September 2013 - Page 2 of 2

The Dense, Divine, Anti-Inflammatory, Diet Friendly Brownie

Published on September 14, 2013

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When I went on an anti-inflammatory diet, or The Endo Diet, as some with endometriosis might call it, I had to cut out most of my favorite foods. One of the biggest complications was dessert.

Now, don’t get me wrong, I went through my detox and cut them out, all right! But after having excision surgery to remove the biggest majority of my disease, I decided to try reintroducing foods to figure out what triggered my symptoms, and which foods to eat again. I (thankfully!) found that chocolate was OK. Gluten, however, was not.

After a few failed attempts at using rice flour and all purpose gluten-free baking flour (note to the wise: if it contains garbanzo beans, it’s going to turn your sweets very bitter), I felt like my baking days were most certainly at an end. But then I found a recipe on Pinterest that opened my eyes to the many uses of sweet potato and avocado…in BROWNIES!

I bought all my ingredients, and went about making the recipe…except when I finished the dough, it was dry, clumpy, and bitter. Hm. Not the way I like my desserts. Containing healthy ingredients, like avocado, sweet potato, almond butter, and applesauce, was just not enough for me to overlook a bitter brownie. My sweet tooth is not that lenient.

So…I adapted. And OH! What a sweet, delicious, dense treat it was! So here, I bestow upon you, my recipe for:

The Dense, Divine, Anti-Inflammatory Diet Friendly Brownie!

(Psst…you can’t even taste the avocado!)

Ingredients:

(all organic, when possible)

1 cup sweet potato puree (about 2 small, or 1 large potato)
1 ripe avocado
1/2 cup almond butter
1/2 cup unsweetened applesauce
2 tbs vanilla extract
2 eggs
1/2 cup maple syrup OR raw honey*
1/2 tsp salt
1 tsp baking soda
1/2 cup rice flour
1/2 cup cocoa powder
1/2 cup vanilla rice milk
1/3 bag (or more if desired!) Enjoy Life chocolate chips**
Coconut oil spray

Directions:

Pre-heat your oven to 375*. Prepare a 9 inch brownie pan by spraying with coconut oil.
To make your sweet potato puree, bake your sweet potato(es) by poking several holes with a fork and microwaving on high for 3-4 minutes, or until soft. You could also bake them in the oven, but I’m impatient! Combine your sweet potato, avocado, almond butter, applesauce, eggs, and vanilla in a food processor, and blend until smooth and well incorporated.

In a small mixing bowl, combine the rice flour, salt, baking soda, and cocoa powder, whisking to incorporate evenly.

Mix your wet and dry ingredients in the bowl of your mixer. Start with your wet ingredients, and add the dry in 3 small batches on low (to avoid a giant mess!). Now, you can start adding the rice milk and sweeteners (maple syrup or honey). You may need to add more to taste. Finally, mix in your chocolate chips, and spread the batter evenly in your baking pan. Bake 30 minutes or until a toothpick comes out cleanly. I baked my batch in my convection oven for 35 minutes, and they were just slightly more done than I wanted. A couple minutes fewer and they would have been even more moist and divine!

Please try them out, share, adapt, and post your own creations! You can find more ideas for anti-inflammatory recipes on my Endo Diet Pinboard!

*you may adapt with your own sweeteners of choice. I tried adding Truvia until I read this and this. I think I’ll stick with the honey, thanks! Just add your sweet ingredients to taste, like I did 🙂

**LOVE this company! Try finding another chocolate chip on the market that doesn’t contain some form of dairy. Or soy. Or nuts! Or whose manufacturer is a verified non-GMO company.

Kelsey is an Early Childhood Educator and blogger from the Boston area. She chronicles her journey using sewing as a positive outlet while living with chronic pain and Stage IV Endometriosis. Diagnosed at 22, Kelsey has spent six years learning about her disease, and has recently become active in Endometriosis research and advocacy. She is a published poet who dreams of writing children’s books, and opening her own preschool that supports reading development. To read more about Kelsey’s daily dabblings in sewing, as well as recipes, preschool curriculum ideas, and information about endometriosis, visit her blog at www.silverrosewing.blogspot.com

Scrotal Gangrene: Adventures in Medical Journalism

by Jordan Davidson

Published on September 13, 2013

2631 views

I’ve been talking about scrotal gangrene a lot lately.

Be it a casual conversation with co-workers, a date, or a telephone call with my mom; I have somehow managed to sprinkle scrotal gangrene into almost every social interaction (in hindsight, perhaps I should apologize for this).

I’ll explain. I’m a health journalist. During the day I edit and produce news pieces, women’s health, digestive health, thyroid health and columns written by patients and doctors. Outside of my day job, I run a support organization for women with endometriosis. My typical day consists of talking about uncomfortable medical topics and then going home and talking about (or writing about, etc…) menstruation. Needless to say, if we were to play the penis game (the game where the person who can yell penis the loudest, wins) — I would win.

Sometimes, I have some extra free-time in which I freelance as a technical medical writer. When I started writing, I was asked what my specialty was — to which, naturally, I replied ‘women’s health.’ So you can imagine my surprise when I was assigned a piece on Fournier gangrene (aka scrotal gangrene).

Based on the amount of research I did for that piece, I am fairly confident that I could (should the occasion ever arise) identify scrotal gangrene. Scratch that — based on the number of necrotizing penises, scrotums and perineums that ambushed my computer screen, I am fairly certain I could diagnose scrotal gangrene as unfortunately, those images are not something easily forgotten.

How does one get scrotal gangrene you ask? In order for gangrene to occur in the genitourinary or anorectal region you need several different types of bacteria to intermingle somewhere around an open wound, rash, burn or any sort of opening in which bacteria could fester. The most common type of bacteria found in Fournier gangrene cultures is E.coli (which is also found in the digestive tract and in feces).

When this bacteria combo makes its way into the body it can cause fever and edema (a type of swelling) in the affected areas. In a matter of hours the skin can begin to necrotize and if not caught quickly, can lead to excess debridement (the shaving off of layers of skin), organ amputation, sepsis and death. Fortunately, Fournier gangrene is incredibly rare and even rarer in women (who can get perineal and vulvar gangrene).

