Category Archives: women

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Hormones and rabbit holes

Medicine is confusing right now. Ok, it is always confusing because we try to base it on science and science is always changing. There are always special areas that are currently a mess. Hormones!

I speak to a patient recently who is female, premenopausal, and is getting hormone replacement therapy for hot flushes and not sleeping well from an outside source. The person wants me to order hormone tests. I do order hormone tests but not the ones she has in mind. I test a TSH, thyroid stimulating hormone, to see if she is low or high in thyroid.

She is thinking of me testing estrogen and progesterone and other related hormone levels. The party line from gynecology MDs and DOs is that these are not useful tests because women’s hormone levels are so varible. However, there are lots of naturopaths out there and functional medicine MDs and DOs who will test levels. Why is the patient asking ME to test them? Most of those naturopaths and functional medicine providers do not take insurance and charge cash. Also, insurance may not pay for them anyhow because the party line is that they aren’t useful. Why would the cash providers check levels? One reason is CASH. Another is to prescribe “bioequivalent hormone replacement”. Sounds natural, right? Well, the natural thing was for the hormones to stop at menopause and all of the hormones are either made in a laboratory from plant pre-estrogens or from pregnant mare urine, so bioequivalent seems to imply natural but it really isn’t. Pills do not grow on trees, they are made by humans in laboratories.

However, I question party lines, and off I go down the hormone rabbit hole. The current guidelines are that female hormone replacement, after menopause, should be lowest dose possible and only for a maximum of three years because of the increased risk of breast cancer. This doesn’t address my question: does premenopausal hormone replacement count as part of those three years? I may need to ask gynecology. I don’t think it counts. A woman is postmenopausal when she has had no periods for a year. Or had her ovaries removed. Or if she’s had a hysterectomy and still has her ovaries, a yearly follicle stimulating hormone and lutienizing hormone test. Both tests rise when the ovaries stop making hormones and eggs.

Also, there is another caveat. We know that when men are on opioids, the opioids can suppress their hormones and lower testosterone. Here is a paper: https://pubmed.ncbi.nlm.nih.gov/31511863/. Half the men studied in multiple studies had low testosterone when on chronic opioid therapy. 18429 subjects (patients) in 52 studies. That is a lot. Women studied? NONE. What? Yeah, none. Why? Here is part of the answer: about a decade ago I worked with the UW Telepain group and asked the head of the UW Pain clinic a question. “If opioids lower hormones in men, do they in women too?”

His reply, “I don’t know.”

“Have you ever tested a woman?”

“No.”

“Isn’t that sort of sexist?”

“Yes.”

So here I am, rechecking a decade later, and we still don’t know if giving women chronic opioids messes up their hormone levels. It would be more complicated and difficult to check women. We might have to do individual hormone baselines or something in premenopausal ones, say, 2 weeks after menses. Remember that for most of the history of medicine, clinical drug trials were only done in men, because, well, sexism. They said women could get pregnant. Yes, but then we gave the drugs to women who could get pregnant. Also, postmenopausal women can’t get pregnant. The whole thing seems stupid to me.

There is an interesting new finding here: https://neurosciencenews.com/estrogen-t-cells-pain-28548/ . Apparently in women, estrogen and progesterone work on receptors at the base of the spine to reduce pain signals using T cells, part of the immune system. The article says this doesn’t happen in men, but they were studying mice. The male mice didn’t seem to have worse pain after estrogen and progesterone were blocked. The female mice were in more pain. But wait, estrogen and progesterone are produced in men as a by product of making testosterone. Less than women, until menopause. Then the 70 year old man has more estrogen and progesterone than his postmenopausal wife. The article says that they don’t know why the receptors are in women and female mice (um, my intuitive guess would be childbirth and micebirth, right? Men don’t do that and women giving birth to a child after the first one sometimes say, “WHY did I want to do THIS again?” I think those receptors are so that women and mice can get through more than one pregnancy.) Now I need to read the article again because maybe men and male mice don’t have the receptors, even though they do have some estrogen and progesterone. Maybe they just don’t have enough estrogen and progesterone.

Maybe we can’t figure out women’s hormone because men aren’t smart enough, heh, heh. Yes, that is sexist right back at all those historical figures who didn’t study women.

At any rate, that still doesn’t answer my two questions: does premenopausal hormone replacement count towards the three year total beyond which hormone replacement increases the risk of breast cancer? And does chronic opioid treatment lower women’s hormone levels?

_________________

For the Ragtag Daily Prompt: hormone.

I took the photograph of a Port Townsend rabbit in 2011.

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Cauldron

2 Ways to Manage the Emotional Cauldron of Anger
Freud’s Theory of the Unconscious Mind

So, the iceberg graphic is wrong, wrong, wrong. Am I right? Icebergs are about 90% below the surface, which is NOT what the picture shows. Regarding the first article, preset timeouts? I think when two people are losing it, that may go by the wayside. My strategy is, “I have to use the bathroom.” It might take a while if I am really upset and want to rip the sink off the wall. But, it lets me cool down, cool off and not say terrible things. Let them stay inside my head until I am calmer and realize how stupid and nasty I wanted to be.

