women's health - Page 10

Underinsured, Underdiagnosed, and Anonymous: Endometriosis and Cancer Part 4

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I just learned, after years of endometriosis pain and misdiagnoses, I had cancer.

My husband and I were suspended in a state of utter shock and disbelief, as the GI/endoscopy center rushed us referrals for a variety of different radiology and imaging services. We were feeling overwhelmed and under pressure, but had precious little time to openly react or otherwise respond to my diagnosis. Right now, we had to have my cancer staged and graded sooner than seemed humanly possible. I drank barium contrast and fasted for digestive system x-rays, I went on a clear liquid diet and temporarily stopped my meds for full-body PET scans, I repeated barium prep for CT scans, and fasted again for MRIs. My diet consisted mostly of chalky colon cleansers, plain water, 7-Up, chicken broth, boiled ham, and scrambled eggs. As trifling as it sounds, this made me crave a juicy steak and pulpy fruit juice like nothing else. By the end of the month, I was allowed to give into my cravings for a night—a bittersweet reward at best—while we waited in high anxiety for my pending results to come in.

My Cancer Diagnosis

I had a greying, high-grade, stage II-B neoplasm, with partial bowel obstruction, which had enlarged to about three centimeters in size. The tumor had grown through the wall of my colon, but had not yet metastasized to my lymph nodes, bone marrow, or other organs. I did not yet have necrosis or jaundice either, but compromised liver function and tissue death were both very real concerns for me now. The fast-growing lump had apparently started out as a benign polyp, but had turned malignant having gone undiagnosed and untreated.

I was young, I’d never smoked, I didn’t drink or do drugs, and I wasn’t promiscuous, so nobody could easily explain how or why this was happening to me (as if those were the only reasons that something like this could happen to anyone). Likewise, no one could tell me how the polyp could have been missed, or why I was denied the medical attention that I had actively and continuously sought– for years, which could have prevented my case of cancer altogether. I did finally and inexplicably get to stay off birth control pills this time though—and, coincidentally, my tumor never increased in size after I discontinued the use of oral contraceptives, hmmm…

Navigating Cancer without Insurance

The diagnostics and staging completed, we were then referred to a local oncologist, radiologist, surgeon, and hematologist for consultation, healthcare review, and treatment selection. The oncology specialist wanted to do an immediate total colectomy with long-term, post-surgery, high-dose chemotherapy port, and a permanent colostomy bag. The radiation specialist wanted to start with daily, low-dose, external beam radiation, personalized intensity modulation radiation therapy, and low-dose oral chemo, for six months. The surgical oncologist did not recommend surgery for temporary or permanent bowel resection or any surgical procedures for chemo pump placement—in fact, they suggested radiation with or without chemo. The hematology lab would be doing my tumor marker and blood panels one to three times per week as needed throughout my treatment, whichever option we chose. And, me–I wanted biological treatment, but it wasn’t covered by insurance, so I reluctantly had to settle for beam radiation and oral chemo in lieu of extreme abdominal resection surgery, since I wasn’t rich.

Next, everybody gave us the obligatory best-case/worst-case scenarios, after which I was scheduled for my radiation tattoos, body molds, and chemo instruction in preparation for my first treatments and corresponding blood monitoring tests. Having turned down radical surgery and the chemo port (per the surgeon specialist’s advice), my oncologist was suddenly and inconveniently unavailable to see me now. So, my radiologist had to reach the oncology nurse to confirm arrangements for my ongoing blood work and prescription refills, since her boss was neglecting to do so on a regular basis. The oncology nurse also secretly stepped in and reduced my chemo pill dosage by half without telling the oncologist (she told me not to tell him about it either), because as she said—off the record—he had prescribed me a dangerously high amount, comparable to that given to a terminal prostate cancer patient. I had to quit the job I loved, my husband had to stay at the one he hated, and I had to take incompletes and signup for medical leave at school…where only last year I had been hopeful, I was once again despondent.

Just one month into chemo-radiation, I quit menstruating, and was no longer able to be intimate with my husband (my still fairly new husband) for the duration of my treatment (my fairly long treatment). I lost all of my lower body hair from the bellybutton down, and went through major skin tone and skin color changes, along with startling food taste changes, and contemptible chemo fog. It had become a challenge for me just to get off the couch to catch a ride to the doctor’s, so much so that my time was predominantly spent asleep, in treatment, or in diagnostics, by this point.