When scrotal gangrene does occur it usually occurs in older people and people with compromised immune systems. Although… There was this one case; regarding a 29 year old male, who masturbated so frequently that he had friction burns. Guess what happened to the friction burns — they got infected, and he developed Fournier gangrene on his penis. He survived but I can’t imagine the procedure to remove the necrotizing skin was all too pleasant.

And that my friends, is why I got into health journalism; so I could teach the world about the importance of personal hygiene. Just kidding… It was to have fun facts to make people feel uncomfortable at parties.

Over-The-Counter Painkillers: Use Medications with Caution

by Philippa Bridge-Cook, PhD

Published on September 11, 2013

2677 views

The over-the-counter (OTC) medications acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) are used by millions of people every day, for common conditions such as headaches, fever, muscle pain, chronic pain conditions, and arthritis. Yet how many people are aware that they can cause serious side effects, and in the most severe cases, death? Because these medications are available over the counter in drugstores and are taken by many people without any discussion with a doctor or pharmacist, the risks may not be well understood.

Medications with Acetaminophen

Acetaminophen is the leading cause of acute liver failure in the U.S., a serious and sometimes fatal condition which in some cases can necessitate liver transplant. Many cases of acute liver failure are caused by acetaminophen overdose; however, half of overdose cases are unintentional. In many cases of unintentional overdose, patients took more than one medication containing acetaminophen without realizing that both medications contained it. Acetaminophen is present in many medications, both prescription and non-prescription. Combination products that have acetaminophen as an ingredient include:

Prescription painkillers such as Darvocet, Percocet, Lortab, Ultracet, and Tramacet
OTC cold and flu medications such as Actifed, Dayquil, Dristan, Nyquil, Sudafed, and Theraflu
Headache medications such as Excedrin

There is also some concern about the safety of acetaminophen at label-recommended doses, especially in patients at higher risk of liver injury from alcohol consumption. Acetaminophen at therapeutic doses may exacerbate the effects of liver injury from other causes. Individuals who are at higher risk of liver injury, such as those who consume more than three drinks of alcohol daily, are severely malnourished, or who take medications that induce liver enzymes, need to be aware of the potential risk of taking acetaminophen.

FDA and the Acetaminophen Medications

Because of these facts, in January 2011, the FDA announced new measures to reduce the risk of severe liver injury with acetaminophen-containing medications. Manufacturers are required, by 2014, to reduce the amount of acetaminophen in any combination product to 325 mg, in order to reduce the risk of accidental overdose when multiple acetaminophen-containing products are taken together. The FDA also requires a boxed warning on the package inserts of acetaminophen products highlighting the risks of liver injury, and the fact that concurrent alcohol consumption has been identified as a risk factor. Further, pharmaceutical manufacturers in the U.S. have lowered the recommended daily maximum dose on the labels of OTC acetaminophen products from 4000 mg to 3000 mg.

In addition to the liver injury risks, acetaminophen is also associated with rare but serious skin reactions. These skin reactions, known as Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), and acute generalized exanthematous pustulosis (AGEP), can be fatal. Reactions can occur with the first use of acetaminophen, or any time it is being taken. The FDA has issued a warning to consumers about these reactions, and will require that a warning be added to the labels of prescription acetaminophen-containing products.

Medications with Ibuprofen

Ibuprofen is another common OTC medication that can have serious side effects. Ibuprofen is a type of non-steroidal anti-inflammatory (NSAID): medications of this type are very commonly used for chronic pain syndromes and arthritis, with more than 70 million prescriptions and 30 billion OTC tablets sold annually in the U.S. Prescription NSAIDs include celecoxib, diclofenac, indomethacin, mefenamic acid, meloxicam, and naproxen (Celebrex, Voltaren, Indocin, Ponstel, Mobic, and Anaprox), and OTC NSAIDs include ibuprofen (Motrin, Advil) and naproxen (Aleve).

NSAIDs as a group (prescription and OTC) are generally well tolerated, but their use can increase the chance of a heart attack or stroke that can lead to death. Individual NSAIDs have different cardiovascular risk profiles. The highest risk is with the newer class of NSAIDs called COX-2 inhibitors, which include celecoxib, rofecoxib, and valdecoxib (Celebrex, Vioxx, and Bextra). In fact, rofecoxib and valdecoxib were taken off the market due to concerns over their cardiovascular safety: clinical studies had shown an increase in the risk of heart attack and death. The traditional NSAID diclofenac also has an increased risk of cardiovascular morbidity and death, similar to the COX-2 inhibitors. The safest alternatives with respect to cardiovascular risk are ibuprofen in OTC doses (less than 1200 mg per day total) and naproxen. The risk of cardiovascular morbidity increases with increasing dose and duration of use.

In addition, NSAIDs can cause adverse gastrointestinal events such as ulcers, and bleeding in the stomach and intestines, which can occur at any time during treatment. Gastrointestinal complications can range from mild, such as indigestion, to severe, such as ulcer-related perforation, obstruction, or hemorrhage. Mild gastrointestinal adverse events such as nausea, heartburn, dyspepsia, and abdominal pain are extremely common and may occur in up to 40% patients taking NSAIDs regularly. Serious complications, although much more rare, are still too common, and their incidence has not changed in the last decade. For example, in patients taking NSAIDs for arthritis, the annual number of hospitalizations for serious gastrointestinal complications is estimated to be about 100,000, with over 16,000 deaths.

Almost 75 percent of patients who used NSAIDs regularly were either unaware or unconcerned about possible gastrointestinal complications, and two-thirds of patients stated that they expected warning signs before developing serious complications. However, only a minority of patients with serious gastrointestinal complications due to NSAIDs had gastrointestinal complaints prior to the serious complication. Risk factors for adverse gastrointestinal events include advanced age, higher doses of NSAIDs, a history of gastroduodenal ulcer or gastrointestinal bleeding, concomitant use of corticosteroids or anticoagulants, and serious coexisting conditions.

