women's health - Page 9

Underinsured, Underdiagnosed and Anonymous: My Hormonal Hardships, Part 4

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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 during this time, which trifling as it sounds 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.

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 relatively 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, 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…

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 worst, my husband’s company announced their looming bankruptcy and liquidation.  That’s when the rejection letters for my previously pre-approved (and thus 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 read the final segment, click here.

Underinsured, Underdiagnosed and Anonymous: My Hormonal Hardships, Part 5

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My radiologist had actually become my primary doctor, as the oncologist remained largely unavailable to me, especially so 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.

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 with 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.

I wrote my story anonymously because I fear the social repercussions and potential backlash of publicly revealing my real name in association with my disease and disorders.  I am uninsured and told by many, uninsurable.

Redefining Healthcare for Women

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As the dust settles on the Komen Foundation decisions of last week, I am reminded once again how compartmentalized and politicized the notion of women’s health has become.  Boobs and wombs seem to represent the sum total of interest in women’s health.  And if the Komen fiasco is any indication, one can’t care about both, because where one stands or one’s employer stands on reproductive issues is now becoming the litmus test that permits or denies access to care. If you are a woman, that is. No such criteria exist in men’s health.

Women’s health is inherently political. We carry the responsibility of continuing the species. With that responsibility inevitably comes intrusion (no pun intended). We seem to forget, however, that women have cancer (not just breast), heart disease, diabetes, immune diseases and the whole host of illnesses that are unrelated to whether or not we bear children. Certainly, whether we have born children impacts these diseases, more so than many are willing to admit, but what we think about birth has nothing to do with our health and should have nothing do with our access to healthcare.

As a private organization, Komen has every right to change its mission. It has every right to fund only those organizations that align with their political or religious views. If it believes strongly in those views, then it should change its mission and hold to it.  However, Komen should be prepared for mass defunding from those who don’t share the same ideology. Early signs of this were evident last week.

There is no delicate or politically adroit way around this issue for Komen and other organizations who believe that views on reproductive rights trump a woman’s access to healthcare or an agency’s access to research funding. If that is the litmus test, however, then say so. Take the stand and own the results. Tell the world that your organization provides preventative healthcare, supports breast cancer research and other activities only for some women and only for organizations that share your views.

Then let the rest of us get on with the business of providing healthcare and research for all women.

Data Matter

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A dirty little secret in medical literature, systematic reviews are only as strong as the individual studies they examine. And when negative data are not published in the major medical or scientific journals, as is commonly the case, these reviews cannot help but be skewed.  A report by the British Medical Journal found that when outcome data were re-analyzed to include the unpublished data for 42 previously FDA-approved drugs, a whopping 93% of the outcomes changed.

All data matter, especially in medicine.  With systematic reviews and meta analyses, the gold standard in scientific publishing, researchers seek to make claims about a particular drug or health event based upon the totality of the published research. Physicians and other scientists use these systematic reviews to guide decision-making. Prescribing a drug based upon the positive findings of a systematic review gives one considerably more confidence than doing so based upon a few unrelated studies. When the systematic reviews are based upon insufficient reporting of negative or null results, the review is likely inaccurate.

Publication bias, as it is called in research circles, is a well known problem to many. By nature, scientific journals gravitate toward positive and novel results, in much the same way TV news reporting tends toward negative, salacious events. Both are clamoring for market share. Unlike in TV news, bias in the research industry can and does have serious consequences when medical-decision making rely on those results. Noted physician and medical blogger Harlan Krumholz, contends that medicine’s biggest threat is not some exotic virus, but missing data.

Case and point, when data about adverse events are withheld from publication, bad drugs, such as Vioxx are released into the market place and presumed safer than they actually are.  A similar scenario is emerging for Yaz/Yasmin. These birth control pills are currently facing a bevy of lawsuits  for some serious adverse events.

