DiversityNursing Blog

By TAMAR LEWIN

At home in Lisbon, a gay couple invited friends over to a birthday celebration, and at the end of the evening shared a surprise — an ultrasound image of their baby, moving around in the belly of a woman in Pennsylvania being paid to carry their child.

“Everyone was shocked, and asked everything about how we do this,” said Paulo, who spoke on the condition that neither his last name nor that of his husband, João, be used since what they were doing is a crime in Portugal.

While babies through surrogacy have become increasingly common in the United States, with celebrities like Elton John, Sarah Jessica Parker and Jimmy Fallon openly discussing how they started a family, the situation is quite different in Portugal — as it is in most of the world where the hiring of a woman to carry a child is forbidden. And as Paulo and João have discovered, even bringing home a baby born abroad through surrogacy can be complicated.

In an era of globalization, the market for children crosses national borders; witness the longtime flow of Americans who have gone overseas to adopt babies from South Korea, China, Russia and Guatemala.

Other than the United States, only a few countries — among them India, Thailand, Ukraine and Mexico — allow paid surrogacy. As a result, there is an increasing flow in the opposite direction, with the United States drawing affluent couples from Europe, Asia and Australia. Indeed, many large surrogacy agencies in the United States say international clients — gay, straight, married or single — provide the bulk of their business.

The traffic highlights a divide between the United States and much of the world over fundamental questions about what constitutes a family, who is considered a legal parent, who is eligible for citizenship and whether paid childbirth is a service or exploitation.

In many nations, a situation that splits motherhood between the biological mother and a surrogate carrier is widely believed to be against the child’s best interests. And even more so when three women are involved: the genetic mother, whose egg is used; the mother who carries the baby; and the one who commissioned and will raise the child.

Many countries forbid advertising foreign or domestic surrogacy services and allow only what is known as altruistic surrogacy, in which the woman carrying the baby receives payment only for her expenses. Those countries abhor what they call the commercialization of baby making and view commercial surrogacy as inherently exploitive of poor women, noting that affluent women generally do not rent out their wombs.

But while many states, including New York, ban surrogacy, others, like California, welcome it as a legitimate business. Together, domestic and international couples will have more than 2,000 babies through gestational surrogacy in the United States this year, almost three times as many as a decade ago. Ads galore seek egg donors, would-be parents, would-be surrogates. Many surrogates and intended parents find each other on the Internet and make their arrangements independently, sometimes without a lawyer or a formal contract.

The agencies that match intended parents and surrogates are unregulated, creating a marketplace where vulnerable clients yearning for a baby can be preyed upon by the unscrupulous or incompetent. Some agencies pop up briefly, then disappear. Others have taken money that was supposed to be in escrow for the surrogate, or failed to pay the fees the money was to cover.

Surrogacy began in the United States more than 30 years ago, soon after the first baby was born through in vitro fertilization in England. At the time, most surrogates were also the genetic mothers, becoming pregnant through artificial insemination with the sperm of the intended father. But that changed after the Baby M case in 1986, in which the surrogate, Mary Beth Whitehead, refused to give the baby to the biological father and his wife. In the wake of the spectacle of two families fighting over a baby who belonged to both of them, traditional surrogacy gave way to gestational surrogacy, in which an embryo is created in the laboratory — sometimes using eggs and sperm from the parents, sometimes from donors — and transferred to a surrogate who has no genetic link to the baby.

But thorny questions remain: How much extra will the surrogate be paid for a cesarean section, multiple births — or loss of her uterus? What if the intended parents die during the pregnancy? How long will the surrogate abstain from sex? If she needs bed rest, how much will the intended parents pay to replace her paycheck, and cover child care and housekeeping?

“The gestational carrier has to agree to follow medical advice, but there has to be some level of trust,” said Andrew W. Vorzimer, a Los Angeles surrogacy lawyer who advises on many arrangements that have gone awry. “Once everyone goes home and the doors are closed, there’s no way to really monitor what’s going on.”

Since the Baby M case, the common wisdom has been that the main risk for parents is the surrogate’s changing her mind. But Mr. Vorzimer, who has tracked problem cases in the United States over the years, said it was the reverse: Trouble most often starts with the intended parents. One intended mother decided, well into the pregnancy, that she could not raise a child that was not genetically hers. Another couple, after a divorce, offered the surrogate mother money to have an abortion.

Over the decades, Mr. Vorzimer said, there have been 81 cases of intended parents who changed their minds and 35 in which the surrogate did — 24 of them traditional surrogates who both provided the egg and carried the baby.

Surrogacy remains controversial, even in the United States, despite the rapid proliferation of clinics, doctors and agencies. When all goes well, supporters say, the arrival of a baby to parents with no other path to a biological child is an unparalleled joy.

Opponents tend to focus on the cases in which the surrogate suffers health problems or is abandoned by the intended parents, or in which the fetus has serious defects. Abortion politics hang heavily over the issue: Often, surrogacy involves twin or triplet pregnancies, with the possibility of selective reduction.

Critics sometimes draw an analogy to prostitution, another subject that raises debate over whether making money off a woman’s body represents empowerment or exploitation.

In Canada, as in Britain, payment for surrogacy is limited to expenses.

“Just like we don’t pay for blood or semen, we don’t pay for eggs or sperm or babies,” said Abby Lippman, an emeritus professor at McGill University in Montreal who studies reproductive technology. “There’s a very general consensus that paying surrogates would commodify women and their bodies. I think in the United States, it’s so consumer-oriented, so commercially oriented, so caught up in this ‘It’s my right to have a baby’ approach, that people gloss over some big issues.”

