Why Am I So Tired All The Time?

womentowomen on November 5, 2013

by Marcelle Pick, OB/GYN NP

If you’re suffering from constant fatigue, it’s a sign that your body’s normal systems are being disrupted. SS Blond Sleepy Woman BreakfastThere’s no reason to try to push through or ignore it. If you’ve tried to get more sleep, reduce stress and change your lifestyle— but you’re still relentlessly tired — your fatigue deserves to be taken seriously. Fatigue tends to snowball, gradually worsening, until you feel like a hamster stuck on an exercise wheel — exhausted and losing steam but not getting anywhere.

The effects of constant fatigue — it’s more than being tired

Unfortunately, women often ignore their increasing fatigue until it leads to other symptoms. By that time, the side effects of fatigue may become nearly constant. They include:

  • Feeling exhausted (mentally and physically)
  • Being tired even after sleep
  • Inability to bounce back from illness
  • Headaches
  • Joint pain
  • Depression
  • Poor short-term memory, confusion, irritability
  • Food cravings (particularly for sweets/carbs)
  • Getting a “second wind” after 6:00 PM that interferes with your ability to sleep later on

The key is not to dismiss your mild symptoms of fatigue when you first notice them. Instead, take the first step and figure out the cause of your fatigue.

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What are common underlying causes of fatigue?

I always pay close attention when any woman tells me she’s exhausted — even if it’s her only symptom. Fatigue is debilitating and discouraging because it can interfere with every aspect of your life — even the fun things.SS Close Up Mature Serious Woman

For women, fatigue is often related to an underlying issue in the endocrine system. What’s more, one endocrine imbalance may be affected by another — such as over stressed adrenal glands intensifying symptoms of hormonal imbalance.

There may be other possible causes contributing to fatigue as well, including: chronic inflammation, food allergies and chemical sensitivities, Lyme disease or the other factors. And fatigue can also result from the combination of several of these factors. Working with a functional medicine practitioner can help you get to the root of your fatigue.

What is Chronic Fatigue Syndrome?

Chronic Fatigue Syndrome (CFS) is distinct from the types of fatigue we discuss here. CFS refers to severe, continued tiredness that is not relieved by rest and does not appear to be directly caused by other medical conditions. For more information, read our article, “Chronic Fatigue – Get Your Energy Back!” and our many other articles in our Insomnia and Fatigue section.

When fatigue takes over: one woman’s experience

Daniela, 33, somehow manages to keep up with her hectic life. She’s always busy in her job as an office manager, coordinating the activities of her two young sons, and training for a 5K race. But lately, she can’t seem to fall asleep at night and wakes up to scribble “to do” lists. And during the day, she’s having trouble focusing.

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Your Health Depends On Optimal Nutrition

womentowomen on November 5, 2013

by Marcelle Pick, OB/GYN NP

Without a doubt, eating well and having optimal nutrition is the number-one strategy for creating lifelong health, regardless of your starting point. You may be highly conscientious and diligent about your diet, or you may be in despair about your nutrition and miles from reaching your goal. Or, you may be “good” one day then wobble or fall down the next. Whatever the case, this section of our site is all about how to make nutrition and eating well the cornerstone to your health foundation.

Conventional medicine has only recently begun to catch on to the enormous impact nutrients have on disease prevention and even disease reversal. But over the years I’ve seen it time and again in my practice: getting the right combination of nutrients through healthy food choices and high-quality nutritional supplements can make all the difference in a woman’s physical health, energy level, and overall vitality.

As women, we’re taking care of children and aging parents, working outside the home, and still doing much of the housework and cooking — it’s no wonder we reach for frozen dinners or take-out menus when it’s time for dinner! But I’ve found that educating my patients on a new approach to food can make those tough decisions about what to eat and whether or not to use nutritional supplements much easier.

The other problem today is that even when we make an effort to eat fresh fruits and vegetables, they’re often grown in nutrient-depleted soil so they can’t offer us the full armor of vitamins and minerals our bodies require. This means that nearly every woman could benefit from some level of nutritional supplementation, but you need to know which ones are right for you and what to look for to make sure you’re getting all the potential benefits.

Take a look at our many articles on the subject of nutrition and nutritional supplements for guidance. What’s wonderful is that you can optimize your health naturally every day — and it’s not as difficult as it may seem.

