more thing they so lugubriously proclaim is the imaginary abortions that hormonal contraceptives bring forth. I always ask them to understand first the physiologic effects of female hormones before they further open their mouth and spew lots of shits. That hormones cause cancer, and then they give you a medical article dated 1975 but refuses to accept articles published lately, refuting all those studies they have. And then a senator shares an anecdote that contraceptive pills caused congenital heart disease of his offspring and made a brouhaha about it on national television. That was really worth saying WHAT THE FUCK! With an asshole-constricted comprehension, you will never expect them to imbibe new and additional knowledge and correct their ill-informed minuscule prokaryotic comprehension.

Should I just shrug my shoulders as if nothing wrong is happening to our fellowmen? As far as my conscience, which was honed and guided in Catholic institutions, is concerned, I need to intervene with whatever means I could to allay such unfortunate mishaps in the lives of our underprivileged fellowmen. In China, they train their children as early as 5 years of age to grow up as medal hoarders during olympics. And that is just olympics. If China devotes such passion for olympics, what about preparing our young people to be the future of our country? Should we not equip them, enhance their potentials with similar passion by providing well for them from conception until they end up independents? Isn’t that our duty and obligations as responsible parents, citizens?

 
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Posted by on December 3, 2012 in RHBill

 

Waging Children

Is poverty alleviation a GAME OF CHANCE? Children are now bet by parents as pawn for poverty alleviation. Just like a raffle draw, the more number of entries you have, the more chances of winning. So your children are your wager to uplift you from poverty?

Listen to what these inconsiderate bastard of fathers say: “pag mas maraming anak, mas malaki ang posibilidad na maiaahon ka sa hirap (the more number of children, the greater chance of having a child that will unburden us from poverty).” Another guy, a farmer said, kung naipasa na ang RHBill, sino ang magiging katulong namin sa pagsasaka (if RH Bill has been passed, how can we have children who will help us tend the farm).” Another absurd statement I hear is “di bale nang hirap sa buhay, basta magkakasama. (it doesn’t matter that we’re hard up in life as long as we are all together).”

If you are poor, and sire a lot of children, there are several things that you deprive your children of.

NUTRITION

Being a minimum daily wage earner, it will be lucky if you can bring home 500 pesos for your family, regularly, that is, DAILY. Imagine, with a family of 10 (couple and 8 children), what would a 500 pesos afford them on the table? Rice (carbohydrates) and 2 instant noodles (carbohydrates) for a viand each meal? What about their protein needs – for growth and body tissue repair, and fats, for energy and carriage of vitamins? Nutrients are not only these macronutrients. There are also micronutrients that our body needs. Often than not, these kids are deficient of these too – vitamin A, iron, iodine, leading as well to poor school and academic performance. How many meals/day can 500 pesos afford them? Are these kids well-fed? Often, parents sacrifice, giving their share to their children. But how can a mother, who isn’t eating enough provide a good breastmilk to her nursing child? If the children are going to school, do they bring along snacks? If they are inadequately nourished, how can they learn well at school? How can they be at par with those who eat healthily? How can they cope up if their brain and body are screaming for nutrition? It has been validated by several studies that children who do not eat well during breakfast perform poorly academically. And if so, how can they be educated well, a tool that will help them for their employment in the future?

HEALTH CARE

Will the mother have access to prenatal care every time she gets pregnant? Is she well-nourished every time she gets pregnant? Is her body well rested from the previous pregnancy to carry on another baby? How many of these kids will be delivered in a hospital? Will the parents afford the cost of vaccine that each  of these kids need? The government only subsidizes a few and select vaccines.

The most common causes of mortality among under 5 years old are neonatal death (death within 30 days from birth), pneumonia and diarrhea. The latter are two vaccine-preventable diseases, affecting children worst during the 1st 6 months of life. Children who are unable to receive these vaccines, because of high cost, at this most vulnerable period are at increased risk. Just recently, the government announced it will provide rotavirus vaccines, but only to select indigenous people only; itt would still not cover many of our kids most of our indigenous kids.

