Ovarian Cancer Is Not a Death Sentence

As told to Jackie Froeber

May 8 is World Ovarian Cancer Awareness Day.

I was 44 years old when I began feeling a pulsating pain on the left side of my lower back. The pain lasted about a day and started around the time I was supposed to start my period. When I didn’t start my period that month, I went to my gynecologist and she told me not to worry. It was probably stress. To be on the safe side, she ordered blood work, including a CA 125 test. She didn’t tell me that it measures the level of CA 125 protein in your body, something that is commonly associated with ovarian cancer. All I knew was that the test results came back normal.

I continued having the monthly pain and no period — and telling my gynecologist — for almost a year, until the day the pain got so bad that I went to the emergency room, where I literally passed out from the pain. The next thing I knew, a doctor was waking me up saying, “You know you have ovarian cancer, right?”

It was the first time I heard those words.

The gravity of the diagnosis did not register with me, even though doctors were trying to transfer me to a facility with an oncology department, which was hard to find because I lived 50 miles from any big city in New York.

After a week in the hospital, I was transferred to Mount Sinai in Manhattan and waited another week for the surgeon to perform a total hysterectomy with salpingo-oophorectomy to remove my uterus, cervix, fallopian tubes and my remaining ovary (I’d had one removed previously because of a cyst). I was given a treatment plan, that included chemotherapy, but I was still in a la-la land of sorts. I knew I had ovarian cancer, but I wasn’t grasping what was ahead.

Two weeks later, I was lying on my couch and thinking about everything I had just gone through when it hit me: I have cancer. I jumped up from the couch and called my oncologist and that was the first time I was really able to hear him when he said, “Yes, Nancy. You have ovarian cancer. We have to start chemo and additional treatment right away.”

The plan was aggressive: chemotherapy 9 a.m. to 5 p.m., five days a week, followed by two weeks off, for 14 weeks. My type of cancer, granulosa cell, is rare and only found in 2% of ovarian cancer cases. My oncologist wanted the chemo to be done in the hospital, but I begged him for an alternative. I had just spent weeks in the hospital, and I was devastated at the thought of going back so soon. By a stroke of amazing luck, we found a doctor in my neighborhood who was willing to give me chemotherapy on my doctor’s behalf, and I was able to get treatment close to home.

After researching the disease and the treatment plan, I was overwhelmed thinking about losing my hair and crushed at the thought of losing my job as an insurance underwriter. It seemed like cancer was going to take up all my time for the foreseeable future. I also knew there was a chance that the cancer could come back, despite the aggressive treatment — but I had to try.

Unfortunately, chemotherapy turned out to be a short-term solution. Less than two years later, in 2008, I felt that same pulsating pain on my left side.. I knew right away the cancer had returned. We caught it quickly, and I had surgery to remove a tumor that had formed on my pelvis — no chemotherapy — but I knew from my research that a recurrence meant my condition was chronic and the tumors could return. The third time, we did the reverse, and I had four rounds of chemotherapy and no surgery.

You simply cannot prepare yourself for the emotional roller coaster of recurrent cancer. And the apprehension never really goes away. After 15 years, I still get unbelievable anxiety every time I go in for a test. In total, I’ve had four recurrences of ovarian cancer (in addition to the initial diagnosis) and four surgeries over the past 15 years. Currently I’m on targeted therapy to maintain the two tumors I still have, and I am avoiding surgery — which is working for me.

Cancer can feel like a full time job: I have CT scans every three to six months and countless doctor appointments. There are days where I battle fatigue, pain in my joints and mental fog, but overall I feel good. I practice yoga and meditate to keep my stress in check. I also stay busy volunteering and helping other women with ovarian cancer.

Looking back on the first time I felt that pulsating pain on my left side, I wish I’d listened to my body and gotten a second opinion or pushed for more testing even though my blood work was normal. I now know that my type of cancer doesn’t show up in an elevated level of CA 125. My new oncologist told me he’d never forget me because I was his only patient with ovarian cancer and a CA 125 level at zero.

Not all women will check the same boxes when it comes to ovarian cancer. I don’t have typical risk factors, such as a family history of the disease, and I don’t have the BRCA gene. I did have some gynecological problems — uterine fibroids and the ovary with a cyst in 2001 — but I’d never even heard the term ovarian cancer before going to the ER in 2006.

It’s true that ovarian cancer rarely has symptoms in the early stages, but an advanced-stage diagnosis isn’t a death sentence. You can live with ovarian cancer and have a great quality of life thanks to the variety of new treatments that are available today.

Today, I’m a board member for the nonprofit TEAL Walk organization, which helps raise funds and support fellow ovarian cancer survivors. There are a lot of us who are 15-plus years out from diagnosis — I’m looking forward to being part of the 20-plus group.

เลือดอุดตันที่เกี่ยวข้องกับวัคซีน COVID-19 ของจอห์นสันแอนด์จอห์นสันคืออะไร? มีคำตอบ 4 คำถาม

โดย มูซูมิซอม, มหาวิทยาลัยแห่งรัฐโอคลาโฮมา

วัคซีนสองชนิด ได้แก่ วัคซีน Johnson & Johnson ในสหรัฐอเมริกาและวัคซีน AstraZeneca ในยุโรปมีความเชื่อมโยงกับโอกาสที่จะเกิดลิ่มเลือดชนิดหายากเพิ่มขึ้น นักวิจัยกำลังตรวจสอบว่าอะไรเป็นสาเหตุของการอุดตันเหล่านี้และกำลังเริ่มเสนอคำตอบ ดร. มูซูมิสมศาสตราจารย์ด้านการแพทย์จากมหาวิทยาลัยแห่งรัฐโอคลาโฮมาอธิบายว่าลิ่มเลือดที่หายากเหล่านี้คืออะไรและเกิดขึ้นได้อย่างไรหลังจากที่ผู้คนได้รับการฉีดวัคซีน

1. ลิ่มเลือดคืออะไร?

