August, 2013 browsing by month


Natural (and Not-so Natural) Ways to Ease PMS Symptoms

Thursday, August 29th, 2013

Any woman who has ever had premenstrual syndrome knows that it is real. It may range from barely noticeable to debilitating, and it changes from woman to woman and from month to month in the same woman. But for women who have come to expect it and live with it for a week or so every month, it is a significant challenge. And it doesn’t help when many people seem to believe it’s “all in your head.”

In my book, Inside Information for Women, I explained that PMS is the body’s response to excess hormones after ovulation if the egg is not fertilized. Different women’s bodies respond to these hormones differently, so the symptoms of PMS can vary greatly, but they may include bloating, acne, breast tenderness, fatigue, and volatile emotions, among other things.  Less commonly, PMS symptoms may become so severe that they interfere with a woman’s daily life – for example, her job or relationships. Women with preexisting psychological disorders seem to be more susceptible to this severe form of PMS, known as premenstrual dysphoric disorder (PMDD).

Fortunately, there are things you can try to alleviate your symptoms. There is no one-size-fits-all PMS remedy, so there will probably be some trial and error involved. Different women respond to different approaches, so be patient and figure out what works for you. Some things that might help are:

  • Getting enough sleep – at least 7 ½ hours a night will eliminate the added stress of being tired and help your body and mind function at their most efficient
  • Meditation and/or relaxation – to promote feelings of relaxation and well-being and relieve stress
  • Altering your diet – try eliminating refined sugar, caffeine, or alcohol to see if it has a positive effect on your symptoms
  • Working regular exercise into your routine – it doesn’t take much to enhance your heart health and make you feel stronger and more energized

But what about when these measures aren’t enough? What if you are one of the unlucky women who responds to the monthly hormonal surge in a more severe way? Ask your doctor about trying an antidepressant.  Studies show some success with SSRIs (selective serotonin reuptake inhibitors), for PMDD, with continuous use having the best effect.

Basically, get to know your own body. If you are having trouble with PMS, start with the above suggestions. You can even try keeping a journal of what you tried and how you felt during a given month. Maybe you will notice a trend and find an effective plan for handling your individual PMS. If not, there are effective medicines available.

– Yvonne S. Thornton, M. D., M. P. H.

Grief and Loss: Taking Care of Yourself During a Terrible Time

Monday, August 26th, 2013

Our responses to grief are not just emotional but also physical, social, cognitive, and spiritual. Studies show that individual response to traumatic events such as death of a loved one or divorce vary greatly, with different severities and longevities. But it’s not easy for anyone. In the meantime, there are some things you can do to help yourself get through a difficult time.

Emotional Help

Expressing your feelings has wonderful therapeutic benefits. You may not feel like talking at all, but talk to someone anyway – a trusted friend, a counselor, or a support group. And find ways to express your feelings openly just for yourself, such as writing or drawing. Give yourself a break from your daily routine. If you can, take some time off work to slow down and take care of yourself. When you feel up to it, treat yourself to something you enjoy, like some music or a massage.

Physical Help

Grief can affect your appetite and desire to go about your daily activities, including exercise. But neglecting your health will have even more dire consequences now than normal. Getting sick right now will only exacerbate your trying emotions and prolong your unhappiness. Even if you don’t feel like it, eat healthy foods every day. Place an emphasis on fresh fruits and vegetables, drink a lot of water, and avoid alcohol, which is a depressant. You may not feel up to a strenuous daily workout, but at least go for a walk each day. The combination of exercise, fresh air, and sunshine can help boost your mood.

Social Help

You will probably feel disconnected from your friends, family, and normal routine – that’s okay. But don’t let these feelings become overwhelming. Accept offers of help and support. Be open about what you need. If that means being alone sometimes, that’s perfectly natural. But don’t sink into a habit of being alone too much. Keep in mind that even if your friends seem to be withdrawing, they most likely want to help – they just don’t know how. So call them up and invite them over, or meet them for brunch. They will be glad you reached out, and you probably will be too.

