health

'Baby Blues' Are Common During First Weeks After Childbirth

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | January 26th, 2017

Dear Doctor: It's been two weeks since our son was born, and my wife seems to be having a hard time. She cries easily and has a lot of anxiety. Is this just baby blues, like my mother says, or is it postpartum depression?

Dear Reader: Congratulations on welcoming a new baby! Your lives have undergone an enormous change, and that's at the heart of your wife's difficulties. Both in the short-term disruption of the so-called "baby blues" and the more serious struggle of postpartum depression, the physical, emotional and hormonal changes a woman goes through after she gives birth can often pose challenges.

First, let us reassure you that at two weeks postpartum, it's perfectly natural for a new mother to feel overwhelmed. Up to 80 percent of new mothers report symptoms of mood swings, anxiety, mild depression, weepiness and negative thoughts or feelings in the first few weeks after the baby arrives.

Your wife's body is not only recovering from the physical and emotional rigors of the birth process, but it is also now returning to its pre-pregnancy state. That means she is experiencing a sudden drop in hormone levels -- estrogen and progesterone in particular -- which have been at record levels during her pregnancy. Add in sleep deprivation and the seismic changes to her daily routine as she learns new tasks and takes responsibility for a new life, and it's little surprise that she feels overwhelmed.

When these symptoms don't go away after several weeks, or if they become more severe, then postpartum depression becomes a possibility. When this is the case, seeing a primary care physician is vital.

Symptoms of postpartum depression mirror those of major depression. These include a sad or empty feeling that won't go away, feelings of hopelessness or worthlessness, pervasive pessimism, a change in sleeping or eating habits, withdrawal from loved ones, and often a lack of connection to or interest in the new baby. Between 11 and 18 percent of new mothers experience postpartum depression. Fortunately, most women who seek treatment for postpartum depression will recover.

Meanwhile, there's a lot that you can do to help your wife right now. Simply listening is important. Get her to talk about how she's feeling and what she's going through so she knows that you care and understand. It's quite likely you both have some of the same feelings, and sharing them can help build up your bond.

Help around the house without being asked. Make a meal, do housework, arrange for her to have some time to herself. Something as simple as getting outside can make a big difference. A daily walk will be good for both of you. Even a drive through the neighborhood just to look around can bring welcome distraction.

The baby blues are an isolating experience that comes at a time of life when women are told they should be happiest. By stepping up to lend a hand, you're not only helping your wife recover, you're also setting the foundation to a parenting partnership.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095.)

health

Marijuana Potentially Useful for Managing Pain

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | January 25th, 2017

Dear Doctor: I try not to use opioids for my chronic back pain, but I'm finding myself turning to them more often. Could marijuana help?

Dear Reader: Pain is one of most difficult aspects of medicine to understand. No one can actually feel the pain of another person, but we can see the suffering that it causes. As doctors, we try to alleviate pain in a number of ways.

Opiates -- starting with opium, which is derived from the poppy plant -- have been used for pain relief for more than 3,000 years. The opiates morphine and codeine, also from the poppy plant, were isolated and made available in the early 1800s. Since that time, multiple synthetic opiates such as hydrocodone and oxycodone have been widely used for pain. These drugs attach to opiate receptors in both the brain and spinal cord.

One problem with opiates is that they relieve pain in the short term, but will not control it in the long term. Thus to relieve chronic pain, a person has to perpetually use the medication -- creating one of the addictive aspects of the drugs. The other problem with opiates is that people become tolerant of the medications, meaning that with consistent use, a person needs more medication to relieve the same amount of pain.

For these reasons, opium and its progeny have been abused worldwide. The United States is facing an epidemic of opiate abuse, with prescription opiate medication leading to a rapid increase in lethal drug overdoses. In 2014, more than 18,000 people died from overdosing on prescription opiates, according to the federal Centers for Disease Control and Prevention.

Marijuana has been used also for more than 3,000 years. It works through the endocannabinoid system of the body, which has receptors in the brain and spinal cord as well as the immune system. The receptors in the brain and spinal cord can decrease muscle spasms and pain, while those receptors in the immune system can decrease inflammation and pain.

A 2015 study published in the Journal of the American Medical Association (JAMA) looked at 14 different clinical trials of marijuana use by multiple sclerosis patients and found relief from chronic pain, nerve pain, and pain and muscle spasm. Another study published in 2015 in JAMA looked at 28 different studies with 2,454 patients and found a 30 percent reduction of pain with cannabis-related products compared with placebo.

Opiates can relieve pain in the short term, such as after surgery or an acute injury. But due to their addictive potential and lack of long-term benefit, opiates are not a good choice for long-term pain relief.

Marijuana is not without its own potential risks and side effects. These include short-term memory loss, poor motor coordination, paranoid thoughts and, for some, psychosis. Long-term use can also create the potential for addiction, but not to the degree of opiate medications. Also, overdosing on marijuana doesn't lead to death, as it can with opiates.

My suggestion in regard to chronic back pain is to try other methods of pain control over opioids. These include physical therapy, yoga and stretching. If these don't work, marijuana is an option, but beware of its side effects -- and try to minimize its use.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095.)

health

How Clinical Trials Work to Advance Medicine

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | January 24th, 2017

Dear Doctor: I keep reading about new cancer drugs that have been developed in clinical trials. What exactly is a clinical trial and how does it work?

Dear Reader: A clinical trial is a scientific study that looks into whether a specific drug, medical treatment, device or approach is not only effective, but also safe. Although clinical trials for new drugs often get the most press, other important advances arise from the process. New ways to screen for disease, new methods of diagnosis, and techniques that will improve the quality of life for people living with disease are all important advances made in clinical trials.

New therapies are tested in treatment trials. Prevention trials investigate methods of lowering disease risk. In screening trials, optimal methods to discover the onset of disease are tested. Supportive care trials focus on quality of life for patients with debilitating disease. Diagnostic trials focus on tests and procedures to pinpoint the exact type of cancer or condition a patient has.

So how does a clinical trial work?

It starts with an idea. A researcher or doctor or other expert comes up with a "what if?" scenario. For example, what if it's possible to develop a drug to help a patient's own immune system fight cancer?

The next step is extensive laboratory testing. If the idea continues to show promise, research moves into a clinical trial.

A detailed plan, known as a protocol, is created. It states who is eligible to take part in the clinical trial, details all of the tests and procedures that will be performed, names the drugs that will be involved, and describes how the drugs will be administered. The protocol also indicates the length of the clinical trial, and how the information will be collected and collated.

Clinical trials are conducted in four distinct phases that may take place over the course of several years. They begin with Phase 1, which is initial testing on a small group of participants to assess safety and identify side effects. In Phases 2 and 3, the new drug or treatment is given to ever-larger groups of people to further evaluate safety and efficacy. By Phase 4, the drug or treatment has been approved by the FDA and is now evaluated in a large population.

If you're thinking about joining a clinical trial, you should know:

-- The specific purpose of the study;

-- Why researchers believe the experimental therapy will be effective;

-- What drugs, tests or procedures the trial entails;

-- Any risks or potential side effects of the treatment;

-- How much time is required;

-- How your daily life will be affected;

-- How you will know whether the therapy is successful.

It's not an exaggeration to say that clinical trials are at the heart of modern medical advances. Many of the cancer treatments that are saving or extending lives today began as a "what if?" idea in a clinical trial. And while participants may join in hopes of being on the receiving end of a medical advance, they also have the satisfaction of knowing that they are contributing to the body of knowledge that will make medicine even more effective in the future.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095.)

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