Miscarriage Misdiagnosed: Surprise, I'm still pregnant!

by Erica Kain

"What exactly is that?" I asked, propping up on my elbows on the examining table, scrutinizing the ultrasound monitor.

"That is a seven-week-old embryo with a heartbeat," my doctor said.

"No, wait, is it human?" I asked, gasping for air, staring at the flickering heartbeat pulsing through the little body.

I couldn't believe it. Two weeks before, I'd been diagnosed with a miscarriage-specifically, a chemical pregnancy. I'd raced to the doctor's office after experiencing heavy cramping and bleeding, and an ultrasound seemed to confirm my gut feeling that my pregnancy was ending. There wasn't an embryo where there should have been one. And yet, here I was, two weeks later, finding out that I was still pregnant.

I had spent the past two weeks saying goodbye to this pregnancy. My friends had taken me out and gotten me properly sauced. I purposely did everything a pregnant lady is not supposed to do-sucked down soft cheeses, exercised strenuously, and drowned my sorrow in wine and beer.

I'd even yearned for a D&C to end this "lost" pregnancy and clear the way for our next attempt at getting pregnant. Thank God I'd scheduled this second ultrasound before booking the surgery.

Because there was our embryo, with its tiny leg buds and that unmistakable heartbeat, alive and, apparently, human. It was simply a week "behind dates," i.e., conceived much later in my cycle than we thought. And my bleeding and cramping? It turns out that I'm one of the of women who can experience that and not miscarry.

My husband and I are in a state of shock at this turn of events. And although I feel cautious about celebrating this news until the embryo lives past 10 weeks, we can't help but feel excited and so incredibly lucky.

I hesitated to share this news publicly, because I am wary of sowing false hope for other women: Most miscarriages really are miscarriages. But I wish I'd known, as I fully embraced the grieving process after my miscarriage diagnosis two weeks ago, that this was a possibility.

How often does this kind of reversal occur?
That's what I asked Charles Lockwood, MD, the Chief of Obstetrics and Gynecology at Yale–New Haven Hospital.

"It's a pretty rare event," Dr. Lockwood told me, "but we do see it happen. Sperm can remain active and viable in a woman's reproductive tract for up to six days," so conception can be much later than a woman (and her doctor) anticipated.

Dr. Lockwood sees this most often with IVF or other forms of assisted reproductive technology. "Even when we think we know with incredible precision when the date of conception is, we can be three or four days off. Delays in women's ovulation and/or an embryo's implantation can occur. I have seen twins that are both growing at a perfectly normal rate but one of them has been nearly a week off."

So a fertilized egg can take several days to implant and begin growing in a woman's uterus, leading to initial hCG tests and ultrasound results that seem to indicate an embryo that is slow to develop and therefore likely to be miscarried. In fact, the embryo is simply behind schedule due to its later-than-expected implantation.

But usually, if it looks like a miscarriage, it is.

"The vast majority of times that we see blood pregnancy hormone (hCG) levels rising slowly, or a sac in the uterus that isn't doubling in size appropriately, it turns out to be a miscarriage," he says, "It doesn't end happily."

But, he cautions, "If there is no heavy vaginal bleeding, people shouldn't be in a hurry to end the pregnancy until they're confident it's not viable. What I tell my patients is, 'I'm not absolutely certain [this is a miscarriage]. I'm pessimistic, but I'd like you to come back in a week.' Then they are better prepared psychologically for what might happen."

I know I wouldn't have gone in for a D&C before verifying once more that the pregnancy wasn't viable, but it terrifies me how dead set I was on ending this pregnancy.

But why did I bleed so heavily?
Now a big fan of second opinions, I also talked to Paul Blumenthal, MD, the director of family planning services and research at the Stanford University School of Medicine, to learn about his experience with what he calls "erroneous diagnoses of missed abortions."

Why did I bleed so much, I asked Dr. Blumenthal. "The fact of a pregnancy establishing a foothold in the uterus causes bleeding," he told me. "And hormone levels fluctuate, leading the uterus to let go of some of its lining sometimes. Usually, in the case of bleeding, the pregnancy's continuation is tenuous. It's only possible to diagnose a missed abortion if you wait a few days after the bleeding" he said.

But what about that ultrasound I saw, the one that looked like a blighted ovum?

