Laura A. Katz MD, a board-certified obgyn talks about life, women's health, motherhood and the "sensitive subjects."
Author: laurakdoc
I am a board-certified obgyn and aesthetics specialist, a mother and a wife. I have been in solo practice for over 20 years. I am also a musician and a beginner tapper. My colleagues and friends thought that I should start blogging to share my thoughts with the world. Here's to hoping that my blog will make you laugh, make you think, and sprinkle in some helpful info in between.
As you may or may not know, I have taken on a lot of stuff lately. In the last few years, I beat cancer, nursed my husband back to health after his heart attack, worked without pay, wrote some books ( buy some will ya?), became my own office manager, became my husband’s office manager, fired staff, hired staff, completely switched billing companies, expanded social media, started a lecture series, started a chemo support group…..whew. I think the list keeps going even after that. It’s a lot. I get it. Most people who foolishly ask me how’s it goin, may or may not want to actually know, but I tell them anyway! Then they get a little stunned. They wonder how I am not an overwhelmed hot mess. I tell them no, I’m actually not. I am enjoying it. Ok, that sounds crazy right? But let’s look at it this way. That is a ton of stuff for one person, I agree, but none of it is bad stuff. My uber positive spin on life right now makes me respond,” ya know, I think it’s the universe telling me that I am finally health enough to take on even more stuff!” Then they give me a weird look and kind of nervously laugh. I go on to explain that I believe in signs and a purpose to just about everything. Whether that thinking is religiously based, spiritually based, or magic based, it doesn’t matter. It only matters if it gets you motivated. Well all these things that have happened have only strengthened my sense of purpose. I like taking care of things. I love how the whole culture of my office has changed. Everyone is happy. Everyone falls over themselves to help each other. We all look forward to going to work every day. I couldn’t possibly have it better and I’m saying that even though we are still regaining economic strength with the new billing company and I am not consistently getting paid. I am there because I love it and I appreciate my whole work gang! They pay attention. They actually watch me for signs of burnout like I watch them…unprompted! It’s amazing. I wanna keep that going as long as I can. It’s a team effort. Being a good leader also means recognizing the skills of everyone around you. I only hope everyone can have a work environment like mine. You can, but you gotta work for it.
Hello everyone. Long time no write. As you know, I have been an obgyn for over twenty years, so I have seen a lot of crap…from the LADIES. I have been the palace of pelvic exams, beauty treatments, intimate secrets and more for many many years. Nothing really surprised me….until the other day.
I was on my social media( because nowadays you can’t seem to be successful in business without using it), and I clicked on one of my many direct messages for one of my companies. I frequently get messages from both male and female clients. That’s right guys, men get beauty treatments in secret too!. For now, let’s call the guy ” Joe.” Well “Joe” sent me a message, after trying to call multiple times. I give him the benefit of the doubt and try to open the message. Lo and behold there was a pic of “Joe” from the waist down in all his naked glory, cradling himself with his hand, as if to accentuate the size difference between the body parts. Whoah “Joe!” What the hell made you think I wanted to see that? I have one at home that I can stare at whenever I want by the way. He included a message to say that he sent it because I am such a sexy doctor….ummm…ok.
Here’s my question “Joe.” What were you hoping to get out of this? Was this flirting, in lieu of flowers or candy? First and last strike for me I’d say. Were you trying to force me to look at your genitals? That’s coercion man.
I decided to do a little research. How did/or since when did sending “D k” pics become so popular? Interestingly, no one knows. GQ did an article about this in August of 2019. It was very interesting. Apparently most men genuinely hope that whoever received the pic will whip themselves into a sexualized frenzy and immediately send back their own nudes. They also noted that most of the time when WOMEN sent nudes, they included their face. Not so with the penises. Just penis only. This tells me that these guys don’t think they have to preconsider at all when sending these little “presents.”
