The Hemp Connection:
mental health

Every other Sunday morning, I pull out my “old lady pill boxes” and load them up with my current selection of supplements, some of which are for PCOS. At times, I confess, I’ve been known to take as many as 90 pills a day. If that sounds kind of crazy, I’m in full agreement with you. I often incorporate Chinese remedies prescribed by my acupuncturist, and those are typically dosed at three to five capsules, three to four times per day, which can quickly add up. I don’t do that anymore. But I routinely take a hearty little handful of things like fish oil, D-Chiro Inositol, Vitamin C, and alpha lipoic acid. I’m sure many of you do too – or you think you should be, if you’re not.

Some doctors want to know everything you’re on, and some don’t bother to ask beyond the fish oil or the Vitamin D3. I actually keep an Excel spreadsheet listing everything I currently take, both supplements and prescription medications. This is for my own tracking purposes (so I can see if there’s something I’ve tried in the past and deleted because it didn’t do anything for me – no point in trying those again), and for the doctors who want a comprehensive record. It’s too much to track on, and often doesn’t fit on the few lines given on a doctor’s intake form. “See attachment” is my favorite labor-saving phrase!

As I updated my spreadsheet today, I got to thinking about the lure of supplements. Americans spend $20.3 BILLION dollars (NIH, 2004) per year on supplements. That’s a staggering amount of money for something that isn’t guaranteed effective, may be irregularly dosed, and can be just as powerful as prescription medications. And yet, we continue to buy. PCOS patients in particular are prone to chasing the latest and greatest potential cure – or at least, anything that might offer some symptomatic relief. When you’ve got a condition that’s frustrating, complex, inconsistent, and impossible to permanently resolve, you’re vulnerable to the seduction of marketers, Twitter feed, and anecdotal reporting.

At this point, I try to limit my supplementation to things prescribed or recommended by my physician, dietician, and/or acupuncturist to treat the symptoms that most concern me, such as high blood sugars and inflammation. If I hear about something new that holds some promise for my PCOS, I research it independently and then make a decision about whether or not to add it to my repertoire. I’m mindful of the fact that there’s a great deal we don’t know about supplements, just as there’s a great deal we don’t know about prescription medications. My goal is to support my body in becoming as normal as possible.

Periodically, I get disgusted with the whole thing, decide it’s too many pills, too complicated, too much money, and too overwhelming. Then I take a supplement vacation. And in the meantime, I’m continuously researching and contemplating what I can delete, or if perhaps it’s best to eliminate supplements altogether. The supplement vacation usually lasts a couple of weeks, and then I go back into it a little more strategically, and with greater consciousness about my own need to be “fixed,” and how that can lead to bad decision-making.

If you take supplements, I encourage you to think about them consciously, and not just chase the promises. If you don’t, don’t feel bad about it, but consider what might actually be beneficial to your mental as well as physical health (fish oil comes to mind!). Be willing to experiment, monitor, and make adjustments. Be patient with your body and your brain. Seek consultation with experts. Do your own research. Treat yourself with the importance you deserve.

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.

For the last few weeks, we’ve been looking at the grief process through the lens of DABDA (a model that focuses on the stages of grief – denial, anger, bargaining, depression, and acceptance). When it comes to dying, acceptance is important¸ but not necessarily critical – if you’re terminally ill, you may die before you reach a place of acceptance. With PCOS though, you’ve got a life-long condition. If you don’t accept it, you’re likely not taking care of it properly. The good news is that acceptance is something you can learn.

Acceptance looks like:

• Generally being pretty okay with what’s going on, even when it’s unpleasant (so you don’t like hearing that you’ve got pre-diabetes, but you’re going to do the recommended diet consistently)
• Eating, sleeping, and exercising appropriately, even when you don’t feel like it
• Practicing good self-care, even when it’s inconvenient
• Having a stress reduction practice, such as meditation, yoga, or therapy
• Being grateful for what you do have (if you can’t quickly create a list of at least ten items, you may be dealing with low self-esteem or depression, which can be helped through therapy)
• Being genuinely happy about the positives of your life – kind of like being grateful, it’s about having a balanced perspective, rather than just focusing on the negatives
• Treating others with kindness, because it’s the right thing to do, and you’re not so angry about where you are and what you’ve got that you’re taking it out on them
• Not constantly comparing yourself to others, because you don’t need to – you know you’re not perfect, but you’re okay with it, and you’re working on what you can
In other words, happiness is about balance, perspective, equanimity, self-respect, and self-care, all coming together to remind you on a regular basis that you’re actually pretty okay, in spite of your PCOS – and even though the PCOS is a drag¸ you believe you can manage it.

