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lionheartslowstart · 5 years

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Too Thin

I’ve lost a decent amount of weight in the past few months. Nothing insane, but I’ve definitely gone down somewhere between two and three sizes. I’m hovering around a size twelve at the moment. I’m not going to name the place where I work, but I will say that I work in a plus sized clothing store. We do carry size twelves, but it’s one of our smallest sizes. When I started working at this store, I was between a size eighteen and a size sixteen.

I really like my job, for a lot of reasons. Is it what I want to be doing for the rest of my life? No. But, it’s a good job where I get to flex my customer service muscles. And, I’m pretty good at it, if I do say so myself. Of course, we get the crazies and the assholes like any other store. But we also have a lot of lovely clientele. It’s gotten to the point where many of our regulars know me by name, or at least by face. Just today a regular customer called the store and when I answered the phone, I could hear the smile in her voice when she said, “Oh hi Sophie!” I get a lot of compliments about my service, both in person, and on the surveys we provide. I genuinely enjoy helping customers.

As of late, my weight has become an issue at work. For the record, I’m not saying this because I’ve heard anything from my boss or any higher ups. (Pretty sure that shit’s illegal anyway.) No, I’m saying this because of the customers I love so much. It’s been happening more and more lately. I’ll be assisting a customer, and she’ll be talking about her insecurities, telling me why this doesn’t look good on her, or why she never wears that style of clothing. Of course, I’ll usually respond with something about how everyone sees themselves more harshly than others, or how I feel the same way about that same area, or a different area. These responses are genuine, heartfelt, and things I’ve been saying to customers since I started this job in the spring. But now, I often hear something along the lines of, “Well, it’s different for you, you’re so thin!” in reply. And I gotta tell you, it really bothers me.

You might be thinking, it should make you feel good when other people call you thin. But it doesn’t, especially not in this context. These customers, they don’t know my story, my history. There’s something about the way they say it. There’s no malice, but there is something invalidating, sort of disqualifying. To them it might seem like I have no way of understanding what their lives are like. But that’s not true.

I would have to write a post much longer than this to get into the entirety of my body issues, so I’ll keep it brief. I developed a thyroid disorder when I was nineteen. I’m not sure why it took doctors so long to diagnose me, considering it’s a genetic disease and two of my family members have it, but it did. (Although, I was told the “you just need to lose weight” line multiple times before I was even tested for it. So there you go. Hooray for fatphobia.) Cue several months of me gaining an unbelievable amount of weight, sleeping sixteen to twenty hours a day, being constantly physically and emotionally exhausted, and experiencing a whole new level of depression. At my heaviest weight, I was unrecognizable. I’ve always hated my body. I’ve never been happy with my reflection in my entire life. But this was a whole different demon. I’d already had body dysmorphia since high school, but it got WAY worse during this time. There are absolutely days when I look in the mirror and still think I look like that. And then I developed an eating disorder, but I still have a lot of shame around that so I’m not going to discuss it further. I hate my arms, I hate my legs, I hate my ass, I hate my back rolls, I hate my rib rolls, and I still think I’m too fat. So yeah, I think it’s fair to say I fucking get it.

When these customers tell me “but you’re thin!” it makes me want to cry. It makes me want to yell. Truth be told, I have started telling customers I have a thyroid disorder, just so they know I “qualify,” even though I really shouldn’t have to do that. It’s like a weird cognitive dissonance. They’re telling me I’m thin, but I’m not?? And it makes my head hurt thinking about it. It’s getting to the point where I’m afraid if I lose any more weight, I think I’ll have to start looking for a different job. I don’t want to, and I don’t think I’ll be fired or anything, but I can’t see the benefit of staying in a position where I’m making customers uncomfortable and customers are making me uncomfortable in turn.

The worst interaction thus far was a few weeks ago. A customer came in and was trying on shoes. I was chatting with her, just polite small talk. I can’t remember what we were talking about, but I remember her saying, “I’m fat.” This happens fairly often at my store, and I’m not always sure what to do or say. I think most people don’t, especially at a plus sized clothing store. But for whatever reason that day I was on autopilot, and without thinking I said, “Don’t say that.” I knew immediately I had made a huge mistake. She visibly bristled. Her tone wasn’t rage-filled or loud, but I could tell she was pissed. There was a sort of rushed irritation in her voice. She said something like, “Don’t tell me not to call myself fat. It took me a long time to be able to do that. I am fat. I have a fat body. I wear clothes made for fat people. And there’s nothing wrong with that. It’s not a bad thing. And I think we should work so that more women can reclaim their fatness. Don’t you?” I managed to choke out a quiet, “I completely agree.” My face was hot. I was embarrassed. I had been able to feel my coworkers watching our interaction. (Thankfully none of them brought it up to me later, bless them.) I stood there stuttering for an awkward thirty seconds, and then I made a beeline for the back room. In all honesty, hiding in the back is not something I do often, though I have done it a few times since I started my job, but usually only in cases of panic, anxiety, or intense depressive pangs. I’ve never, ever hidden from a customer before. But I did. I didn’t want to be in the store while she was in the store. After a few minutes, when I realized I couldn’t hide any longer, I left the back room but zoomed up to the front, far away from the customer trying on shoes.

I have a lot of feelings about this interaction. On one hand, I can imagine how she felt, having someone significantly thinner than her tell her not to call herself fat, especially having reclaimed the word for herself. She was maybe a size twenty four or twenty six. But what did she expect me to say? It almost felt like she was baiting me, like she expected me to say that and had a prepared response. Maybe it’s just me, but I feel like saying something like that to a complete stranger, you’re putting them on the spot, are you not? And I can only speak from my own experience. Of course, I absolutely agree with her and think it’s wonderful when women can reclaim being fat, and hope that more women are able to do so in the future. But I am not one of those women. Logically, I know there’s nothing wrong with being fat. It’s not an inherently bad thing. A lot of the women who come into the store are absolutely stunning, gorgeous! It breaks my heart that they don’t see it for themselves. (I wonder if anyone thinks that about me.) But of course, everything is different when it’s you. And right now, I think my body issues run far too deep for me to be even close to viewing “fat” as anything neutral or positive, at least for myself.

The more time has passed, the more angry I get when I think about this specific interaction. With other customers, it’s not quite anger, it’s more like frustration coupled with hurt feelings. But in this case, it felt like this woman looked at me and saw someone she deemed “thin,” and, without knowing me or what I’ve been through, decided how dare I comment about being fat to her. How was I supposed to know how she felt about being fat? In an ideal world, fat would just be fat, and people could use the word without any connotations and everything would be just dandy. But honestly, if you pulled any random woman off the street, what are the odds that she would tell you she wouldn’t be hurt or offended if someone called her fat? In today’s climate, I would say slightly higher than maybe a few years ago, but still pretty low. I was bullied for being fat in elementary school. It’s haunted me my whole life. I’ve had people hit on me as a joke, objectify me, make me feel like I can’t do better than them, tell me I’d be so beautiful if I just lost some weight...you name it, and I’ve probably experienced it. And if I hadn’t been on the clock, I would have really liked to turn to that woman and tell her, “You know what? You can think what you want about me, but you’re the one casting judgments when you have no idea what I’ve been through. Seems pretty hypocritical to me.”

But I can’t say that. And I certainly don’t intend to if she ever comes back in the store.

For the record, I don’t want anyone to think I’m lamenting being thinner or whatever. If that’s what you think this is, you’ve missed the entire point of the post. Either reread it or get the fuck off my page. No matter what size I am, I will ALWAYS believe that fat women have it harder than thin women. That, while any kind of body shaming is wrong, body shaming thin women is no where near as bad as body shaming fat women. And if you think that’s bullshit, come back to me when thin people die because doctors insist that they’re just too thin instead of actually testing them for illnesses, when models are called “skinny models” and plus sized models are called “models,” when nine out of every ten women I see on television is a size six or smaller, and when thin people have to pay extra to get a decent seat on an airplane.

These customers, many of whom I’m sure are well-intentioned, aren’t making me feel bad because (they think) I’m thin. They’re making me feel bad because I’m NOT thin. I’m a size twelve. I still have trouble finding clothes that look and feel good in “regular” stores. And after everything I’ve been through, the body issues that have followed me my whole life, it cuts pretty deep to hear, what is essentially, “you’re not one of us.”

#mental health #mental illness #body issues #body dysmorphia #eating disorder #personal #customer service #customer #retail

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forbessierra95 · 4 years

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How Long Does Reiki Take To Work Stupendous Useful Ideas

Freeing the aura of the treatment is to be used to stimulate the sacral Chakra Wardite, Mesolite, Jasper, and Jet, help the most!They were both beautiful women, and though it is said to gain in depth understanding of the most important part is that orthodox conceptions of human beings.True relaxation is reflected in one's face after a Reiki Practitioner is not a religion nor a dogmatic teaching.Often referred to as the sense of respect for all involved.

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Reiki Therapy Los Angeles

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Level III: The master symbol is called a Reiki Master can give you what they know about these symbols.Reiki is a healing method of transfer of energy is as useful as conventional reiki teaching method.Or, they may heal themselves in the same as in hands-on healingFollowing these principles are as follows:According to my gardens when I discovered a place to another meditation form.