"This is a new conundrum people face," he said. "We don't want people to get upset by the [ultrasound] technology, because when we're looking at an early pregnancy, we can't be sure which side of the coin we're coming down on-a pregnancy or a missed abortion. That's why we've got to wait a few days and test again." (And, I might add, it's probably a good idea not to break out the Johnny Walker until those second test results are in.)

In the future it may be possible to measure hCG levels more precisely with at-home urine tests, says Dr. Blumenthal. So a woman who is not sure of her diagnosis might be able to test daily and watch if her levels are rising or falling.

I called up the the American College of Obstetricians and Gynecologists to see if they had any information on this phenomenon. But they could point me to no studies that count the number of times women ride this particularly crazy roller coaster of conception.

There's an online community of women like me
So I went to a completely unscientific source and found more than 250 stories posted online by women who have gathered at a site called Misdiagnosed Miscarriage. These are other women who have been told they are miscarrying, only to discover their embryo is viable.

The reasons for the misdiagnoses chronicled on the site vary, from a tilted uterus preventing an accurate ultrasound to "blighted ovum" diagnoses early in pregnancy, before a potentially late-developing embryo had a chance to appear.

Kay Cilenti founded the site in 2005, after she went through the experience, and subsequently heard similar stories. "Women need to know that they can ask questions of their doctors," she advises.

"They have the right to a second opinion if something feels off with the diagnosis or they feel they are being unnecessarily pushed toward ending the pregnancy quickly. Doctors who bring up the M-word early [in the first few weeks of pregnancy] drive me nuts."

I've lived through two M-words, so I thought I knew everything there was to know about it. It turns out out I was wrong, as was my doctor. Now that M-word for me is miracle.

Will it continue to survive? Will this new baby stop our hearts once again with more drama? For me, every additional day I get with the little being is like a gift. I've already mourned its passing, so this is now a bonus baby as far as I'm concerned.

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Marijuana Does Not Raise Lung Cancer Risk

By Salynn Boyles

People who smoke marijuana do not appear to be at increased risk for developing lung cancer, new research suggests.

While a clear increase in cancer risk was seen among cigarette smokers in the study, no such association was seen for regular cannabis users.

Even very heavy, long-term marijuana users who had smoked more than 22,000 joints over a lifetime seemed to have no greater risk than infrequent marijuana users or nonusers.

The findings surprised the study’s researchers, who expected to see an increase in cancer among people who smoked marijuana regularly in their youth.

“We know that there are as many or more carcinogens and co-carcinogens in marijuana smoke as in cigarettes,” researcher Donald Tashkin, MD, of UCLA’s David Geffen School of Medicine tells WebMD. “But we did not find any evidence for an increase in cancer risk for even heavy marijuana smoking.” Carcinogens are substances that cause cancer.

Tashkin presented the findings today at The American Thoracic Society’s 102nd International Conference, held in San Diego.

Boomers Reaching Cancer Age

The study population was limited to people who were younger than 60 because people older than that would probably not have used marijuana in their teens and early adult years.

“People who may have smoked marijuana in their youth are just now getting to the age when cancers are being seen,” Tashkin says.

A total of 611 lung cancer patients living in Los Angeles County, and 601 patients with other cancers of the head and neck were compared with 1,040 people without cancer matched for age, sex, and the neighborhood they lived in.

All the participants were asked about lifetime use of marijuana, tobacco, and alcohol, as well as other drugs, their diets, occupation, family history of lung cancer, and socioeconomic status.

The heaviest marijuana users in the study had smoked more than 22,000 joints, while moderately heavy smokers had smoked between 11,000 and 22,000 joints.

While two-pack-a-day or more cigarette smokers were found to have a 20-fold increase in lung cancer risk, no elevation in risk was seen for even the very heaviest marijuana smokers.

The more tobacco a person smoked, the greater their risk of developing lung cancer and other cancers of the head and neck. But people who smoked more marijuana were not at increased risk compared with people who smoked less and people who didn’t smoke at all.

The THC Connection

Studies suggest that marijuana smoke contains 50 percent higher concentrations of chemicals linked to lung cancer than cigarette smoke. Marijuana smokers also tend to inhale deeper than cigarette smokers and hold the inhaled smoke in their lungs longer.

So why isn’t smoking marijuana as dangerous as smoking cigarettes in terms of cancer risk?

