One of the recurring themes I see in my clients is a lack of self-care. This is one of the indicators that I am working with someone who is depressed. Self-care is often one of the first things to go by the wayside. By self-care, I mean the obvious as well as the things that aren’t so obvious. Obvious aspects of self-care include eating regularly, getting enough sleep, drinking enough water, and taking a shower regularly. Without these basic items being taken care of consistently, your life isn’t going to function very well. Less obvious aspects of self-care that are often lacking include: • Tending to quality of sleep, as well as quantity • Eating a diet that works for your particular body, on a consistent basis • Maintaining decent work hours • Making time for family, friends, and your spouse/partner • Going to therapy • Practicing safe sex • Not driving while drunk • Consulting with qualified health practitioners about your PCOS • Going to yoga • Starting a meditation practice If you’re not engaging in these forms of self-care, your quality of life will be low, your relationships will suffer, and your health will ultimately decline. Above and beyond these basics, there’s a whole host of other things you can do that comprise a complete package of self-care. These might include: • Engaging in clear and open communication • Having a spiritual practice • Making time for art, music, and culture • Practicing a hobby • Shopping at the Farmers’ Markets • Getting massages, manicures, and pedicures • Taking an occasional “mental health day” from work • Doing something silly, juvenile, or useless, just because it’s fun • Having date nights with your spouse/partner • Taking time to play – really play – by yourself or with your friends or children • Getting acupuncture • Keeping a journal • Finding a community of like-minded individuals, and making time for them • Cooking from scratch • Taking a mid-afternoon nap when you need it • Deciding that there are some things that really aren’t worth doing – and then not doing them • Saying “no” to people you don’t like, causes you don’t care about, and anything else that makes you feel irritable, disgruntled, miserable, or resentful • Practicing gratitude • Buying candles – the expensive lavender ones from that little boutique, if that’s what tickles your fantasy • Engaging in community service that pleases you on a variety of levels • Getting real about what size you wear, and getting comfortable about it • Hiring help when you need it • Ordering dessert occasionally • Deciding you don’t care what other people think As you can see, there are many levels to self-care, or emotional nutrition. When you know what you need to do to feed your body, brain, heart, and soul, your priorities become clearer, you’re calmer, and you experience more life satisfaction. Quite often, you’ll find that symptoms of depression decrease. How about making your own list, and committing to practice at least item on it every day? Check in with yourself after a week, and again at 30 days. Note what’s changed. Keep practicing. 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.
The other night, Gretchen Kubacky, PsyD shared in her webinar that managing a chronic illness such as PCOS requires an average of an hour and 40 minutes a day. She stated that this included exercise, taking medications, checking blood glucose, physician appointments, etc.
I don't have PCOS, and as she was listing the activities that fell into the self-care category, I realized that even so, I devote a fair amount of time in my day to self-care. I don't take meds and I don't monitor my biochemistry, but I do (1) make more food from scratch than the average person, (2) swim a mile 3 to 4 times a week, (3) walk instead of drive whenever I can, and (4) commit to a regular bedtime instead of staying up late.
Yesterday, for example, I had a presentation late in the day. So I scheduled my workout first thing in the morning, and did a little bit of work in the afternoon before leaving to speak. There was a free symphony concert I really wanted to attend, but I realized that if I went, I'd be home late and I had to get up early this morning to catch a plane. So as much as I wanted to do the fun thing and see some friends, I came home, packed, and relaxed, so I would be at my best today.
I don't think of those choices as sacrifice at all. They're part of my routine. It wasn't always that way.
Long ago, I lived in Palo Alto, a very population-dense community. My job was only two miles away, but I realized one day that it was taking me longer to drive around and find a parking place than it was to actually drive to work. I decided that walking/rollerblading to work could kill two birds with one stone: (1) I wouldn't waste the driving around to park time and (2) I could have my workout done by the time I got home.
Easy you say? Not really. Even though the benefits were clear in my head, I had a really hard time making the switch. I decided to try only doing the rollerblading commute one day a week at first. Then I added two, then three. It actually took about a year to get into the habit. Once it got into my system, I actually looked forward to it. Palo Alto is a beautiful community and I started to notice that in walking home and enjoying the gardens along the way, I was a lot less stressed.
It was giving up the old way of doing things that was hard. There was probably a little bit of grieving involved. Maybe changing some hardwiring in my brain. It was CHANGE. Any change takes effort, and adjustment.
I got to wondering if reframing that hour and a half as self-nurturing rather than self-care might help some of you. To realize that what you're being asked to do, at least partially, isn't something that you HAVE to do because you're weird or broken or have PCOS, but because it's because you're being asked to take better care of yourself, and because you DESERVE to make that kind of time for your self and your health.
These may not be as glamorous as the choices the food industry and the alcohol industry and the clothing industry might like you to define as self-care, but it does work. These days, and I'm being honest, I value having an hour in the pool far more than I do eating a brownie. It's my one hour where email, phone, Twitter, yadayadayada, is not a concept. I relish the feeling of silently gliding through the water and having my brain and my thoughts all to myself. I love that later on at night, I feel sleepy and actually sleep soundly. I've become selfish about that time and I schedule around it.
If you were to think of that one and a half hours as selfish time, may even a little bit of self-indulgent time, would you be more willing to do it? Instead of viewing it as an hour and a half of suffering, sacrifice, self-denial? It's all in how you market the concept to yourself.
So you have to give up a few tweets and status reports and You Tubes and Facebook friends to accommodate the glucose monitoring. You deserve to be self-indulgent.
When you’re first diagnosed with PCOS, it seems overwhelming. Depending upon how you were diagnosed (with or without sensitivity, by someone knowledgeable or someone clueless, in the midst of an infertility crisis, etc.), you might not have been able to absorb any helpful information that was given to you. You might have been overwhelmed, and felt hard pressed to simply do what the doctor was telling you to do in that moment. Or maybe you got into fighting mode, and immediately ordered a bunch of books, read all the medical pamphlets, and found every website dedicated to educating you about PCOS.
Either way, you may have gotten caught up in being too macro or too micro in how you manage your PCOS. By macro, I mean, seeing the big picture, like knowing you need to lose weight, prevent heart disease, and try to stave off diabetes, but not really getting the details of how exactly you’re supposed to achieve those goals. By micro, I mean, you found information of evidence of some details of PCOS treatment – tidbits of information like: eat low glycemic, take fish oil, maybe inositol helps, soy can be a thyro-toxin, etc. You dutifully apply these bits and pieces as you find them, and you may or may not feel better, but still, you don’t really have a clear concept of why you’re doing all these things. You’re just doing them because someone, somewhere, suggested they might be helpful. So step back a bit to see the big picture if you’re caught up in details, and drill down a bit for more detail if you can’t seem to get a grasp on what you need to do, or are caught up in a panic of possibilities.
Self-care is like the financial world. You’ve had a meeting with a financial advisor, or you’ve read enough articles to get the concepts: slow but steady wins the race; your financial future shouldn’t be based on just one investment but should be multi-pronged; a little bit is better than nothing, it pays to watch for hidden fees; and so on. Translating this into self-care terms, I’d say almost the same things: slow but steady wins the race; one supplement or one exercise isn’t the cure-all; doing as much as you can, even if it’s just a little bit, is better than doing nothing; and it’s important to watch out for people who aren’t motivated by your best interests, and who just want to make a buck from your suffering.