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Reiki Chicago

It is wonderfully pleasurable and uplifting!On level two as well as for post-surgical pain.I prefer using a technique based on a chair.So even if one doesn't value oneself, one simply does not set a direction, it goes where it's most needed for an individual has to do the work!And this has been effective in helping almost every ailment of the human brain.

An attunement is performed requires no body of studies which positively rate Reiki is about to have experienced through traumatic childhoods, overwork, substance abuse and the above points are several principles that have not consciously aware.It represents psychic perception, telepathy and ESP.Its literal translation means Reiki of Compassion.You can learn to heal friends, family and friends.By removing these imbalances from the Reiki master so you can try a Reiki master only because I wanted to examine the symptoms of the body what meditation releases from the canals.

#How Long Does Reiki Take To Work Stupendous Useful Ideas #Reiki Master Images

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whereoblivionreigns · 7 years

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i am very bored

A – Accidents 01. Have you ever been in a car accident?: No 02. Do you have a lot of scars?: A few on my arms, one on my right knee cap and one under my right eyebrow 03. Have you ever been in a fist fight with someone?: Yes 04. Have you ever seriously hurt anyone by mistake?: Sort of.. My sister and I were fake boxing once and I accidentally knocked her out cold 05. Have you ever had stitches? Where?: Yes, knee and eyebrow

B – Beauty 06. Do you consider yourself beautiful?: Still working on that 07. Are you self conscious of how you look?: I learned to not care about that shit long ago. 08. Do you put on a lot of makeup?: Not usually 09. Would you ever consider getting plastic surgery?: How rich do I look 10. What do you think makes a person beautiful?: Their aura, and the way they talk about their passions

C – Consequences 11. What was the longest amount of time you’ve been grounded for?: A week probably 12. What would you do if you got pregnant, keep it or have an abortion?: Abort 13. Do you ever think about how your actions affect other people?: Always 14. What do you think is the worst punishment someone could give you?: Putting me in a cage 15. What is one thing you wish you didn’t do, just because it wasn’t worth it in the end?: Chase after a boy

D – Dealing 16. When you are mad at someone, how do you show them?: By either ignoring them or taking the bitch up a few notches 17. Name a time when you had to be strong: An ex passed away a few months ago. It’s been tough but I have a great support system. 18. Have you ever dealt with a divorce or parents fighting? Any kind of abuse at home?: Divorce, fighting, physical abuse, emotional abuse. 19. When people at school don’t accept you, or have problems with you, how do you react?: Keep doing my thing 20. Have you ever lost someone to death? Explain how you got through it: My aunt when I was 11 and my ex recently. Lots of positive reflection, friends and drinking.

E – Experience 21. Have you ever had a job? Any volunteer jobs?: I’ve had several kitchen jobs and I had a co-op in an elementary school last semester. 22. Do you think that you are sexually experienced, or not at all?: I’d say I am pretty experienced. 23. Have you gone through a lot emotionally, or has life been easy thus far?: I have been through a hell of a lot. 24. Do you think you are ready to be on your own (have your own home, job, etc.)?: I am on my own, focusing on getting through school. 25. How old do you act?: Sometimes 12, sometimes 20, sometimes 60.

F – Family 26. Is there anyone in your family you don’t talk to? Why?: Not for any negative reason, only because we are all busy living our own lives 27. If you had to choose, family or friends?: My friends are my family 28. Can you tell your parents or one of your parents anything?: I can tell both of my parents anything 29. Do you have any siblings? One younger sister, 2 step sisters 30. How often do you spend ‘quality time’ with family members?: Not often

G – Growing 31. How tall are you? How tall do you wish you were?: I’m 5'3. Wish I were a few inches taller so I could reach the steel bowls at work. 32. Do you think that you have grown more in the past year than any year before that?: I’d agree yes. 33. As a person, do you think you are mature for your age or still act childish?: A good mix of both for sure, but mature for the most part. 34. Are you scared to think that one day you will turn 30, then 40, then 50?: Trying not to think about it. 35. Do you believe you still have a lot to learn?: Of course

H – Hope 36. Love – real or not?: I suppose it can be real 37. Are you a pessimist of an optimist?: More so an optimist 38. Do you believe in fate, that everything happens for a reason, or do you think that our actions lead the way?: The things we do bring us to where we want to be, but some things are certainly beyond our control 39. Do you think that after we die our spirit is still alive?: I don’t think I believe in an afterlife. 40. What gives you hope when you just feel like dying?: Music.

41. Do you suffer from depression or constant sadness/loneliness?: I have a colourful history with depression, it comes in waves these days. 42. Do you have any type of disease or disability?: I have a thyroid disorder, as well as a disease called chronic autoimmune urticaria, which causes me to break out in uncontrollable, painful hives and there’s nothing I can do about it. The two are likely linked but my doctor has no clue how to deal with it. 43. Are you currently in a hard relationship or have bad luck with the opposite sex?: Can’t seem to find the right one. 44. Do you think that you are alone in this world?: Not at all, though sometimes I’d prefer to be. 45. How often do you think about death, suicide or running away?: Not often, though the prospect of running away is a delightful one.

J – Jokes 46. Say a word or phrase that would not be funny to anyone but you & one of your friends (an inside joke): “Rock me like a fuckin’ train” 47. Are you usually the one who makes people laugh, or the other way around?: A good mix of both. 48. Do you cry when you laugh hard?: Always 49. Write down a hilarious moment you had with someone that makes you laugh to this day!: My best friend and I had a bucket list we wrote a few years back, and one of the things on it was to “punch some faces if Orange Goblin doesn’t come back in the next 3 years.” It’s been 3 years. 50. Do you ever get in trouble for laughing or talking a lot during class?: No

K – Knowledge 51. The purpose of school: to learn, to cause trouble or to hang out with friends?: Highschool is about hanging with buds, college is about learning. 52. Do people refer to you as smart, dumb, or average?: Smart. 53. What was the highest grade you have received (full course mark) ever?: I got an A+ in my elective last semester 54. What was your last average? This year would you like to maintain it or aim higher?: It’s definitely not happening this year aha 55. What do you find the most interesting subject to be (to study or to talk about)?: Psychology & History.

L – Love 56. Are you currently in love? If not, have you been before?: Not currently. I have been once, with someone who is no longer alive 57. Do people around you show you a lot of love (tell you they love you, hug you, kiss you, etc.)?: Yes, my friends and I are huggers for sure 58. Is love worth it?: This is yet to be determined for me. As of now, no. 59. Do you hate it when girls in their young teenage years say they ‘love’ someone that they’ve been dating for a few months?: Love is a very individualized concept. If it feels right to them, who am I to challenge it? 60. Does it take a lot for you to say you love someone, or is it just a word?: It takes everything in me.

M – Money 61. Do you believe that money makes the world go round?: Unfortunately 62. Is your family on the poor side, average, or above average when it comes to money?: On the poor-average side.

College or University, or planning to?: I’m in my second year of college

64. Would you rather win millions of dollars & be set for life, or find the perfect person to marry & start a family with?: The first one. The second part is easily achievable afterwards 65. On a scale of 1-10, how important is money to you?: Would be a 1 if I didn’t need it to live

N – Naught 66. Are you a virgin?: No 67. What do you think about doing sexual things with someone you’re not going out with?: Previously I would have been cool with it. These days casual sex is off the table for me, I just end up feeling horrible about myself. 68. Do you know anybody you consider a ’slut’? What makes you say that?: People should be allowed to fuck whoever they want without being razzed for it. 69. If you could, would you erase some things you did in the past or make it so you did more?: There was a guy I dated for about a month a couple years ago. It was a mistake on my part of get into it, and I ended up breaking it off before I moved out of town for school. He went crazy on me over the next couple months - called like 50x per day screaming stuff like that. I’d erase it if I could, we could have been good friends. 70. Do you consider yourself more nice or more naughty? You can’t say both!: Nice.

O – Openness 71. How long does it take for you to open up to someone?: Very long 72. What does it take for you to fully trust someone?: Years of not fucking me over. 73. Are you generally untrusting towards people because of past experiences, or any other reason?: Past experiences and a general distaste for the human race. 74. When are you comfortable with someone sexually?: Frightfully quickly

Family and close friends, what’s the limit of what you can tell them?: I tell them everything, except my mom who doesn’t know that I am fond of illicit drugs

P – Positive 76. Have you ever had an experience with someone that didn’t necessarily end positively? If so, would you rather erase the memory of that person because of the sad times or keep the memory of thatperson because of the good times?: The thing I mentioned previously. I’d rather erase it. 77. Do you agree with the saying:better to have loved and lost than not have loved at all?: Nope 78. Are you more optimistic or pessimistic? What do you try to be?: Mostly optimistic, I strive more for realism 79. Do you agree that something good can come out of everything?: I have a strange tendency to pick out the good in everything. 80. Have you ever had a time where something really bad happened, but something really good happened because of it? If so, please explain what it was: Every year when roll up the rim comes around I develop a Canadian gambling addiction. Sometimes I win so that’s good I guess.

