This month’s menopause support group hot topic was “Stressed and Depressed.’ And boy oh boy, is this a popular topic!  We  had one of our biggest responses for reservations  with an impressive waiting list.  Our speakers did a fantastic job of outlining the symptoms and causes of stress and depression as well as a useful discussion about management and treatment.  The most outstanding thing that I observed during the meeting at the Fairlane clinic on May 12 was the phenonmenal openness and support the participants were willing to give to each other.  Now understand, this is largely a group of strangers but with shared interests and experiences.   One woman openly described the physical symptoms of heart palpitations and pain which was eventually diagnosed as anxiety and stress as a result of being care taker for her sick mother.  I was particularly touched when another woman turned around and gave this woman a book she pulled from her bag  and explained, “  This book helped me immensely when I was going through a similar situation.  I knew I brought it for a reason. This is for you.”  The book is:  The 36 hour Day: A Family’s Guide to Caring for person’s with Alzheimer’s Disease by Nacy Mace and Peter Rabins. 

Although the issue of caretaking for parents is not a new one it is now getting much needed attention at the government level. The following was excerpted from a post on the White house web site.  It was written earlier this year by Terrell McSweeny who is Domestic Policy Advisor to the Vice President. 

“The Middle Class Task Force unveiled a series of initiatives in the President’s FY 11 budget that are aimed at helping families with soaring child care costs, balancing work with caring for elderly relatives or people with disabilities, paying for college, and saving for retirement. These are costs that – along with health care – have risen dramatically for families at a time when their incomes haven’t. Some people call this “squeeze” because of the pressure these costs put on family budgets. But for many families it just seems like it is impossible to get ahead. This is particularly true for the so-called “sandwich generation” – people who are caring for children (or grandchildren or adult children who are struggling financially) and their parents. The Vice President often speaks very personally about his experience caring for his parents and in-laws. And almost all of us know someone who has juggled caring for a parent or relative who can’t get along completely on their own. Millions of Americans provide unpaid care to aging relatives – including approximately 23 million caregivers with jobs and 12 million who are also caring for their own children. That’s why the Middle Class Task Force’s “squeeze” initiative includes help for family caregivers. These caregivers play a vital role in helping seniors stay in their communities or at home. But too often they don’t have the support they need to balance caregiving with work and family responsibilities.  Approximately 65 million Americans provide care to a loved one, giving more than $375 billion worth of unpaid care each year—often at their own financial and emotional expense.   The caregiver initiative won’t magically alleviate all the strain on caregivers and their families – but it is an important first step toward providing more support for families and caregivers and the vital services they are performing.”

The group meeting this month really helped me understand what an important issue this is for women who are also coping with the changes and personal health issues of menopause.  The planning team has already started to discuss how we can help meet your needs for information on this subject and likely will repeat the stress and depressed topic and caregiving  as a fall event.  Your imput is welcome either by comment or contact via email through this blog.  Thanks.

written by Deborah McBain, CNM MSN

Seems I’m hearing a lot more about the importance of Vitamin D in the last few years.  And this time of year as the days shorten and sunshine becomes a rare treat, it is timely vitamin to address.  We have long understood the link between Vitamin D and bone health.  Those of you who remember the practice of giving cod liver oil to children  to prevent rickets are witness to this old-time knowledge.  Cod liver oil is an excellent source of nutritional vitamin D.  Since vitamin D is known to help absorption of calcium, menopausal women often are advised to take it with calcium  to help prevent osteoporosis.  Studies now suggest that Vitamin D does a whole lot more than effect the bones.  Low vitamin D levels during pregnancy are being linked to more preeclampsia, low birth weight and premature labor.  Low vitamin D levels in childhood are now being linked to development of  asthma, diabetes and high blood pressure in later years.     A recent study published in the Journal of Nutrition suggests that women with vitamin D deficiencies may have more bacterial vaginosis, a common vaginal infection.  Other research links low vitamin D  levels to higher rates of colon and breast cancer, depression, diabetes, heart disease,  weight gain and chronic pain. Wow!

Chances are that if you live in Michigan you are vitamin D deficientor at least insufficient.  Your risk is even greater if you are older, dark skinned or cover your skin while outside.  Experts in the medical community generally agree that vitamin D deficiency among women is widespread.  Some predict that as many as  70% of white people and 97% of black people are deficient.   Vitamin D is either synthesized in the skin through exposure to ultraviolet B rays in sunlight or ingested as dietary vitamin D.  However it is difficult for humans to get adequate vitamin D from diet alone.  And our Michigan climate and latitude make it difficult to get enough sun exposure.  Then there is the dilemma of increasing the risk of  skin cancer with sun exposure.  Sun screen blocks the skins ability to synthesize Vitamin D.  What is a person to do?