Spiritual and Cognitive Help

Struggling with anger and difficult spiritual questions is normal in a time of loss. Finding someone to talk to about this can be helpful, but understand that sometimes working through these feelings takes time. And don’t be surprised if you find yourself forgetful or easily distractible. This is a normal reaction to intense stress and should ease up as you begin to heal.

– Yvonne S. Thornton, M. D., M. P. H.

Two Most Common Vaginal Infections Can Masquerade as Each Other

Thursday, August 22nd, 2013

At one time or another most women experience some type of vaginal infection. The vast majority of these are easily treatable and no big deal – if they are diagnosed correctly. There is a lot of information on the Internet and today, more than ever, people are diagnosing and treating themselves without consulting a health professional.

The top two vaginal infections are an example of why this is almost never a good idea. Bacterial vaginosis (BV) and yeast infections plague most women sooner or later. It is not typically possible to pinpoint exactly what causes BV, but it is known that having multiple sex partners, smoking, and douching all increase a woman’s chances of developing it. Yeast infections are generally caused by either douching, using antibiotics, or having diabetes, and being pregnant also makes a woman more susceptible.

These two infections can mimic each other’s symptoms and can sometimes be indistinguishable from each other without the proper tests. But they require completely different treatments. BV is caused by an overgrowth of harmful bacteria in the vagina and requires treatment with an antibiotic. Yeast infections are caused by fungi, and require antifungal medications to treat them. Antibiotics will have no effect on a yeast infection (except, possibly, to cause it or make it worse) and vice versa. So while you use the wrong medication, you are enduring discomfort for a much longer time than necessary and taking risks with your health.

While these two infections each have their own trademark symptoms (BV is more likely to produce a fishy odor; a yeast infection is more likely to produce a “cottage cheese” discharge), the symptoms can differ from woman to woman and day to day. And both infections can cause intense itching, pain (during intercourse or otherwise), redness, and burning during urination. You can get an idea of what your infection may be by evaluating the symptoms, but only a laboratory examination of the discharge (under a microscope, known as a wet mount) can confirm it.  Often, it is reported as an ancillary finding on a Pap test.

And confirming is extremely important, because if you are treating the wrong infection, you are wasting your time and money and possibly harming your health. Most cases of bacterial vaginosis do not spontaneously resolve, and bacterial vaginosis has been associated with both preterm births and cervical cancer.   For more information on this topic, read my healthbook “Inside Information for Women”.

Finally, evaluation by a doctor is important because it could be neither of these common infections; it could be something more serious or something requiring a different treatment, like an STI (sexually transmitted infection). So check with your doctor any time you have unusual vaginal symptoms to be sure you are properly diagnosed and using an effective treatment.

– Yvonne S. Thornton, M. D., M. P. H.

Shared Medical Appointments (SMAs)

Monday, August 19th, 2013

There is a new trend in medicine that I find disturbing. I’m talking about the shared medical appointment. A group of patients participate in one shared appointment, 90 minutes or so, with one practitioner or a team of medical personnel.

Advocates of this arrangement say that patients get more time with doctors without increasing doctors’ workloads, and that patients can be an encouragement to one another. I say, it sounds like a way to increase billing without doing any extra work, and that if patients want to encourage one another, there’s always a coffee shop or a support group around the corner. I’m not saying that there’s anything wrong with a patient preferring this method; I just can’t imagine why anyone would. You spend your valuable time and money in order to see your doctor. You should be able to make the most out of every face to face appointment, and not have to share time with other people all seeing the same doctor, whose attention is inevitably divided now.

Each patient should have the right to a private, confidential interaction with a physician. It is well known that people behave differently when other people are around than they do when alone. SMAs require disclosing personal information in front of strangers. A woman might not mention something in a group that she would if she were alone with her doctor. I care about each of my patients too much to impose this kind of group setting on them. Your doctor’s appointment – even routine follow-ups – is your chance to talk with your doctor privately, sharing any concerns openly, and not giving a second thought to who might hear what you say. Furthermore, fans of shared medical appointmets say that they are a way to decrease costs – but they must not mean to patients, because in practice, most SMAs are billed as regular office visits with regular copays.

