It’s All in Your Head!

“The doctor who fails to have a placebo effect on his patients should become a pathologist”

J.N. Blau, M.D.

     The lines between the art and science of medicine are often blurred.  Many years ago, when the earth was cooling and I was a medical student, I was assigned to shadow an older Ob/Gyn in private practice. The goal was to gives us young medical pups a sense of real world medicine.  Dr.Koronik was a gifted clinician as well as a crafty student of human behavior.  One afternoon we were speaking with a patient, a recently married young female, who was completing her yearly exam when she reported her libido, or sex drive, had driven off and she didn’t have the map!  Dr. K had done a thorough physical exam and knew anatomically everything was intact, and so he talked with her at length about her life situation and decided to get some baseline blood work.  She was to return when the blood work was back and review the results and discuss any treatment options.  After she left, Dr. K pulled me aside and said he felt her problem was more from the neck up and not the waist down.  He was not patronizing or minimizing her problem, it was just an honest assessment of what he surmised was the source of her lack of desire.  Upon her return, they reviewed the blood work which supported the idea that all was well physiologically, and Dr.K had a long discussion about stress, relationships, and other important factors in sexual well being.  At the conclusion he presented her with a bottle of tablets and told her that taking one on a daily basis may increase her libido.  I was taken aback and after she left I questioned his prescribing of a medication for what he seemed to think was an emotional issue.  He explained, in what was to be the first of many lessons in healing as opposed to curing, that the “medicine” was nothing more than sugar pills, and that he felt they would aid in minimizing her psychological issues with intimacy.  There are a number of ethical and legal issues involved with this “treatment” but remember this was almost 30 years ago and in a small town in East Tennessee. 

I didn’t see the young lady in follow up, but a few days later Dr.K reported a Ford 350 pickup truck backed up to the rear of his office around closing time.  A burly, six foot something cowboy straight off a movie set ambled out of the truck cab and sauntered to the back door of the clinic.

“Hey doc,” he offered as he thrust his hand in greeting.  “My wife came to see ya a few days ago about this…eh…problem she been havin’ ”.  No doubt, this was the husband of the libido challenged patient.

“I just wanted to come shake your hand for them pills you gave her cause, let me tell ya, I don’t ever want to run out of them things!  I brought my truck here to load up a batch!”

Say what you may but the placebo effect is a real and powerful scientifically validated phenomenon.  There are some amazing studies done with PET scanners, machines that “light up” areas of the brain that are functioning in thoughts and emotions, that confirm that feelings can be translated into physical changes in the brain.  When we feel happy or sad, specific areas of the brain are activated and in turn set off a cascade of hormones, neurotransmitters, and a cavalcade of substances that elicit amazing physical effects.  There is a branch of science called psychoneuroimmunology that studies how our thoughts and emotions effect our immune system.  For example, if you get int an argument with your spouse or yell at your kids getting dressed for school, not only do you feel stressed, but you are more susceptible to catching a cold!  There is even some evidence that chronically stressed or angry individuals are more at risk for certain cancers because their emotional state impairs their immune system’s natural ability to eradicate early abnormal cells.

The Mayo Clinic issued a series of findings on research done on the reasons the placebo effect is genuine:

“A patient whose doctor is supportive and positive may benefit more from any treatment, active or placebo.

A patient who believes a treatment will work is more likely to experience the placebo effect than one who doubts it.

Some patients respond well to frequent and intensive medical attention, whether or not a drug or treatment is potent.”

Indeed, the placebo effect is “all in your head” but it is just as real and often as therapeutic as a drug. 

Now if I could just find some of those “libido” pills!      

Exercise During Pregnancy

The key to healthy exercise during pregnancy is to not wait until you are pregnant to establish a regular exercise program.  Women who enter into pregnancy fit and exercising can, in most cases, continue their exercise regimens with certain common sense caveats.  Begin from the perspective of what can I do instead of what are my restrictions.  Every new mom’s situation is unique, so don’t do anything until you discuss it with your doctor, but it is a conversation you need to have.  According to the America College of Obstetricians there are a few instances where you shouldn’t exercise:

•  Symptomatic heart disease
•  Restrictive lung disease (such as bad asthma)
•  Incompetent cervix/cerclage
•  Multiple gestation at risk for premature labor
•  Persistent second- or third-trimester bleeding
•  Placenta previa after 26 weeks of gestation
•  Premature labor during the current pregnancy
•  Ruptured membranes
•  Preeclampsia/pregnancy-induced hypertension

