Posts in women's health
New worksheet available! Stress LESS.

Hi everybody!

I have been scribbling different versions of this worksheet for some time now, and I finally have a version that I’m excited to share. It is the first in a series of worksheets that I will be making available on the (heyyyyy) WORKSHEETS PAGE!

Me, being  not stressed  about being covered in Jell-o at my son’s 7th birthday party.  Yep, he still likes getting messy, I’ve just joined him.

Me, being not stressed about being covered in Jell-o at my son’s 7th birthday party. Yep, he still likes getting messy, I’ve just joined him.

This first worksheet is all about identifying your response to stressors. We all need LESS STRESS, and I am 100% sure you can shift your perception of your personal stressors (well, most of them anyway) to have less stress.

The basic idea is that you will identify your stressors. After you have identified your stressors, you can then have a real conversation with yourself about whether you choose to have a stress response to that or not. That’s right, you get to choose in more cases than not.

The example I always give in my clinic is when my son was about 2-3, he was obsessed with emptying all toothpaste, all dish soap, all shampoo, bubble bath, you name it..into the sink or the bath tub. We would be having a normal day, getting ready to leave the house and I’d realize that I sent him to get socks (or pants or whatever!), and he didn’t come back straight away. I would know that he was probably getting into something, and I’d feel this mild fury rise in me that he was wasting another tube of toothpaste. Even though the grownups had put it out of reach, my 5 year old probably hadn’t…..lo and behold a sink full of toothpaste AND toilet paper because he actually tried to clean it up. I was right, but I was in no place to acknowledge he was a little kid trying to learn. That moment sucked, and I wanted so much to have had a different response. It was predictable. He did it All. The. Time. He was an insatiable tiny mad scientist.

I had to learn to have a new response in that very moment. I had to decide that I would not allow myself to become stressed about wasted toothpaste. I had to decide that as I walked down the hall, rounding the corner to the bathroom, that I would take pause, assess the situation, and do my best to not allow this particular stressor become STRESS IN MY BODY. It was as simple as making a decision to respond differently. I use this example as a jumping off point. Other stressors may require more complex changes, but I’d highly recommend downloading the worksheet, and see just how many perceived stressors you can shift without embodying them anymore!

Pelvic Health

I recently gave a talk to a group of women about the Pelvic Floor: what is is, what affects it, who is affected, and what to do about it. This was the 2nd time I’ve given this talk (for a monthly series) because it was so well-received the 1st time.

The first talk was a huge success.  There were several people that came to the talk AGAIN the second time around.

The first talk was a huge success. There were several people that came to the talk AGAIN the second time around.

In my talk, we dive right into the hormonal aspects of pelvic floor health, the personal history contributions, and the physical/mechanical factors at play.

I have long taken for granted the fact that people do not know their internal anatomy. I fell in love, head-over-heels-passionate-sleepless-nights-in-love with human anatomy when I was 19. I am visual. I locked in on where every organ, muscle, bone and ligament lived in the human body. Now, I’m teaching people in their 40’s where their bladder is relative to their uterus (or prostate!) and their colon and rectum. it feels like I have always known.

It is now believed to be true that 70-80% of the general population has some degree of pelvic floor dysfunction serious enough to warrant a doctor’s visit. The median age for females is 41. Let that sink in. That is why we decided the time had come for us to do a pelvic floor talk. My bootcamp leader at Wy’east Sisterhood and I were involved in a discussion with women who had never been pregnant, talking about incontinence.

Hold the phone.

People that had never been pregnant had pelvic floor issues? That’s when a light came on for me. I had treated tons of people for pelvic floor issues, but most of them were postpartum. I even said, “Every body that has a pregnancy needs pelvic floor work afterward”.

I had bought into the misunderstanding. People who had not been pregnant would not come to see me for things like constipation, low back pain, prostatitis, erectile dysfunction, or recurrent UTIs because those things haven’t been connected to pelvic floor muscle dysfunction in the mainstream. They didn’t know to come, and I hadn’t told them.

Well, I am telling them (and you) now. We are at a time when the importance of the pelvic floor muscles and organs is being realized. It’s about more than Kegels.

https://www.ncbi.nlm.nih.gov/pubmed/21160318

https://www.ncbi.nlm.nih.gov/pubmed/26926816

Working in working out

  You know how sometimes, you can plan for something, work at it a bunch, and still have it fall flat on its face?

That was me this time last year.

