I've had two different clients share a similar observation in the last couple of weeks, and I thought I'd write about it since it's not uncommon to feel this way in early recovery.
First of all, I want to share with you an article on depression that was recently in the Boston Globe.
This article presents the argument that depression is not about a deficiency of neurotransmitters that need to be balanced with medication, but rather, a condition in which neurons are dying a slow death and gradually losing their function. I've had this premise for awhile; it is the basis of my treatment philosophy for PCOS. Fish oil is the best compound nature has for restoring life to neurons, and when you put it into your diet, the brain begins to function again.
My two clients have both observed that as they began taking fish oil, they felt more alert and their memory and concentration seemed to be better. Signs that Elvis is back in the building!
These two clients also observed, though, that they were feeling more emotional. Not all emotions, especially anger and sadness, are easy to feel. So when you begin to feel these emotions, it can feel like things are getting"worse", not better.
Keep in mind, when neurons are malnourished, that means ALL neurons stop functioning, not just the ones affecting memory. The ones affecting emotion, the ones affecting appetite, and the ones affecting hormones.
If you've had PCOS, your hormones have not been functioning as they should, perhaps for a very long time. And that means you've not had the experience other women have, of fluctuating energy, emotions, you name it. Those fluctuations are normal!
So I often get the question,"What can I do?" The most important advice I can give is, be patient with yourself. Become used to what it means to truly cycle. Get to know what a healthy body feels like. It means it is normal to feel bloated, even constipated, just before your period. Your weight might fluctuate. The cycle should be around 28 days when you're back on track, and every single day within that 28 days may feel different. There may be no such thing as getting on the scale and weighing the same thing every single day.
With regard to your emotions, perhaps as your brain becomes more aware, this is an opportunity to experience what emotions might be about. Emotions are messages from the brain, telling you how you are with regard to balance, and what you need to do to restore balance if it isn't there. Anger is often a clue that a boundary has been violated. Loneliness means you need to seek companionship of some sort. Fear suggests that you need to remove yourself from danger. If they didn't feel uncomfortable, you would not be motivated to engage in behaviors that keep you healthy and safe. So rather than running from emotions, embrace them! They're telling you that your health is returning and things are getting back to normal.
PCOS is so hormone driven that emotions end up on the back burner. Excesses of androgens and stress hormones put anxiety and anger in control. But if you find that these feelings are persistent and do not wane after time, or that they seem to be there even when nothing in your life can explain them, they may be signs of hormone excesses and not really environmentally or event-stimulated emotions. When your hormones have you constantly revved up, it can feel strange to not have that kind of energy rush.
I couldn't figure out why, when I first started recommending yoga to clients, they would come back after one class and tell me they hated it. I figured out eventually, that yoga slowed their bodies down but their heads were still spinning. And being pinned to the floor in a yoga pose while your head is thinking angry thoughts can be a very uncomfortable place to be. Those clients got the same advice I'm giving you. Give the new changes some time. Don't abandon your new lifestyle because it initially feels uncomfortable. It's been a long time since your body has felt normal. Be gentle with your self and get to know/understand that"normal" involves hourly, daily, weekly, and monthly cycles. There is no such thing as being the same weight, temperature, size, or temperament every single minute of every single day.
Our philosophy is a little different than what many physicians will have you do. We're not trying to control your hormones, your weight, or even your diet. We're not trying to force a cycle, a pregnancy, or a clothing size. We're guiding you toward healthy choices that allow your body to be in balance. Sometimes giving up control, and letting the body speak to you instead of the other way around, is the absolute best way to get there.
So if things seem a little chaotic and you feel like you're charting uncharted territory, welcome to the world of female physiology! Ask questions, observe, and embrace the wonderful lesson you're learning, that your body will heal if you let it. There is no such thing as being past the point of no return or"stuck" where you are.
Mindfulness. You hear that word a lot from people like me trying to help you move toward health…it's kind of a tough concept to describe. Over the weekend we were experimenting with the iPad and filming a pilot"Yoga for PCOS" class, and something happened during filming that perfectly illustrated how mindfulness works.
We live in a culture that is constantly bombarding us with stimuli. It has gotten worse in the past 5 years or so with the advent of smart phones, as we can literally be on alert 24/7 with beeps, buzzers, and"push" notifications. We can get so drawn in to social networking sites that we feel if we don't read every single status update, watch every single video, respond to every single event invitation, we are somehow missing out.
It is possible to spend an entire day connected to a screen, at the expense of losing connection to real people right in front of us. To see this for yourself, I challenge you to go for several hours with your phone and tablet left behind, and spend time in a public place. Look at how many people are focused on their phones…texting, IM'ing, talking…instead of participating in the world right in front of their faces. I have actually started turning off email and wireless connection on my writing days, so I am focused on one thing, and not constantly being tempted to shift my focus by random, multiple notifications coming at me from all directions.
The drawback to this is that when you are absorbed with your techno toys, you are also not listening to important messages your body is sending you.
You might ignore hunger. Which might seem like a good thing…except that in ignoring hunger, you often push yourself to the point of being ravenous before you respond to the cue.
You might ignore that you are tired, and stay up half the night playing Farmville, and you know if you regularly read this blog, poor sleep hygiene drives insulin resistance and worsens the symptoms of PCOS.
You might also ignore emotions. Feeling angry, sad, lonely, are uncomfortable to allow yourself to do. But those emotions are no different than physical cues, they are guiding you toward actions you need to take. If you ignore your emotions, they don't go away, they just amplify and amplify until they get your attention. If this is how you choose to deal with your emotions, their magnitude by the time that you are forced to acknowledge them, can be so great, that your response to them is at risk of being extreme--rage fits, excessive exercise, binge eating, alcohol dependence--are all common ways that people often deal with emotions they are afraid to face.
Mindfulness is a conscious exercise that develops your ability to be more aware, throughout the day, of how you are feeling. It is also called"being present". Your attention is on you, your immediate surroundings, and how you feel in those surroundings. If you pay attention to those things on an ongoing basis, and make conscious decisions about how you are going to address the situations, you can avert a lot of emotional outbursts, and binge/compulsive-type behaviors that sabotage PCOS management.
Meditation is a way to practice staying focused on yourself without being pulled away by distractions. Most people struggle with meditation at first, because until they start, they are not even aware of what thoughts and feelings they have been avoiding. It can be extremely uncomfortable. If you stick with it, it does get easier, you do develop more comfort with those thoughts and feelings, and they tend to not hit the magnitude where they convert into toxic behaviors.
When we were filming the other day, one of Sarah's kitties really wanted to help. So while Sarah and Deborah were busy focused on practicing meditation, kitty felt a little bit left out because her usual attention-getting behaviors were not working for her. (That is often what happens when we stop allowing ourselves to be distracted…the people who are positively reinforced by distracting us lose their own distraction and"up the ante" to pull us back into the unhealthy thing they need to do.)
So in this video, Kitty works and works and finally gets Deborah 's attention. For a split second, Deborah's focus on meditation was broken. But she quickly caught herself and got right back into the groove.
Now if it wasn't Kitty wanting some loving that could wait, and rather a sudden thunderstorm, Deborah may have chosen to prioritize getting out of the rain.
Practicing mindfulness is exactly like that. You develop the ability to close out distractions. You can't ever really make them go away, life is about prioritizing and ably handling then,any distractions that are thrown in our path. The goal is to acknowledge them, just as Deborah acknowledged Kitty, and get back to more of a personal focus as quickly as possible.
