Heatstroke: A Summer Risk for the Healthy and Frail

heat-strokeThis May was the hottest on record since temperature measurements began to be taken during the mid-1880s. This broad problem of rising world temperatures has persisted into June. The most well-documented case of the effects is the heat wave in Pakistan where more than 1,000 lives have already been lost from heatstroke as temperatures move above 112 degrees.

“Heatstroke” is a colloquial term used to describe two distinct entities: (1) severe non-exertional hyperthermia (overheating of the body), which generally affects  the very young, the disabled, the poor, those who are isolated because of mental illness, or the elderly; and (2) exertional heat illness, which mostly affects otherwise healthy adults and adolescents. These two groups are linked due to underlying causes and effects (too much heat or sun exposure and a lack of hydration) and the eventual health impact (extreme elevations of body temperature leading to bodily dysfunction).

Heat exhaustion sometimes occurs when a person exercises and works in a hot environment and the body cannot cool itself adequately. Dehydration occurs with water loss from excessive sweating, which causes muscle cramps and weakness, along with nausea and vomiting. This makes it difficult to drink enough fluid to replenish the body’s water supply, and the lack of body water impairs further sweating, evaporation and cooling.  If the humidity is too high, sweat on the skin cannot evaporate into the surrounding air and body temperature cooling fails.

Heat exhaustion and heatstroke are caused by environmental conditions. As outside temperatures rise, the body reacts by sweating. This evaporation of water from the skin and respiratory tract is the most effective way of ridding the body of excess heat. Less effective reduction in heat occurs from the direct radiation of heat into the environment, the transfer of heat to air or liquids moving over the body.  These normal cooling mechanisms become ineffective when humidity rises above 75% and  air temperature rises above normal body temperature.

Next Page: Prevention

Sex Talk: No Interest in Sex

We have had a great response to the series of Sexy Saturday Conversations we inaugurated last year. Many women have written to say that they enjoy the frank talk between Dr. Pat and Dr. Hilda, two friends who just happen to know a lot about sex and relationships.  

However, we’ve heard from more than a few women who want to know why we keep talking about “keeping that spark alive.” There is a theme these women would like us to address: Why assume that all women want to have a sex life, partnered or not? 

This seems like a good conversation for Dr. Pat and Dr. Hilda to have—especially in light of the findings of a recent peer-reviewed study, “Sexual Activity and Satisfaction in Healthy Community-dwelling Older Women.” Among the results of their survey of 806 women (median age 67), the researchers found, “Forty percent (39.87%) of all women [surveyed] stated that they never or almost never felt sexual desire.” Why might that be?—Ed.  

Dr. Pat: Women, even in their early 40s, do tell me that they have no interest in any sexual activity with their partner. Other women tell me that they are unattached, and happily so, with no interest now or in the future in developing a relationship with someone that has a sexual component. What do you hear from women over 40, Hilda?

Dr. Hilda: I hear this too, and not just in the office. We all know people who have no interest in sex. Zero. And they often feel as if there is something wrong with them . . . that the world is judging them.

Dr. Pat: It is true that each man and woman has a unique appetite for sex, just as they may have varying appetites for food, rock climbing or other extreme sports, wine, travel, or other sources of pleasure that may not be shared by everyone. However, as gynecologists, Hilda, we do have an opportunity to use this information about “no sexual interest” from a patient to take a sexual history. Hilda, what are some of the questions that you would ask a patient who reports that she has no sexual interest at all?

Dr. Hilda: I would like to know, first of all, if she ever had pleasure from a sexual experience. That determines the rest of the questions.

Dr. Pat: I agree. If she had pleasant sexual encounters over the years, was she ever really interested and orgasmic, or did she just go through the motions because the partner was a nice enough person and the relationship had reached a stage where sex was the next expected thing?

Dr. Hilda: Or were these women capable of having orgasmic sex with a partner who knew what to do, but then, over time, developed a long-term relationship with someone who had no talent in this area, so they just decided to opt out of sex? And there are other women who may not be in a relationship, and have just found that the effort expended in developing an intimate relationship was just not worth it, or was no longer important to them.

Dr. Pat: Then there are medications that totally lower the libido. Many antidepressant medications, for example.

Dr. Hilda: And, of course, illness that causes fatigue, pain, or constant worry and anxiety about the impact of this illness of the course of the person’s life.

Dr. Pat: Then there are women who have unexpectedly aged into a new stage where opportunities for many things seem to have decreased—women who are forced into early retirement, who may have limited social contact as a result of this, along with the inability to afford to do the things they did when they were employed, had fewer financial worries, and had a broader social network. I find that this takes a real toll on a woman’s libido.

Dr. Hilda: When we have a conversation with a patient who tells us that she never had any interest in sexual activity, it is important to gently ask if we can take a brief sexual history. Pat, I always tell the patient in this part of a consultation that she should not answer any question that makes her uncomfortable. This gives her permission to end this line of questioning at any time. What do you do?

Dr. Pat: I agree that WHEN a woman reports no interest in sex for all of her life, there may be issues that she could find too uncomfortable to discuss with anyone other than a therapist. It is important to reassure her that she is in control of this brief conversation.

Dr. Hilda: I ask the standard questions, don’t you? I usually start with “How old were you when you had your first sexual experience? Did you want to have that sexual experience, or was it something that you were somehow forced to have?”

Dr. Pat: I always find that it is important to give the patient some uninterrupted time in a safe place to ask if the first sexual experience was a pleasant one. Or were there unexpected results from this experience that caused her to be afraid of sex, or wary of sex, for the rest of her life?