A child’s health status and nutritional status have direct relationship. And health does not only encompass one’s physical well-being, it also includes his mental faculty. The better nourished a child is, the less sickly he becomes. Protein helps in the patient’s growth. In relation to diseases, protein brings about formation of antibodies needed to combat infection. It is easily understood therefore that a malnourished child is less-equipped when it comes to combatting diseases, and thus is more vulnerable. Compound this fact again with the child lacking vaccines. He has already nil immune system to begin with, then lump it with malnutrition; this now brings the child at a double jeopardy. And when they need hospital care, will they afford it? Often than not, those who need one are from the poor sector. Will they be always at the mercy of random samaritans to be able to survive?

EDUCATION

Will they be able to afford quality education a private school can offer? If not, in the government school, what is the quality of education will they imbibe; wIth congested class rooms, abbreviated class periods, rotating in shifts? Physically, their lack of nutrition impairs their academic performances. Their sickliness aggravates their deficiencies. And then, now, this environment as school, who from my humble opinion, isn’t conducive for learning. Can the poor parents afford to send all children to college, with such income, without resorting to working while studying? Of course, I am not saying it is wrong to be a working student, but ideally, academic years should be solely dedicated to studying, or else, the child will easily burn out if he still has to work, especially with the younger generations.

So what have we here in reality? Many of these kids do not finish elementary, few reach high school education and rarely if not nil achieve college degree. Children are forced to help their parents to augment the family income. But when they reach adult and join the labor force, they are disadvantaged, courtesy of their lack of education and frail health. If it is their time to be parents, how many of them will follow their parents’ example? It usually ends up in a vicious cycle, and its sickening.

So what happens now to the wager of their parents? Who among them can indeed uplift their family from poverty, given their disadvantaged background?

 
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Posted by on September 27, 2012 in Personal, RHBill

 

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Why Single Women, And Yes, Nuns, Ought To Take Contraceptive Hormones

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Birth Control Pills (Image courtesy of © iStockPhoto / Ceneri)

When I once said that nuns and single women who do not intend to get pregnant would benefit from taking contraceptive pills, one anti-RH Bill reacted saying “that is hysterical!” I didn’t think HYSTERICAL was even the appropriate word to say, even if she wanted to express disgust based on her knackered beliefs.

Let us put it that a woman has her first menstruation (called menarche) at age 15 years of age, and menopauses at 45 years of age. Granting she has a regular monthly menstrual cycle, that would make her mens 12 times a year. If she will have 30 years of reproductive age, then that would mean, she will have 360 menses in her lifetime. (Although realistically, nowadays, some girls already start menstruating at 9 years of age. To give you an idea when to expect the girl will mens for the first time, note at how old she is when her breasts start to enlarge — termed medically as thelarche. Approximately two years after that, she will now start her menstruation.)

During a woman’s menstruation, there is interplay between estrogen and progesterone. During the first day until day 14 of a woman’s menstrual cycle, ESTROGEN predominates especially on the day just before ovulation. The latter is responsible to prepare the uterus for an incoming pregnancy as well as ovulation in concert with other hormones; it’s level declines once the ovary has released an ovum. Once ovulation occurs, the corpus luteum (the cells surrounding the ovum in the ovary) release PROGESTERONE. The latter on the other hand ensures that the reproductive organs are optimum for a pregnancy to proceed.

PREGNANCY AND ITS EFFECT ON ESTROGEN ELEVATION

I have emphasized in my other blogs the role of progesterone as the hormone responsible for keeping the pregnancy intact. While estrogen may still be produced during pregnancy (as estriol), its potency is a lot weaker than the estrogen produced during non-pregnancy state (estradiol).