Enjoy the video! It is one of several segments the kitties helped with…as the person behind the camera I was experiencing my own special mindful moments, working extremely hard to not disrupt the session with laughing, or peeing in my pants from not laughing.
We had a great time, and will have updates soon on how you can participate in our yoga program.
I have been in Vermont all week, busy teaching PCOS classes at Green Mountain at Fox Run. I have been so busy that checking email and answering my phone has been pretty much an afterthought. I realized how easy it is to drift into becoming attached to electronics in unhealthy ways.
I decided to Google"iPhone addiction" just for fun, and found a Stanford survey reporting the following results obtained from 200 students, most of whom had had their iPhones for less than a year:
When asked to rank their dependence on the iPhone on a scale of one to five, five being the most addictive, ten% said they were fully addicted. 34% ranked themselves a four and only 6% said they weren't addicted at all.
Nearly a third worried they may become addicted someday.
A full 75% admitted to falling asleep with the iPhone in bed with them, and 69% said they were more likely to forget their wallet than their iPhone when leaving in the morning.
Why is that an issue? When you are so attached to what is coming out of your electronic gadget, you are not paying attention to important cues your body may be giving you about stress, emotions, hunger…you may be so caught up in what is happening on Facebook that you fritter away time that you could be spending on yourself, in physical activity…your life is virtual, not REAL.
I see disturbing trends that show how detached we are becoming, such as people Tweeting from a meeting, reporting that they are at the meeting. How can you possibly be getting anything out of the meeting if you're not even paying attention to the people you are physically with?
I see people posting Facebook status reports from"getaways" in remote locations…when I thought the point of getting away to a remote location is to not be communicating with the rest of the world for a little bit.
I hear stories of people so attached to their iPhones that they actually feel phantom vibrations if they try to live without them.
If you bring your phone to bed with you, it's disrupting your sleep. And when your sleep is disrupted, you are more likely to be insulin resistant and hold on to weight.
Tell me…honestly…is that 3 am text you're waiting for really worth the 5 extra pounds you may be carrying just to get it?
Electronic food for thought: If you are really that important and indispensable, you don't have an iPhone. Your personal assistant does. If you're unable to detach from your Blackberry, you're a slave. Everyone you allow to contact you at 3 am is someone who has taken control of part of your life.
Take it back! Challenge yourself to leave the phone for a half hour or an hour. Leave it in the kitchen at night. Don't bring it to the gym. Give yourself one technology-free day a week. See what happens to your awareness. Of your emotions. Of your hunger/fullness. Of your choices of how to fill your time.
You might find that you start setting more limits with mailing lists, Facebook friend lists, Twitter follows, etc., because all that electronic chaos interferes with your life.
Technology isn't a bad thing, at all…my business is able to exist because of it. But if it is not used respectfully it may be one of the most important reasons your optimal health is so elusive.
You can't just read about, status report, tweet, electronically discuss healthy living. You have to LIVE it.
I actually came into working with PCOS through the back door, as someone who had specialized in eating disorders treatment first. I'd left my work at a treatment center, launched an eating disorder website, and women started calling me saying,"I used to have an eating disorder, now I have something called PCOS…do you know anything about it?"
It happened enough times that I started researching the syndrome, realized there was not a lot of good, standardized information about PCOS, saw the niche that needed filling…and there you have it, the Cliff's Notes version behind the inception of inCYST.
The correlation between the two conditions is so strong that I often wonder if it isn't the exact same problem being given a different name and treatment, depending on whether or not a physician or a mental health professional makes the initial diagnosis.
Because diagnosis and treatment can start in two completely different environments, there can be problems with outcome.
--Physicians accustomed to other diagnoses that respond to a simple medication or surgical procedure, may not have the interest in considering the emotional aspects of PCOS. A dermatologist actually said to me once,"I just want to take care of skin cancer. I really don't want to deal with all of those emotions."
--Even dietitians who work with diabetes and can assume they have expertise with PCOS, may not have the patience to delve through the layers of hormones and emotions and reactions to imbalances between the two, to help a client understand how all of these pieces fit together.
--Psychiatrists may be prescribing medications that exacerbate hormone imbalances and PCOS, and not consider that the weight gain and other side effects are a huge reason for medication noncompliance.
--Psychologists may not understand that anger, even rage, and depression, is very strongly affected by hormone imbalances, not entirely based on what's going on in a person's world. They also need to understand that a client can be absolutely, completely, 100% compliant with every single assignment they're given…and STILL have cravings and not lose weight. They need to not project that disappointment on the client, but take it as a cue that they may be missing an important part of what's going on.
--Eating disorder specialists I've worked with seem to be much more comfortable working with"thin" women with eating disorders. I remember when I worked in the treatment center, the women with binge eating disorder never seemed to get the same sort of attention. There seemed to be a size discrimination even coming from professionals who were supposed to be advocating for the opposite.
--Body image specialists may not completely understand that with PCOS, there are genuine and valid body image issues that are not distorted thoughts. There is facial hair. Acne scarring. Hair loss. And the cysts on the ovaries can create a feeling of bloating that is valid, not imagined.
My personal feeling is that you cannot effectively and successfully treat PCOS unless you are helping both mind and body.
If you're a physician, you need to be sure that your client has adequate emotional support rather and not just increase a medication dosage because you're not seeing progress on lab reports that you'd like to see.
If you're a dietitian, you need to have access to a size-neutral psychologist who understands the syndrome and not be afraid to refer and work together as a team.
If you're a mental health professional, you need to understand that just because your client has a disease with a physiological basis, your place in their treatment is not threatened…in fact, it is more important.
You just need to enhance the number and type of issues you can help them with.
All of us need to stop attaching symptoms and needs to a certain weight. To assume that if we get down to a certain weight the syndrome magically goes away. It's there no matter what. I just had an enlightening conversation with a dietitian who has gone through my training, is embarking on her PhD, is normal weight, and teaching at the university level. Even though she's doing all the right things, she says she STILL has times when her appetite is out of control and it completely frustrates her.
The link between eating disorders and PCOS is very, very strong. We need to embrace it and study it so we can help women tackle both and accomplish great things in their course of managing the syndrome. All of us are going to have to step outside of our personal comfort zones as professionals to be effective, and to stop thinking we can help women with PCOS all on our own outside of the structure of a team. inCYST would like to make that a rewarding risk for anyone who chooses to take it.
So 2011 has been designated inCYST's year of eating disorder outreach. We've got two learning opportunities for you who are interested in learning more.
This coming Monday, at 12:30 pm Eastern time, inCYST dietitian Janenie Wade and her business partner Ellen Shuman will be on our radio show sharing more about their collaboration with A Weigh Out, an online and phone coaching program specifically designed to help women with binge eating disorder and able to account for the presence of PCOS. Come tune in and get your toes wet, and see what they're doing! Maybe it will inspire you to want to do more as well.
This spring, in Scottsdale, Arizona, the Binge Eating Disorder Association is holding its annual conference. It's a great place to start learning more (in a beautiful climate, I have to add!).
Of course, we're always looking for mental health professionals to join us at inCYST as well. Our training is open to anyone who would like to take this on. Just let me know if you're interested.
Due to some unusual cramping and bleeding, I went in to see my reproductive endocrinologist (RE), who is dually board certified as a gynecologist and an endocrinologist. If you have PCOS, and especially if you’ve ever tried to get pregnant and had a problem doing so, you have probably been referred to a RE. REs have a specialized understanding of the way our hormones affect our fertility, blood sugars, insulin resistance, and other PCOS-related conditions. They treat many PCOS patients, because PCOS is a primary cause of infertility.