Although risks of ibuprofen at OTC doses have not been as well studied as prescription NSAIDs, or NSAIDs as a group, the same risks are definitely present when taking OTC ibuprofen. The risk of an adverse event increases with increasing dose of ibuprofen, and for heart disease, the risk also increases with longer duration of use. Many users of ibuprofen may exceed the label-recommended dose in an attempt at better pain relief, or combine ibuprofen with other NSAIDs, both of which would increase the risk of adverse events. The label-recommended dose of OTC ibuprofen is 400 mg per dose, up to 1200 mg per day. However, in my own experience I have been advised by multiple doctors to take 600 to 800 mg per dose, up to 3200 mg per day, without any discussion of the potential for adverse events. Not surprisingly, I have NSAID-related gastritis. I have also talked to many chronic pain patients who routinely exceed the label-recommended doses of both ibuprofen and acetaminophen, and combine these medications with other prescription pain medications containing NSAIDs or acetaminophen. Although this might be acceptable for some patients, in some circumstances, it should definitely not be done without a physician’s recommendation and discussion of possible side effects.

Bottom Line with OTC Painkillers

The bottom line is that although acetaminophen and ibuprofen are generally well-tolerated at OTC dosages, especially for short durations of use, the potential for serious side effects exists. Just because a medication is available without a prescription doesn’t mean it is safe to use in all circumstances. Patients should be aware of the potential risks of these medications, and discuss their use, both in duration, and dosage, with their physicians. In addition, individual patients may have relevant medical history or concomitant medication use that puts them at higher risk of an adverse event, even with OTC medications, another reason to discuss their use with a physician.

Anti-NMDAR Encephalitis and Ovarian Teratomas

by Chandler Marrs, PhD

Published on September 10, 2013

4951 views

In 2005 researchers began documenting the existence of a new form of encephalitis, a brain disease that afflicts predominantly young women (80%) and children and attacks a critical set of brain receptors, the N-methyl-D-aspatate receptors (NMDAR). The disease, called Anti-NMDAR Encephalitis, produces a syndrome that over the course of several weeks to months progresses from flu-like symptoms, to psychosis, to catatonia, to the ICU and the need for mechanical ventilation. It is treatable, when identified in a timely manner, but because of the physiological importance of the receptor it attacks, if not treated in time or treated sufficiently, anti-NMDAR encephalitis can be fatal. Interestingly, there is an important connection to ovarian health that makes this disease process particularly relevant to women – 60% of the cases present with ovarian teratomas.

NMDA Receptors and Brain Function

NMDA receptors are the brain’s and the indeed the body’s primary mechanism through which activity is initiated. NMDARs are excitatory receptors that bind with glutamate, the excitatory neurotransmitter. NMDARs, along with the AMPA receptor (α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid), a secondary excitatory receptor regulate all brain excitation. These receptors are located all over the brain, but are especially dense in the hippocampus, where learning and memory occur, and the frontal and prefrontal regions where planning, motivation, impulse control and emotional regulation take place.

NMDARs are also dense in subcortical regions, where all sorts of functions involving movement control, motivation and emotionality are controlled and in the brainstem, the region at the base of your brain where a set of nuclei called the medulla oblongata reside. The medulla oblongata control heart rate, respiration and vomiting reflex. Impair the functioning of the medulla oblongata by injury, by reducing NMDARs or even by alcohol poisoning, sedative or pain killer overdose, and heart rate and respiration will slow to a stop, until death becomes imminent.

Too much glutamate-NMDAR activity and seizures ensue. This is because brain’s major inhibitory neurotransmitter called GABA becomes ineffective at reducing brain excitation. Reduce glutamate/NMDAR activity and the perception of pain is also be reduced, but with far too many side-effects to make NMDAR antagonist likely therapeutics. Conversely, too little glutamate and NMDAR activity also will lead to seizures, psychosis, and even, cell death. It’s a complex balance between brain excitation and brain inhibition that must be maintained. When that balance is disrupted, serious illness occurs.

What is Anti-NMDAR Encephalitis?

As far as scientists can tell, anti-NMDAR encelphalitis begins with an illness, sometimes a virus or a vaccine, and in 60% of cases, an ovarian teratoma, that causes the body to have an immune reaction against the NMDA receptors. The immune reaction elicits the production of an antibody that tells certain types of NMDARs to involute into the cell so that they are no longer active. From the cases thus far, the disease process follows the path of the receptors attacked. It appears to begin in the frontal and temporal cortices and progress to the deeper brain regions and subcortical structures until it reaches the brain stem and mechanical ventilation is required. Flu like symptoms emerge first, hence the belief that the disease is triggered by illness, medication or vaccine. The flu-like symptoms are then followed by a memory deficits and rapid disintegration into psychosis, paranoia, delusions, hallucinations. Sometimes seizures occur, sometimes they do not. If untreated, within a period of weeks, the afflicted individual lands in ICU requiring mechanical ventilation. The mortality rate is approximately 4% and the median time from disease onset to death is 3-5 months. When treatment is initiated, the recovery process mirrors the disease onset stages, though in reverse. Recovery can take years.

The Connection between Anti-NMDAR Encephalitis and the Ovaries

One of the many striking components of this disease is the co-morbid presentation of ovarian teratomas, in 60% of the cases. Teratomas, sometimes referred to as dermoid cysts, are a unique type of tumor that contain germ cells that can grow into brain or nervous tissue, glands, fat, and even skin, teeth and hair. It is not uncommon for teratomas to have teeth or hair. Treatment and indeed survival of anti-NMDAR encephalitis is predicated upon tumor removal, in most cases.

Ovarian teratomas represent an error in germ cell division; germ cells being those cells handed down at birth from our parents that contain the genetic materials needed to form ovarian follicles (eggs) for women, sperm cells for men. The germ cells are pluripotent and contain all the ingredients to make skin, gland and other tissue, hence the nervous tissue, hair, nails and other components found in these tumors. Typically germs cells divide in a logical sequence that eventually results in oocyte, an egg, that will then become fertilized or not. In some women (and men), the cell division progresses unconventionally, producing the teratoma. In part, the teratoma develops as a result of epigenetic factors including the health and environmental exposures of our parents, even our grandparents. In utero exposures to medications, vaccines and other toxins can cause errors in germ cells, and as a result, many individuals are born with these errors, but not all are triggered. Germ cell division is very highly environmentally influenced suggesting that exposures later in life can trigger errors in germ cell development, as in a teratoma.