Germany flatly prohibits surrogacy, with an Embryo Protection Act that forbids implanting embryos in anyone but the woman who provided the egg. Ingrid Schneider of the University of Hamburg’s Research Center for Biotechnology, Society and the Environment said it is in children’s best interest to know that they have just one mother.

“We regard surrogacy as exploitation of women and their reproductive capacities,” Dr. Schneider said. “In our view, the bonding process between a mother and her child starts earlier than at the moment of giving birth. It is an ongoing process during pregnancy itself, in which an intense relationship is being built between a woman and her child-to-be. These bonds are essential for creating the grounds for a successful parenthood, and in our view, they protect both the mother and the child.”

With all that is known about adopted children’s seeking out their biological parents, other European experts say, it is wrongheaded to create children whose relationship with the woman who provided the egg or carried them will be severed.

Emotional and Financial Costs

The restrictions in many countries have been a boost for American surrogacy. For overseas couples, the big draw is the knowledge that many states have sophisticated fertility clinics, experienced lawyers, a large pool of egg donors and surrogates, and, especially, established legal precedent.

“We chose the United States because of the certainty of the legal process,” said Paulo, an engineer and scrub nurse. “Surrogacy is very secretive in Portugal. People don’t talk about surrogacy, and it’s hard to get any information. In the United States it is all clear.”

But it is not cheap. International would-be parents often pay $150,000 or more, an amount that rises rapidly for those who do not get a viable pregnancy on their first try. Prices vary by region, but surrogates usually receive $20,000 to $30,000, egg donors $5,000 to $10,000 (more for the Ivy League student-athlete, or model), the fertility clinic and doctor $30,000, the surrogacy agency $20,000 and the lawyers $10,000. In addition, the intended parents pay for insurance, fertility medication, and incidentals like the surrogate’s travel and maternity clothes.

Because surrogacy is so expensive in the United States, many couples travel to India, Thailand or Mexico, where the total process costs half or less. But complications have arisen — as in the case of a couple stuck in India for six years, trying to take home a baby boy, whom genetic testing had found not to be related to them, apparently because of a mix-up with the sperm donation.

Four years ago, according to Stuart Bell, the chief executive of Growing Generations, a Los Angeles surrogacy agency, only about 20 percent of its clients came from overseas, but now international clients are more than half. Other agencies report the same trend.

“Anyone who can afford it chooses the United States,” said Lesa A. Slaughter, a fertility lawyer in Los Angeles.

Some lawyers who handle surrogacy tell of ethical problems with intended parents from abroad. Melissa Brisman, a New Jersey lawyer who handled Paulo and João’s surrogacy, had a prospective client from China who wanted to use five simultaneous gestational surrogates. She turned him down.

Mr. Vorzimer, in California, had an international client who wanted six embryos implanted.

“He wanted to keep two babies, and put the rest up for adoption,” Mr. Vorzimer said. “I said, ‘What, like the pick of the litter?’ and he said, ‘That’s right.’ I told him I wouldn’t work with him.”

Probably the most agonizing cases, though, are those in which the intended parents and the surrogate do not agree on what to do about a fetus with severe defects.

Heather Rice, an Arizona mother of three, said her first surrogacy was “an experience so great I knew I wanted to do it again.” She had a very different experience the second time, when, after two miscarriages, a routine ultrasound showed that the 21-week-old fetus had a cleft in his brain.

“Mom walked out of the room, left me lying there, and I thought: ‘This is not my baby. I should not be dealing with this by myself,' ” she said. “But I told Mom, ‘I’ll respect your decision, whatever you decide, because this is your baby.’ A couple days later, they called and told me they didn’t want their little boy so I should get an abortion.”

With only days left before an abortion would become illegal under Arizona law, Ms. Rice found herself unwilling to kill the fetus.

“I think my motherly instincts kicked in when they didn’t want him,” she said. “I told them I just couldn’t do it. Dad told me God was going to punish me for disobeying them.”

Ms. Rice found a woman whose child had the same condition who wanted the baby. And on the 28-week ultrasound, the brain looked somewhat better. When Ms. Rice called and told the intended parents that someone would take the baby, they said they had decided they wanted him after all. At the delivery, though, the mother did not show up.

“When I called, she said Dad had been in the waiting room all night,” Ms. Rice said. “I was crying. I said he has to come in; he’s the father; he should be here. He came in, he cut the cord. He took the baby. And that’s the last I ever heard from them.”

Ms. Rice said she had no idea how the baby was doing, or even whether his biological parents had kept him.

“I found them on Facebook, and there’s no trace of him, so I think they gave him up for adoption,” she said. “I don’t know where he is, and it kills me every day.”

“I love being pregnant, but I don’t want to have any more children — oh, getting up in the middle of the night; oh, day care; oh, I’m done,” she said. “It’s great to see Thomas and Dennis with Nico, and how excited they are about twins. The money is nice, but we could manage without it, and it’s not why I’m doing this.”

Undeterred by Local Laws

For the Portuguese couple, the journey began when Paulo saw a television report about surrogacy, showing a gay couple who were unidentifiable in the shadows. The next day, he went to the television studio to ask how to find the two men. The producer would not share their names, but on rewatching, Paulo and João saw the name of the Connecticut fertility clinic.

Two years later, they were in a hotel in central Pennsylvania for the birth of their son, Diogo. His American passport had arrived. The bittersweet farewell dinner with the surrogate and her family was over, and the flight home was booked for the next day. All that was left to do was gaze at their sleeping baby, angelic in his white onesie, his starfish hands extended.

