Tuesday, August 16, 2011

Baby Leland

With adoration from Mom and big sister, snuggles from Dad, and some CranialSacral therapy from his big brother and midwife, Leland is surrounded with love. Welcome Leland Miles.

May all babies be born into loving hands...

 K. Michelle Doyle, CNM, NYS LM

Baby Zen

Arriving on the night of a full moon and shooting stars, Zen is as calm and reassuring as his name.
Welcome, Zen!

May all babies be born into loving hands... 

 K. Michelle Doyle, CNM, NYS LM

Friday, August 5, 2011

Yoga for Reversing Osteoporosis and Osteopenia

Yoga works! The conclusion of this study is: "This pilot study tends to give support to the hypothesis that practicing yoga for as little as 8 to 10 minutes daily will raise T-scale ranking in older patients." So, keep stretching, keep breathing and stay strong!

May all babies be born into loving hands...

 K. Michelle Doyle, CNM, NYS LM

Yoga for Osteoporosis: A Pilot Study : Topics in Geriatric Rehabilitation 8/5/11 1:19 PM
Topics in Geriatric Rehabilitation: July/September 2009 - Volume 25 - Issue 3 - p 244-250 doi: 10.1097/TGR.0b013e3181b02dd6 Article
Yoga for Osteoporosis: A Pilot Study Fishman, Loren M. MD, BPhil(Oxon)
Author Information
Columbia College of Physicians and Surgeons, New York.
Corresponding Author: Loren M. Fishman, MD, BPhil(Oxon), Columbia College of Physicians and Surgeons, 1009 Park Avenue, New York, NY 10028. (Loren@sciatica.org).
Context: More than 200 000 000 people suffer from osteoporosis or osteopenia worldwide. An innocuous and inexpensive treatment would be welcome.
Study design: Serial controlled repeated measure. Patients: Eighteen serial patients with osteoporosis or osteopenia, average age 68 years.
Methods: Qualifying blood and urine tests and dual-energy x-ray absorptiometry (DEXA) scan preceding 10-minute daily yoga. DEXA scan repeated after 2 years.
Outcome Measurement: Comparison of pre- and postyoga DEXA scans, injuries.
Results: Yoga practitioners gained 0.76 and 0.94 points for spine and hips, respectively, on the T-scale when compared with controls (P = .01). Five patients with osteopenia were reclassified as normal; 2 patients with osteoporosis are now osteopenic. There were no injuries.
Conclusion: Yoga appears to be an effective way to build bone mineral density after menopause.
OSTEOPOROSIS and osteopenia are better understood than they were even a decade ago, yet ancient methods appear applicable to their prevention and cure. We conducted a pilot study using yoga to reduce and ultimately prevent osteopenia and osteoporosis. Many of the world's estimated 200 000 000 sufferers of osteoporosis and osteopenia are unlikely ever to be able to afford either medication for these conditions or treatment of the fractures that are their consequence.1 Those receiving bisphosphonates, by far the most common pharmacological treatment, are at increased risk for gastrointestinal disorders, osteonecrosis, and severe muscle cramps,2,3 and while medicines such as loop diuretics strongly promote osteoporosis through calcium loss, calcium itself promotes cardiovascular and cerebrovascular events and sudden death in people older than 75 years.4
Over 55% of everyone older than 50 years will have low bone density,1 and a woman's risk of hip fracture is equal to the combined risk of breast, uterine, and ovarian cancer.5 Women are as likely to die after a hip fracture as from breast cancer.1,3 Men older than are more likely to contract hip fracture than prostate cancer.1,6 Yet a recent definitive review of chronic disease in a leading journal does not even mention osteoporosis.7
Everett Smith outlined the support for unusual pulls bones as a means of building bone strength. In a study of turkey wings published in this journal almost 20 years ago, he outlined this application of Wollf's law: The architectonic of bone follows the lines of force to which that bone is exposed.8,9 Biochemical markers of osteoid synthesis such as 3H-uridine have very persuasively risen in intracellular concentration after as little as 10 seconds of osteocyte compression.10 Japanese and American studies sending ovariectomized mice into space confirm that gravity, while a ubiquitous and powerful force, is second-best compared to the action of muscles themselves.11 Their point is that muscles are stronger than gravity. One need do no more than lift a finger to prove it.
Tennis players' dominant arms clearly share genetic and nutritional conditions with their contralateral partners, but asymmetrically increased bone mineral density (BMD) is evident there and in many other examples of response to physical stressors.12,13 The often observed fact that yoga practitioners seem to live long and fracture-free lives suggests that the unusual and unusually prolonged pulls they voluntarily self-administer may be a stimulus to bone health.
Study participants were invited through public announcement and from among our current patients. Inclusion criteria were osteopenia or osteoporosis by dual energy x-ray absorptiometry (DEXA) scan, that is, T-scale values below -1.0 for spine or hip, and commitment to 2 years of daily or near-daily yoga. Exclusion criteria included history of bone disease, such as osteofibrosis cystica or osteomalacia, or metabolic or endocrine disorders specifically affecting bone, as detected by tests listed below, and current pregnancy.