I picked the Tillamook Burn Trail Race as my first 50K distance race.  It's beautiful, or rather....brutiful.  With over 7000 ft elevation gain and loss over 30 miles of lush old growth forest, I really had my work cut out for me when I found out I had gotten a spot from the waitlist for this race.

I toed the line last spring, started strong, but then a few hours in, the terrain started to eat me alive.

I realized around mile 16 that my finish was in jeopardy.  With each mile completed, it actually started to feel like the finish line was moving away from me.  There was a 5pm cutoff for the race.  I was dangerously close to going over time.  The final 1450ft ascent before the finish, I knew it was over for me.  They let me through the last aid station so I could complete the distance and cross the finish line.  My family was waiting there for me, and it didn't matter to them that I missed the official time by 14 minutes.  It really only mattered to me.

Turns out it mattered to me a LOT.  Way more than I understood until the past few weeks.

I took the fitness attained from training for that race and churned it into the next race, and the race after that.  I volunteered at other races and got inspired.

I went to grown up up running camp and highlighted my areas of weakness so I could hone those skills and become a better athlete.

I cross-trained when I could (read: grabbing those 5-10 minute slots to kettlebell, stretch, squat, handstand, lunge, or whatever!).  I ran in the rain, the mud, the snow, the ice, the numerous mini-landslides, in jeans, pajamas, snow gear...to make it happen.  For me.

I studied the Tillamook Burn course this year and chunked it down into 8 sections.  I set time goals for each checkpoint.

Do you know what?  It worked.  I finished 38 minutes faster this year, and the day was a pure joy.  365 days and a lot of work later, I finished that bad boy.

Set goals, huge goals, and work towards them every day.  Work it into your day.  Stay focused. It's important to me that my kids see me doing this valuable self-care, even though I'm balancing parenting them and seeing my patients.  Be patient.  Do many small things.  I promise, it's worth it.

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The sweetest finishes sometimes take a long time to get to.

 

 

 

Training With the Flow by Amanda Roe, ND

Having a uterus and ultrarunning is generally pretty rad. There is nothing like running into some badass women in the woods, tearing up the trails and having a great time. We push each other to be better, dream bigger, run stronger. How many times have you been digging deep for the next internal power surge to arise and been inspired either by thinking of another woman runner, or witnessed within yourself that core sense of knowing you’ll rise to the occasion? We lift one another up in this sport. In the interest of elevating women in sports, let’s lift the mystique of that monthly visitor that can throw a bit of a wrench into an otherwise finely tuned machine. Periods run interference on even the best training schedules and can set you back a week or two at a time. Most of us are already balancing our running with career, family, and the odd (gasp) other pastimes besides running. Raise your hand if any of the following scenarios sounds familiar. I know.

“I was packing the car up a few months ago to leave for an early morning race. I ran back in the house to pee only to find that Aunt Flo came by to wish me luck. The race was set to start in 2 hours. I thought she was coming on Tuesday!”

“I’m scheduled for a long run on the weekend, but have been bleeding and cramping for the past two days. My legs feel weak, my back hurts, and I would eat a Taco Bell Party Pack faster than a gaggle of teenaged boys right now. How can I cement the wherewithal to get 20 miles in bright and early? My 50K is 6 weeks.”

“Looking ahead at my race calendar, again I count the weeks to go: seven weeks until the next race. I have my period this week. It should be 8 more weeks until ‘that time of the month’, but it’s going to be a close call. Can’t I just plug it up and pretend it’s not happening??”

There are so many factors that affect our biggest days out there racing and training, and uterine behavior (or misbehavior) doesn’t need to be another big unknown. Getting a general sense of your cycle can empower you to do all the right things to guide your body toward training and racing strong, before, during, and after your period.

HERE COMES AUNT FLO: Running before period (Days 15-28 of cycle)

Hydration is key. There are a lot of hormones leaving the system during this time, and it can feel akin to a detox. For women who experience premenstrual headaches, be extra sure to keep those electrolytes balanced and the excretion (ahem, peeing and moving your bowels) humming along. If you’re up for it, a trip to the sauna or hot yoga class can aid with the processing. Decreasing inflammation is also vital, particularly if you get bad cramps or have endometriosis. Focus on foods high in essential fatty acids, known for decreasing cramping and clotting, like olives and olive oil, avocado, nuts, seeds, fatty fish (like salmon, cod and halibut). Decrease coffee, alcohol, and limit sugar, as these amplify inflammatory pathways in the body.