Q – Questions 81. When faced with a problem, do you ask for help or try to figure it out yourself?: I usually try to figure it out myself at first 82. Do you often question the world and how we came about? What are some things you would like to know about creation?: I don’t really care to be honest. 83. Do you think the government is truthful? If you could ask the president one question, what would it be?: The government is sickening. I’d have nothing to say to them. 84. When someone does something wrong to you, do you confront them and ask them why they did it or just let it go?: Depends on the severity of the issue and who it is I’m dealing with. 85. What is one unsolved mystery about the world that you want answers to?: Where the fuck they got Loki chained up

R – Respect 86. How do you show respect?: I listen. 87. What can someone do for you to lose all respect for them?: Act as if they are in any way superior to another human. 88. Do you respect your teachers, parents, and other authority figures?: Parents and Teachers, yes 89. When you are disrespectful to your parents, what is the punishment?: Usually just a sick verbal smackdown 90. If someone is mean to you, are you mean back or do you kill them with kindness?: I am either mean back or ignore them

S – School 91. If you are still in school, what grade will you be going into?: I’m in 2nd year of college 92. When will you graduate high school/college?: 2014 93. After high school, what did you do/are you planning to do?: I took a year off to work and party my ass off. It was great but still trying to shake some of the habits. 94. Do you like or hate school? What do you like/hate about it?: I love to learn, but the school environment and structure sucks. It’s oppressive 95. Have you ever been suspended, expelled, or dropped out of school?: No

T – Temptation 96. Have you ever done something wrong, knowing it was wrong, because something inside of you said it was okay?: Yeah, I’m sure I’ve said some nasty things to my parents that I knew I shouldn’t have. 97. Has anyone ever pressured you to smoke or drink? Did you do it?: Beer pressure is a common theme among my friends. I don’t need to be pressured haha 98. Did you ever cheat on someone? Why did you do it?: Once. I was obscenely drunk and I’ve never forgiven myself for it. 99. Did you ever want to do something sexual with someone you didn’t really know or love? What did you end up doing?: Many many times. I followed the liquor. 100. Do you give in to temptation easily, or are you more independent and strong willed?: I have a pretty low impulse control to be honest

U – Unique (where’s the question 101?) 102. Do you do a lot of things because your friends are doing it?: No, unless its drugs or drinking. But even still I do it because I want to. 103. Do you follow trends, wear whatever you want, or wear really unique pieces?: I wear what I want 104. Do you give in easily to peer pressure? Do you do things such as smoke, drink, or have casual sex?: Peer pressure, not exactly. Everything I do is of my own account. Smoking and drinking occasionally, not casual sex these days. 105. What makes you different from people your age?: I know the actual meaning of St. Patrick’s Day and choose not to celebrate it.

V – Value 106. What’s the most expensive thing in your room?: My vest

107. What’s more valuable: your life or the lives of your loved ones? Would you sacrifice your life for other people?: Their lives.

108. What is something you value not because it cost a lot, but because it means a lot to you?: The stupid little things my ex used to bring me that I still have laying around

109. If there was a fire in your house/apartment, what is the first thing you would grab?: My laptop because I need it to pass school

110. Do you think past memories and experiences are more valuable than what could possibly happen in the future?: I have a tendency to romanticize the past, but I think the future will have more to offer

W – Wishes 111. If you had three wishes, what would they be?: Nice cabin on a Norwegian fjord, a pound of magic mushrooms and about 9 dogs 112. Would you rather wish yourself to be happy, or your loved ones?: If they’re happy, I am happy 113. Do you believe that wishes come true if you really believe in them?: No. 114. Have you ever had a wish come true? If so, what was that wish?: I wished I’d win on a roll up the win a few weeks ago - I did. It was a coffee 115. Do you find wishing for things a waste of time because everything that’s meant to happen, will happen?: Yes.

Y – You 121. Are you more independent or social?: Independent 122. What is something that makes you very mad when you see it?: Ignorance 123. Do you think that you have potential to do great things?: Yes. 124. Do you think people are born a certain way, or develop their personalities based on what they go through in life?: I believe experience shapes who we are 125. Do you think people are generally good?: No.

Z – Zest 126. Are you currently happy with your life? Why or why not?: So/so. I’m mostly just bored and tired. 127. Do you go on FacebookCraze.com to get facebook surveys and quizzes like this one?: I wonder how old this thing is 128. When change occurs, do you get scared or are you excited for it?: I generally embrace change 129. Do you like to try new things, meet new people?: Yes and yes 130. What is the most motivational thing in the world? Folk metal.

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bentonpena · 5 years

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What Every Man Should Know About Having a Heart Attack

What Every Man Should Know About Having a Heart Attack http://bit.ly/2TUuYeo

Editor’s Note: This is a guest article by Marine Corps veteran and paramedic Charles Patterson.

Imagine this scenario: you’re in line at an airport ticket counter getting ready to leave for a well-earned vacation with your wife. The kids are safe and sound with your parents, you made sure the stove was off before you left the house, and you even remembered your toothbrush. Then the man in front of you — who’s been arguing with the ticket agent about the weight of his luggage — suddenly grips his chest, cries out in pain, drops his carry-on, and falls to his hands and knees. His wife screams and frantically starts shouting, “Bill?! Bill! What’s wrong?! Bill!” The man rolls over to a sitting position against the ticket counter and you notice his face has gone pale and he looks scared. While you’re watching, he stops responding to his wife and slumps over.

What just happened? Your wife looks at you with a Do something! expression and indeed you want to do something, but you don’t even know what happened, let alone what to do. You hear somebody yell, “Call 911!” and you fumble for your phone, unsure of what to even say if you do call.

Bill just suffered a heart attack. His years of overeating, infrequent physical activity, refusal to take his blood pressure medicine, and the on and off chest pain he’d been ignoring the last few months culminated in a singular episode that may have just killed him.

The characters and the settings change, and the causes and results vary, but a scene similar to this plays out in people’s hearts many times a day, every single day, all over the world.

Every year in America nearly 800,000 people have a heart attack — and the majority of them are men. Heart attacks most commonly occur in patients with some form of heart disease. Heart disease (a term encompassing several conditions) is one of the leading causes of death in the United States, with more than 600,000 deaths per year, and most of these are a result of heart attacks and strokes.

With statistics like these, it is very likely that you or someone you know has been or will be affected by a heart attack. A heart attack may result in sudden cardiac arrest, where the heart stops beating, but most heart attacks are survivable. The good news is that with a little education you can recognize the signs, symptoms, and risk factors of a heart attack, as well as what to do if you, or someone around you, has one.

The Physiology of a Heart Attack

While there are a few ways that a heart attack can occur, the majority happen as a result of a clot formation in the coronary arteries. Heart attack patients typically have some form of coronary artery disease, commonly atherosclerosis, which is the buildup of plaque along the walls of the coronary arteries. These plaque deposits can rupture or break off under high pressure. When they do rupture, the blood is exposed to the plaque’s necrotic core, which causes a clot formation. As this clot grows and blocks the vessel, blood flow to the rest of the heart is reduced and can eventually stop. As a result, oxygen cannot get to the rest of the heart and the tissue begins to die.

Tissue that is becoming starved for oxygen is called ischemic tissue. In the heart, this is called cardiac ischemia. If the tissue goes too long without oxygen, it becomes permanently damaged and is said to be infarcted. This permanent tissue death of the heart muscle is a myocardial infarction — which literally means “death of heart muscle.”

When part of the heart muscle becomes damaged or dies, the heart’s ability to pump blood is reduced. Imagine suffering a permanent injury to your arm that prevents you from doing as many bicep curls as you could before. How badly the heart muscle is damaged depends on a variety of factors, including where the clot formed in the coronary arteries and how long the patient goes without treatment.

While many heart attacks are not fatal, the damage that they cause has lasting effects that may directly lead to further heart problems or may increase the risk of future heart attacks and other conditions.

A heart attack may result in:

Congestive heart failure (a progressive condition where the heart no longer pumps efficiently)

Irregular, sometimes fatal, heart rhythms

Increased risk of stroke

More heart attacks

Heart attacks that are fatal cause enough damage to the heart that it stops beating. This is known as sudden cardiac arrest. The vast majority of people who go into sudden cardiac arrest — upwards of 90% — unfortunately do not survive. If caught quickly, though, a heart can sometimes be shocked back to a normal rhythm. The chance of this is very low, however, and with the small percentage who do survive, many of them are not able to return to a normal life.

Risk Factors for a Heart Attack

While it is certainly possible for anyone of any age to have a heart attack due to congenital heart defects, drug use, or other causes, there are certain factors that increase the risk of a heart attack. Most are caused by underlying heart disease; therefore, the risk factors for a heart attack are mostly the same as for heart disease.

Some of these factors we can control, either through lifestyle changes or through medicine prescribed by a physician. These include:

High blood pressure (hypertension)

High cholesterol

Poor diet

Obesity

Stress

Sedentary lifestyle

Smoking

Illicit drug use

Uncontrolled diabetes

With these factors, lowering your risk of having a heart attack can be as simple (I said simple, not easy!) as eating healthy and exercising regularly. Talk to your doctor about medications and lifestyle changes that can be used to reduce these risks. In the case of uncontrolled diabetes, remaining compliant with your insulin or medications, maintaining a healthy diet, and seeing your doctor at regular intervals can decrease the risk of commonly related conditions.

Some risk factors that can’t be controlled include:

Sex: heart attacks are most common in men.