Dr. Hilda: We know that incest, rape, date rape, pregnancy, or family or friends’ finding out about the sexual experience and reacting in a judgmental way, can have a lifelong impact on the ability to enjoy sexual intimacy. These women often feel judged and guilty even if they are in a loving partnered relationship.

Dr. Pat: For women who report that they have no interest in sex, I generally ask about masturbation. Some women may not identify self-pleasure as sex. I ask, “How old were you when you began to masturbate? How often did you masturbate until you decided that you had no interest in sex?”

Dr. Hilda: Sometimes you can get lots of information from this question. If a woman has never masturbated, there may be a layer of guilt and shame about sex. Negative messages that she may have received during childhood can have a lasting negative effect on her desire for sex and her ability to experience sexual pleasure.

Dr. Pat: I find that an important question to ask in these consultations is, “Were you ever orgasmic?” Women who may have suffered from sexual abuse as children and young adolescents may never have had an orgasm. We call this “primary anorgasmia.” Fear, shame, and the capacity to feel safe with a sexual partner are a few of the barriers to this condition.

Dr. Hilda: I do hear from women who are not in a partnered relationship that they are happy without a sexual relationship. They don’t have sexual fantasies. They don’t masturbate. They like other things, like going on trips, going to the movies, being involved in church and community activities, and they may be passionate about work or social causes. After all, we  have only so much energy. And some people choose to spend part of that energy on sex, and others just don’t see the point.

Dr. Pat: The point is, not everyone is alike. Women come to this site to read about sex because they want information. And maybe because they like the idea of two friends who are gynecologists—who share a professional interest in sexual issues—having a drink and discussing sex from a professional and personal point of view. We certainly hope so!

Dr. Hilda: We do understand that sex is not important to every person. And there is no judgment here. If someone is in a relationship that is celibate, and that is fine with both partners, then there is no problem. If a woman is unattached and has no interest in sexual activity, then that is not a problem either.

Dr. Pat: We celebrate the differences here, not impose a standard that is “right.”

Hormone Therapy and Breast Cancer: The New York Times Ends the Week With More Bad News

The Million Women Study is a British observational study that began in May 1996 and ended in December 2001. Women were 50-64 at the time the study began, and their numbers included one in four of all women in this age group in Great Britain at the time.

The latest report to describe the fate of these women reveals more disturbing news about the risks of hormone therapy and breast cancer. The study appeared in the January 28, 2011 issue of the Journal of The National Cancer Institute and a report about it appeared in last Friday’s edition of the New York Times. There, it joined a long list of articles that describe an ever-escalating concern about the use of systemic hormone therapy.

There has been some interest in the timing theory, which has promoted the idea that women given systemic hormone therapy early in their menopausal transition were less likely to suffer from the cardiovascular complications (blood clots, strokes and heart attacks) and perhaps less likely to have an increase in breast and endometrial cancer.

While this observational study does not carry the scientific weight of those, like the Women’s Health Initiative, that are prospective, randomized, and compare their subjects to control subjects, the sheer numbers of women involved, and the time that has elapsed since the women were enrolled in the British study, are important.

The findings revealed that the lowest number of women who developed breast cancer since beginning the observational study were those who did not take any hormones, followed by those who began hormone therapy after five years past menopause. The highest rate of breast cancer was found in the group who began hormone therapy when they were most likely to be symptomatic—just before or within five years of menopause. The length of time that hormones were used, and the impact this had on the future development of breast cancer, were not as clear.

However, it is clear that each woman who chooses to use systemic hormone therapy must do so knowing that right now, the only certainty is that the medical and scientific community cannot even state how long a woman can use the lowest dose possible of systemic hormone therapy to control her symptoms without increasing her risk of breast cancer.

The only comfort that practicing physicians and their patients can take from all of these reports is that the real risk of developing breast cancer with the short-term use of systemic hormone therapy is low.

This continual emergence of data from important scientific studies remains in stark contrast to the marketing barrage from the “bio-identical hormone” industry, which claims that systemic hormone therapy that is compounded by special pharmacists does not have any side effects, including no increase in breast or uterine cancer.

Until the FDA investigates the claims of these purveyors of hope for women who want relief from their symptoms, doctors will be besieged by patients who call asking if the doctor prescribes “safe” bio-identical hormones.

Hello Washington! We need a little help here on the front lines.

The Menopause Libido Myth: Dr. Pat’s Notebook

Menopause. Hot flashes, night sweats, sleep disruption, fatigue and crankiness. It surely can make any woman feel less than sexy. But don’t believe that “Menopause took my libido away” line as the primary reason for a loss of sexual interest.

There are often other factors at work that can diminish your sex drive long before menopause—for starters, the quality of your partnership and your attitude toward sex.

Some women have never had much of a libido. They feigned sexual interest in order to date and mate and reproduce. With children came exhaustion and the nightly prayer, “Oh Lord, not tonight,” while their partners prayed for sex. This dance of unbalanced desire continued until these women found their big out: “Menopause took my libido away.”

On the other hand, there are women who were always interested in sex, but bored or sexually frustrated in their marriage. When they reach menopause, they’re more than happy to give up unsatisfying sex. Now, they can claim “Menopause took my libido away.”

Women who liked sex and were happily orgasmic can lose interest in sex if their relationship becomes dysfunctional, or an affair has eroded the trust in the marriage. These women actually look forward to saying “Menopause took my libido away.”

It doesn’t have to be that way.

There are many women who keep their libido in great shape after they reach menopause. They like sex for the sake of sex. To them, initiating sex is both a right and a turn-on. Shared sexual power and a mutual interest in setting aside time for making love has kept their menopausal libido alive and well. Menopause did not “take their libido away.”

What can you do to take charge again and ensure a healthy libido well after menopause?