If woman gets pregnant for 9 months, the effect of progesterone is greater than the effect of estrogen. Even if estrogen is also produced during pregnancy as estriol, its effect to other organs such as ovary and uterus is dampened to nil. Thus, in cases where the woman is able to carry her pregnancy to full term, that would save her 9 months from the potent effects of estradiol to her body. If she will exclusively breastfeed (no breastmilk substitute whatsoever is given to the baby) after giving birth as well, this will have the effect of LACTATION-INDUCED AMENORRHEA (woman’s menstrual cycle remain arrested as effect of exclusively breastfeeding her baby) for about 6 months. Thus, one pregnancy will save the woman at least 15 months free from effects of elevated estrogen (estradiol) level. If in her lifetime, a woman will bear 4 children, all of which were term pregnancies, then she will have a total of (15 x 4) 60 menstruation free months in her lifetime. This means, she is on the advantage of 300 months exposure only, compared to women who never got pregnant, who are exposed to the potent effects of estradiol for 360 months.

EFFECT OF UNOPPOSED ESTROGEN ELEVATION

What effect does estrogen have to a woman? Most commonly discussed effects of unopposed estrogen elevation would range from benign (leiomyoma, or myoma of the uterus) to malignant such as cancer of the uterus, ovary, and breast, among other else.

Cancer

It has been established that most cancers are mainly genetic (meaning, inheritance of cancer genes from either side of the parents). But aside from the genes for expression of cancers, there are also genes for cancer suppression that comes along with its inheritance. Whichever of these genes predominates, that is  what is manifested clinically or physically or biochemically or physiologically by the person involved. If a person has breast cancer gene, and the gene for its suppression is muted or ineffective, then the person will have breast cancer manifestations. On the other hand, if the person has breast cancer genes, but his cancer suppression genes are enhanced and working effectively, then the person will not show signs of breast cancer, but still at risk and will readily convert once those cancer suppression genes are skewed. (Confused? hahaha). These cancer suppression/expression genes are regulated by the environmental factors to which the person is exposed to. In the case of breast cancer, one environmental factor is elevated estrogen (estradiol) level.

Estrogen naturally exists in 3 forms in women. The ovary produces (1) estradiol, the most potent form of estrogen, and this is the form usually seen elevated among nonpregnant women during the reproductive age group. This is believed to be the most potent of the three forms. Another form of estrogen is produced during pregnancy is (2) estriol; this has been noted to be the a lot weaker in comparison to potency of estradiol. Another form of estrogen is found among menopausal women, (3) estrone. During the reproductive age group, estrogen is produced by complex enzymatic process at the ovary. Postmenopausally, estrone is converted peripherally at the liver, adrenal glands, breast and fat tissues.

If a person has inherited the breast cancer genes, and keeps on being exposed to elevated estradiol, then she can develop breast cancer, especially if her breast tissue also has the hormone receptors for estrogen. These receptors will bind with the circulating estrogen and thus bring about the genesis of cancer. Between non-pregnant woman (who has 360 times of exposure) and a woman who got pregnant for four times (who only has 300 times of exposure), it is the former who is more susceptible. This only goes to show that even if the woman never took exogenous sources of estrogen (such as oral contraceptive pills), they can still have breast cancer. (I previously blogged a colleague who was single and died at the age of 42 from breast cancer. She too was not taking contraceptive pills — The Pain She Should Never Have.

DO CONTRACEPTIVES OFFER ANTI-CANCER BENEFIT TO WOMEN?

Contraceptive pills contain synthetic progesterone alone or in combination with estrogen. Among its many benefits, the effect in focus is its role in suppressing ovulation. With a sustained elevated level of progesterone from religious intake of contraceptive pills or injectable hormones, this suppresses elevation of estradiol (which leads to ovulation). With lesser if not complete non-exposure of the reproductive organs to estradiol, nothing will stimulate the cancer expression genes and therefore no cancer formation. Of course this is NOT always absolute and there are always exceptions, but these exceptions are often minimal compared to those who will benefit from the treatment.