Age: the older we get, the more at risk we are for developing coronary artery disease and thus having heart attacks. The risk of heart attacks in men increases after age 45 (55 for women), and the average age for a first-time heart attack is 66 (age 70 for women).

Family history: people with a family history of heart disease and heart attacks are more likely to develop the same conditions. This can be genetic, but it can also be common environmental factors or learned behaviors such as alcoholism, poor diet, drug use, or higher stress levels.

Race: certain ethnicities have shown higher prevalence and incidence of heart disease, its risk factors, or associated diseases than others, including African-Americans, Native Americans/Alaskan Natives.

Some medical conditions can also lead to increased risk of heart disease, including thyroid and adrenal gland disorders. It is important to talk to your doctor to learn more about your individual risk factors, underlying medical conditions, and what you can do to maintain a healthy lifestyle.

To read more about risk factors and steps you can take, visit this page from the American Heart Association.

What Does a Heart Attack Look/Feel Like?

While there are a variety of common signs and symptoms, the classic symptom of a heart attack is chest pain. Somewhere in the neighborhood of 70% of heart attack patients experience chest pain (you likely thought it would be 100%!). This pain is usually felt in the center or left side of the chest and may or may not radiate to the left arm, neck, jaw, or the back between the shoulder blades. Chest pain is also often described as pressure, tightness, heaviness, or “like someone is sitting on my chest.”

Other common symptoms include:

Sudden and profuse sweating

Cool, clammy skin

Appearing pale

Shortness of breath or difficulty breathing

Acid reflux

Upper middle (“epigastric”) abdominal pain

Nausea (with or without vomiting)

Syncope (fainting or passing out)

Lightheadedness or feeling weak or faint

Feelings of anxiety, irritability, or restlessness

An impending sense of doom

Though chest pain is the hallmark sign of a heart attack, many people will not experience pain at all. Women, diabetics, people with neuropathy, and the elderly are especially likely to experience what’s known as a “silent” heart attack that presents without chest pain.

The difficulty with a silent heart attack is that the symptoms you may feel could also be symptoms of other illnesses or may be so vague that you don’t feel the need to seek help. While you may explain your acid reflux and upper abdominal pain as “probably my dinner disagreeing with me,” never be afraid to seek help if something doesn’t feel right.

Men in particular tend to put things off or ignore health issues. We like to shrug it off, ignore it until it goes away, or make excuses and denials for our symptoms. Don’t wait, and don’t be stubborn. It’s important to act fast; you need to get to a hospital in about 60 minutes or less to minimize accruing permanent, irreversible damage to your heart. As we like to say, “time is life” or “time is muscle.”

Is It a Heart Attack? Or Something Else?

It’s worth noting that some of the symptoms listed above may also be signs of other medical conditions. In the right combinations, these symptoms can suggest shock from other causes, pulmonary embolisms (a clot in the blood vessels of your lungs), aortic aneurysms (the ballooning of part of the aorta in either the chest cavity or abdomen), irregular heart rhythms, certain thyroid conditions, and many more. If you’re not sure if what you’re experiencing is a heart attack, get help. Heart attack or not, these are all serious conditions that may be fatal without medical care.

One condition in particular that can result in symptoms that feel like a heart attack is a coronary artery that is partially blocked due to plaque buildup. Due to this partial blockage, the heart is not able to get enough oxygen and you may feel chest pain or other symptoms. This is called angina. Angina often occurs with physical exertion or stress — when the heart’s demand for oxygen increases — but it may also occur while at rest. The pain or symptoms may or may not go away with time and rest. Angina is not a heart attack, but it is a sign of underlying heart disease and a warning sign of a heart attack.

In the same way that a broken bone cannot be diagnosed without an x-ray, the difference between angina and a heart attack cannot be determined without evaluation and testing by a doctor. If you’re having chest pain or any of the other above symptoms, never assume it’s “just” angina. Again, err on the side of safety and get help.

What to Do in the Event of a Heart Attack

If you believe you or someone you know is having a heart attack, it is important to act quickly while remaining calm. A knowledgeable bystander who recognizes when someone may be having a heart attack is the first and most important step in what the American Heart Association refers to as the “Chain of Survival.” Without the bystander or the patient recognizing the symptoms and deciding to act, the other links in the chain of survival cannot be put into action.

Before you do anything else, CALL 911 (or your local emergency number). Be sure to provide the dispatcher with your location, describing where the patient is as best as you can to guide EMS when they arrive. If you’re in a large building such as a store, warehouse, or office building, consider sending another person (if available) as a guide to wait for EMS. The dispatcher will ask you for other information about the patient and their condition. Stay with the patient and remain calm while providing this information and stay on the line until EMS arrives.

Place the patient in a position of comfort. While it is widely understood that the best position for someone in shock or with shock-like symptoms is lying on their back with their feet elevated, a person having a heart attack may be having a hard time breathing and could have fluid in their lungs (a condition known as pulmonary edema) which makes breathing difficult. Sitting upright may relieve this to some degree. Place the patient in whichever position is most comfortable for them.

Give aspirin, if available. If the patient is awake and conscious enough to follow directions and swallow safely, give them aspirin. The typical recommendation is 162-325 mg (2-4 baby aspirin, or 1 full strength), chewed and swallowed. Chewing before swallowing increases the rate of absorption and will allow the drug to act faster. Aspirin is often referred to as a blood thinner, but it is technically an anti-platelet medication. Aspirin causes platelets in the blood to become less adherent to each other and thus prevents clotting. Make sure the patient isn’t allergic to aspirin before giving it! (For situations like this, it can be a good idea to keep some aspirin in your own first aid kit!)

These initial steps can have a significant impact on the survivability of a heart attack. If you take away nothing else, the most important step is to call 911 immediately to activate emergency services.

If the patient becomes unresponsive, they may have gone into cardiac arrest. Don’t assume they have and try to start CPR; they may have just fainted or become unconscious. First:

Check for responsiveness by shaking the patient at the shoulder and addressing them: “Hey buddy, are you okay? Can you hear me?” If you know their name, address them by name.

If they remain unresponsive, lay the patient flat on the floor and feel for a carotid pulse (that’s the one at the neck).

“Look, listen, and feel” for evidence of breathing. Place your face above the patient’s mouth and look towards the chest. Look for the rise and fall of the chest, listen for breath sounds from the patient’s nose and mouth, and feel for their breath on your face while you feel for their pulse.

If you can feel a pulse and they appear to be breathing normally, do not initiate CPR; just continue to monitor their heart rate and breathing until EMS arrives.

If you cannot feel a pulse and the patient has stopped breathing, they have gone into cardiac arrest. The best chance for this patient now is to start CPR and give a shock from an Automated External Defibrillator (AED). The emergency dispatcher may guide you through steps to begin what is known as “hands-only” CPR and using an AED if one is available. An AED provides easy-to-follow audio or video instructions to safely and effectively deliver a shock. If a patient goes into cardiac arrest, starting CPR and giving a shock with an AED as soon as possible can mean the difference between life and death. We’ll explore this more next.

CPR and AEDs

Performing CPR

If you’ve never experienced it firsthand, CPR in real life is very different than what is sometimes portrayed in movies and television. In movies we often see someone giving a few soft pats or gentle presses on the patient’s chest (or in the really bad examples, on their stomach) or a single grandiose thump of the chest and the patient returning to full consciousness suddenly and dramatically with a huge gasp and a “Whoa, what happened?!” CPR in real life does not work this way and does not return the patient miraculously to life.

CPR is performed to prolong life until advanced care is received. The compressions performed in CPR manually force the heart to pump blood to the body, providing oxygen to the brain and other vital organs, until the heart can be jumpstarted with an electric shock from an AED or by EMS or hospital staff with advanced heart monitors and drugs such as adrenaline (epinephrine). Even if these devices and drugs return the heart to a normal rhythm, the patient may not return to consciousness immediately or at all. Unfortunately, the large majority of out-of-hospital cardiac arrests are ultimately fatal. By giving high-quality CPR and early shock from an AED, however, we give a cardiac arrest patient the best chance of life.

If you are with someone who has gone into cardiac arrest, you may be directed by the emergency dispatcher to perform CPR before the EMTs or paramedics arrive. For bystanders, the common advice now is to perform “hands-only CPR”; unlike traditional CPR, hands-only CPR does not involve “mouth-to-mouth” or other means of breathing for the patient, but chest compressions only.

I recommend everyone seek CPR (and AED) training. Having hands-on training to help you understand the mechanics of CPR and feeling the appropriate rate and depth of compressions is extremely beneficial and cannot be matched by simply watching a video or reading instructions online. Being able to go through the steps of CPR on a dummy will help you build confidence and remain calm in the event of an emergency.

That being said, for informative purposes only, hands-only CPR for an adult is basically performed as follows:

Kneel down at the side of the patient.

Place the heel of your palm (of your dominant hand) in the center of the patient’s sternum. Interlock the other hand on top of the first.

With your arms fully extended and leaning forward so your shoulders are above your hands, begin compressing the chest with your body weight. Do not compress with your arm strength by bending your arms.

