Cost vs. Care? New Gynecologic Cancer Screening Guidelines
Okay, I give. I had promised that I wasn’t going to be just one more voice in the breast cancer screening debate. But when the US Preventive Screening Task Force (USPSTF) of the Department of Health and Human Services came out with revised Breast Cancer Screening and Pap Smear recommendations in one week, I could no longer sit idly by and say nothing.
Last week the USPSTF blew us all out of the water when they recommended that women no longer perform breast self examinations (BSE’s) and that annual screening mammography not begin until age 50. This is a huge departure from the previous guidelines promoted by the task force, The American Cancer Society and the American College of Obstetricians and Gynecologists which state that “women should perform breast self examinations monthly and that they should have clinical breast examinations by their physicians annually. Screening mammography should begin at age 40, be performed every 1-2 years and then be performed annually after age 50.”
Courtesy of BreastCancer.org
The Task Force concluded that BSE is not effective in reducing the incidences of breast cancer and that rather than doing BSE, women should just be “aware” of their breasts.” WTF??? How are you going to be aware of your breasts if you don’t know how they feel? Are women to rely solely on visible discoloration, dimpling or nipple retraction? What about non visible tumors, such as those that are close to the axilla (arm pits) that are typically only found on palpation? Many breast cancers in young women under 40 are found via BSE. Just before my 33rd birthday I found a cyst during a BSE. It actually bursted when I had a mammogram, but I found it initially myself. What if I hadn’t been doing BSE and it hadn’t been a benign cyst?
As far as the mammography recommendations go, the USPSTF states that for every 1900 women screened between the ages of 40 and 49, only one breast cancer is diagnosed. According to them, this small yield does not make the test worthwhile. However, the one breast cancer that will be detected out of 1339 women screened between the ages of 50 and 59, makes the test worthwhile. So what makes the life in the 50’s more valuable than the life in the 40? Their argument is that you have to screen more women in the 40’s to find a cancer and the rates of false positives, “unnecessary” biopsies and surgeries make the screening in this age population “not cost effective.” And with that statement, I think we have found the rationale.
Thankfully the American Cancer Society and The American College of Obstetricians and Gynecologists have flat out rejected these recommendations. Research studies have repeatedly demonstrated that breast self examination and annual screening mammograpy after age 40 saves lives. While the USPSTF may not be impressed at” just one life saved”, the families of those mothers, sisters, daughters, aunts, cousins, etc…are most grateful that their loved ones with breast cancer were diagnosed early and that many of them are alive and well today.
Later in the week news broke that Pap smear guidelines were also revised. The USPSTF now recommends that Pap Smears, the test used to detect cervical cancer, no longer be performed annually, but every 2 years and that the screening not be initiated until age 21. Previously the recommendation was that Pap Smears be initiated at age 18 or at age of first intercourse and then be performed annually but at least once every 3 years. Since cervical cancer is rare in women under age 25, the Task Force feels comfortable recommending that onset of screening not take place before age 21. Again their rationale stems from the fact that many women will have abnormal pap smears and be subject to potentially invasive screening and treatment and yet have no actual abnormality. In simple terms, It’s just not cost effective.
This makes me wonder, if Pap smears are of little benefit for women under age 25 because they are at little risk for developing cervical cancer, why the big push to vaccinate 11 year old girls with Gardasil, The “Cervical Cancer” vaccine ? If the task force is not concerned about screening for Cervical Cancer before age 21 (since it is rare in women under age 25), why not wait until a girl is actually at risk for “developing” cervical cancer and give her the vaccine at say, 18? Gardasil is designed to prevent young women from contracting 4 strains of the Human Papilloma Virus, two of which are known to lead to cervical cancer and two which cause more than 90% of all cases of genital warts. If we are so concerned about each of our young women becoming “One less” woman stricken with cervical cancer, doesn’t it stand to reason that we should do all that we can to be sure that they are healthy, including routine Pap Smears? The USPSTF does not differentiate between those young women who are sexually active and those that are not, they just issue the blanket statement that all women begin screening at age 21. Likewise, the recommendation for Gardasil is for all girls at age 11. But again, if cervical cancer is slow growing and highly treatable, is the vaccine really necessary? Why not just treat once disease is more likely detectable-that is what they are advocating for breast cancer, isn’t it? Seems to me that a “scare” tactic was utilized. Cancer scares people and fear sells.