Unfortunately, this primal impulse has somehow lead to validation of the “d k” pic as a valid form of courtship! What?!!! The Journal Of Sex Research says that the thinking is very transaction oriented. ” IF I send this pic, they will send one back.” When we look back in history, the ‘D k” pic goes all the way back to Roman graffitti. I am not kidding you. Initially it had to be drawn or scribbled by hand but now with technology, it can all be potentially anonymous, which leads to a ton of risky sexual behaviors. The same study made the distinction between solicited( did you ask for it?) and unsolicited( no thank you). The only scenario in which unsolicited pics were welcome was for gay men on dating sites. For the rest of folks, it only stimulated shame, anger, and disgust.
So, we’ve studied it. Most people don’t like it.( Yeah right here!) I say cut it out will yah? Know your audience! It’s one thing to send a nude to a person you are in a relationship with ( if they are into that kind of thing). It’s quite another to send anonymous body part pics to someone you don’t even know. The moral of this story is put it back in your pants! I have no desire to look at it! #penisstrangerdanger
For a long time now since my chemotherapy ended, I have endured the effects of hypothyroidism because my poor thyroid was chemically destroyed with little hope of its recovery. The thinning hair, the dry skin, the ridiculous fatigue and the inability to lose weight have become a part of my daily routine, despite constant medication dose adjustments, doctor’s appointments, etc. Don’t get me wrong. I am extremely grateful that my liver and kidneys recovered. I can’t live without them, but this thyroid stuff is still a bummer.
Well, just when I’d settled in with those symptoms, my thyroid decided to take a turn and launch me in the opposite direction…..hyperthyroidism. Let’s talk about how it is different.
Hyperthyroidism can result from four main causes. The first is inflammation/thyroiditis of the gland due to viral infection, medication side effects, or pregnancy. The second is Grave’s disease. The third is taking too much thyroid medication. The fourth ( although very rare) ifsfrom non-cancerous growths of the thyroid or pituitary gland.
Here are the symptoms. There are so many, let’s break them down into categories.
Menstrual- irregular periods or periods that are very short and light
Behavioral- hyperactivity and irritability
Eyes- puffy eyes or protruding eyes
It all sounds fabulous doesn’t it? Nope! I was looking up risk factors for hyperthyroidism. The most common ones are family history of thyroid disease, pregnancy, chronic illness like pernicious anemia and adrenal insufficiency. I haven’t really seen my reason in many resources: the chemo destruction of the thyroid, but I can tell ya, it exists and is very difficult to treat.
All of these symptoms sound pretty annoying but not life- threatening, right? Wrong! Hyperthyroidism needs to be treated! If you have any of these symptoms, you need to see your doctor. Let’s look at what happens if hyperthyroidism goes untreated.
It can lead to weak, brittle bones and osteoporosis. Our bone strength depends on the amount of calcium and other minerals in them and too much thyroid hormone vastly decreases our calcium absorption.
Thyroid eye disease can develop. This affects the muscles and tissues around the eyes leading to bulging eyes, gritty sensation, pressure and pain in the eyes, retracted eyelids, red eyes, light sensitivity and even double vision. These untreated problems could even lead to loss of vision.
It can lead to a dermopathy that causes the skin to change color and swell. The swelling is often so significant that the skin on the shins and feet literally shins to the eye.
The most dangerous potential complication of untreated hyperthyroidism is a thyrotoxic crisis or thyroid storm. This requires immediate emergency care. Symptoms can include fever, tachycardia, nausea, vommitting, diarrhea, dehydration, and even delirium.
The first step in getting diagnosed is to go to the doctor. Get a thorough history and physical exam. The doctor will look for signs like tremor, overactive reflexes, moist skin, rapid pulse, eye changes, etc. They will examine your thyroid. labs will be ordered like T4,T3 and TSH(thyroid stimulating hormone). Make sure you are fasting when you get these tests. Also make sure you are not taking any b vitamins like biotin for at least 3 to 5 days before. If your tests are positive, you will probably get a thyroid usn.. If there are nodules, you will probably have to have a radioiodine scan.
