Women Physician’s Voices Count in Prenatal Alcohol Exposure Awareness

The first female physician in the United States, Dr. Elizabeth Blackwell, would turn 196 today.  In her honor, a group of physicians established February 3 as National Women Physician’s Day.  Inspired by her maverick spirit (after all, how dare a woman in the mid-19th century think she could be a doctor?!) and participation in the recent Women’s March, I envision a paradigm shift when we female doctors are going to end the ignorance surrounding prenatal alcohol exposure.

As a pioneer in medicine who graduated medical school in 1849, Dr. Blackwell may well have been at the forefront of the Temperance Movement, which occurred in the late 1800’s to early 1900’s.  At that time, medical doctors understood the devastating effects of alcohol on reproductive outcomes, low birth weight, prematurity, child/family mental health, and infant/child morbidity and mortality.  Public health statistics abounded, fueling the fire for Prohibition in 1920.  What a pity we lost all that knowledge after its repeal in 1933.

At that time in history, mostly men called the shots in society because they were the main holders of wisdom in science.  Professional papers were written, published in high brow journals, read by a handful of intellectuals and scientists, then put on shelves to collect dust.  There was no Internet for information sharing.  If one did not make it to college, medical school, or professional school (i.e., law school, doctorate programs, etc.), then most scientific advancements and knowledge about medical matters were hidden within academic institutions.

Today, only those of us motivated, bright, and resourceful can endure the rigors of 4 years of college, another 4 years of medical school, and another 3-6 years of residency in our desired field.  In many ways, our knowledge is as hidden from plain site as ever.  One of the key areas of my interest has been in raising awareness about the leading known and preventable cause of neurodevelopmental disorders, birth defects, and developmental delays – which can occur as early as the third week after conception.  Since this time frame is often before a woman may know she is pregnant, our society can and must do more to encourage sexually active alcohol consumers to contracept  to avoid unintentional exposure of their offspring.

It is my hope to help childbearing age alcohol consumers understand that they should stop using alcohol if pregnant or planning a pregnancy and to use contraception until they have stopped using alcohol.  Their partners should support them in this effort – after all, it takes sperm 3 months to develop, and alcohol methylates the sperm DNA.  These methylation effects last for several generations, passing silently through the genome into unsuspecting offspring.

Theodore Geisel, also known as Dr. Seuss, once wrote – “Unless someone like you cares a whole awful lot, nothing’s going to get better, it’s not!”  Unless we speak up about what we know about prenatal alcohol exposure happening early in pregnancy so the lay public understands, people will not hear our message.  As a change agent and spirit sister of Dr. Elizabeth Blackwell, I am determined to get this message across.

Susan D. Rich, MD, MPH, DFAPA

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BSTS Talk Show – FASD Awareness Day

What’s the best way to promote awareness about ND-PAE?

Join us as the BSTS interns discuss last years FASD Awareness Day, where they kicked of the condom campaign by passing out condom bookmarks at the Barking Dog Bar in Bethesda, MD. This was to promote awareness of the dangers of prenatal aochol exposure even prior to pregnancy recognition.

If you are planning a pregnancy, avoid alcohol, and if you are drinking alcohol, avoid pregnancy!!

“Prince George’s County Maryland – An Opportunity for FASD Awareness”

Last summer, local attorney Evan Wilson had a “light bulb moment” during Dr. Rich’s presentation in Prince George’s County, MD on June 20 about FASD and the law. Dr. Rich and two of the “BSTS change agents” met with him to discuss his perspectives about the role of the judiciary system in identifying and assisting individuals affected by FASD. As a juvenile delinquency attorney, he represents indigent minors in court who cannot afford to pay a lawyer. As Assistant Public Defender in PG County, he sees his job as educating the court about his client as a whole and not solely focused on a “snapshot” of the person’s life. Like the age old question – “Do we look at the crime or the individual?”, public defender Wilson sees the importance of making the court aware of challenges they face in their lives. “If you look at a person they are more than one event, they have a whole life behind them.” He emphasizes the importance of the right treatment protocol for a successful recovery to prevent recidivism (future delinquent acts).  He believes that further education and awareness in the PG County court system to be able to appropriately intervene in the lives of adolescents and adults affected by FASD.

Raising Awareness About FASD

Dr. Susan D. Rich has given Grand Rounds at the University of Minnesota Department of Psychiatry on November 12, 2014 and at Georgetown University Medical Center on Tuesday, January 6th about the topic of Neurodevelopmental Disorder associated with Prenatal Alcohol Exposure (ND-PAE), the diagnostic term in DSM-5 for Fetal Alcohol Spectrum Disorder.