 

Information On Urinary And Pelvic Health In Women

womentowomen on November 3, 2013

by Marcelle Pick, OB/GYN NP

The hourglass shape of a woman’s body allows the pelvis to provide primary support for everything above it. The pelvis is the foundation upon which much of the body’s structure rests, and just as with any other kind of structure, it’s important that this foundation be solid — after all, the rest of the body depends on it.

One critical area of the pelvic “foundation” in women is a set of interwoven muscles called the pelvic floor. These muscles cradle our lower internal organs, much like a hammock holds a person, while encompassing three important passageways: the urethra, vagina, and rectum. When the floor of the female pelvis is compromised, it’s easy to see how many things can go wrong — from painful intercourse to incontinence and urinary tract infections. I know it’s easy to take our pelvic and urinary health for granted, but when pelvic health becomes an issue, it can have a tremendous impact on our lives and our overall health.

I’ve seen so many women at the clinic — young and old, with children and without — devastated and embarrassed about urinary incontinence. It affects more women than you may realize. Chronic infections, surgery, childbirth, accidents and many other things can cause changes in the urethra and the bladder that result in urinary and even bowel incontinence. But rest assured, there are solutions. Pelvic floor exercises, pelvic physical therapy (PPT), acupuncture, and good nutrition are just some options we’ve found helpful for bladder and bowel control in women.

Another major area of concern for our patients is urinary tract infections. Whether you can’t seem to get rid of them or you want to focus on preventing UTI’s, we’ve had years of experience. And the answer does not always include antibiotics. There are so many ways to boost your immune system and prevent recurrent infections from both yeast and bacteria without resorting to prescription medication. You may be wondering, is cranberry really the answer? What about vitamin C? Find the answers you’re looking for. And take good care of your foundation!

 

Vitamin D — The New Giant For Bone Health And Overall Disease Prevention

womentowomen on October 28, 2013

by Marcelle Pick, OB/GYN NP

New research is revealing connections between vitamin D deficiency and a myriad of health concerns, including cancer, depression, osteoporosis, immune dysfunction, diabetes, heart disease, and more. In fact, mounting research documents the impressive degree of disease prevention that can be obtained from higher vitamin D blood levels. Thankfully, more and more conventional practitioners are testing vitamin D levels in their patients these days. Since there are several forms of D, be sure you request evaluation of 25[OH]D, which is short-hand for 25-hydroxyvitamin D. This is the test that accurately detects vitamin D status. The normal range varies from lab to lab, and protocols used in some labs may be less accurate than others.

The issue for many people is that long-term effects of vitamin D deficiency may not be visible for many, many years, so it’s easy to overlook — for both patients and practitioners. But if you’re serious about disease prevention and fracture prevention, I recommend vitamin D level testing twice a year, at the end of the summer and mid-winter. The National Institutes of Health sets the normal vitamin D range at 16–74 ng/mL, but leading vitamin D experts are calling for the low end of this range to be moved upward. Here are the levels we strive for:

  • For basic bone protection and optimum calcium absorption you need at least a 32 ng/mL vitamin D (25[OH]D) level all year round.
  • For degenerative disease prevention, a higher level of 50-70 ng/mL is better.

Studies have shown a 60-77% reduction in cancer risk with vitamin D supplementation and research suggests that hip fracture could be reduced by 50-60% by bringing vitamin D blood levels into the therapeutic range.

Research is showing that we use between 3000 and 4000 IU of vitamin D daily — much more than previously expected. So how do we replenish these stores? Nature intended us to get most of our vitamin D from exposure to sunlight. Studies show that bathing suit exposure during summer, until the skin just begins to turn pink, results in skin production of 10,000–50,000 IU of cholecalciferol (pre-vitamin D). I know it’s difficult in our modern society to spend enough time in the sun to fill our vitamin D stores (especially if you live in northern latitudes). And vitamin D is also not found in very many foods. So a quality vitamin D3 supplement is one of the best ways to cover your disease-prevention bases.

Women to Women has formulated our own high-quality vitamin D supplement enhance your health – click here to find out more.

Currently vitamin D researchers are suggesting supplementing with 2000 IU of D3 daily along with 15 minutes of sunlight. For details on this current recommendation see the Scientists’ Call to Action published by Grassroots Health, a Public Health Promotion Organization (refer to their website, GrassrootsHealth). For addition in-depth discussion, see our articles on vitamin D deficiency and Vitamin D Testing and Treatment.