Get your vitamin D level checked.  Ask your health care provider about getting this simple blood test the next time you go for an exam.

Consider taking a supplement.  There is no general agreement about the optimal intake of vitamin D. Some researchers say the current recommended intake of 400 international units (IU) to 600 IU daily is inadequate and suggest a much higher daily intake, from 1,000 IU to 5000 IU.  Cholecalciferol is the preferred form.   It is easily available in any drug store and not terribly expensive. If your blood levels are low your health care provider may give you with a high dose prescription form of vitamin D.  Experts reassure that it is rare and dificult to get too much Vitamin D but check with your care provider.

Include nutritional sources of Vitamin D in your diet.  Look for vitamin D fortified foods such as milk,cereals, orange juice and yogurt.  Other foods with vitamin D include tuna, salmon, beef liver, egg yolks, cheese. ( and of course cod liver oil if you can stomach it)

Continue limited sun  exposure.  (if you can find it!)  Most experts say that 15-30 minutes of sun exposure without sunscreen is reasonably safe.  Getting this amount most days of the week can help boost most peoples vitamin D levels safely.

written by Deborah McBain, CNM MSN

During our last support group meeting on November 12th we discussed the stresses of the holidays.  In preparation for the meeting I anticipated that shopping, decorating, cooking and time management issues would be big stresses.  But for those attending, loneliness, concern about ailing parents and  the sadness of lost traditions were prominent concerns.  These wise women had, for the most part, solved the problems of doing too much during the holidays.  They have trimmed their card and gift lists, let other family members lighten the load of entertaining and simplified decorations.   The emotional issues that come with getting older are the concerns that dim the joy known from past holiday seasons.  Below are some ideas shared among the group.

• Consider adopting new traditions which better suit family members changing interests or abilities.  New traditions can be  adapted to honor the old ones.  For example, if Grandma can no longer host the holiday then maybe some of her recipes can be prepared by younger members of the clan.
• Rather than spending money on gifts, plan a family event by going to a concert or musical to celebrate.
• Call friends or family and plan occasions ahead of time to avoid being alone.  If inviting people over and on a budget think about a dessert gathering or potluck.
• Consider volunteering to be with other people, make friends and avoid loneliness.
• Investigate community resources to assist with caring for ailing relatives.  Churches, hospitals, public health departments and private Alzheimer groups often have low cost options for respite care.

Nothing could be much more stressful during the holiday than becoming a victim of crime.   Unfortunately, during economic downturns crime increases.  Don’t  make yourself an easy target.  A member of the HFHS security staff stopped by Wednesday to share some holiday safety tips.

• Keep windows and doors locked even when you are at home.
• Do not leave gifts visible through windows.
• Be very cautious answering the door.  Criminals may pose as couriers delivering gifts or solicit for non-existing charities. Always ask for ID whenever anyone requests entry, even if dressed as utility worker or police officer.
• Shop during daylight hours or do not shop alone.
• Do not wear expensive jewelry and avoid carrying a purse.
• Do not overload yourself with packages but avoid dropping packages off at car and then return to store.  Criminals watch for this and can break into car and be off with purchases within minutes.

What stresses you out about the holidays?  What helpful tips have you acquired over the years to help ease the strain of this time of year?

written by Deborah McBain, CNM MSN

A common concern during menopause is how it effects memory.  Science is not always clear as to what changes are from menopause and what is from aging.  Further complicating the issue is the significant effect of sleep and mood on our memory abilities.  Has menopause effected your memory?

The third and final lecture in the HFHS Neuroscience Institute’s “Program for Women- Science for a Healthy Brain” on October 30 was well attended by about 100 people.  Dr. Rhonna Shatz, board certified by American Board of Psychiatry and Neurology, spoke about how memory worked.  She reassured the audience that most concerns about memory have more to do with normal lapses in attention than with serious memory disorders.  For example, it is normal to temporarily forget a person’s name but not normal if one cannot remember the name or the person later.  It is normal to forget for a moment where you are going but not normal to forget how to get home and start to restrict your driving routes.  Other symptoms of dementia include frequent hesitations in word finding or using improper substitutions; frequent errors or extreme slowness in number calculations and forgetting to pay bills; marked and sudden changes in personality or tiring of hobbies with no interest in new pursuits. 