One vaginal ultrasound and one pregnancy test later (the doctor and I duly noting that I am well over 40, infertile by all medical definitions, and just about as likely to be pregnant as Mother Teresa), it was determined that there’s a UFO in my uterus! Well, not really, but that’s what it looks like on the ultrasound screen. So, if it’s not a polyp, a cyst, a fibroid, or a baby, what is it?
Cancer comes to mind, and the possibility of cancer necessitated an endometrial biopsy, which is a very uncomfortable procedure in which the tissue in your uterus (the endometrium) is sampled (that’s medical-speak for pulled out in tiny chunks) and sent to the laboratory to be tested. Fortunately, no cancer was found. However, given that PCOS patients are much more prone than average to conditions such as hyperplasia (a proliferation of sometimes questionable looking cells) and endometrial cancers, the recommendation is almost always surgery to remove the tissue, be it a polyp, a cyst, or in this case, something unidentified. I am fortunate to have a highly skilled, aggressive doctor, who knows me and my condition very well, and I agree with this recommendation.
That was the good news, but then I learned the bad news – that my eggs had officially expired. While some doctors question the accuracy of the anti-mullerian hormone assessor, it’s a pretty accurate way to determine whether your eggs are still of use (and to what degree), or if you are pre-menopausal or post-menopausal. No longer having viable eggs was not unexpected, given my age. Nonetheless, there’s an emotional hit to all of this. There is a sense of loss, of unrealized potential, and a need to acknowledge that the door on having a biologically related child, created with my own eggs, has officially closed. At the same time, there is a surprising sense of freedom and relief accompanying this news. Given my personal and family medical history, I no longer have to make an active choice about passing on my genes. With assisted reproductive technology, the doors are open to carrying a pregnancy anytime up to age 53. I just know now for certain that, for me, a pregnancy would mean using donor eggs.
A visit to the RE can be painful or uncomfortable, confusing, enthralling, educational, inspiring, or worrisome – all at the same time. Surgical procedures and testing add to the complex mix of emotions aroused by having a condition or conditions you don’t entirely understand, an equally confusing array of treatment options, time pressures, and a host of medical practitioners, all with their own particular slant on what constitutes your best treatment plan, and why.
For me, that means surgery next month to remove the UFO, continued monitoring of my endometrial condition, and of course, more visits to the RE, especially should I decide to pursue a pregnancy with donor eggs in the future. I like the idea that I still have options, the immediately pressing medical concern is being addressed appropriately, and some aspects of my fertility still offer possibilities. PCOS has a rhythm and a flow of its own, shifting in prominence at various stages in your life and reproductive cycle, and contributes to a mix of emotional experiences. In choosing how to manage your care, your fertility, and your emotions, I hope you too are able to focus on the positive.
If you have not had the opportunity to hear Gretchen's interviews with pcoschallenge.com, please take the time to do so! Gretchen will also be hosting a PCOS expert webinar next Tuesday…to attend please contact www.pcoschallenge.net for more details on how to do so.
Twice in the past week comments with somewhat of a religious energy about them have been sent my way. One set of comments came from someone who was using the Bible to try and argue that something we were doing at inCYST was not appropriate. Another came from an atheist who felt that we should not be incorporating religion or spirituality of any kind in our work.
Both sets of comments came unsolicited, and it is timely that in that same week, a post from Dr. Gretchen that she had scheduled weeks before went live with thoughts about God and spirituality.
I figured it was my opportunity to share where we stand on that. Actually where we stand on quite a few things.
We at inCYST are here to help. We have Christians amongst us, but we are not a Christian organization. We also have Buddhists, and some of us are Jewish. And we do have an atheist or two.
We do not identify ourselves by our religion. We do practice religion or lack thereof, but it's not what we use as our identity.
Whether you are Hindu, Atheist, Wiccan, or Catholic, you have a pancreas, lungs, and a heart. Most of you have a uterus. All of you have brains. Last time I checked, an Atheist brain worked the same way as a Christian one did…the only difference is the thoughts and emotions those brains generate. It doesn't matter to me what those thoughts and emotions are, I care most that the brain is operating in a healthy environment and to its fullest capacity.
If Christianity is your spiritual perspective, we seek to understand how it supports your path to wellness and to incorporate that into our recommendations. If you're an Atheist, then we'll work to understand and support that as well.
We'll do the same for Democrats, Republicans, Libertarians, lesbians, heterosexuals, transsexuals, 25-year-olds, 65-year-olds, men, women, Latinas, African Americans, Caucasians, Hungarians, Australians, people living in the city, people in the boonies, people on an island.
We don't look for reasons to separate ourselves from you. We look for ways to connect and support.
We work in health care, with anxious and hurting people. We really don't have the luxury of dividing people into piles and deciding which ones are more worthy of helping. When they come to you, and you have information and resources that can help them, you use them on behalf of helping them.
To the person who used the Bible to scold, I don't think that the Bible was intended to be used as a means to scold. To the Atheist who asked us not to incorporate spirituality, I'll kindly not force religion on you since that is not something you wish, but for those who ask us to consider their spiritual path in our work together, we will gladly honor their request.
Everyone who comes to this blog comes for a reason — they need help. And every single one of those individuals is valued…and welcome.
Our attitudes control our lives. Attitudes are a secret power working twenty-four hours a day, for good or bad. It is of paramount importance that we know how to harness and control this great force. -Tom Blandi
I have a friend who likes to say “I (heart) my attitude problem” – she loves her attitude problem, she’s proud of it, she parades it in front of anyone who will listen. She’s got a bad attitude, and she doesn’t want to fix it – and that’s one form of attempting to control. She alienates a whole lot of people with her bad attitude, thereby proving to herself repeatedly that she’s unlovable and unacceptable. Maybe you have that kind of twist on control issues, or maybe yours looks more like this:
• “Don’t worry; I’ve got it handled.”
• “If I follow this specific diet and exercise plan, I will lose weight, and everything will be okay.”
• “If I can schedule it, I can plan for it.”
• “I’ve mapped it, scheduled it, programmed it, imagined it, and now it’s going to happen exactly that way.”
• “Sure, I can do all of this by tomorrow.”
• “If I could figure out what to do to prevent him/her/it from acting that way, I wouldn’t be suffering.” How often have you said one or more of the above, all the while thinking distressing secret thoughts that go more like this:
• “I’m a liar, liar, pants on fire – but maybe I won’t get busted – this time.”
• “What am I thinking?! This is insane!”
• “If I talk enough, or move fast enough, no one will notice that this is a disaster spinning out of control.”
• “Who am I kidding? I can’t even control what I put in mouth for 24 hours, let alone anything else.”
We all have illusions of control, to varying degree. That’s fine – sometimes it’s even protective. But the problems occur when you don’t realize your illusion of control is actually an illusion, you believe your own phony story about precisely how in charge you are, or you slip over to the opposite side, believe you have no control over anything at all, and stop taking charge of what you can control.
Awesomely enough, however, your attitude IS within your control. You cannot control the weather, your mother, most of your hormonal fluctuations, or the state of the economy. You can’t even control the emotions that flow through you. But you can control your response to those emotions (getting stuck in them vs. letting them flow freely), your attitude towards life in general (pessimism vs. optimism), a goodly number of the people you hang out with, the influences you expose yourself to, and a host of other things. How about focusing your energy on the few things you truly can control?
Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. 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 Gretchen@drhousemd.com. You can also follow her on Twitter @askdrhousemd.