  • Plan for a fulfilled sex life well before you reach menopause. Don’t wait until a pattern of denial and poor behavior in your relationship make isolation in bed inevitable.
  • Talk to your partner about finding time for emotional and physical intimacy. Develop or continue a little public display of affection.
  • Discuss the issues of physical change that will come to both of you with age, like vaginal dryness, thinner genital tissue, and potential erectile dysfunction. Face it before it happens. Don’t let shame and embarrassment ruin your sex life later on.
  • Most importantly—and I can’t emphasize this enough: Avoid women who complain that all their husbands ever want is SEX. These women are toxic. Choose friends with happy couplings. Choose to spend time with women who like to laugh about sex and themselves, and still notice who is hot and who is not.

Sex doesn’t cost a thing. It improves longevity, quality of life, and overall health. Menopausal sex without the fear of pregnancy, the mess of the monthly cycle, or young children knocking at the bedroom door can be a spontaneous and joyful part of the second half of life.

Don’t let anyone tell you that “Menopause will take your libido away.”

Dr. Pat’s Notebook: Not Another Hormone Scare!

November 7, 2010 by  
Filed under Hormone Therapy, Media

If you were alarmed by the recent New York Times article, “Breast Cancer Seen as Riskier with Hormone,” you’re not alone. The day it came out, my computer crashed with hundreds of emails from worried women wanting clarification, validation, and the straight scoop, all summed up in one question: “What does this mean?”

It means a few things. It means we have some additional data from an old study that mostly confirms our knowledge that hormones can increase the risk of occurrence and the severity of breast cancer. But it also means that we need to take our morning news with a dose of perspective.
The alarmist media we associate with politics these days seems to be spreading to medicine. And as in politics, this report is not what you’d call fair and balanced.
Now that I’ve had a few days to read and discuss the findings with other experts in the field, I am certainly less alarmed than the average reader of the Times.

Here’s the straight story.

The Women’s Health Initiative (WHI) is the most rigorous study into the impact of hormone therapy on the cardiovascular health of post menopausal women. The latest followup of WHI Secondary Outcomes was just published in the Journal of the American Medical Association. And, I might add, released to the media several days before it reached practicing physicians.

As with the initial findings, this follow-up report confirms a slight—and I do mean slight—increase in the incidence of breast cancer in women on combined continuous estrogen plus progestin therapy (PremPro), as compared to women who were given no hormone therapy at all (the placebo group). The absolute numbers: 385 cases of breast cancer in the hormone treatment group versus 293 cases in the control group, out of a total of 16,608 women.

The original study did not report separately on breast cancer deaths. In this new WHI data, there were 25 deaths related to breast cancer in the hormone treated group and 12 deaths from breast cancer in the placebo group, from the start of the study (November 15, 1993) through this most recent review (August 14, 2009).

So we’re talking 2.6 deaths on hormone treatment versus 1.3 deaths on no treatment, per 10,000 women per year.

That’s really only one more woman who developed breast cancer. Per 10,000—ten thousand—women.

Not exactly a headline grabber, is it?

Many critics of the WHI still argue that the interpretation of the latest observational data—now 17 years out from the start—is plagued by an important flaw: at the start of the study, the median age of the participants was 63, more than a decade past the average age of menopause. Older women were chosen because, the reasoning went, they wouldn’t have menopausal symptoms and as a result would be less likely to know if they were on the hormonal medications or the placebo.

The median age of these women now is well over 70. Increasing age is known to be one of the most significant risk factors in the development of breast cancer. So in terms of gauging the risks of hormone therapy, findings for older women—already at risk for breast cancer based on age alone—has been extrapolated to the treatment of much younger women.

Even so, we need to give the WHI study its due. Over the years, it has clearly shown that postmenopausal hormone therapy has risks and rewards. From this data, we’ve learned that hormone therapy shouldn’t be used to prevent coronary artery disease or decrease heart attacks and strokes. And it’s clear that no woman should use it as a specious attempt to avoid aging, to keep a youthful complexion, or from an inappropriate fear that menopause will ruin her life.

On the other hand, there are times when hormone therapy can be appropriate. Women with severe symptoms of menopausal syndrome are few, but for them, it’s hard to look at anti-depressants and sleeping pills as the only recourse. I do feel that women who are not functioning and who find that they are “themselves again” with hormone therapy deserve the option of short-term therapy without constant anxiety from overblown headlines.

Bottom line: Women who have significant menopausal symptoms should evaluate the risks and benefits of hormonal treatment with their health care providers. If they choose to use systemic hormone therapy, they should use the lowest dose for the shortest period of time consistent with their needs.
In the meantime, maybe what we need is a health advisory for media headlines. The media need news that will alarm their readers, and they need to be the first with the scoop on the bad news of the moment. They are not as concerned with balance as they should be, nor are they concerned with the anxiety and fear that their lead sentences will produce in their readers. Maybe the New York Times should have a black-box warning around these alarming health articles: “Check With Your Doctor Before Reading This.” And keep your speed dial on 911.

One Woman’s Weight-Loss Journey: Winning by Losing

This posting recently appeared as a comment on a January 2009 “Ask Dr. Pat” column about mindful eating. We thought it made a terrific article on its own, and asked the writer’s permission to post it here.

Many readers have come to the WVFC website in search of the “Dr. Pat Diet” that Dominique Browning mentions in her book, Slow Love, and talks about in her WVFC interview. We’ve prevailed on Dr. Pat to write a new post about it, which should be online by mid-June.

Meanwhile, we invite other readers who’ve had success with weight loss and mindful eating—following Dr. Pat’s plan or another approach—to send us your stories, either as a comment here or by emailing us at editorswvfc@gmail.com.  – Ed.