And, when it didn’t feel like things could get any worse, my husband’s company announced their looming bankruptcy and liquidation. That’s when the rejection letters for my previously pre-approved (and thusly documented) life-saving medical procedures began to arrive from the insurance company. It’s also when we found out that because my husband’s employer was liquidating, not restructuring, that we would only qualify for one month, not one year, of COBRA benefits, and that the one month of COBRA coverage we were eligible for would cost us $1,300 even in light of the hundreds of thousands of dollars (literally $300,000+ in just one month of the bankruptcy/liquidation notice) in bills which had abruptly begun to flood our mailbox.

To Be Continued.

Read earlier parts of the story. Part1, Part2, Part3.

Underinsured, Underdiagnosed, and Anonymous: Endometrial Cancer, Part 5

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Endometrial Cancer

Since the last post, I had begun chemo to treat my cancer.

My radiologist became my primary doctor, as the oncologist remained largely unavailable to me, after hearing the news that my health insurance would lapse within the coming months. The oncologist increased my dosage of radiation, and rescheduled my GI, endoscopy, and radiology follow-up exams to earlier dates. The radiation office not only waived a significant portion of their own service fees for me due to the situation, but also helped us to handle a big part of the lengthy medical dispute we were facing with our insurance company. They eradicated most of the tumor, but could not remove my residual scar tissue, before our COBRA expired. Even with all that they had done for us up until then, there were still strict systematic limits as to what they were permitted to do for us after that time. Not only was I without insurance yet again (my husband was too), but I was also now without the support system that had been my radiologist and their crew—something that was much much harder to overcome than I had expected it to be.

Remission from Endometrial Cancer

I was in remission, but back to square one as far as access to medical coverage went. I was in remission, but I had undergone medically-induced premature ovarian failure, and was deemed post-menopausal before I would even reach my thirties. I was in remission, but couldn’t take hormone replacement therapy or herbal alternatives, because I was already at increased risk for recurring and/or second cancers. I was in remission, but had semi-permanent radiation scars and temporary post-chemotherapy cognitive impairment. I was in remission, but I still wasn’t well enough to return to work, go to school full-time, or to take a belated and long overdue honeymoon yet. I was in remission, but I was depressed, and didn’t know how to move forward without the regular group of doctors and nurses who had been there for me emotionally only a week before.

Why was my life saved (and through such extreme measures), only to be put right back at risk, through the ever-incipient denial of insurance, medical assistance, and access to healthcare? What was the point of it all?? It felt like maybe I shouldn’t have been striving so hard to live, but instead perhaps that I should simply have accepted the inevitability of my own death (something I am now faced with every day that I do wake up in the morning, anyways). My husband had only been able to find part-time jobs, since his old workplace had closed. So, we knew that we would have to move out-of-state to get the help that we needed. We just hadn’t anticipated that it would be even harder to get coverage, aid, or access, once we left. And, we still don’t know how much harder it will get, as we continue to race border-state budget cuts and residency requirements, just trying to keep me alive. Sometimes, it’s hard not to doubt that we’ll make it in time at all.

I have always worked hard, and I’ve always tried to give back to the community. I was glad to pay my dues, and happy to put in my time. So, I have an exceptionally hard time understanding how so many have come to turn their backs on me as I ask them to help keep me from dying, if not from hurting, particularly when that’s supposed to be their job. How come I’m not worth your time and attention? Why don’t I deserve to live? What’s so wrong with me, that you can’t even tell me what’s wrong with me?