So what is one to do, who does one trust?  I don’t know the answer to that question, but I think that good first steps include transparency and open access to data and research. As a patient, this includes access to scientific and medical research as well as access to our own medical data. As we report in the stories below, access to research is at risk if the Research Works Act passes.

A next step is to demand all data be published in drug studies, the good, the bad and the ugly. The British Medical Journal reports, those data are available in many, but not all cases, through FDA and other repositories. However, culling and analyzing those data along side the published reports is no easy task.

Perhaps a third option, is post-market crowdsourcing. Granted, not the best option when dealing with potentially dangerous therapeutics, but in this new environment of empowered patients and big data, crowdsourced research is becoming more common. The organization adverseevents.com is aggregating patient-reported adverse reactions to medications. It’s freely available to patients and physicians globally. A myriad of other companies have come on the market in recent years to crowdsource the research for all sorts of medical conditions. These companies offer patients the opportunity to participate and learn directly from the research conducted. Unlike traditional clinical research, the data and results are not cloistered, but are open and readily accessible.

In the end it all comes down to data and how we use it to make decisions about our health.  I believe data matter. I believe data ought be open and accessible. What do you think?

Participate in Crowdsourced, Post-Market, Adverse Events Research

Take a few minutes to complete a survey about the medications and surgical procedures you have utilized. Take as many health surveys as are applicable and share the surveys with your friends. All surveys are anonymous and completely voluntary. We’re adding more surveys every month, so check back frequently or sign up for our weekly newsletter to keep abreast of the latest research news.

Take one of our health surveys:

Crowdfund Research on Medications that Matter to You

Lucine Health Sciences and Hormones Matter, are unfunded and run by Dr. Chandler Marrs along with a cadre of dedicated volunteers. We know the work we do is important and needed and so we’re doing it anyway, despite the lack of funding. We’re bootstrapped to the nth degree, but determined to fill the critical data void in healthcare, one study at a time.

We’ve set up an unsubscription model to fund our education and research programs. We call it an unsubscription because it is not really a subscription in the true sense. It’s just a mechanism to fund the work that maintains our commitment to open access health information on Hormones Matter.  By purchasing an unsubscription you are supporting our continued operations and research; research and health information we all need but can’t get anywhere else. To help fund additional research: Crowdfund Us.

 

Cortisol: The Stress Hormone

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Cortisol is a steroid hormone produced in the cortex of adrenal gland. It belongs to a class of hormones called glucocorticoids and plays an important role in regulating cardiovascular function, blood pressure, glucose metabolism, sugar maintenance, and inflammatory response. Cortisol is best known as the stress hormone. It is released in response to stress, and is part of the fight or flight system.

Under normal conditions the body regulates cortisol levels which are usually high in the morning and low at night. But under stressful conditions more cortisol is secreted. Small increases in cortisol produce positive effects such as increased sustained energy, diminished pain sensitivity or memory enhancement. But a prolonged cortisol increase during chronic stress results in negative side effects: increased blood pressure, sugar imbalance in blood, decreased bone density, cognitive problems, and reduced thyroid function. It also slows down healing processes and suppresses the immune system, perhaps the reason we are more apt to get sick when we are stressed.

Continuously, stress-induced elevated cortisol levels lead to an increase in the level of other hormones (testosterone, estradiol, insulin).  High cortisol levels are often linked to insulin resistance (Type 2 Diabetes), weight gain and general inflammatory conditions. High cortisol is toxic to the brain and can cause memory loss and contribute to Alzheimer’s disease or senile dementia. Elevated cortisol levels and lack of diurnal variation have been identified with Cushing’s disease. Low cortisol levels are found in primary adrenal insufficiency (e.g. adrenal hypoplasia, Addison’s disease).

Cortisol and progesterone bind to common receptors in cells. Cortisol blocks progesterone activity, and some suggest, that high levels of cortisol, initiated by chronic stress, dispose one to a condition called estrogen dominance.  Estrogen dominance is condition where women cease to ovulate regularly and progesterone concentrations are lower than necessary during the second half of the menstrual cycle. Many suspect estrogen dominance underlies PMS and other cycle related symptoms.

