welcome to health iq i'm dr. alan siegel.tonight we have two special guests: dr. tiffany werbin-silver she's an ob-gynand dr. lauren adler she's a pediatrician. they both are atwestchester health associates. welcome doctors, how are you, so together as obgyn at apediatrician the relationship is a very important one in our medical world. tell us a little bit about i'll start with you dr.silver tell me about the importance of working closer to the pediatrician asyou're bringing one of your patients through their first or second child. well lauren and i worked together atwestchester health and our relationship
starts not only when i deliver childrenbut actually prenatally when we counsel our patients together in bringing a babyinto the world and preparing for a baby to come into this world and counselingour patients as far as what to expect when the baby is born so ourrelationship begins even before a child is born helping women navigate throughpregnancy through their whole delivery process then into the world of aneonate and through childhood and circling back into adolescence and thenonce they reach adolescence they come back into the world of gyn andhopefully as they go through into the world of obstetrics again when they'reready. so full circle of
life so to speak and as a pediatrician how important is it to to meet thatmother and meet that person before actually the baby is actually born. ithink it's really important you know particularly from new parents who are worried about what to expect when the baby comes to know that they've metthe person who's going to be taking care of their baby when he or she is born, answerany questions that they might be having before the delivery and to start thatrelationship you know right away while the baby's still in utero because it'sgoing to be you know we see babies until they're 21 years old. because sometimesthe questions the mothers have a detent
it could be more concerned about babythan themselves and then that fine line between you know answeringquestions as a pediatrician as an obstetrics specialist andand saying the baby's fine we need to take care of you right nowand then you know make sure they must focus on their health. so often withthe new mom i have to tell them you know the baby's fine you need to take care ofyourself mom's are still worried about breastfeedingand doing the right thing. they're exhausted they're not drinking andeating so really making sure that both patients are taken care of.and yet both specialties are
obviously so important you know with ourfamilies and taking care of everyone but no means so much to us our wives ourchildren but also like a lot of new concerns out there things that wehaven't been focused on in the past. zika virus being one of those things andthere's a lot of questions about it and how it may be transmitted or how it maybe you know passed onto a baby and although we haven't had a lot of caseshere in westchester united states you know you're probably getting a lot ofthese questions in your practices so you know dr. silver. sure and weget a lot of those questions now about zika in terms of you know in the lastcouple of months it's been about travel
since all of this came out especiallysince it was may of last year when and when this all came up with the first casein in brazil and since that time we've had a lot of questions from patients butwhere can i travel to and that area of travel has expanded not only frombrazil through south and central america and africa and all those areas but nowpeople are concerned because not only has it been about traveling to those areasit's also been about those who have traveled and come home and not reallybeing transmitted through mosquitoes but transmitted through sexual contact withpeople who have traveled to those places and exposure to the virus through thatso there has been a lot to learn and
everything that has happened has come tous at a very exponential rates every day we get new updates and information newinformation. so is this is a new virus dr. adler something around or we just haven't heardabout it and all these years. we just haven't heard about it all these years it was firstdiscovered in the early nineteen hundreds actually they were doingresearch in the rhesus monkeys and they found a rhesus monkey that have zika andthen the first human case was in 1952 it was mostly in africa and not really inthe americas and then 2014 it was first discovered in chile and has spread sincethen. so as part of your standard of care
are we havin to test for this or is itjust if symptoms arise that they think there may be an indication or is itsomething where people just want to get tested for just to make sure you knowthat they don't have you know whether the pregnant. as far as currentrecommendations right now yeah i don't care what the other kind ofchanging probably weekly at this point right and everyday it sort of changesso really if there has been exposure and actually as current as this past tuesdayi got an email saying that every pregnant woman should be asked at everyvisit at every obviously obstetric visit about their possibility for exposure toseek meaning that every time they come