How do you treat hyperthyroidism? Anti thyroid medicines are one option. They prevent the thyroid from making too many hormones. They usually take several weeks to work. Beta blockers are a symptom treatment option because they can bring down the rapid heart rate and tremors. They don’t do anything to the thyroid hormone levels though. Radioiodine therapy is an option. This makes the gland shrink and usually makes it underactive. This can lead tro hypothyroidism, which also needs to be treated. The most drastic option is removal of all or part of the thyroid. This is reserved as a last resort if meds , iodine etc are not an option or did not work. There are risk to this surgery which include,but are not limited to damage to the vocal cords and the parathyroid glands.
The bottom line is that hyperthyroidism needs to be taken seriously because serious complications can occur. So, if you have any of those symptoms, please seek a doctor’s care right away.
What does it mean to overshare? To overshare is to reveal an inappropriate amount of detail about one’s personal life. I think it is somewhat subjective to determine just what is inappropriate. I think it’s different for everybody and even somewhat situational. In my profession, it is just a way of life.
I just heard these words the other day. “I don’t mean to overshare..but”. I am never sure what the point is of leading with that statement. Does the patient expect me to be shocked? Ask them to refrain from saying what they were going to say? Heck no! My usual reaction is to just buckle up and lean in closer. I can’t wait to hear what they have to say. Usually it is something pretty juicy and intimate….my orgasm was mind blowing from that treatment you did, I had the best sex ever after I started that medicine, a very personal description of a vaginal sensation, etc, stuff like that.
Why worry about saying stuff like that? If you can’t tell the gynecologist stuff like that, who the heck can you tell? My very profession is all about oversharing. It’s not like you can just blurt out stuff about your pelvis just anywhere. But you can here! The best way for me to help you with any of your concerns is to know everything!…every…last….detail. There is nothing embarrassing about it. If you tell me everything, we can either celebrate it or get to the bottom of the problem together. It is a win win. So, c’mon. Let’s start sharing.
I don’t think there is a dry eye or a non-stunned heart in the house when it comes to thinking about the recent sudden passing of Stephen “tWitch” Boss. We are all saddened and stunned. We are all wondering how we missed the signs. We are all asking the question ” How could we prevent this from happening?” Instead of continuing to ask these questions after the fact, it is time to talk about it and get educated for the future. I know I need to.
I recently read an article from the CDC about suicide. I realize that a lot of you may not put value in anything that the CDC says right now, but I am using this as just a resource for some definitions, etc.
First of all, let’s define what suicide is. Suicide is defined as death caused by injuring oneself with the intent to die. A suicide attempt is defined as when someone harms themselves with an intent to die, but they do not die as a result of their actions. It is a serious, devastating, personally intimate, and also public health problem. It is the leading cause of death in the United States, causing up to 45,979 deaths in 2020. This literally translates to one death about every 11 minutes. The numbers of people who think about suicide or attempt it is even higher! In 2020, approximately 12.2 million Americans thought about suicide, 3.2 million planned an attempt, and 1.2 million actually attempted.
Suicide does not discriminate for age. It affects all ages. It was in the top 9 leading causes of death in 2020 in people ages 10-64. It was the second leading cause of death for people ages 10-14 and 25-34.
These statistics are overwhelming. Suicide causes emotional, physical and economic devastation. Survivors may have long term injuries or suffer long term depression. It affects friends, family, co workers, and the community at large. Emotional distress pervades the lives of the victim’s family along with shock, guilt, depression, etc. Sometimes family members can begin to think about suicide. Suicide is also devastating from a financial standpoint. in 2019 suicide and non-fatal self harm cost about 490 billion in medical costs, work loss costs and quality of life costs.
So, what can we do about this? Is there anything? Let’s talk about that. I have been through this before with a friend in high school. We did not reach her in time and I have missed her ever since. I remember being wracked with guilt and self blame, on top of the sadness. Why didn’t I see this coming? What should I have done? The questions kept coming and still do. Let’s talk about some strategies that might help. We’ve got to try something.
It is said that suicide is preventable. I am not sure that is true in every case. I worry that this kind of statement may only lead to more self blame for everyone left behind. Having said that, I do truly believe that everyone has a potential role to play to save lives. We need a comprehensive public health approach as well as a family and friends approach.