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Your Foundation Rests On Adrenal Health

womentowomen on October 28, 2013

by Marcelle Pick, OB-GYN NP

As the great balancer of more than 50 hormones in the body, the adrenal glands have a broad impact on your health and energy. The adrenals are primarily responsible for activating your stress (“fight or flight”) response, shifting energy away from restorative processes like digestion and toward the organs of action — your heart and skeletal muscles — by pumping adrenaline and cortisol into your bloodstream. But they also synthesize numerous other hormones, including androgens and their precursors, such as testosterone and DHEA, as well as estrogens and progesterone — which is why it becomes more important than ever to support our adrenal glands as we approach menopause, a time when our bodies come to rely more heavily upon the regulation of hormones.

But aside from the life-critical job the adrenals play in activating your stress response and supplementing healthy hormonal balance as we age, the hormone cortisol itself has a powerful hand in so many other regulatory processes across all your systems: protecting the body from stress by regulating blood pressure, normalizing blood sugar levels, helping to regulate the immune and inflammatory responses, and influencing mood, memory, and clarity of thought.

Maybe this helps explain why, when your adrenal reserves are depleted, you might feel a little crazy, and your sleeping and eating habits seem a little crazy, too! In Ayurvedic medicine, the adrenal glands are connected to the “root” chakra and contribute to our groundedness, nourishment and physical health. With persistent stress, we become increasingly less grounded, which can increase stress even more — and the constant demand for stress hormones means the adrenals become depleted and ultimately exhausted.

But my experience with women over the years has shown me that you can provide stronger grounding and support to the adrenal glands by making some simple choices when it comes to eating and nutrition. Will your food choices make or break your adrenals? Not exactly — stress is the number-one major offender when it comes to adrenal depletion, and you can read more about this in our article on stress and the effects of high cortisol — but good nutrition, well-timed meals and snacks, and sometimes a gluten-free diet can significantly relieve the strain on your adrenal glands.

Think about the tires of a car. If you buy good quality tires and routinely check their air pressure, balance and rotate them, and patch any holes, the foundation for how your car moves on the road will be safe, steady, and strong. You’ll get better gas mileage, the car will respond better when road conditions are slippery or uneven, and the car will last longer. The same goes for adrenal function. Selecting high-quality foods, building a strong nutrient base, and paying attention to when and how you eat all make for more efficient and healthy adrenal function — and better health all around. Just as neglecting your tires may not immediately compromise your safety or your car’s efficiency, your adrenals can take a lot of strain before you begin to see the effects on your body.

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Psychological Symptoms Of Adrenal Fatigue

womentowomen on October 28, 2013

by Marcelle Pick, OB/GYN NP

  • You’re irritable and quick to lose your temper.
  • You’re prone to road rage or become extremely angry over little things.
  • You feel as though you’re constantly on edge, ready to “lose it” at the least little thing.
  • You feel listless, depressed, or emotionally numb.
  • Your sex drive is low.
  • You frequently have nightmares.
  • You often feel an overpowering urge to cry.
  • You have trouble concentrating or feel mentally foggy.
  • You suffer from free-floating anxiety.
  • You are easily startled.
  • You simply feel stressed all the time.
  • Everything seems like a chore.

As you can see, some of the symptoms are contradictory: can’t sleep/can’t stay
awake; always on edge/listless and depressed. That’s because adrenal dysfunction is a progressive condition that moves through successive phases, manifesting differently as the condition gets worse. The condition also shows up differently in different women, primarily as three main types.

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The Stress Response

womentowomen on October 28, 2013

by Marcelle Pick, OB-GYN NP 

Adapted from Is it Me or My Hormones?

In recent years, the word “stress” has taken on such negative connotations, but from the body’s point of view, it only means any type of demand or challenge that requires the body to expend extra energy. Getting up from your seat and walking across the room is a minor stressor, for example, because it requires more effort than remaining seated. Dinner with a sexy new romantic partner—thrilling as that may be—demands more energy than eating a bag of potato chips while sprawling on the couch. Mobilizing energy and expending it on a chosen task—rising to the occasion, in other words—is an essential part of what makes life interesting and rewarding.