“It’s like a miracle,” said Paulo. “I cried when I saw the flight booking on the computer. I said: ‘Look, João. It’s not us two anymore. We are three.' ”

Getting to three was long, stressful and expensive, with problems at almost every turn — and one large hurdle remaining, as they apply for Diogo’s Portuguese citizenship.

After speaking to the Connecticut clinic, they chose a surrogacy agency that asked them to wire $100,000 up front. On the verge of sending the money, João decided that was too much. Without telling Paulo, he went back to his online research, and discovered complaints against that agency. Their second agency did not work, either: After months of back and forth, the agency turned them down, apparently because of concerns over their finances.

“They wasted almost a year of our time,” Paulo said.

Even with an agency they praise as responsible and responsive — an agency owned by Ms. Brisman, the New Jersey lawyer — obstacles continued. Their first donor’s eggs did not produce a pregnancy. The second had a genetic disorder that did not show up in the initial paperwork. A third produced a good supply of eggs, but after the first embryo was implanted, the surrogate miscarried. Their next surrogate did not get pregnant on the first try.

Through it all, the bills mounted. João and Paulo said they planned to burn them so their son would never have to think about the price, which they acknowledged was hundreds of thousands of dollars.

They have also decided not to answer any questions about which of them is the father — embryos that were inseminated by each were implanted — unless Diogo is the one asking.

“The information belongs to him,” Paolo said.

In the end, their warm relationship with the woman who bore their child was about the smoothest part of the process. The night before they were to take Diogo home, she sent an emotional text: “I know I’m doing well because I haven’t cried yet,” she said. “But I know I will.”

João and Paulo, like most international couples using an American surrogate, want their baby to be a citizen of their home country. But many Chinese parents take a different tack, keeping the American citizenship automatically conferred on every baby born here. Some hope the baby will attend an American university or help the family to live and work in the United States. But for Chinese clients, too, overseas surrogacy carries a complication, making it difficult for the baby to get a hukou, or household registration card, granting access to local schools and hospitals.

And there is another issue in China: restrictions on the number of children per family. Some Chinese couples, particularly older couples, turn to American surrogacy for a second child, whose American citizenship might clear the family from scrutiny.

But most surrogacy agencies say they will work only with intended parents who cannot carry their own baby, as recommended by the guidelines of the American Society for Reproductive Medicine. So Chinese clients who seek an overseas surrogate to get around the one-child rule create a dilemma.

“We usually only take clients who have a medical need for surrogacy, but in December, we decided to bend that rule, for Chinese people, government officials, who would be in trouble if they break the one-child rule,” said Karen Synesiou, chief executive of the Center for Surrogate Parenting, in Encino, Calif. “We’re thinking of it as political surrogacy.”

Then, too, agencies and lawyers say, there has been a recent uptick in the number of clients seeking “social surrogacy” — that is, having someone else carry their baby so as not to damage their career, or their figure. And not all agencies follow the guidelines.

“We don’t feel like we should be the gatekeepers when it comes to that,” said Saira Jhutty, chief executive of Conceptual Options, a California agency.

Final Hurdles at Home

For all the intimacy of carrying a baby for someone else, there is no template for the relationship between intended parents and the woman who will bear their child. Most contracts contain a clause requiring confidentiality unless both parties agree otherwise. And most stipulate that there will be an abortion if the fetus has serious defects, or a reduction in case of triplets or quadruplets. While no court would force a woman to have an abortion, lawyers say, a surrogate who refused to honor the agreement, and proceeded to carry a baby to term against the intended parents’ wishes, could perhaps be made to pay the costs of rearing the child, under the legal concept of wrongful birth. As surrogacy spreads, lawyers say, litigation over such issues may erupt.

For those from abroad, getting an American-born baby home can involve tangled immigration problems. Some countries require a new birth certificate, a parental order or an adoption. Some will not accept an American birth certificate with two fathers listed as the parents. Occasionally, a baby can be denied entry into the parents’ home country.

But international law is catching up with social practice: On June 26, in a case involving two sets of children born to American surrogates, the European Court of Human Rights ruled that France had violated the European Convention on Human Rights, and undermined the children’s identity, by refusing to recognize their biological father as their legal parent, easing the way to French citizenship.

The decision will most likely smooth the path for Paulo, João and their son, who entered Portugal on his American passport. So far, efforts to register Diogo in Portugal have failed, because the Portuguese process requires that a mother be named. Meanwhile, they have been advised to seek a residence card for him.

“They told us to wait three months for an answer,” Paulo said in a recent email. “We still do not know how this will end.”

Source: nytimes.com

By Peggy Eastman

In an unusual and powerful educational session held on the last day of the American Society of Clinical Oncology Annual Meeting, three oncologists shared what they have learned from their personal experiences with cancer, and how what they have learned has improved their practices.

“It's very difficult to speak about these issues in a public forum,” said session moderator Teresa A. Gilewski, MD, an oncologist in the Department of Medicine at Memorial Sloan Kettering Cancer Center, who has organized and led several innovative sessions at ASCO meetings over the years. She thanked the speakers for being willing to share their personal stories with the ASCO audience despite the strong emotions their stories clearly triggered in all those in the room.

The first to speak, Andrew S. Artz, MD, MS, Associate Professor of Medicine and Clinical Director of Hematopoietic Cellular Therapy at the University of Chicago Medical Center, related how his three-week-old daughter displayed a tumor in her left eye, and a suspicious area in her right eye, first detected by his wife. They obtained an immediate referral to a pediatric ophthalmologist from the baby's pediatrician.

