i live here too.

It is one of the most clear memories I have from early on in my career.  Some friends were over and asked how long we had lived in our home.  When I answered, my eldest, in the sincerest of voices proclaimed “Mom, that’s not true.  Dad and I live here and you live at the hospital!”  It’s pretty hilarious now but at the time I was crushed.  CRUSHED.  I remember the days in residency when I felt like I hadn’t been home in forever.  Let’s be honest. Sometimes it still seems that way.  Home in time to eat and sleep and then back up before everyone else and off to work.

September is designated as Women in Medicine month by the American Medical Association. One third of our nation’s physicians are women. Many of these women chose medicine as a career during a time when they had very few role models who were women.  Many of them delayed starting their own families to learn to care for the families of their community. I have the privilege of training with, working with and knowing some incredible women physicians. These women spend many years training for a career in which they will give countless hours to improve the health of others. Most do it for a salary that is less than their male counterparts.  They juggle rounding and homework and office visits and basketball practice and charting and so much more.

Women are under-represented in leadership in medicine; and a recent survey of physician mothers revealed that most women have felt discriminated against because of pregnancy, breastfeeding or motherhood. Does this make men at fault?  Certainly not. But we work in systems that have long overlooked that its workforce is changing. Fortunately, physician moms are working to improve policies and procedures so the women that come into medicine after us have the opportunities to lead their communities to better health.

So here’s my shout out to women in medicine.  You are some of the toughest, smartest, most caring and passionate women I know. You will change the future of health. And you are unstoppable.

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be safe this summer ladies.

Summer is in full swing and yesterday was the first Sunday of the Pastor’s sabbatical. For as long as we have been married he has worked at our church.  16 years.  For most of those years his weekly day off was my longest day of the work IMG_3307week.  And my days off after being on call overnight were the Pastor’s busiest days.  So this year he gets to take two months off to rest, recover and reconnect.  For the next 8 weeks, Sundays and postcall days will be filled with brunch, swimming, day trips and, hopefully, some other fun adventures as a family.

 

In honor of all things summer….here are the gynecologist’s list of “Summer DOs and DON’Ts”

DON’T go without sunscreen.  Especially you pregnant ladies.  I know what you’re thinking…”sunscreen is for people who look like you and those red headed kids of yours.” WRONG.  Sunscreen is for everyone.  That is, everyone who doesn’t want to get skin cancer or look super wrinkly when they are old.  And, sunscreen is for year round. I thought my dermatologist was going to whack me when she found out I wasn’t using a moisturizer with SPF.  Don’t worry, I do now…every day…I’d like to avoid looking 100 before I retire.  I used to know someone who used hand sanitizer on her kids like a zillion times every day but then those same kids would swim for hours at the peak times of sun exposure turning brown, brown, brown all summer.  Just because you don’t get red doesn’t mean your skin is safe friends.  Tips for everyone: use broad spectrum SPF 30 or higher; reapply every 2 hours; find water resistant formulas.  Pregnant women should opt for oil free (your skin is more prone to break out) and opt for a lotion instead of a spray.  (Never spray anyone’s face…esp your kids and remember sprays make it easier to miss spots!).   And when your baby comes ask your pediatrician about how best to protect that brand new skin from the sun.

DO wear your seatbelt. This seems obvious to me. The Pastor and I took a recent road trip and you’ll be surprised to know that Missouri and Indiana will tell you how many people died in auto accidents that month.  The 10 year old reading road signs alerted us to the number.  Ouch.   But lots of pregnant patients choose to go without.  I wish you could hear how loud I am screaming this at you.  Pregnant ladies!  For the love of all things including your baby!!!  Wear your seatbelts!  Put the lap belt UNDER your belly and the shoulder strap across your chest. Auto accidents are a leading cause of death for pregnant women.  Your uterus, placenta and fetus were not made to sustain direct or indirect trauma from an accident and you can imagine the increase in magnitude if you are thrown from your vehicle because you failed to wear your seatbelt. A quick search of the CDC will tell you that those without a seatbelt are 30 times more likely to be ejected from the car during an accident and 3 out of 4 ejected individuals will die as a result of their injuries.  So let’s all just buckle up, ok friends?