The Connection between Teratomas and Anti-NMDAR Encephalitis

What does an ovarian teratoma have to do encephalitis? Researchers don’t know for sure, but think that because the teratomas express nerve cells with NMDA receptors, when the immune system recognizes the teratoma as foreign and begins to attack, it also attacks brain NMDARs, mistakenly so. What they have observed is that if the teratoma is not removed, survival is difficult. They have also observed that in cases where no teratoma is found, recovery is more complicated and arduous than in cases where the teratoma is found and excised.

Symptoms of Anti-NMDAR Encephalitis

Approximately, 70% of cases begin with flu-like symptoms that include: headache, fever, nausea, vomiting, diarrhea and upper-respiratory symptoms. Within a few days to two weeks, this progresses to psychiatric and cognitive symptoms that include everything from anxiety and insomnia to hallucinations, delusions, mania, memory deficits, delirium, language difficulties to frank mutism. This is followed by autonomic instability (heart rate, blood pressure and temperature instability, incontinence), alternating periods of agitation and catatonia, oral/facial tics, limb jerking, posturing. Motor and complex seizures may develop, including status epilepticus (continuous seizures), coma can occur and mechanical ventilation is required to maintain breathing. In all cases, hospitalization is required during the acute phase, which can last 3-4 months. During the recovery phase, which can last many more months, hospitalization and/or direct supervision may also be required because of an on-going need for nocturnal ventilation assistance and also because of a unique dis-inihibition of frontal cortex functioning with high degrees of uncontrolled, impulsive behavior.

Diagnosing Anti-NMDAR Encephalitis

Diagnosing anti-NMDAR encephalitis is difficult because many of the traditional first line tests come back negative. Brain MRIs are normal in 50% of patients and mostly normal or only transiently abnormal in the remaining patients. This is in direct contrast to the severity of the patient’s illness. Brain biopsies are also unremarkable. The electrical activity of the brain is often abnormal with electroencephalograms (EEG) showing slow, non-specific and disorganized activity in general, with electrographic seizure and/or rhythmic delta-theta activity during catatonia, but this pattern not necessarily solely indicative of anti-NMDAR encephalitis. Blood tests for the anti-NMDAR antibodies also are often not indicative of the illness. From the research thus far, it appears that the most accurate test involved measuring the antibodies involved in anti-NMDAR encephalitis via cerebral spinal fluid (CSF). Antibody titres appear to follow the course of the disease and recovery, even relapse and remission.

If anti-NMDAR encephalitis is suspected in women, imaging for ovarian teratomas should be conducted, and if found, the teratomas should be removed.

How is Anti-NMDAR Treated?

Because anti-NMDAR encephalitis is an immune response, the goal of treatment is to reduce the concentration of anti-NMDAR antibodies. This is done with corticosteroids to reduce inflammation, plasmapheresis or plasma exchange to clear out the antibodies and intraveneous immunoglobulin (IVIG) treatment to boost the immune response. If an ovarian teratoma is present, it must be removed. If the teratoma is not removed, prognosis is poor, recovery is possible, but takes significantly longer. In general, treatment of the acute phase, where mechanical ventilation is required and recovery require months of hospitalization. Full recovery can take years. The disease also appears wax and wane with periods of remission and relapse.

Final Thoughts

The connection between anti-NMDAR encephalitis and ovarian teratomas is fascinating and though not fully delineated, presents one more bit of evidence that ovarian health is connected to total health. I suspect as the research progresses, our understanding of ovarian teratomas will expand exponentially and offer clues to a myriad of brain and autoimmune diseases currently unrecognized and often inappropriately treated. Who knows, perhaps the environmental factors, medication and vaccines influencing germ cell and teratoma development will garner more respect too.

The Quest for Contraception and the Plight of the Inbetweener

by Lana Hanson

Published on September 6, 2013

2237 views

When you read about what women did in ancient Greece and Rome to ward off unwanted pregnancies, you’re tempted to do a full-on spit-take! I mean, our doomed sisters had to rely on wild dances and fancy amulets to keep sperm out of the egg’s personal space.

Ever wonder how that worked out for them?

Well, we women of today also face so many nightmarish birth control options – all sorts of pills and devices that could kill us – that the ancient one of crossing your fingers as you open your legs actually sounds like a refreshing idea.

So is it really preposterous for us to want safe and affordable contraception? Is it too much to ask that a woman be able to avoid the dilemma aborting a fetus or not by safely and affordably not getting pregnant at all? Not all of us pine away to be like that ideal reality show rabbit – AHEM! I mean multi-mother – Michelle Duggar.

The struggle for reasonable contraception only gets worse for “Inbetweeners”: that growing segment of women who fall between the cracks of “too poor” and “earns too much income to qualify for…” Inbetweeners defy many stereotypes: they can be married, single, or divorced, childless or not. They can be women who’ve been thrown for a loop yet not knocked down, by huge financial setbacks like divorce, loss of home, death of a spouse, personal illness, depression and/or job loss. Inbetweeners often don’t appear “needy” in appearance or attitude though they are.

You can think of Inbetweeners as the Indiana Joneses looking for what I’ll call The Holy Grail of Contraception. Sure, their jobs might not entail surviving fire pits or jumping over piles of writhing snakes; but they toil long hours for minimum wage and have no affordable health insurance.

This propels them to the doors of Planned Parenthood, where they hope to find some contraceptive security. But Planned Parenthood has it’s own struggles. Often Planned Parenthood is at the mercy of the companies and programs that supply its contraceptives and arbitrarily change their prices. That means countless women suddenly and inexplicably get kicked off programs that have supply reduced cost birth control, leaving these Inbetweeners in the dust because they’re sorely stretched to pay the staggering full price on just a one month’s supply of birth control. And Planned Parenthood staffers, no matter how sympathetic, can only shrug and say “I’m sorry.”

And Ms. Inbetweener can dream on about the possibility of getting a reduced-cost IUD! If she’s not destitute enough, these programs snatch that possibility from her desperate uterus, ‘cause the regular price for an IUD runs into the hundreds. In many cases, using birth control isn’t totally about avoiding unwanted pregnancy. For example, an IUD stanches periods that can be out of control and create havoc in the life of the sufferer. And many women have limited birth control options due to age or lifestyle habits.

But of course sorry is what an Inbetweener will be if she gets knocked up and can’t provide for the needy little cherub that’s been conceived. Her choices boil down to: Cough up big bucks to stay baby-free, leave the whole responsibility for “protection” with her partner (fuggeddabboudditt!), or have one baby after another, get even poorer and more dependent on public assistance, and find herself accused of “living off the system.”