Finally, studies on SMAs are very limited. You will have to decide if the shared medical appointment is right for you, but you won’t see me implementing them anytime soon. I don’t believe this can ever have the value of consulting with a doctor one-on-one with the focus on you and finding the source of your medical problem. In short, shared medical appointments don’t save patients any time or money and do not deliver the same standard of care that an individual appointment can. This is one trend that I would like to see stopped in its tracks.

– Yvonne S. Thornton, M. D., M. P. H.

It Is Okay to Decide Not to Have Kids

Thursday, August 15th, 2013

For many women, the choice to become a mother is an easy one. To these women it feels natural; they look forward to it and, usually, love it once it happens. For other women, the choice is also clear – the choice not to become a mother. For many women, this is an easy choice to make, but not such an easy one to share with their loved ones. After all, we still live in a culture that expects women to become mothers. A girl becomes a woman, gets married, and has kids. A woman who deviates from this plan is somehow “wrong.” Women have fought so hard over the years for equal rights, including the right to make choices for themselves – so why are we still so hard on women who make the choice to remain child-free?

Lately, the ranks of childless women have been speaking up in a big way. They are making themselves heard loud and clear: We don’t want kids. Period. Not, we don’t want kids now, but we realize we might change our minds later. Not, we can’t have kids. But we don’t want them. It is not going to happen.

These women will not be made to feel guilty because so many women want kids but can’t have them. Nor will they buy into the idea that they are selfish or bad because they choose freedom over babies. And they do not accept the premise that they somehow do not understand their own desires or “will change their minds later.” They are bravely claiming for themselves lives of free time, solitude at will, career immersion, or vacations at the drop of a hat – basically, they are choosing to do what they want to do, when they want to do it.

Unfortunately, an “us and them” mentality has begun to take shape around this issue. Moms, understandably, get defensive when they feel like their choices are being disparaged. Childless women feel ostracized by moms. This is a disturbing trend that we should nip in the bud, because women can potentially be such a great support system for each other.

And let’s be honest: the fact of the matter is that no matter what you choose, you are going to be judged for it. You are either fat and lazy or thin and stuck-up. You are either poor and uneducated or rich and mean. You are either a bad mother with too many kids or you are a selfish, close-minded woman with no kids. You can’t please everyone, and sometimes, you can’t please anyone but yourself. So please yourself. Life is short; how you live yours must be your own choice.

As women, it’s time we stop tearing each other down and start empowering each other to make individual choices – and supporting each other in those choices. It’s not “us and them.” We are all still women, with dreams and plans and feelings. Let me empower you: it’s okay not to have kids – and it’s okay to have them. No one can make the choice for you but you.

– Yvonne S. Thornton, M. D., M. P. H.

Teachers Required to Give Students False Information

Monday, August 12th, 2013

In a prime example of why parents must stay informed about their children’s school curriculum, North Carolina governor Pat McCrory signed a bill in July requiring that middle school students must be taught that abortion is a preventable cause of preterm births. Incidentally, this comes after McCrory’s promise not to sign any bills regarding abortion, period. But McCrory did not act alone; 73 state senators agreed that it was okay to give students erroneous information in the classroom.

I realize that this is a hot button issue for many, but let’s focus on the real issue here: middle school teachers required by law to lie to students. Is lie too strong a word? Absolutely not, and here’s why: There is no scientific evidence that abortions cause preterm labor. Let me say that again. There is no scientific evidence to support the idea that abortion causes preterm labor. This seems to be just another thinly disguised attempt to limit women’s ability to make choices for their own lives.

Proponents of the bill point to recent studies that show a limited risk of preterm births following abortions, but these studies and the recommendations made based on them are flawed. For one, they did not distinguish between successful medical abortions and those requiring surgery. In addition, they did not distinguish between induced and spontaneous abortions. Furthermore, legislators ignore the fact that the studies showed no increase at all in preterm births after abortions from 2000 onward, a fact probably contributable to modernized abortion methods.

