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both conditions said testai this indicates that the link between the two organs begins as early as conception and underscores the importance of adopting healthy lifestyle habits as early as possible he added that means you can avoid bad habits that eventually lead to hypertension diabetes and cholesterol that eventually will lead to cardiac disease which eventually will lead to stroke which eventually will lead to cognitive decline testai noted however cardiovascular health is more complicated than having good genes and adhering to a healthy lifestyle it s not clear for example why some people who should be predisposed to developing heart disease do not develop it something testai refers to as enhanced resilience for example hispanic or latino patients who have relatively poor cardiovascular risk factor profiles seem to be less susceptible to developing cardiac disease more research needed while genetics may partly explain the paradox testai believes other protective factors are at play including strong social support networks testai referred to the aha s life s essential 8 the eight components of cardiovascular health these include a healthy diet participation in physical activity nicotine avoidance healthy sleep healthy weight and healthy levels of blood lipids blood glucose and blood pressure more evidence is needed to show that effective management of cardiac disease positively affects cognition currently cognitive measures are rarely included in studies examining various heart disease treatments said testai there should probably be an effort to include brain health outcomes in some of the cardiac literature to make sure we can also measure whether the intervention in the heart leads to an advantage for the brain he said more research is also needed to determine whether immunomodulation has a beneficial effect on the cognitive trajectory the statement s authors noted they point out that the interpretation and generalizability of the studies described in the statement are confounded by disparate methodologies including small sample sizes cross sectional designs and underrepresentation of black and hispanic individuals an important step reached for a comment natalia s rost md chief of the stroke division at massachusetts general hospital and professor of neurology at harvard medical school in boston said this paper is an important step in terms of pulling together pertinent information on the topic of heart brain health she praised the authors for gathering evidence on risk factors related to af hf and chd which is the part of the puzzle that is controllable this helps reinforce the message that controlling vascular risk factors helps with brain health said rost but brain health is much more complex than just vascular health she said it includes other elements such as freedom from epilepsy migraine traumatic brain injury and adult learning disabilities share this share on reddit opens in new window reddit share on x opens in new window x share on tumblr opens in new window tumblr share on linkedin opens in new window linkedin share on pinterest opens in new window pinterest share on whatsapp opens in new window whatsapp share on telegram opens in new window telegram email a link to a friend opens in new window email print opens in new window print like loading posted in medicine tagged alzheimer s american heart association cardiovascular diseases cognitive decline dementia health mental health wellness nov 07 my womb isn t my legacy posted by zedie 0 we must look beyond women s childbearing potential in healthcare and society in general zha is a physician and a nonfiction writer been thinking about you when are you going to start a family a distant friend texted me out of the blue i am intentionally child free i explained without children what kind of legacy do you plan to leave in recent months the attacks on childless womenopens in a new tab or window have clearly escalated from devaluing our votesopens in a new tab or window to questioning our worth in the world the sentiment that the value of someone with a uterus depends entirely on their fertility isn t unique to politicians and abrasive friends as a primary care physician and a medical history scholar i have seen it echoed in medicine much too often childlessness as a disease plato taughtopens in a new tab or window that the uterus is an internal animal subject to the desire to make children and when this desire is unfulfilled the beastly organ begins to wander throughout the body and provokes illnesses of all kinds the idea of a trouble making nomadic and feral uterus hysteria can be tracedopens in a new tab or window to one of the oldest medical texts in human history the ebers papyrus the treatment pregnancy what else opens in a new tab or window childlessness was a disease state to be cured by childbearing even today 3 500 years later remnants of this mythical pseudo scientific belief still lurks in women s health for instance people suffering from endometriosis are still advisedopens in a new tab or window by uninformed healthcare professionals to go away and have a babyopens in a new tab or window as a treatment or even a cureopens in a new tab or window despite pregnancy offering nothing but an illusion of improvementopens in a new tab or window and a rocky road aheadopens in a new tab or window the uterus as a scapegoat indeed medicine still can t look beyond uterus ownership if a patient has a uterus anything can be blamed on it thyroid disorder you are just pms ing opens in a new tab or window severe pain and rectal bleeding due to colon cancer while pregnant relax pregnancy can be uncomfortable opens in a new tab or window appendicitis irritable bowel syndrome ruptured ovarian cysts any abdominal pain while having a uterus bad periods are just part of being a woman opens in a new tab or window as much as we scapegoat the uterus when the organ actually falls ill we do a terrible job of diagnosing and treating it endometriosis affects up to 15 of peopleopens in a new tab or window with a uterus 50 of infertility sufferersopens in a new tab or window and 70 of thoseopens in a new tab or window who have chronic pelvic pain yet with an average diagnosis delay of 6 7 years in patients ages 18 45 it has earned the title of the missed disease opens in a new tab or window its treatment is inconsistent at best if not outright lackingopens in a new tab or window similarly premenstrual dysphoric disorder pmdd affects between 2 to 8 opens in a new tab or window of the 1 8 billion menstruating peopleopens in a new tab or window worldwide its debilitating emotional and physical symptoms are linked to a sevenfold increaseopens in a new tab or window in suicide attempt risk yet thanks to symptom dismissal or misdiagnosisopens in a new tab or window it takes an average pmdd sufferer 12 years and six different healthcare providersopens in a new tab or window to be accurately diagnosed pregnancy potential as an excuse a question i often repeat in my practice is we don t know how safe this medication is for a developing fetus are you planning to become pregnant soon due to historical failuresopens in a new tab or window of inadequate drug studies the fda recommended the exclusion of women of childbearing potential from phase i and ii drug trialsopens in a new tab or window in 1977 even if they were on contraception it wasn t until more than 15 years later that congress mandated womenopens in a new tab or window