in and and and sometimes towards the end ofpregnancy you're coming in weekly they should be asked about possible exposureto zika meaning have they traveled, have they been exposed to people who havetravelled you know primarily through sexual contact to the possibility ofhaving been infected and currently right now that would involve testing and andreally the the department of health is running those tests so it's not like ican run the test from my office right now you would have to send them too a hospital or send the samples to the hospital that would run that testand it is you know backlogged in terms of the amount of testing that is being donebecause there are a lot of people who
have had that kind of exposure who haveknown people who have traveled or been intimate with people who have traveledand it used to be is you know recent as last week that those people were theirspouses and it was thought that it was just the males who were transmittingthat sexually and now as recent as this week it was it is now thought thatfemales can pass that on as well so female to female relations male tofemale male to male all of that is a possiblity. and have therebeen diagnosed cases where it has transmitted to a child in utero. not in new york but other other areasor in the in the country and united
states ok so that has been alreadydocumented so these are cases of concern and things that we should belooking out.. right and there is no data to support that women who arepregnant are higher risk for that transmission but it has been provenbasically from whatever documentation that we have from these pregnancies andthese exposures in other countries that it can occur at any point in pregnancyso it's not just limited to a particular trimester it can happen at any point inpregnancy and transmission yeah exactly. and so treatment wise if if there is awoman who is pregnant and she does test positive but maybe can you test thebaby at the same time or you have to you
can test both right so yeah thatwould you treat, can you treat? unfortunately there is no treatment sowhat that would involve is you know basically testing to see if there istrue exposure you know you can test the fetus you can test the amniotic fluidyou can test parts of the placenta and all of that and then if you have a trueexposure what you would do and what it is considered a standard of care as youmentioned is to watch with serial sonograms and watch the growth of thebaby in particular what you're looking for when you are monitoring somebodywith an exposure to zika and approving exposure is to look for documentation ofwhat people know or associate zika
exposure pregnancy with the smallbrains what we term microcephaly and so it's not only associated withmicrocephaly or small brains but also calcifications in the brain eye abnormalities its associated with thebiggest risk factor is really demise or death of the fetus. users can be veryserious events and as a pediatrician obviously if you know this were to occurin new york you know this would make a more obviously difficult case fromstar that's not what we're looking for for the for the families and for thechildren or so so that it did people do have to understand where they travel isimportant to understand there is a
exposure out there obviously there's still certain parts ofthe world that are more you know cold hotbeds for the virus at this point andthere is travel to and from brazil. i think that you know there should be definitely some caution for those families especially if they're lookingto have children or you are in the faze of having children so youmentioned the the sonograms i know there's been a lot of greattechnology changes in sonograms sometimes they look like movies practicallythey're so real right so so how important is the technology and and doyou follow along with the sonograms and
get all the information that you'refollowing that child and during the self-immolation. if there was a mom whowas exposed they would follow the baby while the baby was in utero with serialsonograms. when the baby's born the most important thing is you knowfinding out what the exposure has been we can test the babies again throughlike blood test urine test and then really just monitoring the babymeasuring the head for microcephaly we could do what's called a head ultrasoundwhere they actually use the ultrasound machine through the fontanel in the headand see if there's any calcifications having the baby see an opthamologistchecking the hearing and just following
that baby's neurodevelopmental progressas they get get older. right because the virus essentially from what i understandis it's not leaving the body it's it's staying with you right? there's so in terms of treatment youknow there's no antibiotic treatment. there's no antibiotic treatment but like other virusesyou can you get over the infection you clear the virus through but for it for afetus that was infected that neurodevelopmental problems you know canpersist. right okay, now you probably get a lot of questions also forlike what are the worst things i could do for my child you know while i'm havingyou know the pregnancy and during
so what other things that, we knowsmokings bad we know drinking is bad what are some other things that peoplemay not think are so bad but maybe are bad and the things that peopleshould avoid. i think using common sense obviously no drugs no alcohol smokingeating healthy getting you know your fruits and vegetables and taking yourprenatal vitamin is important right and different prenatal vitamins has beensome controversy but yet you do need to be aware what brands you are taking what types you're takingwith the source of where they're coming from because you know if you get poor youknow quality vitamins or just like taking poorquality food and sometimes there can be