Although this concludes our review of the DABDA process, we’ll look at bringing it all together (remember, grief is a non-linear process, and these emotions can pop up at any time, or repeatedly) and incorporating it as a permanent point of reference.

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.

This week continues our discussion about PCOS and the grief process, through the DABDA (denial, anger, bargaining, depression, and acceptance) model. Depression is so common among PCOS patients that I write about it quite often. It’s important for you to remain conscious of the clues that you may have depression. Many, if not most of my PCOS patients have some form of depression.

When we’re talking about depression in the context of death and dying, it looks like it does in PCOS too. If you’re suffering from depression, PCOS-related or not, it might look like:

• Sleeping too much or not enough
• Eating too much or not nearly enough
• Being irritable, snappish, and short-tempered
• Feeling suicidal
• Feeling hopeless about your future
• Feeling helpless to do anything to make things better
• Having an overall gloomy, pessimistic perspective on life

It is certainly easy to feel down when you think about the fact that PCOS is so challenging, misunderstood, and often misdiagnosed, and mistreated. It is one of those conditions that benefit less from standard medical treatment and more from diet, exercise, and good self-care. It comes with embarrassing physical symptoms that are time-consuming and costly to manage. There’s not a lot of research being focused on the condition. All of that is definitely overwhelming.

Not to mention, the hormonal imbalance inherent to PCOS can cause depression, even if you manage to maintain a positive attitude, take good care of yourself, and have a good support system. Sometimes, depression invades your mind and soul, because your body’s overwhelmed your coping mechanisms. Depression is best-treated by a professional therapist, sometimes with the assistance of a medical doctor known as a psychiatrist (a specialist in psychotropic medications – medications for mental health conditions).

Next week, we’ll talk about the final stage of the DABDA process – acceptance.

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.

This week we’ll talk about bargaining, from the perspective of how bargaining plays out in relationship to our PCOS, and the sadness and grief that are often parts of PCOS. Bargaining is part of the DABDA (denial, anger, bargaining, depression, and acceptance) model that is typically applied to chronic/terminal illness. In the dying process, bargaining looks quite similar to what it looks like in PCOS, although it tends towards making deals with god, or trying to manipulate doctors. In PCOS, it looks more like this:

• Making a deal with god to be more attentive to him/her, if only the PCOS will go away
• Trying to negotiate with doctors – “Okay, so I’ll take the metformin like you said, but I’m still going to keep eating fast food, and it should all balance out, right?”
• Negotiating with your dietician, personal trainer, etc. – “I’ll do the cardio, but then I don’t have to do weights today.” Or, “I’ll come in three times a week, but only if you cut your fee in half.” Or, “Look, I know that dark green leafy vegetables are really good for me, but they give me gas, so can’t I just have a (pre-sweetened, sugar-laden, actually junk food) yogurt instead?” (HUH?! As you can see, we get very creative with our attempts to avoid what we don’t want, and get what we do want instead.)
• Over-exercising in order to compensate for eating badly – we develop a strange, twisted, internal logic that allows us to, essentially, do whatever we want. We convince ourselves that there are no consequences.
• Eating badly but taking lots of medication or supplements – this is another favorite form of a secret internal balancing plan that absolutely has no scientific or logical merit. It doesn’t just apply to food.
• Figuring, I’m young, I can do what I want until ___ age, then I’ll behave – the damage is occurring now, the bad habits are just getting more cemented as daily behavior, etc.

And here’s the thing about these games that we play with ourselves, our partners, and the professionals who try to help us – who’s it hurting? Really? You know the answer to this one. It’s only hurting you. I know reality is uncomfortable, but you’re spending so much energy on this bogus bargaining practice. What if you applied all of that energy to grounding yourself in reality, and taking small, manageable steps towards getting your self-care practices in line with what you know (or at least believe) to be true?

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.

This post continues our mini-series on PCOS and the grief process. Today, we’ll focus on anger, which is the second stage of the grief model known as DABDA (denial, anger, bargaining, depression, and acceptance). Anger is a tricky emotion. People often label anger as bad, or undesirable. They deny it, refute it, avoid it, hide it, and act out around it. Anger and sadness that feel unmanageable are two of the most common reasons people show up in my office.

