In the first case-based class of medical school, students are asked to answer a virtual patient’s question about the development of the fetus. These students are smart and they know all about betaHcG and are anxious to showcase their knowledge of the menstrual cycle with fluctuating levels of various hormones (FSH, progesterone, etc.). Yet one question brings confusion, “How pregnant is this woman?” The related question, “When does pregnancy start?” leaves the students flummoxed. Is it at conception? But how do you know when that happens? Or does implantation make more sense? It’s a great example of how detailed facts need the larger context.
The usual dating is gestational age, based on the first day of your last menstrual period. However, you can also date a pregnancy with embryological age, starting at conception.
How you date a pregnancy can depend on your perspective. My very general guideline:
Pregnant woman is the focus = gestational age (e.g., obstetricians) 1
Focus on embryological/fetal development = embryological age (e.g., developmental biologist) 2
But why are there two types of dates? We might need a bit of a primer on the menstrual cycle and how it relates to pregnancy.
Implantation happens between days 20 and 22. Pregnancy is often detected after the first missed period.
This graphic is intentionally simple, removing all the hormones and other fun stuff (Ed: which you can find here). You’ll note that it says approximately day 14 and day 28. In textbooks, we often see that women have 28-day cycles and everything has a nice schedule. However, women are not textbooks and sometimes have shorter or longer cycles and/or have ovulation at slightly different times. Therefore, knowing when fertilization and conception happen can be a bit tricky. An obvious marker is the first day of the last menstrual period (LMP). Why the last day? Well, another variable is the length of menses but everyone has a first day so to be consistent, that is the marker used.
We generally use gestational age when discussing pregnancy. So when someone says that they are 8 weeks pregnant, they mean it has been 8 weeks since the first day of the LMP (last menstrual period).
But that means that the first two weeks of pregnancy has nothing happening. If you are concerned about development, you don’t start counting at week 3 but start at the time of fertilization, two weeks later. Therefore, the embryological age is generally two weeks later.
But remember, we have essentially picked gestational age as the convention for discussing pregnancy dates. If there are markers in development to suggest that the embryological age is different (for example, the fetus is 12 weeks, not 13 weeks), the gestational age is often reported to the mother. In our example, the dating would be changed to 14 weeks.
Due to the difference in these dates, we see confusion beyond medical students thinking about this for the first time. It was recently reported that Arizona had changed its abortion law to be the most restrictive – but it hadn’t. It had just joined other states in making the limit 20 weeks gestational age. Remember, this is the accepted convention for pregnancy dating – but many articles picked up on that initial two weeks of nothingness in gestational age and confused it with embryological age. Was this an example of details without understanding of the greater context?
Synonyms include developmental, conception, and fetal age. ↩
Opinions expressed in this piece are those of the author and do not necessarily reflect or conflict with the opinions of DXS editors or contributors.
Dr. Catherine Anderson is a Clinical Instructor for the Faculties of Medicine and Dentistry for UBC in Vancouver, Canada. She also leads the Future Science Leaders program, helping teens excel in science and technology. She received her PhD in Medical Genetics and has spent the last 10 years helping people understand the biological sciences: the information and the impact on our lives. You can follow her on Twitter @genegeek.
It started a few months after I had my second son. A pain. Sharp, unrelenting, abdominal. Occasional blood from a place where blood isn’t supposed to appear: the rectum. There. Got the R-word out of the way. After I had laparoscopy for presumed endometrial scarring as the cause of the pain, the pain nevertheless persisted. So, I was referred to a gastrointestinal (GI) specialist, or gastroenterologist. The GI doc I saw first was a man who, I later, discovered, was the GI doctor for my uncle and my father. They loved him. There probably was a sort of “hail fellow well met” male camaraderie between doctor and patient there that made them sympatico. Me, not so much. He looked at me, looked at my age (36), and decided that all I needed was to take some ibuprofen. He literally sent me home with instructions to take some ibuprofen a few times a day and call him, not in the morning, but maybe in a couple of weeks.
Two years later, after more episodes of blood in the toilet, continued pain, and, pardon me, but I think this information is important, a whole lot of mucus coming out of there, I went to another GI doctor. For whatever reason–even though my symptoms weren’t necessarily a match for colon cancer, even though I didn’t, to my knowledge, have any risk factors for colon cancer, even though I was still quite young to have colon cancer–he decided to do a colonoscopy. As I emerged from the anesthesia after the procedure, I saw my GI doctor talking with my husband. “How did it go?” I asked, groggy. He sort of smiled at me and said, “You’re not going to remember any of this, but those symptoms you had saved your life.” Unbeknownst to him, amnesia meds don’t work on me–I’ve had ample subsequent opportunities to test that hypothesis–and I did remember it.
How did it save my life? What they found in my colon, near where it meets my lower small intestine, was a large, flat growth, about two inches (5 cm) by one inch (2.5 cm). In GI parlance, it was a large, flat (sessile) polyp, which is not a good kind of polyp. Closer analysis of the thing after my GI doctor deftly removed it during a second procedure revealed it to be a tubulovillous adenoma with cancerous tendencies. In fact, my medical records from that doctor now say the word “cancer” on them.