PCOS self-care is a life-long project. If you don’t have a solid base, the structure will topple (kind of like the financial structure in this country and many other parts of the world). You need a good plan, and good advisors for creating a personalized nutrition plan, taking care of your mental health, getting enough of the right kinds of exercise, and getting plenty of sleep. If these basics aren’t in place, it won’t matter how many stress management techniques you practice, or which supplements you take, or which specialists you see. Meditation can’t fix five hours a night of sleep. Supplements can’t fix a steady diet of junk. A naturopath can’t re-regulate your body if you’re smoking or doing drugs. It’s pretty simple – build the foundation first, then the rest of the structure will follow naturally. Embellish later, when you’re feeling pretty good with the whole situation. You don’t decorate a house before it’s built. And so it is with PCOS self-care.
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.
It's 2010! It's also the time for reflection and resolutions. Don't forget to give yourself credit for the positive! Often times we try a new behavior, food, or activity, and because it didn't create a miracle or immediate change, we discontinue it and assume it didn't work. The truth was, we didn't give the new choice an opportunity to take hold and unfold.
We also tend to make the same old resolutions revolving around diet and exercise. Rather than fall into that trap here, I came up with a list of 10 other, less obvious, but equally important things you can do to help manage your PCOS.
Here's to another year of PCOS outreach. I am grateful for all of the wonderful people this blog has brought into inCYST's world, and I look forward to more good times and new friendships!
1. Prioritize yourself.
Most of my clients are highly intelligent, accomplished, passionate, and creative. But what strikes me is how easily they devote all of that energy to others…and have trouble using it to benefit themselves. Make time for healthy behaviors. They're appointments with yourself that are equally as important as any appointments you make with your doctor. Your body is trying to tell you that if you deserve anything, it's time for self-care. Make 2010 the year you agree and take action!
2. Be informed.
Over the year I've become busy with Twitter. I am disturbed at the number of tweets promising miracle supplements and cures for PCOS. Even moreso, I am disturbed to see that these tweets are the ones tending to be most often retweeted. The tweets with the most logical, evidence-based advice…sit there largely unread. If"fixing" PCOS was as easy as taking a pill, it wouldn't affect one in ten women. Don't get caught up with anyone promising a miracle or a pill. You deserve better than that. Be sure that any advice you try has research and evidence behind it to support its validity.
3. Be gentle with yourself.
I don't allow my clients to use self-deprecating language, and I confront them on self-punitive behaviors. Every single one of you is special. You deserve respect, and you deserve to celebrate the many positive things about you the rest of us see. You're not broken, and you don't need to be fixed. What you need is for the rest of us in your world to support a positive self-image and to see your goodness on days when you have a hard time with that. Expect more of that and less of the"broken speak" and see what comes into your life.
4. Take responsibility. You can spend hours and hours on the Internet. You can participate in chat rooms and support groups and share your story. OR…you can take action. Many women I've tried to help have been more invested in sharing their story and their misfortune than they have in learning how to change their fortune. Are you suffering from what I call"PCOS Paralysis"? Is your time devoted to keeping you stuck, or are you consistently trying new things and working to be consistent with the behaviors that work? You can't see change unless you implement change. One step at a time is good enough. Those steps eventually add up to make a difference.
5. Create a support network.
inCYSTer Stacey Whittle (Santa Monica, CA) recently shared this quote on her Facebook fan page: "In 2010 CHOOSE your friends. Do the people you invest much of your time with sharpen you and amplify your happiness/productiveness? You will take on the habits, attitudes, beliefs and even mannerisms of the people you surround yourself with." Look around you. Are you surrounded by people who support healthy change and who help you to add those changes in your life? Or are you expected to be a lone wolf in the middle of people who are stuck in the lifestyle that helped make you sick to begin with? Look for people who live the way you would like to, and spend more time with them.
6. Try something healthy.
It does no good to read about it, tweet about it, debate about it. You have to live it!
7. Persist.
Remember, the days you need to take care of yourself the most…are the days you least feel like it.
8. Turn off your technology and live!
There is only so much the Internet can do for you. The life that will turn your situation around, is the one that exists off of your computer/iPhone/television screen.
9. Get some sun.
It will increase your vitamin D levels, improve your melatonin metabolism, increase your activity, improve your mood, and give you some nature-based inspiration. It really works.
10. Celebrate your beauty.
You are not broken. You do not need to be fixed. Your beauty is about who you ARE. Not about what you could be. Celebrate it. Be proud of it. Don't wait until you lose weight/conceive/resolve your acne to take care of yourself. Take care of yourself first, and see what happens to your weight/fertility/skin. Make 2010 the year you take care of the beautiful person you are, the way you deserve to be taken care of!
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 have been sicker than I recall being in a long time. I need to take the rest of the week and prioritize sleep and rest so this nasty virus does not drag on and turn into something serious.
You all should know, it takes a lot to keep me down, but with record blog traffic, I feel like I am accountable to all of you for modeling the very behaviors I advocate for. Self care is super important. If I do not take care of myself first I can take care of no one else!
So I will be back starting next Tuesday with regular daily blog posts.
So by now I'm sure you've heard the news about the new mammography recommendations. I wasn't on the panel and I'm not a breast cancer specialist, but I do have some thoughts pertaining to what these findings and the potential implications mean, to women reading this blog.
It's a mixed bag.
1. First of all, it's not the scientists, it's not the government, and it's not your doctor who is in charge of your health. YOU are in charge of your health. If you're using this situation as an excuse to be paralyzed about self-care, you've been defeated and you've turned your health over to someone else.
2. Keep in mind, many women with PCOS have high estrogen levels, meaning they have extra estrogen that can find its way to estrogen-sensitive tissues and cause problems such as cancer. You are potentially an at-risk population that needs earlier mammograms than the average American woman. It is important when discussing your personal need for earlier mammograms, that this health issue be included in the decision making. If your physician does not acknowledge or understand the relationship between PCOS and cancer, it is your right to find a physician who does. Sticking with the same physician and allowing that attitude to guide your health choices is turning your health fate over to someone who doesn't deserve it.
3. The good news is, women with PCOS are already used to advocating for themselves so doing so with the mammogram issue is not something they're likely unaccustomed to doing. Be assertive!
4. The bad news is, women with weight issues tend to avoid doctor visits because they don't want to be chided about losing weight. If you don't go to the doctor, all of the above don't even matter. Find a physician who will treat you respectfully…AND MAKE A COMMITMENT TO REGULAR PHYSICALS.
5. Remember, getting a mammogram is not the only thing you can do to reduce your risk of breast cancer. Breast self-exams are very important. Women with poor body image are not the best at conducting breast self-exams. If you're having trouble with the idea of looking at and feeling your breasts, the consequences could be as serious as not getting that mammogram. Ask for support.
6. A local television station sends out a monthly self-exam reminder, which I'll forward to all of you as well. If that helps you to remember to do them, then it's our pleasure to be a part of that. Here is information on how to perform a breast self exam.
7. All of the dietary recommendations you see here are made taking into consideration the implications for risk of other diseases, including cancer. Taking care of yourself in ways that benefit your PCOS, also reduce your risk of breast cancer. So eat well, be active, manage your stress…and get some sleep!
Remember, your health is YOURS. Not the government's, not your doctor's, not your insurance company's. Care for it like it's your most valuable possession. Because it is.