More effective marketing would have been to market Gardasil as a prevention against genital warts. Each year women under the age of 25 account for the majority of new genital warts cases. Approximately 6.2 million new HPV infections occur every year in the United States and approximately 20 million individuals are currently infected. Some women are diagnosed via Pap smear and subsequent colposcopy or cone biopsy while other young women will actually present with lesions that can be excised and biopsied. Treatments for warts include cryotherapy, Tricloracetic Acid therapy, laser therapy and more invasive procedures such as Loop Electrosurgical Excision Procedures (L EEP). But with such readily available and effective treatments for genital warts available is there the same urgency to prevent genital warts as there is to prevent cervical cancer? Would consumers be willing to take the vaccine if marketed to prevent genital warts as opposed to cervical cancer? (Surveys show that less than 1/3 of young women in the appropriate age range for vaccination have actually received Gardasil to date.) To push consumers towards vaccination, something stronger was needed and cervical cancer became the “buzz” used to promote (push) Gardasil.
But I digress. Has anyone else noted that these two new recommendations, both calling for reduction in screening for gynecologic cancers, came just before the US senate was about to debate the Democratic Health Care Reform Bill which includes a public (government sponsored) option? Look, if the public option is accepted and the Democratic Health Care Reform bill becomes law, women who are currently uninsured and very likely not receiving any sort of cancer screening, as well as women who choose the government sponsored health insurance plan instead of a private (more expensive) insurance plan (such as Cigna, Blue Cross & Blue Shield, Aetna, etc…) will cause an increase in utilization of health care screening services. A government subsidized plan with see an increase in claims and subsequent payout while private insurance companies may very well see a decrease in revenues. More utilization of services with less profit. Hmmm…
I won’t profess to know the collective mind of the USPSTF and since I was not present during the review of the recommendations nor privy to the discussions, I won’t state that these recommendations are a means of cost containment in the event that Congress does pass a health care reform bill that includes a public option. But the timing is suspect. It behooves all of us to watch vigilantly as the health care reform bills are debated. The recommendations by the USPSTF may be the very means by which the government and private insurances deny women access to preventive screening tests. I am worried that women won’t receive screening mammograms and Pap Smears more frequently than the USPSTF recommends-even if their health situations dictate more frequent screening. I worry that young girls will be forced to receive a vaccine for which we have no long term data (side effect profile) and no proven long term efficacy. I am worried that young girls may later be denied treatment for HPV related diseases if they didn’t take the vaccine, increasing their morbidity and mortality. I worry that we’ll see an increase in the incidence of more deadly cases of breast cancer. No one can predict the future, but I am concerned that if these guidelines are enforced “One Less” may very soon become “a whole lot more”.
Add comment November 23, 2009
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Tags: breast cancer, breast cancer screening, Cervical Cancer, gardasil, genital warts, HPV, HPV vaccine, mammography, Pap Smears
Implosion Within: A Ruptured Ovarian Cyst
I woke up early yesterday morning to go to the bathroom. It was oddly annoying to be awakened from a sound sleep to move my bowels, but when nature calls….Shuffling back to bed I began to feel pain in my lower right side. “Perhaps I’m not done,” I thought and shuffled back into the bathroom. The pain increased. This was not coming from my bowels. Lying down was completely out of the question, so I meandered around my house for a bit, trying to find comfort. The more I wandered, the stronger the pain got until I finally climbed back into bed in a fetal position. When the pain became so intense that it was difficult to breathe, I woke up my husband.
“Something’s wrong,” I said. “I’m in pain.”
My husband sprang up from his sound sleep and after frantically groping for his glasses, began firing questions at me. “Do you need to throw up?” “Are you having diarrhea?” “Describe the pain; is it sharp, dull, does it move…”
While I realize that he was trying to be helpful, if I could have uncoiled from my fetal position, I would have belted him in the mouth. Instead I did my best to answer his questions.
“I’m taking you to the emergency room,” he declared. It was just after 6am by this point and I really couldn’t see making that arduous trip when my GYN’s office would be open in 2 hours.
“Look,” I said. “Get me one of the Vicodin I have left from my ablation. That will give me time until the doctor’s office opens. In the meantime, you’re going to have to get the kids up and out to school.” There were grumbles at the mention of managing the kids solo, but my husband made me comfortable and proceeded to tend to my children.
Not long after I took the Vicodin the pain began to subside. I slowly began to unfold from my fetal position. After 8am I began calling my GYN’s office to see if I could be seen later in the day. The lines were all busy, but I was finally able to leave a message for my doctor’s nurse. By the time I finally talked to my doctor’s nurse, I was feeling better and the pain had subsided considerably. I probably wouldn’t have even scheduled an office visit except that my husband was hovering over me with the look of panic in his eyes (I think he was more concerned that he would have to care for the children alone indefinitely!), so I took the open 3pm appointment for an ultrasound and examination with one of the nurse practitioners.
