Chinn GYN, LLC
Knowledge for You, about You
Knowledge for You, about You
May 24, 2019
Mental health is an odd concept. It is odd to think of mental health as distinct from health in general. However, this is the unfortunate siloed approach that most modern medical practices use to approach any emotional or organic mental concerns. The vast majority of medical providers will address the body and concerns related to the body as separate from anything related to the brain. The following are just ten of many reasons this approach is problematic.
1. It engenders stigma: When we perceive the brain as an organ that is utterly distinct from the rest of the body, we dismiss concerns related to brain function and mental wellness as issues that either are not “medical” in nature or are somehow within the individual’s control, implying personal weakness if something is not working well.
2. It creates a division in care services, such that individuals know where to seek assistance if they have physical pain but are often left adrift or directed elsewhere to address their mental pain.
3. It demonstrates a very narrow understanding of the essential, integrated functioning of the body and the mind, dismissing the important ways in which untreated or unmanaged anxiety, stress, depression, or other mental concerns impact our physical health and well-being.
4. It allows providers to ignore essential components of patient wellness and allows providers to remain ignorant in relief measures and treatment modalities because they view mental health services as “specialized care,” not an integral part of the care they regularly provide their patients.
5. It reduces patients to bodies, not beings, which results in suboptimal care that doesn’t consider all the potential factors that contribute to both the healing process and overall health maintenance.
6. It fractionates care. Requiring patients to see a separate provider to discuss mental concerns results in their primary healthcare provider having a very limited understanding of who the patient truly is, which limits the ability to actually partner in developing care plans or discussing care concerns.
7. It alienates and shames patients, who may be reluctant to voice concerns regarding their mental functioning because they suspect their providers may be disinterested or perceive themselves as poorly equipped to help. The reality is that everyone has mental health, just as everyone has cardiac health, just as everyone has gynecologic health. Some is better than others, and each woman is affected by different things that may compromise her health and wellbeing, on all levels. We all have mental health concerns. They are just as unique and different from one woman to the next as our other health concerns.
8. It results in inappropriate treatment or misdiagnosis. When providers are not attuned to mental health as a critical component of overall functioning, they can misattribute reported symptoms to isolated physical ailments and begin a course of treatment that may not address the root cause.
9. It results in provider hesitation to learn about management options for mental health concerns, which widens the chasm between mental health and physical health as perceived as conditions a provider is capable of treating. As the provider becomes less informed, the provider becomes less capable of addressing patient concerns.
10. It delays treatment. For all of the above reasons, women are often late to request, receive or initiate mental health treatment, which results in more advanced conditions that are more difficult to manage and require more intervention than may otherwise have been the case.
When we integrate mental health care seamlessly into our routine provision of healthcare, we take into account the whole individual and all of the factors that combine to affect health and well-being. It allows us to fully treat concerns, both mental and physical, and treat them in their earlier stages with greater response to treatment and improved outcomes. In our modern era, it is an absolute shame that we continue the archaic practice of separating mind and body, as if that were even possible, and it is imperative that healthcare providers begin to see women as multi-faceted beings, not just female-shaped flesh. We are committed to breaking this mold, and we will always view you as a complete being, from the innerworkings of your brain to the very tips of your toes.
Top 10 Reasons to Move Your Body (even when you don't want to...)
Top 10 Reasons to Move Your Body (even when you don't want to...)
June 27, 2019
It seems like there are not enough hours in the day to get everything done. If you’re like me, when life gets busy, one of the first things you tend to let go of is exercise. I have all the excuses: my full-time practice, my children and their various activities, managing a household and all its demands, wanting to make sure I give time to each member of my family. But the simple, annoyingly certain truth is that I just feel better on so many levels when I exercise. There’s no getting around it. There is, however, a lot of difficulty finding ways to schedule in that “exercise.” I do not have time to dedicate to going to the gym to exercise for a full hour every day.