A meta-analysis on the effect of oral contraceptive pills among women who had genetic mutations (BRCA1/2) for expression of ovarian cancers have shown that oral contraceptives reduce the risk for ovarian cancers, proportional to the length of use. The same meta-analysis also stated that OC formulations used before 1975 were associated with a significant increased risk of breast cancer (SRR: 1.47; 95% 1.06, 2.04), but no evidence of a significant association was found with use of more recent formulations (SRR: 1.17; 95% 0.74, 1.86). (highlights were mine). (Reference: Oral contraceptive use and breast or ovarian cancer risk in BRCA1/2 carriers: A meta-analysis.S. Iodice, M. Barile, N. Rotmensz, I. Feroce, B. Bonanni, P. Radice, L. Bernard, P. Maisonneuve, S. Gandini. European Journal of CancerVolume 46, Issue 12August 2010Pages 2275-2284).

Do women ought to take contraceptive pills, even if they are not married? 

 
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Posted by on September 22, 2012 in Breast Cancer, RHBill

 

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The Myths of Breakthrough Ovulation & It’s Purported Abortion

A woman posted a meme on twitter talking about “breakthrough ovulation” and how these eggs fertilized after breakthrough ovulation gets killed by contraceptive pills. I asked her to explain scientifically how does the killing happen, but I never got a reply. My guess was she really did not know what she was talking about and thus the answer (because she just want to instill fear among her readers). How responsible tweet that was huh?

Breakthrough ovulation can happen, especially when the female taking pills is not compliant and does not follow instructions well. According to Dr. Dennis Higginbotham, “failure rates for pregnancy with BCP’s (birth control pills) can be 1% to 5% depending on the particular pill and on the patient compliance. Skipping pills is the usual cause for failure, but ovulation (and pregnancy) can occur even when the pill is taken properly.” (highlight is mine; Reference: https://www.healthtap.com/#topics/breakthrough-ovulation-on-birth-control). Following his statement, it would show that the pills are 95-99% effective in suppressing ovulation.

Pill are composed of synthetic estrogen and/or synthetic progesterone. Some pills are plain progesterone, while some are combined estrogen and progesterone. The hormonal contents of birth control pills are minute as compared to the volume released by the ovary. It mimics the hormone’s action by causing ovary to stop ovulating, thins out the uterine wall, thickens the cervical secretions, all for the purpose of preventing pregnancy.

What are the circumstances surrounding ovulation? When a woman ovulates, there is a high estrogen level in her blood, there is the surge of luteinizing hormone. These two events are important to trigger the eruption of the ovum from the ovary. What are the sequela of elevated levels of estrogen? In the uterus per se, it causes thickening of the walls, increase in blood vessels, as if preparing for a possible pregnancy. That’s what estrogen does to the uterine lining. So, what will happen in cases of breakthrough ovulation, and this egg becomes fertilized? It has a rich uterine lining for implantation. This is contrary to the claim of misinformed anti-reproductive health bill measure that because the woman is taking pills, the uterus is thin and cervical mucus is thick disallowing pregnancy to happen. This is false! Estrogen and progesterone are endocrine hormones. This means that it is secreted by a certain organ, but its effect is transmitted to other organs sensitive to it via the bloodstream. In contrast, paracrine hormones/substances are substances which exert effect to nearby organs by diffusion but not via bloodstream. So in breakthrough ovulation, where the egg gets fertilized, PREGNANCY will take place, NOT ABORTION. As Dr. Higginbotham mentioned, there is 1-5% failure rate.

During the woman’s menstrual cycle, estrogen hormone predominate during the 1st 2 weeks (day 0-14). This hormone prepares the uterus and other reproductive organs for the forthcoming “pregnancy,” assuming that the egg gets fertilized upon its release – uterine lining thickens, there is increase in blood vessels, glycogen, etc. Everything happens in a concerted fashion for the anticipated pregnancy. By around day 14 of the menstrual cycle, the luteinizing hormone surges (released by the pituitary gland) and then triggers the release of the ovum.