Inbetweeners aren’t financially irresponsible; it’s just that once the bills are paid, they don’t have much left for food, never mind paying for reproductive freedom. Yet they wish to make mature choices about reproducing – and shouldn’t that be respected???

Any which way an Inbetweener tries to seek help, she is discriminated. There’s just no way to win at being a grown, responsible and sexual woman in America.

Still, we women have always been more resilient than we’ve ever let on. The ladies of ancient Greece and Rome knew it in their bones as they whirled feverishly to stave off undesirable futures. Their light fingers rubbed the milky amulets while prayers dripped from their quivering lips. Though their choice always teetered between peril and bliss, they still fiercely claimed it.

Let’s not be lesser sisters than our ancient ones – let’s keep up the good fight for safe and affordable contraception they started as best they could, long ago!

Is Biology Destiny? Being Female and Hormonal Birth Control

by Holly Grigg-Spall

Published on September 5, 2013

3073 views

What does it feel like to be female?

Why is discussion of female biology so controversial?

How does “biology is not destiny” thinking and anti-essentialism impact how we think about being female?

In a blog post I wrote some years back titled ‘Beyond Female’ I asked those questions. It would later became the catalyst for my forthcoming book ‘Sweetening the Pill or How We Got Hooked on Hormonal Birth Control.’ Over the years, I had come to realize discussing biology, and specifically female biology, was a very contentious issue mired in the politics of the “biology is not destiny” mantra of mainstream feminism. The notion that biology is not destiny impacts how we view birth control and as such it precludes the very mention of any potential dangers associated with hormonal contraception. What follows here is an excerpt from my book with some additional text specifically for Hormones Matter^TM, where I explore what it means to be female and the role the pill plays in that discussion.

Female Biology is Important

In order for us to be able to honestly and openly discuss that the pill negatively impacts women it must be acknowledged that female biology is important. Such a discussion cannot avoid the claim that female bodies are different from male bodies.

By arguing that a drug changes female biology and negatively impacts mood specifically, it must be admitted that our experience of life is connected to our biology. It is necessarily claimed that who we are is linked to our biology. To say that the ovulatory cycle, a specifically female bodily system, can not be shut down and ignored without serious repercussion, because it is vitally important to women’s health, is to run the risk of inciting the furor of those who feel they have fought long and hard to wrestle down and defeat the connection between women and their bodies. Such statements are controversial. Even using the word ‘female’ can be contentious today.

In regards to the pill, we need to talk about “women” and “femaleness” because this is integral to how and why the pill came to exist and why it is still taken by so many women. To say that the pill can change the way a woman feels by meddling with her biology reads as anti-feminist. It is also anti-feminist to not take women at their word and validate their personal experience by acknowledging it to be right and true.

Marketing the Pill – Beyond Femaleness

Taking the pill might be seen as an act of trying to get beyond femaleness. As femaleness in our culture is understood in the negative, escaping its confines is good and progressive. Any dislike we develop of being female and of having a female body is rooted in the history of female bodies being seen as problematic and in need of male control.

This drug is not just birth control; it is, as a Yaz tagline once explained “beyond birth control.”

Taking these drugs is about being ‘beyond female.’ Female is not good, female is not something you want, female needs to be controlled, influenced, changed and organized into something neater, easier and less frightening to you and those around you. When we take the pill we shut down the interior indicators of our femaleness. The exterior remains and it is this that makes it acceptable. In actuality, the pill makes women more physically attractive within the boundaries of our Western patriarchal capitalist culture. We are free of messy periods, we may have clearer skin, be slimmer, we may have bigger breasts, and we are supposedly rid of troublesome PMS.

The former YazXpress area of Bayer’s promotional Yaz website asked women to ‘Get with the program!’ Women taking or interested in taking Yaz were able to sign up for an “insider’s guide to Yaz, fashion, music and style.” The articles in this guide were co-created by the magazine editors at Elle and Cosmopolitan, the pages of which frequently feature print adverts for birth control brands. Yaz was associated with an affluent, glamorous way of life.

Taking Yaz would lead to the life of an attractive, confident ‘Sex And The City’ type of woman. Coolness, sexiness, modernity and glamor were linked to taking this brand.

In 2009 Bayer took on Lo Bosworth, star of The Hills, a popular Los Angeles-based reality show about a group of twenty-something women aspiring to make it in Hollywood, as a spokeswoman for Yaz in Canada. Of her support for the drug, Bosworth remarked, “As a ‘Gen Yer’ working in the entertainment industry, I need to be disciplined. I need to make sure I’m taking care of myself so nothing interrupts my day.”

Plastic Surgery versus the Pill

Although certain procedures have entered the mainstream in the US, women who have plastic surgery can come up against much criticism. Discussion circles around ideas of women taking plastic surgery choices too far, getting obsessed with making changes, making choices based on their insecurities or in response to difficult experiences such as the failing career and the bad break up. A woman who chooses to undergo plastic surgery is choosing to change her body. She is exerting control over her body. She is choosing to be ‘beyond’ human through changing her very physicality. She is choosing to not age or not submit to what her genes, her biology, have given her.

How does plastic surgery factor under the women’s liberation message of “my body, my choice” and why is so much said about the psychological and social impacts of this choice?

Why are people who have lots of plastic surgery a concern, but not people who take a drug to shut down their ovulatory cycle, stop their periods and ‘perfect’ their bodies from the inside out?

Environmental Estrogens

We are used to seeing labels for “BPA-free” plastics as we have become more aware of the synthetic estrogens in many everyday plastic products. One study shows seventy percent of items made of plastic leach chemicals that act like estrogen.

The perfected body, as our ideology teaches, is not female but male. If we shut down the essential biological center of femaleness, the primary sexual characteristics, then can we say that women on the pill are still “female”? The mythology of the pill reveals how femininity is valued within our society. Women on the pill still have their secondary sexual characteristics. We understand judgment and valuation of our femininity is directly correlated with our appearance, significantly our attractiveness. Women who are not attractive by the Western cultural standards have their femaleness questioned, as do women who have less defined visual secondary sexual characteristics, such as smaller breasts or a wider waistline or shorter legs. The ideal body in this age of plastic surgery has exaggerated exterior signs of femininity.