 

So what kind of exercise is best in pregnancy?  The simple answer is that there is no best.  Much of that depends on what you have been doing prior, or better yet, what you enjoy.  I can hear you now, “I don’t enjoy any type of exercise!”.  It’s time for a little attitude change because it’s not just about you anymore.  You see, exercise not only helps you while carrying the little bambino, but also helps the bambino. Women who exercise in pregnancy have a lower incidence of gestational diabetes, hypertension, and    excessive weight gain, all of which can lesson the problems for the baby.

There are a few common sense guidelines to follow with exercise in pregnancy:

 

•  After the first trimester, avoid exercises lying on your back
•  Start slowly and gradually build up to at least 30 minutes of exercise a day
•  Avoid brisk exercise in hot, humid weather or if you have a fever
•  Wear comfortable clothing to keep cool
•  Wear a bra that is comfortable and gives lots of support
•  Drink plenty of water to stay well hydrated at all times
•  Consume an appropriate diet to keep energy up

 

The rule of thumb for exercise in pregnancy is that it is generally good coupled with a dose of common sense.  Most reputable doctors will tell you not to skydive or alligator wrestle whilst with child, even if an ancient Egyptian aristocrat invites you.

Preventing Breast Cancer

     A common misbelief is that mammograms prevent breast cancer.  They don’t.  What mammograms do are reduce the death rates of those who get breast cancer.  Early detection, of which mammograms are supreme, is the single most important predictor of survival.  Get it early; get it out; get better.  However, most would agree that if we move things back a step and focus on true prevention, breast cancer rates could plummet.  The old adage, “an ounce of prevention is worth a pound of cure” is no better illustrated then by the steps everyone can take to decrease their risk of breast cancer.

 

Watch the weight

An increase in weight at any age, but especially after menopause, increases your risk of developing breast cancer.  There also seems to be a connection between belly fat and risk.  The more you have…the greater the harm.  The increased incidence is probably related to the fact that extra fatty tissues increase the circulating estrogen in your system which in turn may promote the development of abnormal breast cells.  The good news is that losing weight and maintaining a healthy BMI (Body Mass Index) reverses this risk.

Lose the booze

Believe it or not, alcohol is the most well established dietary risk factor for breast cancer.  A huge national study estimated that women who consume more than one alcoholic drink a day can increase their risk almost 20%!  All other things being equal, teetotalers are less likely to get breast cancer and be thinner than the average adult beverage consumer.

Forage for fruit

Both fruit and vegetable consumption can lower your risk.  It’s as simple as putting down seven servings of the green stuff a day and you can decrease the chance that breast cancer will come calling.  Various studies indicate the best types of veggies and fruits include broccoli, cabbage, brussels sprouts, cauliflower, collards, kale, spinach, carrots, tomatoes, citrus, berries and cherries.  There is nothing like a good kale and cabbage smoothie to end the day!  Why not try a refreshing tomato juice cocktail instead of that glass of Chardonnay?

Sweat with the oldies

Richard Simmons doesn’t have breast cancer, and you might not either if you exercise every day.  The key is consistency and persistence, not necessarily intensity.  Studies show that a brisk walk for 30-45 minutes three to four times a week can lesson your risk.  I’m sure it is related to weight management, but there are chemicals produced during exercise that are powerful immune system boosters that provide protection independent of the fat burning benefit.

Pick your fats

We have all heard about the wonder of fish oil and omega 3 fatty acids.  Not only do these powerful antioxidants benefit your heart, but studies suggest those women with low omega 3 blood levels have a higher rate of many cancers, including breast.  Obviously eating cold water fish, like mackerel and salmon, increases these levels, but many nuts and seeds such as flax seeds, pecans, and hazel nuts are also excellent sources.  Minimize your intake of saturated fats (meats, lard, butter) and use olive and canola oil in cooking.

White is not right

White rice, white potatoes and white flour are all high glycemic carbohydrates (very good at raising blood sugar levels) and these and other similar foods stimulate a type of hormone production which in turn promotes cellular growth in breast tissue.  This is not to say that Minute Rice is carcinogenic, just keep in mind that over consumption of high glycemic carbs promotes both weight gain and are “pro-inflammatory”.  In other words, everything in moderation, nothing in excess.