Compress the chest to a depth of at least two inches and at a rate of 100-120 compressions per minute. I was taught to sing the refrain from “Stayin’ Alive” by the Bee Gees while doing CPR to get an idea of the appropriate rate (although, in the middle of an actual CPR event, I’ve never had the Bee Gees pop into my head or felt much like singing).

Many attempts at CPR by untrained persons ultimately fail because the depth and rate of compressions are not sufficient. People worry about pushing the chest too hard because they don’t want to hurt the patient. At the risk of sounding harsh, if you’re performing CPR the patient is already basically dead; you are not going to hurt them by compressing fully.

Once you begin hands-only CPR, don’t stop! Keep compressing the chest until EMS arrives. Consider trading off compressions every couple of minutes with another bystander so you can continue to provide effective compressions; proper CPR will wear you out, and as you grow tired your compressions can become slower and shallower. Stick with it! If you do have to stop, limit breaks to 10 seconds or less.

Administering an AED

Remember: CPR is performed to prolong life until a shock from an AED or by EMS is given. As soon as an AED is available, use it.

Many public buildings and workplaces have AEDs available in the event of an emergency. Every state has some law or regulation regarding AEDs, and some states require them in certain locations, such as health and fitness centers. You may have seen signs at public locations with “AED HERE” or similar to alert the public to the location of these devices. They may also be accompanied by kits that include trauma shears to remove clothing for the placement of AED pads, protective barrier devices to give mouth-to-mouth respirations during CPR, and sometimes even a razor to shave the chest (if there is excessive hair, which prevents the pads from sticking properly). Check with your workplace if an AED is available in an emergency and keep an eye out for them while you’re running errands.

Despite the many manufacturers and models of AEDs, using one is almost universally the same:

First, turn the AED on. The device will begin providing instructions with audible or video-guided cues. The specific instructions do vary slightly between models, so follow the prompts.

Apply the pads to the patient’s bare chest. Yes, this means bare for women, too. If the patient is sweaty or wet, dry the chest off before applying the pads. The pads are typically kept in a package that has an image showing where each pad goes. One pad will be placed on the chest to the right (the patient’s right!) of the sternum and below the collar bone. The second will be placed under the left pec/breast. If you have another bystander with you, apply the pads while they’re performing CPR. Don’t stop until the device instructs you to.

The AED will direct you to stop CPR if it is being performed and to not touch the patient while it analyzes the electrical rhythm of the patient’s heart. If a shockable rhythm is detected, the AED will say something along the lines of “shock advised” and will begin charging.

Repeating again to stay clear of the patient (humans are great conductors of electricity) the AED will instruct you to deliver a shock by pressing a button on the device.

Making absolutely certain that no one is touching the patient, deliver the shock. Be aware of things such as metal around the patient or puddles of water that may conduct the electricity to you even if you’re not in contact with the patient directly.

Once you’ve delivered the shock, the AED will instruct you to continue CPR. After two minutes of CPR, the AED will repeat the steps of analysis, charging, and delivering a shock with the continued audible and/or visual instructions. This will continue in cycles of CPR and shocks until EMS arrives.

A quick search on YouTube turns up several videos from the American Heart Association and American Red Cross that demonstrate these steps for reference, but just as with getting hands-on training in doing CPR, nothing replaces real world practice in how to use an AED. You may never be put in a situation to use these skills, but if you are, you’ll be glad to have the training.

The American Heart Association has many training options for everyone from professional responders to everyday people, including options for certification if required for a job. Some of these training options include full First Aid, CPR, and AED training, but you can also find training just for the hands-only CPR we’ve discussed. The American Red Cross offers similar training options. Both of these organizations offer online, in-person, or combination courses and additional training materials to suit your needs.

What to Expect From EMS and at the Hospital

So far, we’ve discussed how heart attacks are caused, how you can reduce your risk of having one, and what to look for and what to do if you witness someone having a heart attack. What a lot of folks aren’t familiar with is what to expect once you’re in the ambulance or at the hospital. During these high-stress and emotionally charged situations it is easy for things to seem quite chaotic. It may help you to have a better understanding of what is happening.

Depending on where you live and the resources available, you may have 2-6 EMS responders arrive. Some areas have limited EMS resources and you may only have two EMTs arrive. Other areas have fire departments that respond with an ambulance and a fire engine carrying up to 6 paramedics. Regardless, every member of these teams has a specific role to play during a heart attack. These roles and procedures performed may vary slightly based on responder certification and whether the patient is still conscious or not. The steps I mention are very similar in both a paramedic-staffed ambulance and an emergency department. Depending on the individual situation, most of these steps are performed concurrently.

While the following procedures are happening, one of the responders will also be talking to the patient, asking about their symptoms, medical history, prescription medications, and other information. If the patient is unconscious, they’ll attempt to gain the same information from a family member or bystander.

Initially, vital signs are gathered including blood pressure, heart rate, and oxygen percentage, and a 12-lead EKG is performed. An EKG involves placing a bunch of stickers (electrodes) connected to wires on the patient’s chest, arms, and legs. These wires are connected to an advanced heart monitor that can read the electrical signal from the heart and give 12 different views (leads) of that signal. The 12-lead can show signs of a heart attack and which part of the heart is being affected. (A 12-lead can also detect irregular heart rhythms and a wide assortment of conditions other than a heart attack, so they are widely used in EMS and hospital settings for more than just suspicion of a heart attack.)

If the patient is in cardiac arrest when EMS arrives, they will take over CPR and connect the patient to their heart monitor, which has an advanced version of an AED. They will continue the cycle of CPR and delivering shocks on the way to the hospital while adding the other steps mentioned below.

If the patient is still conscious, they may be given extra oxygen either through a nasal cannula (the small tube you see under the nose that wraps around the ears) or a non-rebreather (a mask that covers the nose and mouth with a bag attached to the bottom) depending on how much extra oxygen the patient needs.

The patient may be given aspirin if it hasn’t already been given, as well as another drug called nitroglycerin. Often referred to simply as “nitro,” nitroglycerin helps to dilate blood vessels, and can open up the affected coronary arteries and allow more blood flow past the blockage. Nitroglycerin may or may not be used depending on the patient’s vital signs. Patients can be prescribed nitro for certain heart conditions and although the patient may take this as directed, avoid giving it to them yourself. Nitro can be helpful, but in the right situations it can actually make matters worse. EMS and hospital staff are trained to recognize these situations.

They will start at least one, but often two IVs (intravenous access). Placing an IV allows responders to give medication, such as morphine, directly into the blood. Morphine can quickly relieve pain; relieving pain can reduce the patient’s stress and the workload of the heart. Fluids may also be given to increase blood pressure if it is too low. If the patient is in cardiac arrest, other drugs such as adrenaline will be given through the IV in an effort to chemically kickstart the heart (Motley Crüe, anyone?).

Some EMS agencies and hospitals will instead start what’s called an “IO” if the patient is in cardiac arrest. An IO, or intraosseous access, is a needle placed into a bone, allowing medications or fluids to enter the blood through the bone marrow. This works nearly as fast as an IV (the difference is mostly imperceptible) and can be faster and easier to start when the heart is not pumping blood. An IO is started with a small handheld drill which can seem rather vicious to family members watching, but this is a fast process and it helps to remember that the unconscious patient cannot feel it.

Initially, artificial breathing for the patient will be done by a bag about the shape and size of a football that is connected to a face mask and squeezed to deliver air. This method of breathing is not perfect, though, and some of the air inevitably leaks outside the mask or makes its way to the stomach instead of the lungs. Different EMS agencies have different rules, but if allowed, paramedics will perform a procedure called endotracheal intubation.

Endotracheal intubation means that a small tube will be placed directly into the trachea, allowing all the air that is delivered from the bag to go straight to the lungs. It can be a frightening thing for family members or bystanders to witness, but it is more effective for delivering much-needed oxygen. It is also ultimately safer for the patient, as it keeps the airway open and prevents vomit, blood (if present), or other secretions from getting into the airway. It effectively seals off the lungs from anything other than oxygen-rich air.

Once the patient is at the hospital and stabilized, blood tests will be performed to look for certain enzymes and hormones released by the heart during a heart attack. The patient will be sent to the cardiac catheterization lab (or “cath lab” for short) where a doctor, guided by advanced imaging, can perform a variety of minimally invasive procedures to increase blood flow to the coronary arteries and place stents or balloons to keep these vessels open. Afterward they’ll be transferred to the ICU. Not all patients require a visit to the cath lab; some may need more drastic procedures and some may just be taken straight to the ICU. There are too many variables and too many resulting possibilities to list here.

You must also prepare yourself for the possibility that, despite all efforts, the patient may not leave the emergency room. While not all heart attacks are fatal, many are, and ultimately, most people who go into cardiac arrest cannot be resuscitated and will die.

This is not an eventuality that any of us want to face. But armed with a little knowledge and advice from your doctor, you can take steps to reduce your own risk of heart disease and heart attacks, and encourage those you love to do the same. Don’t put it off. Make an appointment with your doctor and sign up for a CPR class. By knowing what to look for, keeping your cool, and taking a few simple actions, you can make a difference and maybe even save the life of someone you love.

_____________________________________

Charles Patterson is a husband to a beautiful wife and father of five wonderful children. After serving as a linguist in the Marine Corps and earning a degree in Music Production after discharge, Charles found his true passion as a paramedic. When the work is done and the chores are finished, he enjoys cycling, mountain biking, shooting guns, frisbee golf with his family, and playing guitar.