SHARK WEEK: Running during period (Days 1-7 of cycle)

Use your discretion in determining when and how much to run. For some women, the increased circulation from exercise actually helps relieve cramping and clotting. For other women, running can cause more fatigue. Eat iron-rich foods: dark leafy greens, eggs, beets, poultry, and beef. Combining iron-rich foods with Vitamin C or foods high in Vitamin C (citrus, spinach, berries) will help your body absorb more iron naturally. Magnesium can also help a bunch. Epsom salt baths are great way to relieve muscular tension from cramping, low back pain, and leg pain.

GETTING OFF THE COTTON PONY: Running after period. (Days 7-14 of cycle)

Sleep is your buddy, and you’re likely to be feeling much better now that your body is resetting. Treat it to some daily nourishing blood-builders like spinach, black beans, dates, and carrots to stay on top of your game. Run strong, and tear it up out there, my friends!

Pap happy.

Guess what?  The guidelines have changed for Pap smears!  I know that coming in for your annual exam is about as fun as going to the dentist for a filling, but I am proud when you ladies come in and take care of business.  I like checking in with you each year.  However, the guidelines have changed, and it means we won't be seeing eachother quite as often. To summarize: Under Age 21: no pap smear, no HPV testing Age 21-29 Pap every 3 years Age 30-65 Pap + HPV every 5 years

Here's a nice article written by a colleague, Aviva Jill Romm, MD.  This is a great summarization of the new guidelines.

If you want more info from the U.S. Preventive Services Task Force, click here.

On being human.

This is an absolutely fabulous article written by a mama on self-forgiveness and being human.  I love it.  I think if we keep in mind what it means to be human, to replenish our stores of grace, and to forgive ourselves when we feel we haven't been our best selves or parents....we can have healthier happier dynamics at home and in the world. Give it a read!

Naturopathic care for Postpartum Mood Issues

Naturopathic doctors are trained to look for the root problem causing someone's symptoms, rather than just making the symptoms go away.  If we address the underlying cause, we can allow the symptoms to recede for good.  This is no different for postpartum women, and there are a number of reasons WHY women develop postpartum mood disorders.  Naturopathic doctors, especially those trained in the art of midwifery or who have had special training in pregnancy and birth, are very well-equipped to figure out how to best help each woman on an individual basis. Dr. Adriana Azacarate-Ferbel is a Portland area Naturopath who has studied Postpartum depression extensively.  I met with her last fall when I began researching this topic more myself.   She outlined the most common underlying reasons for development of Postpartum depression:

  • Fatigue and Sleep Deprivation
  • Hypothyroidism
  • Hyperthyroidsim
  • Immune system dysregulation
  • Pain
  • Low Cholesterol levels
  • Hormone imbalance
  • Neurotransmitter
  • Insulin resistance

Sometimes, it may be a combination of one or more of these that can cause postpartum mood disorders to develop.  Because this is true for many women, the Naturopathic approach is multifactorial as well.  The earlier we can recognize the symptoms and determine what's actually going on, the better.  In my office, a primary work-up to determine the underlying cause may include:

  • Thyroid testing, followed by nutritional supplementation and/or medicine to balance the thyroid gland (if needed)
  • Combination Hormone and Adrenal Saliva testing, followed by treatment with herbs and nutrients known to balance female hormones, DHEA, and/or cortisol (and are safe for breastfeeding).
  • Lipid panel, to look at cholesterol levels, followed by nutritional counseling to ensure adequate levels.
  • Comp. metabolic screen, Iron panel, and Complete blood count, to assess for blood sugar issues, anemia, and immune system problems
  • Musculoskeletal assessment to determine sources of pain that may be adding to increased stress and fatigue, followed by massage, acupuncture, or other forms of physiotherapy
  • In some cases, neurotransmitter testing will be done first.  This is especially true if someone has a marked history of depression, anxiety, or psychosis.

I could write pages and pages on this topic.  This is just a jumping-off point.  There is still a lot to learn about this realm of women's health, but we have a very good grasp on how to make the transition to motherhood a happy and healthy time.