มีคนจำนวนน้อยในสหรัฐอเมริกา พัฒนาลิ่มเลือดที่เป็นอันตราย หลังจากได้รับวัคซีน Johnson & Johnson การอุดตันส่วนใหญ่เกิดขึ้นในสมองของผู้คนและในทางตรงกันข้ามคือ เกี่ยวข้องกับจำนวนเกล็ดเลือดต่ำ.

โดยปกติเกล็ดเลือดจะช่วยให้คน ๆ หนึ่งหยุดเลือดเมื่อได้รับบาดเจ็บ หากคุณได้รับการตัดหรือได้รับบาดเจ็บร่างกายจะตอบสนองโดยการส่งเกล็ดเลือดซึ่งทำหน้าที่เป็นแผ่นแปะชั่วคราว แผ่นแปะดึงดูดเกล็ดเลือดอื่น ๆ และเกาะติดกัน เพื่อหยุดการสูญเสียเลือด. เนื่องจากโดยปกติเกล็ดเลือดจะช่วยกระบวนการแข็งตัวการรวมกันของเกล็ดเลือดต่ำและการแข็งตัวของเลือดมากทำให้ลิ่มเลือดเหล่านี้ผิดปกติทางการแพทย์

การอุดตันที่เฉพาะเจาะจงเหล่านี้เรียกว่าการอุดตันของไซนัสในหลอดเลือดดำในสมอง – แม้ว่าจะหายาก แต่ก็ส่งผลกระทบต่อรอบ ๆ สองถึงห้าคนต่อล้านคนต่อปี และเป็น อาจเป็นอันตรายถึงชีวิตโดยไม่ได้รับการรักษา. โดยปกติวัคซีนไม่ได้เป็นตัวกระตุ้นให้เกิดลิ่มเลือดชนิดนี้

3. ทำไมผู้หญิงถึงมีลิ่มเลือดอุดตันมากกว่าผู้ชาย?

ถึงตอนนี้แพทย์ยังไม่ทราบว่าอะไรทำให้ ผู้หญิงอ่อนแอกว่าผู้ชายและสิ่งที่ทำให้บุคคลเสี่ยงต่อการเกิดลิ่มเลือดเหล่านี้ การอุดตันเหล่านี้อาจเกิดขึ้นได้แม้ว่าจะไม่บ่อยนักในผู้ที่ไม่ได้รับวัคซีน นักวิทยาศาสตร์ทราบดีว่าผู้หญิงมีแนวโน้มที่จะเกิดก้อนชนิดนี้มากขึ้นถึงสามเท่าโดยไม่ได้รับวัคซีน นักวิจัยหลายคนคิดว่าเป็นเพราะ การคุมกำเนิดหรือการเปลี่ยนฮอร์โมนอื่น ๆ ที่ผู้หญิงใช้

4. เหตุใดวัคซีนจึงอาจทำให้เลือดอุดตันได้?

นักวิจัยเชื่อว่าสิ่งนี้เฉพาะ การแข็งตัวของเกล็ดเลือดต่ำ คล้ายกับปฏิกิริยาที่บางคนได้รับเมื่อพวกเขา ได้รับเลือดทินเนอร์ที่เรียกว่าเฮปารินเรียกว่าภาวะเกล็ดเลือดต่ำที่เกิดจากเฮปาริน

บางครั้งแพทย์ใช้เฮปารินเพื่อทำให้เลือดของคนบางคนบางลงในกรณีที่หัวใจวายหรือก้อนเลือดเมื่อต้องมีการไหลเวียนของเลือดอีกครั้ง แต่บางคนพบปฏิกิริยาที่ตรงกันข้ามและเลือดของพวกเขาจะจับตัวเป็นก้อนมากขึ้นแทน สิ่งนี้เกิดขึ้นเนื่องจากร่างกายกระตุ้นการตอบสนองภูมิคุ้มกันที่ไม่ต้องการหลังจากได้รับเฮปาริน

ในผู้ป่วยเหล่านี้เฮปารินจะยึดติดกับผลิตภัณฑ์ที่ปล่อยออกมาจากเกล็ดเลือดที่เรียกว่าเกล็ดเลือดแฟคเตอร์ 4 เมื่อเกิดเหตุการณ์นี้ระบบภูมิคุ้มกันจะพิจารณาว่าเกล็ดเลือดแฟคเตอร์ 4 รวมกันและเฮปารินเป็นปัญหาดังนั้นจึงสร้างแอนติบอดีเพื่อตอบสนอง แอนติบอดีเหล่านี้ยึดติดกับเฮปารินและเกล็ดเลือดแฟคเตอร์ 4 คอมเพล็กซ์และร่างกายซึ่งตอนนี้คิดว่าจำเป็นต้องซ่อมแซมอาการบาดเจ็บทำให้เกิดการแข็งตัวมากขึ้นในขณะที่ใช้เกล็ดเลือดมากขึ้น นี้ ส่งผลให้เกล็ดเลือดต่ำพบได้ในผู้ป่วยเหล่านี้

เมื่อแพทย์ตรวจดูเลือดของผู้ป่วยที่เกิดลิ่มเลือดหลังจากได้รับวัคซีน Johnson & Johnson หรือ AstraZeneca พบว่าคล้ายกับเลือดของผู้ที่มีปฏิกิริยาการแข็งตัวของเกล็ดเลือดต่ำต่อเฮปาริน สิ่งนี้ทำให้นักวิทยาศาสตร์และแพทย์เชื่อว่า กระบวนการเดียวกันอาจนำไปสู่การอุดตันเหล่านี้ เกิดจากวัคซีนทั้งสองชนิดบทสนทนา

มูซูมิซอม, ศาสตราจารย์อายุรศาสตร์, มหาวิทยาลัยแห่งรัฐโอคลาโฮมา

บทความนี้เผยแพร่ซ้ำจาก บทสนทนา ภายใต้สัญญาอนุญาตครีเอทีฟคอมมอนส์ อ่าน บทความต้นฉบับ.

