Thoughts from Between the Knees

It is hard to believe that birth control pills have only been around for 50 years. For many of us, we can’t imagine life without them. But try to picture life for women before easy contraception.

We got married early, often in our mid-teens. We started having babies right away: really, there were no other options. And we just kept having babies, until we got too old, our insides fell out, our husbands stopped wanting to have sex with us, or they died. Basically, our lives were ruled by our fertility.

Birth control pills became available in the early 1960s. We can now plan our families, or choose not to have children. This allowed us to get a better education, get better jobs, stay in the workplace longer, become financially independent, and sometimes even make more money than our spouses. Birth control pills have truly changed our society. Without easy, safe contraception, equality for women is impossible. Look at 3rd world countries.

So in my humble opinion, birth control pills are the best thing since sliced bread. Not only do they give us the ability to plan our families, they improve a host of problems that can be associated with our menstrual cycles. Everything from acne, to menstrual cramps, to endometriosis, to pre-menopausal problems can be improved with the use of birth control pills. And for these problems, I call them “menstrual cycle management pills”.

Basically, a teenager can go on birth control pills for painful cramps, stay on them until she would like to get pregnant, have her family, and stay on them until menopause. Miraculously, for most women there are no serious long term health problems from using birth control pills. No increase in cancer, no decrease in fertility, no nothing. And there are some interesting benefits to using birth control pills: easier, shorter periods; less ovarian cysts; less endometriosis; less anemia; ½ the chance of endometrial or ovarian cancer! Who knew?!

Is there a best pill? No: 80% of women would be happy with any of the pills. 20% may have to try a couple of different pills to find one that suits them best. The most common side effects for women starting birth control pills are breast tenderness, nausea, headaches, mood swings, and irregular spotting. These problems occur in less than 15% of women, often resolve after the second month, or go away after a change to a different pill. Weight gain IS NOT a common side effect!

So if you have been putting off considering birth control pills as an option for you, make an appointment to discuss your concerns!

…than nagging to get your other half motivated to get back into shape. This is from Prevention magazine, via MSNBC.com: http://www.msnbc.msn.com/id/43429948

My ex-husband (who is a really good guy, by the way) used to think that I would get him to go on nice long walks with me so that I could nag him about stuff and he couldn’t escape. That is certainly not what I thought I was doing, but as I have said before, perception is everything.

I don’t think any of us like to nag. In a perfect world, we would ask once, and poof! it would be done.

But there is one “nag topic” that really hit me the other day. Nagging our husbands/partners about their health. Last week one of my patients, 50 years old and a widow for 3 years, expressed her anger at her now deceased husband, for not taking better care of his health. He dropped dead of a heart attack at age 51. With tears running down her face, she told how her kids missed him, she missed him. How she has struggled to support a family alone, and unprepared. She was angry that he smoked, was sedentary, ate badly, let things around the house fall to pieces etc, etc. How could he have been so selfish? Of course, she had nagged him, but of course to no avail.

I hear this all the time. It’s just that most men don’t drop dead at age 51. They still think they are immortal. Many won’t even see a doctor for a check up. Most will not change their habits until they have an “event”: heart attack, stroke, cancer. But more subtle, is the erosion of physical capability: sexual function, “playing with kids”, stamina for leisure activities. For many wives who make the effort to stay active and fit, this is terribly frustrating as well as frightening. Will their spouse die prematurely? Will they become disabled, leaving them to play nursemaid? What will happen to them financially?

Ladies, your are not their mother, or their nursemaid. You are a partner. And your concerns deserve attention. You both have a responsibility to take care of yourselves, but there is only so much you can do about your spouse.

My advice is that you sit down with your spouse, tell him you love him, that you are concerned about his health. Suggest he see a doctor for a check up, if appropriate. Tell him you will help him make changes to his habits. But if he is unwilling to change, tell him you want to make sure your financial house is in order, that you both have current wills, that both of you have adequate life and disability insurance so that there is financial security if something happens to either one of you. Leave the door open for him to change his mind in the future. Then stop nagging. The only thing that is truly in our power to control is our own behavior. So take good care of yourself.

And for those of you who don’t take care of your own health, consider this column to be me nagging you! You owe it to yourself, and your family!

Are we having fun yet?

For those of you who need a definition: Fun: something that provides amusement or enjoyment.