My ultrasound showed multiple uterine fibroids (no news there!), a couple of ovarian cysts on my left ovary and a lot of fluid around the right ovary. Watching the scan I realized that I had “fluid in the cul-de-sac” meaning fluid in the area surrounding my ovary. I had seen this when I used to work in infertility when the doctors would retrieve the eggs from women after they had been hyperstimulated. The fluid would often spill into the pelvis after the follicles were punctured and the eggs retrieved or after the follicles had spontaneously ruptured. since I had not been hyperstimulated yet was somewhere near the mid-point in my cycle, an ovarian follicle or cyst had likely ruptured. The nurse practitioner confirmed my suspicions and I returned home with orders to take anti-inflammatories.
Ovarian cysts are quite common and frequently occur in women of childbearing age. Each month several follicles develop to mature eggs for ovulation, but ultimately only one will go on to mature an egg which will be ovulated. The body usually reabsorbs the remaining follicles, but not always. Follicles that aren’t reabsorbed but persist as fluid filled sacs or (Functional) cysts can cause pain and pressure within the abdomen. When they burst, the fluid they contain irritates the tissue in the abdominal cavity causing intense pain. The pain will gradually subside over a few days, and is relieved with anti-inflammatory drugs. In other cases, the follicles don’t rupture but continue to grow and cause pain as well as put pressure on surrounding structures such as the bowels or bladder, sometimes obstructing them. Cysts that don’t go away and continue to cause problems must be surgically emoved.
In women who repeatedly develop ovarian cysts related to ovulation (functional and luteal cysts), birth control pills can reduce the number of cysts they develop because birth control pills prevent the ovaries from developing follicles. Other types of ovarian cysts such as endometriomas (cysts made up of tissue from endometriosis), cystadenomas (cysts that form on the outer surface of the ovaries), and dermoid cysts (cysts formed from a variety of tissue types) are also easily managed conservatively with careful monitoring is they cause no symptoms, with medications (endometriomas) or via surgery if they cause too many problems.
Overall I would say that I am pretty lucky. While having a ruptured ovarian cyst pretty much knocked out my day, it could have been a lot worse.
If you have any of these symptoms, talk to your doctor, you may have an ovarian cyst.
- Pressure, swelling, or pain in the abdomen
- pelvic pain
- dull ache in the lower back and thighs
- problems passing urine completely
- pain during sex
- weight gain
- pain during your period
- abnormal bleeding
- nausea or vomiting
And get help immediately if you experience any of these symptoms:
- pain with fever and vomiting
- sudden, severe abdominal pain
- faintness, dizziness, or weakness
- rapid breathing
Symptom list is from The National Women’s Health Information Center of the US Department of Health and Human Services. www.womenshealth.gov.
Add comment November 4, 2009
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Tags: abdominal pain, functional cyst, luteal cyst, ovarian cyst, ruptured ovarian cyst
All Stressed And Nowhere To Go
Recently I was sitting in church service and the pastor was explaining to the congregation why he was taking 6 weeks off. He was overworked, stressed, exhausted and burnt out. He felt ineffective in his position and asked the elder’s board for a leave of absence. When he returned, he recounted days of rest, reading, counseling and overall rejuvenation-both physically and emotionally.
As I sat in the congregation I was surprised at my range of emotions. My first reaction was, “Oh my Pastor. I hope that you get the rest you need.” This sentiment was immediately followed by, “Jeez, I wish there was some way for me to get 6 weeks off. I wish there was some way for me to get one week off! In my house, I’d have to be admitted with some sort of medical calamity to have that kind of time off.” The acknowledgment of the impossibility of getting time off from my life and responsibilities welled up an anger in me that I’ve not encountered before.
When my pastor took time off, the pastoral staff handled the pastoral duties. Our church has a large congregation and we have about a dozen pastors on staff handling the various needs of the congregation. So while my senior pastor took time off, the church was by no means left in a lurch or at a dearth of pastoral care. We also have a vibrant and very capable administrative staff who handles all of the day to day needs of the church. Because of the structure of our church, any major decisions have to be voted on by the board of elders and the congregation, so that arena was also covered. Our church was in excellent hands in the absence of our senior pastor. Why is it that I can’t get time off? I am exhausted, overworked, stressed and burnt out. Why can’t someone else take over for me for awhile and let me get some much deserved rest? Because there is no one available to take over the duties and responsibilities that I perform. No, I’m not tooting my own horn thinking that I am the only one that can care for my family. I am not delusional to think that someone else can’t do what I do, it’s just no one is around to step in when I need help.
My life is so unlike my church. As a wife, mother and struggling business owner, The responsibilities for our family and my business fall completely on my shoulders. My husband has a very demanding job and travels extensively both domestically and internationally. Unfortunately, our families all lives out of state so I am on my own most of the time. For all intents and purposes, I have been a married single parent for the past almost 4 years. All decisions regarding the care of our home, the kids, everything-I had to decide and manage. It’s been a daunting task, but one that I have learned to do and do well. But I’m running out of steam. I don’t want the job anymore.
