family resemblance.

I often catch myself doing something that one of my family members would do.  For example, when I heat up my coffee in the microwave and forget about it for the next hour. When I begin to search for it I think “that’s what Grandma Gilbert would do.”  I will use the same hand mannerisms as my mother or work through a tough decision in a similar way that my dad would.

Ultimately you are your family.  In both nature and nurture. Not only do we, at many times, behave like our parents but we inherit part of their genetic makeup.  This is pretty common knowledge, right?  We expect our children to have similar hair or eye color as ours, to be of similar height, to resemble one parent or the other.  But you give more than just your dark hair or your hazel eyes to your kids and your pick up more than just your eye rolling and coffee misplacing skills from your elders.

We as gynecologists care about your family history.  Why? Because your risk of certain diseases, including cancer, could be increased based on your family history.  We know that about 5-10% of gynecologic cancers are hereditary cancers.  What is a hereditary cancer syndrome?  It is a genetic predisposition to a certain type of cancer so the patient is at a largely increased risk of developing a certain type of cancer and these cancers are often diagnosed at a younger than expected age.  When I talk to medical students about what I do every day, I tell them that one of the most important things I do is try and prevent disease. When I ask, “Do you have any family history of breast, ovarian, uterine or colon cancer” not only am I going to remind you about how often and when to screen for these diseases but if your family has been affected with these cancers we will talk about how you might be a candidate for genetic testing that could save your life.

For example, if your family history includes women affected with breast and ovarian cancer, you or your relatives might be affected with a BRCA mutation.  Or if you or your close relatives are diagnosed with uterine or colon cancer then my mind is on alert to think about Lynch syndrome testing.  When we identify women affected by a hereditary cancer syndrome we can offer those patients early and more intensive screening and in some cases even perform risk reducing surgery.  Every month we learn more and more about how cancer develops and discover better ways to treat and prevent cancer.

I have a cousin who was diagnosed with stage 4 ovarian cancer in 2012.  She’s pretty much a rockstar.  She spends her days running her nonprofit caring for patients and their families. You can check her out at http://www.tteal.org.  She is an advocate for early detection of ovarian cancer as well.  She is inspiring to me.  You can be an advocate as well.  You can advocate for yourself and your own family.  Learn your family’s history.  Talk with your physician.  Find out if you or someone in your family is a candidate for testing for a hereditary cancer syndrome.

You might still turn out like your grandmother leaving your coffee to sit in the microwave.  That wouldn’t be so bad.  But you might also find out you can reduce your risk of cancer by simply sharing your family history with your physician. Something to think about.

transparency in all things.

In the 6th grade I wanted to star in a musical on Broadway.  My favorite music at the time were the soundtracks to “Annie” and “The Sound of Music.”  This continued on for many years until I realized that some sort of musical and/or theatrical talent would be required for that dream to come true.  One memory I have from that time of my life is my Jr. High drama class.  Mrs. Means had us do monologues.  My favorite one to do was to recite Charles Finn’s poem “Please Hear What I’m Not Saying.”  It was written in 1966 and I remember feeling so cool memorizing and reciting it because it was so dramatic and thought provoking.  The poem is about wearing masks; fooling people into thinking you are OK.  Part of the poem is below.

I idly chatter to you in the suave tones of surface talk.
I tell you everything that’s really nothing,
and nothing of what’s everything,
of what’s crying within me.
So when I’m going through my routine
do not be fooled by what I’m saying.
Please listen carefully and try to hear what I’m not saying,
what I’d like to be able to say,
what for survival I need to say,
but what I can’t say.

Sometimes as a physician I feel like my patients walk in wearing masks.  Part of my job is to read between the lines.  To figure out what my patient isn’t saying.  To ask the right questions to find out the real reason why they’re here, where the fears lie, where the focus needs to be.   Sometimes I don’t know what someone is really worried about until the very end of the visit when I get the “oh and one more thing…”   That’s usually the most important thing.  Sometimes when you walk into a patient’s room you can just tell that there’s something more going on.  It’s a challenge to discover what it is and try and help them through it.

