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I’m challenged to write something blog-worthy. They say write what you know so here we go. An odd not-your-everyday-type of thing happened to me the other day. Coming out of a sparsely populated Starbucks with my grande coffee topped with whipped cream in hand, I looked up and there was Harrison Ford looking at me saying, ‘Hi’. I said ‘Hi’ back and walked on by. I had no idea how to handle this situation as I did not take ‘Running Into Giant Movie Stars 101′ in college. I figured he didn’t want to be bothered so off I went. Of course I texted, Facebooked and Twittered everyone that Harrison Ford just said ‘Hi’ to meeeeee!

A couple days later I thought maybe I had made a mistake and it was someone that just looked like him. So I googled his name and found out sure enough he is making a movie here in our city.

Now, here is what I think may be blog-worthy: I am amused by where my head conversations have taken me, “Dang, I should have said something like, Welcome to our city; How are ya?; Whatz up?; Dude what are you doing here?; Do you like being a movie star?” …or maybe inviting him and Calista over for dinner. Let’s see, what should I make?A barbeque! Can’t go wrong with hamburgers!…you get the idea. I play it over and over in my head. Reliving the moment our eyes locked and he gave me a “Hi” with that crooked little smile.

OK enough of that. Here’s what I’m pondering, what is it about most of us common folk that has an intense desire to be seen, recognized and noticed by someone who is seen, recognized and noticed? It happens all the time with the fanatic seekers of autographs fueled by the millions of sales in movie star magazines with the latest forbidden photo snapped by the paparazzi. Don’t tell me that if you ran into Harrison Ford today and he gave you that crooked smile that you would not be agog and either left speechless or embarrass yourself by saying one of the head-verbages mentioned above.

They’re just people like you and me with very unique jobs that make them incredibly rich and famous. Other than that, like you and me…

I have no answers for my pondering’s and this is not the first time I have run into a mega movie star and had it flip me around affording amusing introspection.  So, what would you do? Do you have a plan? Cause you just never know, Harrison Ford may be your next best friend!

Jan Menopause

It seems that by now I would have learned how to deal with difficult people. Annoyances such as complaining, judgments, criticisms, gossip, unsolicited opinions and advice given more out of manipulation and control than care and concern are just some of the ‘jeepers’ that make me ‘creepers’!

Today a comment was thrust upon me that sent me into a rather unattractive altered state. I was beyond peeved and before I gave a response, I called a friend who reminded me to not do anything while I’m angry. Well I’m cooled down but still bugged and need to scratch the itch…hence this blog.

I have read numerous self-help books on how to express anger, how to avoid co-depency and how to be an emotionally balanced person, etc.  They worked great while I was reading them but putting the concepts and ideas into action? Baffling.  I so admire others who can graciously handle difficult situations with an, “I understand you feel that way, but I feel…” or “I so appreciate your opinion and I would like to share mine if that is alright with you…”. Um, just not in the realm of my personal word formations.

Rarely do my annoyingly provoked verbal responses take flight, rather they flap around in my head until I’m dang near peckered out. A very wise king once wrote, “A gentle answer turns away wrath” and I have also heard it said that the negatives we perceive in others are merely a reflection of our own personal character defects. If this be the truth, then I believe perhaps the ‘gentle answer’ might need to be to offered to myself first.

Maybe then I would have a source of grace to draw from. Don’t know for sure. Sounds good. I do feel better. Now I gotta make the call.

Jan Musings Relationships

Let’s go back to delivery methods.  We have these different kinds of hormones: semi-synthetic, synthetic, bioidentical, (bioidentical from a pharmaceutical company, or bioidentical from a compounding pharmacy.) That is one little clarification we should articulate again here because those are both the same and different.  Pharmaceutical companies have a few select bioidentical hormones. There is Estradiol by itself, it comes either generic or Estrace in a pill, or we have the estrogen-only patches which are actually bioidentical estradiol. Vivelle and Climara and Menostar are examples of those.  And then we have a bioidentical cream called Estrace cream.  Those are all actually made by pharmaceutical companies.  But the pharmaceutical companies only make available a small handful of doses and very select methods of delivery.  Also with the pharmaceutical company comes their patented preservative, or binder, or filler or adhesive, because, you can not actually patent the bio-identical hormone itself.  So you have to patent something special that you do to that hormone.  We are left with the limitations of the pharmaceutical company bioidentical hormones in dosing, combinations delivery methods.