I was lamenting about my situation one day and my mother simply piped up, “Well you’re trying to do too much. Now just set that business aside and focus on your children and family, after all, that’s what’s important.” I love my mother and respect that she grew up in the 1950’s when a woman’s greatest desire was to be someone’s wife. That’s not my goal in life. I love my husband and I adore my children, but I want, no I insist on having an identity of my own. My business is something that I feel I was put on this earth to pursue. I am passionate about woman’s health; I love learning about it, tracking the trends and seeing how the specialty is evolving and how I can impact that evolution. I could no more give it up than I could breathing. Yet, I my children and family also need me.What do I do?
I started this blog to document my journey back to health and wellness. In all honesty, I am not much closer to that goal than when I started. Dr Edgerton is doing what he can to balance my hormones and to give me some relief, but there are some things that the hormones are not going to be able to fix. Drugs are great to help cure what ails us. But unless we get to the underlying problem, we’re never going to be truly healed. My problem is not my hormonal imbalance. My hormonal imbalance is a symptom of the bigger issue-my life is out of balance. Until I regain some balance in my life and make room for and resources available to take care of myself, I won’t achieve wellness.
I have some ideas about what needs to be done. I have actually begun to pursue and implement some of the changes. Time and my health will indicate whether my choices have been effective. But the good thing is that if I make a mistake, I can make changes. This life is a journey and for a time I’ve been on the wrong course. Starting today, I’m resetting my path.
Add comment October 30, 2009
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Tags: adrenal fatigue, Bio-Identical Hormones, Hormone imbalance, stress
Discussing “Safe Sex” With Your Parents
I get a variety of newsletters and health information via e-mail but this one really got me thinking. HealthDay reported “Older widowers who recently lost their wives are more likely to have a sexually transmitted disease than their counterparts who are still married.”
I have to confess, I initially chuckled over this lead paragraph. Dirty old men, I thought. But as I read the entire news brief, I actually felt a wave of anxiety.
The study looked at more than 400,000 U.S. couples aged 67 to 99 years in 1993. Within six months to a year after their wives died, men were 16 percent more likely to be infected with a sexually transmitted disease. And for recently widowed men, the risk of having a sexually transmitted disease rose by 83 percent after 1998. That’s the year that Viagra went on the market as a treatment for erectile dysfunction. Again I just shook my head-until I really gave that statistic some thought.
My parents are roughly 70 years old and as far as I know, they are in reasonably good health. Now, should my father pass away my mother would again enter the dating pool-an arena she’s not been a part of since the late 1950’s. When my mom was a young woman, the most common STD’s were mono (not technically a STD but a virus spread by kissing) and gonorrhea. In my mother’s day, there was virtually (or literally ) no Chlamydia, genital warts or Herpes. Now at the tender age of 70, she would not only be exposed to, but according to this study she would be at increased risk of contracting a STD.
Now this is what broke me out into a cold sweat. Would I need to discuss safe sex with my mom? Many of you are like me, a member of the “sandwich” generation; raising your own family while also caring for (or at least monitoring the health and well being of) your parents. I don’t know about you, but I just can’t imagine discussing safe sex practices with my mom (or my dad should the situation be reversed!) How does one even broach such a topic? And at what point does such a discussion become infringement of privacy?
My head went into a dizzy whirl as I pondered this situation. However the more I thought about it, the more I am convinced that we children HAVE to have such conversations with our parents. They are from a generation when such topics weren’t openly discussed and quite frankly, many of our parents may have absolutely no idea how serious the STD situation has become. Gone are the days when a simple course of antibiotics solved the immediate shame. Today our parents can contract diseases that they could carry for the rest of their lives or that could actually kill them.
I can’t think of a more awkward topic to discuss with either of my parents at this stage in our lives. But the facts are what they are. Just as I love my children and want them to make wise health care choices, I want the same for my parents. One can only make wise, informed choices when they have the necessary tools and information. Just as I will swallow hard and have “the talk” with my children, I shall will also bite from the other side of this ’sandwich’ I’m in and have a similar talk with my parent(s).
The study appears in the Sept. 17, 2009 online edition and the November print issue of the American Journal of Public Health.
Add comment September 23, 2009
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Tags: parents, Sandwich Generation, STD's
Did Merck Use Good Laboratory Practices Getting Gardasil Approved?
In my circle of moms, the discussion about Gardasil has been quite active. A fellow fitness mom and friend Chris Caffey Heidel spoke eloquently about her concerns not only about Gardasil’s efficacy and potential side effects, but to laboratories to use Good Laboratory practices, rules and habits advocated by the Late Senator Edward M. Kennedy (later signed to law) to ensure that research laboratories follow a standard set of guidelines that will help ensure that Americans are safe and healthy. Chris has graciously allowed me to reprint her blog post here. You can view the original blog post at http://librafitnessaustin.com/?p=270. So here in its entirety is Chris’s post. Thanks Chris!