Gretchen Kubacky, Psy.D, is a psychologist practicing in Los Angeles who specializes in helping people diagnosed with endocrine disorders.
She's dedicated to helping women like you, and we're so excited to have such an awesome member on our team!
PCOS may be about hormones, but hormones are what create emotions. If you don't recognize both parts of the disorder, it's going to be hard to get better.
Gretchen, we're so glad you are here and we look forward to your contributions!
Last week, I wrote about the seductive quality of nutritional supplements, and how sometimes it’s necessary to slow down, reevaluate, and maybe not take some of them. This brings me to the point of today’s post, which is that sometimes subtracting is better than adding.
When it comes to our health, particularly with PCOS, we have this mind set that more is better. More exercise, more restriction, more supplements. Must be better, right? But sometimes more is just more, and it might even be counter-productive. When you get to a place where exercise is interfering with getting enough sleep, or ruining your social life – or it might even be part of an eating disorder. Or when you’re on the no sugar, no alcohol, no wheat, no red meat, no dairy, no fun diet plan, to the point where you’re burned out, irritable, and chronically on the edge of a binge – and, oh yeah, it’s wrecking your mood and making you the world’s most boring dining companion – maybe it’s time to reconsider. Same with the supplements, as I wrote about last week. Over-indulgence may actually be counter-productive to health. Even meditation can be counter-productive, if that extra 20 minutes a day is cutting into your sleep.
Overdoing it can extend into any area of your life – social, educational, and of course work. Again, more isn’t necessarily better. It’s just more. Contemplate that. It’s just… MORE. Kind of like our emotions. The emotions themselves don’t actually have any power. They come in, we observe them, and they move along. It’s when they pile up inside (MORE) that they tend to create problems.
What if instead of doing more, buying more, being more, limiting more, working out more, you tried less? Less commitments, less restrictions, less stress, less choices? Maybe even a little less blog-reading!
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'm glad you stopped by the blog. I thought I would answer your question since it's likely one that others have. It's a little more complicated of an answer than you might have anticipated.
SCENARIO ONE: Empowered Use of Ice Cream
If you're eating well in general, and you'd like to have a little bit of ice cream once in awhile, good for you! It turns out that ice cream, because of its fat content, has a lower glycemic index than many people would anticipate. And…women who eat at least one fat-containing serving of dairy are more fertile than women who do not. The best way to capitalize on this, is to eat ice cream in conjunction with a meal, so that the protein and the fat from that meal further modulate blood glucose levels. The fewer ingredients, preservatives, additives, and stablizers your ice cream has, the better. Eat it at the table, not standing in the kitchen, not out of the carton, not sitting in front of the TV. Savor every delicious spoonful.
SCENARIO TWO: Ice Cream's Calling the Shots
The worst way you can ever eat ice cream, is by the bowlful, right before bedtime. Raising your blood sugar around bedtime increases the risk of precipitous drops in blood glucose during sleep. In response, your body will secrete cortisol to bring the blood sugar back up, so that when you wake up, you've got a high fasting blood sugar. It is why you may not be hungry for breakfast. Start to take notice — what was going on in your food world the 12 hours before you woke up not hungry? If you can identify either a long stretch of not eating, or eating something high in sugar, not balanced with protein…figure out a way to change it.
The most important question I might ask you here, is why you're looking for PCOS-friendly ice cream. If the answer is, you're not quite ready to make true PCOS-friendly changes, and hoping there is a way for you to continue along your path that, while comfortable, is heading you down a serious path of medical complications, you're in denial. It simply doesn't work that way.
There is no ice cream, no ice cream at all, that is PCOS-friendly when eaten as an emotional outlet for loneliness, stress, anger, frustration, or any other emotion you're struggling with. You're only fueling your PCOS fire and making it worse by using food to cope with the emotions the disease is intensifying. Perhaps your PCOS diagnosis is your invitation to learn to use other outlets for those emotions, rather than hiding from them or self-medicating. If that is what you want, you need to be honest with yourself. You're looking for binge-friendly foods, not PCOS friendly foods. That's NOT what we write about or support.
Last week I posted a quote on my Facebook page that came across my Twitterfeed:"Resentment is like drinking poison and waiting for the other person to die". I got more than a dozen"likes" for that one. If you're bingeing on ice cream because you're angry at your spouse, your doctor, me, your diagnosis, your body, whatever…all of us walk away unscathed. The only person you're hurting is you.
Make this the day that ice cream becomes something you have a little taste of after a satisfying meal, and stops being the thing you turn to when something is feeling out of control.
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.
I missed the live version of this interview but stayed up until midnight listening to it. I was going to just catch the first few minutes but Ellen and Sasha did such a wonderful job of talking about body image, eating disorders, and PCOS, I was hooked!
It's such a great, thorough, and compassionate look at a part of PCOS that is not easy to discuss. A lot of physicians who treat PCOS are more skilled at managing your lab values than your emotions…and it can be frustrating to feel that such an important part of your disorder is not being acknowledged.
I do not intend to criticize physicians with my comment. They are often under pressure to see their patients in a tightly scheduled day, and if they're good at managing your insulin level, they need to be respected for what they're best at.
One of the things PCOS Challenge AND inCYST are trying to do, is provide support that sometimes simply is not available in a medical office visit. A major goal at inCYST, as well, is to network with physicians and help them understand the importance of recognizing this very important aspect of PCOS, and knowing where to refer their patients if they can't or don't want to be the caregiver offering emotional support.
If you've been feeling like that support is what you need, then a good start might be to listen to this broadcast. I guarantee, at the very least, you will learn that you're not alone. www.pcoschallenge.com
Thanks, Sasha and Ellen, for taking the time to talk so compassionately about such a challenging topic!
In my experience, dietitians tend to come from one of two schools of thought: (1) those who believe in structured meal plans and (2) those who promote a concept known as intuitive eating. It is very all-or-nothing. Which is ironic, since intuitive eating is supposedly about eliminating all-or-nothing thinking.
I've worked with both, and at this point in my career, in my chosen specialty, I am a blend of both. And that is what seems to work best with PCOS.
It would be nice if women with PCOS could be intuitive eaters. But it isn't a natural talent, and it often isn't possible out of the starting gate.
Here's a story from my caseload to illustrate.
A few years ago, I met with a young woman with PCOS. We met for an hour and half. I sketched out a meal plan for her and explained how it would help her cravings and make it easier for her to eat intuitively. She was very polite and accommodating, but at the end of the session she asked me,"But what am I going to do about my cravings?" I reminded her that her cravings would decrease. She asked the same question again. We went in this conversational circle several times, and it finally hit me, that my poor client had struggled with her intense carbohydrate cravings for so long that she no longer even knew what hunger was. She had also been let down by so many health professionals giving her bad advice that she didn't trust mine.
I finally asked her to tell me what she normally did when she had cravings. She motioned me to follow her into her kitchen, where she opened a drawer and showed me her stockpile of Snickers, 3 Musketeers, and Baby Ruth bars. I was completely humbled. I realized that since I don't have PCOS myself, I had no way of relating at all to the women who had the syndrome who I wanted to help.
I told her to do her best to follow my meal plan, and if the cravings got to be really bad, to have a candy bar.
The good news was…she never once needed a candy bar.
Lesson two for ME was…now that we'd eliminated the cravings, I was working with a completely blank slate, with a person who really had never had an opportunity to learn what foods she liked and didn't like, or what hunger and fullness really were. She had been at the mercy of cravings for years.