I get to care for a lot of wonderful people.  Some of them I meet for the first time when they walk into my office.  Some of them I have known for many years before they come to me for OB or Gyn care.  But some of my favorite people to care for are the patients that know me…but I don’t know them.  The patients that at the end of the visit tell me that their fiancé is someone I know or their mom is my patient or they know my husband, my family, etc.  These patients have taught me a lot.  It goes something like this.  Me: “Is there anything else you need or that I can address for you today?”  Them: “No, but just so you know I am married to so and so and they know you from such and such.”  Me: “Oh, how cool!”  Because they walked in the door as an “unknown” I treated them like any other patient I didn’t know.  I didn’t make assumptions about what they needed, how they felt, or hold any bias or belief about them.  And they have taught me to do the same thing for all my patients, even the ones I have seen for many years.

So, when you enter your doctor’s office, whether it’s your gynecologist, your cardiologist, your psychiatrist or your family physician…take off your mask.  Attempt to be fully honest.  Tell your doctor what it is that worries you the most, what you need the most, what you’re looking for.  While I won’t promise that we as physicians will have the answer or be able to give you what you want I can promise that we will be honest with you in return.  We will tell you what we can and can’t do…what we know in medicine to be true and what we just don’t know about your disease yet.  We will try to relieve your anxiety and your suffering.

This past Wednesday was Ash Wednesday.  At our church we assembled to hear how we could be shaped and transformed during the season of Lent.  At the end of the service we receive the imposition of ashes.  The ashes are placed as a symbol, a reminder, that we are a broken people in need of a redeeming Savior.  It’s hard to ignore a giant smudge of oily ash on someone’s forehead.  As awkward as it may seem, it’s kind of nice.  You don’t need to ask someone if they went to an Ash Wednesday service.  It’s clearly visible.  How would we feel if our most urgent needs were smudged on our forehead for the healers in our life to see.  Maybe we can all make an attempt to be more transparent.  In the doctor’s office and with each other.  I hope the next time you visit the doctor you remember my 6th grade dream to be on Broadway and Charles Finn’s poem and do your best to be transparent.

photo credit to zach lucero.

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1 in 3.

I am writing this post as we prepare to watch Super Bowl 50.  If you know Pastor Jason and I, you know that we love sports.  I mean, we love Jesus, our families, our jobs, and all that stuff. But we love sports.  One of our favorite things to do when we were in our first few years of marriage was to go to the NCAA Men’s Basketball Tournament every year.  We would travel to the nearest city with first round games.  We have been to see the Oregon Ducks football team play in several different states and (confession) our oldest learned most of her counting and math skills watching the scores change during a game.

So back to the Super Bowl.  As much as I love watching the NFL it always gives me this nagging reminder that domestic violence (DV) is a huge problem in our culture.  We don’t talk about it unless someone famous is accused and then we find ourselves watching the media’s commentary on the subject.

1 in 3 women will be the victim of violence by an intimate partner at some point in their lifetime.  No, seriously, 1 in 3. Every 9 seconds a women in the US is assaulted or beaten.  Now DV victims can be men, but I’m a gynecologist so today we’re going to focus on women, who are 4 out of 5 victims. Oklahoma is ranked 3rd in the US for women killed by men in single victim-single offender homicide.  DV costs our nation millions each year in lost wages and treatment of injuries for victims. The emotional impact on these women and their children cannot be adequately measured.

And unless you’ve been living under a rock, you probably know that the NFL has had several major incidents with DV in the last year.  First Ray Rice, a wide receiver for the Baltimore Ravens, we caught on tape beating his wife in an elevator.  The NFL suspended him two games when they heard of the accusations, then suspended him indefinitely once the public saw the gruesome footage.  (He has appealed, won and is eligible to play again).  Then defensive end Greg Hardy was accused of DV after an altercation with his girlfriend.  He told police that his girlfriend “fell in the bathtub.”  At the NFL hearing for Hardy, the defense attorney claimed that Hardy was the victim, and basically accused his girlfriend of being promiscuous.  A common defense for DV perpetrators is the thinking that women need to be “put back in their place.” After he was reinstated, Hardy was then signed by “America’s Team” the Dallas Cowboys where he has continued to make sexist comments and act violent towards his teammates.  And now Heisman Trophy winning Johnny Manziel has been accused of beating and threatening to kill his former girlfriend.