August 26th, 2009
Thank You, Senator Kennedy
In addition to being a personal trainer, I have worked for over 10 years in the pharmaceutical research field, most of those years in Quality Assurance. My job is to make sure that laboratories and other companies working in pharmaceutical research are following FDA regulations and accurately reporting results. It’s not always pretty, but overall, drugs these days are much safer than they were before the 1970s. Prior to that time, there were no significant laws governing the quality of laboratory research. Mail fraud was about all anyone could be convicted of. In the 1970s, several cases of fraud in studies submitted to the FDA were uncovered that led to a series of hearings in the Senate, chaired by Senator Edward Kennedy (i.e., “The Kennedy Hearings”). These hearings resulted in the creation of the Good Laboratory Practice regulations. Laboratories conducting preclinical research are now required to follow these regulations and to also staff a Quality Assurance Unit. Hence, my field of expertise.
I appreciate these and other efforts by Senator Kennedy throughout his long career to do right by the American people. What an incredible legacy. Thanks, Teddy. I hope that our Congress will honor Senator Kennedy’s passing by truly working together in a bipartisan way to enact meaningful legislation that can help address the current health care crisis in this country. One can only hope.
Below is a favorite quote from Senator Kennedy that is often used in Good Laboratory Practice training sessions.
“Inaccurate science, sloppy science, fraudulent science—these are the greatest threats to the health and safety of the American people. Whether the science is wrong because of clerical error, or because of poor technique, or because of incompetence, or because of negligence, is less important than the fact that it is wrong. For if it is wrong, and if the FDA did not know it was wrong, then the protective regulatory barrier between a potentially dangerous drug and the patient is removed.” – Senator Edward Kennedy (D-Mass.), The Kennedy Hearings
Add comment September 10, 2009
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Tags: Cervical Cancer, gardasil, HPV vaccine, vaccination
A must read for moms of young girls
I started this blog as a way to chronical my personal journey back to good health. Since having my son in 2003 I’ve struggled and am now just finding practitioners and treatment s that are really helping me. But today I have to speak about something a little bit different, ensuring the safety of my daughter.
Those of you that know me know that I had uterine fibroids and had quite a journey having my children. A large motivation for me to get healthy is so that I can pass on good health habits to my daughter. Always in my mind is her well being and how I can help her to avoid many of the health pitfalls that I encountered. When Gardasil, the vaccine that is touted to prevent cervical cancer, came on the market I immediately began tracking it and I have to say that I have not been impressed with what I have seen. Now I am even more concerned. I just recently received a news piece stating that one of the actually clinical researchers for the Gardasil Vaccine has serious concerns about the vaccine. (Read her comments here http://budurl.com/ekmf) The vaccine is proving to have some very serious side effects and now there are questions as to whether or not the vaccine is effective after 5 years.
As many of you may know, I write and research a lot of women’s health issuses for Austinwoman Magazine as well as for my own business and personal edification. For the past couple of years I’ve been watching Gardarsil, the vaccine that is supposed to protect women from getting cervical cancer. I have to say as a former clinician and reseacher and as a mother of a young daughter I have been skeptical of this vaccine. First, my radar always goes up when something is rushed through the FDA when there is no clear danger to the public. Then when Gov. Rick Perry made that crazy Saturday Mandate that all girls going into middle school must take the vaccine, I was even more skeptical-especially when I saw that one of his former aides works for Merck and was “encouraging” the mandate. It’s was unclear to me if Perry’s support garnered him any funding, but if he did in fact receive funds from Merck as a result of Mandating Gardasil, isn’t this a conflict of interest? I reviewed the FDA filing documents, http://www.merck.com/product/usa/pi_circulars/g/gardasil/gardasil_pi.pdf as well as the Vaccine and Related Biological Products Advisory Committee report on Gardasil (one of the documents that explained the review process of the FDA). In these documents Merck openly reports that there are 9 reported cases of systemic autoimmune disorders that presented after the subjects enrolled in the Gardasil trials and took the vaccine. There was one case of Juvenile Arthritis, 2 cases of rheumatoid arthritis, 5 cases of arthritis and one case of reactive arthritis. That is all that is said. Merck does not go on to say whether or not these systemic cases arose as a result of taking Gardasil or that the subjects had a predisposition to autoimmune disorders. Merck makes no comment on these findings.