The diagnosis after genetic testing was that the tumor was advanced retinoblastoma due to a mutation (based on her young age and two unaffected older siblings). The baby's rare cancer was a shock; he noted that there was no history of cancer in his family.

“It was a drastic transformation for me,” said Artz of the experience with his baby. “I never realized how anxiety-provoking the word ‘suspicious’ was until you're faced with ‘suspicious’ yourself.”

Artz and his wife were offered three treatment options, one of which was immediate enucleation of the left eye, and one of which was an investigational intra-arterial chemotherapy treatment approach, which was initially discouraged by the specialists they consulted.

“Remember, I'm already at a university; these are my colleagues,” he said. While being at a major medical center was an advantage, it also presented a delicate balancing act in terms of seeking additional opinions on his daughter's cancer. Ultimately, he and his wife chose the investigational retinoblastoma treatment following systemic chemotherapy. The baby had a recurrence one year later, which was treated with intravitreal chemotherapy; and she is now fine, yet will continue to have a lifelong increased risk of cancer.

Artz said he has learned a great deal from his personal experience about how oncologists can better help cancer patients cope: “To us it's a stage; but patients want to tell you about how it was diagnosed,” he said. In short, they want to tell their story to the oncologist. “That initial experience [with a patient] paints a canvas of who you are.”

Now, in his practice, he said, “I am more humble and more patient-centric; I am more willing to offer non-cancer related advice [on caregiving and caregivers, for example]. In addition, “I ask for feedback from patients, and I schedule more time for new patients.”

He offers this advice to oncologists: “Don't try to walk in a patient's shoes, just make the shoes fit better.” From his own experience, Artz has also developed specific suggestions for oncologists on interacting with cancer patients and their families (see box, next page).

In the summer of 2006, the late neurosurgeon Kelvin A. Von Roenn, MD—known for his dedication to training young residents in the art and science of neurosurgery—began to show serious and ominous physical symptoms. “I thought I knew a whole lot about grief until I experienced it myself,” said his wife, Jamie H. Von Roenn, MD, Professor of Medicine at Northwestern University's Feinberg School of Medicine and ASCO's Senior Director of Education, Science, and Professional Development.

Her husband had fatigue, nausea, a decrease in appetite, renal failure, and a bilateral ureteral obstruction; his diagnosis was undifferentiated small cell carcinoma of the renal pelvis. His blood urea nitrogen (BUN) level rose to 100, and he had dialysis and chemotherapy and underwent a nephrostomy. His wife knew too well that his prognosis was poor.

“He was kind of a stubborn ‘I can do anything’ kind of guy,” she said. She told his oncologist, “He wants it straight.” The treating oncologist told the Von Roenns that Kelvin (who had brain metastases) had perhaps six months to a year to live. As an oncologist, “I knew it couldn't be that long, but I wanted to believe it,” said Jamie Von Roenn; her husband died in October 2006 at the age of 56.

At the time of diagnosis, the Von Roenns had been married for nearly 28 years; their three children were 14, 16, and 22.

After his diagnosis, the Von Roenns, who were in the habit of going out on a date every Saturday night, sat on their bed and cried. “That night was the only time he cried,” Jamie Von Roenn remembered. “He wasn't up to going down and talking to the kids, so I did.”

Through her personal experience with her husband's incurable cancer, Jamie Von Roenn said she has learned many lessons or had ones she already knew reinforced. The first was that “even in an excellent hospital, it's stunning to me how terrible the care can be... if I wasn't there, he would not have been OK.”

The second was that most patients want the truth about their disease: “It undermines the hope people have when you don't tell them the truth,” she said, because it prevents them from making the most of the time they have left.

The Von Roenns chose hospice care at home, which she calls “good in the midst of bad.” Kelvin Von Roenn was cared for on the first floor of their home. “The most frightened I ever saw him was when he was tied in a wheelchair and we carried him downstairs,” she said.

During his last days, she and her husband went through what she calls the “five things” people need to say to each other when someone is dying: “I forgive you, forgive me, thank you, I love you, and goodbye.” One evening each of their children went in and talked to their father and went through the five things with him.

“We had our last days as a family,” said Jamie Von Roenn. Her husband's elderly mother managed to come to see him, since he could not go to her. Her husband and she planned his funeral; “It makes a huge difference to know what someone wants,” she said. “He was determined in his last weeks of life to help me with financial things,” an area he had handled. When their financial advisor cried, Jamie Von Roenn decided, “This is the person who cares,” the one she wanted to turn to for help with money issues.

Perhaps the biggest lesson she learned was how to deal with grief personally after her husband's death, which she said has given her an increased appreciation for helping families deal with grief: “The signs and symptoms of grief are emotional, physical, behavioral, and cognitive.”

The cognitive symptoms include preoccupation, confusion, and an inability to concentrate. She described the major tasks of grief as:

“As grief decreases, acceptance increases,” she said. She defined acceptance as “a sense of inner peace and tranquility that comes with the letting go of a struggle to regain what has been taken away — The only way out of this is resilience; that's the way we restart our lives.”

When Alyssa G. Rieber, MD, was 21 and a first-year medical student at the University of Alabama School of Medicine, she was diagnosed with Stage II Hodgkin lymphoma. At the ASCO meeting, she told the audience that this personal experience has given her a valuable perspective on treating the patients she sees today as Assistant Professor in the Department of General Oncology, Division of Cancer Medicine, at the University of Texas MD Anderson Cancer Center.