things in there that shouldn't be there.vitamins in general are not regulated by the fda so it is important to make sureyou're getting your vitamins from a reputable source other special specificvitamins you recommend? you know i think whatever is tolerable and coming from areliable source is usually what i recommend i think most important in thevitamins is the folic acid content because of everything that's in vitaminreally what we know has been proven is the folic acid prenatally orpreconception i should say because that's what we know will prevent neuraltube defects or spinal cord problems in a baby so if you can get on a prenatalvitamin prior to conceiving at least
three months we know that that is whatstudy proving to prevent the spinal cord problems that we look for. so evenpreventive starting to take vitamins before preganncy like a lot of people may notthink those lot of times people don't even know that they're trying or maybeor maybe they don't realize that they're already pregnant and then andmaybe they have still continued some habits but typically speaking that questioncomes up like all you know i've been drinking and i've been doing thatis everything okay in the first trimester you know the first few weeks idon't you know that's not that was good but not that it's terribly bad dependingon the extent of right right back up
yes one of your great healthy everything in moderation you know we always been here we've allhad those stories where it was like oh i we didn't know yeah what about exercise and fitness youknow for both the baby and are there other studies that have shown you know ahealthy mom healthy baby obviously know that makes sense but you know tothe point where proper exercise you know that diabetes issues can cause problems, poor eating habits you know it affects both the baby and the mom sowhat are the important aspects there. i think exercise is always important andexercise in pregnancy is important as
well i think they used to be that theydidn't recommend you get your heart rate above a certain amount but now you can. rightand i think that anything that you are usually adjusted to and normally used to is continuing it you can continue to doand is perfectly acceptable to continue to do. if you're not a marathon runner once youget pregnant it's not time to start training for a marathon that's not thetime to get all in shape and whatnot but i think if you're accustomed to doingsomething you can continue to do it as long as you are comfortable and anytimethat you're not or you feel like it's too much that's the time to back downbut if you're usually get on the bike
and you do a certain amount you cancontinue to do that as long as you're feeling okay about it but at some pointyou're going to start to get a bigger belly and at some point your heart rateis going to get too high and you're not going to feel so comfortable doing itand your body is going to tell you i need to back down and i need to slow downand and you don't need someone to tell you to do that you're gonna feel it onyour own and you're going to want to do that so i think it's perfectlyacceptable i think there are always going to be exceptions and you shouldalways before starting anything new or feeling different about your exerciseroutine talk to your doctor about it and
see you know whether it's acceptable orwhether you should modify your exercise course so it's not a general blanketstatement but i do think that diet and exercise are always important and youshould continue to do it and that's sort of my motto. even after the baby'sborn here to do because i i strongly believe in what you model for yourchildren is what they learn to do and so a happy healthy family starts withmom and dad eating healthy exercising showing their kids. what about some of the myths and thelegends of playing music to the baby and the baby like how do you feelabout those. i think why not you know what they
can hear in utero you know it'scertainly not going to harm them if you're not blasting music into the bellybut i think it helped i think it helps mom and dad to feel bonded to the babyand feel like they're already starting to do something parental i think that's important.maybe not attend rock concerts for... so as a pediatrician ido have to ask this question there's always a hot topic right so vaccinations at anearly age and and you know studies that nothing's really been so over theconclusive showing that it causes you know autism or other types oflearning disabilities are you know what is your overall opinion
on it and is it based on like themercury or things that are you know what's going on in the industry at thispoint. i mean as a pediatrician and as a mom i full heartedly strongly believein vaccines. all the scientific evidence that i've read all the studies i've readreally support the use of vaccines in terms of their safety and their efficacy.i know that there's a lot of information out there on the internet you can readalmost anything but i think really getting your information from yourdoctor is the most important thing and not necessarily believing just what youread. the studies show that again the vaccines are safe i vaccinated my kidsaccording to the same schedule i want to