Luckily for me, exercise is not confined to what the media and mass-marketed fitness products have caused us to think that it is. Exercise does not just occur on the elliptical at the gym. It does not just involve running, which my asthma and my scoliosis make me HATE. Exercise is any kind of physical activity in which I move my body in ways that elevate my heart rate and enhance my strength. I love gardening and working around my house, which are both great ways to get my exercise and feel productive while I do it. This may not be true for you; you may HATE gardening but LOVE running. More power to you. For every individual woman, there is a way to integrate exercise into your life that will be fulfilling (and possible) for you. Here are the top 10 reasons for finding your own method of integrating exercise — from me to you not just as a provider, but as a person who never has enough time to exercise, but always comes back to it because it’s just that important (dang it):
1. IT MAKES YOU LESS LIKELY TO DIE.
Seriously. Research demonstrates clearly that regular exercise reduces the risk of mortality from all causes for most individuals, regardless of age. The beneficial effects are dose-dependent, meaning that the more you exercise, the less likely you are to die. The effects of exercise alone have been independently studied and exceed the effects other lifestyle changes to improve health (for instance, exercising has a bigger impact on duration of life than quitting smoking). Vigorous exercise (at least 20 minutes three times a week) combined with regular exercise (at least 30 minutes of moderate activity most days of the week) cuts the risk of death in HALF. If there were a pill we could take that would do this, every single person in America would take it.
2. IT REDUCES THE RISK OF STROKE AND HEART DISEASE.
Regular exercise decreases the likelihood of heart attacks and death related to heart problems. Heart disease is the leading cause of death among women. Not only does it make it less likely that heart disease would develop in the first place, but it reduces the likelihood that heart disease, if already present, will cause illness, impairment or death. It also significantly decreases the risk of stroke. Both of these findings are thought to be related to the decrease in blood pressure that results from regular exercise, as well as decreased overall inflammation for people who exercise regularly. For both things, exercise makes it less likely that you will get them in the first place, and, if you are unlucky enough to get them, exercise will make the consequences less severe.
3. IT REDUCES THE LIKELIHOOD THAT YOU WILL BECOME DIABETIC.
As with heart disease, regular aerobic exercise improves blood sugar levels and increases the body’s sensitivity to insulin, both of which reduce the likelihood that existing diabetes will progress and decrease the chances of developing diabetes over one’s lifetime.
4. IT DECREASES YOUR CHANCES OF DEVELOPING CANCER.
Exercise protects against the development of breast, intestinal, prostate, endometrial (uterine), colorectal and pancreatic cancer. And not by a little: you are 1/3 less likely to develop these kinds of cancer if you exercise regularly.
5. IT SHRINKS YOU.
Even if you are not dieting, regular aerobic exercise and resistance training leads to a reduction in body fat and, potentially, weight loss. Especially for women, regular exercise is associated with less weight gain in middle age, regardless of diet. If you are dieting, adding in exercise greatly reduces body fat and results in greater retention of lean mass when compared to diet alone. Beyond fitting into a particular size of skinny jeans or looking good for the beach this summer, preventing or treating obesity results in tremendous health benefits throughout your lifetime.
6. IT IS GOOD FOR YOUR BONES.
Weight-bearing exercise (activities that involve standing, squatting, lifting, running, jumping, posing or planking) results in significant increases in bone mineral density, making it less likely that your bones will break now or as you age.
7. IT MAKES YOU SMARTER.
Dementia occurs much less frequently among individuals who have exercised regularly throughout their lives. Even among younger individuals not at risk for dementia, regular exercise results in significant improvements in cognitive function.
8. IT BOOSTS YOUR MOOD.
Yes, really. Running in the rain will make you more likely to smile later. People who exercise regularly are less likely to have depression than those who don’t. And, people who are depressed report dramatic improvements in their moods and decreased depressive symptoms when they start exercising. Higher energy expenditures also result in less overall stress, and people report less anxiety when they have been exercising than when they have not made space for exercise in their lives.
9. IT IMPROVES YOUR FUNCTION.
Not only does regular exercise make it more likely that you will remain healthy and require fewer sick days from work, it also makes it more likely that you will be able to take the stairs without panting; lift heavier objects; and engage in work, play and life with greater ability and ease. Individuals who regularly exercise are less likely to require assistance with their activities of daily living and are less likely to become disabled in general. For disabled individuals, exercise improves overall function and enhances independent ability to perform most tasks.