DV is something we should all care about.  You see, DV is not limited to women who are in relationships with professional athletes.  It is not limited to the poor, the black or the non-religious.  The National Coalition Against Domestic Violence puts it this way…

“Intimate partner physical abuse is not bound by age, socioeconomic status, race, ethnicity, sex, sexual orientation, gender identity, religion or nationality; it exists in all communities. Contrary to popular belief, physical abuse is not simply a mal-adjusted person’s occasional expression of frustration or anger, nor is it typically an isolated incident. Physical abuse is a tool of control and oppression and is a choice made by one person in a relationship to control another.”

Why do we have a domestic violence problem?  Lots of reasons, but probably the foremost is that we tolerate it.  We lack education and awareness.  We think of DV as a problem between 2 people, and fail to recognize it as a problem in our culture.  Deion Sanders characterized Manziel’s relationship with his girlfriend as “inflammatory” and that his problem is that he is in a relationship with her…I would argue that if the allegations are true Johnny Football’s problem is that he is a perpetrator of DV. We wonder how a women can’t “get out” when she is pregnant or had children.  We shake our heads at women for “staying with that guy” and fail to understand the social, economic and physical isolation that often makes it impossible to women to leave the men that abuse them.  We don’t understand that women who attempt to leave an abusive situation and are unsuccessful are often subjecting themselves to an escalation of violence and increasing their risk of being a homicide victim.  We make excuses for men who abuse women and fail to understand that no amount of wrong makes DV a right.  As a culture, a country, a community we fail to recognize that this problem belongs to us as well.

Can we love football and still work to eliminate domestic violence?  I’m not sure.  I hope so.  What I am sure about is that we will ALL encounter someone who is a victim of DV.  It might be the friend who becomes increasingly isolated.  It might be the woman who visits your church.  It could be your neighbor, your co-worker, your boss.  I hope we keep our ears and eyes open.  I hope if we see something we say something.  I hope we avoid the thoughts of “she should have…” and come to understand that victims of DV are just that.  Victims.  They need someone to be their voice, their shelter, their advocate.

So when you watch Lady Gaga sing the National Anthem or while you’re enjoying Cam’s “dabbing” or Peyton’s pizza commercial, don’t forget that we live in a culture that hasn’t found a way to end violence against women.  Don’t forget that you can do something about it.  Don’t forget the 1 in 3.

 

“when are you going to…”

 

So I have this friend.  I have known her since college but wouldn’t call her a friend until maybe the last 5 years or so. Our friendship has evolved in that time and I can honestly say that I like her more with each passing year.

We both have 2 kids.  Her oldest and my youngest are the same age.  She used to ask me all the time, “when are you going to have your 3rd baby?”  At first I would literally laugh out loud and roll my eyes.  But she would still keep asking.  Like ALL the time.  It just kept coming, the same question.  You see my friend can’t wait to have baby #3 and maybe #4.  She has a plan for when she wants them and her life after that.  I can’t imagine managing my life with another child, let alone 2 more. Pastor Jason and I with 4 kids is the stuff sitcoms are made of. Pure chaos I’m sure. I think for a long time my friend didn’t really believe me that I wasn’t going to have another baby.  And for awhile I was sure she was never going to stop asking me about it.