be included in clinical research today safeguarding a potential fetus is still an excuse for only a scant percentageopens in a new tab or window of medication trials to focus on pregnancy related outcomes making pregnant and lactating people drug orphans opens in a new tab or window this forces clinicians like me to overestimate the harm medications have for anyone who could become pregnant reinforcing the minimizing view of uterus owners as only prenatal pregnant or postnatal in the eyes of medicine uterus owners as baby vessels following this logic the value of a uterus varies according to its candidacy as a baby vessel my patient julie has wanted her uterus taken out due to severe bleeding and pain for over 30 years you are too young your child might need a sibling your husband might want more kids the doctors said when they rejected her request now at age 45 after three kids julie is finally getting a hysterectomy they found some shadows on my ultrasound and thought i might have cancer even though my biopsy was benign the doctor still thinks it would be safer to have my uterus removed she told me while julie was ok with the decision she was unsettled by the lack of diagnostic certainty the prevalence of hysterectomy for women younger than 45 is one in 36opens in a new tab or window 2 8 in america but by age 75 it increases drastically to 42 as the racist history of hysterectomy abuseopens in a new tab or window clings to our time it s no surprise that this number is the highest for black womenopens in a new tab or window at any age and through more invasive meansopens in a new tab or window to be clear as our bodies age our body parts can fail but no other organ is taken out at a steeper rate or more casually than the uterus once it s deemed too old for reproduction performed nearly 500 000 times a year hysterectomy is among the most common surgeriesopens in a new tab or window in the u s not only is it the lone operation on the list of common surgeries where an entire organ is removed but over 99 opens in a new tab or window of the time it s done for benign reasons of course benign doesn t mean unnecessary many suffer from debilitating non cancerous conditions that warrant hysterectomies by today s treatment protocols and these patients have every right to receive a hysterectomy to help with their symptoms but let s imagine if the prostate or the testicles caused dysfunctional symptoms as much as the uterus did and prostatectomy or orchiectomy were said to be the standard of care would one in three menopens in a new tab or window over 50 walk around without a prostate or testicles or would we have cured them with something much less invasive by now such as a pill a uterus owner is more than a person attached to a uterus our pregnancy choices and fertility status shouldn t dictate our healthcare to prioritize the well being of people over their body parts medicine and society as a whole must look beyond uterus owners childbearing potential my womb isn t my legacy i replied to the friend my words are patient s name has been changed for privacy share this share on reddit opens in new window reddit share on x opens in new window x share on tumblr opens in new window tumblr share on linkedin opens in new window linkedin share on pinterest opens in new window pinterest share on whatsapp opens in new window whatsapp share on telegram opens in new window telegram email a link to a friend opens in new window email print opens in new window print like loading posted in medicine obs gyn tagged endometriosis fibroids health hysterectomy womb women s health nov 07 anatomy of a suicide crisis life after abuse love shouldn t hurt posted by zedie 0 lee is a psychiatry resident content warning discussion of suicide domestic violence if you are in crisis text or call 988 do you know what it is that i fear the most when i yearn for something so much in a world so hopeless that it weakens my heart gyeongseong creatureopens in a new tab or window it s a discomfiting idea to confront the idea that psychiatrists may need help we re doctors after all islands of resilience for our patients amidst a sea of chaos while we re wonderful advocates for our patients we hide our most vulnerable moments fearing the ramifications but we re subject to human experiences depression regret shame anxiety as much as anyone else domestic violence and its associated mental health outcomes constitute one such experience from which physicians are not exempt despite a pervasive mythopens in a new tab or window that it should not happen among educated medical professionals leaving abuse is among the hardest things we will ever do some of us will returnopens in a new tab or window some of us will not survive most of us will face humiliation dismissal and re victimization from the individuals and institutions meant to protect usopens in a new tab or window and what of the aftermath of abuse the pain that lingers even years after leaving september and october are challenging months for me an intersection of suicide prevention awareness and domestic violence awareness for weeks now i ve tried to write about the mental health impact of intimate partner violence ipv i could have reviewed papers on its physiological effects or the impact of relational trauma i could have offered dataopens in a new tab or window on risk factors for perpetration and victimization but no statistics will sufficiently convey what is happening inside us in lieu of data i offer narrative one of our most powerful tools for connection and empathy in medicine unless you have lived through domestic violence yourself i cannot make you truly understand the intensity of emotion many of us rage and wonder how is it that those of us who survived continue to endure this pain while our abusers move on but me i withdraw morosely existing on the periphery of other people s lives and wondering just how valuable my life is i ve become a voyeur envying people who return to daily stability and love that i borrow only transiently from my support system because i worry i m a nuisance withdrawal while emotionally safer is deeply lonely my sleep is chronically poor my emotional load at baseline is too heavy and with enough stressors i fall into a deep prolonged guilt ridden depression but it becomes dangerous when my mind races uncontrollably and one insidious thought my life is no longer worthwhile overwhelms all others the first time it happened i was debating stay or leave in an abusive relationship i didn t appreciate the danger at the time i felt worthless in fact he outright told me so a quiet exit from the world felt like my only choice privately i called it my escape plan my little secret the one thing i could control the idea lived in the back of my mind for weeks the thoughts started racing one afternoon i knew unequivocally i was remorselessly unloved in that relationship and i feared inconveniencing others with my problems i collected materials i wrote a note i never completed the act like i was nothing i didn t tell anyone unwittingly inspired by virginia woolf how many times have people used a pen or paintbrush because they couldn t pull the trigger i started writing to cope but many women like me take the route i seriously contemplated on the psychiatry consult service i met that version of myself in the form of a patient who had left a relationship similar to mine and later attempted suicide in a highly lethal way for therapeutic...
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