In death and dying, the person who is dying may be angry at god, the doctors, herself, her family, the guy who gave her the disease, the environment, and a number of other things. Likewise, the loved ones who are losing someone may have the same types of anger. In chronic illness, we may have the same targets for our anger, which may result in self-hatred, low self-esteem, acting out, and damaged relationships.

There is SO much to be angry about when it comes to PCOS, I’m sometimes surprised that we’re not all raging, all the time. At various times in learning that you have PCOS, and then starting to deal with it, and then just living with it for a long time, you might experience anger towards:

• God, because you have it
• The universe, for creating this thing
• Doctors, because they can’t cure it
• Your parents, because they gave you the genes that cause it
• Any woman who doesn’t have it
• Men, because they can’t have it
• The medical industry, because they haven’t cured it either
• Your body, because it’s not working “right”
• Other people, for not understanding
• Anyone who has children, if you want them and don’t or can’t have them
• Anyone who seems to enjoy perfect health, in spite of living an obviously unhealthy lifestyle (think, daily consumer of fast food who still has a perfect cholesterol panel, and no weight issues)
• Yourself, for not doing your self-care better, or more perfectly
• Any other medical professional, personal trainer, or other well-meaning individual you’ve ever encountered who said something stupid, irrelevant, pointless, misdirected, or just generally lame, in an effort to get your body to behave
• Dieticians who tell you what to eat without understanding your particular brain chemistry

All of this anger might lead you to act out, which could look like:

• Eating whatever you want, whenever you want – in spite of knowing better
• Failure to exercise – again, in spite of knowing better
• Overspending – because if you’re going to be fat, you might as well look good
• Unhealthy sexual behavior – “I’ll take whatever I can get, since no one would want me otherwise.”
• Manifesting other illnesses that are stress-related
• Being verbally or emotionally abusive towards your spouse, your kids, or others

Note that these things are not purely related to anger; they may also be indicators of other conditions, including mental health disorders.

These are big lists, and you are absolutely right to have a lot of anger about a lot of things related to PCOS. But you can’t live in anger all the time. Well, you can, but it’s surely not a healthy choice. So, how do you deal with all this anger, and get it out of your system, so you can move on to something more productive? And why do you even need to do that in the first place? I believe you need to get over the anger for the simple reason that Freud was right on this count – anger turned inwards becomes depression, and we’ve already got enough trouble with that, given the hormonal set-up we’re dealing with. Also, it tends to lead to negativity, self-hatred, and a more pessimistic perspective, none of which is helpful.

You can get rid of your anger in a lot of ways. Journaling, talking to friends, and talk therapy are certainly good choices. Creative expressions may help as well – creating collages, photographs, movies, music, or poetry that express your feelings are all great. I don’t like to encourage violence, but some clients report that there can be some great satisfaction in doing things like playing one of those video games where things explode when you hit them.

In other words, anger is actually a healthy emotion, but you’ve got to handle it the right way. Next week, we’ll address the concept of bargaining, in the context of grieving your PCOS.

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.

I recently mentioned that I was embarking on a mini-series of blog posts about the grief process, and how it relates to PCOS. I talked about a handy summary term known as DABDA, which stands for denial, anger, bargaining, depression, and acceptance. Denial is present in our lives in many ways, and it’s actually a very helpful defense – sometimes our minds go into denial, because unconsciously, they know that we’re not quite ready to handle a crisis, trauma, or issue yet. For example, the woman who sees signs of cheating in her marriage, yet overlooks the hints, bypasses opportunities to question her husband, and insists that her neighbor can’t be right – yet she KNOWS in her heart that it’s true. That’s denial.

In death, denial is often quite literally a failure to recognize or believe that a person is dead, that they died a certain way (i.e., suicide), that the death was unavoidable, or that they are not at fault in the death. While one is in the process of dying, the denial may simply be a belief that it is not possible to be dying from THIS – not me, not now.

Specific to PCOS, denial looks:
• “I don’t have PCOS – it’s something else – they just haven’t come up with the right diagnosis for me.”
• “PCOS is no big deal – I mean, I had to have an IVF and all, but whatever – I got my baby, and now I can ignore it.” J
• “PCOS isn’t like a terminal disease or anything, so why do I have to deal with it?”
• “Having a baby will fix it. That’s 10 years away, but in any case, I don’t have to deal with it now.”
• “Those medications don’t really work (so I’m not going to take them).”
• “If I just can find the right combination of supplements, this will all be okay.”
• “If I go gluten-free, I’ll be cured – but that’s so impossible, I won’t even try.”
• “I’m pretty sure that dark chocolate is a health food, so I’m going to have this entire 3.4 ounce bar.”
• “Exercise is overrated – I’ll just gain weight if I gain muscle mass, right?”