DO use insect repellent. I have no problem with blood and guts.  You know this.  If you follow along, you also know that I think bugs are the worst!  Actual conversation with my dad.  Me: Dad, killed a spider outside.  It was like the size of my face, I promise.  Pastor is out of town, can you spray my house?  Dad:  If it was outside it was one of the good ones. His death will be on your conscience.  But yes, I will come and spray.  (end scene). However, as terrifying as spiders are…mosquitos carry all sorts of diseases including zika virus and west nile virus.  Then there are ticks.  I don’t know if you have seen a tick up close but this image is not for the faint of heart.  Tick borne disease are the ones you learn about in med school that have the cool names and then you learn about them and are terrified. Tips: Use your bug spray with DEET (even you pregnant ladies), cover exposed skin, avoid standing water and if you are out doing some crazy activity like sleeping in a tent (no thank you) make sure you check your skin for ticks.

DON’T overgroom. I’m not even sure overgrooming is a word.  But for today I am making it one and asking you ladies, pregnant or not, to stop it.  Summer is a hassle. Shaving your legs and armpits all the time, wearing a swimsuit; I get it. But let’s not go overboard. Not only are there literally THOUSANDS of grooming related injuries each year, the good Lord gave you pubic hair for a reason.  (I know, commence freaking out that the gynecologist said pubic hair in her blog.  Resume reading when over freak out moment).  And while none of us know the exact reason, it is most likely to keep dirt and other stuff out of your vagina and to reduce irritation of that sensitive skin.  So be swimsuit ready.  But overdoing can result in lots of skin irritation or even infection.

So there you have it.  Summer safety tips from the gyno.  Oh, and in case you were thinking about blowing off one of your fingers with fireworks, here’s an OBGYN joke just for you…

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Summer of fun.

I’m back!  It has been almost a month since my last post.  In that month I have felt TERRIBLE.  At one point I thought I would never stop coughing and that I would get diabetes from my cough drop consumption.  Don’t worry, I switched to sugar free. But now I’m about 89.32% better and have found the time to write again.  (Which is code for I can stay up late and finish things).  And so here we are.

It’s July.  For most people July represents the middle of summer.  Vacations, lazy days at the pool, short days at work.  In medicine July means ALL THINGS NEW.  As in, all the things are new.  New medical students, new residents, new academic calendar. You see, I work in Academic Medicine.  Which means that I work at an institution of higher education where we train medical students to become competent, caring, ethical physicians and then train physicians to be competent, caring, ethical specialists in their chosen field.  Sounds easy, right?  I will try to briefly introduce you to what the summer is like for those of us insane enough to participate in this great adventure of education.

Medical school is 4 years long and almost exclusively completed after a 4 year bachelors degree is achieved.  In the first 2 years students spend their time in courses learning anatomy, the complexity of each organ system, structure and function of the body and its cellular systems, human behavior and so much more.  They come to class, have small group sessions, read and read and read some more and take lots of exams. By the time they come to the third year they are ready to see how all they have learned can be applied to patients and diseases.  Oh and did I mention they also have to pass the first step of the 3 step medical licensing exam? In the third year our goal for a student is to be able to see a patient, perform a basic physical exam and formulate a differential diagnosis.  What that means is that when they hear a patient’s symptoms and know their history they can think about what diseases they are most at risk for and/or most likely to screen-shot-2016-09-25-at-6-38-08-pmhave.  Only once that is done can we as physicians begin to think about what testing and treatment someone might need.  Medical students don’t do anything without supervision.  Sometimes patients will ask if the medical student is going to perform their surgery or deliver their baby. I can answer that with a resounding NOPE.  What a medical student will do is participate in surgery with me where they will learn the hows and whys of that specific operation.  They will check on their patients in the hospital and often serve as an extra set of eyes, ears or hands to ensure that all the details of patient care are taken care of and nothing has been overlooked in making sure a patient makes it safely home after surgery.  In addition to all this they are reading, going to lectures, taking tests.  At the end of the third year we hope they have chosen a medical specialty.  Then they spend their final year of medical school spending time in areas of their chosen specialty, as well as interviewing for a residency position and taking the 2nd step of that all important medical licensing exam series I mentioned before.  So for me July means making sure the syllabus and all the materials our third year students get and use equip them to learn the most they can about women’s health.  It means making sure those 4th year students who have chosen my specialty have the best opportunity to train at the institution of their choice for residency.