Be strong.  Live healthy!images

Baby blues

imagesDid you know that about 80% of all new moms experience some form of postpartum mood flux?  There is a normal drop in mood, increase in anxiety and tearfulness that occurs in most women right after they have a baby.  In most of these women, it is hormonal.  The pregnant body is pumped full of estrogen, progesterone, relaxin, prolactin, and oxytocin.  When the baby is born, all these amounts shift---mostly dropping off like the cliffs of the Grand Canyon. Having a baby opens women up in so many ways: physically, emotionally, and spiritually.  It is a very wonderful and overwhelming time in all regards.  It is also a very vulnerable time because the body is going through so many changes AND there is a tiny little being that must be tended to 24 hours a day.  "Baby blues" affect up to 80% of new moms within the first few days postpartum.   I've seen that days 4-6 postpartum tend to be the most difficult for women mood-wise.

About 10% of new moms will go on to develop postpartum depression.  The onset of postpartum depression actually tends to be anywhere from 6 weeks to 6 months after the birth.  The symptoms are similar to depression: low mood, sleep issues, appetite changes, panic, anxiety, disinterest--plus constant concerns about ability to care for the new baby, and possible fears of actually harming the baby.  If a mom has had issues with depression prior to pregnancy, she is at a higher risk for developing postpartum depression.  Sometimes, it can be due to underlying physiological issues like hypothyroidism (which can also develop in the postpartum period).  So it's good to rule out root problems to best help with treating the symptoms.

Roughly 2% of new moms will suffer from postpartum psychosis.  This is a very serious condition that must be addressed immediately and is thought to also be due to the drop-off of hormones that occurs after the birth.  Symptoms of postpartum psychosis are seen within the first 2-3 weeks following the birth and include:

  • insomnia (other than not being able to sleep because the baby is awake)
  • mania
  • flight of ideas
  • self-harming
  • constant thoughts of harming the new baby
  • disinterest in the new baby
  • complete shift of mental status (that friends and family easily notice)

Often, these women need in-patient help with stabilizing mood, but there is a lot that can be done naturopathically to support a woman in this situation.  With the right support, these women go on to embrace being a mother.

There is a whole slew of new research coming out on postpartum and antepartum mood disorders.  More prenatal care providers are broaching the subject with their patients as well.  One of the best tools we have is to educate the patient and her family about the signs and symptoms so early intervention can occur.images-1

Next week, I'll be writing about some of ways naturopathic doctors help women who may be at greater risk for developing postpartum depression, anxiety, or pychosis.  Until then, enjoy the days as we begin to welcome Summer this year!

Herbal Nutrition in Pregnancy

DSC_0606Herbal Nutrition for Pregnancy Red Raspberry Leaf (Rubus Idaeus): tones the uterus during pregnancy, prevents hemorrhage, provides excellent source of Vitamins C and E.  Also good source of Calcium and Iron.

Nettles (Urtica dioica): great tonic.  Has lots of Vitamins A, D, C, and K. Provides Calcium and Potassium as well.  The Vitamin K is instrumental in preventing hemorrhage during birth.  Also good for leg cramps and hemorrhoids.

Mint family (Mentha spp.): safe and helpful in pregnancy for digestive issues: morning sickness and indigestion.

Oatstraw (Avena sativa): good source of minerals for growing baby and for integrity of veins.  Oatstraw is calming and nourishing.  This herb is a personal favorite!

Specific issues during pregnancy*

Morning sickness:  1-2 cups Raspberry leaf tea, 1-2 spoonfuls of ginger root (Zingiber off.) decoction, peppermint of spearmint tea, alfalfa (Medicago sativa) tea for B vitamins

Varicose veins/Hemorrhoids: 1-2 cups daily of Oatstraw tea, 1-2 cups of nettles tea, raw parsley (Petroselinum sativum) in salads, witch hazel (topically)

Anemia: 1 TBS Yellow dock (Rumex Crispus) decoction per day.  Can also try teas of Dandelion root (Taraxacum off), Parsley, and Nettles.

Heartburn/Indigestion: Anise or Fennel seed tea for after meals, Papaya enzymes, raw almonds, Slippery Elm (Ulmus fulva)

Bladder Infections: unsweetened cranberry juice, Uva Ursi leaves infuse for 8 hours, then drink one cup every 12 hours.  Can add yarrow (Achillea millefoilium) if not clear with just Uva ursi.

Hypertension: garlic, cucumbers, Hops (humulus lupulus)—only during 3rd trimester, Passionflower tincture (15 drops per day), Skullcap (Scutellaria off.) 1-2 cups per day, Hawthorn berries (Crataegus off.)

Late Pregnancy uterine tonics: Black and Blue Cohosh (Cimicifuga racemosa and Caullophyllum thalictroides), Squawvine (Mitchella repens)

*Please consult a helath care practitioner before beginning any new herbal or nutritional regimen