My friend challenged me.  While I was adamant to her that there was “no way in he##” I was having a third baby, and I had a hundred reasons why, I had to ask myself “was I at peace with that decision?”  You see, my friend challenged me to seriously examine what I wanted out of life, and be OK if it didn’t look like what everyone else was doing.  What will probably come as no surprise to you is that we live in a world where all of us are harshly judged for being stay at home moms, for being working moms, eating GMO or non-GMO, for having too many kids, no kids, not enough kids, and everything in between.  And we buy into the thinking that what everyone else is doing is what we were made to do.  We are looking for that one thing that will make us just as happy as our favorite “frenemy” on social media who we imagine has a life just that much better than ours.

Identity is an interesting thing.  We were all created to be and do different things.  I can’t wait to see her toting around her 3 or 4 kids, serving in church, encouraging others and finding ways to show her kids what is most meaningful in life.  Me, I’ve got research to do and papers to publish, podcasts to produce, medical students to educate and stuff to do at church with pastor Jason.  My two kids think it’s cool that mom “does surgery and gets the babies out” and “teaches the almost doctors” and that makes me proud.  I think Mother Teresa said it best.  I cannot do what my friend does and she cannot do what I do.  What were you created to do?  I hope this post gives you permission to examine your own life and ask yourself “when are you going to…” and fill in the blank with what you were created to do.  I am so thankful for my friend.  She inspires me and I hope I can challenge those around me with the same question.  So when are you going to…?  Together we can serve God, serve others and we can change the world.

we can do better.

Yesterday the US Preventative Services Task Force made a recommendation regarding screening for depression in adults and specifically addressed postpartum depression (PPD).  This is in alignment with the American Congress of OBGYN (ACOG) recommendation to screen women at least once during the pregnancy or postpartum period.  The official recommendation is below.

“The USPSTF recommends screening for depression in the general adult population, including pregnant and postpartum women. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up.”

Seems pretty obvious, right?  Women have babies and we should screen them for a disease that is twice as common in women as it is in men and can have devastating consequences for families.  But it’s more complicated than that.  One: we don’t talk about postpartum depression.  Two: we don’t allow women to admit when they need help.  Three: we don’t have good systems in place to give women with PPD the comprehensive care they needs.  And by “we” I mean us, as in you and me, Oklahoma, America.  All of us.

Postpartum is a really bizzare time.  You spend approximately 40 weeks, if you’re lucky, carrying another human being inside you.  You devote a large portion of your blood supply, nutrients and other resources keeping this person alive and growing them into someone that can survive in this world.  Then you give birth to them.  Which is a huge deal no matter how you do it.  Walk in and drop out a baby in 30 minutes, labor for 4 days, have a c-section…it’s all a big deal.  If you don’t get that, let me know.  I’ve got stories for you.  And then you get to experience the strange period of time called postpartum.  For those of you who’ve been there, you know what I’m talking about.  You sleep for anywhere from 30 minutes to 2 hours at a time, someone is always crying or needing to be fed, you are leaking fluid from literally everywhere, and you’re body is trying to figure out where that person who used to live inside you went. Weird, huh?  But baby’s here so we instantly forget that the mother existed and focus on the cute bundle of joy who’s drooling all over your shirt.  We don’t begin to consider that the mom might be overwhelmed, and for most it wouldn’t cross our minds that she would be depressed.  We can do better.

Our culture doesn’t do well with mental health conditions.  We see depressed or anxious people as “weak” and “crazy” and those that seek psychotherapy as someone who “can’t keep it together.”  If you have high blood pressure or diabetes you don’t get this flack.  We treat you with lifestyle modifications or medication or physical therapy for your conditions…your mental health should have the same priority as your physical health.  It should be treated with the same respect and compassion.  We don’t roll our eyes at people with cancer; we come alongside them in prayers of healing and hope and support then in every way we can.  Why can’t we do the same with PPD and other mental health issues?  Let’s start the conversation.  The USPSTF and ACOG has recommended we screen because we as physicians can make a difference by asking women about PPD.  The community at large can make a difference by accepting that women with PPD are no different than moms who aren’t affected: both of them care deeply for their families and want to be the best possible mothers.  We can do better.