Self-Care Is Important At Every Age

To kick off Women’s Health Month, we’re exploring the importance of self-care for women of all ages. Join HealthyWomen’s CEO Beth Battaglino and Patricia Geraghty, medical director of Women’s Health, Comprehensive Wellness for a Q&A on all things self-care on Instagram Live, Wednesday May 5 from 11:30-11:45 a.m EDT.

For your best friend, it might be the thought of sinking down into one of those overstuffed chairs, submerging her feet in bubbly blue water and getting a relaxing foot massage before having her toenails painted in the season’s hottest new nail color. For me, it can be as simple as taking a brisk walk in the early morning.

No matter what self-care looks like to you, it can help you recharge, manage life’s challenges, and hit the reset button — which can be a much-needed boost to your mental and physical health.

To learn more about how self-care and our health are connected, I spoke with Saundra Jain, a psychotherapist and adjunct clinical affiliate at the University of Texas at Austin and member of HealthyWomen’s Women’s Health Advisory Council. Jain said that practicing self-care can decrease anxiety and stress as well as improve our well-being. “Self-care and mental health are two sides of the same coin.”

She added that self-care is unique to the individual and what works for one person won’t necessarily work for another.

For some, self-care in the form of manicures, massages and scented candles work well, but these specific practices may not be fulfilling or financially accessible for everyone. And that’s OK. Self-care can come in many different forms: working out, enjoying hobbies, seeing loved ones, talking to a counselor, practicing yoga, taking art classes, spending time with animals, taking a nap, enjoying a meal, or even just being outside.

Jill Emanuele, Ph.D., senior director of the Mood Disorders Center at the Child Mind Institute in New York, suggests that when thinking about how to incorporate self-care, we should ask what our goals are, what we need, what is out of balance in our lives, and which approach to self-care will work best for us.

“Self-care is like filling up the gas tank. We need to refill our energy, otherwise it will get depleted,” Emanuele said.

Self-care in your thirties and forties

Samantha Vinokor-Meinrath, a 31-year-old Jewish educator in Ohio, said that in her early- to mid-twenties she viewed self-care as socializing with friends and partaking in certain indulgences, but now that she’s gotten older, self-care has a different meaning and is now more about trying new hobbies, often on her own.

Vinokor-Meinrath began knitting and taking knitting classes, even if she didn’t know anyone else in the class. Taking her dogs for walks is another important self-care activity she enjoys. “I came to like being alone. I can do these things at my own pace — stay at the park longer and visit new parks. Self-care now is more about identifying what works and not always needing to share it or post about it. It can be just for me to enjoy.”

Improving sleep habits can also be an important part of self-care. Emma Simmons, a 40-year-old nurse in Virginia, says that, for her, self-care is ensuring she gets enough shut eye. “Sleep is essential. My work hours have always been hectic, but when I don’t prioritize sleep, I can feel my stress level go up.”

Self-care can be challenging for those who are in the midst of caring for young children. Emanuele suggests trying to find small moments throughout the day to recharge. For example, you can take a moment for yourself to sit and enjoy your favorite coffee or snack while your children are engaged in an activity or your baby is in their crib. If support and resources are limited, instead of paying for childcare, close friends can take turns watching each other’s children so each parent has a little alone time to recharge.

Self-care in your fifties and beyond

The reasons we practice self-care can change throughout the years. Jacinda Velez, a 53-year-old web designer in New York City says that her motivation for how and why she practices self-care is different in her 50s than it was when she was younger.

Velez says that she used to take long walks throughout different neighborhoods in the city to exercise. While she walked, she enjoyed people watching, looking at all the pretty buildings, and exploring the city. But in her 50s, Velez says her motivation for this form of self-care changed.

“I have always loved walking, but my self-care routine when I was younger was more about fitness and entertainment. Walking around the city for hours provided both, but now I don’t have as much free time and my motivation for walking is less about fitness and entertainment and more about my mental health. Clearing my head, resetting my mind, and just having some time to myself.”

Kathy Radigan, a 55-year-old writer and mother of three from New York, said that, when her children were younger, she often looked for self-care activities that she could do while she was home with her children. “Gardening was something I really enjoyed. I could be outside in the garden with my children nearby and get to do something I loved without having to worry about finding childcare.”

But, at this point in her life, Radigan said, sometimes self-care can just be watching reruns of her favorite TV shows from her childhood that bring back happy memories. Radigan also joined a Facebook gardening group that has helped her connect to others with similar interests.

Dr. Sharon D. Allison-Ottey, executive director of The COSHAR Healthy Communities Foundation and a member of HealthyWomen’s Women’s Health Advisory Council, says that self-care is often seen as something for younger people, but it’s just as important as you age. Self-care can look different to older people who may not have grown up with this notion. “They grew up in a different time. Self-care was not spoken about in the way it is now and it could be seen as being selfish or indulgent to take time just for yourself, especially if there are other people to take care of,” said Allison-Ottey.

Claudia Long, a 66-year-old attorney in California, says that self-care changed for her in her 60s. “I used to think that I shouldn’t be reading during the day — that was something I should wait to do at night, and during the day, I need to be doing something more productive — but now I have given myself permission to do more of the things that I enjoy and want to do.”

Finding the right self-care is something that everyone deserves. “Keep reminding yourself that self-care isn’t a selfish or indulgent act. It’s a way to nurture and sustain better physical and mental well-being,” said Jain.

Self-care suggestions:

  • Go for a brisk walk to help clear the mind and relieve stress
  • Do calming/breathing exercises. There are also different apps that guides users through relaxation exercises
  • Try out different activities, such as journaling, knitting, reading, going for a bike ride, and learning to play an instrument
  • Join a social media group that positively focuses on your interests
  • Listen to music or a podcast
  • Get enough sleep. At every age, sleep is crucial to wellness
  • Watch a movie/TV show that will provide a much needed distraction
  • Take a break from technology — sometimes we need turn things off to recharge
  • Talk with a trusted friend or counselor

If you need mental health support, please contact NAMI, the 24-hour Crisis Text Line or SAMSHA.