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Beautiful series of pictures taken by accident by the team of Jacquez Donnez as they were preparing the woman for partial hysterectomy. (source: http://login.totalweblite.com/design/1120/index.asp?pageid=34422&AccId=4049)

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Image courtesy of http://www.britannica.com/EBchecked/media/99761/The-steps-of-ovulation-beginning-with-a-dormant-primordial-follicle

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Image courtesy of http://ib-biology2010-12.wikispaces.com/Human+Reproduction

When the ovum is released, the follicle is converted into corpus luteum. Estrogen level now declines dramatically. The corpus luteum now releases progesterone to sustain the ovum. If the ovum gets fertilized, there is rapid proliferation of cells until the fertilized ovum will transform into blastocyst. This happens until about 13 days from fertilization. Up to this point, the corpus luteum provides progesterone for this developing embryo.

By around 13th day post-fertilization, the blastocyst implants. It may cause a minor bleeding in some women (post-implantation bleeding) while others may not. The outer layer of the blastocyst now imbeds itself into the rich vascular uterine wall and forms the placenta. Once implanted, the placenta now assumes the role of producing progesterone for nine months until the baby’s birth, as the corpus luteum has already involuted. This predominance of progesterone over estrogen during the period of pregnancy inhibits the ovary to release ovum for nine months as well.

This effect of progesterone predominance during pregnancy is mimicked by intake of contraceptive pills.  When the woman takes in hormonal pills, the progesterone becomes elevated thereby inhibiting the ovary to release an ovum, the uterine lining not prepared for pregnancy and the cervical mucus viscid, unfriendly to sperm that might swim up to the fallopian tube. Hence pregnancy will become unlikely.

Now it makes me wonder why these anti-rh bill supporters keep on saying that contraceptive pills are abortifacient. How can abortion happen when no ovum is released? And when there is no ovum released, what is there to fertilize? As of now, majority are in acceptance of the fact that fertilization is when human life begins. In cases of breakthrough ovulation which they repeatedly claim, again, if there is ovulation, then the uterus and the cervix is also prepared for a pending pregnancy because the effect of estrogen that lead to ovulation is also echoed in other parts of the female reproductive organ and not on the ovary alone. It does not happen that estrogen causes ovulation, but uterus remains thin and cervical mucus remains viscid. Estrogen and progesterone effects contradicting at the same time? No, dear anti-rh bill supporters, estrogen effect is endocrine. Again, read the meaning of endocrine as I have mentioned above. And if you insist on this premise that an ovum is released but the uterus and cervix is unprepared for a pregnancy, leading to the abortion of that fertilized ovum, then you should be one who is menstruating while pregnant because you think that estrogen and progesterone effects can happen at the same time. I wonder what subspecies of homo sapiens you are, perhaps Homo sapiens mutatis?

 
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Posted by on September 19, 2012 in Pregnancy, RHBill

 

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My Friend’s Thought: One Reason Why We Need RH Bill

friend of mine (he was the mayor of his year level when I was the governor of our college back then), arrived after doing some missionary works down south of the Philippines. I could see the disappointment and frustration in his face as he related what he found out.

He came to know of a girl, she is 14 years old. Pregnant… for her 3rd child. Yes, you read that right. Pregnant for her 3rd baby at age 14. My friend thinks, it seems that in that tribe, as long as the girls reaches menarche (first menstruation), they are being taken wives by older men.

He also talked to a leader of the tribe (they’re called datu). He has vast land, around 20 hectares. He rents it out to a multinational company. The company pays him 1,000 pesos per hectare, so that would sum to 20,000 pesos… Per month? NOOOOOO… Per YEAR, yes, per year!!! In addition, my friend told me the datu has about 10 wives. And each wife has lots of kids. So it makes my friend think, how can a 20,000 sustain that big family? How cannot he be impoverished when aside from the big family he has, he is being taken advantaged of by this big multinational company?

What took me was my friend saying, this scenario should really be seen by those men in congress, especially those who oppose the passage of the reproductive health bill. They are so impossible to contend with. There is really a need for it to be enacted.

When he departed, I thanked him, for understanding how life goes on among our poor fellows, for sharing the passion about how reproductive health program will help our poor women, save lives/reduce deaths, and in the long run, help alleviate their conditions.

 
 

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