In fact, David Grimes, a North Carolina professor of obstetrics and gynecology, called the bill “state sponsored ideology,” and pointed out that “the World Health Organization, the CDC, the American College of Obstetrics and Gynecologists, the American Academy of Pediatrics… and the American Public Health Association have all concluded that abortion does not cause prematurity.”

So why would these legislators support this bill? Do they have their own agendas, or do they just not understand the facts? Who knows – just do your part by staying informed, thinking for yourself, and getting your facts from the experts, not the politicians. Have a conversation with your middle school kids about this and other sex education topics. Don’t leave it to the schools.

To close, let me be crystal clear on this. This issue has nothing to do with how anyone may feel about abortion. It has only to do with the integrity of our schools’ curriculum being compromised by untruth. Be the voice of accuracy at home. Teach your kids how to find reliable information. You are free to teach your children about your moral beliefs. But at least tell the truth about the facts so that they are free to develop their own morals and form their own conclusions based in reality, not folklore.

– Yvonne S. Thornton, M. D., M. P. H.

Your Shoes Could Be Hurting Your Health

Thursday, August 8th, 2013

It’s no secret by now that high heels are harmful to your health. You are probably aware that wearing high heels can increase your risk of falling or developing foot, leg, or back problems due to the pressure exerted on various parts of the foot and the misalignment of your ankles, hips, and spine. You probably already know that you should limit high heels to no more than two inches and avoid tight, pointy-toed shoes.

But did you know that your beloved flip-flops are just as bad?

Flip-flops literally expose your feet to a whole host of potential problems. From relatively benign issues like cold feet or stubbed toes to more serious injuries like cuts or broken bones, there are many problems which are completely avoidable by wearing protective and supportive shoes.

As if the potential for injury weren’t enough, researchers now suspect that flip-flops may prevent you from being as fit as you could be. When you wear flip-flops, you are forced to bunch your toes up to hold them on your feet. This prevents your arch from flexing naturally, which alters the way you walk. Think of this as a ripple effect, where you grip your shoes with your toes, which prevents you from flexing your arch, which prevents you from “pushing off” from each step strongly enough, which forces you to compensate with your hips, which puts more stress on your knees. The result is an unnatural gait that does not fully engage all the muscles in your legs and backside that walking should engage.

So think twice before wearing those flip-flops out to run errands or to the office (if you are lucky enough to work in that kind of office!). Flip-flops are great for occasional wear – to the pool or the beach – but not for hours on end, day after day. Your day-to-day shoes should be supportive and ergonomically correct. If you want to wear an open shoe like a sandal, at least make sure it has a strap that wraps around your ankle so that you aren’t tensing those toes up to hold the shoe on.

You should be aware that, with their lack of arch support, ballet flats do not fare much better under scrutiny than flip-flops. Incidentally, research shows no additional benefit from wearing “toning” sneakers; regular walking or running shoes will do just fine for exercise, and any comfortable, well-fitting shoes with good arch support are fine for daily wear.

– Yvonne S. Thornton, M. D., M. P. H.

High Rate of Smoking Relapse After Pregnancy and Delivery

Monday, August 5th, 2013

It is no secret that smoking can have an incredibly harmful effect on a growing fetus. Smoking during pregnancy can lead to major problems, from fetal deformities to miscarriages and stillbirths. All women are encouraged to quit smoking well before conceiving, and those that do not are encouraged to quit smoking as quickly as possible after discovering that they are pregnant. There are many intervention programs in place to help women who smoke quit during pregnancy. However, there has been a lot of concern in recent years that smoking cessation during pregnancy is not permanent.

Studies have shown that upwards of 48 percent of women who do quit smoking during pregnancy will relapse afterwards, with a sharp increase in relapse occurring up to a point about six months after delivery. Traditional intervention programs designed to help women quit smoking during pregnancy have shown low success rates in helping a woman quit smoking overall.