vaccinate my patients childrenwith. but has there been a trend to spread out some of the vaccinations sothey're not as ... not in the medical field at all no you know exactly and youknow i have some concern about lots of people who want to come in and spaceout the vaccines we'll work with them we'll do that but really the schedule that i recommend is the schedule that's been studied and we knowit's safe and efficacious and to use the vaccines in another way to space themout might not be as efficacious because we know that you know if you get them ata certain time you build your immunity and you boost it if you spread them .. and you feel like maybe
that we're more knowledgeable onlearning disabilities now we're more knowledgeable about what you knowsomething's good executive function disorder autism you know spectrumthey're all these things were just we just know more than we did 20 30 yearsago but for me no more i was a child i don't know what i had but he told me so exactly i think we're more apt to diagnosisthings i think we expect more educationally from our children now thenmaybe we did years ago and i also think that there's a lot of otherenvironmental things that are different that could be causing somebody .. i'm glad you brought that up that's
actually a good point environmentaltriggers for both pregnant mom and young child there are a lot of environmentalexposures and and whether you know the vaccination thing is a trigger which wedon't believe it is you know look there's led in the water there's toxicity that we put on our grass andthey spray stuff all the place you're in front of electrical magnetic computersall day so you know you have any comments on on exposure orexposures to point out this should be a concern ... i mean the same questions that dr. adler gets i get as well and so you know i getthe same questions in terms of what are
you going to recommend because i dobring it up at the visits as well in terms of let's start thinking about whatyou're going to do and that in the hospital you're going to get offered todo the vaccinations in in the delivery room at the time of delivery to getoffered to do your first hepatitis vaccine everybody state-mandated has toget vitamin k shot for their babies and some ointment in the eyes so i do bringit up and it always initiates a conversation about vaccines in additionto all the other sources like you mentioned all the environmental stuffand it's interesting especially here in westchester where i feel like there is ayou know a large percentage of autism
and a large diagnosis or larger thanother areas diagnosis of developmental disabilities or delays and autism andit strikes a whole other discussion i would say in terms of is that related tothe environment is that related to what we're doing is that related to vaccinesand it's hard to say you know i like lauren i i do believe in vaccines ivaccinated my children according to the regular schedule i don't know is it is it whether that weare more learning to do we do we actually know more than we did way backwhen is it related to the vaccines i'm not sure and then i also be socialeconomic issues where you want to
obviously was just doing up the middleupper income area we have access to the professionals like yourselves and othertypes of professions that started you know about disabilities and and sothere's there's this kind of push to kinda getting one kid checked out kindof early to make sure you know that things are you know what they should beand and you know there's i guess like they called the spectrum so it's likeit's all over you know where they fall in that line and i guess you know if you really want to puteveryone on that line you almost could to something great so what about likesome silly is like well water like as
well water concern because there are alot of homes that have well water and should water be tested in the homeespecially when somebody's got pregnant is there a concern besides you know because they don't getthe water reports from the town if they're doing water when you should getyour water tested there's a whole issue with led and get your getting the labtesting and there's a lot of underground oil tanks in my sister which you know duleek and they can leak into wells andthen also there are issues on those lines so i think the environmentalfactors are important i think you know
the queen of the better for for everyoneand and as its best especially more so maybe when you're pregnant and you haveto worry about not only yourself but the child know what about like you know newtechniques or technologies come out and your practices anything new and excitingfor either one of you i know medicine is always changing especially when i bringon all the orthopedic guys so hey and he knew was diagnostics that theultrasounds are getting their phenomenal you can practically see your childbefore it's born so exciting i three the imprint on your wall yeah you know ithought was so cool actually was recently somebody brought in and it maynot just you may not be as new as i
think since my youngest is four yearsold but they bring in tape recordings so that you can tape record the heartbeatof your baby from your sonogram and then you put it inside a bear yeah that'ssomething that meeting idea and then you put it inside a bear is a gift to thebaby to the baby little door no nice really that technology one little gifts but somethinginteresting to do that i'm actually looking into is and i don't know thatmuch about it yet i'm just learning about it is genetic testing forpsychiatric medications so there's a genetic test that you can do reversereally see what medication will help