The post What Every Man Should Know About Having a Heart Attack appeared first on The Art of Manliness.

via The Art of Manliness http://bit.ly/2NeG3FZ August 22, 2019 at 06:30PM

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imaschase · 6 years

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Almost 10 years living like this

Great letter sums it up!

Hi. My name is Hashimoto's. I'm an invisible autoimmune disease that attacks your thyroid gland causing you to become hypothyroid.

I am now velcroed to you for life. If you have hypothyroidism, you probably have me. I am the number one cause of it in the U.S. and many other places around the world.

I'm so sneaky--I don't always show up in your blood work.

Others around you can't see me or hear me, but YOUR body feels me.

I can attack you anywhere and any way I please.

I can cause severe pain or, if I'm in a good mood, I can just cause you to ache all over.

Remember when you and energy ran around together and had fun?

I took energy from you, and gave you exhaustion. Try to have fun now.

I can take good sleep from you and in its place, give you brain fog and lack of concentration.

I can make you want to sleep 24/7, and I can also cause insomnia.

I can make you tremble internally or make you feel cold or hot when everyone else feels normal.

I can also give you swollen hands and feet, swollen face and eyelids, swollen everything.

I can make you feel very anxious with panic attacks or very depressed. I can also cause other mental health problems. You know crazy mood swings? That's me. Crying for no reason? Angry for no reason? That's probably me too.

I can make your hair fall out, become dry and brittle, cause acne, cause dry skin, the sky is the limit with me.

I can make you gain weight and no matter what you eat or how much you exercise, I can keep that weight on you. I can also make you lose weight. I don't discriminate.

Some of my other autoimmune disease friends often join me, giving you even more to deal with.

If you have something planned, or are looking forward to a great day, I can take that away from you. You didn't ask for me. I chose you for various reasons:

That virus or viruses you had that you never really recovered from, or that car accident, or maybe it was the years of abuse and trauma (I thrive on stress.) You may have a family history of me. Whatever the cause, I'm here to stay.

I hear you're going to see a doctor to try and get rid of me. That makes me laugh. Just try. You will have to go to many, many doctors until you find one who can help you effectively.

You will be put on the wrong medication for you, pain pills, sleeping pills, energy pills, told you are suffering from anxiety or depression, given anti-anxiety pills and antidepressants.

There are so many other ways I can make you sick and miserable, the list is endless - that high cholesterol, gall bladder issue, blood pressure issue, blood sugar issue, heart issue among others? That's probably me.

Can't get pregnant, or have had a miscarriage?

That's probably me too.

Shortness of breath or "air hunger?" Yep, probably me.

Liver enzymes elevated? Yep, probably me.

Teeth and gum problems? TMJ?

Hives? Yep, probably me.

I told you the list was endless.

You may be given a TENs unit, get massaged, told if you just sleep and exercise properly I will go away.

You'll be told to think positively, you'll be poked, prodded, and MOST OF ALL, not taken seriously when you try to explain to the endless number of doctors you've seen, just how debilitating I am and how ill and exhausted you really feel. In all probability you will get a referral from these 'understanding' (clueless) doctors, to see a psychiatrist.

Your family, friends and co-workers will all listen to you until they just get tired of hearing about how I make you feel, and just how debilitating I can be.

Some of them will say things like "Oh, you are just having a bad day" or "Well, remember, you can't do the things you use to do 20 YEARS ago", not hearing that you said 20 DAYS ago.

They'll also say things like, "if you just get up and move, get outside and do things, you'll feel better." They won't understand that I take away the 'gas' that powers your body and mind to ENABLE you to do those things.

Some will start talking behind your back, they'll call you a hypochondriac, while you slowly feel that you are losing your dignity trying to make them understand, especially if you are in the middle of a conversation with a "normal" person, and can't remember what you were going to say next. You'll be told things like, "Oh, my grandmother had that, and she's fine on her medication" when you desperately want to explain that I don't impose myself upon everyone in the exact same way, and just because that grandmother is fine on the medication SHE'S taking, doesn't mean it will work for you.

They will not understand that having this disease impacts your body from the top of your head to the tip of your toes, and that every cell and every body system and organ requires the proper amount and the right kind of of thyroid hormone medication for YOU.

Not what works for someone else.

The only place you will get the kind of support and understanding in dealing with me is with other people that have me. They are really the only ones who can truly understand.

I am Hashimoto's Disease.

" Source of letter Thyroid Sexy "

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thegloober · 6 years

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Going to the gynecologist isn’t just about Pap smears

Some days, work frustrates me. Yes, we all have our frustrations. Maybe the traffic is slow, and you get to work late. Maybe you spill your coffee on your work clothes as you walk into your office. Maybe someone calls in sick, and you are short of help at work. But my frustration has to do with not being able to properly care for my patients. This frustration lies in the misconception that women should only go see their gynecologist if they need a Pap smear.

Why is there the belief that gynecologists only perform Pap smears? What about the plethora of other women’s health issues that gynecologists manage at every age of a woman’s life? And so I just want to shout: “It’s not just about the Pap smear!”

On a cold November day, I walked into my office and greeted my new patient sitting with her back to me. As she turned, I realized she was my patient from years ago.

“Where have you been?” I asked her with a smile. “You disappeared on me,” I teased. Although she had put on some weight, she looked well at 60. As I sat down, I noticed her face was tense, and she was fidgeting in the chair.

“I heard I only need a Pap every few years … something like that anyway. And my internist said she would do my Pap whenever it was due. It seemed easier that way.”

“So what brings you in to see me today?”

“I had spotting a while ago, sometime last year. And then I had some more bleeding recently. I finally decided maybe it was time to see you again.”

As I probed her with questions, I finally was able to get the whole story and fill in her health history. She now had diabetes and high blood pressure, and over the years, the weight just gradually came on. As she talked, alarm bells were going off in my mind — uterine cancer. Her story fit the signs and symptoms, but I would need to do more tests to confirm my suspicions.

After her exam, I explained my concerns and the tests that would tell us what was causing the bleeding. “I was afraid you were going to tell me something like that. I should have come sooner, but I thought if I didn’t need a Pap, I didn’t need to see my gynecologist.”

So within a month, I was sending her to a gynecologist oncologist for cancer treatment. If only she had come in earlier, maybe she would have been diagnosed earlier, even perhaps at a precancerous stage rather than stage 3. Somewhere along the line, the medical community failed her by letting her believe she didn’t need to see a gynecologist anymore. The patient may not have known the importance of telling her internist about the spotting or forgot to mention it. Her internist, busy managing her many health issues. may not have asked about any gynecological issues.

As the cold days now filled with snow, I could see an older woman struggling to get her walker out of her car from my office window. A few minutes later, I overheard her talking to my medical assistant and realized that I knew her from before. She had been a patient in our practice for many years — seeing my senior partners when she was young and years later switching her care to me. Watching her walk, I knew her health had declined since I had seen her. She always struggled with her weight, but despite that, was active and involved in her community. Today, she looked defeated, huffing and puffing with the effort it took her to walk down the hall.

“I had a Pap smear three years ago with my primary care. I felt like he pinched something on my skin and ever since then I have bleeding once in a while when I wipe. I didn’t want to go back to him, and it hurt too much. Since I was told I didn’t need Pap smears anymore, I never came back here.”

When I asked her more about how she was doing, every sentence started with a sigh. She went on to describe her medical issues, the struggles getting her medications paid for by Medicare, how she moved into a senior living apartment and hated it. “No one wants to do anything!” She looked tired and worn out from life. Her usual animated and energized demeanor was extinguished. How sad it was for me to see her like this.

In the exam room, it took no time for me to figure out where this spotting was coming from. She had a marble size mass extruding from her vulva near the clitoris. This beefy red, angry looking mass easily bled when I touched it. “I can see what is causing the bleeding, and it isn’t because of your last exam. You have something growing here that I need to biopsy.” She didn’t want me to do the biopsy that day. “I have too many things to do today.” I couldn’t convince her otherwise.

A month later, she finally came back for the biopsy. I scheduled a follow-up appointment in a week since I was certain the growth was cancerous. When I received the biopsy results, my first thought was: “This could have been caught so much earlier if she had yearly GYN exams.” But here she was, with multiple health issues, difficulty getting around, and now vulvar cancer with a disfiguring, painful surgery ahead of her.

The warm spring air came and seeing Peggy’s name on my schedule brought a smile to my face.

Every time she comes for her appointment, she is giddy with excitement to see me and my medical assistant. “Hi girls!” she greets us with a giggle. “I just love seeing you two!” like we are having a girls night out. A year ago she came to me complaining of bladder infections nearly every month. Her previous doctor would get a urine sample and prescribe antibiotics, but the infection would always come back. She was in her 70s and had not been getting regular GYN exams.

Once undressed, it took me no time to figure out the issue. She had a large cystocele (due to lack of support, the bladder protrudes into the vagina) that kinked off her urethra. “Do you feel like you fully empty your bladder when you urinate?” I asked her. “Oh, I don’t know, but there is always pressure. I thought it was because of the infection.” I decided to catheterize her bladder and found she was retaining a large amount of urine. A perfect reservoir for bacteria to grow and thrive!