In an article in Psychiatric News in 2005, Dr. Rich said:  “I was furious when I first heard the term ‘funny-looking kid,’ or FLK, almost 12 years ago. A rural pediatrician was describing how doctors overlook the possibility of fetal alcohol syndrome (FAS), the physical and neuropsychiatric effects of prenatal alcohol exposure. He said, ‘They look at the parents and say – `They’re pretty funny looking, too.. .so, I guess it’s genetic.’ My passion for prevention of alcohol-related birth defects has been fueled by such attitudes.”

Dr. Rich has been speaking widely about her clinical work with patients who have ND-PAE and the clinical link between autism and FASD. In November, she also spoke at the Minnesota Organization on Fetal Alcohol Syndrome’s annual conference: “FASD and Human Rights.”  During October, she chaired an all day Etiology, Diagnosis, Treatment, and Prevention in an Era of DSM-5 at the American Academy of Child and Adolescent Psychiatry annual conference in San Diego, California.

DSM-5 includes the diagnosis of “Neurodevelopmental Disorder Associated with Prenatal Alcohol Exposure” (ND-PAE) under “Specified Other Neurodevelopmental Disorders” (315.8). The Centers for Disease Control and Prevention estimates that as many as 1 in 20 (or 2-5%) of school aged children in middle class communities have some degree of this preventable disorder. Up to 85% of individuals with ND-PAE have a lifetime prevalence of moderate to severe mental illness.

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The Story of 10 year old Annie Who Lives with FASD

Recently, states have been restructuring the departments of health and human services to provide more comprehensive, consolidated care in a systematic way rather than through disjointed bureaucracies of the past half century.  Departments of Mental Health, Public Health, Substance Abuse Services, and Developmental Disabilities – all essentially serving the 12% of the population in the socially disenfranchised underclass – are being reorganized to provide a holistic approach to better serve the underserved populations and disadvantaged.

With change comes concern that even the best intentions may lead to more people falling through the cracks. One mother is fighting to raise awareness about the risk that children like her adoptive daughter with FASD will be lost in the remodeling of health and social service agencies.  “Her little world got robbed. She doesn’t experience things like everybody else does.”

http://www.kfdm.com/shared/news/top-stories/stories/kfdm_vid_12607.shtml

Let’s all join our voices together to ensure that this restructuring actually helps to fill the gaps between service agencies by eliminating some of the bureaucracy and make it easier for families to access services.

Save the Date – Open Door Book Reading and Signing in Bethesda, MD

Event Details
Martha Collins and Mary Evelyn Greene
Sun, 23 Nov, 2014 2:00 PM – 4:00 PM 
Martha Collins reads from Day Unto Day. She is joined by Mary Evelyn Greene, author of When Rain Hurts. The reading will be followed by a reception and book signing.

Martha Collins is the author of Day Unto DayWhite Papers,  and Blue Front , a book-length poem based on a lynching her father witnessed when he was five years old. Collins has also published four earlier collections of poems, three books of co-translations from the Vietnamese, and two chapbooks. Both White Papers andBlue Front won Ohioana awards. Blue Front also won an Anisfield-Wolf Book Award, and was chosen as one of “25 Books to Remember from 2006” by the New York Public Library. Collins’ other awards include fellowships from the NEA, the Bunting Institute, the Ingram Merrill Foundation, and the Witter Bynner Foundation, as well as three Pushcart Prizes, the Alice Fay Di Castagnola Award, a Lannan residency grant, and the Laurence Goldstein Poetry Prize.

Mary Evelyn Greene, Senior Managing Attorney with the Environmental Integrity Project, adopted two IMG_3401toddlers from Russia in 2004. Ever since, she has devoted herself to improving her alcohol-exposed son’s conditions, publishing articles in Adoptive Families Magazine and Adoption Today along the way. She is a contributing author to Easy to Love but Hard to Raise (2012), a collection of stories written for and by parents of special needs kids. She currently lives in Silver Spring with her husband and children. When Rain Hurts is her first book.

Location: The Writer’s Center
4508 Walsh Street
Bethesda, MD 20815
Fees: Free admission
Contact: 301-654-8664 or post.master@writer.org
Calendar: Workshop & Event Calendar
Category: Open Door Reading
As part of the BTST Book Club series Dr. Rich and her change agents were very fortunate to be given the opportunity to sit down with Mary Greene and talk with her about her journey of adoption and the struggles and joy she and her husband have experienced since then.
From discussions about her son’s disruptive behavior to learning about and dealing with his FASD-related special needs, she opens up her life in a very honest and touching way.
“When rain hurts” by Mary Greene
Her book has inspired us and will hopefully motivate others to change their lifestyle behaviors before, not just during, pregnancy.