I am not alone. I lost weight and learned why I was eating by working with Dr. Pat. Her insights, advice, inspiration, dedication and, for those of us fortunate enough to know her, the unwavering doggedness in making us think, really think, about what we do, what we have, who we are and the road ahead.

I am not alone with weight issues, the extra glass of wine with a Saturday night dinner, a ballooning of my waistline, elevated lipid levels, glucose level issues, fatigue.

I am not alone with career highs and lows and the “what happened” questions we no longer have answers to.

I am not alone with aging and sick parents and role reversal in caregiving.

So after spending too many days physically and mentally exhausted, winded after walking up a few flights of subway stairs and finding that clothes with elastic waistbands are my fashion trend of choice, I said “enough.”

Dr. Pat was and still is there every day to help. We discussed my goals and how to get there.

I report that after five months of her support and encouragement, along with reminders to “engage my brain before I engage my mouth to chew,” I have lost 32 pounds and 25.75 inches total all over, head to toe, on the Dr. Pat “Food for Life” plan. I am 5′5″, so my initial 170 plus pounds was certainly over the top.

“The Diet” referred to in Dominque Browning’s Slow Love is not a diet in the traditional sense. Rather, it is a blueprint for the rest of our lives. It is “Food for Life,” a plan for all of the days ahead and to actually live – not the slow death we were all heading towards with unhealthy food choices fraught with disease, pills and a lot of “if onlys.” If you are around the peri-menopause or menopause age, sorry ladies: We are too old to keep playing with poor eating choices and emotional eating without consequences.

For those of you who sayyou can’t do this, you need your carbs – you can. I know. I was the bagel, pasta, and cookie queen.

For those who say I will wait until after a special occasion to start: there will always be a special occasion or some other reason to delay.

For those who say I am too busy, my schedule too crazy: I am a busy litigation attorney. My schedule changes every single day, often with little to no notice. I run around to courts and client meetings and am subject to last-minute late days based on receipt of a document in the mail, a phone call or an email. So if I can do it, you can. (A company called Built makes the cutest neoprene lunch bags – even in black. They fit nicely into a work tote. That along with portion size cottage cheese, V-8, water, and zip-lock bags – super easy.)

A food management program, like a life management program, takes planning and the engagement of one’s brain. We know that even with planning, stuff happens. But eating those slices of bread or the cookies sitting on top of the coffee pot does not change the stuff going on. Nor does it reduce the anger, frustration, disappointment, sadness from the events in our lives that are beyond our control.

The choice to take a healthier journey, both physically and mentally, is an individual and highly personal one that you must make for yourself. You will know when you are ready to do this, and it has nothing to do with fitting into that special dress or the party or family event coming up. This is a life choice. Your own choice – for you and you alone.

If you are reading this, you have the tools to start: Women’s Voices for Change. Read the articles, essays and comments. I am struggling with what most women our age are struggling with: career, family, weight, medical issues. Things and situations we believed would always be the way they were, we now know are not. When I need to nurture myself, I look to Women’s Voices for Change and solace in the words of women – such wise women.

Be selfish, ladies. Love yourself first and for all that this entails. Know, as I do, that you are not alone.

Staying Motivated to Stay Healthy

January 7, 2010 by  
Filed under Fitness, Healthy Eating

As the icy wind howls (for many of us) and we all get back into our weekly routines, it can be hard to believe the resolutions we made in the glitter and shine of New Year’s Eve: making time for the gym, packing a healthy lunch, remembering to breathe.

To help you stay motivated for healthy changes, here’s some WVFC posts you might have missed the first time around.

A few smart cooking techniques can make healthy eating delicious, and pretty easy. Check out our recent excerpt from the Mayo Clinic’s latest report for tips about braising and baking, and using herbs and spices to capture flavors without salt or fat. Earlier, Keri Gans, our nutrition expert, offered some tasty diet tips to get you through the holidays, and not exacerbate menopause’s increased diabetes risks.

Of course, exercise — even just walking more inside your house! — was also on most lists. We learned that even Oprah struggles just as much as the rest of us to make healthy diet and exercise a priority. But Dr. Pat fought back the holidays with boxing lessons from her trainer, loving its twin challenges of body and mind.

“I see myself fighting back from sloth, fighting off gluttony, fighting in Madison Square Garden.

As I am boxing, I imagine that I am wearing a special form-fitting body suit like those worn by superheroes, only my colors will be those of our own www.womensvoicesforchange.org: orange and white. I am suddenly fighting for The New Menopause!”

Feeling daunted by the thought of fighting for time on the treadmill? Contributing editor Elizabeth Willse has some tips and tricks to help you find space for your workout in a crowded gym. Interestingly, this season she reports that her favorite gym in Midtown Manhattan doesn’t have the usual throngs. Maybe this is the year everyone’s working out at home? Maybe each got a Nintendo WiiFit game for Christmas? (The latter’s not a bad option, as long as you actually do more than use it to create a million mini-Miis.)

You can work out at home, of course, if you have space. You could use that Wii, and/or follow along with a DVD. (Netflix.com and Blockbuster Videos actually have fitness videos you can rent and try out.) Or if you want a personal trainer to come to your house, you can find someone online. Accredited certification organizations like the National Academy of Sports Medicine and the American Council on Exercise maintain databases of personal trainers who can come to your house and train you there.

At the gym or at home, listen to our resident physical therapists, Eveline Erni, who offered serious tips  (and a few protective exercises) to make sure your knees stay healthy.

Perhaps dancing is more your style than jogging or jabbing (it’s great for your mind and body, too). Last April, Chris Lombardi reported on a scientific study that proves dancing is good for you. And we’ve all seen how Dr. Pat has resolved to greet the new decade, by making time for music and dancing.

