About me

I am an OB/GYN and a pain medicine physician. I authored the book,The Preemie Primer, a guide for parents of premature babies.

In addition to my academic publications, my writing has appeared in USA Today, theA Cup of Comfort series, KevinMD.comEmpowHer.comExceptional ParentParents PressSacramento Parent, and the Marin Independent Journal.

I also am fascinated with social media and how we can use it to build a better Internet. I’ve written about Twitter, on-line reviews, and why I think doctors should blog.

I was born and raised in Winnipeg, Canada and graduated from The University of Manitoba School of Medicine in 1990 at the age of 23 (I started young). In 1995 I completed my OB/GYN training at the University of Western Ontario and moved to the United States to complete a fellowship in infectious diseases at the University of Kansas. After completing my fellowship I continued my studies in pain medicine. I am board certified in OB/GYN in both Canada and the United States. I am also board certified in pain medicine by the American Board of Pain Medicine and by the American Board of Physical Medicine and Rehabilitation. That’s why I have so many letters after my name.

Jennifer Gunter MD, FRCS(C), FACOG, DABPM

Discussion

186 thoughts on “About me

  1. Hi Dr. Jen!

    I’ve read several articles that you’ve written on the “abortifacient” qualities (or lack thereof) of the Mirena IUD. I’ve been obsessing about the “evidence” that some groups, mainly religiously affiliated groups, say they have for Mirena’s ability to prevent implantation of a fertilized egg (if the egg even ever gets fertilized in the first place). You’ve also mentioned the potential for miscarriage. I’m obsessing about what some are calling “embryonic deaths”. I’m just not sure if one can call a fertilized egg “life”….considering that more than half of fertilized eggs fail to implant “naturally”. I would love to see what studies you reference. I trust your medical background, but I’ve developed an unhealthy obsessive complex over fertilized eggs and the 2 years my wife had a Mirena IUD between our two kids before my vasectomy. Any help you can give me would be GREATLY appreciated. Thanks so much!

    Posted by Keith Zeise | January 26, 2017, 2:22 pm
  2. I saw your interaction with Dr Dude online. I’m not media savvy but saw on his FB page his main medical practice was in radiology…. we know how much he actually dealt with patients…ZERO. I’m a disabled RN because a highly respected hospital could not diagnose my severe weight loss over 10 month period. But they did take me off my IBD medication worsening my condition to include adult failure to thrive and osteoporosis. My body was literally eating itself. Anyway, health care, insurance, and big Pharma need fixed. Price of epi pens? Narcan? Shortages of resuscitative drugs? Please!!!! Lastly, people who cuss have been proven to be honest!!! ✌🏻

    Posted by Carol | February 3, 2017, 11:52 am
  3. Dear Jen,

    I came across your site while looking for data to my sister (who lives in another state)about Trump apparently writing his own Dr. letter, and in reading your impressive background, saw that you have experience in pain management.

    I am hoping that my finding your blog is a fortuitous coincidence for me. I am trying to find evidence to deliver to my own Pain Dr’s nurse practitioner to show that the new drug Movantik can produce false positive urine tests for hydromorphone, before it is too late.

    I am hoping that you may have already encountered a situation where urine tests performed by “Millenium Laboratories” appear to be unable to distinguish the new OIC drug Movantik from hydromorphone, or have spoken to another physician who has encountered the same thing, or perhaps know of a resource I could reach out to to help find proof that this is the case.

    I have called the FDA, Astra-Zeneca, and others that they have suggested I contact, with no success so far, and cases they have opened won’t even start to be investigated until it is too late for me to remain in my Dr.s pain management practice.
    (Somewhat Twilight-Zone-like, of those I called, Millennium was the only one that would not even try to answer any question I posed, instead deflecting even the simplest of any question I tried to ask, until the question was “How can I get a copy of this recording?”, at which point the person on the other end put me on hold for two minutes, and asked me for a callback number when she returned).

    [ This Monday afternoon, when I see my electrophysiologist at UCLA (a periodic followup for a succesful atrial flutter repair via ablation a few years ago) I will try to see if there is a pharmacologist there who might be willing to speak with me about this, but I’m just barely not holding my breath]

    Because the Nurse Practitioner has repeated the same test multiple times, with no change in variables, (but somehow hoping she can tell me the results were different) I have a short time frame left. (I’ll be seeing the Dr. himself a week from now regarding a urine test I was administered just before beginning this investigation a week ago, and barring some miracle, I expect he will “discharge” me).

    I know that P.M.physicians may feel a patient could say anything on their own behalf, and the environment in which they have to practice these days leads them to feel themselves up against inordinate pressure to protect their licenses, so finding proof that the urine positives are indeed false positives soon is likely the only thing that will vindicate me, keep me from being discharged, and keep me from being “branded” as unwanted in any subsequent practice.