I used a validated screening tool (EPDS) in my clinic for postpartum depression.  I haven’t always done it.  But then I had patients come back one or two or three years after having their baby and tell me about how they suspect they were suffering from PPD and didn’t know who to talk to.  So now I try to screen everyone I can.  But we have to work to create access to resources for these moms.  Yes I can counsel someone about the risks and benefits of taking medication for PPD.  But many moms just need a therapist, or a support group, or even just a community of faith or a community of friends to share the burden with.  I hope the USPSTF recommendations will encourage my partners in healthcare to increase our efforts to screen and treat women during pregnancy and postpartum.  And I hope that those of you outside of healthcare will lend a hand, share a story or take a turn holding a baby for that new mom. I hope that all of us have the courage to ask postpartum women how they are coping and be accepting of any answer they give us with a willingness to listen and help.  We can do better.

The picture above is me and some of my residency classmates (sorry guys) literally hours before I had my first baby.  I was a 3rd year resident training to be an OBGYN.  I thought I knew what I was getting myself into.  Now I look at that picture and see someone who had spent the previous 3 years working 80 hours a week and cramming her brain full of all the information it would hold…but had no idea how things were about to change.  I was a (postpartum) hot mess.  I struggled to care for my baby and certainly didn’t care for myself.  Fortunately I had friends and family who made sure I ate, slept and was wearing clean clothes (thanks mom).  That baby reminded me of what a vulnerable human being I was.  Of how much grace I needed. She is now doing multiplication and her sister is giving me sass about anything and everything.  I love them dearly and am grateful for the opportunity to experience the bizarre part of life we call postpartum with each.  But we can do better…let’s try.

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wheelhouse.

What’s in your wheelhouse?  If you’re not familiar with the term, the wheelhouse in baseball is the part of a batter’s swing range where they can make the best contact with the ball.  It’s an area of expertise.  Something you’re great at or feel really comfortable with.  Something you’re excited about doing because you know you will kill at it.

I spend a significant amount of time diagnosing, treating and counseling patients with HPV (human papillomavirus) related diseases.  And while I love delivering babies and doing surgery on women, HPV is in my wheelhouse.  Like, I read everything I can about it, I go to the scientific meetings, I have literally seen hundreds of women (or more) with these problems.  Now don’t get me wrong, no one bats a thousand so I still see things that I haven’t seen before, I still have patients that don’t fit the rules for their disease process and I have to really think hard and ask my experts around me about what is best for management…but I feel pretty comfortable with most things in encounter in this arena.

If you follow me on twitter you know that I love to retweet scientific articles.  All my twitter crushes are people who write about OBGYN topics and post articles of the same.  Many of those I retweet are about HPV and the diseases caused by the infection.  You see, HPV is responsible for almost all of the 12,000 cases of cervical cancer diagnosed in the US annually.  About 4,000 of these women will die of their disease.  So, I give this lecture to our second year medical students.  They show up with their MacBooks and their phones ready to record what I say and I get to talk about how to better take care of the women of Oklahoma.  Well, first I tell them that the information won’t be on their test…so I’m instantly a better speaker and much more popular.  Then I tell them how at least 29 states do better than us at HPV vaccination of both young men and women.  How our death rate from cervical cancer in Oklahoma is among the worst.  How we fail to educate our young people about human sexuality, sexual health, HPV and HPV transmission, and how to care for themselves over a lifetime.  It’s really just me mic dropping for an hour as I get louder and more excited as the lecture goes on.

The summary of the lecture is that we don’t do so well taking care of our women in lots of areas, but one of them is in regards to HPV vaccination and cervical cancer prevention.