I resolve to add music back to my life. I lost the habit of turning on the sound system when I walked in the door and have not given much thought to the emptiness that is there now. I need to crank up the volume and start dancing again every night.

A Pat Pause Before Christmas

December 21, 2009 by  
Filed under House & Home

‘Tis the week of the season when we often allow the lists to dominate and permit anxiety the role of dominant feeling. More put-upon than under the spell of what we once believed to be magical, we wake with worry that we haven’t done enough and disbelief that the date is so late.

Today though, we must pause. We must stop to remember that on this day a miracle occurred in the far-off land of Kentucky. Patricia Allen was born.

Patricia Yarberry Allen greeting the Time of Your Life luncheon.Today we celebrate the ability to be in touch with courage, to understand the power of the outrageous, to believe completely in re-invention, and to be damned certain that nothing is going to put an invisibility cloak over the most powerful segment of our society—dames and ladies like us, who have an indomitable leader whose birthday deserves lights, cameras and action.

It turns out that this is the week of choosing just as this is the time of our life that gives us a choice. We choose to shout our love for this gorgeous force of a woman and to take this time of our life to make the choice to be heard.

Women’s voices sing and shout in praise of Pat Allen’s dreams and leadership today. And Women’s Voices recommits itself to her vision of all we can be for all of us and all of you. 2010 is going to be a memorable year, and we never forget that it’s Dr. Pat Allen who inspires us to make it so.

Thanksgiving Day: A Day of Introspection and Gratitude

November 26, 2009 by  
Filed under Musings

Patlunch1croppedI did not feel well enough to travel this holiday. Normally, I would have pushed my way through it, but my husband gave me this gift of the day, the turkey and stuffing and pumpkin pie that I needed for my soul. I needed time to be and not do more than I could do, for just one holiday. I have never been fond of holidays, except for my birthday and July Fourth, but I have always given it my best effort at often significant cost.

My family is all happily ensconced in the bosom of extended family experience: My husband and step-sons, Garrett and Hunter, are with our Michigan family celebrating the first Thanksgiving together since the death of the family matriarch, my beloved mother-in-law, Natalie McIntyre, who died on Mother’s Day, 2008. Jane, the baby of the family, is a graduate of the Culinary Institute of America and has been in charge of creating the most delicious Thanksgiving foods in America for almost 20 years now, so this part of the family ritual will be the same. And of course, she does it effortlessly. None of the chaos that is found in my Thanksgiving kitchen would be allowed in the kitchen of the yellow house in Orchard Lake. The family is connecting with old and new ways of celebrating this year, and I know that each one there will be redefining the family so that it will endure.

My son Baxter is spending Thanksgiving with his father and step-mother in Savannah, Ga. He enjoys time there, where entertaining is such an important part of that city and important to this part of his family. Ashley and his perfect wife, my precious daughter-in-law, are making their first Thanksgiving Day dinner in their home. They don’t know that I have taken a sabbatical from just one holiday, or I would have been unable to pull this off.

patsmomI most miss being in Kentucky today.  Everyone from my family will be home but me. The phone call to my sister was the hard one. But no one has siblings like mine. We accept and love each other and always believe that what we say to each other is the truth.  So, when I said I needed a holiday off the grid, she understood. My brothers and sisters are fabulous cooks, and I know what each of them will bring to the table. Mommie will be the center of love and attention, our beloved mother who always selflessly made such a fantastic Thanksgiving meal and taught us by example and inclusion to do the same. Missing my Kentucky family on this Thanksgiving is the sad part for me.

I am spending part of day here in my office. My work, by my choice, has always been the central part of my life. Some people are just like this.  I am most content in patient interactions, giving both the patient and the doctor a quiet time for review of their lives and their health issues. It is a time of focused listening for me. The work continues, of course, after the patient visit is over. The results of tests arrive and the real work of medicine, the creation of a narrative of the patient’s life and the organization of symptoms, the integration of the physical findings begins.  I am at my best in this detective work, the work of a biographer if you will.

newyorkpresbyterian-cornellI began to work in a hospital full time 47 years ago, when I was not quite 15 years old. I lied about my age in order to get that job, but I needed independence, and that meant that I needed a job. Since my first day as a nurse’s aide, I have always been at home in a hospital.

I am thankful today for my relationship with New York Presbyterian Hospital, where I have been at home since 1976. My hospital has been ranked No. 6 in the nation in overall care  for several years now. This hard-won acknowledgment of good medical care has come from leadership and integration of staff at all levels in patient-centered care and from constant improvement in all aspects of the patient experience. The physicians at the hospital are exciting to be around because they are at the top of their game and reinforce excellence throughout our hospital community. After my training was completed in the hospital, I moved to my office here at 90th and Madison in New York City. I have been in this cozy office for over a quarter of a century.

This Thanksgiving Day is the one I have chosen for reflection and remembrance of some of the many people and events along my life’s long journey that made it possible for me to have this wonderful life. But I want most to remember those who make it possible for me to give the best I have to my patients and to the women over 40 with whom I have an ongoing conversation online.

I have chosen incredible doctors and therapists, who work with me to solve diagnostic problems and create therapeutic plans, who provide efficient and thoughtful care in their offices and surgical suites, and who always teach me something new and encourage me to be the primary-care doctor that I most love being.

Gynecologists are primary-care doctors, of course, but most don’t have the luxury of time that is necessary to do this when they are seeing many patients, delivering babies and operating on patients. I have left all that behind, because its season for me has passed. I miss the excitement and joy of delivering babies, I miss the camaraderie on the delivery floor and in the operating room, but I knew at each stage of leaving a part of the professional life of an obstetrician gynecologist behind, that it was always the right time for reinvention. I felt on that memorable day in the delivery room, as I gave a baby girl to a beloved patient for the last time, that I had completed a cycle of my life with dedication and joy. My first day in a hospital as a nurses’ aide began in the delivery room, and that memory was still with me at the time of the last delivery of a baby.