Adenomas, the type of tumor this was, are “of greatest concern” in the colon. They come in three types: tubular, tubulovillous, and villous. The larger the size, the greater the cancer risk. Mine was large and on its way to becoming cancer. According to my GI doctor, I’d've been dead in another 5 years had I not had that colonoscopy and appropriate intervention. In other words, if I’d waited until the recommended age for a first colon cancer screening–age 50–I’d have already been dead for seven years. In fact, I would have died this year from colon cancer. My mind was saying, “This would have been It. This would have been the thing, in a different time, that would have killed me. My potential death was growing inside of me, and I managed to put a stop to it.”
It’s true: Colon cancer can be prevented Finding and removing polyps in the colon can prevent colon cancer from developing. But first, you have to have the screening. Because more than 90% of cases of colorectal cancer happen in people ages 50 or older, the starting age for screening is currently set at age 50. If you have symptoms like the following, though, don’t delay. If a GI doctor dismisses you as my first one did–that polyp of mine was probably growing in there for a few years–get a second opinion.
Blood in or on the stool (as I had)
Stomach pain or aches that do not go away (as I had)
Unexplained weight loss
A change in bowel habits (diarrhea, constipation, frequency)
A feeling of incomplete emptying
Colon cancer is associated with some risk factors. These include
Having previously had colon polyps or colorectal cancer yourself
A family history of polyps or colorectal cancer
A history of having inflammatory bowel disease (Crohn’s or ulcerative colitis; not to be confused with irritable bowel syndrome or IBS)
A family history of inherited disorders related to polyps of the colon
Of these factors, I thought going into my GI doctors that I had none. Only later did I learn that my father also had had some polyps found and removed, although of the more typical and less-threatening variety and at a later age (in his 50s). In addition, in the past year, my octogenarian maternal grandmother had a large colorectal cancer removed that had likely begun its evolution from a polyp years ago, but she had never undergone screening. I cannot stress enough how important it is for a family to share health history so that these risks can be known and for anyone to have appropriate screening either at the recommended age or in the presence of symptoms.
Speaking of family, there is my own. My having been diagnosed with a precancerous growth at age 38 means that my first-degree relatives–siblings, parents, children–should have screening at least by that age and preferably years before. There is some understandable reluctance to have a colonoscopy. Outside of the obvious ignominy of having someone shove a tube up your rectum while you lie anesthetized (I woke up during my second–yep, there’s a tube in there), there is the preparation for it. I’ve done just about every prep known to modern medicine, having now had five colonoscopies–all my follow-ups have been clear, and I don’t need another for four years now (!). Yes, they’re unpleasant, and they take quite a bit of willpower. You have to drink what they tell you, take the pills that they tell you, not eat when they tell you, and consume only what they say is OK. You’ll never want to see Jell-O or Gatorade again, and I can’t stare down a bowl of clear bouillon any more without feeling a tad nauseated. But the goal of a prep is a completely clean colon. The cleaner you get it, the more accurate your findings will be and the less likely you’ll have to do it again simply because you conducted–pardon me–a crappy prep. March is Colon Cancer Awareness month. Be aware and embrace the reality that polyps happen and that so far, finding them requires this daylong unpleasantness. But also embrace the fact that the prep won’t kill you. Instead, it will help you prevent a cancer that does, in fact, kill 50,000 people a year in the United States alone.
This year, five years after that first colonoscopy would have been the year I’d've been one of those people. Thanks to that procedure, I am instead alive and well enough to tell you about it, and my three young sons still have their mother. I’d starve for a week and drink Gatorade until I puked to make sure of that outcome. ————————————————————– By Emily Willingham, DXS Managing Editor
[Editor's note: We are pleased to be able to run this post by Dr. Kate Clancy that first appeared at Clancy's Scientific American blog, the wonderful Context and Variation. Clancy is an Assistant Professor of Anthropology at the University of Illinois. She studies the evolutionary medicine of women’s reproductive physiology, and blogs about her field, the evolution of human behavior and issues for women in science. You can follow her on Twitter--which we strongly recommend, particularly if you're interested in human behavior, evolutionary medicine, and ladybusiness--@KateClancy.]
Over the course of my training to become a biological anthropologist with a specialty in women’s reproductive ecology and life history theory, or ladybusiness expert, I have learned a lot about miscarriage. Only it wasn’t miscarriage, it was spontaneous abortion. Except that some didn’t like the term spontaneous abortion and used intrauterine mortality (Wood, 1994). Or fetal loss. Fetal loss is probably the most common.
There is also pregnancy loss (Holman and Wood, 2001). You can use that term, too. Oh, or aContinue reading →
[Editor's note: I was on Twitter, as usual, a couple of days ago, and started seeing tweets with the hashtag #SSCAbc. They contained information that I, an avid consumer of science and medical information, don't normally see addressed in breast cancer stories, including for young women with breast cancer and how to talk to children about having breast cancer. I've aggregated some of those tweets below, but you can read more at the hashtag here, which represents the Seattle Cancer Care Alliance, whose representatives were conducting the Twitter session.]