While a medical student, Rieber underwent four months of chemotherapy and then radiation, managing to continue on with her classes.

Unmarried at the time of diagnosis, Rieber learned how it feels to be a patient. Her mother, who did not cook, “started cooking like crazy,” Rieber remembered, in order to fill her daughter with nutritious food. “She would cook and I would throw food away,” Rieber said. She lost her appetite and had a metallic taste in her mouth. “I lost my hair, and everybody was concerned.” She resorted to wigs, “which are always too hot and itchy, and you end up wearing a hat anyway,” she remembered.

Rieber, now married with two young daughters, said that today when she interacts with families as an oncologist she tries to bring “honesty, empathy, encouragement, and hope.” She noted that “being able to talk to the person [oncologist] as someone who's gone through this is very helpful,” and that “Sometimes hope is all we have to offer to get them through the day.”

She said her experience as a cancer patient has helped her better understand the following:

• The family response to a loved one's diagnosis of cancer brings shock, fear, and anxiety for everyone, and coping is different for everyone;
• Family members have a heightened sense of their own mortality;
• There may be a concern among some family members that cancer can be “caught,” especially among children (who need a careful explanation on their own level that cancer is not infectious);
• The time to treatment seems extremely long to families, who have a sense of urgency; this requires taking the time to give an explanation of the steps needed to determine the best treatment before therapy can begin;
• The family has concerns about the cancer patient's physical changes, such as weight loss, which can lead to battles over nutrition—wanting to feed the patient when he or she has no appetite and cannot eat. “I tell the patient, ‘Drink a shake,’ and I tell the family, ‘Back off,’” Rieber said;
• The end of treatment doesn't necessarily mean a return to normalcy: “Just because treatment is over, that doesn't mean patients are back to ‘normal.’ Many people don't just bounce back,” Rieber said;
• The end of treatment does not mean the end of worry, and of “the anxiety that never goes away.” The cancer survivor may feel that “every little lump is cancer until proven otherwise. The patients will have that forever.”

Source: http://journals.lww.com/

By AP/ Danny Johnston

LITTLE ROCK, ARK. A south Arkansas woman celebrated her 116th birthday Friday with cake, a party and a new title - she's now officially the oldest confirmed living American and second-oldest person in the world, the Gerontology Research Group said.

Gertrude Weaver spent her birthday at home at Silver Oaks Health and Rehabilitation in Camden, about 100 miles southwest of Little Rock. This year's festivities included the new award from the Gerontology Research Group, which analyzed U.S. Census records to determine that Weaver is the oldest living American, rather than 115-year-old Jeralean Talley, who was born in 1899.

The research group, which consults with the Guinness Book of World Records, found that the 1900 Census listed Weaver as 2 years old - putting her birthday in 1898, said Robert Young, the research group's database administrator and senior consultant for Guinness.

That makes Weaver the second-oldest person in the world behind 116-year-old Misao Okawa of Japan and the 11th oldest person of all time, he said.

"Normally, 116 would be old enough to be the world's oldest person," Young said. "There's kind of heavy competition at the moment."

Weaver was born in southwest Arkansas near the border with Texas, and was married in 1915. She and her husband had four children, all of whom have died except for a 93-year-old son. Along with Census records, the Gerontology Research Group used Weaver's 1915 marriage certificate, which listed her age as 17, to confirm her birth year, Young said.

Although no birth record exists for Weaver, she celebrates her birthday each year on July 4 and did the same this year. At her 115th birthday party last year, Weaver was "waving and just eating it all up," said Vicki Vaughan, the marketing and admissions director at Silver Oaks.

"Most people want to know, `Well, can she talk?'" Vaughan said. "Her health is starting to decline a little bit this year - I can tell a difference from last year, but she still is up and gets out of the room and comes to all of her meals, comes to activities. She'll laugh and smile and clap."

Weaver first stayed at the Camden nursing home at the age of 104 after she suffered a broken hip, Vaughan said. But Weaver recovered after rehabilitation and moved back home with her granddaughter, before returning to the nursing home at the age of 109.

Scientists study the very old for clues about longevity, including genetic, lifestyle,and environmental factors.

Weaver cited three factors for her longevity: "Trusting in the Lord, hard work and loving everybody."

"You have to follow God. Don't follow anyone else," she told the Camden News this week. "Be obedient and follow the laws and don't worry about anything. I've followed him for many, many years and I ain't tired."

Source: cbsnews.com

By JANE E. BRODY 

Pregnancy, or the desire to become pregnant, often inspires women to take better care of themselves — quitting smoking, for example, or eating more nutritiously.

But now many women face an increasingly common problem: obesity, which affects 36 percent of women of childbearing age. In addition to hindering conception, obesity — defined as a body mass index above 30 — is linked to a host of difficulties during pregnancy, labor and delivery.

These range from gestational diabetes, hypertension and pre-eclampsia to miscarriage, premature birth, emergency cesarean delivery and stillbirth.

The infants of obese women are more likely to have congenital defects, and they are at greater risk of dying at or soon after birth. Babies who survive are more likely to develop hypertension and obesity as adults.

To be sure, most babies born to overweight and obese women are healthy. Yet a recently published analysis of 38 studies found that even modest increases in a woman’s pre-pregnancy weight raised the risks of fetal death, stillbirth and infant death.

Personal biases and concerns about professional liability lead some obstetricians to avoid obese patients. But Dr. Sigal Klipstein, chairwoman of the committee on ethics of the American College of Obstetricians and Gynecologists, says it is time for doctors to push aside prejudice and fear. They must take more positive steps to treat obese women who are pregnant or want to become pregnant.