Family Meals Are Good for the Grown-Ups, Too, Not Just the Kids

By Anne Fishel, Harvard University

For all the parents feeling exhausted by the cooking, cleaning and planning of a million meals during the pandemic, there’s some good news. Commensality, or the sharing of food with others, is beneficial for your physical and mental health.

Most parents already know that family mealtimes are great for the bodies, the brains and the mental health of children. More than two decades of studies reveal that kids who eat with their families do better in school and have bigger vocabularies. They also have lower rates of depression, anxiety and eating disorders, as well as healthier diets and better cardiovascular health.

But what may come as unexpected news to beleaguered parents is that these same shared meals are also good for adults. Across the life span, from young parents eating with toddlers to parents talking about pandemic-coping strategies with their school-age kids and Medicare-eligible adults eating with younger generations, shared meals are associated with healthier eating and better mood.

Healthy for all adults, but especially for parents

For adults, both with and without children, there are numerous health benefits to eating with others. Even unrelated adults, like firefighters, have enhanced team performance when they cook and eat together as they await the call to action.

On the flip side, researchers have found that eating alone is associated with an increased likelihood of skipping meals and the downstream effects – lower intakes of nutrients, reduced energy and poorer nutritional health.

Regardless of parental status, adults who eat with others tend to eat more fruits and vegetables and less fast food than those who eat alone. Even when a home cook isn’t particularly focused on healthy cooking, home-cooked meals lower the odds that adults will be obese. Large portion sizes, the embrace of fried foods and a heavy hand with butter are more common at restaurants than in a civilian’s kitchen.

Adults who park their dinner plates in front of the television may have a greater chance of weight gain, just as evidence from the U.S., Sweden, Finland and Portugal supports the connection between obesity and kids’ eating dinner while watching TV.

In addition to these benefits of dining with others, there are additional boosts for adults who eat with their children – and they pertain equally to mothers and fathers. When kids are present at mealtime, parents may eat more healthily, perhaps to model good behavior and provide the best nourishment they can to their kids. When there is plenty of conversation with kids chiming in, the pace of eating slows down, allowing diners’ brains to register fullness and signal that it’s time to stop eating.

For kids, eating more family meals is associated with lower rates of obesity. The act of eating with others does not correlate with reduced weight gain in adults, though – unless their dining companions include children. Parents who dine with their kids also tend to report less dieting and binge-eating behavior. Parents may dial back some of these destructive behaviors when they know their kids are watching and ready to imitate.

Despite all the work, a boost for mental health

It may seem counterintuitive that a process that demands so much time and resources – the energy to plan the meal, shop for it, prepare it, serve it and clean up after – could also lead to boosts in mental health. Much more obvious is how kids would benefit from their parents’ demonstrating their love and care by providing nightly dinners.

But researchers have found that having frequent family meals is associated with better mental health for both mothers and fathers, despite mothers’ carrying more of the burden of meal prep. Compared with parents who rarely ate family meals, parents who regularly dined with their kids reported higher levels of family functioning, greater self-esteem and lower levels of depressive symptoms and stress.

And mental health benefits don’t depend on a slow-roasted pork shoulder or organic vegetables. Since it’s the atmosphere at the dinner table that contributes most significantly to emotional well-being, takeout or prepared food eaten at home will work nicely too.

In an earlier study of parents of infants and toddlers, couples who attached more meaning and importance to family meals were more satisfied with their marital relationship. It’s unclear in which direction the causality goes. Is it that those in more satisfying marriages gravitate toward creating daily rituals? Or that enacting daily rituals leads to more robust relationships? In either case, the establishment of meaningful rituals, like shared mealtime, during early stages of parenthood may add some predictability and routine at a time of life that can be very busy and fragmented.

Just as for children, family dinner is the most reliable time of the day for adults to slow down and talk to others. It’s a time to step away from video calls, emails and to-do lists, and instead connect face to face. Dinnertime often allows for a few laughs, a time to decompress and also to solve logistical problems and talk about the day’s events and what tomorrow holds.

Family meals are a COVID-19 habit to keep

For parents taking the long view, there is another perk to family dinner. When adolescents grow up having regular family dinners, they are much more likely to replicate that practice in their own homes when they become parents. Adults who reported having had six to seven family meals a week as a child went on to have frequent family meals with their own children. Family dinner and its benefits may be an heirloom you pass along to future generations.

Shared mealtime, however, is not equally accessible to all. Frequent family dinners are more common among white Americans, those with higher levels of education, married people and those with household incomes that are middle class or higher. While family meal frequency in the U.S. remained quite steady overall from 1999 to 2010, it decreased significantly (47% to 39%) for low-income families while increasing (57% to 61%) for high-income families. This gap can be understood in terms of structural disparities: Low-income parents often have less control over their work schedules and may need to juggle more than one job to make ends meet.

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As people now tiptoe back to living more expansively, many are reflecting on what they learned during the pandemic that might be worth holding on to. There is some evidence that more families ate more meals together during the COVID-19 pandemic than ever before. Some families who didn’t prioritize eating together pre-pandemic may emerge from the past year with a new appreciation of the joys of commensality. Of course, others may already be bookmarking all their favorite restaurants, eager to have chefs cook for them after feeling depleted by so much home labor.