We had to start with a structured meal plan in order to learn what many of us learn as children. I literally had to put foods on the list for her to commit to preparing and trying. Gradually, she started to understand what hunger and fullness was, and a good chunk of the time, she was able to use some intuitive eating skills.
But the story doesn't end, even THERE!
As the layers of disordered eating peeled off, and food became less of a priority, my client now had to deal with the reality that she now had quite a bit of free time on her hands that once belonged to food procurement. She had to learn to deal with that time in ways other than boredom eating, or eating in response to emotions she was becoming aware of.
Something else that I've learned is that there are times when intuitive eating can be the primary tool a woman with PCOS uses, and there are times when it simply won't work. You may need to be a little bit more structured when you are under stress, when you've got a cold, haven't slept well, are pregnant, etc. When you are insulin resistant, and you're increasing activity and decreasing food intake, you may have times when you feel very hungry, to a degree that doesn't match what you observe about your routine. It can feel scary, and it can be tempting to binge. You may need to gently back yourself out of that corner with some simple structure.
Each one of you has a different story, a different PCOS presentation, a different hormone function, a different brain, and a different response to food. The most important thing you can look for in a dietitian, is not one who is going to tell you that you need to be an intuitive eater, or a structured eater, but one who empowers you to discover who YOU are and to help you design a lifestyle that accommodates what you need to do in order to maximize your potential.
Our inCYST dietitians are all trained to help you map out this path of discovery. If you've tried the"all or nothing" approach to restoring eating sanity, and no way seems to work well, consider engaging the help of someone who understands that you are unique. Our referral page is getting longer as professionals complete the training. Be sure to check in the next few weeks as I add names and contact information for options that might work for you.
We've got a new feature that we launched yesterday on the radio show. Amber is a woman with PCOS who, after a few years of not really knowing what to do for her PCOS, dealing with the many emotions that come with receiving the diagnosis, and taking the diagnosis out on herself…has decided it's time to change perspective.
In addition to her interview, she'll be blogging for us once a week as she works with me on her nutrition and with Craig Ramsay on her exercise plan.
I'm really excited about this because it's a first-hand view of what this journey, what many of you are looking for inspiration for, is like. Amber has been told that we don't expect perfection, and that this project will be more meaningful if it chronicles the ups and downs, the good and the bad.
So she's going to update us on Fridays about how it's going…what she's learning, what's working, what's hard, what's easy, what she wants the rest of you to know.
A huge thanks to Amber. It takes a lot to be so open when you're working on yourself. I'm honored to be part of the process, and hope you find it helpful!
I've never experienced infertility. I was overweight as a child/teen, but I've been the same weight for most of my adult life. I'm relatively healthy. I'm not saying this to intimidate anyone, but rather to share an insecurity I've had about what I do for a living.
I always wonder how in the world women who have those issues can even find me relevant and helpful if I've never had to experience them?
The last two months have presented me with a situation that, even though it may not be apparent on the outside, has very much changed me on the inside. I've learned a lot about control, gratitude, and what is truly important in life.
And I feel like this journey, challenging as it is, is molding me into someone better equipped to help the people who come to inCYST for help.
Regular readers of the blog will remember that I wrote about my sick kitty in October. I thought I was dealing with a simple urine crystal issue that a diet change would fix. I'm a dietitian, I know how to change diets. This was simple, or so I thought.
Well, Rodeo simply never recovered from the crystal incident. He would not eat. He became lethargic. About a month after the vet visit, I noticed, he just wasn't breathing well. Being the data fiend that I am, I started monitoring his respirations. They seemed stable, so I figured maybe he was allergic to the new diet he'd been prescribed for his urine crystals. I changed back to the old diet and waited to see if he responded.
Then he crashed. I got the last appointment on a Friday evening with his vet, and learned that he was dealing with one of four potential diagnoses. One was a fungal infection (no problem), one of those was a 100% fatal virus (that would require euthanasia), one was cancer (fatal over time), one was heart disease (manageable but life-shortening).
I had to wait almost a week for the pathology report to come back, and to get an appointment for an ultrasound with a cardiologist. (Yes, my cat has more specialists in his Rolodex than I do at this point).
The good news is, it's not the fatal virus, and it's not cancer, but it is heart disease, and it's a serious problem. There is no cure, but there is a lot I can do to manage the situation.
Sound familiar?
I told the vet,"If you can give me heart disease, I'll take heart disease. I can do that." Two sentences I never, ever envisioned coming out of my mouth at any point in my life.
I can tell you this. I have a reputation for being pretty even-keeled in even the most adversarial of situations. During my eating disorder treatment center gig, it was not uncommon for cans of Ensure to be flung my way after a tough counseling session. Nothing phases me after that!
But the night I came home from the vet with a couple of medications and no idea what was happening, I laid on my bed and cried my heart out. I didn't even notice that Rodeo had jumped up on the bed. He felt like crap, and he was sitting there trying to take care of me. I realized, of my two kitties, he is the one most affected by my emotions. And here he was, more concerned about me than about the X-ray, the aspiration, and all the poking and prodding he'd been through.
That was reality check #1. I knew I needed to allow myself to feel what I was feeling, but I needed to learn how to do it in a way that didn't turn itself back on the problem in a negative way.
As I imagine has happened with many of you, my life changed in a mere instant. I became hyper aware of respiratory rates, fluid intake, food intake, urine output, medication times…my life was filled with new details I had no choice but to learn to live with.
Even though I run a business, it's the holidays, and I had committed to coordinating vendors for a huge market here in Phoenix. Even though my five major plans for December revenue pretty much collapsed within days of getting the kitty diagnosis. Somehow, I had to figure out how to make it all work.
This is where I started thinking of all of you. How many of you readers are busy, successful women, juggling a million different responsibilities, happily living out your lives…when you're told you have to start monitoring what you eat, when you eat it, when you ovulate, when you menstruate, what your blood glucose number is…and on top of it all, every expert on the planet expects you to figure out when to work out, to plan the perfect meal combination, each and every meal, to buy the supplements, and on top of it, manage your anxiety, frustration, and anger over the situation?
Do these health professionals even have a clue? Did I ever have a clue with any of my clients I thought I was helping with inCYST? That's what's been going on in my head in the two months since Rodeo's diagnosis.
Reality check #2 for me was realizing what I was doing any time I had a free moment, especially during the week when I didn't know what I was dealing with. I found myself surfing the Internet, Googling symptoms, reading everything I could find about lymphoma and cardiomyopathy, looking for the worst in kitty, looking for anyone, anyone at all, who could tell me that there was a supplement or pill I could give him that would just make this all go away.
That behavior is known as magical thinking. It is a very common thing to do when faced with a situation that leaves you feeling cornered. Getting older. Cancer. Weight that won't come off. Infertility. It's about trying to find something, anything at all, that can give you the illusion that you're in control of something. Note that I used the word illusion. You're really not in control. You've transferred your need to be in control of outcome to a concrete, more manageable option. That's all. The only thing magical thinking succeeds at, is allowing us to avoid the pain of a situation. In many cases, it keeps us distracted from constructive and helpful things we can be doing.
So…knowing from working with all of you that this is what I was doing, I told Rodeo's vet what I do for a living, that I'm a real biochem nerd, and that I was probably dealing with my stress by reading waaay too much about cardiomyopathy. I told him at any time I was becoming annoying and intefering with his treatment plan and Rodeo's progress, he had permission to put me in my place. We negotiated a few things I wanted to try, one we're using, most we're not.