Why is this such a difficult question to answer? Why don’t some of the things I do “for fun” exactly feel like fun? Why do I sometimes feel a bit uneasy when I am having fun? What is the problem here?

When I ask my patients what they do for fun, why do I almost always get this funny look, and a long silence? Then a sheepish admission that they don’t really know what they do for fun. Somehow life feels too much like work.

Perception is everything. Maybe we think fun things should be special, big events that stand out from the rest of our lives. But don’t we often have fun doing many of our regular activities: going to the movies, having a casual dinner with friends, watching the kids’ sporting events, playing tennis with the neighborhood team?

When my kids were little (3 and 4) the weeks were exhausting, for everyone. Some Friday nights we would go to Chuckie Cheese for dinner. Don’t laugh, it worked for us. My husband and I would sit and drink a pitcher of beer, and the kids would play until they were dead on their feet. They would be asleep by the time we got home. And we grownups shared a couple of hours together, having a beer, kind of like the old days. It was fun.

So take a good look at your life. Make a list of the regular things that you do that are chores, you really wouldn’t do them unless you had to. And then list those regular activities that, in truth, you really enjoy, but sometimes forget that you really do enjoy them. There may be times in your life when the list seems very unbalanced: then it may be helpful to really schedule some “fun time”. But it never hurts to rebalance the list every so often, to get rid of some of the “should do’s” , and add more “really enjoy this” activities.

It also helps to try new things. Get everyone out of their routine once in a while. Learn to do something new – a new sport, a new hobby, a new class at the gym. And talk about what you think would be fun. Have everyone make a list of fun things they want to do in the next 6 months. Put it on the refrigerator, talk about it, plan for it, anticipate the fun!

Our medical system focuses on verifying the absence of disease. The annual health evaluation is about ruling out the possibility that you have a disease, which can be treated by a medication or a procedure. “Your blood pressure, pap smear, and mammogram are normal”.

Medical training programs focus on system based diseases, which fragments the view of the human body, rather than evaluating its function as a whole. This leads to the situation we are in now, where we each have multiple specialists, perhaps a primary care MD, but no one really considers our whole being.

When we consider ourselves healthy, we really mean we don’t have any diseases.

Frankly, that’s just not good enough for me.

I prefer a goal of WELLNESS which is a balance between our physical, mental, and spiritual health that allows us to awaken from a good night’s sleep refreshed, a smile on our face, a spring in our step, and the energy to finish the day. It is so much more than the absence of disease.

Our lifestyles predispose us toward an imbalance between our physical and mental selves. We sit in chairs, drive in traffic, spend all day indoors, sleep too little, eat too much of the wrong things. We think too much, worry too much, and watch too much.

How can we become “well”? Sounds so easy – it is not. But it is very much worth trying. Let’s start with the basics:

Sleep: Get enough! Did you know that at the turn of the 20th century, people slept an average of 10 hours a night!!! Most people need 7-8 hours a night. Make it a priority. Write your bedtime in your calendar!

Healthy Eating/Food vs Edible Substances: Food comes from the earth. If you can’t tell where it grew, or exactly what went into it, think twice before you put it in your mouth. (What tree did an Oreo grow on?) Edible substances are what the food industry makes, and what they make us think we should eat. They are what fill the grocery store.

Exercise/Movement: The human body was not designed to sit in a chair all day. It was designed to move. Go to a park and watch the little kids – it’s as if they can’t NOT run! Get yourself a pedometer. Wear it for a week doing your usual activity – monitor the steps you take each day. Then try to increase the number of daily steps by 200 each week. Take a break from the chair/computer for 5 minutes every hour – walk a flight of stairs, take 10 deep slow breaths, go outside if you can.

Stress Management/Fun: What do you do for fun? A difficult question to answer for some people. Think of fun as the antidote to stress. I like to divide my world into 3 boxes: things I have to do, things I think I should do, and things I want to do. Try to get rid of the “shoulds”. I ask myself “who says I should”? Is it really important? Is it fun? What will happen if I don’t do it? What will I do for fun today?

Indoors/Outdoors: If we don’t spend time outdoors in nature, we lose sight of our place in the world. We become disconnected from the larger rhythms of life. Watching animals, feeling a breeze, seeing the sun and the moon can help take us out of our own little worlds. Enjoy the bigness of the outdoors.

The goal is a lifetime of wellness. There is no finish line. It is about enjoying the process.