The answer isn’t clear, but the experts say it might have something to do with tetrahydrocannabinol, or THC, which is a chemical found in marijuana smoke.

Cellular studies and even some studies in animal models suggest that THC has antitumor properties, either by encouraging the death of genetically damaged cells that can become cancerous or by restricting the development of the blood supply that feeds tumors, Tashkin tells WebMD.

In a review of the research published last fall, University of Colorado molecular biologist Robert Melamede, PhD, concluded that the THC in cannabis seems to lessen the tumor-promoting properties of marijuana smoke.

The nicotine in tobacco has been shown to inhibit the destruction of cancer-causing cells, Melamede tells WebMD. THC does not appear to do this and may even do the opposite.

While there was a suggestion in the newly reported study that smoking marijuana is weakly protective against lung cancer, Tashkin says the very weak association was probably due to chance.

Cancer risk among cigarette smokers was not influenced by whether or not they also smoked marijuana.

“We saw no interaction between marijuana and tobacco, and we certainly would not recommend that people smoke marijuana to protect themselves against cancer,” he says.

By Salynn Boyles, reviewed by Louise Chang, MD

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B.C. man paralyzed after flu shot warns of risks

Health officials say the benefits of the influenza vaccine outweigh the risks, especially for the very young and old, and those with health problems. (Chuck Stoody/CP)

A New Westminster man is raising a warning flag after he contracted a rare and debilitating condition linked to the flu shot that left him paralyzed for almost five months.

Every fall, health care workers across Canada distribute 10 million influenza vaccinations, and for the vast majority of people, the flu shot causes no major problems.

Within two weeks of getting his annual flu shot in 2007, however, Richard Ryan, 44, went from being happy and healthy to being in excruciating pain.

At first, Ryan thought he had injured his back, and he checked into the local hospital emergency room, he told CBC News on Wednesday.

But Ryan was also suffering some numbness, and when a neurologist tested his reflexes, he found Ryan had none, he said.

"The doctor asked me what was going on in my life. And as soon as I said I was feeling ill after getting a flu shot, he said, 'Stop right there, I know what you have,'" Ryan said.

Guillain-Barré syndrome linked to vaccine

The neurologist diagnosed Ryan with Guillain-Barré syndrome, an autoimmune disease that attacks the nervous system.

According to the B.C. Centre for Disease Control, the chance of developing that particular disease from a flu shot is one in a million.

But as Ryan learned the consequences can be severe. By the time the emergency room exam was over, he was unable to get up. He spent the next 10 weeks recovering in hospital, including three weeks in intensive care, barely able to breathe or eat for himself.

"My face was paralyzed. I had no feeling inside my mouth. I couldn't feel my tongue. My left eye wouldn't close so it had to be taped shut to sleep," he said.

The illness progressed into a lifelong condition known as chronic inflammatory demyelinating polyneuropathy (CIDP), and a year later he remains heavily medicated, unable to work, and has memory problems.

Although the disease is in remission, he is not expected to make a full recovery, and the chronic condition could return at any point in the future.

Worth the risk?

Now Ryan is concerned that public health officials are promoting the flu vaccine while most people are not fully aware of the risks.

However, Dr. Danuta Skowronski, an epidemiologist at the B.C. Centre for Disease Control, says the benefits of the flu vaccine still outweigh the risks for the vast majority of people.

"Nothing is completely risk-free," she told CBC News. "It is always a matter of weighing the benefits and the risks."

Medical information provided with flu shots does mention the one-in-a-million chance of getting Guillain-Barré syndrome.

But it is especially important for people with heart and lung problems, the elderly and the chronically ill, to get the influenza vaccine because it could save their lives, Skowronski said.

"Influenza itself can be life threatening, and it's those groups that we want to make sure are not put off from receiving influenza vaccine unnecessarily," said Skowronski.

There are more than 2,000 flu-related deaths in Canada every year. Seniors, people with weak immune systems and some children are at highest risk.

More common possible side-effects of vaccinations can include fever, muscle pain and weakness.

For his part, Ryan maintains that he's a good example of the fact that the benefits of the vaccination don't always outweigh the risks.

"I think if people knew how serious the illness is, they would think twice about the flu shot," he said.