But parents may want to remember that the science suggests shared mealtime is good for the mental and physical health of each member of the family. As people start to heal from this past year of loss, disruption and anxiety, why not continue to engage in nourishing practices that are helpful to all? In my family therapy practice, it will be a top recommendation.The Conversation

Anne Fishel, Associate Clinical Professor of Psychology at Harvard Medical School, Harvard University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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เข้าร่วมกับ Beth Battaglino ซีอีโอของ HealthyWomen ในขณะที่เธอเป็นผู้นำการสนทนากับผู้เชี่ยวชาญจากสภาที่ปรึกษาด้านสุขภาพสตรีที่ประสบความสำเร็จของเราในวันพุธที่ผ่านมาใน Instagram Live ในแต่ละสัปดาห์เราจะพิจารณาหัวข้อเฉพาะที่ส่งผลกระทบต่อผู้หญิงทุกวัยอย่างละเอียดยิ่งขึ้น เราหวังว่าคุณจะเข้าร่วมกับเรา อินสตาแกรมสด สำหรับการสนทนาที่สำคัญเหล่านี้

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Patricia Geraghty, FNP-BC, WHNP,

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กายาตรีเทวี, MD, MS, FAAN, FACP
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Emily Jamea, Ph.D. , LMFT, LPC, AASECT

Women’s Health Advisory Council (WHAC)

Our Women’s Health Advisory Council includes a network of medical experts and health professionals who specialize in a range of health conditions pertinent to the women we serve. This group of experts and doctors lend their expertise to inform our content, and medically review our resources for accuracy. Meet our Women’s Health Advisory Council members.

DaCarla Albright, MD

DaCarla Albright, MD
Associate Professor of Clinical Obstetrics and Gynecology
University of Pennsylvania

Ivy Alexander, PhD, APRN, ANP-BC, FAANP, FAAN

Ivy Alexander, PhD, APRN, ANP-BC, FAANP, FAAN
University of Connecticut
Adult-Gerontological Primary Care Nurse Practitioner Track

Sharon Allison-Ottey, MD

Sharon Allison-Ottey, MD
CEO CARLDEN Inc and Beautiful Woman Inside and Out
Internal Medicine and Geriatric Medicine

Heather Bartos, MD

Heather Bartos, MD
Founder of Badass Woman, Badass Health
Sexual Health

u200bNancy Berman, MSN, ANP-BC, NCMP, FAANP

Nancy Berman, MSN, ANP-BC, NCMP, FAANP
Nurse Practitioner
Michigan Healthcare Professionals
Women’s Health

u200bSeema Bonney, MD

Seema Bonney, MD
Founder and Medical Director
Anti-Aging & Longevity Center of Philadelphia
Prevention and Wellness

u200bEmily A. Callahan, MPH, RDN

Emily A. Callahan, MPH, RDN
Registered Dietitian Nutritionist
Owner and Founder, EAC Health and Nutrition, LLC

u200bArnold Ceponis, MD, PhD

Arnold Ceponis, MD, PhD
University of California San Diego Health System

u200bChristina Y. Chen, MD

Christina Y. Chen, MD
Mayo Clinic
Geriatric Medicine

u200bBarbara Dehn, RN, MS, NP, FAANP, NCMP

Barbara Dehn, RN, MS, NP, FAANP, NCMP
Nurse Practitioner
Women’s Health, Menopause

u200bHeather DeMille Hirsch, MD

Heather DeMille Hirsch, MD
Brigham and Women’s Hospital
Women’s Health

u200bBarbara DePree, MD, NCMP, MMM

Barbara DePree, MD, NCMP, MMM
MiddlesexMD, Women’s Health LHP Holland Hospital
Menopause, Sexual Health

u200bGayatri Devi, MD, MS, FAAN, FACP

Gayatri Devi, MD, MS, FAAN, FACP
Neurology, Cognition in Menopause
Park Avenue Neurology

u200bCindy Duke, MD, PhD, FACOG

Cindy Duke, MD, PhD, FACOG
Physician, Scientist, Influencer
Nevada Fertility Institute
Ob-Gyn, Reproductive Endocrinology & Infertility

u200bDaihnia Dunkley, PhD, RN

Daihnia Dunkley, PhD, RN
Assistant Professor
Farmingdale State College
Obstetrics (Maternal-child nursing),
Black/Minority Maternal Health Disparities

u200bMarissa Duswalt Epstein, RDN, MBA

Marissa Duswalt Epstein, RDN, MBA
Director, Nutrition Institute
The University of Texas At Austin

Robyn Faye, MD, FACOG, NCMP, IF, CSC

Robyn Faye, MD, FACOG, NCMP, IF, CSC
Abington Primary Women’s Healthcare Group
Sexual Health, Pelvic Health

u200bRena Ferguson, MD PC

Rena Ferguson, MD PC
Adjunct Professor
Stony Brook University
Psychiatry and Neuromodulation

u200bDeborah Friedman, MD, MPH, FAAN

Deborah Friedman, MD, MPH, FAAN
Professor, Neurology and Neurotherapeutics and Ophthalmology
University of Texas Southwestern Medical Center

u200bDebra Furr-Holden, PhD

Debra Furr-Holden, PhD
Public Health/Epidemiologist
Associate Dean for Public Health Integration
Michigan State University College of Human Medicine
Public Health, Epidemiology

Patricia Geraghty MSN, FNP-BC, WHNP

Patricia Geraghty MSN, FNP-BC, WHNP
Medical Director, Women’s Health
Comprehensive Wellness
Women’s Health

u200bNieca Goldberg, MD

Nieca Goldberg, MD
Medical Director
Joan H. Tisch Center for Women’s Health NYU Langone

u200bCheryl B. Iglesia, MD, FACOG

Cheryl B. Iglesia, MD, FACOG
Director Section of Female Pelvic Medicine and Reconstructive Surgery
MedStar Washington Hospital CenterProfessor, Departments of Ob/Gyn and Urology
Georgetown University School of Medicine

Saundra Jain, MA, PsyD, LPC

Saundra Jain, MA, PsyD, LPC
Adjunct Clinical Affiliate
The University of Texas at Austin
Psychology, Mental Health

u200bEmily Jamea, PhD, LMFT, LPC, AASECT

Emily Jamea, PhD, LMFT, LPC, AASECT
Certified Sex Therapist
REVIVE Therapy & Healing
Sexual Health & Relationships

Laurie S. Jeffers, DNP, FNP-BC

Laurie S. Jeffers, DNP, FNP-BC
Clinical Assistant
New York University
Women’s Health, Menopause