The most unexpected joy in my professional life came from the formation of Women’s Voices For Change with Faith Childs and Laura Sillerman, launched on Nov. 21, 2005. We are the Executive Board now of a growing organization that has created www.womensvoicesforchange.org  as a forum for women over 40 to describe and define who we are in this Second Spring of life we call The New Menopause. Our focus began with the need to change the meaning of just one word, menopause. Menopause has been a word that the media, advertising and the corporate world has shunned or used in demeaning ways. Women themselves have chosen denial, shame and fear in response to this word.

The growing numbers of contributors who have joined us write to create a portrait that is an accurate one, not one based on outdated assumptions. We write to give women not yet physiologically or psychologically there plenty of hope that this transition is the best opportunity for self-invention that life will offer them. We write to give templates for hope and change to those in the tornado of the transition.

Women in the New Menopause, who choose to be present and fully aware of their life experiences, learn to use the fuel of this sometimes volatile life passage to make choices and create their own change. We learn what is important, we divest ourselves of the unnecessary, and we focus on ways to make meaningful change in our individual lives, our communities and our country.

I am especially thankful today for the extraordinary and unexpected contribution to Women’s Voices For Change from two donors who wish to remain anonymous, along with a recent event given for WVFC by the extraordinary jeweler Verdura. These important gifts will allow us to implement a long dreamed of way to include women across America in the creation of our portrait of women who are unafraid of the word menopause, and who will encourage those in the media and the advertising and corporate world to recognize us for who we really are. Women in The New Menopause are visible, and we are well positioned to be part of the reinvention of our country as we face a new normal no one wanted and many refused to expect.  We are more highly educated. We control more of the economic resources than any other demographic in this country. We are politically active across the spectrum. We decry political inactivity and waste in the government that has so little now. Waste will be noticed and noted again and again.

I am thankful for all the members of the Board of Women’s Voices For Change. Each brings wisdom, intelligence, creativity and energy to our mission. Thank you Faith Childs, Laura Sillerman, Elizabeth Hemmerdinger, Catherine Wood, Lisa McCarthy, Leslie Frances, Dr. Elizabeth Poynor and to our newest board member, Coleen Caslin. We are all thankful to our Executive Director, Mary Kelly Selover, and the staff that supports www.womensvoicesforchange.org, directed by our editor, Chris Lombardi. We bring joy and support to each other as we work on our mission to make the New Menopause a life destination that is viewed with optimism.

On this Thanksgiving Day, Nov. 26, 2009, I am grateful for our readers who are becoming our writers. Our small effort that has grown only with the help of the famous public relation firm, “word of mouth,” makes a difference only with your voices that are diverse and memorable. Write your way through The New Menopause with us and give other women who are without support and knowledge of options your description of the best time of your life. And when there is a rough patch, write through it and know that we are here with you.  Do the work that allows you to reinvent yourself, and write about it here at www.womensvoicesforchange.org.

Happy Thanksgiving.

Anesthesia and Amnesia: Wisdom From Age To Just Deal With It

July 13, 2009 by  
Filed under Humor, Musings

patlunch1croppedThis morning I had a visit with my very competent oral surgeon on New York City’s Central Park South. Since I would receive sedation for the procedure, I was fasting overnight and none too happy. No coffee — and it was morning. The surgeon behaved like a saint while I whined about yet another visit, yadda yadda. But, I do remember he got that IV into me really quickly. “At least I don’t have to listen to anymore words from her mouth,” I could just hear him saying to himself as I drifted off.

It is odd being partly awake and yet unaware of time — luckily having no discomfort, while still being able to follow directions: Hold this, move that, bite down.

When the procedure was completed, I was freezing, since my natural thermostat requires 85 degrees Fahrenheit for real comfort and this surgical suite was about meat-locker temperature. I was given a blanket for my shoulders and felt better. I declined the offer to sit in the recovery room, since I knew there was coffee at the front desk, which the kind receptionist had promised me would be in the waiting room when my procedure was completed.

sarabethsAfter my coffee, I felt still a bit tired. I decided that since I had hours off from work, I would treat myself to breakfast at Sara Beth’s on Central Park South.  It’s at the base of my friend’s building, one I know well; and I do love the restaurant’s wonderful breakfast choices. It was only a few feet away from my surgeon’s building.

The sun was shining on the tables outside on the sidewalk. The park was visible across the street. My coffee and omelet were as good as I had imagined they would be. I took time to read the papers, feeling like a tourist on holiday.

I paid my bill, stood up, picked up my orange purse cand prepared to leave. Years of leaving things behind have trained me to look around carefully to make sure that I have left nothing important behind. Then I saw it: a dark navy wooly blanket, on the back of the chair. It had been on my shoulders as I swished along the sidewalk feeling quite pretty, thank you very much, and then still there as I had enjoyed my time alone for breakfast al fresco at my table for the hour of my holiday breakfast. I had, however, been draped in an old woolly blanket —in July, just half a block from Bergdorf.

Then I realized that the anesthesia impact had been a bit more than I had expected. There is a reason doctors tell you to make no important decisions for 24 hours after anesthesia, after all. So, I picked up my blanket, folded it nicely and returned it, just up the street to the concierge at the surgeon’s office building.

This growing older thing is becoming more attractive I realize now. I can wear a blanket at breakfast just off Fifth Avenue, simply because I am cold and no one cares. The days of public embarrassment are over.