Three different clients in the last two weeks have expressed the same inspiration independently of each other, so I figured I'd let them inspire me on this blog topic.
Each of these women expressed that once they stopped mentally fighting with themselves over their diagnosis, stopped focusing on how badly they're feeling, and started prioritizing their self-care, they began to lose weight and feel better.
Up until the point that they had this moment of inspiration, they were fighting against the disease, feeling sad and angry because of the diagnosis, and much of the time, interfering with their own potential to succeed at feeling better.
Here's the deal.
1. Your PCOS is not going to go away. You can fight with it for the rest of your life. You can draft an encyclopedia's worth of reasons why you shouldn't have to be asked to make different food choices, get out and walk on your lunch break, go to bed a little earlier, set boundaries with your husband. You can even complain about the dozen doctors who don't get it. But the whole time, you'll be stuck in a body that is even more tired, frustrated, and depressed than it already is. Unfortunately, you can't just go jump into a newer, upgraded model. The model you have to learn to work with…is the one that you were given.
2. Accepting that you have PCOS is ABSOLUTELY NOT accepting defeat. I hear in a lot of comments that many of you feel that by accepting your diagnosis, you're failing, that somehow being stubborn and fighting back, and demanding more money be devoted to research and the development of a cure…is the most productive path you can take. Have you considered the psychology of this argument? That until a cure is found, you've committed yourself to not taking care of yourself and unloading choices that make it even harder for you to function normally and enjoy TODAY? It seems to me that now that you've discovered you have PCOS, you have an extra special reason to be treating yourself a little more proactively, so that if and when that day of a cure does arrive, your body is in the absolute best condition it can be in, ready to respond to this new treatment.
Acceptance is actually a stage in the grieving process. If you've ever lost a loved one, you likely know how sometimes you fight to keep the memory of that loved one in your presence out of fear that if you stop fighting, stop feeling sad, stop wrapping your day around the sad thoughts, you've let go and lost the person forever. It's not really that way. When you accept the loss, you just put them in a place in your heart and spirit where they still have your love, but you have room for new and different experiences that they do not share with you.
Accepting that you have PCOS is a lot like learning that if you have curly hair, you need a different kind of hair conditioner than someone with straight hair. Now that you know how your body works, what makes it feel badly, what helps it to feel better, you have an opportunity to make choices that drive you more often toward feeling better.
You can still be a PCOS advocate, you can still fight for more and better research, you can still research your disease. Only you're feeling a whole lot more energetic in the process.
Oh, by the way, I'm willling to bet…even if a cure is found, it's not going to be any kind of vaccination that allows you to eat Fritos and Twinkies ad lib without consequence. You're still going to have to prioritize self-care in order to see progress. Just sayin': )
I encourage you to think about whether or not fighting against yourself and pushing away all of the possible choices that could help you to feel better isn't part of why you're not feeling better?
It's ok to accept. A diagnosis. Help. Support.
Thanks for coming and using this blog as a part of your personal PCOS acceptance plan.
Research has repeatedly shown that people who write down their goals are much more likely to meet them. As we wrap up 2011, and head into 2012, I invite you to write down your goals for the new year, as they relate to your health and self-care. Here are some suggestions to get you started.
• Choose from the following list of self-care behaviors, and try one each week, or each month:
o Learn how to meditate.
o Go to a yoga class.
o Eliminate sodas/pop from your diet.
o Get a consultation with a psychiatrist if you think medication might help your depression or anxiety.
o Find a new doctor if you don’t like the one you have.
o Get your hormones tested.
o Find out what low glycemic eating is all about.
o Take an afternoon to go on an “artist’s date” – do something that fuels your creativity, delights your senses, and brings you joy.
o Cook at home, twice as often as you do now.
o Rearrange your schedule so that you actually are getting enough sleep (eight hours, please).
o Get some practice with boundary-setting. Start small. Say “NO” to someone or something you don’t want to do. Be clear and firm. Do not apologize. Applaud yourself.
o Walk for 30 minutes after dinner, every night. Walk with a friend or loved one, and double the benefit.
o Call a friend you haven’t seen or spoken to in months.
o Read something more meaningful than People magazine.
o Stop watching the news right before you go to bed. Better yet, put yourself on a “news diet” for an entire week.
o Go to therapy.
o Keep a journal.
o Stop conning yourself that French fries are a vegetable.
o Go to a farmers’ market, and buy one weird, unusual, or new vegetable or fruit that you haven’t tried before; ask the farmer how to prepare it.
o Have sex more often, with yourself or someone you love.
o Consult with a professional, inCYST-trained dietician.
o Start a gratitude practice. Every morning when you get up, write down five things that you’re grateful for. Do the same every night. Try not to be repetitive.
o Tell someone in very clear terms precisely why you value them.
o Reduce your caffeine intake.
o Switch from milk chocolate to dark chocolate.
• Share your list with a friend, and ask her to serve as an accountability buddy for you. Her job is to ask you each week, “Did you do what you intended to do? Why or why not? How did it feel to do it? Are you going to keep doing it?” If you’re feeling brave, blog it, post it somewhere in your house or office, or share it with your FaceBook friends. Accountability is an amazing thing in helping us adhere to our goals.
• Be gentle on yourself if you fail, are slowed down for some reason, or give up on some aspects entirely. Life is full of hazards, roadblocks, and other impactful situations. You cannot control them; you can only adapt.
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
Ringing in the New Year with visions, dreams and intentions is part of our contemporary culture. The ball drops in New York; the sun rises wherever you are, and we all seem to sense change is in the air. January 1 marks the time when many people decide to make a change and transform some aspect of their lives in ways they believe will make their lives better. Often resolutions are related to health and well-being. Here’s a new resolution: recognize health insurance is not heathcare; and vow to seek healthcare, not a payment system. For the approximately 45% of Americans with health insurance through their employers, January 1 is also the start of the year for most health insurance policy annual contracts. The same holds true for the approximately 11% of Americans have some other type of insurance, and the 25% with a government plan. Whatever the type of insurance, it’s likely the insurance company changed the rules as of 12:01 January 1. And their changes may have a substantial impact on the care of your health, impacting what you envision as a means to have a better life in 2012. The insurance company didn’t consult you on the policy changes. They didn’t ask you want you need or want to feel and be healthy. In the paradigm of the 80% of insured Americans, insurance companies are in the driver’s seat to decide what healthcare is and who can provide it. It could mean different types of treatments are covered or not covered; different types of allowable “doctors” are considered acceptable or not acceptable; and of course it all revolves around a method to parse the dollars between providers, patients and insurance companies – the power triad of today’s “healthcare system.” Making money in the healthcare system: insurance & pharmaceutical companies
Insurance is a contractual payment system. It’s a method to pay to certain people what the company determines is allowable care, under the terms of the policy. The payment system has very little to do with actual care that relieves suffering and improves well-being. When you let a payment system determine what care or well-being is, that substantially limits your options to make your life better in any way that resembles your personal concept of well-being.
Stephan A. Schwartz, a regular contributor to Explore: The Journal of Science and Healing has coined our current healthcare system as the “illness profit system.” And there seems to be plenty of profit to go around. Insurance companies, by their very nature of being corporations, have as their number one job to return shareholder value – to make money. CEO’s get paid a lot of money to do this. The heads of health insurance companies, healthcare consulting firms and other health related companies are among the highest paid executives in any industry. According to the LA Times, McKesson CEO John Hammergren received $145.3 million in compensation in 2010. Fierce HealthCare reports Omnicare CEO John Figueroa was compensated 98 million last year; and Aetna’s Ronald Williams took home $57.8 million before retiring in April 2010.