10. IT PROVIDES NEW OPPORTUNITIES TO CONNECT.
Hiking with friends, biking with your significant other, or signing up for an organized event like a softball competition or a sponsored run with a group of co-workers are just a few examples of how to integrate exercise into your life. You’ll be exposing yourself to new experiences, creating a sense of accomplishment and fostering deeper connections with others. Some activities, like organized walks or runs, have the additional benefit of providing a greater sense of purpose when they also benefit a charitable cause. Have you always wanted to learn to dance? Bend your body like the master yogis? Ski the slopes of Mount Baker with grace? Bike on behalf of children with muscular dystrophy? The possibilities are endless.
As you undertake your commitment to lacing up your shoes, rolling out your yoga mat, or buckling your helmet, know that much more than the satisfying fulfillment of your now-months-old, neglected New Year’s Resolution is in store: the more you exercise, the better you will feel. Period. The more you exercise, the easier it will get. Period. The more you exercise, the better you will be. Period. It is worth it, and you are worth it.
The Importance of Being Female: Why Gender-Specific Primary Care Matters
The Importance of Being Female: Why Gender-Specific Primary Care Matters
July 19, 2019
Recently, Megan Rapinoe, the record-breaking American professional soccer player whose adept ball-handling skills assisted the US Women’s National Team to their fourth World Cup victory, drew public attention to the gender-based pay discrepancy that exists in the world of professional soccer, which is applicable to most of us only in the sense that we may be female and we may experience a similar discrepancy, although likely not in relation to our fancy footwork. Nationally, across the board, a woman is statistically paid 79 cents for every dollar that a man is paid for doing the exact same job. This is regardless of job type, socio-economic bracket, or worker seniority. Women are also significantly less likely to hold high-level or high-paying jobs than men, and they are less likely to receive promotions to such positions relative to their male counterparts. Until 1988, women could not apply for any commercial business lending without having a male co-signer to vouch for her ability and competence to conduct business. We know a gender-related pay gap exists; we know a gender-related opportunity gap also persists. We know you know this. And we know all y’all know that there is gender inequality for sure in the performance of household chores as well as the management of work-family conflict (we can cite the highly powered scholarly studies that support this, when your oppositely gendered partners rebut). But, did you know that these discrepancies are also pervasive when women receive their medical care?
If you, as a woman, were walking down the street and suddenly collapsed, having a cardiac arrest, you would be 15% less likely than a man to receive CPR from any bystander, which means 15 women out of 100 needing CPR would be allowed to simply die, while all 100 men would at least benefit from an attempt to save their lives. If you were lucky enough to receive this CPR, you would be 25% less likely to survive from the CPR than if you had been male. The research speculation regarding this finding is that this is because women have breasts and rescuers feel odd about performing effective compressions on a female chest as opposed to a male chest.
Innocent bystanders and the general public’s bias and concern about touching your breasts aside, even the providers who have been trained to provide women’s clinical care (including touching their breasts) are less likely to respond appropriately to women. Women are significantly less likely to have been counseled on recognition of the symptoms of a heart attack because they are different from the widely publicized symptoms, which pertain only to men (who were the sole subjects of most clinical trials until well into the 1990s and remain the sole subjects of many clinical trials, particularly pharmaceutical trials even today). Even if a woman does report with symptoms consistent with a heart attack, she is considerably more likely to be dismissed and to have her symptoms attributed to “anxiety” or “agitation,” than to a cardiac source. Women are less likely to undergo tests to check their hearts or receive recommended treatments. A woman having a heart attack is 59% more likely than a man experiencing the EXACT SAME EVENT to be misdiagnosed from the outset. Even if she is diagnosed, she is 50% more likely to die. The vast majority of primary care doctors admit that they routinely rely on the “characteristic symptoms” of heart disease when preventively assessing patients, despite the fact that their entire female patient population would have a completely different clinical presentation.