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Each patient had BMD tested by DEXA scan within 6 months of joining the study, and once osteoporosis or osteopenia was confirmed, urine was tested for collagen cross-linkage (NTX), and blood was drawn for tests including the following: thyroid stimulating, parathyroid hormone, erythrocyte sedimentation rate, electrolytes and blood chemistry (SMA-18), complete blood cell count (CBC) with vitamin D 25-OH, and vitamin D1,25- dihydroxy.
Only patients with normal laboratory values were then taught a regimen of 10 yoga postures, with frequent adaptations in keeping with the participants' abilities and limitations. The poses taught were the triangle pose (Trikonasana), the upward and downward dog poses (Adho Mukha Svanasana and Urdhva Mukha Svanasana), the bridge and rainbow (Setu Bandhasana and Urdhva Dhanurasana), 1-legged and 2-legged forward bends with specific personal instruction on keeping the back straight and avoiding kyphosis while doing so (Janu Sirsasana and Paschimottasana), the boat (Navasana), Supta Padangusthasana, and 3 twisting poses with straight-back instructions (Marichyasana, Matsyendrasana, and Jathara Parivarthanasana) (Figs 1- 13).
Figure 1
Figure 4 Figure 7
Figure 2 Figure 5 Figure 8
Figure 3
Figure 6
Figure 9 Figure 10 Figure 11 Figure 12
Figure 13
Participants were taught simpler alternatives when necessary for safety, for example, modified forward flexion to avoid vertebral fractures,14 advised to stay in each position for 20 to 30 seconds, and asked to rest for 5 to 10 minutes following the 8- to 10-minute routine. For pictures and more details, see the Web site sciatica.org.
We telephoned the patients periodically to give them encouragement and discuss problems. When we saw that compliance was below 30%, we instituted a newsletter and online notice board.
Patients succeeding in doing yoga consistently for 2 years and controls were then given another DEXA scan. In patients receiving medication such as bisphosphonates, the nomogram for improvement for their particular dosage and duration was taken as baseline, and improvement/deterioration only beyond the nomogram's mean was taken as change. In patients receiving medications that had no nomogram and those with multiple previous DEXA scans, projections based on previous data were used to establish the predicted change in BMD, and deviation from that prediction was taken as change due to the study intervention.
A total of 117 patients entered the study between October 10, 2005, and May 2, 2008. There were 9 men in the group, which consisted of 87 people with osteoporosis and 30 with evidence only of osteopenia. Compliance thus far is poor, with only 31 of 117 patients responding positively to telephone inquiries (26.5%).
To date, 11 patients have completed the 2-year protocol and 7 patients have served as 2-year controls. The mean BMD of the 11 intervention patients has improved well beyond that of the controls (Table 1 and Fig 14).
Table 1 Figure 14
The patients doing 10 minutes of yoga daily showed an increase in spine BMD equivalent to 0.563 units on the T-scale; their hip BMD increased to 0.867 units. Control values were -0.12 and -0.07 for spine and hip, respectively, over the 2-year study period. Although the number of patients who have completed the study at this point are insufficient for rigorous statistical analysis, there are strong trends worthy of note: People doing yoga have improved their spinal T-scores by an average of 0.69 T-score units and their hip T-scores by 0.87 T-score units in 2 years.
Because of the small number of patients in the control group, we analyzed these results by comparing them with the null hypothesis, that yoga did not improve bone density. This is a strong condition, because, in fact, in patients older than 30 years, BMD actually declines without any treatment. This is what has been revealed thus far in our group overall. Using 1-tailed t tests, the DEXA scan results from only 11 patients proved significant, P < .01 for both the spine and the hip (Table 2).
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Table 2 We will certainly continue our study. Still, these early findings are encouraging.
The value of a low-cost and healthful means of combating osteoporosis is considerable. While bisphosphonate use is associated with gastrointestinal toxicity, jaw and other sites of osteonecrosis, severe and sometimes irreversible leg cramps and bone pain, and other side-effects, yoga injuries are uncommon15 and nearly always minor. Yoga has been shown to reduce back pain, arthritis, and anxiety and to improve gait, neural plasticity associated with motor learning, all capacities that mitigate against the falls that produce osteoporotic fractures.15-21
This study will continue until a statistically significant internal sample is reached. Assuming for the moment that the results obtained so far are borne out, we may draw optimistic conclusions: There is no tachyphylaxis known with yoga, no law of diminishing returns that is well known with bisphosphonates and some other medicines. The effects of yoga are therefore likely to be additive: 6 years are likely to yield 3 times the benefit seen after 2 years. At that rate, a person with osteopenia (T-score of -1.0 to -2.5) or minimal osteoporosis (T-score of -2.5) will have spine and hip BMD that is neither osteoporotic nor osteopenic within 6 years of a quiet, costless, and virtually riskless practice of 10 min/d.