This resource explains strategies to reduce suicide with the best evidence that is available at this point. The intent is to help states and communities to prioritize suicide prevention strategies that could potentially have the most impact. The strategies it focuses on the most are 1) strengthening economic supports, 2) Creating protective environments 3) improve access and delivery of suicide care, 4) Promote healthy connections, 5) teach coping and problem-solving skills, 6) Identify and support people at risk, 7) Lesson harms and prevent future risk
Let’s break each of these down.
Strengthening economic supports- This means strengthening household financial security and stabilizing housing
Create protective environments- This means reduce access to lethal means among persons at risk for suicide. Create healthy organization policies and culture. Reduce substance use
Improve access and delivery of suicide care- This means we need health insurance coverage for mental health issues. We need more providers in underserved areas. We need to provide rapid and remote access to help. We need safer suicide care.
Promote healthy connections- Focus on healthy peer norms and engage members of a community in shared activities that are positive.
Teach coping and problem-solving skills- This means teach parenting skills to improve family dynamics. Support emotional resilience through education. Support social and emotional learning.
Identify and support people at risk- The first challenge for this is to be able to identify who is at risk. We will talk about that in a minute. We need to be able to respond to crises and have safety plans and follow up after attempts. OUr job is not done after an unsuccessful attempt. Multiple therapies must be available
Lessen harms and prevent future risk- Again, our job is not done after an unsuccessful attempt. Postintervention is extremely important to prevent future attempts
Now that we have talked about these strategy categories, lets talk about what contributes to risk of suicide. What are we looking for? We need to keep in mind that suicide is rarely if ever caused by a single event or circumstance. It is a range of factors at all levels: society, relationship, community, and individual.
Let’s look at some individual risk factors.
History of depression or other mental illness
Previous attempt
Criminal or legal problems
History of child abuse
Financial or job problems
Violence victim or perpetrator
Hopelessness
Chronic illness or pain
Aggression
Let’s look at Community Risk Factors
Suicide cluster in the community( a pact, etc)
Community violence
Discrimination
Lack of healthcare access
Historical trauma in a community
Let’s look at Relationship Factors
Bullying
Loss of relationship
Violent relationships
Social isolation
Bullying
Family history of suicide
Last, but not least, let’s look at societal factors
The stigma and labels attached to getting help for mental health issues
Unsafe media portrayal of suicide
Easy access to lethal methods
So, what are the warning signs? Look for things like someone talking about being a burden. Look for isolation. watch for increased anxiety. Listen for talking about unbearable pain or feeling trapped. Mood swings are a concern. Watch for too much or too little sleeping. Listen and pay attention if someone talks or posts about wanting to die. Watch out for increased rage. People that are at higher risk include veterans, people in rural areas, mine workers, and construction workers. The LGBTQ population is also at higher risk of suicide.
When we see or hear those warning signs, what do we do? We can use all the strategies we already talked about above: financial support, better access to care, create protective environments, connect people with each other and their community, teach coping and problem solving, identify those at risk and prevent further risk. More immediately, if you think someone is at risk, talk to them. Have them contact the 988 Suicide and Crisis Lifeline. There are two options
Call or Text 988
Chat at 988lifeline.org
This is 24 hour, confidential support with a trained crisis counsellor.
The bottom line of all of this is, keep an eye on the people you care about. Ask questions. Have frank discussions. Seeming OK on the outside does not always mean they are ok on the inside.
As my lymphedema gently nudged me awake from my slumber this morning, I suddenly realized that today is a huge mental load. Today is exactly two years from the day I bolted awake with a feeling of dread, a big lump on my neck and the unconfirmed knowledge that something was horribly wrong. Even though my diagnosis was not confirmed until about two months later, that is where my journey truly started. I should have realized it was coming. On the surface, I was suppressing the memory, but my body knew better. I haven’t felt like myself in days. I had some random panic attacks. My fibromyalgia was flaring like nobody’s business and I got my first migraine in a long time. Now it all makes sense. I was refusing to acknowledge my internal ptsd out loud, but my body was doing it for me.