Tofu a day

There is a great discrepancy in breast cancer rates between western women and oriental females.  Women from the Japan have half the cancer rate as those in the U.S.  There are a number of factors but most scientist agree that diet plays a big role.  Those women who consume a greater variety and amount of soy based products during their lifetime have a lower risk of breast cancer.  Keep in mind this is an effect that only applies over many years, and probably relies on heavy consumption in childhood and the young adult years.  There is much less evidence that simply beginning to eat soy products later in life has any protective effect at all.  Maybe those soy based baby formulas are on to something!

Don’t worry, be happy

This one requires more space than I have here to explain, but suffice it to say that stress and poor sleep are both risk factors for breast cancer.  The mind-body connection is a powerful one affecting everything from the immune system to our digestive health.  The more stressed we are, the more certain inflammatory hormones are produced, the more cellular damage occurs, the more chances for cells to become cancerous.  After all, what is there to worry about when you can finish your ten mile run, pop open an ice cold tofu and salmon smoothie, cook your dinner of lentils with olive oil, and relax!

 

resources: Dr.Ann Kulze and women’shealth.com

Fed up of Heavy Bleeding?

Each month during a woman’s period (menses), the inner lining (endometrium) of the uterus is shed.  This varies from light and occasional to extremely heavy with significant cramping and discomfort.   There are many options to deal with controlling heavy bleeding.

For women who have completed their childbearing, one effective approach is to perform an endometrial ablation.  This is an incision-less, quick, outpatient procedure whereby the inner lining (endometrium) of the uterus is destroyed.   One of the most popular methods of accomplishing this is the Novasure endometrial ablation.  All of our physicians currently perform this popular service in our office.   Call today to discuss whether you are a candidate for this procedure.

Done with having kids?

After having completed childbearing, many women wonder what their options are regarding birth control. Not everyone remembers to take the Pill everyday. The good news is, Women’s Health of Augusta has several options that could be a great fit for you. If you desire permanent sterilization, consider the Adiana procedure. This is an incisionless in-office procedure to block your fallopian tubes. With the help of intravenous medications, the procedure takes only about twenty minutes and is virtually painless. Keep in mind, this procedure is permanent and irreversible. Call our office today to find out more information. If you have questions regarding insurance coverage for this procedure, our helpful staff will be more than happy to assist you.

Call for your New Pregnancy appointment….

We have been delivering babies at University Hospital and St. Joseph’s (Trinity) Hospital since the 1970s.  We provide convenient and comprehensive care.  All our doctors are seeing new high risk and low risk pregnant patients.  Please contact our office today to schedule your new pregnancy appointment.

Finding out you are pregnant is exciting but it can be overwhelming.  We strive to provide care keeping that in mind.  Your initial Obstetric visit allows us the opportunity to answer concerns and to individualize care.  Our office staff will help answer insurance and financial questions.   Thousands of women from the CSRA have entrusted us with their care during this very special time in their lives.  We are honored to continue this tradition and are excited about your pregnancy.

Urinary Incontinence concerns?

The loss of bladder control is a very common problem.  It tends to worsen after child birth or as we get older.  The severity can range from occasional loss of urine during activity (such as coughing or running) to incontinence while at rest.  Other bladder symptoms such as urgency and frequency can further complicate the treatment of bladder control.

If urinary symptoms affect your daily activities or prevent you from engaging in certain activities, then contact your doctor.  In some cases, simple lifestyle changes and pelvic floor exercises can make a difference.  Other patients may be candidates for surgery such as a Vaginal Sling, which is performed by all our providers.   These are minimally invasive outpatient procedures that typically last less than half an hour and provide a supportive hammock under the urethra, preventing it from opening prematurely when you cough or sneeze etc.

If you or someone you know is having bothersome incontinence, schedule an appointment to discuss options with your doctor.

Gardasil Vaccine

We continue to offer the Gardasil Vaccine which helps protect against the most common strains of Human Papilloma Virus, which can cause abnormal pap smears. Contact Women’s Health of Augusta at 706-733-4427 for an appointment.

3D Sonograms

We have a new ultrasonographer, Jennifer. Schedule your keepsake 3-D Sonogram pictures with her. Contact Women’s Health of Augusta at 706-733-4427 for an appointment.