And I am adhering completely to what the doctor ordered. Even if it means staying up past my bedtime to get a med in, even if it means passing on a social invitation if it interferes with the treatment plan, even if it means using money I wanted to spend on something else to buy medication. The vet is not cheap. But he's incredibly smart. If kitty is going to get better, I can't be bargaining with him because of the inconvenience the instructions impose on my life as I wish it was.
Reality check #3 has been about how much control issues can be triggered when life throws a curve ball. We can do everything exactly perfectly. And Rodeo has a bad day. Or Rodeo can go dumpster diving, eat a fish head, throw it up, and be perfectly fine. At least for a day. How Rodeo feels today, is not at all about what I did for him this morning. It is about the consistency of what we do over time.
Oh, I'm so embarrassed to even be saying this, but this simple reality took me awhile to"get". I wanted him to always breathe perfectly. To eat when I gave him the food. To love the deli turkey. It doesn't happen that way. Some days he eats like he's the size of Zenyatta, other days, nothing strikes his fancy. I have had to learn to roll with it, and to not view one incident as failure, but as a challenge to figure out what another option might be.
On the days when things don't go as planned, I have to adjust my life. Yesterday morning, for example, meds did not go in at 8 am as scheduled. I spent 4 hours getting them in, but realizing that the four hours it took to make that happen was four hours I'd planned to spend making my contribution for a holiday potluck I was to attend tonight…I made the choice to cancel my attendance, focus on medication, and spend the evening tonight taking care of myself here at home.
Reality check #4. You know what happened when I stopped stressing about how I was going to do both the medications and the potluck and OMG what happens if I'm at the potluck and he bottoms out?!?!?! Rodeo settled in to one of the absolute best respiratory patterns and ate better for me than he did all week. I suspect he picked up on my more relaxed demeanor and was able to put energy into himself that he was putting into me. Some of the things I am inadvertently doing affect kitty as much, if not more, than the things I am supposed to be doing.
Reality check #5. I sometimes find myself getting annoyed at people complaining about things that now seem minor in the big scheme of things. All these people complaining about having to much to do for Christmas? In my eyes they are lucky they are able to participate. I have to remind myself, their situations are different and even though I might envy them, in their own scenarios are lessons from the Universe in action that may not include a cat. Still working on that one.
There are many early Christmas gifts this situation has brought me.
First of all, I have kitty happily sleeping on the bed today. He doesn't fit into a stocking and probably wouldn't consent to it if he did…but he's here compliments of two of Santa's finest elves…er…angels in elves' clothing, Dr. Oyan and Dr. Paige.
Secondly, my priorities, as healthy as I thought they were, needed some addressing. I have been able to let go of situations that I simply have no time to accommodate. I have more time to myself, since I'm home more, and that has given me quiet time to think about what inCYST will be for all of you in 2011. I hope you like the inspirations you'll see in the next 12 months.
Thirdly, I feel like I have a much better idea of what it is that you all need from inCYST in the first place. I am still at a disadvantage for not having experience every single thing you all have exactly as you have, but I have been humbled, I'm dealing with a challenge, and it cause me to consider every inCYST choice I make in an entirely different fashion. Humility is never a bad thing on which to base intention.
Fourthly, I've learned that it's not always bad if success has to be redefined. Of course I'd love it if there was a cure for cardiomyopathy. But there isn't. I can be angry about it, not follow the vet's instructions because I managed to find an obscure website on the Internet that contradicted them, turn to supplements which would put more control in my hands than his, or do nothing and hope the Calgon cardiomyopathy fairy will just swoop in and whisk us away to Kitty Tahiti.
None of that is going to happen. I got over it, decided to listen to the vet, and to redefine success as staying informed, being proactive and communicative with new information, and to the best of my ability, prioritize my life so that I can enact the recommendations I've been provided with. It's slowly turning things around. Not curing them. But, gratefully, allowing kitty to breathe. Oxygen in heart cells…is a lot more important than a complete and total cure. We have learned to think simply.
Finally, I still don't know what it is like to be infertile, not be able to lose weight, or live with insulin resistance. But at least I am more aware of how important it is to always remember that no matter who are you are, when you look to inCYST for help, guidance, support, inspiration, your story, especially the part we don't know about, or cannot immediately relate to, is important to consider in everything we say and do.
I hope all of you are enjoying your holiday season, whatever customs you practice.
One last thing. To all of my friends who are tired of hearing me talk endlessly about the cat, now that he's stabilizing I can get back to the gym and put the stress there. I appreciate all of your ears and support.
Couples are funny things, and their communication dynamics can be complicated by their different styles and approaches to problem-solving. For example, I’m pretty equally right brain/left brain in my approach to things – I’m always in touch with my emotions, but there’s a good dose of logic that goes with it most of the time. However, I often take a non-linear approach to problem-solving. I often think about the problem, research it a bit, tuck it away, pull it out and look at it again, consult with someone, ignore it, make a decision and change my mind, and then do a little more thinking, and finally come to THE ANSWER. My partner, however, is both an engineer and a mathematician – as in, he has a Ph.D., and teaches the stuff. Engineering is the art of reducing complex problems to a series of readily implemented, streamlined strategies that improve function and efficiency. Needless to say, he often approaches problem-solving quite differently! His process looks more like this series of questions: • What is the problem? • How bad can it be? • What’s the worst outcome? • Can I survive this outcome? • What is the urgency level of this problem? • What resources do I have for solving this problem? • Who will be impacted if I don’t solve this problem now? • How will I know if the solution is satisfactory? He does not proceed to the next question until he has answered the first question, and so on. At first, this process of his really irked me. I thought it was slow, painful, tedious, and unnecessary. I thought it was slowing down getting to THE ANSWER. My brain’s not going to change when it comes to this fundamental wiring, but what I’ve learned from his process is the same thing I’ve learned from practicing mindfulness, hypnotherapy, and psychotherapy. Slowing down leads to better results. Applying logic reduces stress. Rating/ranking your priorities minimizes pressure. Looking at all of your options, and perhaps selecting one that is just “acceptable” is better than searching for elusive “perfection.” When it comes to PCOS, and the many complex and related diagnoses, treatment plans, supplementation options, diet and exercise approaches, and mental health conditions that we face, it’s easy to get overwhelmed, and caught up in a psychological spin cycle. We try to solve all of our problems at once. We get angry and frustrated when yet another approach isn’t working. We’re always looking for the best, the latest, and the greatest dietician, supplement, prescription medication, miracle food, or whatever else it is that we think will rebalance our unbalanced hormones. We forget to apply logic. We dismiss the engineering approach as unnatural, overly masculine, or outside of our training. I suggest that, instead, you view yourself as capable, competent, and curious. Then make it true. Try the engineering approach, and see if you land on a different solution that fits or feels better. I’d like to hear how it goes. 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.
Two weeks ago this Sunday, my friend was featured on CBS Sunday Morning. To celebrate, she had a viewing party at two other friends' popular local store. I was planning to go, and stop at the gym on my way home. Then I decided that with the weather being so perfect, I could use the 10 mile round trip there and back as my gym. So I woke up early, strapped on my Rollerblades, and headed to the celebration.
Two minutes out of the door, I took the first tumble on my Rollerblades that I have had in 23 years of using them. I sat, hurting, on the street corner, thinking about what to do. My first thought was"if I go home and sit, this is going to be even worse, maybe it will be better to head over anyway and keep things mobile." So that is what I did. It wasn't that bad, really, until I skated home. I had a huge bruise on my tailbone and ended spending most of the rest of the day in a fetal position, which is the only position that didn't hurt.
