Group B strep
DEAR DR. ROACH: My daughter tested positive for group B streptococcus while pregnant with her first child, who had no medical problems after delivery. She’s almost 36 weeks along with her second and just tested negative for GBS.
I’ve read that a carrier can test positive some times and negative others, but if she’s been positive once, wouldn’t any pregnancy actually be at risk? What is the usual protocol in this type of situation?
ANSWER: Group B streptococci are a type of bacteria commonly found in a pregnant woman’s vagina, rectum or urine. It can predispose the infant to serious illness, including meningitis, sepsis and pneumonia.
For this reason, women are screened between weeks 35 and 37 of pregnancy, and those who test positive are treated with antibiotics during delivery to protect their child from illness. Antibiotics reduce the risk of GBS-associated disease from 1 in 200 to 1 in 4,000.
A woman, like your daughter, who has been positive in the past may be at higher risk for being positive again, but since she is negative, her child is not at an increased risk and she does not need the antibiotics.
However, women whose children had early GBS disease, or who had a positive GBS culture of urine anytime in pregnancy, still should receive the antibiotics.
DEAR DR. ROACH: What I want to see is a chart of bone density results for a 70-year-old white woman, to gauge where my results are in comparison.
Am I normal for loss, or higher or lower than normal for bone loss? I’ve searched for this, and every time, I’m compared to a 30-year-old!
Of course I have lost bone mass; that’s life. My sister’s results are from a different doctor, and we can’t even compare ourselves!
ANSWER: There are three ways that bone density results are reported. One is called the absolute bone density, and it is given in grams per square centimeter.
This number varies depending on the machine, and one machine cannot be compared against another. However, the two other numbers are designed for easy comparison.
The first is called the T-score, and that is the one that compares you against a healthy 30-year-old woman (men get compared against healthy young men).
Bone loss does go down with age, so a 70-year-old woman is expected to have a negative T-score, meaning that she has less bone density than a 30-year-old.
The definition of osteoporosis can be made by T-score, with a result below -2.5 putting a woman at high risk for fracture.
The second score is the Z-score, and it is less known, but that’s the one that compares you against other people of your age and gender.
If you have a Z-score of zero, that means your bone loss is as predicted for your age. A very negative Z-score suggests a reason other than just age for bone loss, such as vitamin D deficiency.
Ethnic background also has an effect on bone density: Black women tend to have higher bone density results than white women (about the level of white men), and are at lower risk for fractures.
Of course, there are large differences among individuals within an ethnic population as well as differences between populations.
DR. ROACH WRITES: A recent column about a woman with breast cancer who waited six months for a primary care appointment, unable to speak to her doctor directly, generated some letters.
Most of these concerned my naivete about how hard it is for a patient to speak with his or her physician or get a timely appointment in 2018.
Others asked a very reasonable question: If the woman couldn’t get through to get an appointment, how could she talk directly to her doctor to clear up the misunderstanding?
A colleague of mine, Dr. Will Harper in Chicago, posted some excellent advice on my Facebook page (facebook.com/keithroachmd) that I wish I had said: In this particular case, the patient could have had her oncologist call the doctor’s office.
As naive as I might be, I know that doctors take phone calls from colleagues very seriously, and I bet this suggestion would yield rapid results.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to To Your Good Health @med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.