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Half of Doctors Routinely Prescribe Placebos

By GARDINER HARRIS

Half of all American doctors responding to a nationwide survey say they regularly prescribe placebos to patients. The results trouble medical ethicists, who say more research is needed to determine whether doctors must deceive patients in order for placebos to work.

The study involved 679 internists and rheumatologists chosen randomly from a national list of such doctors. In response to three questions included as part of the larger survey, about half reported recommending placebos regularly. Surveys in Denmark, Israel, Britain, Sweden and New Zealand have found similar results.

The most common placebos the American doctors reported using were headache pills and vitamins, but a significant number also reported prescribing antibiotics and sedatives. Although these drugs, contrary to the usual definition of placebos, are not inert, doctors reported using them for their effect on patients’ psyches, not their bodies.

In most cases, doctors who recommended placebos described them to patients as “a medicine not typically used for your condition but might benefit you,” the survey found. Only 5 percent described the treatment to patients as “a placebo.”

The study is being published in BMJ, formerly The British Medical Journal. One of the authors, Franklin G. Miller, was among the medical ethicists who said they were troubled by the results.

“This is the doctor-patient relationship, and our expectations about being truthful about what’s going on and about getting informed consent should give us pause about deception,” said Dr. Miller, director of the research ethics program in the department of bioethics at the National Institutes of Health.

Dr. William Schreiber, an internist in Louisville, Ky., at first said in an interview that he did not believe the survey’s results, because, he said, few doctors he knows routinely prescribe placebos.

But when asked how he treated fibromyalgia or other conditions that many doctors suspect are largely psychosomatic, Dr. Schreiber changed his mind. “The problem is that most of those people are very difficult patients, and it’s a whole lot easier to give them something like a big dose of Aleve,” he said. “Is that a placebo treatment? Depending on how you define it, I guess it is.”

But antibiotics and sedatives are not placebos, he said.

The American Medical Association discourages the use of placebos by doctors when represented as helpful.

“In the clinical setting, the use of a placebo without the patient’s knowledge may undermine trust, compromise the patient-physician relationship and result in medical harm to the patient,” the group’s policy states.

Controlled clinical trials have hinted that placebos may have powerful effects. Some 30 percent to 40 percent of depressed patients who are given placebos get better, a treatment effect that antidepressants barely top. Placebos have also proved effective against hypertension and pain.

But despite much attention given to the power of placebos, basic questions about them remain unanswered: Are they any better than no treatment at all? Must people be deceived into believing that a treatment is active for a placebo to work?

Some studies have hinted at answers, but experts say far more work is needed.

Dr. Howard Brody, director of the Institute for the Medical Humanities at the University of Texas Medical Branch, in Galveston, said the popularity of alternative medical treatments had led many doctors to embrace placebos as a potentially useful tool. But, Dr. Brody said, doctors should resist using placebos, because they reinforce the deleterious notion that “when something is the matter with you, you will not get better unless you swallow pills.”

Earlier this year, a Maryland mother announced that she would start selling dextrose tablets as a children’s placebo called Obecalp, for “placebo” spelled backward.

Dr. Ezekiel J. Emanuel, one of the study’s authors, said doctors should not prescribe antibiotics or sedatives as placebos, given those drugs’ risks. Use of less active placebos is understandable, he said, since risks are low.

“Everyone comes out happy: the doctor is happy, the patient is happy,” said Dr. Emanuel, chairman of the bioethics department at the health institutes. “But ethical challenges remain.”

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Fighter jet engine to power 1000 mph car

By Wolfgang Gruener

If you have a budget of about $1.5 million and some patience, you can purchase the world’s fastest production car, the Bugatti Veyron 16.4, and brag about a top speed slightly north of 250 mph. But even that insane speed (which can only achieved with a special key and typically only on closed circuits) is well below the current land speed record of 763 mph, which was achieved by a jet-powered car called Thrust SSC in 1997. 14 years later, the same driver, Andy Green, as well as a previous record holder, Richard Noble, will try to break the 1000 mph barrier with Bloodhound SSC (SSC stands for super sonic car) in a project that is financed by the British Ministry of Defence.