Legitimate Concerns For Oral Contraceptives

In a piece for the Vice magazine website, porn actress Stoya writes on her experience choosing a birth control method. She admits she feels hormonal contraceptives are the best choice for an actress having sex with men but states, “the pill and I don’t seem to get along well.” After suffering with side effects in her teens Stoya had not considered using the pill again until she began performing in scenes with men. She started taking the latest brand, “Four months into taking Yaz, I was miserable. I bled profusely the whole time. Instead of migraines once or twice a month, I had them multiple times a week. I had intense mood swings and was constantly dizzy. I had planned on giving it another one or two months, hoping that my body would adjust, and then I fainted while waiting in line at the bank.”

She came off Yaz and four years later decided to try Ortho Tricyclen Lo, but only lasted three months. She now takes Loestrin 24 Fe and still experiences continuous bleeding and mood swings but describes how pleased she is with one particular side effect – an increase in the size of her breasts, “Dragging myself out of bed became a herculean effort, and the idea of showering or brushing my teeth was beyond my abilities. Everything felt tragic and hopeless. My only redeeming qualities were my tits. They were by no means giant hooters, but they were noticeably fuller, which was pretty cool. I started to think hormonal birth control was a patriarchal plot to keep women down by rendering us completely loony. The question, “How can we ever break the glass ceiling, if we can’t stop crying?” actually came out of my mouth. I still feel nuts, but hey… at least this B-cup kind of fits.”

Stoya has self-awareness and insight into her situation but she sacrifices her health and well-being partly, it seems, because she’s not aware of the alternatives or feels they are off-limits to her. She wryly jokes about her predicament.

Female Sexuality

A woman on the pill is likely to experience low libido and will certainly feel some detachment from her sexuality. The feeling of sexuality is different from female sexuality, but is vitally important, as it is personal to women and separate from their relationships to men. Not feeling sexual could lead to a desire to look exaggeratedly sexual and to appear and behave very sexually in an act of over-compensation. Such a desire can be fulfilled in part through plastic surgery.

The Blame Game – On Being Hormonal

We support modifying and suppressing our bodily functions with science to perfect our faulty bodies even when we are generally healthy and well, and even when the notion of what it means to be faulty is so spurious. When experiencing the side effects from hormonal contraceptives women have a tendency to blame what they view as their own overly hormonal, unpredictable, difficult bodies that in reacting negatively to these drugs are behaving badly. It is their bodies that are not good enough for the drugs.

Medical Marketing and Birth Control

Even if we are not ill, science is making us better. We are becoming better humans, better women. The pill is no longer about birth control; it is about being a better, improved woman. It is about moving beyond our femaleness, about asserting loudly that biology is not destiny; but should it be?

Pharmaceutical companies move the target constantly from birth control to menstruation suppression, from acne control to mood control and in so doing they are betraying their motivations. By medicalizing the normal physiology of the female body, and saying overtly that it needs to be controlled and improved upon they are betraying the foundations of pill promotion. If we believe we should get beyond our femaleness we are accepting that women’s bodies are bad and need to be made good. The consumer economy is crafty; it will always find an avenue for assimilation. The pharmaceutical companies are listening at the door to our presumed post-feminist talk. What do you think?

About the Author: Holly Grigg-Spall is a writer and activist. Her work has featured in the Washington Post and the UK Times and Independent newspapers. She has contributed to re:Cycling, the F-Bomb, Bedside Manners, Ms. magazine’s blog, and Bitch, amongst others. You can find out more about her forthcoming book ‘Sweetening the Pill’ and documentary project at Sweetening the Pill, on Holly’s Facebook page or by following Holly on twitter: @hollygriggspall.

Participate in Research

Hormones Matter^TM is conducting research on the use patterns and side effects associated with oral contraceptives – the birth control pill. If you have used and/or are currently using oral contraceptives as a birth control option, please take this important, anonymous survey. The Oral Contraceptives Survey.

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Birth Control vs Hysterectomy in Catholic Hospitals

by WS

Published on September 4, 2013

6679 views

I was raised Catholic but did not agree with some of Church doctrine and left the Church as a young adult. In my wildest dreams, I never imagined that I would have a hysterectomy and be castrated in a Catholic hospital (or any hospital for that matter) for a benign ovarian cyst. You can read about my Unnecessary Hysterectomy here. I suspect many other women have had healthy organs removed at this greater metropolitan Catholic hospital or some other Catholic hospital. With hysterectomy the second most common surgical procedure and the prevalence of Catholic hospitals growing, millions of women likely have had unnecessary hysterectomies at Catholic hospitals. This made me wonder, why would the Catholic Church condone (and profit from) unnecessary hysterectomies but prohibit contraception. It seems a bit hypocritical at least, unethical at worst.

A Spider Web of Contradictions in Catholic Hospitals

Catholic doctrine prohibits contraceptives. Yet, Catholic hospitals perform hysterectomies and ovary removals (castrations) for benign conditions that can typically be treated with less drastic measures such as contraceptives. Hysterectomy is permanent birth control. So is removal of ovaries. How is hysterectomy justified but not contraceptives?

In an article entitled Do Religious Restrictions Force Doctors to Commit Malpractice, the hazards of treatment at religious hospitals are discussed. In the case of a potentially fatal ectopic pregnancy, removal of the fallopian tube which negatively affects fertility complies with Catholic doctrine while an injection of methotrexate that preserves the tube and fertility does not.

According to Catholic moralists, an injection that destroys an ectopic embryo is a direct abortion, while removing the part of a woman’s reproductive system containing the embryo is not.

But the end result is the same – a pregnancy is terminated. So why not at least preserve the woman’s fertility and health-promoting hormone production by administering the drug versus removing her fallopian tube?!

Another story in the cited article involved a woman with Lupus who was pregnant with a nonviable anencephalic fetus. Although continuing the pregnancy risked the woman’s health and her very life, pregnancy termination was denied.

The above situations would be considered medical malpractice since they caused harm to the patients. And what makes even less sense is that neither of these were viable pregnancies. Catholic Church dogma caused (intentional) harm to these women.