Pharmaceutical companies are also big winners in the power triad. In 2009-2010, seven of the big pharmaceutical companies paid 17,700 presenters a total of $281.9 million to promote their products. These presentations to physicians were instrumental in a"combined prescription drug sales amounting to 36 percent of the $300 billion U.S. market in 2009." Only 10% of what big pharma makes is spent on research to cure diseases and save lives.
The losers in this system: patients and physicians
According to Bloomberg.com, “Forty-nine million Americans reported spending 10 percent or more of their income on insurance premiums and out-of-pocket costs last year, according to the Commonwealth Fund study.” Patients spend more and more. As of 2008, 38% of adults used some sort of “complementary alternative medicine” (CAM). Anything labeled CAM is generally not covered by insurance, with rare exceptions of some limited use of acupuncture or chiropractic. Not only do people spend money on insurance premiums, they’re paying providers directly for health care that actually works for them. No wonder we have the most expensive health care system in the world.
Many M.D.s are also struggling with this current power triad. Holistic physicians who want to spend more than 7 – 10 minutes with their patients, and want to provide CAM care that works are seeking ways walk away from the insurance model, and serve patients in ways that help patients fundamentally heal. While they’re reluctant to talk about it, a recent CNN article discusses the economic challenges for M.D.s trying to operate in this system, and how many of them are going broke. http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm?hpt=hp_t3&hpt=hp_c1
Your resolution for the care of your health
The month of January didn’t even exist until about 700 B.C. when the Romans adjusted the calendar and move the “new year” from March to the new January. Julius Caesar introduced the Roman calendar, a solar-based system, in 46 B.C., and decreed the new year would be January 1. During the middle ages the new year was celebrated on various days in December, January and March. Even today, cultures around the world celebrate the new year on dozens of different days.
So, while January 1 has passed, any day can be the start of a new year. What will you resolve about the care of your health? There is an opportunity for transformation just as significant, if not more significant, than the common “eat right and exercise” resolution. At the core of your being, what’s your vision for the well-being of yourself, your family, or even the planet? Bring your vision, your resolution, to fruition by really knowing what you mean by “health” and “care” and spend your money accordingly. Resolve to not confuse health insurance with healthcare. Those two terms mean vastly different things.
About the author:
Deb Andelt is co-owner of Experience In Motion, which equips organizations with tools to curate meaningful experiences for customers and employees. Deb’s personal journey from decay to wellbeing inspired an emphasis in improving healthcare experiences for patients and practitioners by focusing on experiences that heal and self-caring as a way of organizational being. www.experienceinmotion.net.
Over the last week, the women in our Facebook group have been commiserating about the hard time they have achieving reimbursement from their insurance companies for their health care. I'm starting to sense that for many, they've defined their journey to health as beginning, if and only if…when and only when…insurance will pick up the tab for it. And until that day comes, they sit, feeling paralyzed, defeated, and invalidated.
So I thought I'd share a few of my professional insurance stories with you to give you an idea of how insurance really works. It's not really what you think.
One physician told me several years ago, she knows there is a lot of PCOS in her practice. But since it is a complex disease, she doesn't make the diagnosis. Why? It's not a profitable position. Her exact words to me were,"I make more money writing scripts for runny noses. PCOS is a Pandora's box. And I have medical school loans to pay."
Another physician invited me to lunch awhile back, she'd started a weight management program and she wanted to partner with a dietitian. Excited, I brought all of my PCOS literature along. The lunch was nice, but as it progressed, she explained to me that she was leaving her family practice specialty and moving into cash pay, because there was far more money in the latter. I could tell, she didn't really want to take on PCOS because it would cut into her profit margin. She wrote me after the lunch, saying she decided I'd have to drive too far for the arrangement to work. (I responded by saying I thought that whether or not a job gig was too far should have been MY call…but that's another story for another post.)
Several years ago, I had a meeting with a reproductive specialist in Beverly Hills. He came to the meeting, and like the other physician, explained that he felt he was working way too hard for the money he was earning, and was looking for revenue streams that would fix that. He was hoping I'd do work for him for which he'd keep the majority of the income. He was also writing a screenplay and once he ascertained in a very roundabout way that I didn't know anyone to get it to…the enthusiasm seemed to wane. I never heard from him again.
For 3 1/2 years I was the director of dietary services in a well-known eating disorder treatment center. Twice a week we had staff meetings where we discussed patient progress, and the reports were shared with insurance companies to negotiate for longer stays. We never got what we wanted. The owner of the treatment center taught us that the most successful case managers in insurance companies are the ones who decline the most claims, because they save the most money. It came to a head one time when a woman had been approved by her insurance company, traveled all the way to Arizona, only to find that they reversed the decision while she was en route. She knew the system, however…and she went to check in to a local hotel, called her admissions counselor, and threatened to commit suicide. She was admitted.
The point I'm trying to make here, is that insurance companies, no matter how touchy-feely, warm-and-fuzzy they may sound around enrollment time, don't think of you as women needing help with medical problems. They view each of you as a cost center. PCOS is an expensive diagnosis to treat. And since one in five women has it, if they started approving PCOS claims, they'd put themselves out of business. So they don't like to recognize it.
If you're feeling angry right now, you have a right to. The system is set up to not serve well, women with PCOS. It's not going to change any time soon.
You have a choice about how you're going to deal with this reality.
You can let it defeat you. You can sit on the sofa, watch television, and eat that box of donuts you brought home, out of anger at your situation. It's not really going to help you get better, though. And it doesn't come close to hurting the corporations who have hurt you.
Or…
you can prioritize self-care. You can make a choice to eat better. Exercise a little more. Manage your stress. Sleep more. Take control. You can buy Hillary Wright's book and implement her recommendations. Watch Sasha Ottey's PCOS Challenge TV Show. Join our Facebook group and share ideas. Walk in the upcoming Walk-a-Thon. You can do everything you possibly can to move yourself toward health. You just might lose weight. You just might improve your fertility. You just might feel better.
I honestly don't see the system changing much during my lifetime. There are too many companies with income to lose if true reform occurs. The most I can do, is raise money for research to put information into journals that pressures insurance companies to let you get acupuncture, or take a nutrition supplement, or get mental health counseling. So that is what I do.
It's not fair. It really sucks. So? Are you going to let it disable you, or turn it into the fire underneath you that prompts you to value self-care? We hope you join us in the choice that has a chance of making a difference.
I'm inspired to write this post as a result of having a handful of women follow our advice on their own, and once they discovered they were pregnant, they reached out and asked for help.
I am truly honored and flattered that these women have reached out. What is heartbreaking for me is, that in more than one case, by the time they reached out, there was not much I could do…and the story has not always had a happy ending.
I am not writing this to shame or scold anyone, or to suggest that I could have changed the course of anyone's pregnancy. I am not God and I do not aspire to be.
But when I read these posts collectively, it strikes me that while some of you really, really wish to have a child, you don't believe you can. Of course you don't. There is a whole industry out there needing you to believe that, because that belief on your part is what keeps them in business.