Now one can say that these are completely unrelated reactions, but no one knows this for sure. One can also say that statistically, this is not a significant number. The total number of people on this particular study who received the vaccine was 11,813 and only 9 who took Gardasil ended up with an autoimmune disease. So 0.0762% of the participants had an autoimmune reaction. That’s pretty small. However, multiply this percentage by the number of girls who are targeted to get the vaccine which according to the CDC is approximately 30 million girls. A simple algebra equation reveals that 22,860 girls could be at risk for developing an autoimmune disease if the 9 girls who developed autoimmune diseases in the clinical trials actually developed their diseases as a result of taking Gardasil. For all of the clinical trials there were 102 serious adverse events reported for all of the study participants, 21,514 (the 11, 813 who took Gardasil + 9701 who took placebo). This number translates to 14,220 potentially serious adverse events if 30 million girls are vaccinated. I don’t know about you, but 14,000 girls developing an autoimmune disease from a vaccine is a pretty significant number to me.
Merck claims that by making Gardasil a mandatory vaccine, the estimated annual 9710 new cervical cancer cases and estimated 3700 deaths (Data for 2006) would be significantly reduced but not avoided altogether. However, if women continue to get annual pap smears and pelvic examinations and to act promptly if they receive an abnormal pap smear, rates for cervical cancer are similarly reduced.
Everyone has to make their own decision when it comes to caring for their children. But
in light of these findings from one of the clinical researchers, My daughter won’t be getting the vaccine.
1 comment September 5, 2009
awellwomansjourney
Tags: Cervical Cancer, Daughters, gardasil, HPV, HPV vaccine, young women's health
Which Came First?
So I finally got my saliva test results back last week. There really was no surprise. My adrenals are shot and my cortisol pattern bears this out. Apparently cortisol levels should be lower in the early morning, enabling you to get up and to get busy, rise during the day when you need to be productive and fall later in the day as you should be relaxing and winding down. My pattern was the complete opposite. My levels were highest in the early morning, hence my early morning awakening complete with my mind rushing and not being able to go back to sleep. During the day I would get progressively more fatigued and weary, as if dragging through the mud. Then at night, I’d become somewhat wired and often have trouble falling asleep. Dr. Edgerton started me on a 3 month adrenal support plan and we’ll see how things go.
My adrenal patterns have made me wonder what came first, my increasing anxiety and insomnia leading to hormonal imbalance and adrenal fatigue or my hormonal imbalances leanding to insomnia and anxiety?? It’s really a tough call.
Our fast paced society really does not lend itself to periods of rest, reflection and contemplation-those times of rejuvenation. However, without them, one ends up in a state of internal and external turmoil much like I experienced. I am very cognizant now of the effect that sleep (or the lack there of) and stress have on my health. One may say, “Well duh!!” but in my case, while I knew it in my head, it was something else entirely as I lived it. While I am a full blown believer, I still struggle with keeping things in perspective, allowing time to rest and rejuvenate and letting go of the “small stuff.”
Christiane Northurp, MD speaks extensively about heeding the body’s cues and tuning into its wisdom in her book, The Wisdom of Menopause. She actually states that the when a woman is experiencing physical and emotional unrest it may in fact be due to hormonal imbalance, but it is also due to the imbalances in our lives. The pain and discomfort is a wake up call that something is wrong, out of balance and we need to attend to it. Boy did I get that message loud and clear! And like any good pupil, I am studying the events leading up to my state of imbalance, seeing what I need to change and rectify and doing my best to move forward.
Now I take a thyroid supplement, DHEA, iron, Vitamin D, and adrenal supplements daily. In addition to my multivitamin and Calcium tablet it looks like a lot and my 3 y.o. was quick to point this out. Sometimes I feel a bit like a fool for ever getting so far out of whack and yet, in an effort to be kinder to myself, I acknowledge the struggle, congratulate myself on those days when I am able to refrain from over exertion, excessive stress and taking on that last little task “to help someone out.” Each day is another in the journey. I’m just glad that the damage was not irreparable and that I can continue on.
Add comment September 1, 2009
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Tags: adrenal fatigue, anxiety, fatigue, Hormone imbalance, stress
A Good Night’s Sleep
It’s been two weeks now since I’ve started on my bio-identical hormones and I have to admit that I am feeling better. For the first time in over a year I don’t feel like I am slogging through mud. Although I was keenly aware of how badly I’d been feeling, the confirmation has come in the contrast of how much better I am feeling now. I am still a bit tired and I expect that it will take some time for me to replenish my sleep given the deficit I have been in.
I am sleeping through the night and I just can’t believe what a difference it is making in my overall outlook. I used to go to bed at 10 or 11 pm and by about 3am, I’d be awake. If I was lucky, I’d get back to sleep within an hour or so. But often I’d lay there, staring into the darkness and listening to my husband snore. The more that I tried to will myself to sleep the worse things seemed to get. I’d get even more agitated each time I looked at my clock and saw the night slipping by. Sometimes I’d take Benadryl because I knew that I had a busy day and needed to sleep. Other times I toughed it out and just dealt with the consequences the next day. My gyn’s solution was Ambien, but I found that made me groggy the following day if I did not allow for a full 8 hours of sleep, so couldn’t always take it.