I wish that I could leave you with a happier ending, but this never-ending vicious cycle has not left us witch much optimism, hope, or spare change, ourselves. Aside from knowing that my tumor is back, we don’t know just how bad it is. What we are gravely aware of is that I am out of the safety net and into the danger zone for lymph and bone involvement plus metastatic cancer growth. It’s proven impossible to get a standard colonoscopy and biopsy at my age (twenty-plus years too young) without a doctor’s order, and impossible to get a doctor’s order without insurance or assistance (but, you’ve already heard that story before)…all this, even in spite of my personal history of colon cancer. And, it will be equally impossible to get any traditional treatment if/when the cancer spreads to my liver or lungs, too. But, at least nobody will be talking about colostomy bags then, anymore. When we do find the rare body scanning clinic that will take cash patients on self-referral, they all also inevitable deny me the less-invasive virtual colonoscopy because I’m “still in my childbearing years” even though I’m medically documented as being POF, and haven’t had a period in over six years now. You’d think it would be a non-issue, but for some reason it isn’t. Maybe someone out there can understand our fear and despair, but a lot of other people just don’t seem to care.

Read earlier parts of the story. Part1, Part2, Part3, and Part4 .

Are We Marks? The Greed and Chicanery of 21st Century Corporate Culture

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Corporate Culture has Run Afoul

By now everyone is aware of Bank of America’s latest in a long stream of fee gouging practices- the $5 debit card fee. This is on top of an endless array transaction fees charged to customers that generate billions in profits annually, and of course, the billions from the bailouts and the foreclosure crisis. Although blatantly evident on Wall Street, the shift in corporate ideology that rewards chicanery pervades every aspect of American life, especially healthcare and most especially women’s and children’s healthcare.

We’re at a place in time where corporations would rather spend billions lobbying favorable regulations and billions more fighting and paying out consumer or patient lawsuits for faulty products than build a quality product or provide a quality service in the first place. How else does one explain the medical marketing of dangerous drugs to otherwise healthy women– think HRT, Yaz and Yasmin, Prozac, Wellbutrin and other anti-depressants to pregnant women (and to rest of the un-depressed population for that matter)? How else does one explain why incredibly dangerous products like Yaz/Yasmin are still on the market despite having more serious adverse events than drugs already off the market because of safety issues (VIOXX) (see  comparison of Yaz side effects below, from www.adverseevents.com  or click on the graphic below).  How else do we explain why it took so many years to remove DES from the market place despite evidence of both teratogenic and carcinogenic effects from the onset or why HRT, was allowed to be marketed as the magic pill that cured all, without any evidence whatsoever? How else do we explain why we not only bought these drugs but demanded them (besides the fact that many are addictive)? How else does one explain that in the 21st century only 30% of practice guidelines for obstetricians and gynecologists are evidence based? Thirty-percent!!!


I guess one really doesn’t need evidence if the treatment choices are limited to bad and worse. Indeed, it’s probably a good thing that more people, patients and doctors alike, don’t question the prescribing practices, the medical efficacy or the very real risk some of these meds pose. Maybe we are marks.

Where did this racket of corporate miscreance come from? I would argue it came from us, or rather because of us. For some reason, we the consumer, the citizen, the patient, the physician, the politician, checked our common sense and personal responsibility at the door of mega-marketing. Somehow we convinced ourselves that we deserved everything, but had to pay for nothing. We abdicated our personal responsibility for our own health, happiness and financial stability to others. And now we are facing the consequences: ill-health, physical and economical, personal and global.

The economic crash exposed the fealty of our financial system and is exposing the very real flaws in our corporate, insurance-based, medical system. The system has taken medical decision-making away from the physician and the patient and placed it squarely in the hands of pharma marketing engines and insurance companies. We’re at a juncture in time, where the sheer economic reality of buying pills to solve all medical problems, is contrasted by the fact that many simply cannot afford their meds anymore and must look to alternative solutions for health.

With all crises comes innovation and change, maybe with this one, we can get back to the “first do no harm” principle of medicine. Maybe we can get back to personal responsibility for health. I think Bill Maher said it best “We’ll stop being sick,when we stop making ourselves sick.”

For a laugh-out loud assessment of modern healthcare by Bill Maher click here.

To look up or report adverse reactions to common medications go to: www.adverseevents.com

Warning: This site does not offer medical advice. If you have questions about your medications or your health, please consult your physician. Do not attempt to discontinue any medication without physician approval and supervision.