This is important because the risks of second-hand smoke are still much higher than is safe, especially with the association of second-hand smoke and the development of childhood asthma. Women are encouraged to make every attempt to quit smoking, not only for their own health, but also for the health of their families.

It is becoming increasingly obvious that quitting during pregnancy—when there is a strong motivation to quit—does not have the lasting effects that could be hoped for. Additionally, the stressful time after delivery is often debilitating to a woman’s efforts to remain nicotine-free.

It is strongly suggested that women who quit smoking during pregnancy seek some sort of aid, counseling, or even medical intervention after delivery in order to prevent smoking relapse. There are a number of products and coping strategies available that can help. While it is admirable to want to quit, it may not be wise to attempt to go “cold turkey”, even for women who have gone without a cigarette for up to, or over, nine months.

Women should remember that their lives change in many ways after they deliver a child. The coping strategies a woman develops during pregnancy may not work in the postpartum period, especially without the motivation of being pregnant to prevent smoking relapse. As a woman’s Ob-Gyn will most likely be the doctor a woman sees the most during the postpartum period, they are an incredible resource for helping their patients stay off the cigarettes for good.

I have helped many women quit smoking in my years as a doctor, and with help a good number of those women never smoke again.  Women need to take extra steps to quit smoking permanently to ensure both their health and that of their families.

– Yvonne S. Thornton, M. D., M. P. H.


Teen Pregnancy May Be Associated With Obesity Risk in Later Life

Thursday, August 1st, 2013

Concern about the increased prevalence in teen pregnancies has raised a lot of questions societally as well as within the medical community. It is no secret that an event such as childbirth can play a large role in a woman’s health, and the potential changes that may take place are increased in a teenager, whose body is still growing and changing throughout adolescence. From very real concerns such as the potential for premature delivery to the psychological effects of becoming a mother at a very young age or giving a child up for adoption, there is much fodder for examination and research.

One study has even suggested that there is a potential association between adolescent pregnancy and obesity later in life. However, it is important to note that this association is still vague at best, and researchers have yet to uncover a cause for this heightened obesity risk.   While it is possible that the associations between adolescent pregnancy and obesity is caused by the physiological changes that take place in the female body (and in particular the adolescent female body) during pregnancy, there are also many factors –primarily psychological and sociological—to take into consideration in order to determine the underlying cause of this association.  I believe that these young women, obese or not obese, gain so much weight when they are pregnant that obesity is the result of the pregnancy and they cannot lose the weight postpartum, given the additional responsibilities of raising a child.

Demographically speaking, adolescent mothers are more likely to be from a racial minority, to have lived in poverty, or to have attained a lower educational level than many of their peers. Four out of five black women are either overweight or obese.  It is highly likely that at least part of the association between adolescent pregnancy and weight gain is due to this “crossover”, as women of these demographics are also those most likely to be classed as overweight or obese. This is part of the difficulty in determining whether or not there are other physiological factors to take into account.

My take on the conclusions of this study and the entire situation of pregnant adolescents  and future obesity is that these young women are looking for acceptance and have very low self-esteem.  Their feelings are exploited by their male counterparts, who have a biological imperative to be intimate and not be rebuffed. Consequently, sexual intercourse is a form of being “accepted” and “loved”, only to find out later that the girl is pregnant, has gained excessive weight during the pregnancy and is now alone being responsible for a new life.  Her old habits (no exercise and cheap fast food) with a low or nonexistent income lead to her obesity and that of her child.  Then, it becomes a vicious cycle.

Regardless of the reasons for the prevalence of overweight and obese women among those who were pregnant as teenagers, studies like these highlight the importance of increased contraceptive aid and sexual education among female adolescents. At present, it seems that the primary association between these two groups of women, i.e.,  those who become pregnant as teenagers and those who are classed as overweight or obese in adulthood,  is a lack of education or awareness about their bodies.

– Yvonne S. Thornton, M. D., M. P. H.