Dr. Edgerton, the doctor treating my hormone imbalances, first gave me magnesium capsules to take one hour before bed. I could take up to 4. They did the trick, but I often felt weird in the morning, sometimes had a bit of a headache and a weird taste in my mouth. But I would sleep most of the night and if I did wake up, I would fall back to sleep in less than an hour. But the best thing has been prescription Melatonin. The Melatonin capsules are 10mg and I began by taking one a night, then another and another until I slept through the night. Initially it took 6 capsules for me to sleep through the night. While on vacation last week I was able to drop back to 4 and just last night I actually slept through the night with no medication at all! It has been months since I’ve slept a full night, without interruption and without medication. I hope this is the start of my body resetting itself and being able to sleep on its own.
I still have pangs of anxiety but I realize that much of it is stress. Having a family, a home and a business to run are stressful. It’s been tough on all fronts and many has been the night when I’ve awakened and my mind begins whirling with all manner of thoughts about the kids, work, bills…That is slowing down. I don’t know whether to contribute the improvement to the thyroid replacement or to the DHEA but I am inclined to think the DHEA. I started taking the thyroid medication one week before the DHEA and now have been on both for a week. I honestly don’t recall not having the “mind whirling” before this week, so it must be due to the DHEA which I just started taking.
I have a follow up appointment in 2 weeks when I’ll see how really fried my adrenals are when I get the result of my cortisol saliva tests. You know it ain’t good when they tell you that you have to come in for the results. But I’m not concerned. If Dr. Edgerton can figure out what is going on with me and make me feel better, it’s all good.
Add comment August 14, 2009
awellwomansjourney
Tags: Bio-Identical Hormones, Hormone imbalance, Hormone Replacement Therapy, Insomnia
Hormones To The Rescue!
I have just started Hormone Replacement Therapy. I had my follow up visit with Dr Edgerton 5 days ago. I have to admit, all things considered, I’m not as hormonally whacked as I had thought I’d be. However, there were definitely some imbalances.
Let’s start with the good news. Overall, my body is functioning pretty well-all things considered. My cholesterol is good as is my Homocysteine level hence my risk for heart disease is pretty low right now. I’ll have to watch this as the years go on because there is a really strong family history of heart disease on both sides of my family. Another good level was my fasting blood sugar. Given that 3 of 4 grandparents died with/from complications of diabetes and heart disease, it’s nice to know that I am currently not in iminent danger of these dreaded diseases. And with my low blood pressure I am not at risk of metabolic disease. To further avoid that little bullet, I have to get my weight down and hopefully getting my hormones balanced will help that. My other systems-liver, kidney, etc.. all seem to be functioning well.
So let’s take a look at the things that weren’t so good. My thyroid hormone level is on the low end of normal. No news there. Although I have been taking a supplement, it hasn’t been able to fully replace me to an acceptable level so Dr. Edgerton is prescribing thyroid hormone. The good news is that my pituitary gland sends the proper message to my thyroid to produce the hormone, and my thyroid does produce hormone enough to keep me just within the normal limits. But as far as having functional levels of thyroid hormone, I’m not even close so Dr. Edgerton is prescribing thyroid hormone.
Working our way down, my testosterone level was also borderline. Given that I am not having trouble with my libido yet have been extremely fatigued and with low energy, Dr. Edgerton has opted to replace my DHEA hormone, a precursor to testosterone. This should not only help my testosterone levels, but also my energy levels.
My estrogen levels were okay but my progesterone levels were pretty crappy. Classic case of estrogen dominance. No surprise there given that I just had an endometrial ablation for recurrent uterine fibroids and heavy menstrual bleeding. So I’ll be taking prescription grade bio-identical progesterone.
What did come as a surprise is that my Vitamin D levels were really quite low. I know that there is currently an almost epidemic low of Vitamin D amongst most Americans but given that I take a calcium supplement that contains Vitamin D and a multivitamin with Vitamin D, I thought that I was doing okay. So I’m now taking prescription grade Vitamin D. (I’ll discuss vitamin D and its actions and benefits in the next post!)
Finally, my iron stores were low. Again, so surprise there given that I’ve been having periods from Hell. It’s interesting that my Hemoglobin and Hematocrit levels were normal, so I’m not anemic but heaven help me if I get injured or otherwise hemorrhage. So I’m starting Ferritin.
Overall there were really no surprises, except for perhaps the Vitamin D. I feel pretty confident that once I start on the hormones I’ll be able to get back to my normal self.