Dr. Klipstein and her colleagues recently issued a report on ethical issues in caring for obese women. Obesity is commonly viewed as a personal failing that can be prevented or reversed through motivation and willpower. But the facts suggest otherwise.

Although some people manage to shed as much as 100 pounds and keep them off without surgery, many obese patients say they’ve tried everything, and nothing has worked. “Most obese women are not intentionally overeating or eating the wrong foods,” Dr. Klipstein said. “Obstetricians should address the problem, not abandon patients because they think they’re doing something wrong.”

Dr. Klipstein is a reproductive endocrinologist at InVia Fertility Specialists in Northbrook, Ill. In her experience, the women who manage to lose weight are usually highly motivated and use a commercial diet plan.

“But many fail even though they are very anxious to get pregnant and have a healthy pregnancy,” she said. “This is the new reality, and obstetricians have to be aware of that and know how to treat patients with weight issues.”

The committee report emphasizes that “obese patients should not be viewed differently from other patient populations that require additional care or who have increased risks of adverse medical outcomes.” Obese patients should be cared for “in a nonjudgmental manner,” it says, adding that it is unethical for doctors to refuse care within the scope of their expertise “solely because the patient is obese.”

Obstetricians should discuss the medical risks associated with obesity with their patients and “avoid blaming the patient for her increased weight,” the committee says. Any doctor who feels unable to provide effective care for an obese patient should seek a consultation or refer the woman to another doctor.

Obesity rates are highest among women “of lower socioeconomic status,” the report notes, and many obese women lack “access to healthy food choices and opportunities for regular exercise that would help them maintain a normal weight.”

Nonetheless, obese women who want to have a baby should not abandon all efforts to lose weight. Obstetricians who lack expertise in weight management can refer patients to dietitians who specialize in treating weight problems without relying on gimmicks or crash diets, which have their own health risks.

Weight loss is best attempted before a pregnancy. Last year, the college’s committee on obstetric practice advised obstetricians to “provide education about possible complications and encourage obese patients to undertake a weight-reduction program, including diet, exercise, and behavior modification, before attempting pregnancy.”

An obese woman who becomes pregnant should aim to gain less weight than would a normal-weight woman. The Institute of Medicine suggests a pregnancy weight gain of 15 to 25 pounds for overweight women and 11 to 20 pounds for obese women.

Although women should not try to lose weight during pregnancy, “a woman who weighs 300 pounds shouldn’t gain at all,” Dr. Klipstein said. “This is not harmful to the fetus.”

Dr. Klipstein also noted that obesity produces physiological changes that can affect pregnancy, starting with irregular ovulation that can result in infertility.

Obese women are more likely to have problems processing blood sugar, which raises the risk of birth defects and miscarriage. There is also a greater likelihood that their baby will be too large for a vaginal delivery, requiring a cesarean delivery that has its own risks involving anesthesia and surgery.

The babies of obese women are more likely to develop neural tube defects — spina bifida and anencephaly — and to suffer birth injuries like shoulder dystocia, which may occur when the infant is very large.

High blood pressure, more common in obesity, can result in pre-eclampsia during pregnancy, which can damage the mother’s kidneys and cause fetal complications like low birth weight, prematurity and stillbirth.

It is also harder to obtain reliable images on a sonogram when the woman is obese. This can delay detection of fetal or pregnancy abnormalities that require careful monitoring or medical intervention.

Source: http://well.blogs.nytimes.com/

By GILLIAN MOHNEY

Ronnie and Donnie Galyon are eagerly awaiting a major milestone this Saturday. Even though it’s not the conjoined twins’ birthday, the duo plans to celebrate turning 62 years, 8 months and 7 days old with a big block party.

The reason for the celebration? The date means they will have lived longer than the original “Siamese Twins,” Chang and Eng Bunker, who became famous as a sideshow act in the 1800's.

“Put it this way -- I’m stoked,” Ronnie Galyon, 62, told the Denton Daily News.

Ronnie and Donnie Gaylon were born in 1951 and live with their younger brother, Jim Galyon, and his wife in Beavercreek, Ohio. The Galyon twins are joined from the breastbone area to the pelvis and spent their first months on Earth in the intensive care unit.

“They weren’t even expected to live the first day, let alone get out of the hospital, let alone live 62 years,” said Jim Galyon. “This has been a life-long goal to meet and beat the Bunker twins. It means the world to them.”

After growing up, the pair performed in carnival sideshows and circuses until they retired in 1991, according to the Associated Press. The Galyon twins lived on their own after retirement, although they moved just a few houses down from their brother so that he could help them. The twins moved in with their younger brother after they became deathly ill following a viral infection and were in the intensive care unit with various health problems, including blood clots in Ronnie’s lungs.

With the help of the community and the Christian Youth Corps, Jim Galyon was able to build an addition on his house and make it handicap accessible. He and his wife now care for his brothers 24 hours a day.

“[They] have their own totally different personalities,” said Jim Galyon. “Donnie can be very serious and reserved; Ronnie is very happy-go-lucky.”

While the duo is excited for the party on Saturday, they’re really anticipating their next birthday. This October the twins will turn 63, breaking the record for the oldest pair of conjoined twins, according to Guinness World Records.

The twins have been excited about breaking the official record for years.

“It’s what me and Donnie always dreamed about, and we hope to get the ring, because we’ve dreamed about getting this since we were kids,” Ronnie Galyon told the Denton Daily News.