July 1st also marks the day new residents begin their training.  These are recent medical school graduates who have gone through a very competitive process to secure their place in a residency training program. Each specialty in medicine has residency training and each specialty decides how long that training should be.  For example, OBGYN residency is four years long. Neurosurgery residency is 8 years long. (no thank you).  While in residency these doctors have a focused practice where they will learn every detail of their specialty.  It is also the time when they are trained to perform procedures and surgeries all in a supervised environment with the intention that at the end of their training they are ready to care for patients on their own.  In the meantime they will spend up to 80 hours a week in the hospital where supervising physicians will provide guidance, support, and supervision.  At the end of those at least 10,000 hours of training each resident will decide whether to join a private or hospital based practice, become an academic physician or, for those brave/crazy enough, pursue even more specialized training.  One of our greatest privileges is to watch those residents graduate and know that they will provide the kind of patient care you would want for your family and friends.

It’s a long journey into a career as a physician.  It can consume more than a decade of your life.  In truth the learning never stops.  For those in OBGYN we have a written and then oral exam to become board certified after residency.  To maintain our specialty certification we read articles and participate in chart reviews each year. We attend conferences and workshops to learn from one another and maintain and improve our skills. We read articles and travel across the country and collaborate to find the most effective ways to educate our medical students and residents.

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So if you see a medical student or a resident, give them a hug or a handshake or a pat on the back.  During a time when there is a lot of uncertainty in healthcare they have made the choice to commit their lives to the service of others. When no one can seem to agree who should have access to care or who will pay for that care, they have dedicated a huge chunk of their lives to ensure that care is available no matter what.  Now if you’ll excuse me, it’s July so I need a nap.

 

i’m not making this up.

A few months ago I was at dinner with friends, one of whom is pregnant. The topic of drinking in pregnancy came up and someone said to me “you just tell people not to drink because you have to, not because it’s really harmful right?” Um…I made that face. That face.  You know. The one where  you couldn’t possibly believe what you heard but, then again, you heard it.  The one where your eyes are big and your mouth is open.  After a pregnant pause I explained that national and now international guidelines recommend against any alcohol consumption in pregnancy.

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We all know that you are never going to get more unsolicited advice than when you are pregnant.  What you can and can’t do including raising your hands above your head or eating peanut butter in the bathtub along with what your baby should eat, how it should sleep, what it should wear and where it should go to college.  Whether or not you should consume alcohol in pregnancy is among that advice.  However, drinking during pregnancy is the most common cause of birth defects in the United States. And while these birth defects are most common among women who drink heavily, there is no safe amount of alcohol consumption for a pregnant woman.  Alcohol use in pregnancy is associated with low birth weight, preterm birth, birth defects and developmental disabilities.  Health care providers are encouraged to discuss discontinuation of alcohol for women who are pregnant and those actively trying to get pregnant.

April is alcohol awareness month. It was established to reduce the stigma associated with alcoholism and increase awareness about alcohol abuse, treatment and recovery.  Excess alcohol use costs the United States about 250 billion dollars per year.  About 5 billion of that is related to alcohol use in pregnancy.  So no, as gynecologists we don’t just say these things because “we have to.”  We say them because we truly want the best outcome for you and your baby.  So if you should find yourself with two lines on that pregnancy test, congrats!  It’s time to take a break from alcohol.  If you are already pregnant and haven’t stopped drinking I would urge you to do so now.  You can tell your grandmother, your best friend, the lady at the grocery store and the dude at the gas station that you are doing everything you can to take care of yourself and your baby.  Really.  We’re not making this up.

women on lockdown.