Now, at our clinic, and what most people who are really accustomed to prescribing bioidentical hormones do, is they use specialty compounding pharmacies.  Because now, we can prescribe all customized and individual doses.  Maybe you don’t need just the .5, or the 1 or the 2 milligram that the pharmaceutical company makes.  We think you would do just as well with .25 or we need to tweak it a little bit and give you .35.  So, we can customize your dose and titrate the dose up or down.  We can also customize a combination.  No pharmaceutical company yet makes a combination of bioidentical estradiol with bioidentical progesterone.  They also don’t make a combination bio-identical estrogen/progesterone formula that has the testosterone in it.  So we can now individually prepare a formulation that has not only the bioidentical hormones but the select interim specific doses that we want, and in specialty combinations. And we can use other hormones that we are interested in like estriol or DHEA that have their own added benefits.  In addition, we can do this in pills, in capsules, in sublingual lozenges, in sublingual drops, in creams, in gels, in vaginal, in topical deliveries.  We have so many more variability’s and circumstances and ways that we can help women by utilizing these compounding pharmacies than by just sticking with what the pharmaceutical companies provide.  But they are, in fact, the same hormones, if we are talking about bioidentical hormones, the commercial pharmaceutical products and the compounded products have the same benefits and the same risks.  It’s just that we have a lot more flexibility, a lot more individualization, a lot more circumstances that we can help with these compounding of specialty formulations.

Dr. Tori Hudson         For excellent HRT information go to:     http://drtorihudson.com/

Jan Menopause

As I sit here just a stones throw past my mid-life mark, I once again make a courageous attempt to figure out how I managed to get here so quickly, where the past 40 years went and why it feels like I have lived today too many times before. Heady stuff for first thing in the morning.

Sipping my Starbucks ‘Tall Coffee In A Grande Cup Packed To The Top With Whipped Cream’ (you must try it, it’s fabulous), the sun peeps out and gives a wink before darting back into it’s dismal hiding place. But no matter, my beverage of choice puts a smile on my face and for the moment I am content.

The music blares above me as caffeine-craved people come and caffeine-saturated people go and I can’t help but turn my attention to the conversations around me, as for some reason people at coffee shops tend to talk in voices intended to command attention at something like a rodeo.

“It was like my mother shot herself in the foot”…”I think slinking from you is the hardest to do”…”I could eat a hundred of these, they’re so moist but have a bit of chew”…”Set the thing upright, I’m telling you, you gotta set it upright or it won’t work out”…’We all have our own stuff and I don’t know. I just don’t know”… “They have to fill out their paper work and get fingerprinted”…”I know myself well enough and there’s a reason, I swear there’s a reason”…

There was one more that I couldn’t quite make out but sounded like, “No, no, no, it was dripping from the cracker barrel”…?

A cacophony of voices planning their day, reporting on their lives, connecting with another life. I am amused because as I am basking in my caffeine glow it all sounds to me like a song that Paul Simon might have wrote.  I think it coulda been a big hit.

Taking in my surroundings, I step away from my weighty ponderings and feel refreshed. You see, I’ve been swimming a little bit too much in the Mid-life-Menopause Regret & Remorse Pond lately. Reflection is good. I just need to remember to season it with acceptance and gratitude because if I meander down the path of shame for my life’s missteps, my perceptions cloud and that Pond turns to quicksand.

So here’s to a cup of joe, this marvelous mid-life,  a hearty conversation topped off with a dash of gratitude.

Jan Menopause, Mid Life Madness, Musings

Transcript from the DVD “Blitzed by Menopause”:

Many of you are wondering about hormone replacement therapy and have all kinds of questions. I can really appreciate that because there really are lots of questions to ask and lots of questions to be answered.  We want to try to address all of the different kinds of hormones that are available, the different dosing issues, combinations of hormones, delivery methods of hormones, and some pros and cons and benefits and risks of hormones.  That is kind of the territory at which I think most all the questions lie.

So lets start first with all of the different kinds of hormones.  And by the way, we are talking about hormones here, we are not talking about herbs that have constituents called phytoestrogens.  We are talking about hormones, and there are hormones of all kinds.  Some are made from a natural substance and some are made from a natural substance and then turned into various kinds of hormones, and some are semi-synthetic or synthetic.