So you kind of sort of try what we offer, for a day here, a day there, and even if the changes are sporadic, they are enough to gently shift your hormones in the direction they should be going. For at least part of the journey. But not all of it. And when the journey abruptly ends, it is not just your heart that breaks. My heart breaks too.
My wish for all of you, is that before you embark on this journey, you commit to believing in it. You cannot have trepidation. You cannot just dip your toes in the water and run the minute it gets hard. You have to believe you can do this. All of it. The better sleep habits, the better eating habits, all of it. You have to do it without a"what if?" in your head. Because if you're kind of sort of doing this, and a pregnancy catches you off guard, you may have done a lot of what you need to do, but not enough.
Again, I'm not here to shame you. At all. It is far worse for me to see some of you nearly hit the finish line…only to have it snatched from you just as you thought you had it. I think it is worse than never seeing it at all.
The time to commit to this taking better care of yourself thing, is now. Not if and when you conceive. Nothing we ask you to do here is wacky, expensive, toxic. All we are doing is showing you how to self-nurture. It is doable, and should be done. Now. Not just because you want to conceive, but because you deserve to take care of yourself.
We cannot treat individual cases here on this blog, so while we give you an awful lot of information and some of it works really well for some of you, it is not sufficient for everyone.
I encourage you to either get involved in a Power Up for PCOS group where you can access more detailed information, or reach out and ask for an individual consultation. Yes, there is a lot of information to be had for free on the Internet. And yes, there are really expensive options you can buy. We aspire to be right in the middle, to be the best we can be with the information we are really good with. Sometimes it does require an investment.
We would love to invest in your learning how to invest the best possible self-care you can give yourself. Don't put it off until you conceive. Make it part of your conception plan.
Thought I would bring a psychotherapist's perspective to treating PCOS. In the past few months I have attended three scientific conferences and one practitioners conference on PCOS. The one unanimous and certain recommendation from every one of them was 'lifestyle, lifestyle, lifestyle'. But what does that mean? Does it mean eat less and exercise more? Does it mean feel shame when you indulge in holiday egg nog this season? No. Lifestyle to me means just that…style your life. Make changes to honor your life and take care of your chronic condition. Attached is an outline I wrote to help me explain and promote 'Lifestyle' to my clients.
Treating PCOS: Lifestyle for Success A Psychotherapist's Approach Stacy Korfist, LMFT L is for the lifestyle change that is critical to make. No more diets, no more ‘someday’. Lifestyle change obviously includes nutrition and exercise, but it also includes stress management, adopting a new way of living, a new way of coping and a new way of playing that is essential.
I is for Identity. This is your sense of self; your self esteem. This includes facing anxiety and depression. Setting appropriate boundaries helps you to claim yourself. I is also for Integrity. No more broken promises to yourself or others. They only lead to self deprecation and more shame and depression. Be a person of your word.
F is Food & Feelings. Eat when you are hungry; stop when you are full. Understand the thoughts and ideas which fuel eating behaviors. Learn all you can about insulin resistance. Don’t be fooled into another diet that is too difficult to sustain. See a dietitian that knows about polycystic ovarian syndrome.
E is the Education and knowledge that you must obtain in order to take care of yourself. PCOS is a chronic condition, not one that requires only medication. YOU must be your own case manager. PCOS involves almost every organ in your body. Learn about lab work and what your results mean. Don’t assume your treatment team is aware of your ‘whole self’. Trust yourself. Don’t be afraid to speak up. Remember, PCOS is a syndrome, a squirrely disorder which pops up in many places.
S is for Support and Healthy Environment. Surround yourself with encouraging people and rid yourself of as much conflict and chronic stress as possible. Pay a little more for organic food and avoid false estrogens in plastics and cleaning products.
T is Teamwork. You can’t do this alone. Ask for help, make plans ahead and let others help you. Being strongly-weak will get you so much farther than being weakly-strong. Assess your treatment team. Are you being seen by too many providers; broken up into too many pieces? Are you taking too many medications?
Y is for YES! Yes is the attitude to have. In order to avoid deprivation backlash, it’s important to focus on what you can have versus what you cannot have. Live with full passion. Y is also for Yesterday. Let go of yesterday and focus on today and tomorrow. Having a positive future-focus will help achieve successful endeavors.
L is for Lower Threshold, not lower calories. Although weight loss is important for some, reducing calories too much can prove counter-productive. People with PCOS can have a lower threshold for oxidative stress. It doesn’t take as much to put the body in stress mode. Exercising too much or restricting too little are stressful on the body. When you do this, you often experience backlash and yo-yo weight gain.
E is for Energy and Experiential Therapies. Learn mindfulness skills. Occupy your body. Achieve mind-body congruity. Change requires an awakening. We awaken in movement, awaken in relationship and awaken in journaling and art. This allows us to be with ourselves, in our own space. It teaches us self monitoring and self regulation, which slows down reactivity.
Stacy Korfist, LMFT Redondo Beach, California (310) 720-6443 info@pcosnetwork.com
(Note from Monika: Dr. Gretchen will be offering counseling from our Santa Monica office. She has a few spaces left in her"pay what you can" introductory offer for Friday, September 16. If you're interested, email monika at afterthediet dot com for more information)
One of the purposes of the “Mental Health Monday” feature of this blog is to acquaint you with some of the psychological aspects of PCOS, and how mental health issues are impacted by the condition. There are also coping skills, insights and ideas about ways to help yourself, and education about how to create change.
You may have some vague symptoms that seem like something a therapist would know about, but you’re not really sure when or if it’s appropriate to have a consultation or session with me or some other health psychologist or therapist. My specialty, health psychology, focuses on medical conditions and how they impact our mental well-being.
PCOS causes or contributes to a variety of mood disorders, and can either mask or mimic some other physical conditions. It can be challenging to sort out which symptoms came first, and what your treatment priorities are. Here are some of the symptoms you may be experiencing that indicate a need for psychological evaluation and treatment, and that may be connected to your PCOS:
• Difficulty sleeping, or sleeping far too much • Physical aches and pains • Unexpected weight gain or weight loss • Uncontrollable food cravings, especially for carbs • Panic attacks, or anxiety attacks • Feeling jittery all the time • Mood swings • Thoughts of suicide • Constant irritability • Trouble relating to other people • Isolating yourself • Pain issues that don’t seem to be connected to injury • Feeling overwhelmed • Difficulty coping with your diagnosis • Having a new diagnosis • Infertility issues • A recent loss • History of trauma, domestic violence, or other acute stressors • Developing complications, such as diabetes
Additionally, you may want to receive education about PCOS and related mental health issues, identify a medical and psychological treatment team or plan, and work on developing coping skills and strategies for managing your PCOS. These are all things that health psychologists do, and that could be part of your reasons for consulting a health psychologist.
It can be scary to contemplate calling a psychologist, but at the same time, simply taking the first steps to get help may also result in improvement. Knowing that you’re doing something good for yourself, and that there ARE experts who can help, will often jump-start the healing process. You may be inspired to improve your self-care practices. You may also start practicing the self-care skills that you have, but haven’t been using often enough.
In a future “Mental Health Monday” post, I’ll address what actually happens in a therapy session, so you can learn more about what to expect, if you haven’t already experienced therapy.
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.
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’ve been having an interesting conversation on Twitter with a woman who advocates for size acceptance.