In 2013 the Center for American Progress rated Oklahoma as one of the worst places to live for women. Why?  Well, in addition to our above average gender pay gap, ranking near the bottom for women in poverty, and the huge number of uninsured women, Oklahoma has more women in prison than any other state in America.

As a background, the United States imprisons more of its population than any other nation in the world.  In the last 20 years, the percent growth of female inmates was twice as much as male inmates.  So, as a country we have a trend.  When you look at my own state, Oklahoma, we have experienced exponential growth in female incarceration not screen-shot-2016-12-26-at-9-09-16-pmseen in any other state.  As of 2015, Oklahoma puts 127 of every 100,000 women behind bars.  Compare that to 63 of 100,000 as the national average.  From 2015 to 2016, the number of incarcerated women in Oklahoma increased by 9.5% while the number of incarcerated men decreased by 1%. This begs two questions from me: Why do we have so many women in prison? And then, are we any safer or better off with all these women behind bars?

First, at least 2/3 of the women in Oklahoma who are in prison have committed non-violent crimes. Many are incarcerated due to drug offenses, which up until recently carried serious jail or prison time due to Oklahoma laws.  There is no compelling evidence that we are any safer with a high female incarceration rate.  According to the our state Bureau of Investigation, violent crime in Oklahoma was up about 3.5% from 2013 to 2015, and non-violent crime was down by about 4.5% in that same time frame.  The overall violent crime rate in Oklahoma has decreased 7.3% in the last 10 years, while the rate of female incarceration doubled in the same time frame.

For the last couple of years I have given a lecture to our second year medical students on the state of women’s health in Oklahoma.  The good, the bad, the ugly.  I always touch on our incarceration rate.   Why?  Because our other state health indicators are major reasons why we incarcerate so many women.  1 in 25 women enters prison pregnant.  Over 2/3 of incarcerated women have a minor child. The consequences for these children are devastating.  Also, more than half of incarcerated women in our state have experienced domestic violence in adulthood and/or abuse in the home as a child. About 70% have been diagnosed with a mental health disorder.  Why does this matter? Because in 2013, our state ranked 46th (where 1st is best) in mental health expenditures per capita that were state funded.  picture1Most women in our state who enter prison live in poverty and have a lack of education. Again, we rate 40th out of 50 for number of women in poverty.  When women in Oklahoma are marginalized in health and economics, they are disproportionately more likely to end up in prison.  But is the news all bad? Fortunately, no.  In 2015, our state passed 2 bills that allowed reduced sentences for drug offenses and judges to deviate from mandatory minimum sentences.  Then, in 2016, the people of Oklahoma passed a state question that made certain drug and theft related offenses misdemeanors instead of felonies.  The money saved from the reclassification of these crimes will be used for rehabilitation programs, thanks to another state question supported by the voters in my state.  Tulsa County, along with the George Kaiser Family Foundation, have established a Women in Recovery program.  Since 2009, they have helped 475 women and over 1,000 children.  But we still have a long way to go.

Why should you care?  What can you do?  I think, no matter what state you live in, the rate and growth of female incarceration in our country should alarm you.  As a gynecologist I’m probably biased but I think we can measure the success of our nation by the success of its women.  If we can keep women out of prison their children are more likely to succeed in school and avoid drug abuse and addiction.  We should be advocating for increased mental health services in our states and in our nation; for reduction in the gender pay gap and other measures to reduce the number of women and families in poverty.  We should find ways to reduce domestic violence in our nation.  We should support efforts like the Women in Recovery program, and drug and mental health courts that focus on rehabilitation services.  No one knows this better than my sister-in-law, who also happens to be editor-in-chief of this blog.  She works in the drug court system.  She sees women as offenders every day in her home state of Missouri.  She knows it takes, sometimes, half a dozen times or more for offenders to find recovery.  She will be the first to tell you there are no easy fixes and no simple answers.  But I believe if we begin to change the idea that prison is the solution, then we can begin to create a culture where we focus on restoration and rehabilitation for our women.  I think we will all benefit. We have a shared brokenness.  We should share in the efforts of recovery.