Because of confounding factors such as calcification of the aorta and osteoarthritis of its many joints, the spine's T-score is a less reliable indicator of total bone mass than is the hip's T-score. In this pilot study, the hip BMD increased 54% more than the spine BMD, lending further credence to the efficacy of yoga in building bone.
This study focuses on the currently standard measure of bone strength, BMD as determined by the DEXA scan. But bones are not solid; they have a varying delicate internal structure of struts and crosspieces that also contributes to their overall resistance to fracture, known as bone quality. The quality is a function of both the BMD and the structure of trabecular bone, inner elements that span bones' interior to support the cortical bone that forms the hardened outer region of most bones. Bone quality contributes an estimated 40% to 60% of bones' abilities to withstand traumatic stress. Bone biopsy and noninvasive techniques such as micro-magnetic resonance imaging and supercomputer imaging are currently in the mid-stage of development; before long, they will add to our understanding of bone strength and what activities or medications are most effective in creating and sustaining it.
This pilot study tends to give support to the hypothesis that practicing yoga for as little as 8 to 10 minutes daily will raise T-scale ranking in older patients.
We are currently beginning a second trial that we believe will be safer than the first, though the first trial has had no fractures or other mishaps to date. We are supplying a 10-minute video along with entrance to the study. It is possible that we will be able to noninvasively examine bone quality in this study as well. Those interested should communicate with us through our Web site sciatica.org.
1. Iqbal MM. Osteoporosis: epidemiology, diagnosis and treatment. South Med J. 2000;93(1):2-18.
2. Loud KJ, Gordon CM. Adolescent bone health. Arch Pediatr Adol Med. 2006;160(10):1026-1032.
3. Cooper C. The crippling consequences of fractures and their impact on quality of life. Am J Med. 1997;103:12S-17S; discussion 17S-19S.
4. Sorensen HT, Christensen S, Mehnert FF, et al. Use of bisphosphonates among women and risk of atrial fibrillation and flutter: population based case- control study. BMJ. 2008;336:813-826.
5. National Osteoporosis Foundation. http://www.nof.org/osteoporosis/facts.htm. Accessed 2006. 6. MacLean C, Newberry S, Maglione M, et al. Systematic review: comparative effectiveness of treatments to prevent fractures in men and women with low
bone density or osteoporosis. Ann Intern Med. 2008;148:197-213. 7. Anderson GF, Chu E. Expanding priorities-confronting chronic disease in countries with low income. N Engl J Med. 2006;356(3):209-211. 8. Lanyon LE. Osteoporosis and exercise. Top Geriatr Rehabil. 1989;4(2):12-24. 9. Wollf J. The Law of Bone Transformation. Berlin, Germany: A Hirschwald; 1892.
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10. Pead MJ, Suswillo R, Skerry TM, Vedi S, Lanyon LE. Increased 3H-uridine levels in osteocytes following a single short period of dynamic bone loading in vivo. Calcif Tisue Int. 1988;43:93-97.
11. Kumei Y, Morita S, Nakamura H, et al. Osteoblast responsiveness to 1-alpha-dihydroxyvitamin D3 during spaceflight. Ann N Y Acad Sci. 2004;1030:121-124. doi: 10.1196/annals.1299.087.
12. Jovanovi! JD, Jovanovi! ML. Biomechanical model of vertebra based on bone remodeling. Med Biol. 2004;11(1):35-39. UC 617- 089.843:616.711:611.018.4:612.017.
13. Rubin CT, Lanyon LE. Regulation of bone formation by applied dynamic loads. J Bone Joint Surg. 1984;66A:397-402. 14. Sinaki M, Mikkelsen BA. Postmenopausal spinal osteoporosis: flexion versus extension exercises. Arch Phys Med Rehabil. 1984;65(10):593-596.
15. Sherman KJ, Cherkin DC, Erro J, Miglioretti DL, Deyo RA. Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomized trial. Ann Intern Med. 2005;143:849-856.
16. Williams KA, Petronis J, Smith D, et al. Effect of Iyengar yoga therapy for chronic low back pain. Pain. 2005;115(1/2):107-117. 17. Deckro GR, Ballinger KM, Hoyt M, et al. The evaluation of a mind/body intervention to reduce psychological distress and perceived stress in college
students. J Am Coll Health. 2002;50(6):281-287. 18. Haslock I, Monro R, Nagarathna R, Nagendra HR, Raghuram NV. Measuring the effects of yoga in rheumatoid arthritis. Br J Rheumatol.
1994;33(8):787-788. 19. Kolasinski SL, Tsai AG, Garfinkel M, Metz M, VanDyke A, Schumacher J. Iyengar yoga for treating symptoms of osteoarthritis of the knees: a pilot
study. J Altern Complement Med. 2005;11(4):689-693. 20. DiBenedetto M, Innes KE, Taylor AG, et al. Effect of a gentle Iyengar yoga program on gait in the elderly: an exploratory study. Arch Phys Med
Rehabil. 2005;86:1830-1837. 21. Telles S, Hanumanthaiah BH, Nagarathna R, Nagendra HR. Plasticity of motor control systems demonstrated by yoga training. Indian J Physiol
Pharmacol. 1994;38(2):143-144. Cited By:
This article has been cited 1 time(s).
Maturitas Mind-body therapies for menopausal symptoms: A systematic review Innes, KE; Selfe, TK; Vishnu, A Maturitas, 66(2): 135-149. 10.1016/j.maturitas.2010.01.016 CrossRef Keywords:
bone mineral density; exercise; osteoporosis; Wollf's law; yoga © 2009 Lippincott Williams & Wilkins, Inc.
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Leena's Story