Denial’s great when it really is needed and protects you, like the child who is being molested and denies it until she’s an adult, when it’s actually safe for her to tell someone. Or when you just got a cancer diagnosis, and you don’t quite get that your particular cancer has a 75% mortality rate – and maybe if you realized that before you got a chance to explore treatment, you’d consider suicide to be a good option. Sometimes it’s protective.

Yet, as adults, most of the time, denial is working against us. It prevents us from seeing the real picture of what’s happening with our bodies, our lives, and our relationships. It prevents us from grieving. It keeps us from making decisions that will improve or protect our future. It stops us from eating better, or exercising more, or getting enough sleep (another favorite form of denial that I hear all the time is “I don’t know how I do it, but I can totally get along on five hours of sleep” – to which I say, BALONEY!). It stops us from spending money on the help we really need. It allows us to continue engaging in damaging behaviors, poor self-care, and unhealthy relationships.

If reading this gives you a little stinging sensation of recognition, there’s good news. You can start to acknowledge reality. Talking to someone who cares about you, sharing your fears and the thoughts you’ve been hiding, is a good start. If you can’t do that, put it in writing – it’s amazing how seeing it in black and white can help to bring clarity to your random thoughts.

Next week, I’ll address anger, and the insidious impacts that it has on your health.

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.

A recent inCYST post on grief really resonated with me. Perhaps it’s because I’m a Certified Bereavement Facilitator, so a lot of the work I do is directly related to grief, particularly “out of order” deaths such as suicide, homicide, and miscarriage loss. Or perhaps it’s because there’s so much sadness and loss surrounding chronic illness that, for me, the issue of PCOS cannot be addressed without looking at the issues of loss. In any case, I want to introduce a commonly used model for grieving, since I’ll be talking in more detail about it over the next few weeks, and relating the elements back to PCOS.

Elizabeth Kubler Ross was a physician who worked with terminally ill patients. The model was first described in relationship to terminal illness, and the process that patients go through as they struggle to reach acceptance of their situation. It has come to be applied extensively to grief therapy work. The model is known as DABDA, which stands for denial, anger, bargaining, depression, and acceptance. I’ll be devoting a post to each of these five items.

The first thing to know about grieving is that grieving is a non-linear process, with unpredictable timelines and variables, and that no two people grieve the same way. It’s estimated that most people grieve adequately and appropriately on their own, but about 30% would benefit from the assistance of a professional grief counselor. All of those phases of grieving – denial, anger, bargaining, depression, and acceptance – may occur in order, out of order, simultaneously, repeatedly, in an overlapping fashion, or perhaps not at all before you finally reach a state of peaceful resolution around the loss.

Also, the “normal” grieving process may go awry if you have multiple losses, too many losses occur in a short period of time, or you’re not permitted to grieve openly. For example, your mother dies, and then three months later your sister and brother-in-law are killed in a car crash. Or you’re close to 40, and end up having five IVF cycles in the space of eight months, and five miscarriages. Then you have something called “complicated bereavement.” Complicated bereavement typically needs some outside help to work through.

Grieving doesn’t just take place in the context of death or a diagnosis of terminal illness. Grieving can occur in relationship to chronic illness, loss of finances, sexuality, spouse, freedom of movement, employment, and even in response to seemingly positive situations, such as the birth of a child, which also means leaving something else behind. There may be grief associated with graduating from school, leaving a job or a neighborhood, or a myriad of other situations.

In reference to PCOS, losses may include loss of femininity, loss of reproductive capacity (infertility, miscarriage), loss of health or the illusion of health, loss of freedom (all of the things you can’t or shouldn’t do if you want to be healthy), finances (the money spent on non-covered health practitioners, supplements, special dietary items, personal trainers, etc.), sexuality, relationships, and many other things. There is often a great deal to be grieved, which contributes to the chronic low-level sadness that accompanies many PCOS patients. You may not have labeled what your feeling as grief, but that may in fact be precisely what you’re feeling and doing.

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.

6:30 a.m., Miami International Airport, feeling jet-lagged and just about destroyed from over 24 hours of travel, I looked through my stupor at the people who have come to reside in my head as “The Airport Couple,” a poignant lesson in what happens when you don’t take care of yourself. I love to people-watch at the airport, but this was not my usual people-watching.