    Below is a brief summary of my reasoning for believing that naloxegol is the culprit. Would you, or perhaps one of your readers, be able to suggest additional resources I have not considered?

    While trying to research this on the web (which is not easy, as my field before retirement was computer science, not pharmacology), googling for variants of “false positive” led me to an article at the US National Library of Medicine (US-NLM) which ended with the conclusion:

    “clinicians should be aware that the commonly used opioid antagonist naloxone can produce false-positive opiate immunoassay results.

    That was the first interesting hit I found, as available literature stated that naloxegol is essentially “PEGylated” naloxone (naloxone with the addition of a very short bit of polyethylene glycol, serving to inhibit passage across the blood-brain barrier). Looking further, I found an article in the Journal of Biochemical Chemistry that was mostly greek to me, but contained structural images on it’s last page showing just how close the structures of naloxone and hydromorphone are to each other, independently seeming (at least to my layman’s eyes) to provide support for the conclusion drawn by the US-NLM article.

    It seemed possible, then, that the same conclusion about naloxone might also apply to naloxegol, although I have not found an irrefutable reference for this as of yet.

    I’m assuming that an antibody designed to match surface features that distinguish hydromorphone from other opiates could also match features of a more recently introduced molecule, naloxegol, bearing those same features.

    Thinking about this in computer science terms, unlike antibodies produced naturally to key on specific antigens (in an environment where an antibody is being used to match one of a fairly small subset of members of a huge, but sparse domain), as far as I can tell, antibodies produced in the lab do not have the luxury of being tailor-able “at run-time”, and so must act similarly to search functions for “hash buckets” in Computer Science.

    Trying to search a huge domain when the range of possible values is sparse can be an enormously expensive task, so one can instead use an algorithm (called a “hash algorithm”) which assigns (or retrieves) values to or from a limited number of “buckets” that can each hold the specifications or values of several interesting members of the sparse sets, related by the design of the hash algorithm).

    A bucket can hold several different values, so once a search has “hashed” to a particular bucket, a “distinguishing function” can do the rest of the work, identifying the correct member within the bucket . Yes, there are two lookups done, rather than one (first the hash lookup, then the differential), but the cost doing it this way can be many orders of magnitude less than the alternative. The only “serious gotcha” is that the “distinguishing function” must have been designed to consider all possible values that could have led one to the hash bucket in question, otherwise one could get “a wrong answer”.

    Given the number of opioid-ish molecules with surface features similar to hydromorphone, I would wager that a procedure similar to that used in “hash lookup” mechanisms may already be used by the urine tests, but that it had not occurred to test designers yet to add a function to distinguish (the completely unscheduled) naloxegol from it’s older cousins.

    (One hope I have is that there may be a different kind of test that does not need to use what I am calling a “distinguishing function” if something like that is even used by the type of test I have been administered).

    Posted by Michael | February 6, 2017, 1:23 am
    • Dear Jen,

      I don’t know the degree of relevence, but as I was starting to coalescing a list of published items I had found, I also found and just added an abstract about circumstances of GS/MS false positives to the others. If appropriate and accepted in the moderation process, could you keep it together with my previous posting?

      – Thanks

      Desperately (and more so, day by day) looking for reports of false positives for opiates (especially hydromorphone) being reported in those taking nalexogol (sold as Movantik), as has been reported in those taking naloxone (a non-PEGylated naloxegol, (to say it backwards)).

      Ref:
      The article “https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2975969” at the US National Library of Medicine ends it’s discussion with the conclusion
      “clinicians should be aware that the commonly used opioid antagonist naloxone can produce false-positive opiate immunoassay results.”

      I’ve also noted the substantial similarity between the structures of hydromorphone and nalexogol as displayed in in the wikipedia pages:
      The last page of the article http://www.jbc.org/content/268/21/16059.full.pdf
      in the Journal of Biochemical Chemistry shows comparable similarity between hydromorphone and nalexone
      (also noting slight “style preference” difference between that Journal’s drawings and ones in Wikipedia pages)

      Bearing in mind that I’m not a chemist, and much of this is over my head,
      could this have any relevance:

      Ann Clin Lab Sci. 1995 Jul-Aug;25(4):319-29.
      Mechanism of interferences for gas chromatography/mass spectrometry analysis of urine for drugs of abuse.
      Wu AH1. Toxicology Laboratory, Hartford Hospital, CT 06102, USA.

      “Abstract:
      Although gas chromatography/mass spectrometry (GS/MS) is recognized as the definitive procedure for confirming positive immunoassay screening results of urine for drugs of abuse, targeted GC/MS analysis does have limitations.
      [ . . . a brief mention of false negatives, then back to . . . ]
      False positive results can also occur through a number of mechanisms. Two substances with the same mass spectrum require gas chromatographic conditions that enable adequate separation of the compounds prior to MS analysis. In the case of optical isomers, special columns or derivatives must be used for identification and quantification. The widespread use of selected ion monitoring may further limit GC/MS assays. Drugs that produce similar high molecular-weight mass fragment ions could potentially interfere if they have similar GC retention times and if inappropriate ions are selected for monitoring. The conversion of one drug to another by the GC/MS instrument itself is a particularly insidious problem.”