Another treatment done in Catholic hospitals that has me scratching my head is endometrial ablation. Although it reduces fertility, pregnancy can still occur but can be dangerous to mother and unborn child. So some form of birth control is recommended after ablation if tubal ligation was not also performed. Yet according to Is the Novasure System Ethical?, Novasure ablation has been given a passing grade by the Catholic Church. With the Church’s mandate against contraceptives, I wonder how many women are prescribed contraceptives to treat their heavy bleeding BEFORE this procedure is offered. However, in defense of the article, it does state that drug therapy is typically the first-line treatment after doing a full work-up to determine the cause of the bleeding. And if that fails then D&C should be the next step which should include polyp removal if polyps are found. However, it does not mention removal of fibroids despite being a common cause of abnormal bleeding. Although the article recommends starting with conservative treatments, the high rate of unwarranted hysterectomies and ablations indicate poor compliance with these standards.

According to a study published in 2008, the long-term problems caused by ablation too often lead to hysterectomy, the rate being highest (40%) for women having the procedure before age 41. This is further discussed in Endometrial Ablation – Hysterectomy Alternative or Trap?. However, again, in defense of the above cited Novasure article, it was published in 2005, three years prior to this study on the long-term effects of ablation. And, in addition to surgical risks, the article does mention the long-term risks of accumulation of blood in the uterus and the risk of impeding diagnosis of endometrial hyperplasia or cancer. Despite this 2008 study showing the long-term harm of ablation, the use of this procedure does not appear to be declining.

According to Catholic Doors,

To obtain a hysterectomy is a mortal sin.
The ruling by the Congregation for the Doctrine of the Faith stipulates that the only time a woman is morally permitted to have a hysterectomy is when the uterus is so damaged it presents an immediate threat to her health or life. [National Catholic Reported; August 12, 1994]
In general, an hysterectomy is morally justified if the removal of the uterus is necessary for grave medical reasons. It is not justified when the purpose is direct sterilization.
Therapeutic means which induce infertility are allowed (e.g., hysterectomy), if they are not specifically intended to cause infertility (e.g., the uterus is cancerous, so the preservation of life is intended). [Humanae Vitae]

Unnecessary Hysterectomy, Ethical Principles and the Hippocratic Oath

Birth control issues aside, how do all these overused gynecological procedures comply with the three ethical principles of the Catholic Church – respect for persons, beneficence, and nonmaleficence? For that matter, how do they comply with the Hippocratic Oath to “first, do no harm?” Since they cause harm, they violate the three ethical principles of the Catholic Church as well as the Hippocratic Oath. One must question if women are getting INFORMED CONSENT in any facility, religious or secular, but that is a topic for another day.

Ascension Health defines beneficence as follows:

As a middle principle, the principle of beneficence (and nonmaleficence) is the basis for certain specific moral norms (which vary depending on how one defines “goodness”). Some of the specific norms that arise from the principle of beneficence in the Catholic tradition are: 1) never deliberately kill innocent human life (which, in the medical context, must be distinguished from foregoing disproportionate means); 2) never deliberately (directly intend) harm; 3) seek the patient’s good; 4) act out of charity and justice; 5) respect the patient’s religious beliefs and value system in accord with the principle of religious freedom; 6) always seek the higher good; that is, never neglect one good except to pursue a proportionately greater or more important good; 7) never knowingly commit or approve an objectively evil action; 8) do not treat others paternalistically but help them to pursue their goals; 9) use wisdom and prudence in all things; that is, appreciate the complexity of life and make sound judgments for the good of oneself, others, and the common good.

Why is Hysterectomy So Pervasive at Catholic Hospitals?

For Catholic hospitals with accredited Graduate Medical Education (GME) programs, resident minimum surgical requirements may very well increase the rate of unwarranted hysterectomies. But that is certainly a poor excuse for removing an organ. Even so, if they can get around the GME abortion requirements for religious reasons (Catholic hospitals will not perform abortions) they should be able to do the same for hysterectomies, 98% of which do not meet the “grave medical reasons” test.

Hysterectomies and ablations (that too often lead to hysterectomy) are big business. Hysterectomies are estimated at generating $5-16 billion annually, and so revenues may be another reason Catholic hospitals prefer gynecological procedures over medical (pharmaceutical) intervention (birth control or other). Refusing to prescribe contraceptives may increase their ablation and hysterectomy business and therefore their bottom line. So the 76% of hysterectomies that don’t meet ACOG criteria may be even higher in Catholic hospitals. And the ongoing negative health effects of these procedures further contribute to the bottom line of these “health care” conglomerates.

Could profits trump Catholic doctrine on contraceptives and Catholic ethical principles when it comes to performing destructive gynecological procedures in Catholic hospitals?

My experience certainly proves this as all my sex organs were removed for a benign ovarian cyst, certainly not a “grave medical reason.” I can say the same for many other women with whom I’ve connected since my unwarranted hysterectomy and castration. And the overuse of ablation appears to be just as rampant. This procedure is being done on women in their 20’s and 30’s, many of whom are now considering hysterectomy or have had one to get relief from the post-ablation pelvic pain.

Just as a man’s sex organs have lifelong (non-reproductive) functions, so do a woman’s. Any procedure that disrupts their normal functioning can cause permanent adverse effects. At least medications can be stopped if the side effects outweigh the benefits.

For more information on the necessity of the uterus beyond the childbearing years, watch this video.

Participate in Research

Hormones Matter^TM is conducting research on the reasons for and outcomes of hysterectomy. If you have had a hysterectomy, please take this important, anonymous survey. The Hysterectomy Survey.

To take one of our other Real Women. Real Data.^TM surveys, click here.

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The History and Future of Abortion Laws in America

by Lisbeth Prifogle, MFA

Published on September 3, 2013

2458 views

The article you are about to read is neither an look at the morality of abortion nor a defense for women’s rights. It is a look at the history, future and constitutionality of abortion laws. I am neither pro-choice nor pro-life. I’m not republican or democrat. I am not a feminist. I don’t believe we should categorize and label ourselves over generalities because each choice we make has the potential to redefine who we are and who we think we are. That being said, it was extremely difficult to drudge through websites to find facts on this subject. The argument for/against abortion has been so politicized that every site has a slant. I did my best to leave politics behind and just look at the facts on this subject.