You might think, because of the pink ribbons and the publicity, that breast cancer is the biggest overall health concern for women and that it is the source of the greatest mortality for women. In fact, heart disease is the leading cause of female death worldwide. A woman is three times more likely to die of heart disease than she is to die of breast cancer, and yet her PCP is more likely to focus female preventive care on a patient’s breasts than on the vital organ that lies beneath them.
Gender bias also plays out significantly in clinical pain management. Women are more likely than men to have their pain inadequately or inappropriately treated. They are significantly more likely to receive anxiety medication and sedatives in response to a complaint of pain, and men are significantly more likely to receive medication intended to treat pain when they report having pain. The results of studies examining physicians’ discrepant responses to and treatment of women as compared to men are applicable not just in the United States but in the world at large. Across the board, women are treated differently, and generally to their detriment.
In clinical trials and studies, women have long been regarded as the smaller counterparts of men. Research conducted on men has and still is extrapolated to apply to women, despite the fact that women’s bodies, metabolic processes, hormonal environments, and physiologic functioning are utterly distinct from those belonging to men. On the one hand, women continue to be treated as distinct from men, more hysterical and hypochondriacal, and on the other hand, the medical model often assumes that they are nothing more than miniature men. Most drug trials are conducted exclusively in male populations; “best treatments” that are then released to market for treatment of a general adult population are actually best treatments only for men, and we often do not have enough information to determine how well a medication might work in a woman’s body or what side effects or adverse effects a woman might experience in response.
When women are diagnosed with a mental illness by a primary care provider, they receive worse medical treatment (receiving less health monitoring and taking more potentially harmful medications) than men. Non-smoking women are three times more likely than men to develop lung cancer and five times less likely to have it diagnosed in a timely fashion. Women are significantly more likely than men to experience a stroke, and they are significantly more likely to have a delayed diagnosis or a missed diagnosis. If a woman survives that stroke, she will have worse quality of life than her male counterpart.
These are not “women’s health” conditions. These are not conditions related at all to any unique female components. Or, are they?
I would argue that all medical conditions occurring in women are women’s health conditions. And, I would argue that all medical professionals providing care to women should be trained specifically in the provision of care to women, just as all medical professionals providing care to children are required to have received specific training in pediatric medicine. The sad reality, however, is that primary care is seen as primary care: everyone gets the same average of 7 minutes per visit face-to-face with their medical provider, and, at the end of the day, the women are more likely to die simply because they are women. In most primary care settings, women are referred out for their gynecologic concerns, because “those parts” are considered “specialized,” and women’s health-specific issues and concerns are routinely neglected or ignored.
It is time to stop fragmenting care. It is time to stop relegating “women’s health” to gynecologic care. It is time to see women as whole people (who are statistically juggling more varied responsibilities than their male counterparts, are carrying more household/family/caretaking demands than men are, and are less likely to prioritize their own need for medical care as a result), and to provide integrated care to women that allows them to receive care for their physical, psychological, and emotional states in a single space that offers distinct expertise in caring for women as biological beings that are not just small men. It is time to craft a model of care that allows women to have knee concerns (in her female knees that are uniquely different from any male’s knees) in the same space that she has uterine concerns, and it is time to both promote and insist upon gender-specific, comprehensive models of primary care.
So, You've Decided to Breastfeed...
So, You've Decided to Breastfeed...
August 1, 2019
From the moment you pee on that stick for confirmation (or often even well before), your breasts loudly announce your pregnancy. First, they’re tender. Then, they’re bigger AND tender. Then, they’re changing color and getting strange bumps they didn’t have before. Then, as you near the finish line, they start to ooze or leak. There is no escaping the fact that the pregnancy hormones are preparing your body not just to create and birth another person but also to biologically feed that little person. If all of this is a normal, natural process, why is it so DIFFICULT for some of us to breastfeed? Our bodies make milk without our consent, just as our babies grow without our consciously consenting to the development of tiny kidneys. If we are programmed to do this, shouldn’t it be as easy to grow and nourish our babies OUTSIDE our bodies as it is when they are IN?