Susan Kellogg Spadt, PhD, CRNP, IF, CST

Susan Kellogg Spadt, PhD, CRNP, IF, CST
Professor of Ob-Gyn
Drexel University College of Medicine
Pelvic Pain, Sexual Dysfunction

u200bSheryl Kingsberg, PhD

Sheryl Kingsberg, PhD
Professor Reproductive Biology and Psychiatry
Case Western Reserve University

u200bJoyce Knestrick, PhD, FNP-BC, FAANP

Joyce Knestrick, PhD, FNP-BC, FAANP
Visiting Professor
George Washington University
Family Medicine

Rashmi Kudesia, MD, MSc, FACOG

Rashmi Kudesia, MD, MSc, FACOG
Assistant Clinical Professor of Obstetrics & Gynecology
Houston Methodist Hospital
Ob-Gyn, Reproductive Endocrinology & Infertility

u200bLisa Larkin, MD, FACP, NCMP, IF

Lisa Larkin, MD, FACP, NCMP, IF
Founder and CEO
Ms. Medicine
Internal Medicine, Women’s Health, Menopause

Ayanna E. Lewis, MD

Ayanna E. Lewis, MD
Attending Physician
Department of Medicine
Division of Gastroenterology
Mount Sinai South Nassau
Gastroenteology, Hepatology, Inflammatory Bowel Disease

Allison E. Lied, MD

Allison E. Lied, MD
American Board of Plastic Surgery
Holzapfel and Lied Plastic Surgery
Plastic Surgery

u200bElizabeth Liotta, MD

Elizabeth Liotta, MD
Dr. Liz Liotta, MD, LLC

Holly F. Lofton, MD

Holly F. Lofton, MD
Clinical Associate Professor of Surgery and Medicine
Director, Medical Weight Management Program
Fellowship Director, Clinical Obesity Medicine Fellowship
Lead of Clinical Access and Education Programs, Comprehensive Program on Obesity
NYU Langone Weight Management Program
Obesity Medicine

u200bJessica Matthews, DBH, NBC-HWC

Jessica Matthews, DBH, NBC-HWC
Director of Master of Kinesiology in Integrative WellnessPoint Loma Nazarene University; University of California- San Diego
Behavioral Medicine, Integrative Health

u200bMary Jane Minkin, MD, FACOG, NCMP

Mary Jane Minkin, MD, FACOG, NCMP
Clinical Professor, Department of Obstetrics, Gynecology and Reproductive Sciences
Yale University School of Medicine
Ob-Gyn, Menopause

Melissa Nassaney, DPT, PT, MS
Physical Therapist
Pelvic Health Rehab
Full Circle Pelvic Health
Pelvic Health

Connie Newman, MD
Adjunct Professor
NYU Langone School of Medicine

Smita Patel, DO
Founder and Medical Director
Integrative Neurology and Sleep
iNeuro Institute

Jennifer Payne, MD
Associate Professor of Psychiatry and Director, Johns Hopkins Women’s Mood Disorders
Psychiatry, Mental Health

Joann Pinkerton, MD
Professor of Obstetrics and Gynecology
Division Director of Midlife Health Center
UVA Health
Menopause, Women’s Health

Lauri Romanzi, MD, MScPH, FACOG, FPMRS
Obstetrics and Gynecology
New York, NY

Sabrina Sahni, MD, NCMP
Clinical Assistant Professor
Obstetrics and Gynecology & Reproductive Biology
Cleveland Clinic Lerner College of Medicine
Menopause, Women’s Health

Glenn Schattman, MD
Associate Professor
Weill Medical College of Cornell University
Reproductive Health

Jessica Shepherd, MD, MBA, FACOG
Women’s Health Expert and Minimally Invasive Gynecologist
Baylor University Medical Center
Ob-Gyn, Women’s Health

Isabel Smith, MS RD CDN
Registered Dietitian
Founder Isabel Smith Nutrition, Inc.

Kim Templeton, MD, FAOA, FAMWA
Professor of Orthopaedic Surgery
University of Kansas; American Medical Women’s Association

Kim Tran, MS, PharmD
Pharmacy Manager
Jackson Health System

Sophia Yen, MD, MPH
CEO and Co-Founder
Pandia Health
Reproductive Health

Kidist Yimam, MD
Medical Director, Autoimmune Liver Disease Program
California Pacific Medical Center; Department of Hepatology and Liver Transplantation
Liver Disease/Hepatology

Kristen A. Zarfos, MD, FACS
Medical Director
Breast Surgeon, Specializing in Breast Health
Breast Cancer care
Trinity of New England, St. Francis Hospital
Breast Health

Danica Roem Is Transcending Gender

Danica Roem made history in 2017 when she became the first transgender lawmaker in Virginia. A champion of LGBTQ rights, she recently introduced a bill in Virginia that bans the “gay and trans panic” defense that has historically been used in cases of murder and manslaughter against gay and trans people. It was signed into law by Gov. Ralph Northam, making Virginia just the 12th state in the United States to ban this defense, which allows people to use their fear of homosexuals and transgender people to justify violence against them.

Delegate Roem recently spoke with HealthyWomen’s editor-in-chief, Jaimie Seaton, to discuss the importance of trans rights and what these legislative changes can mean for the LGBTQ community.

This interview has been edited for length and clarity.

HealthyWomen: I’m stunned that legislation banning the gay and trans panic defense is necessary in 2021. Can you tell me the impetus for the law you introduced in Virginia?

Del. Roem: The reason I introduced the bill in the first place was because a 15-year-old out constituent of mine from Manassas Park High School sent me an email last summer, asking if I would introduce the bill. That constituent was worried about what it meant for him living as an out person in society at a time when someone can quite literally get away with murdering or assaulting someone for simply existing as an LGBTQ person. And I recognized the fear in that email that I had when I was a 14-year-old closet case in October of 1998, during my freshman year of high school when Matthew Shepard was killed. And this was the defense that was raised following his murder. And then four years after that, when I was a freshman in college, in October of 2002, Gwen Araujo was killed for being a trans woman. And her assailant, her murderer, used the same defense in that slaying.

