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Addressing Domestic Abuse

Monday, September 30th, 2013

Domestic abuse is the misuse of power by one adult in a relationship over another. It means that one partner uses control and fear to overpower the other. Domestic abuse may be physical, psychological, sexual, social, or financial. It may be regular and continual or it may be occasional. Domestic abuse accounts for some 85% of all violent crime against women.

Because domestic abuse takes many forms, it causes many different types of harm. Violence can cause physical injury as well as emotional. Depending on the form the abuse takes, the victim may experience physical, emotional, social, or spiritual injury. It can have severe repercussions on a woman’s sexual health and overall well-being. Domestic abuse increases the risk of depression and suicide. It disrupts family life and can have serious negative effects on children.

Warning Signs to Look Out For

When you are getting to know someone, any of these behaviors should make you think twice about continuing the relationship.

  • Jealousy or controlling behavior
  • Pressuring you to make a commitment too soon
  • Having unrealistic expectations
  • Attempts to isolate you or discourage you from seeing your friends
  • Blaming other people for his or her problems or feelings
  • Cruelty to animals or children
  • Pressuring you to have sex when you don’t want to
  • Verbal abuse; saying cruel things meant to hurt you
  • Breaking, throwing, or striking objects
  • Any use of force during an argument, such as grabbing your arm or holding you down

Why Do the Victims Stay?

It is easy to say you would never stay in an abusive relationship – until you find yourself in one. Abusers are master manipulators. Often women find themselves in situations where they believe they cannot get along, financially or emotionally, without the abusive partner. They feel trapped. They may fear the abuser too much to report the violence; they may be embarrassed and not want others to know about their situation.

Where to Turn for Help

If you find yourself in an abusive relationship, know that you are not alone. Millions of men, women, and teens have found themselves in the same situation: people of all races, socioeconomic statuses, education levels, and sexual orientations.

If you are in immediate danger, call 911 or get to a safe place quickly. Battered women’s shelters typically have various support services such as legal, emotional, and financial. If you have time to make plans, get in touch with friends or family members who will give you the support and help you need. There are many resources available for victims of domestic abuse. Try a national or local helpline. Or talk to your doctor for more information.

The National Domestic Abuse Hotline is 1-800-799-SAFE (7233).

– Yvonne S. Thornton, M. D., M. P. H.

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Meditation Shown to Be Helpful in Treating Physical, Psychological Disorders

Thursday, September 12th, 2013

Meditation has become increasingly popular in the clinical setting over the past few decades. It is known to have medical benefits, and there is evidence that it may have psychiatric benefits as well. This study examined the effects of meditation on substance abuse disorders and turned up some promising results.

The idea that meditation has healing aspects is not new. Scientific interest in meditation has been growing for some time; in 2007 alone, almost 70 peer-reviewed articles devoted to the practice were published. Meditation is probably the most extensively evaluated “alternative” treatment available to patients. Mainstream health care providers now widely accept the mind-body connection and implement meditation in a number of applications. Meditation has been shown here to have a positive effect on hypertension, here to help patients mitigate the stress of having a chronic illness, and here to promote good cardiovascular health.

Similarly, meditation has been shown to be helpful in psychiatric settings. Possible benefits being studied include improvement of anxiety and depression, help with substance-abuse disorders, and reducing self-injurious behaviors in the context of personality disorders.

Meditation in Youth Intervention

Certain studies, such as this one, have also taken a close look at the effect of meditation on children and teenagers from 6 to 18 years old. This study examined the results of different types of meditation, such as mindfulness meditation, transcendental meditation, and mindfulness-based stress reduction on youth with preexisting conditions like hypertension, ADHD, and learning disabilities. The study concluded that meditation does seem to be effective in treating physical, psychosocial, and behavioral conditions in youth.

Limitations of Studying Meditation

One of the problems with scientific study of meditation is the nature of meditation itself. Literally meaning to reflect or ponder, meditation is generally described in spiritual, mystifying, or imprecise terms that make it difficult to define scientifically. In addition, meditation is generally private and subjective, which makes the activity tricky to scrutinize, test, and analyze. Another issue with studying meditation is that “meditation” is actually an umbrella term encompassing many different techniques. These techniques have differences involving control of different areas, such as concentration, breathing, and relaxation. Therefore, when considering the results of a study, one must take into account the specific type of meditation used and not generalize the results of the study to other types of meditation.

Conclusion

Given the limitations of meditation studies, it’s safe to say that further research is needed to understand the full scope of its benefits and drawbacks, as well as what specific areas meditation may affect, such as relapse prevention or enhancement of motivation. However, meditation is showing great potential in the treatment of substance abuse disorders. It appears to facilitate cue extinction, reduce cravings, lessen compulsive behaviors, and promote healthier decision making. Meditation also shows promise in many other health-related areas. We have probably just begun to tap into this natural wellspring of healing through mind-body connection.