We Cannot Manage What We Do Not Measure

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Pay attention to the whimper or be forced to cry uncle. Those are your choices. Those were the choices that faced the nation ten and twenty years ago as naysayers to the economic policies certain to bankrupt our country became evident, but they were ignored or lambasted as fringe. The collective wisdom forged forward with derivatives, with the merging of investment and saving banks, against the whimpers of many, only to cry uncle in 2008 as the catastrophe loomed.

As the ‘other 99%’ seek to realign our political and economic situations, women must lead the changes in the health industry. We must pay attention to the whimpers, to the evidence that something is off, and more importantly, we must take heed before uncle is cried. How do we do that within such a flawed system of industrialized, profit-based medicine? Education, measurement, transparency and responsibility.

Education. The number one factor contributing to health is education. The more educated women (and men) are the better health they experience. Why? Better decision-making. Although there are clear associations between income and health, the association between education and health is stronger.

Education allows one to navigate the morass of medical marketing, cut to the truth, and identify the untruth in advertising. Education permits women the confidence to seek alternate directions in health and not simply take what is prescribed to them as gospel. Quite simply, education permits responsibility in health choices. It doesn’t necessarily lead to taking responsibility or making the right choices; we’ve all seen really smart, highly educated people do really stupid things. Rather, education creates the environment where those choices can be made.
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Unite Walking Uteri: Repair the Economic Moral Fabric, One Woman at a Time

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For a website devoted to women’s hormone health research, I seem to write a lot about the current economic and political situation. That may seem odd on the surface, but a deeper dive reveals an inextricable connection. The recession has forced American values into re-alignment and like or not, health is at the center. And women’s health, because we bear children, is at the nexus.

As a woman, who has born children, I take offense to the fact that in political, economic and healthcare debates, women have become no more than walking uteri. From both the political Left and Right, our choices to bear or not bear children seem to represent the sum total of the interest in our health. Sometimes our breast health is considered and on a rare occasion other aspects of our physiology enter into public discourse and even research, but mostly it is our childbearing that garners the attention.

Even so, the pretense that the debates currently dominating the public arena involve anything closely related to women or health is false. These are debates about money and power—getting it and keeping it– and we are simply the tokens of that economy. But we don’t have to be, because as walking uteri, they have failed to recognize one important point- we can walk the other direction.

Although we are only 50% of the population, we consume 80% of the medical care and we control the medical decision-making in most families – that is our power. The makers of HRT know this all too well.  They saw their profits drop by as much 70% when the unfounded marketing claims that HRT cured everything came to light.  Millions of women transferred their consumer purchasing power to the bio-identical hormone, nutraceutical and other health-related industries. As hospitals began dictating C-sections, a whole movement of home-birth evolved; home-birth in the 21st century- who could have predicted that?  As more and more toxins are found in our foods and especially baby products, companies marketing healthy, organic products are born. Our uteri are walking right out the door and creating entire industries that place health and well-being center stage.

So, while politicians covet big money from the corporations that obliterated the economy and decimated women’s health; while protestors protest the profligate practices of Wall Street (finally) and pundits decide which side of the ratings fence they are on, women are quietly re-building the economy. Inc.com indicates that women lead 40% of all business in the US (2010), but received less than 8% of investment capital. Perhaps as a result of the lower capital, we are better at bootstrapping, have higher growth, better returns and our businesses succeed more frequently than companies led by men. Our companies are less risky; none of the high-flying financial shenanigans that got us into this mess in the first place. Perhaps because of the inequities in healthcare and research perpetrated on women by men interested only in the functionality of our collective uteri, we’re building companies that address women’s health-beyond the uterus.  Companies like Lucine, and many, many others.