them like in terms of kids with a ddthat's a lot of trial and error what medications going to work at what thoseif you can there be there is literally myself a little bit yes so they canactually do a pretest is now one thing that made no sense something regardingsome yeah they wouldn't exactly so some medications at a specific dose will bebeneficial and that a difference will give you an adverse reaction of somegroups medications are not going to work it up for you at all because of thespecific genetic receptors that you have we mentioned genetics and obviouslythat's a big part of you know what you guys are looking at when you're comingthrough
you know the pregnancy & and looking atthe family history and uh and you know the test that women usually have to gothrough there's a lot of you know not controversial but ok what ages theywanted an amnio should we do an amnio sure there's another test after my methat they do earlier than avenue the gps yes organic telopea so and then you knowwhich one safer which one do you recommend everything is a whole lot ofnon-invasive pregnancy test that people are doing now and people how do you feelabout the cuz i thought my kid's head will not start moving with the idea whatyou're talking about that's what i think you know everythinghas come a long way and to do all these
non invasive testing an earlier timeeven then the chorionic villus sampling is fabulous just because you can getwith more sensitivity and specificity and that are you know so better clarityin terms of finding out the more frequent genetic abnormalities meaningthings like trisomy 21 which is commonly known as down syndrome or other morecommon disorders like trisomy 18 and 13 which are also has comp not as commonbut more frequent like down syndrome in addition to the two sex chromosome soeverybody kind of wants to know about it find out the jet there but in addition to the genderthere's some very vital information in
there so you can find out those threechromosomal abnormalities in addition to the gender and so all of that can happenat a time that's earlier than you know both cvs and and the amniocentesis whichis a little bit later on in pregnancy so having those non-invasive pregnancytests or ni pt's has really remarkably changed our genetic testing andcounseling for patients so the still recommended to do those procedures oryou wer it depends so these non-invasive pregnancy tests are really done forwomen who are going to be what we call advanced maternal age at the time ofdelivery so over the age of 35 or if something else triggers the need to dothat kind of testing so something is off
on a sonogram or something about theirhistory is republicans age that you kind of gauge yeah you just really exactlyexactly and you could do it pretty early the problem is sometimes you don't getenough it's basically testing fetal cells and maternal blood so you could doit pretty early sometimes you don't get sufficient cells so we typically runinto the scary thing for parents to start learning all these things and thenbut you know what i personally went through this and you know my daughterhad trans reciprocal relocation and i was like what like what right do sowithout knowing the knowledge of it and you know and then getting the facts inlearning about ok exactly what it is and
what the possibilities are orange andthe statistics are in orange it's it's a frightening for parents and you knowpeople that are even myself being in the healthcare field the light i had no ideawhat they were talking about sounds like a lot all about it so it's but that'sthat's the beauty of having you know more than one doctor as a team and andkind of talking about things and looking at statistics and right here big scarywords and we don't even know what does that equate to long-term i know what isit means how will that affect you or how will that affect her right and so tellus the best part about you know what are you guys in the delivery room togetheryou could you get the call right now
going to the nursery to see the babieslook like the highlight of my day was with the moms and dads are so excitedthe babies so you know this isn't your initial checks like after the time andwe examine the baby measure the head circumference checking from head-to-toego to the moms room dr. karen exactly tell them how the baby's doing make surethat feeling is going well babies doing all the things that they're supposed todo basically peeing and pooping and eating ebony when people give you backyour environment that was like just keep by then the relationship just keepsgoing on and on everything's working together so very closely
well that's nice that you guys have aprofessional relationship and pediatrician and obgyn working closelytogether i mean obviously between your two specialties we can do anotherhalf-hour show with you and i have really have one half hour tonight toshare between the two of you so i want to thank you both for coming on the showand i think you know the the main thing that we touched on earlier on it withzika virus is obviously awareness education not panic and just just opencommunication with your doctor's let me know while you know possible exposureshas there been any contact as anyone travelled are there any symptoms andjust just be pragmatic about it and get
a good night's sleep and one should beok right thank you for coming on the show thank you i want to say thank you forwatching dr. alan siegel health like you and we will see you at our next show thanks again
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