control. period.

A tough thing to come to terms with as an adult is how little control we have over life.  Growing up we can’t wait to be in charge of our lives.  Then you become an adult and realize that there is very little you can control.  Today’s blog is about taking control back from your uterus…and your ovaries for that matter.   Hang on kids, this one’s not for the faint of heart.

I have control issues.  The more things I think I’m in charge of the better I feel.  Seriously.  I blame my parents.  (Just kidding mom and dad!)  I’ve been this way since I was small.  Trying to be in control of what I wore, what my older brother did, where we went when…sounds amazingly wonderful for my parents right?  This is why I was the LAST child.  Well one of my favorite things about my job is giving women control over their lives and their bodies.  If you haven’t heard the news ladies, your reproductive system is working hard most of your life just to do that…reproduce.  And that means a wonderfully complex rollercoaster of hormonal shifts resulting in either pregnancy or a menstrual bleed.  Really?  These are my options.  Awesome.

Humans have been trying to prevent pregnancy since at least the 1500’s.  I won’t drag you through the remote history of attempts at contraception but just know that it involves the use of alligator dung, fish bladders, mercury ingestion and more.  The first commercially available oral contraceptive was available around 1960.  In the 50 years since it has become illegal to advertise or have any public information distributed regarding contraception.   It was available to married couples only.  In fact, it wasn’t until 1972 that birth control became legal for everyone in the US.  Contraception as we know it, with many safe and reliable choices, is a reality that only came into existence in the 1980’s.  To recount all this is fascinating to me.  I have a dozen handouts and booklets on contraceptive options for my patients.  It is difficult if not impossible for me to imagine a reality where I wouldn’t have a choice in, if and when I wanted to become pregnant.  Not to mention no control overScreen Shot 2016-08-25 at 10.08.42 PM my own menstrual cycle or the multiple medical conditions that hormonal contraception is used to control and improve.  A world without hormonal contraceptive options for me is like a world without the internet on a handheld device for the pastor.  Disastrous.

When the pill first became publicly available most women requested it for menstrual regularity.  In fact, many packages had a warning label about the medications “contraceptive side effects.”  But a woman could go to her doctor and ask for the pill for these reasons and then use the medication to safely and appropriately space her family.  Using a hormonal contraceptive for a non-contraceptive indication is quite common these days.  In other words, a lot of my patients come wanting relief from their pain or anemia associated with monthly menses, improvement in their skin from excess androgens and relief from symptoms of things like endometriosis, polycystic ovarian syndrome and others.  Do some of these women use hormonal contraception to prevent pregnancy?  Yes. But some simply use it for these other reasons.  To take control away from their uterus and back into their own hands so to speak.

What most people don’t realize is that you can use the birth control pill and other hormonal methods to completely suppress their period.  No seriously, you can.  And guess what?  It’s safe to do so.  If you ask a room full of female gynecologists who aren’t actively trying to get pregnant if any of them are having regular cycles know what you’ll get?  Crickets.  We avoid periods like the plague.  Why?  Because they are disruptive.  And annoying.  And messy.  Do hormonal contraceptives have risks?  Yes, but these are small compared to the risks of having a baby.  Is hormonal contraception right for everyone? No.  But multiple studies and multiple systematic reviews of those studies have shown extended use of contraception to suppress the menstrual cycle to be no more risky than the usual use of the pill.  Oh yes, and they found that patients were happier not having their period come every month.  Shocking, I know.  When the pill was created it was supposed to mimic a regular cycle so that no one would know you were on the pill.  Sneaky, huh?  Well now every magazine you pick up contains some advertisement for birth control or tampons or something associated with your reproductive organs.  And while we still live in a culture where we raise a fuss about who is having sex with whom (well except for our own kids who would never do such a thing), we have come to terms a bit more with discussing issues surrounding reproduction.  We still have to fight battles for access to affordable and reliable contraception in a country where almost half of pregnancies are unintended.  Sex education in our culture is informal and erroneous at best which propigates most of those unintended pregnancies in both the young and the not so young. But thanks to those who have gone before and paved the way for us to make choices about our own body.  Seriously people.  Someone had to protest for me to gain control over my reproductive organs.  This is the world we live in.

So there you have it.  There are lots of things you can’t control.  What time the baby will deliver.  If your kids will behave in the restaurant.  My work schedule.  How many people will need to talk with Pastor Jason after church.  But fear not.  The menstrual cycle can be controlled.  Don’t want to have a period?   Don’t have to.  Don’t want another baby?  Don’t have to.  Don’t want to be bothered by anovulation or cramps or worsening of some other problem…don’t have to.  You can control at least one part of your life.  period.

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the struggle to stand tall.

I have bad posture.  I am getting better at standing up straight but it has taken me quite a while to get in the habit.  My biggest motivation has been seeing myself in pictures hunched over.   My sister in law, who also happens to be editor in law of this blog, has great posture.  Always standing up straight in photos.  So does her mom.  So a family photo op including me hunched over is uber flattering as you can imagine.