Let’s start with hormones that are made from a natural substance.  Starting with even Premarin, the kind of hormone or estrogen that has been around for the very longest amount of time.  It’s called Premarin.  It’s actually made from a “gamoosh” you might say of hormones found in the urine of pregnant mares.  And that is why they call it Premarin. Pre-Mare-In.  Pregnant Mare’s Urine.  So, these are technically a natural substance, but they aren’t identical to the human hormones, so therefore we call them semi-synthetic really.

There are also hormones that are made from a natural substance and in these cases, plants.  They extract two different ingredients out of either Mexican wild yam or soybeans.  And then they turn that substance in a manufacturing laboratory, into a hormone.  Now, we can turn that into a hormone that is not chemically identical to the human hormones, or we can turn those constituents into a hormone that is identical to the human hormones. And those hormones are ones that often receive a lot of press and attention often, and are called bioidentical hormones. A bioidentical hormone is a hormone that is derived from a plant constituent, but turned into a hormone that is biochemically identical to the woman’s hormones.  Thus, bioidentical, or biochemically identical.

But you can also take these same constituents out of a plant and turn them into a hormone that is not biochemically identical.  And many pharmaceutical options are these kinds of hormones.  And again, I kind of call those more quasi-synthetic.  So, so far we have the Premarin which is from the estrogens in pregnant mares’ urine, not biochemically identical.  We have bioidentical, plant derived, chemically identical to human hormones.  And we have plant derived that are not chemically identical to human hormones.  And then we have just bona fide synthetics that are also made by pharmaceutical companies.  Those are essentially kind of the four different categories of the different kinds of hormones that are available to women.  And some of those are actually available to men as well.  Testosterone, for example.  We have a bioidentical testosterone and we have a synthetic testosterone.  And the bioidentical testosterone available to women is currently only available from a compounding pharmacy.

For example, we can prescribe testosterone to women and to men.  It’s just that there’s not a bioidentical testosterone product available to women and there’s not even a synthetic testosterone prescription available to women as a stand alone prescription.  The pharmaceutical companies have not been allowed to produce a testosterone-only product for women yet.  They have been allowed to produce that for men.  So for women, when we want to prescribe testosterone, we have to go to a compounding pharmacy. And we can prescribe either the bioidentical testosterone or the methyltestosterone.  And we prescribe those in pills or in creams.  Testosterone is an important hormone when it comes to sexual function.  We use a bioidentical testosterone cream from a compounding pharmacy, which is a specialty pharmacy, and we put that in a cream, according to a certain dose, and it is applied to the external genital area right before sex to enhance arousal and orgasm.  We can also put this bioidentical testosterone or synthetic testosterone into a specially prepared compounded combination of hormones: estrogens, progesterone, and testosterone, for addressing sexual function as well as other menopause symptoms.  When we want to prescribe testosterone to a woman, we have to currently use a compounding pharmacy with one exception: there is a synthetic estrogen with a synthetic testosterone called Estratest, made by a pharmaceutical company.

Part II coming soon…

Jan Menopause

Often women ask me the question is, “How long is this going to last, Dr. Hudson?” and “When is this going to end Dr. Hudson?” and I wish I could answer that question. “It’s only going to last this amount of time”, but the truth is I can not discern this.  It’s unpredictable.  It’s different for all of us.  The severity is different for each of us, the duration is different for each of us, which symptoms we have on this long list of potential symptoms is different for each of us.

But, on an average, according to the research, menopause symptoms for seventy five to ninety percent of women last four to seven years.  Now, there’s the ten to twenty five percent of women for whom that’s different.  And we don’t know if at year three, at year four or at year seven if you are going to be on your way out of these symptoms or are you going to be one of these ten to twenty five percent that is going to last longer.  There is no way to really know that.

We are trying to get some understanding.  If you’ve had severe PMS, it seems to have some prediction on menopause being more severe.  That’s one thing we seem to see a correlation with now.  But unfortunately, we can’t really predict what your menopause is going to be like, let alone, can we predict how long it’s going to last.  But we can work with the law of averages and try to give some reassurance. And most symptoms are temporary in most women.

The problem is there’s the women that are not “most women” and the problem is that there are a few symptoms that tend to be progressive, like vaginal dryness, vaginal thinning, urinary incontinence, that set of symptoms tends to get worse with time because that tissue gets more consequences as it is deprived of estrogen for a longer period of time.  But most other things, symptoms, not bone loss, not some of those things, but symptoms, most of those are temporary in most women.