This beautiful little girl's story came to me through a friend, and describes one family's struggle when their precious daughter became critically ill with pertussis. While pertussis may be relatively mild in adults, in infants it can be serious and even fatal. The CDC recommends that all adults receive their TDaP booster to protect newborns from the potentially devastating effects of pertussis. 

May all babies be born into loving hands...

K. Michelle Doyle, CNM, NYS LM

February 2010

Family and Friends,

Leena has been home from the hospital 3 weeks and is improving daily. As many of you know, she contracted Pertussis (AKA whooping cough) at 6 weeks of age, 2 weeks before she was scheduled to start her routine immunizations. Pertussis is potentially deadly in very young babies. She spent 2 weeks in the pediatric ICU at Presbyterian/St. Luke's in Denver (the hospital where I have worked for 13 years), much of that time intubated (breathing by a ventilator), sedated, and paralyzed. Thanks to quick recognition and treatment, exceptional medical care, and prayers from all over the country, we were able to take our baby Leena home with us.

She still needs continuous oxygen and has mean coughing spells typical of Pertussis. These can persist for weeks. But as you can tell from the attached photo, she is in great spirits. We are hoping to ditch the O2 very soon.

From whom she contracted this rare infection is a stumper. Children are routinely vaccinated against Pertussis, starting at 2 months of age. Recently, medical experts have noted that the Pertussis vaccine may lose efficacy in adulthood. So Leena may have contracted Pertussis from an unvaccinated child or a previously-vaccinated adult. We will never know.

We do know that increasing numbers of parents, many of them in Colorado, are declining childhood vaccinations due to publicized allegations that they may cause autism. This claim is based upon a single study published in 1998 in the medical journal The Lancet. The link between vaccinations and autism has never been reproduced in the medical literature. In fact, just last week the study was retracted by the The Lancet because of unethical research methods.

Please share our story with anyone you know who is considering not vaccinating their children. Look what it can do to a child...and look what it can do to someone else's child.

Also, it is a great idea to go to your doctor's office and get a Pertussis "booster." Although Pertussis can assume a mild form in adults, it can obviously have severe consequences in babies. Sorry if this is sounding like a public service announcement.

We hope to put this nightmare behind us very soon. To everyone who supported us and prayed with us over the last several weeks, we will be eternally grateful.


Lisa Farkouh, M.D.

Monday, August 1, 2011

CDC Report on US Infant Mortality

Again, there is so much work to do.... Below is a report from the Center for Disease Control on the (sad) state of the United States babies health.
Local Care Midwifery, PLLC is working to make the US a better place, one baby at a time.

May all babies be born into loving hands...