As the Galyon twins plan to make history, their family is working on compiling a history of the twins’ former life on the road. They’re asking anyone who might have seen Ronnie and Donnie Galyon in their circus days to can contact the Galyon family at Worldsoldestconjoinedtwins@gmail.com.

Source: abcnews.go.com

By Rossalyn Warren

When Bethany Townsend snapped herself on holiday with two of her colostomy bags visible, she didn’t expect the photo to be seen by more than 9 million people.

facebook.com

But since her photo went viral, hundreds of other people who live with Crohn’s disease are sharing photos of themselves with their colostomy bags on show.

Facebook: crohnsandcolitisuk

Facebook: crohnsandcolitisuk

The photos are being shared on the Crohn’s and Colitis Facebook page and on the Get Your Belly Out Facebook page with the hashtag #GetYourBellyOut.

Facebook: crohnsandcolitisuk

Those who uploaded the photos are also speaking out about their illness with their stories of support and survival.

Facebook: crohnsandcolitisuk

When Joseph Hendy shared his story, people commented on his photo saying what an inspiration to others he was, adding: “I hope everybody with the same illness reads your story and takes the same positive attitude as yourself.”

Facebook: crohnsandcolitisuk

AnneMarie said that the campaign made her feel brave enough to share her own photo. She wrote on Facebook: “By seeing these posts by so many brave people who have gone through the same, it has inspired me to take my very first photo of me and my stomach.”

Facebook: crohnsandcolitisuk

Tina, shown in the middle here, said: “It’s really great to see so many people sharing their personal and difficult experiences publicly. An inspiration to all. Well here’s my pic, Hope it helps someone somewhere.”

Facebook: crohnsandcolitisuk

Laura said she was proud to join the campaign, saying: “We have suffered in silence and been hiding behind this horrible condition for long enough!! Proud to be a part of it! Get ur belly out people!!!!”

Facebook: crohnsandcolitisuk 

Source: buzzfeed.com

By Vivien Mudgett

Chances are, if you have been a nurse for more than six months, you have been exposed to bullying or disruptive behavior. Research shows that more than 82% of nurses have been a target of bullying or have witnessed it. Over 60% of new nurses who experienced bullying are planning to leave their jobs. The frightening part of these statistics is that bullying is underreported!

Defining Bullying

Bullying is not an isolated incident. It is deliberate, rude, inappropriate, and possibly aggressive behavior of a coworker(s) to another coworker. The behavior is repetitive in nature, and may be overt or covert. It can also reflect an actual or perceived imbalance or power or conflict.

Bullying and disruptive behavior has been recognized as a threat to a nurse’s well-being and a threat to the safety of our patients. When a care team cannot get along, errors are made, patients feel the tension, and patient outcomes suffer.

As nurses, we are all working today in a very stressful environment with heavy workloads. More demands are being added on almost a daily basis. We are struggling to take good care of our patients and the stakes are high. Adding bullying to this equation makes the situation worse.

The paradox of bullying in nursing is that we all joined this marvelous profession because we are caring individuals. We want to show our compassion and be a healing presence to others. So how is it that this behavior is so prevalent in nursing? Research shows that the behavior continues because nurses are afraid of retaliation, normalize the behavior, don’t like conflict, and don’t really know what to do.

Here are 3 steps you can take to address this uncaring behavior in a caring way:

1. Stop and breathe!

   Separate yourself from the behavior for a moment and realize that YOU are not the cause.

2. Diffuse the situation.

   Do not react. Sometime reacting too fast can cause you to behave unprofessionally as well. As calmly as possible, ask to talk in private. If the behavior continues, be prepared to be the one to walk away.

3. Address the behavior.

   Find a private place to openly discuss the behavior and address the conflict.

   Two open ended discussion starters can be:  

   “When you yelled at me in front of the patient (or our co-workers), I felt humiliated. It was unprofessional and now the patient’s trust in the healthcare team has eroded. Was that your intent? Can we agree that in the future, if you have a problem with me, you will address it with me privately?”

   “Are you OK? Help me to understand the situation. I’ve noticed a conflict between us and I think it’s affecting the way we work, can we talk about it?”

In a perfect world, these 3 steps can alleviate and resolve the conflict between nurse co-workers. However, be prepared that it may take further discussion and possibly, include your unit supervisor or nurse manager. By addressing uncaring behavior, you are standing up and choosing not to be a victim.  

If you see someone else being bullied, don’t be a passive bystander. Stand next to the person and use supportive phrases while helping the person being bullied. This is especially if they are not able to speak for themselves at that moment. Most importantly, and most difficult to do: Stay calm, be confident, and always behave with integrity. Take the higher road.

Have you dealt with nurse bullies in the past? How did it go? Let us know in the comments.

Source: nursetogether.com

By Associated Press

WASHINGTON (AP) — Federal health regulators have approved a first-of-a-kind set of robotic leg braces that can help some disabled people walk again.

By Alan Neuhauser

They’re just 12 miles and two train stops away, yet NewYork-Presbyterian Hospital and University Hospital, Newark, exist in “two different worlds,” says Terence Wrong, executive producer of ABC’s  "NY Med."

The show, an eight-episode mini-series, returns Thursday night. In previous seasons it featured one or two top-tier hospitals – Baltimore’s Johns Hopkins Hospital in 2000 and 2008, Boston’s Brigham and Women’s and Mass General hospitals in 2010 and NewYork-Presbyterian Hospital and the city's Lutheran Medical Center in 2012. This year, however, it's turning its HD lenses on a premier hospital in one of the wealthiest zip codes in the world along with one that, while well-regarded, is located in a city that’s had nearly 7,000 shootings in the past decade alone. 