– Yvonne S. Thornton, M. D., M. P. H.

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Heart Attack Risk Peaks after Sex or Exercise – Especially if Activity Is Sporadic

Monday, September 9th, 2013

It’s common knowledge these days that regular exercise and an active sex life are heart-healthy. But have you ever wondered whether all that huffing and puffing was stressing your heart rather than strengthening it? That’s exactly what a recent study aimed to answer. Doctors have known for a long time that physical or psychological stress can trigger heart attacks, but how does this reconcile with the conventional wisdom that exercise is actually good for your heart?

Turns out, both assertions are correct. The risk of a heart attack does indeed rise immediately following strenuous exercise or sex, but only for an hour or so, and only if you do not engage in these activities on a regular basis.

Researchers found that any physical exertion, such as having sex, running, or climbing stairs, raised heart attack risk 3.5 times higher than during periods of rest. During sex, the risk is 2.7 times higher. The risk of dying from a heart attack is five times greater immediately following physical exertion than when you are resting.

However, you should not misinterpret these findings to mean that you should not exercise. The risk is still transient and very low, while the overall benefits of exercise remain compelling. The temporary risk of heart attack after exercise is limited to a one- to two-hour window, while the cumulative benefits of exercise can actually reduce your overall risk of having a heart-related episode. And, the more regularly you exercise (or have sex), the less elevated your risk is after each period of exertion.

It may seem strange to think that activities that pose short-term risks after each occurrence are actually healthy when cumulative effects are measured, but that is the case with exercise, sex, and heart disease. Keep in mind that regular exercisers experienced a smaller increase in risk after these behaviors. For every additional episode of physical activity a person implemented each week, heart attack risk dropped by 45%.

The bottom line is that if you are not a regular exerciser, you should be. Most of us experience occasional bouts of physical activity. You can attenuate your risk of heart attack following workouts by making sure they occur more often. Start your exercise routine gradually to avoid raising your heart attack risk as much as possible. Keep in mind that if you have been completely sedentary, even climbing a flight of stairs could qualify as enough physical activity to raise your heart attack risk.

For these reasons, starting an exercise program under a doctor’s supervision is vital. As you get into a routine of working out and your body becomes accustomed to the activity, your risk of having an exercise-induced heart attack drops more and more. Make the effort to get at least a moderate amount of exercise daily so that your heart is healthier and your sex life is safer – and better.

– Yvonne S. Thornton, M. D., M. P. H.

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Gut Flora of Babies Delivered by Cesarean Altered for At Least Six Months

Thursday, September 5th, 2013

One of the things I discuss in my book, Inside Information for Women, is the modern trend of cesarean on demand, or elective cesareans. For many women, cesarean delivery sounds like a simpler, easier alternative to labor and pushing, and to the many doctors who agree with them, it sounds like a good time management technique – preventing their sleep or other activities from being disrupted by inconvenient spontaneous labor. Women should remember that cesarean delivery is major surgery and carries the same significant risks of all major surgeries. Besides, the postoperative recovery period is more difficult following a cesarean than the recovery period following a vaginal delivery. And now, new studies show an additional reason to avoid cesarean whenever possible – the altered gut flora of babies born this way.

The early bacterial colonization of the intestine in newborns is an essential part of development, and now we have a new understanding of what factors can affect this colonization – and what effect altered colonization has on a child. A recent study shows that babies delivered by Cesarean have disturbed intestinal flora for up to, and sometimes longer than, six months after delivery. Two dozen babies were tested and then followed for up to two years. Fecal samples were tested one week after birth, and for up to 24 months in order to identify certain types of bacteria.

The results were striking. A particular type of bacteria known as Bacteroidetes was found less often in babies delivered by cesarean compared to those delivered vaginally, with a delayed colonization of this bacteria and significantly lower immune responses.

Those lower immune responses could mean a higher incidence of the development of allergies or asthma later. This could be because intestinal microbes influence and regulate certain parts of immune function all through the body. There was also less microbial diversity in the babies delivered by cesarean. That this off-balance mix is linked to allergies and other problems later is the conclusion of several recent studies.

There are factors that still need to be studied, but this is an interesting first step in understanding the link between gut flora and allergies and is a testament to the benefits of natural vaginal birth – Mother Nature knows what she is doing. So, as if there weren’t already enough reason to avoid unnecessary cesareans, the new information gleaned from the studies on intestinal flora confirm that women should avoid surgical birth any time it is safe to do so.

– Yvonne S. Thornton, M. D., M. P. H.

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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.

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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.

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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.

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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.

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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.

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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.

 

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