They both have canes, are morbidly obese, and have extra-large sodas and pound bags of candy – plain M&Ms for her, peanut for him. The breakfast of champions, especially if it’s Diet Coke. They are struggling to breathe, to move, to walk, and even to eat the candy, yet they persevere. They both have an unhealthy pallor that comes more from poor health than bad airport lighting. Neither one makes eye contact with anyone else, not even their spouse. Their isolation, even in the midst of dozens of people, is profound.

Their misery and shame is palpable, and I feel like I should avert my eyes from their pain, and the practice of their addiction to food/sugar. It hurts to watch them, but I am unable to stop glancing sideways at them, in the way that children do when they notice a grotesquely fat or deformed person and simply cannot keep themselves from staring. I am wondering how they are going to make it onto the plane, and if they’ll even survive the flight, let alone whatever comes next. Selfishly, I hope I won’t have to spend the next six hours stuck sitting next to one or both of them. I feel intense sadness for the way that they’re trapped in their bodies, in their diseases, and their disconnection. I wonder which diseases they have, and how many. I make assumptions about diabetes, thyroid disorders, cholesterol problems, and heart disease. As time passes, and my flight is delayed, I add gout, emphysema, and of course depression to the list.

She is probably 52, but looks closer to 70. Walking is laborious, studied, and painful. Her thighs are so fat that her ability to walk a straight line is distorted. Yet she proceeds to the nearest shop to purchase more snacks for him; clearly, this is a form of care-giving. I think he is older, although it is hard to tell. He is almost immobilized, stuck in the confines of the narrow, hard-railed bench/chairs that are uncomfortable even for people of average size. I look for an oxygen tank, certain that must be part of their apparatus. He is wearing extra thickly cushioned diabetic shoes. I wonder about toe amputations. I think long and hard about this human catastrophe, and how preventable almost all of it is.

We struggle, day in and day out, to manage our PCOS, and whatever other diagnoses come with it. We get tired of eating right, limiting sugar and other carbs, avoiding alcohol and grain-fed meat, getting up at 5:30 a.m. to make it to the gym, taking supplements, and going to the doctor quarterly for check-ups. We complain that it isn’t fair that we’re stuck with this condition. We deal with, or don’t deal with, our depression, our anxiety, our obsessions and compulsions, or the thoughts that we might be bipolar. We adhere to diets and violate the diets. We struggle, and wonder why. I’ll tell you why – you don’t want to be The Airport Couple.

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.

We’re all subject to variables – our moods, our family’s moods, the weather, the price of oil, and natural disasters, or the way people in Iowa vote. Some we control, some we don’t, and some we just think we control. It’s important to figure out which ones are which, and treat them accordingly, or the cumulative stress and pressure of trying to bring them back under (that elusive and imaginary sense of) control is going to result in stress. And we all know, stress doesn’t help PCOS.

Let’s assume that, if you take a moment and breathe, you know which ones fall into the category of things we can’t possibly control – earthquakes, toddler’s temper tantrums, the fact that the bananas you put in the refrigerator have rotted, and so on. Since you can’t control, LET GO OF THEM. Gripe and groan if you must, but impose a time limit on it (I suggest five minutes per day of hearty whining – laugh, but try it and see how far you get with the practice).

Now for the things you are CERTAIN you can control – being on time (really? In that traffic?), your weight (and how’s that working with PCOS?), whether or not you get pregnant on schedule (assisted reproductive technology is amazing, but it’s not entirely predictable), the shade you dye your hair (ever tried doing it yourself, only to discover that whatever’s in the box doesn’t look quite the same as the picture on the box?), or how many people you have for your perfectly balanced dinner party (darn that man for getting a stomach flu at the last minute and throwing it all off). Hmmm… I’m still struggling to identify something you can absolutely control.

So is it all hopeless, and you should give up trying to have any sense of order or control in your life? No, but you’ve got be real about it, allow for the vagaries of other people’s desires and behaviors, understand that time waits for no man (or woman), and, most importantly, get that the only thing you can control is THIS MOMENT. You can choose what you put in your mouth, whether you do two more flights on the stair-stepper, kind words or nasty words, whether you act from love or something less, and whether you’ll focus your attention on yourself or trying to control others. That’s really about it. Not much, in the end. Not your spouse, your boss, your child, your mother, the environment, or anything else that is larger than this moment, or larger than you.