The decision to examine the disparity is, in part, dramatic. “You really want to change tempos and speeds on the audience to have an alchemy in the show,” Wrong tells U.S. News.

Yet there’s a far larger idea at work, too.

“It is a tale of two cities,” he says. “The mainstream audience hasn’t really had life in the inner-city thrust in their face since 'The Wire' on HBO. Rather than demonize that world – because it is violent, people do have problems that they don’t necessarily have in Manhattan – what comes through to us is the extraordinary humanity of the patients we meet there and the way they bond and the way the nurses and doctors bond with them.”

The show, he insists, isn’t a typical medical or hospital show, with gratuitous gore or doctors hooking up or an unrelenting stream of life-and-death situations.

Produced through ABC’s news division, "NY Med" captures individual human dramas, Wrong explains, allowing it to paint an intimate and illuminating portrait of modern American health care. Issues range from the practical – “Who’s bearing the costs when a disadvantaged community uses the ER for primary care?" Wrong offers. "Does that impact the hospital’s bottom line?” – to the profound: “the individual will to live, connections and bonds between families and people and strangers,” he describes.

The first episode opens with a woman with a sunburn being rushed to a hospital by ambulance; – viewers soon see that the skin on her legs has bubbled to at least the size of tennis balls. The cameras cut to another patient, a man in the cardiac unit whose aorta begins to rip just as he’s being visited by cardiologist and TV star Dr. Mehmet Oz. Also on the same episode: a teen who was shot multiple times in Newark, a new female urologist helping insert a penile implant in a 73-year-old man, and a married father of three who’s about to have surgery for a tumor on his spine – and who has yet to tell his wife about it.

“Here’s a guy who doesn’t tell his wife that he’s got this life-threatening disease and they kind of capture that intimate moment where she gets through it,” says Dr. Philip Stieg, chief of neurosurgery at NewYork-Presbyterian/Weill Cornell Medical Center, who performs the operation. “Those are things that we as physicians, we have to deal with and help that family get through that.”

And throughout it all, the cameras keep rolling on these real-life patients, doctors and nurses.

Stieg, who says he was at first “skeptical” about participating in "NY Med," says he ultimately chose to take part because “neurosurgery has a story to tell.” 

“There’s hundreds of thousands of neurosurgical procedures, and I’m hopeful that this small little vignette helps people understand that no matter how serious and critical the procedure may be, we have the technology to get you through that process,” he tells U.S. News. “That’s important for people to see. Let’s face it, at some point, all of us are going to be hospital patients.”

And that means the program doesn't merely show the drama of a complicated surgery or a patient fighting for his or her life, but the drama behind the drama: the new urologist struggling to set boundaries with her patients, a nurse struggling with her employers, and even doctors and nurses making mistakes during procedures. “Warts and all,” Wrong says.

“The cost of letting people see quality medical care is that, yeah, there will be warts and blemishes, because this is life,” he adds. 

And that, in and of itself, has value.

“We do feel good that we can show the doctors and the nurses this way, and still so nobly,” supervising producer Erica Baumgart says. “One of the things that we sometimes hear from patients is that they want to participate in filming because it could help other people who have similar conditions get through what they can get through.”

Source: health.usnews.com

By Associated Press

New York state can end its three-decade HIV crisis by the year 2020, Gov. Andrew Cuomo said Sunday as he announced an ambitious plan to deliver a knockout blow to the epidemic by boosting testing, reducing new infections and expanding treatment.

The governor said the state is aiming to reduce new HIV diagnoses to 750 by the end of the decade - about the same number of tuberculosis cases seen in New York City each year - down from 3,000 expected this year and 14,000 new cases of the disease in 1993. If the state is successful, it would be the first time the number of people living with HIV has gone down since the crisis began with the first widely reported cases in 1981.

"Thirty years ago, New York was the epicenter of the AIDS crisis," Cuomo said. "Today I am proud to announce that we are in a position to be the first state in the nation committed to ending this epidemic."

To expand treatment, the state's Department of Health has negotiated bulk rebates with three companies producing HIV drugs. The state is also taking steps to make it easier to get tested, changing how HIV cases are tracked to ensure patients continue to receive treatment, and boosting access to "pre-exposure" drugs that can help high-risk people avoid infection.

Cuomo did not offer an estimate of the cost of the plan, but said it would end up saving the state more than $300 million per year by 2020 by reducing the amount the state pays for medical care for those with HIV.

Groups that have long advocated for HIV patients praised the governor's announcement, saying it shows that efforts to fight the disease are paying off, and that a scourge that once seemed unbeatable can be successfully fought.

"We have the tools and know-how to end the AIDS epidemic in New York, the only question is whether we have the political will," said Jason Walker, an organizer at VOCAL-NY, which advocates for low-income HIV patients. "Even without a vaccine or cure, Cuomo understands that we can dramatically reduce new infections below epidemic levels and ensure all people living with HIV achieve optimal health."

While the state's plan may sound overly optimistic, the number of new HIV cases in New York has dropped nearly 40 percent in the last 10 years because of better, faster tests; access to condoms; public outreach campaigns and other initiatives. Meanwhile, those with the disease are living longer thanks to significantly more effective treatments.

The goal of bringing the disease to below epidemic levels "is ambitious," said Mark Harrington, executive director of the anti-HIV organization Treatment Action Group, but "grounded in reality."

Source: foxnews.com