One thing that wasn’t really addressed was my overall anxious feeling. It has just been pervasive and it’s really obnoxious. Since this is a classic symptom of Adrenal Fatigue, I have to do saliva tests for cortisol. Seems I’m in perpetual “flight or fight” mode & It’s been wreaking havoc with my sleep. Dr. Edgerton has given me some magnesium supplements to help (more about this in another post!), but they are not totally effective as I still wake up early in the morning around 3 or 4 am, So he is also prescribing melatonin. My husband has been telling me to take this, but I tried some over the counter in the past without any help. So I’m going to be trying the prescription grade.
Since this is a bio-identical hormone clinic, all of my hormones are compounded for me. They were ordered the day of my appointment and just arrived 2 days ago in the late afternoon. I’ve only been on them one full day, but I can already give kudos to the melatonin. I’ll keep you posted on how the others do and what if any adjustments are needed.
But I do offer this advice: don’t wait as long as I did to get help. So far my sleep is much improved on the Magnesium and Melatonin and that alone is making me feel better. If the other hormones are as effective as quickly, I am sure I’ll be back to my old self in no time.
I’m just sorry I waited so long, mostly hemming and hawing over the costs, to act. Ladies, there is no price one can give to feeling good. Don’t wait as I did. You (and I) deserve to feel good. You’d never let your child or your husband go about feeling poorly indefinitely so why should you? Have the same respect for yourself and give yourself the same care!
Add comment July 26, 2009
awellwomansjourney
Tags: Bio-Identical Hormones, Hormone imbalance, Hormone Replacement Therapy, Insomnia
NovaSure? For Sure
I had a NovaSure endometrial ablation 4 days ago and so far it is proving to be one of the best decisions I’ve made in a while. An endometrial ablation is a procedure that essentially fries the uterine lining so that it no longer causes heavy menstrual bleeding. In the process, it sometimes gets rid of or decreases uterine fibroids.
I’ve been battling the old “fibbies” for a long time now. First diagnosed in 1995, I used herbs and acupuncture to manage the symptoms. Once I got married we tried to get pregnant but miscarried and found it was due to the fibroids. I had a myomectomy in 2001 and promptly got pregnant in 2002 with my daughter. Two years later I got pregnant again and miscarried again. This time, not due to the fibroids, just not a viable pregnancy. I got pregnant for the last time in 2005 and had my son in 2006.
Things had been pretty good up until about 6 months ago. I started gaining weight, becoming increasingly more bloated with my periods and then the heavy bleeding returned. At first I thought perimenopause and this may in fact be a contributing factor. But when the bad menstrual cramps returned, I knew it was the fibroids once again.
I made a decision a long time ago to leave this earth with as much of what I came here with as possible. That being said, I have no intention of having a hysterectomy. So when the heavy bleeding and cramping started up, I went to my GYN to see what could be done. She ran down the list; Birth control pills, Mirena IUD, another myomectomy, ablation, Uterine Artery Embolization, Hysterectomy. I opted for the ablation.
So bright and early 4 days ago my hubby drove me to my GYN’s office. We arrived at 7:15 am and I was taken back to a room at 7:30 am. Surprised that I only had to strip from the waist down, I was given a lovely powder blue IKEA fleece throw for my legs. I then met with the anesthesiologist. She asked me a few questions and then started an IV in my hand through which she put medication for nausea, some pre-sedation and later some antibiotics. We then casually walked across the hall and a very nice nurse helped me to get comfortable on an oversized lazyboy chair with stirrups. As I settled in, the last thing I remember is the room becoming hazy just before everything went black.
When it was all over, the nursed helped me into a wheelchair and I was taken back to my first room. I looked at the clock and was surprised to see that I had only been gone 15 minutes! My GYN stuck her head in to let me know that everything went great and after about another 15 minutes, I was being wheeled out to my car with my husband. I was there for a total of 1.5 hours. Truly amazing!
Over the next couple of hours, things got a bit crazy. As the anesthesia wore off, the cramps set in and so did the nausea. I had to send the husband out to fill the Vicodin and Phenergan prescriptions. Once I took them, I slept for almost 6 hours (I’m sort of a light weight) but when I woke up, I felt just fine. I had a bite to eat, hung out a bit with my kiddos and fell asleep for the night at 8pm.
I’ve been well since. There is no major bleeding or pain and I actually feel great. I am anxious to see what my periods will be like in the coming months if I have them at all. As long as I’m not doing my version of hemorrhaging, I’m okay.
This NovaSure ablation system is really a slick little procedure. I don’t know what the future holds, but so far so good. I highly recommend it. (Photos courtesy of Hologic, Inc., www.novasure.com)
If you want to learn more about fibroids, visit my website www.nextstepfitness.com and listen to my podcasts.
2 comments July 14, 2009
awellwomansjourney
Tags: endometrial ablation, fibroids, heavy bleeding, Novasure
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