I shared with her that I believe in size acceptance, but that my experience in over 30 years of being a dietitian has been that it hasn’t seemed to help progress the movement to confront it directly. In fact, many popular women’s magazines I’ve seen, tend to politely give lip service to the idea by putting an article in about the topic. At which point, I see it posted by the author on Facebook, all of that person’s friends “like” the post, they get a moment of fame for the piece, and traffic is driven to the magazine’s website. Where everywhere you look there are advertisements and other articles with messages running completely counter to the well-intended message in the “healthy” article.
The magazines don’t care what’s in the article. They want hits, because hits determine advertising rates. If baiting and switching the size acceptance crew to keep them coming back… keeps them coming back, and they read the counterproductive ads, then it’s highly possible that continuing to agree to participate in this vicious cycle only keeps those who feel victimized by the whole media/body image disconnect… further entrapped.
I’m a realist. We live in a country that is based on the right to freedom of speech. The very freedom I have to write this blog post is the same one the magazine publishers have. They really don’t care about my self-esteem, or your self-esteem, at all. They care about keeping their stockholders happy. Getting people to visit your website, regardless of how you make it happen, to keep advertisers happy, to keep ad rates up, to create the bottom line that keeps those stockholders happy… is all that matters to any media entity.
So while I applaud the efforts of my friends who work in size acceptance, I have come to believe that the approach they’ve been taking is quite possibly having the opposite effect.
That is why, several years ago, I dropped out of the eating disorder conference circuit. I stopped participating in the dialogue. I kept hearing the same old dialogue, over and over and over, but it always stopped with “dialogue”. No action plans were coming out of that dialogue, no progress was made in the success rates for treating ANY eating disorder… it just wasn’t making a difference. I wanted to make a genuine difference.
What the women advocating for size acceptance want, those creating the dialogue want… is validation. And they seem to desperately want it from an industry, that quite realistically, doesn’t care about validation. Quite the opposite. They want women to feel BADLY about themselves. Because if they were quite satisfied with their looks, they would not respond to any of the advertisements that keep THEIR stockholders happy, which wouldn’t line the pockets of the companies producing the products who also have stockholders to answer to.
One side of the issue wants dialogue and validation, the other wants money. That is never going to change.
So when I dropped out of the dialogue and went on to create this inCYST network, what I envisioned was that we would create a warm, safe, nourishing community where we could learn to be healthy. We wouldn’t stomp and scream and hold our breath and not do anything for ourselves until the world was perfect, we’d create a perfect world for ourselves. That is why, for the most part, on this blog, even though the majority of the audience we work with has body image issues, history of an eating disorder, and/or weight issues, we don’t really talk about it very much. Talking about it only focuses you on the feeling that you’re being victimized. We’d rather empower you out of that tree.
I care very much about how each and every one of you feels about yourself. But I am not interested in dialogue that focuses you on what someone else is or is not doing. I don’t want to talk about the thing you’re trying to evolve away from. I want to know what you’ve done today. To manage your stress. To eat more folate. To delegate. To move your body.
Let’s imagine for a moment that when we wake up tomorrow, overnight I was given a superpower that allowed me to reinvent the entire media industry. Internet, Facebook, television, Twitter, newspapers, magazines… everything And let’s imagine that I used that super power to reinvent all of those things so that the only messages that could be communicated, anywhere, were positive, nurturing, and reinforcing.
Would you be able to live in that world? Would you be able to have a conversation with someone if you couldn’t talk about body image? If you weren’t spending significant amounts of time reading destructive magazines, following unproductive Twitter personalities, having dialogue about what’s wrong with the world? Would you be able to fill your day with self-nurturing activities? Would you eat better? Would you be happier?
Or would you be totally at a loss for what to do with yourself?
I don’t have that super power, but I aspire to create that kind of world. Last week I sent a thank you note to someone who made a purchase out of our new eMarket. She thanked us for having a place for her to shop where she felt heard and validated. And she also gave me a long list of suggestions for things we could do to expand on that world. I was happy to be able to ask her to “hold that thought” because most of those ideas were already on the drawing board.
I actually don’t want to have that kind of superpower. Because that wouldn’t be very empowering to YOU. I want YOU to take action. To stop looking at those magazines in the grocery store. To stop walking past the healthy salad bar and walking into the fried chicken joint. I want inCYST to be an underground of sorts, of women who have decided they don’t have to be victims anymore.
And who understand that one of the most powerful ways to speak, is with their wallets. If you’re not buying the magazines, not clicking on the websites, you are having a much greater effect on those media corporations than you are with dialogue.
I hope you choose to patronize the companies offering products in our eMarket, because if we can help these companies with great ideas as well as integrity to succeed, they are validated financially and can have the opportunity to become advertisers with power who actually have some influence over the media.
And the bottom line is, I want us to use our community to learn how to live in a world whether or not the media influences do exist. They only have a negative influence on you if you allow them to, and clicking on links and buying magazines opens the door to that path. Not going there is going to mean being more introspective, and talking about things like what you think how you feel, what you aspire to… what your talents are, what action you’re going to take… but for me, that is the dialogue that inspires me.
That world can exist right here, you know. Which is why I don’t participate in the dialogue about media. There are only so many hours in the day and any minute I spend on a fruit less effort is a moment that I’ve wasted because I didn’t use it focusing on YOU and who you are and how we can make inCYST world a place thtat celebrates who you are.
I know it sounds a little weird to some of you who are used to identifying yourself or introducing yourself as afat person or a former fat person or an infertile person,… or other limiting labels. I want to challenge you to, every day, if even for 15 minutes to start with, see how it feels to stop using labels to define yourself. Labels that keep you in a position of disempowerment. Labels that keep you stuck right where all those media companies want you. You might be surprised at how limiting your current labels actually turn out to be.
I want to create a new world and a new econmy with you, supported by health professionals and companies who see your beauty and your talent and who really would like to do business with you. Of course, they have stockholders too. But when they can go back to those stockholders and report that they succeeded with a product that was hard to get on the market because they took a risk on a product they were told didn’t have broad enough appeal… they teach those stockholders to seek out other small companies with big visions.
It’s a trickle up effect. I can offer you options, but it starts with you. And your decision to not focus on what the “bad” guys are doing, but to find those good guys who can help you feel good about yourself.
It’s still dialogue, it’s just dialogue with action plans attached. And from what I can see with who’s buying in our store and the energy it’s creating, it confirms to me that my better action here is to not talk about body image and self-esteem. But rather to encourage those very things with actions.
If you are a solution-focused person ready to take action, inCYST is designed for you. If you're into dialogue it may not be a great fit. If the dialoguing eventually moves you to a place where you're ready to take action…come join our fan page, come to a fundraiser, come to a class at our new office in Santa Monica, work with one of our network members to create change in your life, or simply read our posts and try a suggestion from time to time.
We like to think if you hang around us long enough, you'll start to feel like hanging out on the same old site with the same old ads and articles, Tweeting the same thoughts to the same people, is going to feel a lot less rewarding than what we have going on here. Our network stretches from New Hampshire to Florida to San Francisco to Seattle. Wherever we are, we're pretty great and we have a lot of fun. We look forward to seeing you somewhere, sometime soon. No magazines allowed.: )
I’ve recently been amused by a list of weird, wacky, and unusual holidays. Whole days, weeks, and months are devoted to the oddest things, and I’ll be writing about a few of them this month. Tomorrow, July 3, 2012, is National Compliment Your Mirror Day. I don’t really know or care about the origins of Compliment Your Mirror Day, but I’m going to tell you why I like the concept.