I believe that my constituents today, my teenage out constituents, shouldn’t be living with the same fear in 2021 that I did in 1998. This defense absolutely happens. In fact, we showed nine different cases in committee, and that was just what one researcher could prepare for us before we got into committee. So this is no way whatsoever an exhaustive or exclusive list.

One of the things I would mention here is that trans women in particular face disproportionate violence compared to other communities.

Part of being a healthy woman, it’s not just, “Did you eat kale and apples today?” It’s “Do you have a way out of poverty? Are you able to receive an education? Do you have to rely on survival work in order to get through day to day to day? Do you face systemic racism every day? Is the sexism that women already face compounded with discrimination on sexual orientation and gender identity to go along with that?”

HealthyWomen: And what does the law mean to you personally?

Del. Roem: On a very personal level, the fact that Matthew Shepard’s mother, Judy Shepard, testified for this bill in the House and Senate speaks volumes to the importance of the bill.

[The gay/trans panic defense] is not a defense that’s invoked when there’s a physical altercation or if a queer person is attacking someone else. That’s just self-defense. This is talking about a situation like one that occurred when I was 29. I was with two of my girlfriends; we were just out dancing. And this one guy comes up and I end up making out with him. And his friend starts getting red-faced pissed and is just like, “We have to go.” I can tell at this point, this is not about the fact that his friend found some cute woman on the dance floor. And my friends come up and they take me by the elbows, dragging me out of there and were like, “We have to go now, bye, thanks.”

His temper was about to erupt because he had figured out that I was a trans woman.

If a guy likes you, you shouldn’t have to fear violence if it’s completely consensual. Women as a whole basically expect this violence and are subject to male predators; this happens all the time. If you’re trans and your anatomy still aligns with the sex you were assigned at birth, then discovery of that can lead to your murder instantly.

Someone can snap at you and that’s what the LGBTQ panic defense is based on in part.

HealthyWomen: You’ve done such a great job painting a picture of some of the dangers that people in the LGBTQ community live with, especially trans women. From a mental health perspective, what do you think this legislation means for that community and for trans women?

Del. Roem: There are two real-world effects with this legislation. One is a policy directive that will affect operations in a courthouse, and the other is symbolic in terms of what it actually means. I do not want anyone to think this is solely a symbolic bill. It’s not. This will basically say that if a defendant’s attorney or defendants themselves were to mention or to raise the gay/trans panic defense in a courtroom, the judge, instead of cutting off the person, would simply give instruction to the jury that that it is not to affect the jury’s decision in terms of guilt and sentencing.

Also, Virginia now allows for judge sentencing as opposed to just jury sentencing. We were one of only two states in the country that required jury sentencing. So this will have a very real effect in the courtroom, and hopefully it will be a deterrent to people killing LGBTQ people in the first place.

HealthyWomen: Please tell me more about the mental health and the symbolic aspect of the legislation.

Del. Roem: What this does, along with the other nearly two dozen pro-LGBTQ equality bills that we’ve passed since 2020, is tell LBGTQ Virginians and people across the country, “You are welcomed, celebrated, respected and protected here in Virginia because of who you are, not for what other people want you to be.” It says that we are working to make Virginia a more inclusive commonwealth, and that if you yourself are a queer person or trans person or your kids are or you know someone who is, that it’s OK to stay here in Virginia because even if different parts of the commonwealth might be not as welcoming in terms of how other people interact with you, the policy of the state government is to protect you and to protect your civil rights.

HealthyWomen: What can people do to make their LGBTQ neighbors feel safer in their communities and be good advocates and allies?

Del. Roem: The first thing is just to get to know them. If you’re in social situations, it’s normal and natural to go up and talk to another human being just like you would do with anyone else. So just say, “Hey, how are you doing?” and get to know who they are as people.

The second thing is that when you see anti-LGBTQ policies popping up at your local level, at municipal level, at the state level, or even federal level, you have to fight against them and say this is wrong, because having straight allies really makes a difference.

We have to have straight allies who recognize that our rights do not threaten their rights, and, in fact, LGBTQ people being treated as equal strengthens the community and thus strengthens the ability for straight people and cis people to also live in a fair and free society where their liberty is respected.

And one of the reasons I mention reproductive freedom as opposed to talking about specific issues is that my ability to transition as a trans woman is dependent on reproductive freedom. The ability for me to take spironolactone, for example, without the government interfering, and for me to make those decisions about my anatomy is based on bodily autonomy and the government staying the hell out of that decision.

And for cis women, reproductive freedom means not having the government interfering with your decisions that you make with your body. I want cis women to also understand that link — that when you are fighting for your rights, standing up for reproductive freedom for yourself is to stand up for reproductive freedom for everyone because we need it.

HealthyWomen: That’s a great point. Do you think the health — mental and physical — of the LGBTQ community gets enough attention nationally and from the healthcare community specifically? From medical providers?

Del. Roem: Last year I introduced HB 1429 that prohibits discrimination against trans people in health insurance and health care. So it recognizes trans health care as medically necessary. Now, that bill is only able to affect about 24% of health plans throughout the state because those are health plans that are actually regulated by the state government.

I can’t do something with that for Medicare, for example, or for self-insured plans. I can only regulate state-regulated health care. So, for example, if you work for the DMV [Department of Motor Vehicles], if you work for Virginia Commonwealth University, if you’re just a state employee like I am, my health insurer absolutely cannot discriminate against my transition-related medical care. And in fact, it took until after I won my primary in 2017 for the Virginia State Health Plan the next month to actually state that it was in fact inclusive of transition-related needs, years after the ACA [Affordable Care Act] had already been interpreted through the Department of Health and Human Services to be trans-inclusive.

So, I shouldn’t have to run for office, and trans people shouldn’t have to run for office, in order to have our medical care actually validated and taken care of.

I will tell you the absolute barbarism that we’ve seen in Arkansas for the bill that they passed to restrict trans kids from getting the health care they need — make no mistake about that — it is likely that trans kids are going to die in Arkansas because of that bill, if it is to be enacted and fully enforced, because they will not see the hope that they need in order to have their most severe cases of dysphoria actually be treated.