Even aside from the woes of the first few days (ok, maybe weeks) of sore nipples, engorgement and an occasional plugged duct, mothers preparing to feed their newborns have more persistent, pervasive and insidious battles when we make the choice to use our breasts for their primary biological purpose. If it were simply pain, we would gladly endure. Having already suffered through months of aching backs, episodes of vomiting, swollen feet, exhaustion and the occasional unexpected leakage of urine—surely no one can argue that we mothers aren’t willing to endure discomfort for the well-being of our offspring. Our midwives, obstetricians, pediatricians, mothering websites, what-to-expect pages and Bump apps all tell us that breast milk is the best food for our babies. We know breast is best. And yet so many of us give up, sometimes without much fight.
FIRST, THERE’S THE ADVERTISING.
Thank you, Enfamil, for reminding us we might not be able to breastfeed our babies. Thank you, Similac, for sending us a can of something we can’t bear to waste. We will put that on our pantry shelf just in case. Thank you, parenting magazines and pregnancy-related websites for accepting the generous funds offered by formula companies to promote their products in your banners and sidebars so that these products remain eternally in our periphery, reminding us they are there to save us, if breastfeeding doesn’t quite work out. Don’t get me wrong – formula can be, quite literally, lifesaving when required. But if you’ve decided to breastfeed, throw out the free sample. Or donate it, if you can’t stand to waste it. If it is on your shelf, you will use it, and sometimes before you have to. Committing to breastfeeding means being prepared to provide breast milk for your baby exclusively (unless medically indicated) for the first six weeks. If, during those six weeks, your doctor tells you to give your baby formula, go and get some. But, anticipating problems by hanging onto free formula is like filling your pantry with Girl Scout cookies in anticipation of failing at your strict Paleo Diet.
THEN THERE’S THE ‘HELPFUL’ FEEDBACK.
Cue the lifelong unsolicited parenting advice that starts with the announcement of your pregnancy and ends, well, never. Well-meaning relatives may have a negative response to breastfeeding: “women didn’t do that when I had your mother, and she seems just fine.” And friends have their own input, loaded with emotion and righteousness from their experiences: “I wanted to breastfeed, but my milk didn’t come in,” “My son was allergic to my milk,” “I was starving my daughter to death and didn’t notice,” “Thank god someone gave my baby formula—I didn’t know what I was doing.”
If you choose to breastfeed your baby, make it clear from the start, and set firm boundaries with friends, relatives and co-workers regarding the input you welcome and find helpful. Choosing how to feed your baby is one of the first major parenting decisions you will make, and it will not be the last. Nor will it be the last decision that receives cheers or jeers from the peanut gallery. Establishing clear boundaries around your choice is important and can be as simple as stating, “I have chosen to breastfeed my baby, and I would find it helpful if you would support my choice.” You can choose to offer an articulate argument on why you want to feed your baby, or you can simply stand firm in your choice. In any event, establishing clear boundaries with your well-meaning loved ones sets the stage for unsolicited and often unhelpful advice you will receive when the time comes to choose a method for potty-training, to select a preschool or to allow your child to date. Make your decision about how you will feed your baby about what is best for you and your baby, not about what makes others feel inadequate or uncomfortable.
AND THE BEDROOM…
Before there was baby, there was the business that brought you your baby. Now that there’s baby, someone else is occupying the space in your arms, and the breasts that may once have been a focus of your sexual relationship are now what’s for dinner. Before there was baby, your breasts were erotic and only occasionally tender. Now that there’s baby, your breasts are swollen, sore, cracking, leaking, and constantly at the whim of another person. You’ve traded in your red lace demi for a less sexy, very supportive thick-strapped nursing bra with its absurd latches and flaps. Partners can often feel neglected simply as a result of the distraction caused by the arrival of a new baby. As you return to physical intimacy, it is important to be open about the new role assumed by your breasts and the impact this has on your sex life. After having your breasts handled all day by your nursing newborn, you might feel less aroused (maybe even irritated) at having them handled while the baby is sleeping and your partner is initiating sex. It is important to communicate this to your partner and to both be able to keep a sense of humor about the milk that might leak from your nipples when you orgasm or the nursing pads you had to tuck inside your sexy bra.
AND THE DAILY PUMPING JUGGLE.