Are We Not Worth It? OB/Gyn Decisions Driven by Consensus not Evidence

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A recent study by researchers at Columbia University uncovered what many women have suspected for years, that the clinical practice of obstetrics and gynecology (Ob/Gyn) is steeped in tradition and opinion but lacks data and evidence. The study, Scientific Evidence Underlying the American College of Obstetricians’ and Gynecologists’ Practice Guidelines authored by Dr. Jason D. Wright and colleagues found that only 30% of Ob/Gyn clinical practice guidelines were based on hard data or scientific evidence. Rather, the vast majority of practice guidelines (70%) were based on observational studies, consensus or expert opinion.  Perhaps this is why it takes 5-10 years to diagnose common Gyn conditions, why oral contraceptives are the first line of treatment for every women’s health conditions or why most pregnancy complications are still, in the 21st century, considered idiopathic.  Without data, it sure is difficult to sway expert opinion.  What do you think?
Link to the press release: Ob/gyn Guidelines Often Based Opinion Weak Data

Reference
Wright JD, et al. Scientific Evidence Underlying the American College of Obstetricians’ and Gynecologists’ Practice  Guidelines. Online in press version, September 2011, Obstetrics and Gynecology 118 (3).

The Heart of Healthcare that Works: Know Your Personal Worldview Of Health

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Healthcare Matters

“All the evidence that we have indicates that it is reasonable to assume in practically every human being, and certainly in almost every newborn baby, that there is an active will toward health, an impulse towards growth, or towards the actualization.”
–  Abraham Maslow

Google “healthcare” and it returns 99,900,000 results. Healthcare seems to be a vast, complex, inconsistent, and perhaps unavailable or expensive system ‒ sometimes seemingly devoid of personal connection.  At a minimum, it can be confusing to find what will work for you.  Really work for you, on all levels.

Here’s the good news:  when you define healthcare for yourself, the path towards growth and actualization Maslow speaks of becomes easier to find and follow.  Forget what healthcare is for your best friend, your family, or a generic patient with similar symptoms you read about online.  Forget about some list in your health insurance policy.   That’s just a list based on contractual relationships, which may or may not relate to what works best for you.

Healthcare is deeply, deeply personal.  Only you know what healthcare is for you. It depends on your values, your beliefs, your worldview.  And, those can change over time.

Finding healthcare that works for you is a bit like going on a quest – an adventurous exploration.  You have to know what you’re seeking, the signposts to know you’re on the right path, and some friendly support along the way (wisdom, people, or places) helps too.

To narrow the vast landscape of healthcare to what will work for you, begin by understanding, or perhaps taking this opportunity to create, your personal worldview of health, healing, and well-being.  If your choice of physicians, practices and medicines doesn’t resonate with your worldview, there will be discord.  Discord, at a minimum, makes communication with practitioners challenging.  In some medical sciences this discord would be believed to have a negative impact on healing at a very deep level.  Knowing your worldview gives you a foundation for harmonious choices.

To explore your worldview, some questions to ask yourself include:

• Do you believe health is based on primarily how each part of the physical body separately functions?
• Do you believe the mind can influence the physical body?
• Do you believe there is an interrelationship between mind, body and spirit; a holistic view of your being?
• Do you believe the body is basically like a machine (also identified as a Newtonian view of the world); and should be treated in a mechanical nature?
• Do you believe your choices – from the food you eat, to your relationships (including work), to the surroundings you live in – influence your well-being?
• Do you believe in a “one solution fits most” medicine; or that each person is unique and therefore may require varying paths to well-being, even if the diagnosis or symptoms are similar?
• Do you believe in treating the illness or the person with an illness?
• Do you believe in focusing on the disease (diagnosis, symptoms); or on health and well-being?
• Do you believe in healing, curing, pacifying symptoms, or something else?  Or all of those in different situations?
• Do you generally believe in an interconnected world?  Or a world where all beings and things are separate?

Answering these types of questions will significantly narrow the landscape of your quest – narrow down what will work for you. No one can answer these for you.  You may want to write a personal worldview statement to crystallize your worldview.

Equipped with your personal worldview of health you can then move on to the next steps in your quest:

• Identify what health, well-being and healing mean to you
• Know what qualities of care are important to you
• Understand what “medicines” resonate with you

In the coming articles we’ll delve into each of those areas with more questions to help you find healthcare that works for you.