But the stress response was never meant to be a permanent condition. The human body is designed to respond readily to challenges—and then to release and relax. We even have two complementary aspects of our autonomic nervous system to help us maintain that balance. The autonomic nervous system is the aspect of our peripheral nervous system that controls the activities of our organs, glands, and various involuntary muscles, such as the cardiac and smooth muscles.

  • The sympathetic nervous system mobilizes energy, preparing us to meet challenges of all types. Through a number of glands and organs, including the adrenals, it causes our heart to beat faster, our blood to pump more vigorously, our blood pressure to rise, our breath to come faster and deeper, and a number of other effects designed to help us face any demanding situation.
  • The parasympathetic nervous system stores energy, allowing the body to rest up and prepare for the next challenge. It causes our heart rate, blood pressure, and breathing to enter into a more relaxed state, and it also supports digestion and immune function so that our bodies will be in top condition next time life throws us a demand.

What Do I Do If I Have An Abnormal Mammogram?

womentowomen on October 28, 2013

by Marcelle Pick OB/GYN NP

  • Keep breathing
  • Ask questions, gather information
  • Find a support person to be with you

Sometimes the films just don’t come out right and they need to repeat them.
The three most common “things” that radiologists see in mammograms that they want “worked-up” are:

  1. A new nodule
  2. An asymmetric density — (the breast tissue doesn’t look the same in each breast)
  3. A new cluster of calcifications (little white specks)

The first 2 should have an additional spot compression film to see if it is real and an ultrasound to see if the area is fluid or solid and have a better look at its shape. Nodules that are irregular or spiculated (like a star) are more worrisome.

Calcifications should have special magnification views done of them which can help determine if they are normal or worrisome. Most calcifications are normal and associated with aging — not from taking too much calcium.

If someone tells you to wait 6 months and recheck it it is usually because they think it is benign. However, if you don’t want to wait 6 months you have the right to ask for a second opinion.

If someone tells you you need to have something biopsied you should feel you have gotten your questions answered as to why, and that the mammogram has been worked up sufficiently. Someone should also examine your breasts and correlate them with the mammogram to be sure that nothing is palpable. Remember the point of getting a mammogram is to find lesions early and too small to feel.

Most breast centers today have equipment to biopsy mammographic findings with a needle and thus spare a woman a trip to the operating room. This is called a stereotactic biopsy or a mammotone-core biopsy. This type of biopsy has been shown to be as accurate as a surgical biopsy and much less invasive. I recommend you try to find a center which does these biopsies and does them frequently — our breast center does 2 to 4 stereotactic biopsies a day.

Another way to biopsy is with ultrasound guidance — this is sometimes a bit easier because your breast does not have to be compressed. Most mammographic problems, except calcifications, can be identified on ultrasound. Most breast centers have accredited mammography and ultrasound units and specialized breast-imaging radiologists.

Female Urinary Incontinence – What Causes It?

womentowomen on October 28, 2013

by Marcelle Pick, OB/GYN NP

Don’t just live with urinary incontinence — learn about the causes of incontinence so you can move forward

The other night I was at a charity event and a friend introduced me to a group of eight women whose ages ranged from 35 to 50. One of them asked me what I was working on and I decided to be frank and say I was putting the finishing touches on an article about urinary incontinence in women.

You should have heard the outcry! Each woman had a different story to tell. One had to leave her aerobics class after her shorts got soaked. Another abandoned a grocery cart full of food in the check-out line to sprint for the public bathroom. Another organized her day around easy access to the toilet.

Every woman in that group (some were mothers, others were not) had some experience of losing bladder control. Most seemed to think it was an inevitable part of aging — complete with the requisite adult diapers or incontinence surgery.

Stress incontinence and overactive bladder (OAB), or a mixture of both, are extraordinarily common — but nobody wants to talk about them. In the past, traditional medicine viewed incontinence as primarily a men’s issue. But in my experience almost all women will suffer at some point in their lives from some form of urinary incontinence. What’s more, our bladder control issues can leap from moderate (or non-existent) to severe with the onset of menopause, especially for women who never experienced childbirth.

It’s high time we bring urinary incontinence out into the light and talk about it. Women are so conditioned to suffer in silence, but it’s not good for our health. In fact, women rarely mention urinary incontinence in their annual visits with me. So I ask. Incontinence may not be entirely avoidable as we get older, but it is certainly treatable, and there are very effective alternative methods.