In the Beginning

When America was founded, abortions were legal. There were those for it and against it then as there are now, but it did not affect the laws. There were homes for unwed mothers and campaigns to “adopt not abort,” but the state did not have any laws on the books until the mid-to-late 1800’s.

The American Medical Association

The American Medical Association (AMA) was the catalyst for the first abortion laws, but for reasons you wouldn’t likely expect. Through criminalizing abortion, the AMA could push midwives, apothecaries, and homeopaths out of business by eliminating their principle procedure – abortions. Think about this, the AMA was against abortion for reasons related to business, position and profit and used the morality argument as the wedge.The AMA set the stage for what we see now. It introduced the pro-life side so it could corner the market on the abortion business. The AMA argued that abortion was immoral and dangerous and by 1910, every state had laws forbidding it unless it was to save a woman’s life, in which case a physician would perform it. No more midwives, apothecaries or homeopaths.

Did these laws protect women? No, back-alley abortions increased and more women died from complications. These back-alley abortions weren’t necessarily only unwed or unfit mothers either, women who had medical complications with the pregnancy but couldn’t afford to go to a physician could no longer seek out a midwife or other practitioner to conduct the procedure.

Margaret Sanger

In the 1900’s Margaret Sanger started educational campaigns for contraceptives because she opposed abortion. (For more information about Margaret Sanger, her involvement in founding Planned Parenthood, and her involvement in the Eugenics Movement in America read The History of Birth Control and Eugenics). As a proponent of the eugenics movement she had an agenda to keep, “More children from the fit, less from the unfit,” (Birth Control Review, May 1919, p. 12), but she did not pursue this agenda via abortions. As a nurse she cared for many women who died from complications of botched abortions and was very opposed to the practice because of the danger it imposed on women. Interestingly enough, Margaret Sanger founded the American Birth Control League, what we now know as Planned Parenthood. Today, Planned Parenthood performs legal abortions with government funds. Although it is ironic, I suspect that Sanger would likely approve of the procedure today because it is now a much safer procedure for women than it was during her time.

Roe v. Wade

Jumping ahead a bit to 1973, we come to the landmark case of Roe v. Wade. Texas, along with most other states had strict abortion laws that only allowed it if the women’s health was in danger. In this case, a 21-year-old woman brought a class action suit opposing the constitutionality of the law against abortion. She won. The Supreme Court ruled that the laws restricting women from having an abortion violated the Due Process Clause of the Fourteenth Amendment:

All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the state wherein they reside. No state shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any state deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.

Today, this case is still the basis for the approval or rejection, and appeal of state and federal laws.

Today

The controversy remains heated. In 2012, Arizona passed a law that made it illegal for women to have abortions after 20 weeks of pregnancy, but in May 2013, aU.S. Court of Appeals in San Francisco ruled that the measure violates controlling U.S. Supreme Court precedent under the court’s 1973 decision in Roe v. Wade. It was a unanimous ruling. However, prior to the Court of Appeals decision, federal judge James Teilborg ruled the law constitutional because it did not prohibit women from ending their pregnancy, just forced them to do it earlier in the pregnancy.

More recently, on July 18, 2013 Texas Govenor, Rick Perry signed a law making it illegal for a woman to have an abortion after 20 weeks of pregnancy. Texas joins 12 other states with similar laws.

While I’m a firm believer of State rights under the Tenth Amendment (which is why each state has different abortion laws). Legislation should not be based on what is considered right or wrong according to a politician’s beliefs; laws should be based on what is safe for the citizens the law is supposed to protect. Is an abortion after 20 weeks unsafe? That is a discussion we have not had. It’s certainly not common; according to the Guttmacher Institute, an abortion rights organization, it is estimated that only that 1.5 percent of abortions takes place after 21 weeks of pregnancy.

The Slippery Slope

In recent years, several states have passed “wrongful birth” laws. These laws prohibit medical malpractice lawsuits against doctors who withhold information from a woman that could cause her to have an abortion. Who are these laws protecting? The patient? The politicians’ re-election campaigns? The doctors? Take a minute to set your personal beliefs aside and think about this – there are laws that allow doctors to withhold medical information that could jeopardize the life of both the mother and fetus. How is that safe? How is that even remotely constitutional? How is it more morally acceptable to potentially allow both mother and child die in order to prevent an abortion? Yet, we the people have accepted it.

The Future

While most arguments about abortion never make it past debating morality and women’s rights, these laws and debates should dive into much deeper issues – state rights, separation of church and state, and the role of the government in our everyday lives. I can’t say whether or not abortion will be legal or illegal in five years or fifty, but one thing I know for sure is the absurdity of the bills introduced, laws passed, and what politicians say will continue to get out of control. Unless, we as citizen’s speak up.

I’m sure we all remember Representative Todd Akin’s statement in August 2012 on the subject of his opposition to abortion even in the case of rape, “If it’s a legitimate rape, the female body has ways to try to shut that whole thing down.”

More recently, in January 2013, a bill was introduced in New Mexico that would prevent abortion in the case of rape or incest because it would be considered “tampering with evidence in cases of criminal sexual penetration or incest.” This bill would make an abortion in the case of rape and incest a third degree felony potentially punishable by up to three years in prison!

I wish I was making this up, but as the saying goes, the truth is stranger than fiction. In my opinion, it’s all razzle dazzle to distract the public from the fact that we don’t need, nor should we have laws for or against abortion, but instead have regulations that monitor the safety of the procedure as it changes with technology. Maybe in the future voters will see the deeper issues in this debate and undo what the AMA set in motion in the pursuit of profit, power and prestige.

September 2013 - Page 2

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Final Thoughts

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Female Biology is Important

Marketing the Pill – Beyond Femaleness

Plastic Surgery versus the Pill

Environmental Estrogens

Legitimate Concerns For Oral Contraceptives

Female Sexuality

The Blame Game – On Being Hormonal

Medical Marketing and Birth Control

Participate in Research

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A Spider Web of Contradictions in Catholic Hospitals

Unnecessary Hysterectomy, Ethical Principles and the Hippocratic Oath

Why is Hysterectomy So Pervasive at Catholic Hospitals?

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In the Beginning

The American Medical Association

Margaret Sanger

Roe v. Wade

Today

The Slippery Slope

The Future

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