Saturday, April 18, 2015

What do the Ovaries Mean to a Man? Uhhhhmmm....

by Margaret Aranda, MD, Ph.D.

Men don't usually think of a woman's ovaries too often, unless there is a reason to, such as when their wife of 30 years develops ovarian cancer. Otherwise, the ovaries secrete eggs once a month, and when not impregnated by a sperm, the uterine lining sheds, causing the menstrual period.

Of course it's not all that easy, because a woman's ovaries secrete estrogen, progesterone, and testosterone in different amounts, at different times through the ovarian cycle, so well, Uhhhhmmm... there is the explanation you've been waiting for, regarding her cycles, her period, her Pre-menstrual Syndrome (PMS), Post-Traumatic Stress Disorder (PTSD), irritability, sadness, as well as physical cramping and torture that may lead some to consider suicide.

The women that have virtually no symptoms of belly ache or headache or migraines? We go on, then we go off, and WaLa! No big deal (but don't tell those other women, because they will hate us).

So there are a few things every man should know about his woman's ovaries:

1. She is born with two; one on each side of the uterus. I have detailed this out for you, including hormone production of the hormones, quite thoroughly: Ovaries For Babies

2. After menopause, the ovaries can still work for up to 15 years in some women, so don't let her just rush out to the nearest drive-through Hysterectomy Site and get her uterus out (and what about the ovaries?). With heart disease being the #1 cause of death in women, Uhhhhmmm....we have a choice....a) take a 1:70 chance of getting ovarian cancer, or 2) keep up the monitoring for uterine cancer with a simple blood test called a CA-125. Many have argued: Men get their PSA tested, so why shouldn't women get their CA-125 tested? When I was in medical school, ovarian cancer was a death sentence. Today, things are better although mortality is still considerable. So at some point, men, your wife has to decide and/or some doctor is going to insist that she get a hysterectomy (uterus out) plus oopherectomy (ovaries out, too), and you can't just stare into the wall.

3. For hysterectomy, considerations of whether or not the ovaries should be taken out are spelled out for you roughly here, here, but don't be deceived. There are charges that the whole thing is a racket, and it is a fact that women are dying earlier than they ever have, while men are living longer. Could that be the effect of ovary removal? So yes, many women have 'ok' experiences with their hysterectomy and oophorectomy that it hardly phases them. In fact, some ladies at the office brag about it until every single woman has had one. Guess what? There won't be any grandchildren for you, and you will spend some nights crying. Because you should have been more involved. But now you are being proactive, right? So let's get prepared and realize that not all women have a good outcome.

4. The rest of the women wish they were never born, practically. They suffer severe depression, womb emptiness, and constantly cry. So men, learn about this stuff. Take some time off work to delve into it as if it was your most important "job project" that could make your life either a living hell or a blissful heaven. Because unless you do so, this author thinks you are sitting in the back seat reading the newspaper while your wife is about to morph into another being, and you don't give a crap.

5. So get up and read. Go to her appointments. Act like you're interested. Because who is going to wipe your butt when you get old? Do You have a Long-Term Care Policy in place? Geez. You have a lot of work to do, but just take baby steps, one at a time.

Archives of the Vagina: A Journey through Time
by Dr. Margaret Aranda
ISBN: 978-1-62854-116-8    

Friday, April 17, 2015

What Happens When a Physician Turns into a Patient?

by Margaret Aranda, MD, PhD.

Written from hospital bed to hospital bed as I learned how to read and write again, speak and process brain information. Traumatic brain injury (TBI) is sometimes followed by a more rare condition, diabetes insipidus (DI) that has nothing to do with blood sugar. 

DI occurs because the posterior pituitary gland, that hangs from the brain like a dangling apple, gets smashed on its back, onto the skull. A hormone (i.e. DDAVP, or vasopressin, or anti-diuretic hormone) gets "knocked out," so a 'higher' hormone completely loses communication with it. 

What happens next is that this 'higher' hormone, located in the hypothalamus of the brain, speaks and speaks and speaks and speaks and speaks to the pituitary gland (not knowing it is "broken" or "severed")...and the body pees itself to death. Because the pituitary gland is missing "anti-diuretic" hormone, there is nothing any more to tell the hypothalamus "We're in the desert. Stop Peeing!" 

So most people with TBI die of DI via dehydration and kidney failure, perhaps mostly in their sleep. They are thirsty, thirsty, thirsty, yet keep peeing, peeing, peeing. They don't know that they can NEVER catch up in the drinking. I have had it twice now, and it is no fun. Titrating salt and water, water weight and Na levels ~ That's because the DDAVP is gone. Treatment? DDAVP or vasopressin, or Anti-diuretic hormone. No one wants to be on this drug regimen to "fake" an illness, as I was accused of doing. The unneeded drug will kill a person. Anyway, that's your pathophysiology lesson for today. 

Pituitary gland representation.PNG
Pituitary gland. Posterior pituitary is in blue. Pars nervosa and infundibular stalk are not labeled, but pars nervosa is at bottom and infundibular stalk is at top.)
Image 1. The Posterior Pituitary Gland.  It receives signals from the hypothalamus, to determine total body water (TBW) an prevent either hyponatremia or hypernatremia (both lead to death; the first by turning into a water balloon and having water toxicity; the second leads to death by kidney failure). Resource: Wikipedia

That is just one bit of the scientific, historic, humanistic, philosophical aspects which this book covers. If you or a loved one have suffered a TBI or ANY chronic illness due to accident or misadventure (i.e., Lyme's disease), then this book is for you AND your family AND your doctor AND the caregivers. No one else can "tell it like it is" the way that someone who has "been through it" has. And I have.