When you’ve got PCOS, when you think of the mirror, you’ve probably got negative associations. For many of you, your physical appearance fixations are typically:
• Being too heavy/problems losing weight • Acne and other skin problems • Hair loss • Hair growing in strange places, with abundance
The mirror is not your friend; the mirror is your enemy. Mirrors may have become something to dread, a way to facilitate getting down on yourself, or even a way to practice some really damaging things, like skin picking or cutting (those are both mental health issues, by the way). Many of you avoid the mirror at all costs, even to the point of not having a mirror in your house except where it’s unavoidable, like on the medicine cabinet in the bathroom.
You may dress to hide your body, or your hairy arms. You may wear hats or sunglasses to distract from hair loss, or wear scarves to hide akanthosis nigricans on your neck. You avoid shopping, except online, where you don’t have to be tortured by the multiple mirrors in badly lit dressing rooms. You spend a fortune on potions to fix your skin, dermatologist visits, and special machines that are guaranteed to sweep everything clean. It’s exhausting having PCOS, and doing all of what’s required, if you really commit to it, to look “okay,” “acceptable,” or “normal.”
But the mirror, like the scale, is merely an inanimate object. It doesn’t have the power to make you miserable, or to dictate your behavior. Only you have the power to decide what your mood is, or what your behavior is. Next time you catch yourself starting a litany of denigration because you caught a glance of yourself in the mirror, turn it around (it’s all about reflection) and force yourself to say something positive. It may take time and practice. You may have to really push some boundaries, but you can find something. So instead of focusing on the thinness of your hair, focus on the fact that it’s actually kind of a nice color. Instead of focusing on your hairiness, focus on the beauty of your eyes. Instead of focusing on a roll of fat, take note of how good the color you’re wearing looks on you. Try hard. Be honest. Don’t just default to the garbage you’ve been telling yourself for years. Don’t give up.
If this seems like a real push, start by just exposing yourself to some mirror time. Set a timer on your phone if need be. Start with 15 or 20 seconds. Just look at yourself without judgment. Practice for 30 seconds, then a minute. Work your way up to two or three minutes of just looking at yourself calmly, examining what is, not wishing for what isn’t. Then you can move up to giving the mirror itself a compliment: “you reflect me so well,” “I like the way you cast light on my face,” and maybe, just maybe, you can actually give yourself a compliment. The mirror is a facilitator of self-love. With increased self-love comes increased self-care, and that’s what we’re all about here at inCYST.
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.
As women with PCOS, you've likely had troubles getting our health care system to work in your favor.
The information in this post was sent to me by inCYST provider Karen Siegel, and I wanted to share it with all of you. Specific issues are highlighted in the text below, and you can review the bill yourself at this link.
You may wish to go through this and consider how each of these stipulations would play out in your own personal PCOS situation. If you have suggestions for better ways to do things…get proactive and contact those who represent you in Washington!
I do my best to be nonbiased in this blog, but there are aspects of this legislation that disturb me.
Here are a few highlights of some problems with the healthcare bill.
These problems highlight the reason every bill must be read by the American people before they are signed. (if these points don't get you upset, please check your pulse and call 911):
Disclaimer: This summary was sent from a colleague. We encourage you to conduct additional research on your own.
• Page 16: Eliminates the choice to purchase private health insurance! • Page 22: Mandates audits of all employers that self-insure! • Page 29: Admission: your health care will be rationed! • Page 30: A government committee will decide what treatments and benefits you get (and, unlike an insurer, there will be no appeals process) • Page 42: The"Health Choices Commissioner" will decide health benefits for you. You will have no choice. None. • Page 50: All non-US citizens, illegal or not, will be provided with free healthcare services. • Page 58: Every person will be issued a National ID Healthcard. • Page 59: The federal government will have direct, real-time access to all individual bank accounts for electronic funds transfer. • Page 65: Taxpayers will subsidize all union retiree and community organizer health plans. • Page 72: All private healthcare plans must conform to government rules to participate in a Healthcare Exchange. • Page 84: All private healthcare plans must participate in the Healthcare Exchange (i.e., total government control of private plans) • Page 91: Government mandates linguistic infrastructure for services; translation: illegal aliens • Page 95: The Government will pay ACORN and Americorps to sign up individuals for Government-run Health Care plan. • Page 102: Those eligible for Medicaid will be automatically enrolled: you have no choice in the matter. • Page 124: No company can sue the government for price-fixing. No"judicial review" is permitted against the government monopoly. Put simply, private insurers will be crushed. • Page 127: The AMA sold doctors out: the government will set wages. • Page 145: An employer MUST auto-enroll employees into the government-run public plan. No alternatives. • Page 126: Employers MUST pay healthcare bills for part-time employees AND their families. • Page 149: Any employer with a payroll of $400K or more, who does not offer the public option, pays an 8% tax on payroll • Page 150: Any employer with a payroll of $250K-400K or more, who does not offer the public option, pays a 2 to 6% tax on payroll • Page 167: Any individual who doesnt' have acceptable healthcare (according to the government) will be taxed 2.5% of income. • Page 170: Any NON-RESIDENT alien is exempt from individual taxes (Americans will pay for them). • Page 195: Officers and employees of Government Healthcare Bureaucracy will have access to ALL American financial and personal records.
• Page 239: Bill will reduce physician services for Medicaid. Seniors and the poor most affected." • Page 241: Doctors: no matter what speciality you have, you'll all be paid the same (thanks, AMA!) • Page 253: Government sets value of doctors' time, their professional judgment, etc. • Page 265: Government mandates and controls productivity for private healthcare industries. • Page 268: Government regulates rental and purchase of power-driven wheelchairs. • Page 272: Cancer patients: welcome to the wonderful world of rationing! • Page 280: Hospitals will be penalized for what the government deems preventable re-admissions. • Page 298: Doctors: if you treat a patient during an initial admission that results in a readmission, you will be penalized by the government. • Page 317: Doctors: you are now prohibited for owning and investing in healthcare companies! • Page 318: Prohibition on hospital expansion. Hospitals cannot expand without government approval. • Page 335: Government mandates establishment of outcome-based measures: i.e., rationing. • Page 341: Government has authority to disqualify Medicare Advantage Plans, HMOs, etc. • Page 354: Government will restrict enrollment of SPECIAL NEEDS individuals. • Page 379: More bureaucracy: Telehealth Advisory Committee (healthcare by phone). • Page 425: More bureaucracy: Advance Care Planning Consult: Senior Citizens, assisted suicide, euthanasia? • Page 425: Government will instruct and consult regarding living wills, durable powers of attorney, etc. Mandatory. Appears to lock in estate taxes ahead of time. • Page 425: Goverment provides approved list of end-of-life resources, guiding you in death. • Page 427: Government mandates program that orders end-of-life treatment; government dictates how your life ends. • Page 429: Advance Care Planning Consult will be used to dictate treatment as patient's health deteriorates. This can include an ORDER for end-of-life plans. An ORDER from the GOVERNMENT. • Page 430: Government will decide what level of treatments you may have at end-of-life. • Page 469: Community-based Home Medical Services. • Page 472: Payments to Community-based organizations. • Page 489: Government will cover marriage and family therapy. Government intervenes in your marriage. • Page 494: Government will cover mental health services: defining, creating and rationing those services.