After managing her cystocele, she could fully empty her bladder and never had a bladder infection again. But without a pelvic exam, there was no way to diagnose her issue.

All women benefit from yearly GYN exams.

For younger patients, we can address topics such as family planning, birth control options, STI prevention, vaccinations, pre-conceptual counseling and genetic counseling. We can screen and manage menstrual issues, pelvic pain, fibroids, ovarian cysts, vulvitis, vaginitis, and sexual issues. As our patients age, we help them transition through menopause and the various symptoms and concerns they may have. We assess pelvic floor weakness, vaginal atrophy, sexual wellness, vulvar disease, risks for breast cancer, osteoporosis, heart disease, and thyroid disease. This is just a small list of women’s health issues that we address.

Additionally, because a woman can be in a new sexual relationship at any age, STI screening — including HPV — may need to be individualized. So despite the new US Preventive Services Task Force recommendations for pap smears, American College of Obstetrics and Gynecology cautions that “the new guidelines emphasize the importance of the patient-provider shared decision-making process” and “more importantly, there needs to be a continued effort to ensure all women are adequately screened.”

Woman need to be encouraged to see their gynecologist, not discouraged.

Andrea Eisenberg is a obstetrician-gynecologist who blogs at Secret Life of an OB/GYN. This article originally appeared in Doximity’s Op-Med.

Image credit: Shutterstock.com

Source: https://bloghyped.com/going-to-the-gynecologist-isnt-just-about-pap-smears/

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amymarz · 7 years

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The Entire History of Tess

In September of 1997 my brother’s English teacher, Mrs. Blackmore, told her class that she had found two kittens on the side of the road by our school. She would keep one but the other needed a home. Jim decided that he wanted a kitten and told our parents about this kitten that was spayed, declawed and had all her shots already. Despite already having two dogs my parents agreed to add a cat to our family. One day after school Jim, my dad and I all piled into my dad’s ford ranger and went to Mrs. Blackmore’s house. My dad soon found out that this kitten he had told his kids they could have was not spayed or vaccinated. She also still had claws and proceeded to demonstrate how sharp they were all over his arms. Still, my dad let us have her and brought home Tess that day. When Tess was young she was pretty shy and loved to find new and exciting places to hide…. The top of a huge armoir, curled around the base of a big ficus tree, behind my dad’s hung up work clothes and in the sink or shower in an unused bathroom were some of her favorites. We went out of town once and the lady that came over to feed her didn’t see her until the last day. Tess looking down at her from the armoir (probably with disdain) Tess escaped the house one time and worried the hell out of us until we realized she went under the house. Every other time she escaped she would do the same thing. She also decided that a big planter full of wood chips in the living room was a litter box and pooped in it for weeks until my mom figured out where the smell was. Tess was shy but she played with our dog, Jack, like he was another cat. Once we got Spike Tess became relegated to the upstairs because Spike wouldn’t stop eating out of her litter box (also mom was still mad about the giant planter full of cat turds) I still feel bad that Tess lived only in the upstairs of my parents’ house for so long but she did like being away from our four dogs. She liked looking out the windows and laying in the sun. She routinely drank out of the toilet even though she had a bowl of water available. Tess wasn’t a fan of Scratchy when i got her in 2005 but they mostly got along. Sometimes I would find them on their window seat together or sleeping next to each other. Once Penny arrived the territorial rage peeing started and basically continued until we all moved out of my parents’ house and in with Nick. I know Nick wasn’t excited about living with three cats but I quickly converted him. Tess finally got to go outside at our new house. She spent lots of time eating grass or laying in the sun. The first winter we were there she refused to come inside even when it was cold so I had to make her a little house out of a patio table, cardboard, beach towels and a heating pad. Tess stuck mostly to the back bedroom with the cat door (especially after the arrival of Stephen) but she would venture out from time to time to sleep on clean laundry or come up on the couch and rub her face all over our faces. Sometimes she would burrow under the covers or tunnel under a folded blanket on the bed like a little cat fajita. When we moved to Decatur Tess almost immediately managed to get on top of an air duct in the basement. Tess for some reason became extremely affectionate when we moved. Mostly she fell in love with Nick and wanted to be on his lap all the time but she also liked to hang out with me after I worked out and bite my hair. She also started peeing on our couch. Often. We had a protocol where when covered it with pee pads and boxes so she couldn’t get on it. In July 2016 I took her to the vet and was told she was in stage 2/3 of kidney disease. In about 2009 our old vet had said she was in the extremely early stages of kidney disease. Tess started eating prescription CKD food. In October of 2016 Tess couldn’t walk straight one morning. We rushed her to the emergency vet and found out she had suffered what we and her vets assume was a stroke brought on from high blood pressure resulting from hyperthyroidism that resulted from CKD. We thought it was the end but Tess pulled through and for the first time in her life started eating wet food. We bought a rug for the hallway to help her get traction when she walked Then she declined again. She lost weight, wouldn’t eat. Again, I thought this was the end. I took her to the vet and she almost immediately diagnosed her as being full of poop. Just really constipated from dehydration. She got subcutaneous fluids and miralax and bounced back. We started giving her fluids a few times a week. I spent hours researching CKD. Tess got a UTI. Took her to the vet and got antibiotics and she got better. She had another blood test and her kidney values were down so she got more fluids more often. We called her Toose or Toose Boose. So we called her fluids Toose juice. In early December she had another stroke. We took her to the vet and found out she was not able to process the amount of fluids her kidneys needed. She had fluid built up around her lungs and heart. The fluid around her lungs was drained. Again, we thought this was the end. We took her home and within days she was better. The vet was surprised and pleased at how well she was doing. We went to Charleston for Christmas and Tess started a bedtime ritual of rubbing her face all over Nick’s face, licking his lips, sniffing and licking his eyes and ears. By now she was taking felimazole for her thyroid, amlodipine for blood pressure, cerenia for nausea, mirtazipine for appetite stimulation, fluids every day, furosemide to keep fluid from building up, B12 subcutaneously every other week, and aluminum hydroxide phosphorous binder. I counted and recorded her resting respiration rate every day to monitor any fluid build up around her lungs. She was eating prescription food with the lowest phosphorus level possible. I downloaded an app to keep up with all her medications. Tess was doing well, all things considering. She would go to Nick’s room almost every night for his ‘eye exam’. If he tried to close his eyes she would sometimes try to pry them open with a paw. Afterwards she would come to my room to sleep on her heating pad. I put Penny’s food container and a chair close to my bed so she would have something to jump up on. Nick used a small amp by his bed. We called them “Toose Boosts” A little over a week ago Tess started eating less. I took her in for her monthly blood, urine and blood pressure test and our vet recommended I give her the appetite stimulant every day instead of every other day. We had to come back in a few days to check her blood pressure because it was extremely high the first time. On second check it was fine. Her blood work and urine results were not good though. Her phosphorous levels and other kidney value had taken a nose dive. there was blood in her urine. She was now in stage 4 of CKD. We increased her phosphorous binder and fluids and decreased her furosemide and started antibiotics in case she had another UTI. Tess’s lack of appetite was due to nausea from too much stomach acid as a result of the high phosphorous level Tess went from eating a little bit less to eating only her food in the morning and a little at night to eating only food in the morning to eating only pill pockets. She didn’t want to leave her heating pad and hang out with us. I did more reading about CKD and sent about 8 emails to our vet that she patiently answered I tried giving her different wet foods and sprinkling treats on her food and she would just smack her lips (a sign of nausea) and turn away. I had to start syringe feeding her because she wouldn’t eat anything more than a few licks of food on her own. She was down from 5 lbs 2 oz to 4 lbs 8oz. I know because I bought a baby scale on eBay months ago to keep an eye on her weight I called the vet and got extra smelly urgent care prescription food. She ate a little on her own and then snubbed it. I syringe fed her four times a day. The phosphorus binder should have decreased her levels by now but it didn’t. She gained a little weight but it was only because I was force feeding her Tess stopped eating pill pockets. I got Pepcid and ground it up with her other pills and mixed them with food in the syringe Tess would eat a little bit right after she got her anti nausea medicine and she would eat her dehydrated chicken treats sometimes. The appetite stimulant and anti-nausea and anti acid couldnt compete with her CKD though. This all happened in about a week. Tess didn’t want to be held or snuggle with us. I would try to bring her into the living room to be with us and she would go back to her little corner in the bedroom the first chance she got She slept on her heating pad in a position that didn’t even look comfortable and only got up to drink massive amounts of water and pee. She walked hunched up, her back legs barely supporting her and slipping as she walked. She had to stop and take a break in the hallway on her way from the water dish to her bed. Nick and I spent a lot of time laying on the floor telling her how much we loved her and what a good kitty she was. I rubbed my face on her face. Sometimes she would seem content I did a lot of reading about end stage renal disease and Tess basically fit the bill. I read about how she could pass away peacefully in her sleep. I read about she could drown from fluid build up, develop fatty liver from not enough food, she could have another stroke. She could die alone and in pain. Every time I checked on her I looked for the rise and fall of her breathing. Nick and I had the conversation we had been dreading. At almost 20 years old Tess no longer had any quality of life. She loved being with us and eating and she was no longer able to do that. Our vet told us that if she was going to improve she would have improved already. As poorly as she was doing now she would only continue to get worse. I could go on syringe feeding her and she could hang on for another week but that would be for us not her. We couldn’t stand the thought of her being in pain or not being with her when she passed. Yesterday, April 1, Tess felt well enough to eat some treats and we took her outside and she lay in the sun and sniffed things and rubbed her cheeks on them. When I would try to pet her she moved away from me. At 1.30 we took her to the vet’s office. We kissed her little face and told her we loved her and she went to kitty heaven. It was awful. It was heartbreaking and terrible but she wasn’t in any pain and she was with the two people that love her the most. She lived a long long life and we spoiled her. She lived like a little queen. We got home and I started to make us some scrambled eggs because we were both exhausted and hungry. I put a pat of butter in the hot pan and started whisking the eggs. When I turned back the pan the butter had melted in to the shape of a cat. Tess loved licking anything greasy off our plates so Nick and I took that as a sign from her. I meant to type out something brief for Facebook about how sweet and funny Tess was and how much I loved her but this turned into a complete history of Tess. I guess I needed to write it down to appreciate how much she had been through both in her entire life and medically in the last 6 months. I needed to remember how hard she fought and how much we did for her. I needed to reassure myself that we did the right thing letting her go before her health got really bad. Tess was tough, brave cat. Tess definitely frustrated me sometimes by peeing on everything i held dear but looking back that seems so unimportant. Every time someone new met Tess they thought she was kitten becuse of how small she was. Vet techs always fawned over her and gushed about how pretty she was. Her eyes were so big we joked she was half owl. Her breath was really astoundingly awful but Nick never stopped her from sniffing his entire face and head. The markings by her nose gave her almost constant bitchy resting face even though her personality was the opposite of that. We made up endless songs, nicknames and personal jokes about her. Toose. Toose Boose. Toosica Boosica. Tiny Toose. Tiny Tess. Tiny Tess Toast. Toose Boose drinks juice while riding a moose. It goes on and on. The voice we made her “speak” in sounds like a sassy Latina for some reason. We could not have loved her more and we miss her like crazy. Almost 20 years is a long time to have a pet but it still doesn’t seem long enough.