The Economy Is In Real Trouble When The Upper East Side Sex Toy Shop Had To Shut Down

patlunch1croppedThe loss of sexual interest among menopausal women has clearly become no longer newsworthy in this time of falling stock prices and rising unemployment. Otherwise, why wasn’t it big news when the uptown vibrator store had to close down because of the recession?

Myla, a British lingerie, swimwear and sex-toy line, opened its shop doors just off Madison Avenue at 16 E. 69th St. in September 2004. This was very expensive real estate, and the shop was quite nicely done up. The New York Times did a big piece for the opening. Curious middle-aged women, after lunch at one of their favorite bistros in the neighborhood, came to air shop — to oooh and twitter — and then sneaked back later to buy the goods. A little sexual novelty was good for her and good for him.

Long-term monogamous relationships often run low on libido, especially when the wife has reproduced twice and then flies into the frightening 40s. During the good times, there were trips and spa weekends with the girls; Prada bags and fashion openings; gala events, and summers often spent separated during the week. It was easier, then, for certain wives to initiate sex and work at the orgasm thing, and a vibrator often came in handy. Intimacy, for many of these relationships, was never part of the package, and hot, easy sex that lasts needs some of that elusive spice.

Menopause, with its well-publicized symptoms of volatility and loss of libido, has always been convenient for those women who maybe never liked sex all that much, and for those who married someone with neither great knowledge of female anatomy nor the capacity to be a thoughtful lover.

Many women did find, though, that they missed the girl they once were, or else wondered if they could ever be the sort of woman whose orgasm is easily achieved. The booksellers’ shelves were filled with manuals on how to do it.

  • Pole-dancing classes were sold out two years ago.
  • Goddess tutors helped women find their sensual selves.
  • Physical therapists taught women how to improve their love muscles.

Partners were delighted if women showed any interest in doing it, and unless they were real cads, really wanted to be part of a woman’s orgasmic event.

And up there on 69th Street, just off Madison Avenue, Myla was having a boom time in the good times, with its sweetly sexy lingerie and vibrators that weren’t purple with multiple prongs.

Women, those of us who grew up after the sexual revolution in the late 1960s, if we were interested in sex, generally had a vibrator tucked away, somewhere where the cleaning woman and the kids couldn’t find it. But for the shy and somewhat inhibited woman, a vibrator was often a subject never discussed or acknowledged. I must confess that I visited Myla after The New York Times article — purely for professional reasons, of course. Then I began to give their name and address to patients who were having trouble re-starting the mid-life sex engine, as part of the general conversation that should be part of every visit to a gynecologist. You know, “Any pain in the abdomen? Is the bowel function normal? Any bladder problems? And, how often are you having an orgasm each week?” I am sure your gynecologist asks that question!

Women who complained that they had no libido and could no longer have an orgasm when there was no emotional or physical barrier to successful sex often just needed a bit of genital rehab with local estrogen, coaching and cheerleading and some new ideas to consider. Throw out those nightgowns or T-shirts you sleep in, buy some new lingerie, and how about a vibrator? Practice practice practice was the motto, and motivated women did indeed get their sex lives back for themselves and their partners.

Then the recession slammed households and relationships all over the country. But especially hard hit were many of the relationships that were based primarily on commercial and reproductive transactions. Women who were anywhere near “The New Menopause” grabbed the menopause label; they effectively said, “I am in menopause, honey, and I am done.” Unless these relationships can be reinvented, menopause will continue to bear the blame for this malady, as it has done for so long for other unfortunate conditions.

mylasummerWe at Womensvoicesforchange.org want women to have access to the latest knowledge about all aspects of their menopausal health. And the good news is that sex is generally free, and a mutually orgasmic relationship improves pair bonding and reduces stress. No creams or potions will give a woman’s complexion that post-orgasmic glow. And, nothing makes a woman matronly quicker than giving up sex.

Also, my favorite vibrator store still exists, but in the United States it is now only online. You can find it at www.mylausa.com.

You heard it here first.

Dr. Elizabeth Jelks on Eye Surgery and Dry Eyes

May 27, 2009 by  
Filed under Body Image, Medical Concerns

Dear Dr. Pat,

I am 54 years old and want to have surgery to correct the droopy skin of my upper eyelids and the puffy bags of my lower eyelids. People who know me well tell me that I look tired all the time even though I sleep well and am fortunately in good health. I am, as so many of us are these days, in a competitive job market and can not afford to be thought of as “tired.” I understand that eyelid surgery can result in dry eye, and I really would not want that. What are the chances that I will have this problem?


Dear Sharon,

Many men and women choose to have eyelid surgery, or blepharoplasty, to correct the problems that you have just described. The eyelids themselves stretch as we get older, and the muscles that support the eyelid skin also weakens. This often allows fat to accumulate above and below the eyelids. This surgery is done not infrequently for functional change in vision when the skin hangs over the eyelashes and affects peripheral vision. The end result of this change in tissue of eyelids and under the eyes is often sagging eyebrows, drooping upper lids and bags under the eyes. We are delighted to introduce our readers to a new Medical Advisory Board member, Dr. Elizabeth Jelks, who after a successful first career as an emergency physician is now an expert on reconstructive eyelid and facial surgery, as well as cosmetic surgery. An expert in oculoplastic surgery, Dr. Jelks has co-authored medical journal articles and chapters related to oculoplastic surgery and conducts courses in the subject as well.

I have sent this question to Dr. Jelks for an opinion on this important question. It will be nice, Sharon, to look alert and to look as good as you feel!

Patricia Yarberry Allen

ebjheadshot_webDear Sharon,

Your question is a common one for patients considering having blepharoplasty. There is a misconception that blepharoplasty causes dry eye. In some patients, the surgery causes a response that affects the tear-producing glands, and this is perceived as “dry eye.”