It occurs to me, now, two years later, that I really need to change my strategy. I have made it my mission since cancer to just keep swimming and pushing and to let nothing hold me up or get in my way anymore. I am always in motion, even if I don’t feel well. I sometimes ignore the need to take a break, because I am afraid that it will slow me down enough that I will start to dwell even more on everything that has happened to me. I also spend too much time chastizing myself for my own thoughts because I assume that my trauma clearly wasn’t as severe as a lot of other people’s.
And where is that getting me? NOWHERE! That gets me panic attacks and prolonged fibromyalgia flares and even more missed time doing what I love. I’ve got it all wrong and I need to change my strategy from constant movement to actual acknowledgement. I need to process and acknowledge/accept? what has happened. Otherwise I cannot really move forward. I read a great article in GoodTherapy magazine from May of 2011 written by Susanne Dillman, PsyD. She said that true acknowledgement of trauma is absolutely necessary for healing to begin. She points out that there is no real hierarchy of pain. Trauma is not scalable. This is a belief that is more flawed than accurate. So, me trying to downplay my trauma and compare it to others is getting me nowhere and I need to stop. She says that trauma lies at the utmost extreme of human experience and there is nothing ordinary or expected about it form the individual’s perspective. You cannot compare the danger, horror and fear involved, regardless of the content. The experience is your own. Once something is extreme, trying to rank how extreme it is is useless.
She also points out that you are literally blocking your healing journey by not acknowledging your trauma because you are denying yourself any sense of self compassion. Healing is the only way to truly detoxify trauma. I don’t think she is talking about sitting back and completely wallowing for weeks at a time. She is just saying that you need to realize that it is real and allow yourself to feel in order to get truly past it.
Have you ever said this to anyone? Do you really mean it? What does it really mean? It means please give me the news, whatever it is, in a straightforward manner with no bullshit. Usually it is used in a situation in which bad news is what’s forthcoming. Is that what people really want? I feel like this phrase is said waaaayyy more often than it is truly meant.
I hear this all the time at the office as well. I have patients tell me that they need to know everything and right away. Sometimes this is a complete trap and it does not go well at all when I “give it to ’em straight.” The trouble is that I still can’t completely figure out how to tell ahead of time.
So, as I am want to do, I decided to do some research. I came across an article in Psychology Today that deals with this subject. Let me summarize it for you.
The article starts out by pointing out that there are as many different types of news we don’t want to hear as there are ways and methods to deliver it. The article basically breaks down the process by a few key questions and answers.
The first question to ask yourself is: Is there any good news you can also give? If the answer is yes, start with the good news. Science tells us that people are pushed to act more by bad news if they hear good news first. Dr Angela Legg, a Pace University psychologist says that she prefers a “sandwich technique, good news first, some bad news, then a concrete solution.” If the answer is no, go ahead with the bad news. If there is no chance of any good news to go with it, just get the bad news over with.
The next question to ask is is there any long-term feedback that could be helpful? If so, make sure you include that feedback when you are giving the news.
The next questions to ask are kind of bunched together. Is if the bad news is based on your own judgement or opinion? Are the reasons for the bad news complicated or are they simple? IS the news serious or are you in an important relationship with the person? Then you have to tell them face to face. That shows more empathy and shows that you are invested in the situation, not just a bearer of words.
These are all great suggestions, but none of them are foolproof. Despite best efforts, the doctor patient communication relationship has taken on a whole new level of strain in the last decade. I have noticed lately that patient empowerment is all the rage in the United States. We have pushed aside the old patriarchy of yore where doctors decided and patients complied. Now all patients want equal partnership, if not complete charge, of making decisions for their healthcare. With the invention of electronic medical records, MyChart, and FollowMyHealth and the like, patients even get their results way before I do. I am in favor of this to an extent. I want patients to be involved in their care, but this thinking has extended too far into more of a patient as a consumer, doctor as a supplier relationship. I am not a supplier in a store that patients can go into and dictate what they want and I charge them a price. That is not how it should work. The Wall Street Journal describes a new business model of medicine which requires a new mantra: The customer is always right. But just as doctors playing God won’t fill the bill, neither will patients playing doctor. Dr. Steven Hatch, author of Snowball in a Blizzard” adds that our healthcare system can champion patient autonomy and facilitate more humane treatment and better care by telling patients our real secret. We just can’t offer the kind of confident predictions that patients expect of us. We go on data, science, predictions, experience. There is power and limitations in simultaneously in everything we do and recommend. We need to find some kind of middle ground. I hope we get there someday.