I think having kids makes your posture worse.  Your back does all sorts of shifting around during pregnancy and then you spend the first several years of their life scrunching over to breastfeed, change diapers, pick them up out of their cribs, pick them up off the floor, pick up the toys they left on the floor and finally sitting hunkered down on the floor to create whatever craft it is that is due in the morning for school that you forgot about until the last minute.  In fact, a certain blogger and gynecologist you know might be snuggling up with her heating pad after just finishing a school project and picking up after two children.

If you churched with me today you heard a sermon out of Luke 13 where Jesus heals the bent over woman.  She has had a spine deformity for 18 years.  Most biblical commentaries relate this to osteoporosis.  Osteoporosis affects women more often than men and can result in a fracture of the spine, hip, wrist or another bone.  In the US almost 8 million women are affected with osteoporosis.  Over half of women over age 50 will break a bone due to the disease.  A broken bone might not seem like a big deal but many of these women will require hospitalization, rehabilitation, and some will even have life threatening complications.  And guess what?  I have already passed my prime when it comes to bone health.  Peak bone mass is reached in young adulthood.  This 38 year old can do nothing but keep her bones as healthy as possible.  That’s why it’s important to make sure your kids do things like eat food rich in calcium, exercise daily and get enough vitamin D.  And for you, who like me, have already reached peak bone mass, we need to keep our bones healthy by continuing with calcium and vitamin D intake, strengthening our bones and muscles with weight bearing exercise and avoiding falls by improving our balance.

But what I found most interesting from today’s sermon was not the shout out to osteoporosis but the revelation that this woman not only strugglScreen Shot 2016-08-21 at 11.00.07 PMed to stand tall because of her physical disease but because of the shame heaped on her by her own community of faith.   You see, this was a woman who had a disfiguring physical ailment.  She was labeled as the outcast and treated as such.  What Jesus does in this passage is three-fold, with the miracle of healing coming last and maybe leaving less of an impression with me than the first two.

First, He speaks to her.  While her community of faith had worked to suppress her into a folded bundle as close to the ground as possible, Jesus seeks her out and calls to her.

Second, He touches her.  Not only is she a woman but an untouchable broken diseased woman.  And He just reaches out and grabs her hand.

We are all surrounded by people who have been bent over and crippled with shame by our culture.   Can you imagine if we called them by name and reached out to take them by the hand?  Whether or not you believe in Christ and the miracles found in scripture, you can imagine what kind of world we would create by loosing the bonds created through the oppressive nature of the systems in which we live and work.  If each one of us took a moment to call out to the woman shamed by her past or treated by her society like she doesn’t matter as much as the man sitting next to her…if we reached out to grab the hand of someone who suffers from physical or mental illness…if we dare to move beyond the labels we have given to others, we just might create the change we all are longing to see in our world.

There are lots of things I love about this Jesus character.  But one of the best is the way He is so practiced in His hospitality toward the shamed, the marginalized, the outcast.  Like He’s been doing it His whole life…because He has.  So just like your kids need their milk and yogurt and exercise now when their bones are growing, our kids need to practice calling out and reaching out to the broken, shamed and marginalized among us.  They will strengthen their bones of hospitality and mercy so that when they are old and tired and picking up after small people they remember to speak names and grab hands of those left out by society.  And for those of us who have already reached our “peak bone mass” so to speak; we can still practice finding the suffering and shamed among us, bent over and crippled by the weight of all we have put on them through the years.  We can still strengthen ourselves to become a person whose posture mimics that of a man who had the audacity to call out to and grab the hand of the crippled woman in the back of the room.

And by the way, someday we will all find ourselves crippled and bent down low, waiting for someone to call to us and grab us by the hand and bring healing into our lives.  May we be surrounded by a community that has been practiced in such hospitality.

(photo credit: the internet and @okcfirst on Instagram)

empathy in transition.

This week marked the 7th year since one of my best friends lost her father to lymphoma.  She was 35 weeks pregnant at the time.

Loss is a terrible transition.  The Pastor would say that all transitions in life are difficult, even the good ones.  That learning to navigate transition and helping others walk through it is a sign of leadership.  I see that.  When babies are born mothers become grandmothers, husbands become fathers and sometimes everyone loses their mind.  Why?  Because it’s a transition.  A similar thing happens when we transition from caregivers to patients, from leaders to members of the group, from the beloved to the unloved.  I think what we need most in times of loss, in times of transition, in times of need is not advice, is not prayer, is not experience, but is empathy.

What does it mean to be empathetic?  Simply, as Merriam-Webster would say, it is to understand and share in another person’s experience and emotion.  I think we assume that empathy is easy.  That our culture appreciates it and puts it into practice regularly.  I’d like to respectfully disagree.  I believe that empathy is a learned practice and that we have little practice or patience for it.  You see, being empathetic takes time.  It means we are choosing to sit with another in their silence, in their sadness, and attempt to understand.