Anyone who watches TV, reads magazines, or flips through catalogs has seen some interesting products. Maybe they seem plausible to you, maybe they don’t. However, a little investigation shows they are based less on science and well…actually working, and more on wishful thinking. At worst they’re actual con-jobs, designed to separate you from your money as efficiently as possible (which I guess is a certain standard of success).
As a result, we at Double X Science are starting a new series: “As Seen on TV!” In these features, we’ll look at some of the products shilled on talk shows and infomercials, items lurking between the articles you read in magazines, or things you might find on the shelves of the stores where you shop.
Our first entry is one I spotted in SkyMall, the catalog you (if you’re like me) read if you forget to bring a book on an airplane. Where else can you find dog water bowls shaped like toilets or sports chairs built deliberately too large for anyone, so you look tiny sitting in them? While the catalog is full of impractical items (to put it mildly), some of them go beyond that into the realm of…imagination. Yeah, I’ll call it that. It avoids potential lawsuits.
It’s the Aging Accelerator! With Magnets!
Here’s the idea: depending on which device you buy, you insert either a glass or a bottle of wine, and within 10 seconds! it ages the wine, with the unspoken assumption that this is desirable. (It also evidently works for whiskey, but I’ll skip that discussion in the current article.) Now, anything that promises to drastically alter something within 10 seconds! is probably suspicious to begin with, but that’s the part I’m going to leave alone. After all, magnets do work quickly, so if the device does what it claims to do, it’s quite possible that 10 seconds will be enough time for the magic to happen.
Well, it seems like magic to me. I went to a winery last weekend, and spoke to one of the vintners there (yup, that’s the name for ‘em). She told me that not all wines should be aged, and the reason has to do both with the way wine is made and how it is stored.
First, not all wine should be aged! All wines actually go bad over time, including many of the usual types you may see in the store. That time may be pretty long, but you don’t want to just buy any bottle, stick it in your basement, and wait 20 years to drink it – most of them won’t taste good. According to my source, the days are gone where you might buy bottles of wine and put them in a cellar for your children. (Who has a wine cellar now anyway? I live in a second-floor apartment!) Basically, my source tells me to ask an expert if you have any doubts, but basically all wine is sold today in a drinkable state – no aging is necessary or even wanted. (I can’t endorse it, but Wikipedia has a list of wines that can be aged, and possible ranges.) Earth’s magnetic field has nothing to do with the aging process, whatever the ad says.
Second, the reason some wines age better than others has to do with their chemistry: how much sugar is in the grapes and how much tannin content they have. Red wines typically are higher in tannins because the skins are thrown in with the flesh of the fruit – and tannins act as a preservative. Sugar also acts as a preservative, but it’s not as effective, so white wines (lower in tannins, higher in sugar) don’t keep as well.
The point I’m trying to make is that wine aging isn’t mysterious, either why it happens or how. I don’t have the “Aging Accelerator” package in front of me, so I can’t tell you if they give advice on which wines to put in it and which ones to avoid, but the picture shows both reds and whites. So let’s turn to the way the device is supposed to work: magnetism.
They certainly have one thing right: neodymium magnets are very strong! (Neodymium is one of the “rare earth” elements, found near the bottom of the periodic table, so sometimes you’ll see them referred to as “rare earth magnets”.) When I’ve used neodymium magnets for various experiments, two of them attracting each other pinched my fingers hard enough to create blood blisters.
Admittedly magnets can seem mysterious: understanding exactly how they work requires looking at electrons and atoms, which might seem a little out of the ordinary. However, challenging isn’t the same thing as magical, but some people seem to think that magnets are capable of all sorts of feats, from curing arthritis to – yes – aging wine.
How magnets actually work could be the topic of an “Everyday Science” post, but in brief: the way a material responds to a magnet is called its magnetic susceptibility. Some materials, like neodymium, are very susceptible, but most things aren’t, including the human body. (Some organisms such as pigeons use Earth’s magnetic field to navigate, but exactly how they do it is still not known.) I couldn’t find any particular data on the magnetic susceptibility of tannins or other molecules in wine, but my feeling is it’s not large. Tannins are big biological molecules – think DNA or proteins – and those don’t tend to be magnetic.
But here’s the deal: suppose tannins are magnetic. Why then would exposing them to a magnetic field age the wine? Simply putting a strong magnet near your wine would merely rearrange the molecules inside the liquid – it’s like stirring it, in other words. Obviously stirring something can change the way it tastes, since it can mix sediments in, but that’s not the same thing as aging.
So, let’s wrap up: why should we be suspicious of paying $60 or $100 for an “Aging Accelerator”?
The concept misuses a well-understood physical principle – magnetism. Just because someone doesn’t understand how it works doesn’t mean it can perform miracles.
The aging process is chemical, and we understand how that works – it involves tannins, sugars, and other molecules. There are no secrets, in other words, and nothing simple to make your wine taste better.
Basically, if it sounds like a magic trick, it probably is – but its main result will be to magic money out of your pocket.
We’ll see these kinds of rules repeated throughout the series!
Stay tuned for further installments of “As Seen on TV!”