Today, 12 days later, is the first day since then that I have been mostly free of pain. I live in a second floor condo, and have only ventured out a few times because the stairs have just been unthinkable. I really wanted to swim, but as luck would have it, the heater at the pool was broken, cutting me out of that as well.
I'm really disappointed, and frustrated, because I've been working really hard lately, and physical activity is always a welcome stress release. I had also promised myself tennis lessons this summer as an employee incentive program (yes, we have one in this one-person operation!), in an attempt to better balance my life. And it looked--still looks--like the first half of the summer will be tennis-free.: (
What I am happy about, is that I handled this injury far better than I did when I was off of one leg for 8 weeks due to a ski injury. Back then, exercise was everything. Of course, I was in graduate school for exercise physiology and everyone around me worked out far too much (exercise addiction is the normal social behavior in Boulder, Colorado, where grad school was), so I didn't realize just how far my dependence on exercise for stress management had gone, until fate completely yanked it from me.
It was really hard. I had to figure out what to do with my time. My emotions. My stress. Eventually, I came to realize that far too much of who I was, was wrapped up in exercise. It probably even steered me into studying exercise for reasons at the time that were not entirely healthy! I was stuck in a city where everyone was like that, and when I couldn't be part of it, I found myself alone, quite a bit, because I couldn't partake in the obsession that everyone used to socialize.
But I'm glad it happened. I was young enough to recognize the opportunity I had been given, to learn to be more balanced, to pursue other leisure activities, to come to love myself even if I was not always on a bike, or skis, or skates.
I'm pretty over that obsession at this point, but I do have a driven personality. So when I had this long list of things to do, this research institute to launch, a mortgage to pay, and I couldn't sit at the computer long enough to do the work I needed to do, and I worked longer than normal hours to do it anyway…after a few days, I caught myself trying not to listen to the message.
I had an agenda, and it wasn't happening, and I was trying to steer myself around it. I had to let go, and let life show me what the better agenda was. And when I did, when I took an afternoon off to have some frozen yogurt and stroll Costco with a friend, and just enjoyed a few movies on television…the agenda that made itself clear was far better than the one I was trying to force.
Exhibit A: inCYST eMarket.
Exhibit B: An invitation to speak locally for one of my very favorite health organizations.
Exhibit C: Other friends connecting in ways outside of me, but directly related to my letting go of a few things that turned around and benefitted me.
I think the tumble happened for a reason. It was a big detour sign. I was too busy to see it as I passed it on the side of the road, and I was headed toward a precipitous cliff. I was so focused I was not paying attention to important pieces of the puzzle that were on less-traveled roads.
My message is that whoever you are, wherever you are…if something happened to you today that feels like it derailed your most important agenda, take heart. If you choose to listen and accept with an open heart, who knows what bigger agenda it may be nudging you toward accomplishing?
First of all…it's great to be back! I was traveling, and while it's kind of fun to say I saw both the Atlantic and Pacific oceans in the period of a week, I do like my base camp and I really missed reading research. I'm looking forward to getting back into my daily groove.
Last week, I read an article in the New York Times about insurance companies, and how they are starting to ask consumers to absorb the cost of medications by asking that these medications be paid for not by flat copayment, but proportionate to the cost of the medication.
Nice. First we're convinced that we absolutely need all these drugs, and that we can get them for cheap, then once we're dependent on them…we're thrown under the financial bus.
Right now, the medications that are being sold under this new proportionate plan are not any of the medications that I focus on with this blog. However…since several of the medications you readers are on, are some of the most popular medications out there, I suspect it won't be long before these insurance companies start to see dollar signs in terms of the quantity of people they can expect to help finance this venture. Categories of medications like antidepressants…and insulin sensitizers and statins, which are commonly prescribed when the antidepressants start to mess with hormone balance.
That's the bad news.
The GOOD news is, I finally felt vindicated for having sat through this scenario for the last 25 years, wishing people would see what I have always seen…that when you take responsibility for your own health, and don't depend on people who make money off of you to help you, you have a good chance of getting better results. Think about it. Why would a drug company spend millions and millions of dollars to develop a product that you eventually wouldn't need once you started using it?
My goal, ever since I started what I do, is to put myself out of business. I started learning to play golf last year and it has been very frustrating to have to put it aside to attend to the demands of my growing business. I have a children's story I'd like to publish. And there are a couple of screenplays roaming around in my head that I'd love to get into theaters.
But the drug and insurance industries don't have that goal. Their goal, as is the goal of most corporations, is to increase market share and return on investment. Which means you can (1) increase the dosages of medications you sell to already existing customers, (2) find new customers for your medications by either creating new diagnoses or finding off-label uses for your already developed products, and/or (3) increase the price you charge for the product. Hmmmmm…nowhere in there do I see"helping the patient feel better".
Of course, I'm not naive. I know some medications are entirely necessary and even life-saving. But I also see so many conditions that could drastically improve with a few judicious lifestyle choices.
Last week I listened to the husband of a friend tell me what it was like to go through an in-vitro fertilization (IVF) procedure with his wife. He was near tears as he spoke about the trauma, the callousness of the providers, the emotional stress…the expense, and the feeling of failure as a human being when the entire investment of time, emotions and money did not produce the desired result.
He drove me to the bus stop, and I headed to the airport. As I was standing in line to board my plane, a colleague phoned me. She'd gone through my professional training and had been using my protocol on women with infertility. And she told me, that with just a few nutritional tweaks, these women were getting pregnant! Not only that, their depression was responding with equal profundity. Even the women who'd failed with the same IVF procedure as my other friend and who had given up on ever having children, were seeing results.
There's something very wrong with a system that promotes a $20,000 emotional and financial (mis)adventure over a $12 bottle of Coscto fish oil…but we as consumers need to shift our expectations for help from those who stand to make money off of our misfortunes and invest in choices, behaviors, and financial purchases that are empowering and affirming. You'll never get a company making money off of you to change how they do things if it means less money. But we can certainly get their attention if, collectively, we start to say"no" to some of their answers to our problems and"yes" to options that make more sense.
You bet the power of where you pull out your wallet is tremendous. And when groups of thousands of wallets get together…well, that's the vision I have that will finally get these screenplays out of my head!
Eating well. Physical activity. Adequate sleep. Less stress. It's that simple. It's incredible what prioritizing these four areas can do to your overall health. Not to mention your budget.