      Poster’s comment: Might hydromorphone and nalexogol count as two substances that substantially share the same mass spectrums?

      Unfortunately, I only “grok” part of that Abstract, but obviously, I’m wondering if the similarity of the hydromorphone and nalexogol structures as mentioned above might also extend to similarity of their mass spectrums (or conversely: might the presence of the very short PEG chain throw off mass spectrums commonality by a noticable amount, or again alternately: might the little PEG segment get separated and/or discarded during later processing or perhaps via interaction with any of the eight other medicines I’m presently prescribed???):

      Posted by Michael | February 6, 2017, 3:58 am
      • [I tried posting this a fewminutes ago, but it seems to have gotten lost (no copy with comment about awaiting moderation) – apologies if it appears again ]

        P.S. After writing the above, I came across an article stating that naloxone is a “structural analogue of oxymorphone”. Since two different molecules, both present, cant both be oxymorphone, could this be a source of confusion for the GC-MS technician, who needs to make a distinction?

        Would I be correct in making the uneducated guess that subsequent to the ionization process, the active portions of naloxone and naloxegol would be identical, making the previous paragraph have the same truth value if the compound naloxegol is substituted for naloxone in the first sentence?

        I think I’m very near to losing my Dr., as I couldn’t convince him that there would be any importance to reporting to Millennium the fact that I’m taking Movantik or any of the meds (all of which he has in my chart) Rx’d by other doctors, and I’m afraid that without knowing what other drugs I’m taking, they will again report detecting hydromorphone despite [ fentanyl, oxymorphone, and naloxegol ] being the complete set of opioid drugs present.

        The net result of that would be “discharge” and the concomitant need to find a new physician despite the stigma of being discharged hanging over my head.

        So, if anyone reading this can point me toward any definitive documentation that could help with this issue, or suggest some way to resolve it, I would be greatly appreciative.

        Thank you

        Posted by Michael | February 19, 2017, 11:07 pm
      • Update: I saw the doctor, and although he is not convinced that naloxegol is what is being reported, and still does not believe it is of any importance to tell the lab about non-pain meds, he agreed to prescribe two weeks of Relistor in place of Movantik, and call me in at a random time for another test.

        I have my fingers crossed, but (at least in wikipedia) the main part of the relistor molecule looks much like main part of the movantik and dilaudid molecules, so I am worried that the same thing could happen with methylnaltrexone as it did with naloxegol.

        On the other hand, methylnaltrexone is a much older molecule than nalexogol so there may be a greater chance that it’s spectral signature is present in the MS library the lab has.

        Again, if anyone reading this can help direct me towards a solution, I would greatly appreciate it.

        Posted by Michael | February 19, 2017, 11:30 pm
  4. I am concerned about pediatric transition of self diagnosed trans teens. There isn’t evidence in favor of early transition but there is a lot of political weight in favor. Meanwhile there is a growing community of detransitioners who feel harmed by having been encouraged to medically transition. Is this something you could speak to?

    Posted by Lisa Marchiano | February 26, 2017, 5:45 pm
  5. I just discovered your blog!!!! Yes!!! If only Safari will let me subscribe! I’m am still a fish outta water..lol about to start residency, also I have begun blogging about medicine (still very early stages), but my focus is on forgotten diseases/tropical diseases/ and health disparities. Awesome blog!

    Posted by Kemz | April 26, 2017, 6:00 pm
  6. Hello,

    I always end up shaking my head whenever I read about GP/goop/jade eggs on your blog. Today I clicked through to Leyla Martin’s website so I could shake my head at her too. I was quite horrified to read a claim by her that jade egg practices can heal the trauma of sexual abuse. Isn’t there a trading regulation against profiteering from that kind of horrific experience? Not to mention the obvious hocus pocus bs that it is.

    Just wanted to add that to the already ridiculous ways in which goop et al are taking advantage of women. I read it here: laylamartin.com/programs/jade-pleasure/

    Posted by A | May 24, 2017, 1:47 am
  7. Dr. Gunter, I’d like to subscribe to your blog but when I click on subscribe it doesn’t work. Any ideas? Thanks

    Posted by Sandy Rosen | May 24, 2017, 1:01 pm
  8. Thank you for having the courage to call out Ms Paltrow. Her machine seems to be able to shut down any professionals that expose the frauds and Self Appointed Experts in her posse. People with celebrityitis need guidance and science based information.
    You go girl!
    Tired of the “Poop”

    Posted by Lea Contissimo | May 25, 2017, 11:44 am

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