 

Navigating Invisible Illness in the Age of Modern Medicine

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Much has been about said about empowering and educating patients to be partners in the healthcare dance. From the e-patient and e-health revolutions through the piles of research showing more engaged patients have better outcomes, all seem to point a more active role and increased responsibility for the patient in his or her own care. But how does that work when the illness is not clearly defined, is not easily diagnosed or for which effective treatments are limited? What does it mean to be an empowered patient with an invisible illness?

This is the question that many women face on a regular basis. Indeed, for a number of predominantly female disorders, whether hormonally modulated or not, there are often many years before the symptoms are addressed as real and not figments of the female imagination. Chronic fatigue and fibromyalgia are two such examples, but so are endometriosis and an array of other perhaps more subtle hormone conditions.

During those years before modern medicine and the research community recognize the reality that define a particular disease process; during the years when women are prescribed psychiatric meds for non psychiatric conditions; during the years when pain medications with diverse side-effect profiles blur the line between the original disease and the one that is induced pharmacologically; during those years, how does one become the e-patient, the e-woman, without becoming a physician herself?

Really, we want to know.
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Women’s Hormones: An Intellectual and Ethical Cul de Sac

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Menopause is barreling down with a ferocity that is difficult to ignore. Like many women my age, I’ve had my share of health challenges and, until recently, blindly trusted the pharmaceutical industry to fix all that ailed me. Health by chemistry was a great thing; oral contraceptives, a fabulous invention, allergy meds – ditto, pain killers – wonderful, and on, and on. Take a pill and feel better, isn’t that what we all want? But I, like so many women, have lost faith in pharmaceuticals. It’s not because the science isn’t cool, it is, in every area of pharmacology, except women’s hormone therapies. Here, intellectual curiosity and innovation have been replaced by status quo. Little has changed in this area of hormones and health in 60 years.

Hormones, Hormones, Everywhere and No Innovation in Sight

Since their inception, hormone replacement therapies (HRT) and oral contraceptives have dominated women’s health, immediately moving from seemingly narrow applications when first introduced to the almost mythical status as cure-alls for any female and many general health ailments. The history of both these pills is strikingly inglorious and utterly dumbfounding. Just on general principle, why would anyone believe any medication could be so widely beneficial for so many apparently disparate conditions? It is physiologically impossible.

For HRT especially, if one believes the marketing, the pills provide a veritable fountain of youth. Where is the science? But believe we did, and generations of women may now be paying the consequences.

From the very first estrogens synthesized and marketed to women everywhere (diethylstilbestrol- DES), through today’s HRTs and OCs, profit appears to override health concerns. Even in the 1930’s and 1940s before these drugs came to market, the carcinogenic risks were well known, and yet, they garnered FDA approval and were sold to millions, upon millions of women.

Synthetic Hormones

I have personal experience only with the often ignored side effects of oral contraceptives, as I have yet to reach the age of menopause. In my 20s, while on the presumable high estrogen dose of oral contraceptives that were common then, I had intense bouts of vertigo that would develop even when lying down and ever increasing blood pressure. After years of expensive testing could find no neurological cause for the vertigo and after repeated prescriptions to lower my blood pressure, I stopped taking the pill. I had enough. The vertigo stopped fairly soon thereafter and the blood pressure returned to normal. Over those several years, there was not a single physician that suggested I stop taking the pill, indeed I was prescribed more and more meds to counter the apparently unknown side effects of oral contraceptives and it was recommended I see a shrink because the vertigo had to be psychosomatic.

I look back at that time and I wonder how many other women suffered similar circumstances. What is this propensity to prescribe and continue prescribing medications in the face of apparent ill effects? Why are we ignoring, even at the patient level, the possibility that some meds may not work for some women (or men). The statistics bear this out, but there seems to be a natural inclination to minimize these risks. This is compounded of course, by intense marketing.

As I approach this menopausal stage, I again will be faced with yet another hormone-issue for which the choices are bad and worse. We know from the Women’s Health Initiative (WHI) in 2002, that HRT is not the panacea it was marketed to be and the risks associated with this medication are not benign.