Somehow, the idea of that is actually really calming. It feels overwhelming to hold on to a belief that we can, if we’re just good enough, smart enough, fast enough, or coordinated enough, control everything, or almost everything. If you believe that, you’re pulling a con on yourself, and I encourage you to look at it more closely, and start releasing some of that false belief.

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.

Most people don’t love going to the doctor. It’s right up there with changing the cat litter, and dinner with your mother-in-law. Yet, we all have to do it, and for those of us with PCOS, we have to do it more than usual.

The first thing to do when you’re in major dread mode about visiting your physician is to ask yourself WHY? Is s/he always running late? Is the staff rude? Parking expensive? There’s always some issue with your insurance? The office is kind of funky? You aren’t treated with respect? You just know you’re in for bad news? You’re afraid of pain? You didn’t drink enough water, so there’s no way you can generate a urine sample, and someone’s going to make you feel like a failure because of it? The phlebotomist should be sent to remedial phlebotomy class?

What’s going on? Is it something you can do something about? If so, fix it. Change your appointment time to one where the doctor’s less likely to be late. Tell the doctor her receptionist treats you like dirt. Call in advance and speak to someone about your insurance. Drink the water. Wear the right clothes, so you don’t have to get undressed just to get a blood pressure reading.

Or is the problem so minor that, if you’re honest, you know it’s just an excuse? If all the medical offices are in one plaza, you’re going to be stuck with the extortion (oops, I mean, standard parking fees). So you hate modern, plastic offices and prefer antiques. Does this really affect the quality of medical care? Yes, paper gowns are ill-fitting and awkward. Are you going to change doctors so you can find one who uses cloth? Sometimes the things we focus on are just not the real problem.

Or perhaps there’s something more serious. If you want an hour with your doctor, and they only schedule 20 minute appointments for your type of problem, are you setting yourself up for irritation? Or you’ve had some medical trauma, and anything in a medical setting just makes you anxious and irritable. Quite often, it’s bad news we fear, being chastised for failure to lose weight, improve our blood pressure levels, or getting our fasting glucose numbers under control. If this is more along the lines of the real issue, it’s time to give it some attention, and see what else is going on that prevents you from taking the best possible care of yourself. Remember that doctors aren’t magicians – they can only work with the material you give them.

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.

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“Dysmorphia” may not be part of your everyday vocabulary, but if I tell you that lots of people thought the late Michael Jackson suffered from it, you’ll probably know what I’m talking about. Body Dysmorphic Disorder (BDD, for short), is a complex psychological problem that results in obsessions with imagined defects in your personal appearance.

It drives people to exercise excessively, engage in extreme dieting, reshape their bodies through weight-lifting, get cosmetic procedures including plastic surgery, change their clothes often, engage in approval-seeking behaviors, and dress oddly in order to disguise imagined defects. It may also result in avoidance of mirrors, failure to seek medical help when necessary, refusal to participate in sports, sex, or other social activities, excessive beauty practices such as permanent make-up, dangerous chemical hair straightening, and the like. Many if not most of us have engaged in some of these behaviors at some point in our PCOS journeys.

In a group of people who have anxiety or depression, you’ll find BDD as an additional diagnosis in about 5 – 40%. This is quite a range, to be sure, but I think we’d find an even higher rate of BDD among women with PCOS. BDD is more common among women, actually, since we’ve already got a culture that is fixated on our likes as a central factor in our value. And, we’ve already got a much higher incidence of depressive and anxiety disorders, and our symptoms, while both internal and external, have particularly disturbing external manifestations. It can definitely reach an obsessive level of preoccupation when a woman is losing her hair, covered with excess hair in all the wrong places, erupting in acne, or dealing with stubborn, unbudgeable abdominal fat. The desire to be rid of THE PROBLEM can take an astonishing amount of time and energy.

I have clients who do all of the above, and more. If they’re not tackling the problem head-on (all discretionary funds go towards laser or electrolysis, they will not have sex unless and until they lose 50 pounds, they consider themselves complete failures at managing their bodies and tell themselves so regularly), they’re in avoidance mode. The avoidance usually affects social relationships, and further exacerbates depression – or being forced into a social situation will bring up anxiety.

It’s a complex condition that merits more than passing, gossipy attention from the media. It ruins lives. If you think you may suffer from BDD, please seek professional consultation to see how you can be helped. PCOS is complicated enough, without the extra layer of problems caused by BDD.

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.