Although my doctor wanted to take my uterus out as soon as possible, I talked her into waiting a couple of weeks to give me a chance to prepare. I needed to prepare my family and my practice. I also needed to prepare myself emotionally. She said that as long as my endometrial biopsy was negative, I could wait. It took two days to get the biopsy results back. I walked around for two days thinking that I probably had cancer and going through a mental checklist of what I was willing to do for treatment and what I wasn’t willing to do. I couldn’t sleep, and I couldn’t eat. When the biopsy came back negative, I was incredibly relieved.

I was informed that I was going to need an abdominal hysterectomy since the mass was too large to be done vaginally. They wanted to take my ovaries, just because they were there and I was insistent they leave them in along with my appendix that they wanted to take out! Although I was no longer worried about cancer, I had surgery and the knowledge of the zillions of complications that could occur to contend with.

I realized that I had little control over what was about to happen to me, or so I thought. I could however stop them from taking out healthy organs that would otherwise be taken out simply because they are there. I was told initially that I could not choose my anesthesiologist. I wanted to listen to an audiotape during the surgery and was told that it was up to the doctor in charge of my head (the anesthesiologist). If one doctor was in charge of my head and one was in charge of my uterus, who was in charge of the whole body?! I was told to register for surgery over the phone. I called at the given time and was told that since I was healthy and the registration department was so busy that I didn’t need to go through the procedure. Unfortunately, that meant I had no idea what to expect!

I realized that although this surgery was major to me and would have an impact on my body and my life, for those doing or participating in my surgery, this was routine. It’s their job. Sometimes, I think, those who do it every day forget the true impact of surgery and its implications for the patient. My patients had expressed frustration with various hospital procedures and experiences to me and I have a new understanding of what they were talking about. I decided I needed to take charge and get some of my control back! So, I did. Robin Miller

TOMORROW: Part III

I have always considered myself to be very healthy. In fact, I have prided myself on staying fit, eating a healthy diet, and being as proactive as possible regarding my health. Of course, when, a few years ago at age 53, I started having vaginal bleeding AFTER going through menopause and my life was out of control, I managed to ignore what was going on. When it continued on and off for a couple of months and I caught myself chiding a patient for not letting me know about her intermittent post-menopausal bleeding, I realized I had a problem.

Even then, I was in total denial about anything being wrong with my “very fit” self. I called my doctor and arranged for a pelvic ultrasound. When the ultrasonographer gasped at the site of my ultrasound, I knew I was in trouble. I could see that there was a very large mass filling the space that used to be my very petite uterus. My heart sank. It was so bad that the ultrasound technician walked my ultrasound and me over to my doctor’s office and insisted that my doctor needed to see me right away. I have a doctor who is very calm. When she got upset, insisted on doing an endometrial biopsy and wanted to take out my uterus the next day, I freaked out. She said she didn’t think that I had cancer, but her eyes told me that she was worried.

I am a doctor, I am not supposed to get sick or have problems, right? I realized I had a health issue that I needed to take care of, and I knew it was time for my uterus to come out. I was no longer the doctor I was now the patient. All kinds of feelings were stirred up for me. I have two sons and they were both hatched in my uterus. Now this very important part of me was going to be removed. It is hard to describe, but I felt a deep sadness mixed with a sense of gratitude.. I got very nostalgic when I thought about the births of my children and what I was able to do with the help of the organ I was about to lose. I also was hit with a sense of humility. I realized how insensitive I had been to others who had lost theirs. So many of my patients have had hysterectomies and I dutifully recorded it in the past medical history section of their chart. I never thought about what it meant to so many of those women. Clearly, this was one of many learning experiences for me on this surgical journey. Robin Miller

Stay tuned for Pt II tomorrow.

Spring is here and stress is in the air. There are worries over the economy, unemployment, and the state of healthcare (among other things). There are ways that each of us deals with stress -both consciously and unconsciously. Some people get sick (not a great solution);others overeat; still others drink too much alcohol. But many people have learned to work it out in a healthy way using things like exercise, meditation, yoga, and talk therapy such as cognitive behavioral therapy (CBT).

CBT is a process that looks at a person’s beliefs, and helps to change negative thought patterns.It is like teaching people to look at the cup as half full, rather than half empty.A recent study has found that ten sessions of CBT significantly improved worry in older individuals with generalized anxiety disorder.CBT has also recently been shown to have an impact on depression and health outcomes in those who have undergone cardiac bypass surgery.

If you are stressed out, you are not alone.We suggest that you look to healthy ways to deal with stress and worry.If you feel you need help and would benefit from talking to someone, you might want to find a therapist who does CBT.And of course, you can always exercise too! Are you sick of hearing that from us yet?!  Robin Miller

Thursday 14 Jan 2010

STRESS RELIEF CAN HELP WITH WEIGHT LOSS

In addition to the stress due to what’s going on in this country, I have had a fair amount of personal stress in my life lately. My dad recently died, my youngest son has gone to college and the nest is now empty and my job is changing and getting a whole lot busier. That has led me to this current blog topic….STRESS!

Stress is one of those things that is a natural part of life. And one of those things that can show up physically with new, or worsening, symptoms. Some of us handle it better than others. There are various types of stress. There is acute stress that you feel when you are in danger and that provokes a “fight or flight” response, otherwise known as an adrenaline rush. There is intermittent acute stress that is a hallmark of those with the type A personality. These are people who are stress junkies and thrive on deadlines and rushing around. Finally, there is continuous or chronic stress. This can be seen in people who are oppressed either by a job, relationship or a government.