Are the attempts to de-fund women’s health important, even though they pertain to the most narrow definition of health? Yes. They serve as a reminder that we have more power than we think. We are the consumer market that matters. We can take our consumer buying power and our voting power elsewhere. We can create the industries that matter to us. In doing so, we repair what David Brooks called the ‘moral fabric of our economy.’

Hormone health research and diagnostics matter to me and my colleagues at Lucine. What matters to you?

Underinsured, Underdiagnosed and Anonymous: Endometriosis

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Endometriosis

I am continuing to write this anonymously because I continue to fear the social repercussions and potential backlash of publicly revealing my real name in association with my endometriosis and other health issues. I am uninsured and told by many, uninsurable.

We left off from Part 1 of my story with a tentative diagnosis of endometriosis, a ruptured ovarian cyst, and ever-increasing doses of oral contraceptives. At that point in my life, I was scared, in pain and worried that I and the doctors should be doing more.

But, as it turned out, there was not much more that I could do. The doctors said that even if it wasn’t endometriosis, the pill would probably still be the least invasive and least risky treatment option available to me. They told me this without any intention of scheduling further abdominal inspections, pelvic imaging, endometrial biopsies, or blood draws for biochemical markers, despite my pleas for each. Then again, they had confirmed my endo’ diagnosis without a laparoscope, or CA-125 antigen test, as it was. So, what else should I really have expected from them now? Life on oral contraceptives continued because, apparently, my only other choice was living without a uterus (and risking paralysis due to prior cervical vertebrae injury) at only twenty-five years of age.

I had never had long, frequent, heavy, or uncomfortable periods, much less menstrual cramps, as a young teenager. But, as a woman on COCPs in her mid-twenties, I was experiencing altogether nonexistent cycles, regular breast discharge, ceaseless bloating, and unrelenting gastrointestinal pain and pressure (on top of chronic neck and back pain from the past car accident). One silver lining to my proverbial cloud was that I had finally regained most of the neck control and movement previously lost in the collision. Another consolation to this difficult situation was that I had also saved up enough money, working through physical therapy, to return to school. And, maybe best of all, I had found (without trying) a steady, supportive, and understanding boyfriend, who was not only my match in every way, but who always stayed by my side, through the ups and downs alike. Little did we know the coming financial and health woes to befall us, yet again, over the next few years.

Fast forward about three more years into the future—I had transferred to the university as a junior during the Fall term. My boyfriend and I had been together, going on strong, for four years. And, I had been working part-time at a job that I loved for nearly two years. The future again seemed bright. Healthcare access, however, remained bleak.

The COBRA benefits from my old employer had long expired, not that I could have afforded them at $600 per month anyways. I didn’t qualify for health insurance at my new workplace because I wasn’t full-time there, owing to a loaded class schedule on-campus. And, the only medical coverage that I had been able to afford since leaving the other company was a short-lived, hybrid POS-HMO plan, which I ended up having to cancel early as nobody in my area would accept it (there went another few hundred dollars, I couldn’t afford to lose, down the drain). We had been working around the system, paying out-of-pocket for generic prescriptions, and general lab procedures, at local understaffed health clinics, since no one else seemed willing to work with us. This got us by (it had to) until an unexpected slip-and-fall accident that December rendered a hidden colon tumor palpable in my lower body (something we wouldn’t learn for another four months or so).

The ER wouldn’t treat me, and only served in referring me to a GI/Endoscopy specialist, who in turn refused to see me because I didn’t have insurance. A major medical carrier subsequently denied me coverage as uninsurable due to pre-existing conditions (namely my C2 fracture from nine years earlier, and my endometriosis diagnosis from four years prior), essentially blacklisting me among all other healthcare providers. I couldn’t even qualify for government assistance of any kind. I had come close to dying in just a few short months without knowing what was wrong with me, and we were running out of time and options fast. That’s when my boyfriend popped the question, to get me on his insurance, and to save my life…

To Be Continued.