So what we need is, at the national level, for Roe versus Wade to be affirmed, to have that 14th Amendment right to privacy validated for trans people because it links back to exactly what I was talking about before — reproductive freedom and your healthcare needs and what you do with your body. Even when you’re a minor, how your health care is treated, that must be recognized as a constitutional right under the 14th Amendment, which is the basis for Roe versus Wade in the first place.

So we have to have the federal government affirm that trans health care is health care, and that it is not to be discriminated against.

HealthyWomen: That’s on the legislative side. What can the medical community itself do? What should they be doing that they’re not doing?

Del. Roem: The medical community as a whole, when you take away the fringe groups, is actually getting to a place of being quite supportive in terms of the American Psychological Association, the American Medical Association. The problem within the medical community is that you have a severe lack of access to transition-related health care, especially in rural communities, but even in a lot of urban and suburban areas. You don’t have it, and that means we have to have more of an emphasis on telehealth and your ability to talk to a psychologist or another mental health professional for all of the healthcare needs that come with [gender dysphoria]. And oh, by the way, by coincidence, I talked to my therapist at 11 o’clock this morning. [chuckle]

I’ve been seeing my therapist since November 21, 2012, and that’s one of the things that I talk about publicly. Yes, I still see my psychologist because, for me, it’s about maintenance. I don’t have the same problems I did in 2012 in terms of trying to come to grips with my identity and feeling like I was suffocating. Now it’s just kicking the tires, making sure everything is working all right.

In the same way that any person just has routine check-ins with their doctor for whatever reasons, we should be treating mental health in the same way. And in the trans community, we need to have many, many more options and many more people available who actually specialize in transition-related healthcare needs and are able to work with trans people on their mental health.

HealthyWomen: What would you say to a transgender woman reading this story who maybe isn’t getting the kind of support she needs or doesn’t have access to the health care that she needs in her community?

Del. Roem: We have to be our best advocate, because if we don’t, who will? That is not for me to lay an additional burden on someone whose life is already inherently more complicated than other women in general. At the same time, there are not only resources available, but there are things that people can do as individuals to advocate for themselves, to advocate for their community, so that you actually have that support in the first place. And at the same time, I would also tell her that she has to know that regardless of whether she cares about politics, politics cares about her.

And that engagement with the political system, when you are LGBTQ in general, is not optional, it is vital. Our rights are on the line. Our health care is on the line. Our ability to be treated as equals in society and our basic liberation is on the line. You have to care, because if you don’t, then in the void that is created, someone else will — and that person may not have your best interests at heart, and they certainly won’t have your lived experience at heart.

So that’s what I would tell her: to be her best advocate because she needs to be.


National Center for Transgender Equality

The Human Rights Campaign

The Trevor Project

Going Back to the Office? The Colder Temperature Could Lead to Weight Gain

By Kenneth McLeod, Binghamton University, State University of New York

With millions of Americans vaccinated against COVID-19, many who have worked from home over the past year will be heading back into the office. Adjusting to new routines is challenging and can affect our health and fitness. We’ve been more sedentary or more active, gained weight or dropped pounds.

As part of my work as a biomedical engineer, I study how physical factors influence human metabolism. This includes height and weight, gravity – and air temperature. My research colleagues and I have found that living or working in a cool environment for extended periods can lower core body temperature. That decreases metabolic rate – how fast we burn calories – and commonly causes weight gain.

Maintaining core body temperature

Humans are homeotherms – that is, we maintain a relatively constant core body temperature. Specifically, we keep our body temperature in the range of 97 F to 101 F even in cool environments. Three different types of metabolic activity keep our body warm.

The first is basal metabolism. About two-thirds of the calories we burn each day fuel basic bodily functions, all of which generate heat: breathing, blood circulation, cell growth, brain function and food digestion. Any kind of physical movement also generates heat through chemical reactions that make muscles contract.

A third heat-generating process happens within specialized tissue called “brown fat.” It’s a leftover evolutionary adaptation that kept us from freezing during the ice ages. It kicks in when our core temperature drops to very low levels, but most people lose their brown fat as they age.

With increasing body temperature, our metabolic rate rises and we burn more calories. This generates more heat and further raises our body temperature, creating a positive feedback process which usually keeps our body temperature in the healthy range.

But this process is remarkably sensitive to temperature. For every 1-degree drop in body temperature, our metabolic rate can decrease by more than 7%. This means that the resting metabolic rate for someone at a body temperature of 101 F (the high end of normal) is up to 30% higher than if their temperature were 97 F (the low end). Increasing body temperature by four degrees can burn more calories during the course of the day than the average person burns as a result of all of their daily physical activity.

Body temperature versus physical exercise

This is why changing your physical environment can substantially alter the way your body works – and impacts both health and fitness. If you’re gaining weight and aren’t sure why, check the thermostat where you live or work.

Most offices tend to be kept near 70 F. That’s why so many of your co-workers are complaining of being cold, wearing sweaters or jackets, or using a space heater. This tends to be too cold for most women – and many men – who sit at a desk all day. But it’s more than uncomfortable; it’s not healthy.

The “correct” room temperature is where you are comfortable: not too hot, not too cold. That’s generally between 72 F and 81 F at moderate humidity, but may range as low as 65 F or up to 85 F.

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Working in a cold office slows your metabolism. In addition to making weight management challenging, sluggish metabolic rates are linked to lowered immune response, heart damage and increased risk of developing Type 2 diabetes.

If you don’t have control over the thermostat, you still have a few options besides wearing a coat all day. New technologies include a wearable personal device which changes your perception of warmth and cold; a passive exercise device that increases your metabolic rate by increasing cardiac output; and a “smart” version of the traditional space heater. However you achieve it, do your best to stay comfortably warm in your future workplace.The Conversation

Kenneth McLeod, Professor of Systems Science and Director, Clinical Science and Engineering Research Laboratory, Binghamton University, State University of New York

This article is republished from The Conversation under a Creative Commons license. Read the original article.