There are multiple tear-producing glands in the conjunctiva, which is the thin tissue lining the eyelids and covering the white part of the eyeball. These various glands, plus the lacrimal gland at the outer top of the upper eyelid, produce three layers of the tear film.

  • First, there is an inner mucinous layer that attaches to the cornea, a middle aqueous “watery” layer, and an outer oily layer that helps to keep the tear film together between blinks. These tear producing-glands are affected by the edema (swelling) and inflammatory response that occurs in the immediate post-operative period. When the glands are not producing normally, the result is tear-film dysfunction (TFD). This can result in blurry vision and sometimes sensations of irritation.
  • Second, as we age the amount of tears we produce decreases; we are more sensitive to hot, dry climates, wind, airplane flights and similar situations. Thus, the older patient having a blepharoplasty may be prone to a period of tear film imbalance.
  • And some patients would have a greater tendency to develop temporary post-operative tear film dysfunction: those with immune disorders such as thyroid disease and rheumatoid arthritis, patients with rosacea, and patients on medications such as anti-histamines and anti-depressants.

blephuwThe blepharoplasty patient is evaluated pre-operatively to determine if there is any lid margin disease to be treated before surgery. We test for something known as the “tear break-up time,” a test that judges the stability of the tear film. If there are abnormalities, medication is available to treat the lid margin and stabilize the tear film prior to surgery.

As the post-operative edema and inflammation resolves, which takes the first several weeks, the tear film should return to its pre-operative baseline. All blepharoplasty incisions are designed to minimize damage to our tear-producing glands.

To summarize: No surgery is without potential risk. But if you choose a surgeon who is experienced and does many of these procedures on a regular basis, you are unlikely to have this problem.

On Batting 1,000

May 20, 2009 by  
Filed under Musings

sillermanChris, our inspired and inspiring editor, informed our board that we reached our 1000th entry today. It occurred to us that the news reached the Board, who first met in my kitchen four years ago,  in precisely the same places as our readers find themselves.

Some of us are at near low points on our journeys, and others are in pretty great shape. One is anticipating a very artistic summer, two are involved in breakthrough medical care, another is at the center of a cultural universe, another is practically dismantling the bomb of the economy single handedly. We’re doing mom duty; we’re doing daughter duty. We’re high fashion sometimes and jeans a lot of the time. We mostly take care of ourselves (none to the height of Dr. Pat’s bar, but some mighty close). We have husbands who love and depend on us and ex-husbands who once did. We have busy lives that we sometimes want to flee from, but mostly we take responsibility for.

We are just like you out there, and that’s why we’ve reached Number 1000—because the buzz around women of our age is a sound that feels like it must be made in public. None of us is particularly New Age, but none of us would deny that WVFC feels as much like a channel as it does a blog site.

Photo from All-American Girls Baseball League, 1943

We reached our fourth digit because all of us respect the number of decades it takes to get it right. And while none of us is batting 1000 personally, we believe that–as a demographic–no one has a better average than the women we represent.

Congratulations to all our readers for all the words they’ve inspired. We toast you on this landmark day and thank you for being the reason we got here.

Dr. Pat: 1,000 Posts Later

May 20, 2009 by  
Filed under Newsmakers


Patricia Yarberry Allen: Blog number 1000 went up today at www.womensvoicesforchange.org.

We began to write on November 21st, 2006. We chose to write to create a realistic portrait of women over 40. We knew that we were not the stock characters in sit coms. We knew that we weren’t invisible. We knew that we were just reaching our peak. We had not been left on the shelf because we had a sell by date that had passed by.

Our readers joined in our conversation with comments, and have often then joined us as writers. We look forward to new stories and new insights.

Our marketing has always been that old standby: WOM. That would be word of mouth. All my friends know that I am really a fat balding editor chewing on a cigar caught in the body of a menopausal woman. I am always looking for new writers and want to hear their stories.

We have Poetry Fridays. We have a vital Medical Advisory Board. Many of the writers who contribute on a regular basis have recognizable voices and readers who look forward to hearing about their passions.

We have a wonderful editor, Chris Lombardi, who contacts our writers whenever there is breaking news and makes it easier for us to be part of the national conversation. She talks us through story ideas and supports us as we write and re-write. Everyone needs an editor and we have a wonderful one.

None of us could have imagined how thrilling this experience has been. I must admit that writing is a joyful experience as long as the Muse is around. But she is a fickle bitch, out drinking bourbon with some scandalous playwright just when I need her most.

Blog post number 1000: this is a milestone to celebrate.

Dr. Pat: Faith and Champagne

March 31, 2009 by  
Filed under Musings

ariannachampagneWomen’s Voices for Change had a fantastic lunch today in New York City.  We introduced the first of our “Conversations With” events featuring Arianna Huffington and Silda Wall Spitzer.  The lunch was sold out almost before the tickets left the post office.   Women clearly want to understand how other interesting women navigate midlife reinvention or sometimes just midlife evolution.  These women really had something to say and the audience was aware that they were present at something very special.

faith2After lunch, my friend Faith and I decided that we would celebrate.  We walked down Fifth Avenue in the glory of a spring day bathed in warmth and sunshine and decided that at 3:45 we were ready for champagne.

peninsula1The Peninsula Hotel is at 5th and 55th.  The small tea room/bar is just off the lobby and up half a flight of stairs.  Even though we were 15 minutes early for booze, the staff were delighted to make us happy.

We had not eaten lunch so we had olives, tea sandwiches and champagne while discussing every moment of the lunch and how happy we were that it had gone well.  We stayed on that comfortable sofa for two hours with no deadlines, no phone calls, and no one waiting for us to make an executive decision.  There really is nothing more glorious than this..  A great friend, shared interests and champagne.