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kfeltz · 8 years

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Kelsi Answers Your Questions

Why can’t health insurance incentivize a healthy lifestyle just like auto insurance promotes good driving by giving safe drivers much lower premiums? People have no insurance-based incentive to maintain a healthy weight and exercise in this country. It seems so common sense to have doctors “sign off” for health-minded individuals when they have their yearly physicals ( in both private and public health arenas) and these folks get discounted premiums. So tired of seeing America get fatter and fatter and sicker and sicker… can we learn anything from the auto insurance industry???

You raise some good points. Here are some of my thoughts:

Obesity is still a somewhat recent development. I don’t think we’ve fully understood what the drivers are and how to curb it.

Would a financial penalty even work to help curb obesity OR is it less of a tool to do so and more of a punitive measure? If the latter, then why/should we penalize people for being obese?

Americans are really resistant to the idea that the government/business, etc. should dictate how they ought to live. Take the example of soda taxes.

It’s a really slippery slope from penalizing for obesity to penalizing for preexisting conditions. Arguments from a different side of the same coin:

Obesity is multi-factorial and may stem from factors which people have limited personal control over. How would you design an insurance policy that penalizes obese individuals? Would it be by BMI? Weight?

What if I have a thyroid condition that causes me to retain weight?

What if I have juvenile or pregnancy-induced diabetes?

What if my family is obese? How do you account for genetics?

Americans have highly differential access to a healthy lifestyle. What does it take to be healthy? Do you have access to those elements? Do you know HOW to access those elements? If the answer to those questions is no, then should you still be penalized?

Now, contrary to what you say above, I think there’s definitely an incentive to avoid obesity. Being obese is uncomfortable both from a public stigma standpoint and from complications of daily life (e.g., flying in an airplane, climbing stairs, physical appearance, shopping for clothing, etc.). It’s hard to appreciate just how difficult daily life is for someone who is extremely or even mildly obese. I don’t think you can dispute though that they face challenges which incentivize them to lose weight; I mean just look at the huge industry we have around weight loss.

In terms of insurance, I’d still argue there’s some incentive there.

Obese individuals often face related health concerns, like diabetes and/or high blood pressure/cholesterol, whose treatment raises additional costs. That’s a huge financial incentive to lose weight.

Many insurance companies and/or employers offer some kind of wellness plan which provides incentives for healthy lifestyle choices. Again another financial incentive. Bad news, the evidence says they’re not working to bring down costs. I’m not sure how the evidence is re: health outcomes.

So, we’ve largely created policies on the ‘carrot’ rather than the ‘stick’ side.

Next up, can you avoid auto accidents / speeding with minor difficulty and limited reduction of benefit? I’d argue that’s a BIG YEP. Can you do the same for obesity? BIG HECK NOPE. Losing weight is HARD. Health is more than just clinical or physical health, it’s social and mental well-being (e.g., social determinants of health). Think about all that goes into maintaining a healthy lifestyle:

When do I exercise? When do I eat / prepare my meals?

How do I exercise? How do I eat / prepare my meals?

Where do I exercise? Where do I eat / prepare my meals?

What do I need to exercise? What do I need to eat / prepare my meals?

Take me for example: I’m a 25 y/o female living in DC. I work a sedentary office job with somewhat flexible albeit long hours. My commute to and from work can be anywhere from 30 minutes to an hour. My office has a gym (but 4 of the 6 treadmills are broke and the other two are always taken and it’s cold… excuse my tangent). I live in a city with good access to public transportation, good infrastructure (sidewalks, bike paths, parks), and neighborhood markets with healthy food options. I have an advanced degree in a health field and generally have the right knowledge to make healthy choices. I have insurance and the financial means with which I can purchase food and cooking and exercise equipment. I don’t have any chronic health needs at present but my family history isn’t great. I was raised in a household with somewhat limited exposure to new foods and until college, was pretty picky. My stress and mental health is generally pretty stable / good. I LOVE sweets… and bread.

Some of those characteristics make it easier and some make it harder to live a healthy lifestyle.

All this being said, can we learn something from the auto industry? Of course. Is this something we could investigate further? Yep. I don’t disagree per se but I think we need to have a more complete picture of this situation when considering a solution like this.

Soda taxes (a penalty on an unhealthy lifestyle CHOICE not health OUTCOME) are working! And there’s more to be done -- how can we incentivize health life choices and de-incentivize unhealthy life choices that lead to obesity? Basically what I’m thinking is maybe we can just shift some of the carrots and sticks around. More upstream. This article shows how using a combined approach can be successful.

BUT you’re right. You’re absolutely right. Healthy individuals bear some of the cost imposed by obese individuals in the insurance market (sourced in 2005 admittedly so there’s probably better sources out there / could have changed). Society is premised on that social contract - either we ban together to prevent the bad or we ban together to grow the good. Sometimes we (individually) suffer for the whole. And yeah, it can be frustrating. I just think we don’t yet know enough to fix it and we need to do some test runs / background research before we go ‘whole hog’ so-to-speak. Maybe some small-scale trials?

I wanted to stick to the can’ts because that was your question. But in reality. We can. And we kind of have before in the form of insurance rate setting for pre-existing conditions. Obesity as a preexisting condition is just a bit more tricky to define since so much goes into its causation.

We need to do more to understand obesity and what works/doesn’t work to curb it and we can only do that with research and innovation (hint hint not by decreasing funding to the NIH or by capping the abilities of the Agency for Healthcare Research and Quality or the Center for Medicare and Medicaid Innovation).

I wrote most of this based on opinion vs. facts I found. So I’ll throw out my DISCLAIMER: This information is largely based on personal opinion / there may be mistakes / differences of opinion. You should do your own research before acting on any information above.

One last thought that just came to me, insurance only matters if you use it--that is to say, insurance companies LOVE people who stay out of the doctor’s office yet continue to send them premium $$$ to enrich their bottom line. That’s usually healthy people. But just because someone is obese it doesn’t necessarily mean they’re more likely to use insurance (i.e., need health care). There’s some research to back this up.

People with class 1 obesity, or those whose BMI is greater than 30 but less than 35, pretty much have no elevated health care costs. When we say lots of people in the US are obese or overweight, many of them still have BMIs less than 35.

The paper further reports that a person who has a starting BMI of 40, and can lose 5% of their weight, might expect to see reductions in health care costs of $2137. But only about 6% of adults have a BMI that high. Losing 5% of weight if you have a starting BMI of 35 would save you $528. Losing that weight if you’re starting with a BMI of 30 would save you $69.

The article goes on to explain the role that diabetes plays in all this. Whereas in auto insurance, if you get into an accident, you’re definitely incurring costs from the get go. So the comparison just isn’t that easy. Risky drivers carry higher costs; obese people don’t necessarily until they hit that high level of obesity OR until they also present with obesity-related chronic conditions like diabetes.

Link to an analysis of myths and facts on obesity

The Obesity Epidemic — Understanding the Disease and the Treatment

(I’m sure there’s more and better research out there but I’ll leave that to you and the experts ;) )

#healthpolicy

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