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the original birth story.

Today is the day we’ve been waiting for.  Or at least I’ve been waiting for.  We light the Christ candle.  It is now Christmas. I don’t know about you but I’ve been anxious for the last 4 weeks.  Anxious to sing the songs and hear the stories and remember the day we celebrate the birth of Jesus.  It is difficult for me to comprehend that God’s people waited through 400 years of silence for the birth of Christ.  I would bet that every time a new king img_2375was crowned, a new country invaded, a new period of famine or drought came they imagined that they were on the cusp of a conquering savior’s presence.  And then they got a baby.

It is easy for us to look at the coming of Christ as a baby and make that sound we do when we see a newborn.  You know it.  You’re probably making it right now. It is the sound of seeing something that makes us feel warm and fuzzy inside.  This is my usual response to Christmas.  The warm and fuzzy feeling of  watching the Nativity.  But today I am keenly reminded of the frailty of Christ’s birth.  In a striking move unanticipated by anyone looking for it, God chose to manifest himself on our planet as the most vulnerable citizen.  We don’t have record of the maternal and infant mortality rate at the time of Jesus’ birth but we can extrapolate based on the earliest data we have available.  Based on early European data and other modeling statistical methods the best estimate is that 300 out of every 1000 infants born did not live to celebrate their first birthday.  That’s 30% of babies.  And their mothers.  Infection and hemorrhage were common.  As many as 25 of every 1000 women died as a result of childbirth during the time that Mary was pregnant.  Compare that to giving birth in the US today where, on average, the infant mortality rate is 6 per 1000 and the maternal mortality rate is about 10 per 100,000 women.  When Mary accepted the call of God to be the mother of Christ not only did she accept the shame that comes with being an unwed mother in her culture but I’m sure she knew the reality that many mothers and children did not survive childbirth in her community.

It begs the question: why would God choose to become incarnate in the form of a baby? Why choose the most vulnerable way to represent himself?  Maybe it’s because God enjoys being subversive.  Maybe it’s because no one would have suspected to look in a crib for a savior.  I suspect it is because He is in the business of demonstrating to us that power
is made perfect in weakness; that He is best found amongst those who cannot raise arms to protect themselves.  Dare I say that if you find yourself looking for a savior who will increase your power, fill your pockets and take down your enemies…don’t look inside the manger.  Don’t look in the manger for a savior who will use violence and destruction and despair to bring about his kingdom.

This Saimg_0059-jpgvior, the one found in the manger, will be “God with you” always.  He will be with you despite your words, despite your actions, despite your selfishness. This Savior will stay close to you in your suffering, He will walk with you in your grief and He will rejoice with you when life is gracious and good.  He will ask you to forgive your enemies, to lay down your weapons, to love someone who believes differently than you.  He is the Light that breaks through all darkness.  If you dare to look for the savior born long ago out in the cold this is what you will find.

May your life be filled with the light of Christ as today we light the Christ candle.  May every baby you see today and this week remind you of the vulnerable God who sends a baby in order to bring peace healing and hope to your life.  Merry Christmas friends!

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photo credits: Pastor Jason, yours truly, shiftworship.com, and the internets.

 

modern feminism.

I grew up in a household where I didn’t know that I might be disadvantaged in life because I was a girl.  I don’t remember being told “you can do that even though you are a girl.”  I don’t remember being told “you can do anything your brother can do.”  I remember feeling that I could do and be anything I set my mind to.  Period.  I remember being the only girl at a basketball camp I attended in the 5th grade.  I remember being the youngest and the smallest.  I remember shooting a hundred three-pointers and not making any of them.  I absolutely remember that this was the first time that I wasn’t sure I belonged because I was a girl.