Dec 12th…..Dec 12th 2020. It’s where it all started. The morning I woke up feeling like I was choking with a voice yelling inside my head to get up and look in the mirror. Whether it was my own gut instinct or my late father I will never now. That morning changed my life. I did get up. I did look into the mirror. I saw the lump on my neck and off I went. It was the beginning of a battle of fear, frustration, and anxiety as made my first steps toward my cancer revealing itself and everything that followed.
Well, that was almost two years ago. I thought I was getting better at letting it go. I really did but nope, here we are. It’s less than a month away and suddenly the panic attacks, the anxiety out of nowhere, the wondering about every little symptom is all back. It is PTSD at its best/worst. I can’t really believe how long it took me to figure it out. I guess I had to waste time beating myself up for having anxiety first. We all do. Then it hit me! Of course. The anniversary of one of the most traumatic times in my life is coming up! What normal brain can completely let that go? That trauma gets stored and buried, with significant effort from me. But, even I can’t hold it back all the time. Lord knows I try.
So, what do I do? I can’t keep fighting to suppress it. That will only keep me prisoner to it longer. I have to acknowledge it! I have to embrace that it is real and that it happened and that it affected me in ways that I still don’t fully process. I have to actualize my own feelings about it. The only way to be free is to go forward through it when the feelings flood me. The only power I have is the power to see it for what it is and decide how I want to proceed. The choice of direction is actually completely up to me. I could allow a day( or two or three) to break down and crumble. I could stop functioning. Or, I could move forward and use the experience for good. They say that the final stage of healing occurs when you are able to use what happened to you to help others. That is what I have chosen and continue to chose. I have written my books. I am giving my talks. I am helping other cancer patients. I help other people “get their mind right” for the battle ahead. I share knowledge every day to help give people some sense of control as to what is happening to them. These are the battles I chose to fight every day. These are the battles I want to win. I realize that my past trauma is still with me. I cannot change that, but I can chose to change what I do with it.
How many times have we all waited for someone to take care of something for us? How many times have we been stalled in a work project, waiting for someone to finish their part? The frustration and loss of time in doing this makes no sense. I say forget it! Let’s try a different strategy. It’s time to take ownership.
So, what does that mean? According to the Harvard Business Review, one of the most egregious momentum killers is waiting for someone else to act, take initiative, or take charge. Most of the time, no one is coming. So, why do we do it? If help isn’t coming, let’s liberate ourselves and take responsibility and move forward. Start believing in yourself as an individual and take stock of the fact that it is, in fact, your responsibility for the quality and timeliness of an outcome. This applies even when you are working with others. It doesn’t mean that you are always in charge of everything. It doesn’t mean that you shouldn’t collaborate with anyone. It just means that you take ownership of your part and the results.
The same article in the Harvard Business Review went on to discuss that there are a couple of basic things to understand about taking ownership. First, I think we need to be able to tell the difference between fault and responsibility. When we finger point at others or at ourselves when something is not getting done, the perception of fault gets in the way of taking ownership of a difficult problem. Then, the problem still doesn’t get solved. Get rid of the blame game and we will all be more successful. Second, taking ownership frees us up to move toward getting results or finishing a project. Last, we can actually help others not just ourselves by taking ownership. Sounds like a win win to me.
The bottom line is, taking ownership/accountability/responsibility for your part can only help yourself, others, and the project move forward. Blame and finger pointing does nothing but waste time and energy. Don’t waste the energy. Put your big girl panties on, take responsibility and forge ahead!