Breastfeeding for the recommended year requires that many moms figure out how to continue making milk after they have returned to work and left their babies in someone else’s care, generally to eat from bottles (sometimes of supplemental formula and sometimes of pumped breast milk) while we are apart. In our society, paid maternity leave is limited and laws protecting a mother’s right to the time and space to pump are only now emerging. Breast pumps are strange things that are very expensive. But your insurance will pay for one—ask your provider for a prescription. The Affordable Care Act mandated insurance coverage of this medical device to balance families’ needs to have moms return to work and babies’ needs for continued breast milk. In the state of Washington, employers are required by law to provide employees with accommodations that are not bathroom stalls and the time (30 minutes for every four-hour period worked) to pump sufficiently to maintain their milk supplies after returning to work. Make sure you let your employer know in writing of your intent to express milk when you return from maternity leave in order to have this need accommodated—and make sure you are able to prioritize pumping as you would a scheduled meeting. Ask that your pump break be integrated into your Outlook calendar and that a sign be created for the designated pumping area that alerts your co-workers of your need for privacy to avoid the awkward situation of your manager walking in on you pumping during lunch.
Finally, make sure you practice pumping before you return to work so that you are familiar with all the pieces and their connections and can assemble, dissemble, clean and store the pump parts without difficulty. This will make it easier for you to juggle eating and pumping during the same time period and allow you to feel less pressured and stressed during your pumping episodes.
AND, SOMETIMES, MAMAS NEED SOME HELP.
Most of us live in nuclear households isolated from other women who have had successful breastfeeding experiences who might be able to offer advice and tips on how to improve the breastfeeding experience or normalize our concerns. In addition to all of the pressures that exist outside of biology, we are often set adrift when we are discharged from the hospital and find ourselves, days into sleeplessness and leaking boobs and a baby who won’t stop screaming long enough to latch on, exasperatedly scouring Dr. Google for answers or digging for the number of the lactation consultant who popped by just as soon as we had stepped into the first post-delivery hot shower. Even our pediatricians and obstetricians have limited breastfeeding education and the resources available to provide us with assistance in our moments of milky crisis are limited. All of this while the formula can sings to us from the pantry shelf and bottles beg to be filled and handed to our partners so we can run to the store for a moment of silence alone in the bread aisle.
Remember that help IS available. Make sure you seek that help before it is too late. Set up a lactation evaluation for three days after your baby’s delivery. You can always cancel the appointment, but you’ll have it if you need it. Visit La Leche League for helpful tips and answers to your questions. Add their local chapter numbers to your contacts and send an email to a leader asking them what availability they have to provide support. Establish your network of helpful lactation resources long before your baby is delivered. Attend a lactation class before you are struggling with a real baby with real-time demands so that you familiarize yourself with the process and have the opportunity to meet educators, clinicians and other moms who can help you along the way. If you need a breather from the constant demand from your breastfeeding baby, your partner can certainly provide a bottle while you take a break. Just remember to not skip feedings: that is, make sure you pump if the baby doesn’t nurse to maintain the delicate supply-and-demand system your body uses to know how much milk to generate.
For those moms who have had successful breastfeeding experiences: congratulations! Please, make a point of sharing your SUCCESS with your friends. Please, dissipate the negativity about breastfeeding that bombards so many women during pregnancy. For those moms who have struggled: be gentle with yourselves. What an incredibly exhausting, isolating battle it can be to fight all the social barriers to breastfeeding we face. For those moms who want to breastfeed: ask for help! Recognize early the people who may not provide support and seek out those who will. Involve your partner.
As you navigate the potential struggles that come with the decision to commit to breastfeeding your baby, remember that the ultimate goal is twofold: 1) to form the foundation for a fulfilling lifelong connection with your child, and 2) to nourish this tiny person. What this looks like for you will not necessarily match what this looks like for anyone else—your relationship to your child and all facets of your parenting experience are distinctly unique. Be gentle with yourself, and with your child, as this experience unfolds.
Research clearly demonstrates that breastfeeding IS best. We want to help you be successful – ask your provider for referrals and helpful resources. It is our job as medical providers to help you and your baby navigate the complicated path of obstacles to a satisfying nursing experience.