Last week I posted this graphic describing the grief process on our Facebook page. It got enough comments that I thought it might be worthwhile to expand on it in a blog post. If you haven’t miscarried, or lost a family member, or been through a tough breakup, perhaps you don’t think this pertains to you. But there are many, many things you can grieve. --Being told you can’t have children. --Not getting into grad school and having to change your career plans as a result. --Foreclosing on a home. --Getting older. --Being diagnosed with a chronic, non-lifethreatening illness, like PCOS or infertility. --Accepting that your body likely is never going to be sculpted or dieted into that of Gwyneth Paltrow. Diets? Something to grieve? Absolutely. In most cases I listed, it’s easy to understand how grieving is the result. Let’s talk for a minute about why dieting and self-medicating are often signs you’re in a grief process. Grieving, you see, is about change. Any time you have to move out of your comfort zone and adjust to life in a different world, your potential for entering a grief process is high. If the change involves a promotion and a substantial increase in income, it’s a whole lot easier to adjust and accept than one that involves having to accept news you’d rather not hear. In the case of PCOS, the news, in general, is that choices you have been making in your lifestyle have been counterproductive to your health. And that if you want to regain your health, you’ll need to make different choices. You’ll need to go to bed earlier. You’ll need to delegate more. You’ll need to get to the gym. You’ll need to eat more vegetables and fewer corn chips. Looking at the long list of things your husband, your caregiver, your health coach, and your dietitian are asking… and expecting you to do… can seem insurmountable. I receive, on average, about 5 emails a week from women with PCOS, asking if some supplement (Dr. Oz’ recent show on supplements raised that average), or diet (think HCG), is going to work. I have come to think of those emails as indicators that the person who wrote them is cycling through grief. They just want the PCOS to go away. It won’t go away on its own, the necessary changes that are not user-friendly, and anything that seems like the easy answer seems like it’s worth a try. It’s when your grief process and my expertise collide that we often butt heads. It is my job, as unpleasant as it may feel on the receiving end, to not allow you to succumb to magical thinking and detours that ultimately keep you grieving. It doesn’t feel good when I give you honest answers to your questions. I’m making you aware of something you’ve been working really hard to avoid, that you’re really needing to move out of your established behavioral comfort zone. Am I a sadist? Not at all! I just know that the shortest way out of grief is to walk right through it. It is only when you confront the pain, maybe even get really, really angry about it… that you’ll consider a path that may actually work. I spent an hour on the phone a couple of months ago, with a client who finally “blew” over the fact that her body doesn’t respond to diets, and that when she pushes the diet/exercise/binge/purge thing a bit too far, her body fights back and responds by giving her a weight she doesn’t like. All of the “maybe if I exercise an extra hour today… ” she’s been doing has no logic or science to support it. She’s been bargaining with her body, hoping it will finally give her the answer she wants, that you can use unhealthy means to force your body into being healthy. The reason the conversation lasted so long is because I sensed she really, really wanted me to just tell her that her way of doing things would eventually be right, and she could avoid the reality of living with PCOS if she could get me to say that. Of course, I couldn’t do that. And she became angry. Really, really angry. And we stayed on the phone as long as she needed to vent. Dr. Gretchen has written about anger before, and the importance of not ignoring it in order to move into health. If you don’t allow yourself to get angry… you are highly likely to stay stuck in your grief, bouncing back and forth between overdoing the healthy behaviors and overdoing the unhealthy ones and even worse, exhausting yourself into doing absolutely nothing at all. And because the health-related behaviors you’ve tried have let you down, when you do reach out for help, you’re skeptical of what we at inCYST have to offer you that might be helpful. In addition to the questions I get about supplements, diets, etc., each week, I have at any given time, two or three email threads with women who kind of sort of reach out, but who have already decided that if I don’t give them promises of what they want to hear, that they’re not going to give us a try. If you’re one of those women, and you’ve felt frustrated, perhaps that my response was curt or not compassionate, I hope this blog post helps you to understand. It’s not that at all. I just know, from over 30 years of doing this work, that if someone comes and they’re still doing a lot of bargaining with themselves, their health, and their bodies, that what they’re asking for is not what I can provide. If I become involved too early in the grief process, I stand to become part of the problem, not the guide to the solution. I could actually prolong your grief by keeping you stuck thinking there is an easy way out. I haven’t had PCOS or infertility. But I had a serious athletic injury that took my active life from me for almost two years. My business has hit some really hard times over the years. I’ve lost more than one person in my life, who meant the world to me. I’ve been through all of the emotions and stages in this cycle, more than once, sometimes managing several grief processes and their different stages, simultaneously! Every single time I felt like I couldn’t get up to face the day, or that what I was needing to do to get through that day, was inconceivable and insurmountable, and I challenged myself to get out of bed anyway and do exactly what I didn’t feel like doing… I felt myself move a little further along in the grief. In each case, it’s made me a better person for accepting the challenge. I wouldn’t be the person I am with the experience, perspective, tolerance, compassion, and motivation that I have, if I had not been challenged to face some really horrible situations. If anyone had come along who tried to remove any of the life events I encountered while dealing with my own grief, I don’t think I would have gotten over it. They would have kept me stuck, as well-intended as they might have been. My job, the job of all of us here at inCYST, is to understand what it is that you are grieving, to be aware of where you are in the process of grieving it, and to respect that process. Sometimes we have concrete solutions, and sometimes it’s best to step back while you do some things on your own. It’s called respecting the dignity of the struggle. I do promise you, there is a light at the end of the tunnel if you accept the challenge. But you’ll probably need to struggle. One of my friends who knew the most detail of how much I had on my plate and how hard I was fighting to keep that plate from tipping over and crashing to the ground, used to always tell me the best way to eat an elephant was one bit at a time. I have a special love for elephants now that I have conquered most of the circumstances that had me overwhelmed. Sometimes I think we should include one in our logo design! I guess the point I want to make here, is that really, a very small part of what we can do for you is prescribe a diet or exercise plan. The biggest part of it, is actually more in Dr. Gretchen’s domain. I think most of you know what you need to do. Understanding why you aren’t doing it, may have a lot to do with grieving. If you look at that graphic and feel like you’re going around in circles, perhaps spending sometime with Dr. Gretchen, or someone else who can help you step outside of yourself and understand the process without self-judgment, is the next most important investment you can make in your PCOS care and your overall health.
Earlier this week I interviewed Rebecca Fritz of Phoenix' SuTRA Midtown Yoga Studio about the benefits of yoga for reproductive health.
Despite a growing body of research supporting the idea that yoga has powerful effects on fertility, depression, strength, and overall well-being, I still find many women I talk to, resistant to becoming involved.
One of the biggest barriers, especially for women with PCOS, if there is a weight issue, is the fear of not being able to assume the positions in the class. It's important to understand that there is no right or wrong way to do yoga. However you are able to do yoga, on any particular day, is perfectly fine. I have yet to attend a yoga class in which the instructor hasn't provided options for the varying levels of experience in the class. In fact, in a class I attended a few weeks ago, the instructor gave us permission to assume whatever position we wanted to if the one he was recommending simply didn't work. The most important thing about yoga--is that you try. There's no way you can achieve the benefit if you don't.
Secondly, many women I work with have a tendency to spend much of the day avoiding how they truly feel about what is happening in their lives. Since the process of yoga tends to slow the body down much more quickly than it slows down the head, if this is what you've been doing, it can feel v-e-e-e-r-r-y uncomfortable to essentially be pinned to the mat out of sheer relaxation, while your head is still going a million miles an hour, and for once, fully aware of uncomfortable thoughts and emotions you'd otherwise be avoiding.
But that's the point of yoga, to become aware, acknowledge, and nonjudgmentally, choose to accept. With practice, your head will also slow down. I've learned not to accept the belief that"yoga isn't for me" from someone who has only participated once. You really do have to attend, I'd say, at least five times, to start to achieve and understand its benefit.
Finally, there are so many types of yoga and so many instructors, it is important to find a class, a studio, a style, and an instructor that you feel comfortable with. If something in your environment isn't right, it will be hard to focus on yourself.
Rebecca shared that SuTRA Midtown offers a yoga tasting package, which allows you to try as many classes and instructors as you wish within a two week period. It's a great way to give yourself a chance to experience the benefits and find a schedule that works for you in every single way. If you're in Phoenix, perhaps this could be your way to start the New Year off in a self-nurturing fashion. Or, perhaps you can ask around your own local studios to find a similar offer.
You have to give yoga a chance to work before you write it off. Most importantly, you have to DO it. I'm willing to bet that once you start, you'll wonder why it took so long.