But let’s think about cauldrons, yes? A stew of emotions? Our culture still has little respect for emotions. Just think if we were all nice on the surface all the time and never showed any other emotion. Bunch of AI robots, I think.

Cauldron

It’s not so surprising to look up the emotional cauldron
and have it be about anger. Anger in couples, but the cauldron itself
brings up witches and therefore women. Women in black
women with cauldrons, women boiling angry.

I vacillate between thinking that black men are treated the worst and then, no,
women are treated the worst. Assumptions, useless, toys, pretty, be nice,
true that women don’t get shot as much, but our country found a black man acceptable
in the white house, but not a woman, black or white.

Anger is not nice, I am told. But anger is appropriate at injustice, when people
are discriminated against, treated badly, pushed from homes, jailed, hung and shot.
Much of our country reveres guns to protect homes, a man’s home is his castle,
and what is left for women? Not the workplace, the public, the home.

How dare they take the cauldron as a symbol of anger stewing?
The truth is that men fear women’s anger and rightly. They fear the people
who are enslaved, discriminated against, shot and dismissed, rising up.
Rising angry, anger not in a cauldron, but hot as lava and righteous.

A sermon about fear and abuse and the minister says, this is where anger can be understood
and is right. Anger at the abuse and at the fear, letting people break free.
Energizing a person to leave abuse, to leave an intolerable situation
and no reconciliation without the abuser taking responsibility.

What the cauldron really holds is greed, the people who think they deserve
more than others, more money, more women, more adulation, more more more.
Greed, gossip, lust, and all the other sins. Anger at mistreatment is not wrong
though it may not be safe to show it. Let it be conscious even if not expressed

and fight on.

For the Ragtag Daily Prompt: emotional cauldron.

The photograph is my mother, Helen Burling Ottaway, in 1945. She was seven. I have photographs of my daughter and me with the same expression. Not anger, thought. I cannot credit the photograph because I don’t know who took it.

And to lighten the mood, both sexes are profiled.

Not all anger is right, though, and it’s often because of different interpretations, different frames of reference or misunderstanding.

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Fashions

I did not sort out Italian fashions in the two weeks I traveled with my daughter.

For one thing, we were mostly in tourist areas. It was hot, though not as hot as August. Very thin straps on tops and short shorts or skirts were to be covered to go in to the big churches and the Vatican Museum. Having to cover up is just a little ironic since so many of the sculptures are nude or partly nude, both male and female.

I took a black skirt and a pair of pants that are loose and flowered and cool. These proved to be very good guesses for my age group. I had washable travel button down shirts, which worked well. I never used my fleece jacket or rain jacket, on this trip. My feet complained and I might choose different shoes next time.

One recurring theme that I noticed is leopard prints. Dresses, skirts, shirts, blouses. I saw them in each of the five cities. There also is a recurrence of rompers. My daughter comments, “There are very few people that look good in rompers but mostly people don’t.” I didn’t like them in the 1970s and I don’t like them now. We did see a very few either tall or thin or both women who carried them off.

Tourist wear is all over the place but mostly is driven by the heat. Hats were for sale to tourists and large scarves to double as a skirt to cover short shorts or skirts.

For the Ragtag Daily Prompt: unclear.

This website seems to think leopard prints were in this year. I really do not know. Do you?

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Supplies

When my (now ex) husband and I were first married, we bought two gold chains. I was just starting medical school. Third year we hit the wards. This meant that I was often running around the hospital wearing scrubs, rings off. I wanted a chain to put my wedding ring on. Some people tied them to their scrub pants, but they can get lost.

I go home from Richmond, Virginia to Alexandria. We show the chains to my parents, both used ones, but gold.

My sister reports to me later. “Our mom said, why are they buying gold chains? That’s dumb. They don’t have any money!”

“Maybe they want them,” says my sister.

“Well, I think it’s a waste.”

“You bought more paper the other day.”

“Oh. Hmmm, yes I did.”

“You aren’t using that paper yet and you have an entire vault of paper.”

“Yes, but I am an artist. I need supplies.”

“Katy wants the chain for work to put her ring on. How is that different?”

“Oh, well. Maybe you’re right.”

I am very pleased that my sister defends me but it also was very funny. My mother had a stack with one by ones with thin 24 by 30 boards, on them, stacked five feet high to put paper in. Cheap shelves, though it would be totally unstable in an earthquake. She bought paper that she loved and used it too. She did watercolors, etchings, carried a sketchbook everywhere, oils, scorned acrylics, woodblocks, clay, colored pencils, chalk pastels, oil pastels and then she loved crafts as well. She was a master of paper mache. Artists need supplies, but everyone has something like that. My daughter did not get the pack rat gene and is a minimalist, but even she has some things she really likes. Real stationary, for one.