So far we don’t have any strong connections as to what your mother’s menopause was like in telling us what our menopause is going to be like.  And also, a lot of forty, fifty something year old women now who are just going through this key menopause time have mothers that in their generation, many health problems were solved by removing the uterus and the ovaries.  We have more progressive surgeries now, many more medical options, so the doctors and patients don’t have to choose that as often.  But, for some of us, we don’t know what our mother’s menopause would have been like anyway because she went through it in a rather unnatural fashion by having suddenly her ovaries removed.  And of course hormones were prescribed more easily, less judiciously, you might say, back in those days as well.  It’s more selective now, more weighing the benefits and the risk and more desire on the part of the practitioner to use hormones for the shorter amount of time mostly in this sort of temporary window of symptoms.

For men, if your partner is going through menopause, you might wonder what you can do to be helpful.  And the first thing I think to maybe look at it in terms of your previous experience with your partner is, have you already been through years or months or decades of PMS? And how that has been going and what that has asked of you.  It’s similar.

You know I think many men can find it very difficult and challenging to have empathy and really understand what is going on with their partner during this time of menopause changes.  And I empathize with that.  It’s a challenge, because often you don’t know what to expect, and you don’t know if it’s you or if it’s them.  If it’s them is it some character defect or is it a health problem.  I would just really encourage men to try to learn as much as they can about menopause and I would encourage men to ask their wives and partners questions and really kind of try to bring forth your best inquisitive self.  You’re curious.  You are asking questions, you are wanting to understand.  I think that’s a useful approach because chances are, she’s not faking it.  Chances are, she’s not lying to you about what’s going on with her. Chances are she’s really needing some help.  And if she’s had a difficult time with PMS, and that’s already been challenging for the family, it’s very similar here.  The mood swings…if it’s been difficult to deal with a teenager and their hormonal changes, it’s very similar.  It requires us being more patient, it requires us being more caring, maybe even anticipating, much like you would if someone you knew didn’t feel well.  You just try to do a little TLC.  You try to do a little bit to help out here and there and even just the littlest things can make a really huge difference.  A little piece of dark chocolate under the pillow, or “can I help you with the dishes tonight”.  “It looks like you’ve had a really hard day”.  Just a little extra and I would gather that would come back in a favorable way to you.

And I know that we want things to be balanced in relationships and you don’t want to feel like you are always trying to compensate for what seems to be not going well with your partner but men have hormonal changes too and generally that comes a little bit later and looks a bit different.  But I think just this inquisitiveness, trying to learn yourself, bring forth your best questions and empathy, I think that’s what my advice would be.

Our thanks to Dr. Hudson. For more information visit us at: www.planetsweetpea.com.

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Entering Spring. Awakenings after a seemingly endless sleep.

Entering Midlife. Wishing for sleep that’s encumbered by seemingly endless awakenings.

Beholding Spring.  Air laced with lilac as budding leaves shimmer.

Beholding Midlife.  Doubt encircling dreams as the present clouds the future.

Menopause. Who the hell cares.

Menopause Rap

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1) He: “What’s some good advice for men living with menopausal women?”

She: “Say, ‘yes dear’. Always. No matter what. Forever.”

2) He: “How can we help men understand menopause?”

She: “Sit in a sauna for 8 hours. Then answer questions like, ‘What’s wrong with you?”.. and listen to well intended comments like, ‘Why don’t you just go for a walk…or… Maybe you should go for a quick workout at the gym.”

3) He: “How can we men cope with our wives menopause?”

She: “Keep an emergency kit with you at all times consisting of towels, ice packs and Snickers…that’s for you…add Butterfingers to the mix and it’s a date night”

4) He: “Some men say menopause is making their wives ‘nuts’. Any tips?”

She: “Add apples, celery, mayo and served chilled. Another date night.”

5) He: “Are there any special menopause products that would help?”

She: “See #3.”

6) He: “What should a man never say when his wife is in menopause?”

She: “We’re out of Snickers.”

6) He: “You know, I’m feeling more confused now, than I was at the beginning of this interview…”

She: “Then I have done my job well and welcome you into just one of the 35 symptoms of menopause. For more advise and info go to: www.planetsweetpea.com!

