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.

Original here

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

Original here

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.

Original here