Over a one year period, for every 10,000 women taking and estrogen plus progestin, the risk of developing these conditions increases by:

• Heart disease: 7 additional cases
• Breast cancer: 8 additional cases
• Stroke: 8 additional cases
• Blood clots: 18 additional cases

For estrogen only:

• Stroke: 12 additional cases
• Blood Clots: 6 additional cases

Consider however, the millions of women who will take or have taken HRT for years. As of 2010, over eight million women in the US alone take HRT, and will likely do so for at least a couple years. In this light, the increased risk of disease looks a lot scarier.

• Heart disease: 5600 new cases per year; 28,000 in five years
• Breast cancer: 6,400 new cases per year; 32,000 in five years
• Stroke: 6,400 new cases per year; 32,000 in five years
• Blood clots: 14,400 new cases per year; 72,000 in five years

When the WHI was published, some 17 million women in the US had been taking HRT for many, many years, even decades. That’s 13,600 new cases of breast cancer per year, 68,000 in five years! Despite these data, and the thousands of lawsuits that followed, HRT is still one of the most frequently prescribed medications worldwide. I think we can do better.

Statistics from the Mayo Clinic

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Every Man Knows a Woman with Hormones

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And we all have hormones. Those wonderfully mysterious chemicals circulating and cycling with the regularity and rapidity that makes one’s head spin, female hormones are at once the bane and the joy of man’s existence. Our hormones are what make us find you attractive, laugh at your jokes, date you, sleep with you and bear your children. Our hormones can also turn us into stark, raving lunatics at seemingly benign comments. Most men know and understand this, at least intuitively. You are prepared for the ‘wrath of raging hormones’ if not from direct experience with your mothers, sisters or girlfriends, then from the many locker room and sitcom epithets ever present in modern culture.

What most men (and many women) are not prepared for, and I’d venture don’t understand, is the very real chemistry changes behind the wrath. Much of this goes far beyond just mood changes, often eliciting a bevy of symptoms and disease processes that we’re only now beginning to understand.

In many ways, hormones are just like every other chemical circulating in our bodies, regulating this system or that, entirely responsible for certain functions, secondary and tertiary players in others. Men have the same hormones as women, just in different concentrations. And hormones cycle in men, but not so radically and regularly. What is different between ‘men’s hormones’ and ‘women’s hormones’ is not the hormones themselves, but the systems and structures on which they operate and the reproductive functions that ensue.

To state the obvious, women have ovaries and a uterus. Those structures, along with the brain form the foundation of a beautifully orchestrated and incredibly complex chemical feedback system that not only controls reproduction, but influences just about every aspect of our lives. Estradiol and progesterone concentrations increase several fold across an average cycle, preparing the uterus for a possible pregnancy. In the absence of pregnancy, hormone levels plummet and the lining of uterus, the endometrium sheds. The all-too-familiar mood changes and pain commence.

As a man viewing this process from the outside, it is difficult to appreciate the magnitude of hormone changes affecting the women in your life. When hormones act on the brain or in the body, they do so in much the same manner as many common drugs. In terms of chemistry, menstrual cycle hormone changes are very similar to a drug addiction/withdrawal pattern with increasing dosages of stimulants (like amphetamines) during the first two weeks, a combo pack of sedatives (like Valium or alcohol) plus a few stimulants during the second two weeks, followed by cold turkey withdrawal. Rinse and repeat, over and over again, approximately 450 times during the course of her lifetime. Pregnancy and postpartum follow the same pattern only the dosage of hormones, the duration of exposure and the magnitude of the withdrawal are increased exponentially. The veritable cocktail of hormones that make these functions possible is breathtaking.

What happens when one or more of these chemical messengers gets a little out of sync and the system become dysregulated, as is inevitable in any system that cycles so frequently? Or what happens when an illness or disease, maybe not caused by hormones, develops in the context of this ever fluctuating female chemistry? You get a bit of chaos (think butterflies, not randomness).

As a man, who has women in his life, you have two choices, ignore and avoid the chaos and hope there are no storms on the horizon, or embrace the chaos and find ways to anticipate and alleviate the pain. Many choose the former, including much of medical science. This is the avoidable ignorance, I wrote about last week. I’d like to think the men who love us, choose the latter. Certainly, the men who shared their wives’ and daughters’ stories recognize the need to investigate and develop better treatments for women. They may not understand fully the complexity of women’s hormones, but they understand the suffering, sense that symptoms are being ignored and want nothing more than to make it all better.

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