Dedication: Even if life is difficult, I learned at an early age that one has some control over one's destiny. Thank you, Dad, for teaching me from a young age that I can strive to achieve and never give up. 
   This book is dedicated to Dr. David S. Cannom and Los Angeles Cardiology Associates, which he founded in 1985. It is also dedicated to Keck School of Medicine at USC, Dean Tranquata, Good Samaritan Hospital of Los Angeles, and their cardiology department with Dr. Cannom. 
   I appreciate all the efforts turing the Tilt Table Test as wee as the special care you gave me on the cardiology floor. (Being the only patient without gray hair was iconic) Thank you for all your nursing, administrative, and physician efforts on my behalf. It is a great pleasure to donate a portion of the proceeds of this book to Good Samaritan's Campaign for Cardiology.
   Had it not been for Stanford's University of School of Medicine and the departments of anesthesiology and critical care, I never would have learned how to argue my own medical cases using concepts such as orthostatic hypotension, mean arterial pressure, orthostatics, ataxia, and the relevance of ataxia on the vertebral artery for balance. That little thing called, "balance" that we use when we get up to walk? Most of you take it for granted. We stand up and faint, as the blood pools in our legs and leaves our heads. For this reason, I give with great pleasure some proceeds of this book to Ronald G. Pearl, MD, Ph.D., Chairperson of the Anesthesiology and Pain Management Department, to put it towards his chosen effort. 

No More Tears: A Physician Turned Patient Inspires Recovery
A Place with "No More Tears"
Introduction to My Life
The Accident
Picking Garlic and Doctor Shopping
Before the Accident
Dysautonomia and Living with 'Brittle Dysautonomia'
Fifty Ways to Fall Out of Bed
The Gift of Prophecy
Prophecy during this Writing
Declined Memory
Traumatic Brain Injury (TBI)
News for the Family, Especially the Significant Other
All Men are Not Dogs
The Disabled: News for both Old and New Friends
The Status of the Disabled in My World

Chapters continue on a second blog, yet to come. 
The "Forward", written by Dr. S Cannom himself, will be included.

Sunday, April 12, 2015

What Your Woman in Menopause is Going Through

 by Margaret Aranda, MD, Ph.D.

What are some important things that every husband should know about menopause and how it affects a woman? (Hint: it has to do with how a man is affected) Well, I think the most important thing is that it can cause vaginal dryness, which leads to pain on intercourse. Some women complain that having sex feels 'like a knife stabbing me'. Really. It HURTS, and that's no fun for either partner. And there are other issues, too. Besides the frustration, humiliation, and resentment, and rage that festers. This is discussed in more length in my newest book, out NOW and available on Men, want to stop feeling like you work, take pre-teens driving as a carpool, pay for this and that, and your wife is sweating so much that she has to sleep on another bed? In another room? 

Menopause = 1) male manopause, after prostatectomy  +/- irradiation/chemotherapy/orchiectomy; 2) female menopause, after hysterectomy with uterus and ovaries removed (that's a whole different story); and 3) oophorectomy (ovaries removed due to ovarian cancer).

I have noticed, for example, that a postmenopausal woman can be talking to me at night, and indeed let's make that a ~ cool ~ night with a breeze.  Her upper lip and forehead are covered with sweat.  In fact, her upper eyebrows and neck glisten in the moonlight.  I innocently ask (during our conversation on menopause), "Do you get hot flashes?"

She says, "No, I never get hot flashes."

So I ask, "Do you have pain with intercourse?"  Well, no big response there.  I persist, "Do you enjoy sex?"  She scoffs, "I could take it or leave it." She practically explodes at me!" " I just have sex to make my husband happy, but if it was up to me, I wouldn't even have sex.  And I would not miss it."  She smiles ever so gently. "Ugh!"

So I back up again, "Well, why don't you enjoy it?"  
She thinks.  
She hesitates.  
I wait, patiently.  
"Well, I guess that it just doesn't feel good."  

Results are in from Menopause, The Blog, which you can Click Here to Read.  While millions of women in the USA may have vaginal atrophy from a decrease of estrogen production after menopause, only about an estimated 7% are getting treatment!  This is simply astounding to me!  If you are a husband and your wife is complaining that having sex hurts during menopause, then this affects you as a man.

Studies show that a woman is reluctant to discuss the situation with her doctor, and doctors are reluctant to discuss it with their patients. So what is a man to do?

Firstly, we are reminded once again that with education comes empowerment. Now that you know that your wife could be having this problem, it may be good to talk to her about it. It could be that a woman does not realize that she has vaginal dryness.  The change could have happened so gradually over the perimenopausal years, that she does not realize that she actually has pain on intercourse, or dyspareunia.   So let's just step back a moment and realize that vaginal dryness, vaginal atrophy, and pain on intercourse ~ all these things can happen.  It's ok.  It can happen overnight from surgery, or it can happen over 15 years of natural menopause, naturally, as the ovaries are still secreting hormones. This is when the woman is most likely to be unaware that she is even IN menopause!

Men and Women just need to realize, like the perspiring woman who says she does not get hot flashes, that a woman's body continues to change with time. Men need to continue to be attuned to their woman's body.  Why?  Because menopause can riddle a woman's life with insomnia, restlessness, agitation, depression, hot flashes by day, sweats by night, pain on intercourse, vaginal dryness, dry skin, and general irritability. To name a few. And does that affect a man's sex life? Uhh.

Women can spend fully one-third of their lives in menopause.  
That's a long time to suffer unnecessarily. 
I know it affects you, because it has to affect you.
So we'd better get 'good' at being IN menopause, yes?  
Let's do!

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