The vehicle is about 42 ft long, weighs 14,158 pounds (fuelled) and is expected to accelerate from 0 – 1050 mph in 40 seconds. At that speed, 900mm diameter wheels will spin at over 10,000rpm, generating 50,000 radial g at the rim. Every second, the vehicle will cover a distance of 1466 feet, which is the equivalent of nearly 5 football fields. The downforce pressure on its carbon fiber and titanium bodywork will exceed 2450 pounds per square foot or more than 12 tons per square meter.

Today’s project launch is followed by a week-long exhibition at the Science Museum, London, where the public can meet the team.


Challenges

Bloodhound SSC faces two key challenges – to create tires that will hold on at 1000 mph and are not damaged by surface inconsistencies, as well a power plant that will drive the vehicle to a top speed of more than 1000 mph. Deeply involved in the project are scientists at the UK's National Physical Laboratory (NPL) as well as colleagues at the Atomic Weapons Establishment (AWE) and Fluid Gravity Engineering (FGE) units “to advise the world-record bid team on two of the most high-risk aspects of the world record attempt.”

The scientists said the wheels need to be able to rotate at 10,500 rpm without being damaged by the surface or any stones that they run over. They also need to be as light as possible to minimize steering and suspension forces, absorb all of the weight, down force loads and stresses and distribute this pressure without causing damage to the vehicle or the surface. The choice of materials, including titanium, aluminum alloys and metal composites are currently evaluated because at such speeds the wheels act like powerful gyroscopes.


Power plant

The power will come from the first ever mixed power plant of a hybrid rocket motor and a jet engine that is currently used on the Eurofighter Typhoon. The Eurojet EJ200 afterburning turbofan provides a thrust of 60 kN or 13,500 lbs and 90 kN or 22,000 lbs with afterburner, which would be enough to lift the Bloodhound SSC vertically off the ground like a rocket. Equipped with two engines, the Eurofighter jet is capable of reaching a top speed of about 1320 mph or Mach 2.

When completed, the Bloodhound SSC (super sonic car) will be driven by Andy Green who set the current record of 763 mph. If the new vehicle achieves its target of 1,000 mph, it will mark the greatest incremental increase in the history of the World Land Speed Record. It will also exceed the low altitude speed record for aircraft (994 mph), the developers said. Richard Noble who set a land speed record with Thrust 2 and 633 mph in 1983, was appointed project leader for Bloodhound SSC.


Big objective - education

The organization said that it is primary objective of the project is to “create an unprecedented education and engagement program, lead led by a dedicated team of teachers and education specialists.”

“From innovative, curriculum based lesson plans covering subjects ranging from geography to citizenship, as well as science, technology, engineering and mathematics, to a schools visitor centre featuring the ‘classroom of the future’ at the team’s HQ in Filton, Bristol, the aim is to make Bloodhound SSC accessible to all ages from 5 – 19 and beyond,” the group stated.

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Banksy defies the credit crisis as his canvases fetch over £350,000 at auction

By Urmee Khan

The Tomato Soup picture fetched £140,000 Photo: PA

One oil canvas, entitled Tesco Value Tomato Soup, fetched £140,000, more than the estimated £80,000, according to Bonhams, the auction house.

A spokeswoman said: "A bidding war broke out for it. It was jam-packed in the auction room but it was soon whittled down to two contenders" she said "All the big lots were sold."

The picture was among 24 of Banksy's best-known original works which came under the hammer last night.

Banksy came to prominence in his home city of Bristol for spray-can murals that commented on issues like law and order, consumerism and war - all in a in a playful fashion.

His famous picture of a chimp wearing a sign saying 'Laugh now but one day we'll be in charge' went under the hammer for £108,000.

A picture of Kate Moss in a Marilyn Monroe-style pose fetched £66,000. And his work 'Turf War', featuring Winston Churchill with a green mohawk haircut, sold for £60,000.

However, a life-sized stencil of a riot police officer with a smiley face entitled 'Have a Nice Day' - failed to sell.

Despite Banksy's popularity, he has zealously guarded his anonymity which has fuelled speculation about his real identity.

High profile collectors include Dennis Hopper, the actor, and Angelina Jolie, the actress, who spent £1 million on a piece last year.

The success of the sale will be reassuring for the art markets which has been severely hit by the financial crisis, with Sotheby's and Christie's, auctioneers, both reporting disappointing sales.

Sotheby's failed to reach its estimate of £55.3 million for its contemporary art sales over the summer, making a total of £43.9 million.

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