What is female urinary incontinence?

A sudden urge to go, leaking urine and frequent urination are all forms of urinary incontinence, which is generally defined as a lack of bladder control. While there are many causes, the most basic is a gradual weakening of the pelvic nerves, organs and smooth muscles that are meant to work together to control urination.

The bladder itself is a sac that stores urine from your kidneys. When it’s full, pelvic nerves send a signal to the brain that you have “to go”. Your pelvic muscles, especially the sphincter of the urethra, clench and “hold it” until you get to the bathroom. Once you’re there and safe, your brain tells the sphincter muscles to relax and your bladder empties.

Believe it or not, the muscle anatomy “down there” is still not completely understood by modern medicine. We do know it’s an intricate and amazing arrangement of dozens of muscles which keeps things in and lets them out as necessary. Of course the female pelvic floor is much more complex because women have babies.

But a lot can change in the course of a lifetime. Inner pelvic muscles stretch and atrophy with age, pregnancy, gravity and trauma. Muscles lose their elasticity from lack of use and loss of estrogen. Organs actually move around, often pressing on the bladder itself. In some cases the bladder or urethra become damaged or chronically inflamed and malfunction. Scarring from surgery, injury or infection may disrupt the natural alignment of the organs inside the pelvic area.

And when you think about it, which of us doesn’t experience several of those factors over time?

Do I Have To Take Tamoxifen?

womentowomen on October 28, 2013

by Marcelle Pick OB/GYN NP

This is one of the most common questions I am asked. I think it is because informed women now question it’s side effects. This pill, the most widely prescribed oral medication for breast cancer, has been studied in more trials than any other drug. However, the patent for Tamoxifen is running out and there are some newer hormonal blockers. Tamoxifen has an interesting history. It is not a new drug — it was synthesized back in the 70’s to be a birth control pill. It worked that way in mice, but instead increased fertility in women. Other scientists then decided to try it on advanced breast cancer patients and it did help — extending survival by many months or years. Tamoxifen is now seen as an estrogen blocker to the breasts — it inhibits estrogen from binding to cells. However in other parts of the body, the uterus, bones, ovary, it acts like an estrogen.

We now know that Tamoxifen has some negative side effects, increasing hot flashes, mood swings, and most significantly, increasing blood clots and uterine cancer. The last two are pretty rare, but significant. When Tamoxifen is used in women with more advanced breast cancer, positive nodes or metastases, the benefits exceed these risks. However, for women with earlier stages, like DCIS or very small tumors, one does need to balance the benefits with the risks. A woman should be able to have an objective discussion with her provider about the true benefits of Tamoxifen — is it 3% or 10% improvement — and then make an informed decision. Some women want to do everything, even if the benefit is small; others do not see it that way. For some women Tamoxifen is a safety net; for others it is a poison they cannot swallow.

Tamoxifen is now FDA approved for prevention of breast cancer in women with strong family histories or with atypical biopsies or LCIS. I have found that Tamoxifen is actually best tolerated by the younger women — women from the age 35 to 45. They are still having their periods and do not have any side effects. It is recommended that they take it for 5 years (using contraception, because of potential birth defects) and that the benefits last a lifetime. I have seen perimenopausal women have the most problems with Tamoxifen, as far as aggravating the symptoms of menopause and “just not feeling right.” Some women tough it out, others stop. The recommendation is to take it for 5 years only — the most benefit comes from at least 2 years. No one has tested it for, say 3 or 4 years. I often suggest that women give Tamoxifen a try for at least 3 months and keep a diary of how they feel taking it. Belief is important here and if you don’t think it is going to work, I doubt that it will.

For post menopausal women, newer drugs called aromatase inhibitors are on the market and appear to be superior to Tamoxifen. They block the conversion of estrogen from one’s fat, cholesterol or adrenal sources. Women seem to have fewer side effects, except for joint pain, with these drugs. However, they have only been studied for the last 5 years so we don’t have long term data on them. You can also ask your doctor about ovarian suppression by surgery or pills. The benefits may be equal to chemotherapy, but also have other side effects — going into sudden menopause.

Now being tested is a tamoxifen gel to be applied topically to the breasts. The hope is that it will still have its protective effects without the downside.

Hopefully in the near future we will have a better understanding of which women need which drugs.