In medicine we must practice empathy.  Our patients experience pain, loss and transitions we have never been close to experiencing.  Sometimes it’s easy.  When we cut on someone’s body in an effort to cure them we know that they will be in great pain.  It’s not hard to empathize with the hurt that our incisions inflict in an effort to heal.  We may not have experienced pain to the magnitude of our patients but we understand what pain is and can walk with them through recovery.  Sometimes it’s not so easy.  Our patients experience things like stillbirth, complicated medical illnesses that destroy and debilitate, poverty and hunger we may never know.  We can imagine what they may feel and experience, but it is much more difficult to empathize: to understand and share in their grief may be close to impossible.  Finally, our own experience may get in the way.  Someone who experiences pregnancy and delivery in the same way I did is easy to empathize with.  Another who has a more difficult time may get less of my empathy since they aren’t dealing with the daily grind of carrying another human around in the same way that I did.

When Jamie stood up in the front row of the church with her pregnant round belly shooting forward in her black dress and her tears streaming down her face as she said goodbye to her father, I had no idea how to empathize.  I could not even begin to imagine her grief.  I’m sure my empathy in those early weeks and months was pretty mediocre.  But now we have sat together in sadness and sometimes silence for 7 years.  And she has taught me what true empathy is.  It takes practice.  It is uncomfortable.  It means asking hard questions about thoughts and feelings.  It means walking with someone through the most difficult transitions and staying with them for as long as it takes to get to the other side.

So whether you find yourself in the midst of a difficult transition, or you are in the role of walking with someone through that transition, remember empathy is your greatest role as a Christian, as a friend, as a care provider or just as a human.  Prayer, advice, experience all have their place but empathy will reach further than any of those and change you as you change the lives of others.

the least of these.

If you don’t know, the healthcare system in our state and in our country isn’t perfect.  I know, shocker. We have problems in the system like limited access to healthcare, concentrated health care resources, lack of appropriate funding and lack of educational resources.

You also may realize that Oklahoma does not rank well when it comes to being a healthy state.  A review of our state health department’s state health report will reveal that as of 2014 we received an F in overall mortality with the highest rate for death in heart disease, stroke and are near the top in death from diabetes and near the top in obesity rates.  Almost 20% of our state’s residents don’t have insurance coverage and about 1 in 6 Oklahomans live in poverty.  Most of those living in poverty and many of those without insurance are our state’s women and young adults.

We know that individuals without medical insurance have poorer access to healthcare and overall worse health in general.  They visit the ER more often as uninsured individuals don’t have the ability to access preventative health or have a primary care physician they can see when they have a minor illness or need an urgent visit.  The uninsured with disease are more likely to have it diagnosed at a later stage and develop complications that result in long term harm or death due to their lack of healthcare.

The debate about what to do with our large uninsured population has been going on for over 2 decades.  Not many are willing to claim it isn’t alarming.  But most of us can’t agree  on what to do about it.  Our state has failed to pass a tobacco tax and a plan to expand medicaid; we have not found a reliable way to allow small businesses to provide insurance to their employees and we have left undone the poor, the widow and the orphan in our state.  The Affordable Care Act has helped some in Oklahoma but certainly is not the perfect solution to this broken system.  The reality is that healthcare is expensive.  Layers of administration and bureaucracy contribute to this.  A culture that says we must have the best drug or test and we must get it right away contributes to this.  We don’t have good programs to promote health and wellness, physically or mentally.  As our state gets more sick, the cost to care for our state goes up.  But just because we don’t have the perfect solution doesn’t mean we can check out and ignore this huge problem.

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Last week I had the privilege of staffing the Variety OB clinic, our Federally Qualified Health Center (FQHC) here in OKC.  I always leave these days with the distinct feeling that although my life is radically different in economics and culture than almost every patient I encounter there, I have shared experiences with them having been pregnant and being a mom.  In the end, we are all bound by the common denominator of the shared experiences of our health.  It is almost overwhelming to think about the disparities I encounter when I walk into each room.  My friend and former partner in practice Lydia is the director of women’s health at Variety Care.  They are a safety net clinic.  The clinic provides healthcare to those who cannot afford to go elsewhere.  She is working hard to make affordable and accessible healthcare a dream come true for our state.  Every week she sees this problem lived out.  She sees patients choosing between picking up their antibiotics for their infection or buying groceries for their families.  She sees women with advanced stage breast and gynecologic cancers that are no longer curable due to a lack of access to care.  These women, with proper access to care would have had a great chance for cure.  When her patients don’t show up for appointments she knows that it’s probably not because they don’t care but because they have limited access to transportation or childcare, or they work in a job with no paid time off.

So what are we to do about this enormous problem?  I think the first step is to understand that if you have access to good healthcare resources that there are literally thousands of men, women and children who are desperate for that access. If we only care about spiritual health and ignore the physical health of the community around us we are missing the point.  When you visit your healthcare provider know that you and I are among the privileged and recognize that this problem is a problem that belongs to all of us.  Not just if you are an Oklahoman like me; but no matter where you live.  The next step is to begin to advocate for the community around you.   Ignore the voice in your head that says something is good or bad based on the political party that endorses it.  Be a voice for those without a voice in the system.  Donate to your local community health clinic, speak to your legislator, vote with a heart that believes you should decrease so that those around you may increase.  Have eyes that see the hurting, the hungry and the sick around you.

And let the image that your eyes see move your heart to speak up and show up for the least of these.