 K. Michelle Doyle, CNM, NYS LM

OFFICEInfant Mortality Statistics from the 2007 Period Linked Birth/Infant Death Data Set                                          
by T.J. Mathews, M.S., and Marian F. MacDorman, Ph.D., Division of Vital Statistics
Objective: This report presents 2007 period infant mortality statistics from the linked birth/infant death
data set (linked file) by a variety of maternal and infant characteristics. The linked file differs from the
mortality file which is based entirely on death certificate data.
Methods: Descriptive tabulations of data are presented and interpreted.
Results: The U.S. infant mortality rate was 6.75 infant deaths per 1,000 live births in 2007, not
significantly different than the rate of 6.68 in 2006. Infant mortality rates ranged from 4.57 per 1,000
live births for mothers of Central and South American origin to 13.31 for non-Hispanic black mothers.
Infant mortality rates were higher for those infants who were born in multiple deliveries and for those
whose mothers were born in the 50 States and the District of Columbia and were unmarried. Infant
mortality was also higher for male infants and infants born preterm or at low birthweight. The neonatal
mortality rate was essentially unchanged from 2006 to 2007 (4.46 and 4.42, respectively). The
postneonatal mortality rate increased 5 percent from 2.22 in 2006 to 2.33 in 2007, similar to the rate
in 2005 (2.32). Infants born at the lowest gestational ages and birthweights have a large impact on
overall US infant mortality. For example, more than half (54 percent) of all infant deaths in the US in
2007 occurred to the 2 percent of infants born very preterm (less than 32 weeks of gestation). Still,
infant mortality rates for late preterm infants (34-36 weeks of gestation) were 3.6 times, and those for
early term (37-38 weeks) infants were 1.5 times those for infants born at 39-41 weeks of gestation,
the gestational age with the lowest infant mortality rate. The three leading causes of infant death -
Congenital malformations, low birthweight, and SIDS - accounted for 45 percent of all infant deaths.
The percentage of infant deaths that were “preterm-related” was 36.0 percent in 2007. The preterm
related infant mortality rate for non-Hispanic black mothers was 3.4 times higher, and the rate for
Puerto Rican mothers was 71 percent higher than for non-Hispanic white mothers.

For birth related data requests: births@cdc.gov

LCM Moms and More Group -New Days

The Local Care Midwifery moms and More Group is now meeting TWICE a month. The First Wednesday and the Third Friday of every month.

Still meeting at:         The Guild House of St Paul's Church, 
                                  23 State St., Troy, NY 12180
Still meeting from:    10 AM to Noon

Meeting dates:           Wednesday August 3, 
                                  Friday August 19, 
                                  Wednesday September 7, 
                                  Friday September 16.


PS: You do not have to be a mom, go to LCM for care or have children to join us. Pregnant women, dads, grandparents, and folks considering pregnancy are all welcome.

May all babies be born into loving hands...

 K. Michelle Doyle, CNM, NYS LM

CDC Data on US Births

We have some work to do....

May all babies be born into loving hands...

 K. Michelle Doyle, CNM, NYS LM

Expanded Data From the New Birth Certificate, 2008
by Michelle J.K. Osterman, M.H.S.; Joyce A. Martin, M.P.H.; T.J. Mathews, M.S.; and Brady E. Hamilton, Ph.D.
ObjectiveThis report presents data for selected items exclusive to the 2003 U.S. Standard Certificate of Live Birth as well as key items considered not comparable between the 1989 (unrevised) and 2003 (revised) versions for states and territories that implemented the 2003 revision as of January 1, 2008. Information is shown for educational attainment, tobacco use during pregnancy, month prenatal care began, and checkboxes in the following categories: ‘‘risk factors in this pregnancy,’’ ‘‘obstetric procedures,’’ ‘‘characteristics of labor and delivery,’’ ‘‘method of delivery,’’ ‘‘abnormal conditions of the newborn,’’ and ‘‘congenital anomalies of the newborn.’’
Methods: Descriptive statistics are presented on births occurring in 2008 to residents of the 27 states that implemented the revised birth certificate.
Results: There were 2,748,302 births to residents of the 27-state reporting area, representing 65 percent of 2008 U.S. births. About 78 percent of women had at least a high school diploma; 24.5 percent had an advanced education. One out of 10 women smoked during pregnancy (24-state reporting area) and one out of five smokers quit while pregnant. Almost three-quarters of women began prenatal care in the first trimester of pregnancy. The rate of prepregnancy diabetes was 6.5 per 1,000 and gestational diabetes was 40.6; risk of both types rose with maternal age. Nearly one out of four women had a primary cesarean delivery; less than 1 out of 10 women had a vaginal birth after cesarean delivery. About 27 percent of women attempted a trial of labor before a cesarean
delivery. Seven percent of all infants were admitted to a neonatal intensive care unit.
For birth related data requests: births@cdc.gov