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Not long ago I told one of the church girls that I am a modern feminist.  It was in the midst of me telling a story where I was in a meeting and presented an idea.  A gentlemen across the table from me repeated my idea about 2 minutes later as if it was his own.  I wish you could have seen my face.  The craziest part was that everyone just moved on like it didn’t happen.  Why?  First, I think because it’s a sad but common occurrence.  Secondly, I don’t think anyone feels empowered to say anything.  I read a recent article where women at the White House repeat each other’s ideas and give the author of that idea credit to ensure it is heard.  It’s a genius and embarrassingly necessary idea.  I attended a town hall meeting of sorts with two women in local politics.  They both said they were “recruited” into running by their community.  I couldn’t help but think that maybe these women needed a group of people to lift their voices before they could be accepted into the political arena.

And don’t think that men in our culture are the only ones who limit the ability for women’s voices to be heard.  Many women still believe a wife “allows” her husband to commit infidelity by not engaging in enough sexual activity or being too busy at work or caring for children.  Many women and men believe that a large amount of alcohol or a small amount of clothing “allows” women to be the victim of sexual assault.  These men and women have bought into the lie that women must change in order for the culture to change.  I just don’t buy it.  It’s not a woman problem.  It’s a world problem.  I shouldn’t have to dress or talk or walk or do anything differently to not be treated like I matter less. Our culture says “Women, just be different and the world will then recognize your worth. Stop screwing things up for yourselves by some of you wanting to work and some wanting to be stay at home moms; some wanting to be single and some desperately wanting to be married.”  These statements aren’t blatant of course.  They are inherently biased in so many of the arenas we live and work in.  The subtle and subversive notion that if only my voice was less loud and not so high pitched then maybe I would be “heard” more often.  Screen Shot 2016-10-09 at 8.29.01 AM.pngThe creeping feeling that my outfit or my hair is noticed more often than my skill as a surgeon or my innovation as a researcher.   The indignant  feeling I get when the men in the room during a delivery seem surprised to see me take excellent care of their wives and partners.  We all have inherent biases and until we are brave enough to admit them we will never move forward.

Why do I believe I am a modern feminist?  Because when I read the Bible I am drawn to the women who were incredibly faithful and brave in a culture that did little to acknowledge their existence or worth.  A young Mary who bravely accepted the calling of being the mother of Jesus.  The women who faithfully stood by Him during his trial and execution.  Who took him down to be buried and showed up to tend to his grave.  Who knew He could change the world because the poor, the widow and the orphan were just as valuable to Him as the priest, the tax collector and even the king.  Because I want my Christian community to take up for the most vulnerable and recognize that women in the modern church can and will do the praying, the preaching, the spiritual disciplines and the heavy lifting required to move us toward the Kingdom of God.  Because the church girls, my patients, my sister in law and my coworkers deserve better.

I have two daughters.  God bless the pastor.  When Pastor Jason is at a golf tournament with our oldest there is no “you can beat those boys” talk.  Instead, he reminds her that she has the best golf swing he has seen in a 9 year old.  Better than her dads.  And that she can beat anyone.  Why?  Because it’s the truth.  And the pastor knows that she is more valuable than to be compared to a reference group of men.  My 4 year old believes she can do anything.  And from the short time she has been on this planet I’m not convinced she isn’t correct.  Our world will closely reflect how we treat its women and its most vulnerable.  I want my daughters to live in a culture where no one has to repeat their ideas for them to be valid.  My greatest hope is that my daughters will have a voice at the table.  A voice in the classroom, the boardroom, the operating room.  This modern feminist believes women have the ability to change the world.

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(photo credit: smart physician moms plus the internet plus the tribute to the holocaust victims and survivors in Boston)