So where’s the good news, right?  There is good news…right?  Of course there is!  In fact, my Sunday School lesson to the third graders this week was on good news.  These 8 and 9 year olds are excited about no cavities at the dentist, getting good grades, opening presents, and getting dessert, among other things as good news to them.  The good news for the women of Oklahoma is that we have very safe and very effective prevention against HPV.  The good news is that my girls will get vaccinated around their 11th birthday as recommended by their pediatrician.  The good news is that the vaccine is safe, effective and does not increase the chance that my kids will become sexually active as adolescents.  The good news is that their mom will continue to tell medical students about how they can eliminate cervical cancer and HPV related diseases in Oklahoma and that those medical students will go on to be leaders in their community and tell people about how they can help prevent HPV related diseases…maybe one of them will even be a pastor’s wife.

So that’s my wheelhouse.  In addition to OBGYN care, education and research in women’s health. HPV vaccination, abnormal Pap screening, evaluation and treatment of cervical dysplasia…I plan to continue to try and learn all I can stay on top of my game.

Also in my wheelhouse: eating sour patch kids, hand written notes to friends, drinking coffee, eating bacon, shopping at nordstrom.com, knowing song lyrics (imaging me karaoke rapping) and finding good memes to use in boring powerpoint lectures to my students.

Enough about me.  This post was much more gynecology than theology, but pastor jason would tell you to figure out what’s in your wheelhouse when it comes to church, or to serving your community…and I agree.  Find your passion, find what you’re good at and use it to make your community of faith and your community at large a better place.  Because being great at karaoke rap is pretty awesome, but making sure the vulnerable and marginalized around you know and feel loved is even better. What’s in your wheelhouse?

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steps and stairs.

A few days ago I posted an instagram photo of my fitbit stats for the day…(see above).

I average about 5-7k steps per day at work or about 2 miles or so.  I try to get my fitbit to think I exercised by walking faster from one hospital to the other.  I try never to take the elevator because I work with a surgeon who is probably 20 years older than me or so and walks up 7 flights of stairs to see her patients…if she can do it so can I (#humblebrag).  At the end of the day referenced above my feet and my back hurt.  Most days those miles I walk at work weigh heavy on me.  Most days involve 10-12 hours of work, email or paperwork at home, phone calls and left over worry from the days work…so I have little to no sympathy for others who feel their days are long and hard; feeling mine was longer and certainly more challenging.  Most days…

But this day was different.  For some reason I remembered to be grateful for the wonderful colleagues that surround and support me daily, for the gift of being able to participate in the healing of bodies and hearts, and for the privilege of being able to participate in the birth of new life.  Why today?  Most days I spend more time remembering how few thank you’s I hear, how I have more paperwork than you can imagine and how I am usually still at work when most of my friends have gone home to enjoy their families.  Here’s the thing…I can’t tell you why this day was different.

That’s the way Grace works.  And Mercy too.  It creeps in on you when you’re not looking or expecting.  Or at least it does for me.  I’m minding my own business, being selfish and self-righteous, and all of the sudden you’re wading in it.  The heavy realization that I am who I am, where I am, doing what I do as an extension of grace and mercy.  That my successes are not my own but are simply a result of His grace and mercy.  And the wonderful flip side to that same coin: my failures aren’t too big for that grace and mercy either.

So now I am left with the puzzling question of how to live in that pool of grace and mercy every day.  It is too easy to forget.  In a world where it seems that everyone has picture perfect lives spread neatly across social media platforms, there isn’t much need for grace. But in reality, life is messy.  And hard.  So we desperately need to practice extending grace and mercy to ourselves and to each other.  What does that look like?  I’m not sure but I think it’s writing a note, extending a hand or a hug, giving someone else the benefit of the doubt and reminding yourself on a daily basis that you don’t walk through the hallways of life alone.  I don’t climb those stairs in the hospital alone.  He has given me a wonderful community of people to walk and climb through life with and He walks alongside me as well each day.

So here’s my advice to myself.  Maybe it will work for you.  I hope the next time I find myself in an eye-rolling situation…think bad internet medical advice, people complaining about how hard they work, picture perfect life posts…maybe I won’t roll my eyes as hard.  Maybe I’ll give just a moment of thought to reflect on what today’s graces have been and how I can provide mercy to someone around me.  No promises…I mean I’m pretty good at eye rolling…but maybe.

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