Talk to Your Family, Friends, Neighbors & Co-Workers
You must talk to people about this. We need to get as many people informed about this as possible. Here are a few key points:
This issue is not Republican vs. Democrat. It is government vs. individual rights. "What's the proper role of Government in our lives?" "Do we really want the government making decisions for us that should be between me and my doctor?" "Should the government be eliminating personal health insurance plans?" "Should the government be requiring seniors to attend 'end of life counseling'?"
You may have noticed that we've devoted every Monday to a guest blog by inCYST network member, psychologist Gretchen Kubacky. If you belong to our fan page, you know I've been directly addressing issues related to mental health as well. There is a very important reason we're doing that.
For many of you, it's not that you don't know what you need to do. It's what is going on inside your head that keeps you from taking the action that could help yo. It could be that your depression is so severe that small changes feel like monumental tasks. Or that your anxiety spins so violently in your head that you're paralyzed out of taking action. Or, if you have obsessive-compulsive disorder, you can't get your thoughts out of fruitless loops of thinking (Ha! I didn't mean to make a pun there but I kind of like that one!) to focus on new and different behaviors. Or maybe you have bipolar disorder that leaves you feeling pulled around between being hyperenergetic and completely wiped out. And I do know that more than a few of you live with PTSD, the stress of which wreaks havoc on your metabolic functin. You may be on medication for one or more of these, or you may not. If you are, some of those medications can worsen PCOS.
It's all inter-related. To ignore how your mental health affects your physical health is to ignore the key to your overcoming what you are on this blog to overcome. Just this morning, I read a press release about a study that found that having a mental health diagnosis reduces life expectancy. I certainly don't want THAT for any of you.
So instead of trying to work around these issues as if they do not exist, we're going to begin to talk more openly about them. I've always felt that we do a huge disservice in our culture to people with mental health issues. They're not about being stupid…did you know Abraham Lincoln and Winston Churchill were believed to have bipolar disorder? I actually know that because a client long ago, who has become a good friend, did some research on being diagnosed with the disorder and made a list to inspire her to better self-care and less self-destruction. She is, because she's a very typical, highly intelligent and creative person with bipolar disorder, a very productive member of society. Because she deciede to embrace it. If you look around, some of the smartest people in history lived with psychiatric illness. It's time we stopped acting as if these problems were something to be embarrassed about and started realizing how ultra-important it is to recognize and take care of brains that have them.
I understand if this feels uncomfortable; in fact, making this shift cost us more than a few Facebook follows. But I'm ok with that. I know there aren't very many places people who live with these problems feel safe to talk, and I believe the fallout removed personalities that weren't allowing that to happen.
It's where we're going and I hope you come along with us. I do believe, if we take this on, we have a far better chance of beating PCOS than we do if we hide in the closet and let it determine your fates.
This past week I was watching The Biggest Loser. Not because I endorse their methods for weight loss, but because so many of you watch that show, it's almost required viewing for my job, to know what's being said and how to address it should it come up in our Facebook group.
I was appalled to watch one of the trainers, while a participant was doing situps, dropping a medicine ball on the poor guy's stomach. Nothing about that segment modeled respect for self or others, in my opinion, and it could have done serious damage to the participant. But that is what seems to happen in the world of weight loss. Once your weight exceeds what is deemed medically and culturally acceptable, the rest of the world seems to act as if they automatically have a license to decide how to"fix" you. The behaviors can range from looks into your grocery basket when you're shopping, suggestions that you're somehow not"doing enough" if your weight loss is not linear and predictable (as illustrated by the closeups of the shocked looks of the Biggest Loser trainers when someone does not lose, or…God forbid…gains weight, the assumption that if things are not going the way the trainer needs them to go in order to be the"good trainer"), that the participant must be the one to blame.
PCOS creates an even more frustrating scenario for physicians, dietitians, trainers, family members, everyone watching on as a woman decides she's going to lose weight. We've learned over the years that in many ways PCOS is counterintuitive. When you diet too strictly, weight goes on. When you exercise too much, weight goes on. It seems to be the"canary in the coalmine," so to speak, of imbalances in your life that need to be addressed. And, unfortunately, if you're a person of extremes, and you resort to fixing one extreme with another extreme, you're likely going to find yourself in a place where you plateau, gain weight, etc., with at least a half-dozen people looking on, with a million suggestions for"fixing" the problem.
Years ago I was a dietitian in an eating disorder treatment center. I was literally responsible for the weight gains of anorexics, the weight loss of women with binge eating disorder, and to be sure that bulimics who had been abusing laxatives did not gain too much weight during their withdrawal from those drugs.
Take the scenario I described above and multiply it by 36, which was the census of the treatment center. I absolutely hated Monday and Thursday mornings because those were staff meetings. I had to meet for three hours each morning with all of the therapists, physicians, etc., and discuss the progress of all of the women we were helping. If, God forbid, the weight of one person was not EXACTLY what I'd projected, I was put on the spot to (1) explain why and (2) come up with a remedy. Suggesting that healing from dietary imbalances of any kind was complex and that we were not in charge of all of the parts of the solution was not an option. Much of the rest of the week was spent with patients, family members, and insurance case managers, having the same conversations. In one case it was an attorney of a beauty queen who insisted she'd been promised prior to admission that she would not gain weight despite needing to withdraw from her box-a-day laxative habit and since her temporary fluid gain was in the double digits, I was to blame.
Can you tell how much I thought this job sucked?
The piece de resistance came during one stretch, when we had an overload of laxative abusers in the house (no pun intended) and my boss, desperate to be able to show good weight progress to insurance companies and keep her own"success" record high, asked me to come up with a solution. This was in the days before the Internet, and so I asked to be able to take a day in the local medical library researching intestinal health and dietary strategies. My request was denied. Instead, I was asked to create some type of"cocktail" that would"clean out or speed up the 'progress'" of the constipated individuals.
I looked at my boss and said,"I am a dietitian. I am not a plumber."
As you can guess, it was the beginning of the end of that job, which I actually eventually walked off of, because that particular situation was merely one of many I was expected to endorse that in good conscience I could not.
I learned humility in that job. An Ivy League degree and a master's degree plus stints at Stanford, Apple Computer, and the professional sports world, could not fix what was broken in these women. Only time, self-nurturing, and patience. Every single time I watch The Biggest Loser, I am reminded of that job. And how so many people I worked with based their own success on a patient's numbers recorded in a medical chart. Not on how well she was asserting herself, or sleeping, or challenging herself to eat salad dressing. It was all about the number. That it wasn't about the healers at all, but about empowering our patients to have the confidence to take care of themselves so well that they could fire us because they didn't need us anymore, was completely forgotten.
I guess I was inspired to write this piece because ever since I saw that medicine ball, I've been thinking how badly I wanted the poor guy on the floor to just stand up, tell the trainer to bite it, and walk off the ranch. Because he was being taught that somehow, because of the position he'd found himself in, needing to lose weight, he deserved to be punished and humiliated in the process of regaining his self-esteem. Yup, he had to be humiliated in order to develop self-esteem.
Don't ever let anyone, and I mean ANYONE — a medical professional, coach, or loved one, cause you to believe that they know better than you, what you need for yourself. Or that because your weight is not changing at a rate that THEY have determined is appropriate, that you're somehow doing something wrong. Or that what they have to say about your health supercedes what you believe about your health.
As Eleanor Roosevelt once said,"No one can take away your self-respect, unless you allow them to."