The most dangerous form is chronic stress. After time, those with this type of stress get so used to it they don’t even notice it. The continuous outpouring of stress hormones can lead to obesity, diabetes, heart disease, stroke and even cancer.

It is important that you recognize stress in your life and that you do something about it, especially since there are so many ways to relieve stress. I advise starting with a healthy diet (avoid the urge to devour carbs), exercise is key, and then find ways to relax: read a lighthearted book; listen to soothing music; lay on the sofa holding your dog, and pet her nonstop. There are also complementary medical therapies (CAM) such as massage and acupuncture that can help. Meditation and yoga are great ways to relax and manage the stress response. Some may need the help of a therapist. There are chapters in our book, which go into much greater detail about all of these stress-busters including diet, exercise, and CAM therapies

Regardless of which route you choose, it is important to pay attention to your body and if you are chronically or even intermittently stressed get help and stay healthy.  Robin Miller

Saturday 18 Apr 2009

April is Stress Awareness Month:Are the Effects of Chronic Stress on Your Body All in Your Mind?

As a baby boomer, I have joined the ranks of many of my brethren and can say I am part of the “sandwich” generation. I have children who are teenagers and I am helping them to leave the nest. I had a parent that needed my help to fly and leave his nest as well. How many of you have similar stories to the one I am about to tell?

On June 19, 2008 I lost my father. I would say that he died, but he wouldn’t let us use that term. He preferred that we say he “transitioned”. My father was an amazing man. He lived life with integrity and purpose. He was 84 years old and his mind was as sharp as ever. He had renal failure and had been on dialysis. His body was getting weaker and weaker and he finally decided to stop the dialysis. This allowed him to “transition” on his own terms. Once again his strength and dignity prevailed.

Having now gone through the experience of losing a parent and being there for the transition, it has caused me to look at how we see and experience death in our culture. I realize that each person needs to be allowed (whenever possible) to die on his or her own terms.

My father had expressed his wishes to my family and me well in advance and we were able to discuss them with him and understand what he wanted. He also put these wishes into a legal document known as a living will. In his, he put me in charge. At the time, I didn’t realize how important that was. But, when the time came, I had to act.

I felt like Shirley MacLaine in the movie “Terms of Endearment” when she was fighting for pain medications for her daughter who was dying. I had to scream for morphine for my father when his lungs started to fill up with fluid. Fortunately, after quite a bit of drama, he was able to get what he needed and I honored the promise that I made to him. His transition was peaceful and I am happy that he got what he wanted. In the wake of all this is a massive amount of grief, which is a natural part of life.

I share this story so that it will allow you to pause and think about whether you have a living will. Have you discussed the issues of death and dying with your loved ones? Although many of us live as if we will never die, that is one of those things that is inevitable for all of us.

Although death is never easy, knowing what my dad wanted and knowing that we were able to provide it both with the living will and details of his funeral that he planned ahead of time, made things better somehow.

Death is a natural part of the cycle of life. It is okay to talk about it and to address it when it is staring you in the face. But, it is also important to say all the wonderful things you want to say and understand the wants and needs of others before an emergency situation develops.

Hug your children, your parents, your brothers and sisters and your friends. Tell them you love them as often as you can. That is what my father taught me. I am glad I was able to tell him that many times before his grand transition!      Robin Miller

Last year around this same time, as Robin and I were madly writing away, we were also working with the talented staff at our publisher to come up with a title for our book. I was carrying around a little spiral notebook, and constantly jotting down words and phrases immediately as they came to me for possible use in a title. And there were endless emails of endless lists of ideas shooting back and forth. At one point, I even got out a thesaurus (an abbreviated one of course) and paged through lists and lists of adjectives.

One day, during this time, I was looking after my 8 year old neighbor while her mother was at work, and she naturally became curious about all the time I was spending at the computer and about all the books scattered all over the room. And asked what I was doing. So I told her that my friend and I were writing a book, which of course prompted many more questions – why were we doing it, what was it about, who was it for. After I answered these, she asked what the title was going to be and I told her we didn’t know yet.

So, she immediately said that she had one: “ It’s Your Health, But We Help.”

I laughed, told her it was a great idea, and promptly went back to my thesaurus and other books and computer.

Finally, after months of trying to come up with a title, we realized that what would help the most, as it always does, was to go back to the basics – why we were writing the book in the first place.

We were trying to accomplish several things at once with our book, all based on what we had learned from our own patients over the years. One thing we were trying to do was simplify the huge amount of complicated medical information flying around out there; to pull out the pieces relevant to women in midlife and older, and get down to the basic health issues that all of us need to know in order to best take care of ourselves in the twenty-first century.

We were also trying to prioritize those issues so that you, our readers, would learn which ones simply had to be taken care of regularly or immediately, and which did not. Especially given the state of the healthcare environment today, in which doctors and other clinicians are not able, even though we’d like, to spend the lengthy amounts of time with each patient that we used to. That time just isn’t available anymore. But, that’s another story/blog.

Back to our book. We had two focuses: to make you aware of the most common diseases that occur as we grow older, and of how to prevent them; and, because no matter how well we take care of ourselves we all get sick at some point, to let you know what symptoms indicate true health emergencies and what you should do about them.

But, even with all of the above in our book, we knew one thing for sure, the one thing that we’ve learned from our patients over and over again. That is, that no matter how much information we give or recommendations we make, each of us has to want, and to decide, to do the things that are necessary to stay healthy as we grow older. Our book can only be your roadmap; you’re driving the car.

You now know, of course, what title was chosen. And we’re very pleased with it. But when we need something that sums up our philosophy and that of our book, shorter than its title, we’ve got our “soundbite”:

It’s Your Health, But We Help. 

Janet Horn