I wore that chain for more than 14 years. We were divorced at 14 years but are still good friends. My ex went on the nursing school and has been a Covid-19 hero, much to some people’s surprise.

My mother was inconsistent, as we all are. She prided herself on being frugal and not spending money, but when it came to art supplies, she wanted them. She still could be frugal but she certainly had the supplies and she would stock up when beautiful paper was on sale! And pencils and pastels and watercolors and oils. My father would quote Ralph Waldo Emerson, “A foolish consistency is the hobgoblin of little minds.” Both he and my mother would call each other out when one was being inconsistent. They could be very very funny.

The lead photograph is from winter 1991-92. Mark Warren Wilson, Helen Burling Ottaway, Christine Robbins Ottaway, me and Malcolm Kenyon Ottaway. Taken by Joel F., my sister’s first husband, with my camera. This next was taken by my father and there is Joel F. We went to Colorado and all stayed in a condo and skiied. My father found out that he really did not like heights, either driving or the ski lifts. Joel and Mark staged a pretend dramatic argument making fun of Chris and my arguments, and they were right on. We were quite embarassed and annoyed, but not instantly cured. And the skiing was delightful.

My mother, father and sister have all died. I do miss them. Hugs for all the recent losses of people.

For the Ragtag Daily Prompt: inconsistent.

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Establishing a diagnosis

All of the Long Covid information is pretty confusing, isn’t it? I’ve read that most of it resolves at nine months. Another article says a year. The conference last week says that 96% are clear at two years if they are treated. What percentage are being treated? The US defined Long Covid as symptoms lasting over a month at first, while Europe said three months. I think they have now agreed on three months. This will continue to change and evolve.

When viagra first came on the market, women complained that there was not a drug for them. Pharmaceutical companies were working on it, but you cannot treat anything unless you establish a diagnosis first and women’s sexuality is more subtle then men’s. Anyhow, I wrote this silly poem making fun of the whole thing.

Little Blue Pill

Little blue pill
Little blue pill
Help me help me
I’m over the hill

Don’t wanna have sex
Nope nope nope
Little blue pill
Gives my husband hope

Can’t make a pill
Til we define the disease
Doctors would you
Hurry up please

Little blue pill
Little blue pill
Help me help me
I’m over the hill

Thought them hormones
Would make me hot
Doc was right
They did not

Hot flashes make me
Sweat and moan
No help from that
Testosterone

Little blue pill
Little blue pill
Help me help me
I’m over the hill

Doctor this
Is really no joke
My husband says
He’ll slit his throat

Can’t make a pill
Til we define a disease
They’re trying hard
Those drug companies

I think we’ll know
If they define a disease
Drug companies will plaster it
On tv

Doctor I found
Just the thing
A brand new stimulating
Clitoral ring

Don’t wanna have sex
Nope nope nope
Little blue pill
Gives my husband hope

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For the Ragtag Daily Prompt: establish.

I took the photograph of the old drug bottles today. I like that the potassium oxalate just says POISON on it and gives antidote instructions. Also, no guarantee on the clitoral ring, ok?

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Finish line

I did manage to cross the finish line for the Blogging from A to Z.

It was a bit tricky because I had a last minute trip. I got the tickets last Sunday and flew on Tuesday. I flew back on Friday and got home on Saturday. I traveled super light: no laptop, no big camera, only phone and a small day pack and one change of clothes, so I washed some by hand daily. I am proud that I still got the A to Z done!

I feel more like a finisher than a winner. It does feel good to share so much of my mother’s artwork. Helen Burling Ottaway died at age 61 in 2000, so her artwork did not have much of an internet presence. She is present in the Lake Matinenda Cottage Owners Association here. She and my uncle and other family and friends worked on a Matinenda flora of the wildflowers and plants. There have been two more since.

Hooray for everyone who contributed to or supported or read the Blogging from A to Z this month and hmmm, what should I do next year?

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Daily Evil: Y is for Yellow

Yellow can mean fear or cowardice, but it is also a color. Sunlight, summer, warmth, daffodils, spring and tulips.

This watercolor by Helen Burling Ottaway is from 1999 and my daughter chose the mat. I love her choice, the orange picking up all the oranges and yellows in the painting. Orange would never occur to me, but it is wonderful.

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Daily Evil: X is for Xenophobic

Are phobias evil? A fear of strangers or of foreigners. I think a phobia can make someone behave strangely or dangerously and harm others. I think that the isolation of the pandemic has increased our fear, so it may well exacerbate xenophobia. Not only the pandemic, but inflammatory news and war and changing weather patterns and the news that one in five trees is dying in part of California, unable to survive the warming.

This is a watercolor, again no date, but I think it is of the Olympic Mountains. That means it was painted in the last four years of her life, between 1996 and 2000. She and my father bought five acres with a house and barn in Chimacum, off of Center Valley Road. She loved the views up and down the valley. She was diagnosed with ovarian cancer in 1997 and died in 2000.

The mountains look like they have a crosshatching, Xes to indicate snow and valleys and places where the snow can’t stick. Or has fallen down.