Jan Menopause

One of the things that can become disturbing for a woman or her family members is when some memory changes start to occur.  And this can be not remembering what she said, this could be not remembering what someone else said, this could be going into the kitchen and “I came in here to get something and I don’t remember what it is”, it could be not remembering the movie or the book.  And a family member can feel like “Wow, she’s just not paying attention to me anymore.  She’s just not, she just doesn’t care, she doesn’t pay attention.”  But it’s not that.  It’s really a change in memory, a change in the ability to recall.  Word recall, name recall, trying to speak in a sentence and trying to find a certain word.  Not remembering someone walking down the street and it’s kind of embarrassing, “I don’t remember her name”.  So those things can become problematic and they can become scary. Because for some women, this isn’t just a hormonal change or just a normal age related change, but it’s the beginning of  a progressive change.  And we often don’t know at this point and time, especially in the forty-something, fifty-something what it really means.  And there is really not great ability to discern “is this a terrible problem, is this a minor problem?”.  And often, the doctor needs more time to elapse to understand what is the nature of the situation here.  Alzheimer’s disease is far more common in women than it is in men.  And that’s because of this whole estrogen deal, we think, and the brain.  So it’s not surprising that women have more Alzheimer’s than do men.  And there are other things like osteoporosis which is related to menopause is more common in women than in men because it’s more estrogen mediated than it is testosterone mediated.  But, I’m getting distracted away from memory.

So one of the ways that the hormonal changes can affect our brain chemistry, it could result in anxiety, I mentioned that briefly as part of the mood changes.   But anxiety in particular might need a little bit more attention in that it can be mild, just feeling, waking up in the morning and just feeling a little “off”, a little anxious, or lying in bed at night and worrying a little bit more.  Being a little bit more anxious about going to the party or going to another social event.  But it can also become much more significant and even severe.  There are women that never had an anxiety syndrome, never had panic attacks, and now all of a sudden are in the emergency room with chest pain, heart palpitations, shortness of breath, and there is nothing wrong with their heart.  It’s a bona fide panic, anxiety attack.  And that is a part of this whole hormonal influence on our brain chemistry is worrying more, anticipatory anxiety, stressing about upcoming events.  Any way, shape or form, just feeling more anxious.  Being more sensitive too to what someone says.  You know your husband says something “did he really mean this? did he mean that?” being anxious that he’s… even paranoid.  Maybe more jealousy coming up around this anxiety syndrome can happen all mediated by these hormonal changes.

Often women ask me the question is “how long is this going to last, Dr. Hudson?” and “when is this going to end Dr. Hudson?” and I wish I could answer that question “it’s only going to last this time”, but the truth is it’s…I can not.  It’s unpredictable.  It’s different for all of us.  The severity is different for each of us, the duration is different for each of us, which symptoms we have on this long list of potential symptoms is different for each of us.  But, on an average, according to the research, menopause symptoms for seventy five to ninety percent of women last four to seven years.  Now, there’s the ten to twenty five percent of women for whom that’s different.  And we don’t know if at year three, at year four or at year seven if you are going to be on your way out of these symptoms or are you going to be one of these ten to twenty five percent that is going to last longer.  There is no way to really know that.  We are trying to get some understanding.  If you’ve had severe PMS, it seems to have some prediction on menopause being more severe.  That’s one thing we seem to see a correlation with now.  But unfortunately, we can’t really predict what your menopause is going to be like, let alone, can we predict how long it’s going to last.  But we can work with the law of averages and try to give some reassurance. And most symptoms are temporary in most women.  The problem is there’s the women that are not “most women” and the problem is that there are a few symptoms that tend to be progressive, like vaginal dryness, vaginal thinning, urinary incontinence, that set of symptoms tends to get worse with time because that tissue gets more consequences as it is deprived of estrogen for a  longer period of time.  But most other things, symptoms, not bone loss, not some of those things, but symptoms.  Most of those are temporary in most women.

Jan Menopause

Early morning as sun rises on a new day full of promise.

Foggybrain: “I lost my keys.”

Muddlehead: …”Hey those are my keys, no wait those are not my keys, whose are these?”

Foggybrain: “Dunno. Now I can’t find my wallet.”

Muddlehead: “I saw it outside in the backyard.”

Foggybrain: “What’s it doing out  there?”

Muddlehead: “Dunno but I misplaced my “to-do” list for today and for the life of me, I can’t remember where it is I’m about to go.”

Foggybrain:”Yea, but where are my keys?”

Muddlehead: “Dunno.”

Foggybrain: “I can’t find my coat. I think I left it at Bill’s.”

Muddlehead: “I’m late for work…why are you wearing my shoes??”

…Stay tuned for more conversations with Foggybrain and Muddlehead…

Jan Menopause