We process different types of memories in different parts of our brains.  Parkinson’s disease effects procedural memory or the ability to remember how to do things.  Alzheimer’s disease effects associative memory or the ability to remember facts or put whole memories together.  Both diseases cause dementia, just different kinds.

Dr. Shatz pointed out that since estrogen is a significant hormone in processing memory, the decrease during menopause certainly may effect memory.  Hmm-the estrogen-memory connection may explain a lot about men, birthdays and anniversaries. Do you think so?  Anyway, mental-pause, as I have heard it refered to, may not be all in our heads.  But in research studies, scores on memory tests do not significantly decrease after menopause.  This suggests that the brain, just like other processes in our body adjust to the changing hormones.   Memory loss is not an inevitable consequence of aging.  Memory declines are largely effected by health.  Since health risks increase with age so do risks for memory disorders.  Health problems which increase risk for memory problems are obesity, depression, high blood pressure, high cholesterol and diabetes.  Lifestyle issues which increase risk for memory problems are lack of sleep, lack of exercise and poor diet. 

 Dr. Shatz was very adamant about the delirious effects of anticholinergic medications on memory and advised avoiding them if possible.  Examples of these are some allergy medications and treatments for active bladder.  She advised talking to your doctor about substitutes.  Also, not surprisingly smoking and alcohol intake is not good.

There are many things we can do to preserve our memory abilities.  Prompt diagnosis and proper management of high blood pressure, high cholesterol, diabetes and depression is so important. Weight management is also very crucial in good brain function. As with so many other health issues, exercise, diet and stress management is key.    Dr. Shatz recommends one hour of aerobic exercise per day.  A diet rich in antioxidants keeps the brain healthy.  Good foods for this include almonds, apples, bluberries, broccoli, grapes, red beans, spinach, sweet potatoes, wheat germ.  The yummy good news is the great benefit of  dark chocolate (milk chocolate doesn’t work).  Maintain good sleep hygiene (see 10/  entry).  Finally, it is recommended to stay engaged in life, maintain social contact with others and to continue to learn and try new things.

Everything seems to be related to everything else.  We expand on this whole theme with this month’s Menopause Support Group Meeting on Wednesday, November 12. Topic- “Screaming Meemees and Other Stress Management Techniques”.  What tried and true methods for coping with the holidays would you like to share?

written by Deborah McBain, CNM MSN

I get a lot of questions about how menopause effects mood.  What do you think?  Have your responses to situations changed as you journey through menopause?  How have you coped?  What advice do you have for others?  Your comments are welcome.

On October 9th, the HFHS Neurology Department hosted the second lecture in a series of three focusing on neurological health for women.  Dr. Doree Ann Espiritu, service chief of Psychiatry at West Bloomfield Hospital spoke about mood disorders and women.  Below I share information about mood and menopause and my notes from the lecture.  The final lecture in this series is October 30.  The topic is Memory.  I suspect it will be very popular and space is limited .  Call 313-916-8088 if you are interested in attending.  If you can’t make it, stay tuned here.  I will report back.

It is a common belief that menopause makes you crazy.  In truth, there is no scientific evidence for this.   There is evidence, however, that mood is definitely tied to hormones.  Duh!  Women who have suffered from premenstrual dysphoric disorder or postpartum depression may indeed be at higher risk for mood problems during the hormonal roller coaster of perimenopause.    The good news is that once menopause is acheived (remember this is confirmed 12 months after the last menstrual period) the risk for mood disorders actually decreases.  Whew.

According to Dr. Espiritu’s statistics, a lifetime chance for a women to develop depression is 21%, social phobia,15.5%, drug and alcohol dependence 14%.  Although rates of depression are lower in men, rates of drug and alcohol dependence are higher.  Women are 6X more likely than men to have Seasonal Affective DIsorder (SAD).  We are 3X more likely than men to develop anxiety disorders.  Anxiety disorders include generalized anxiety, phobias, obsessive-compulsive disorders, panic disorder and post-traumatic stress disorder.

Hormones are by no means the only culprit for mood problems in women.  Women with mood disorders should be screened for other causes of their symptoms, according to Dr. Espiritu.  Medical problems, medications and assessment of past and recent traumatic events should be considered.  Some women having their first perimenopausal hot flashes with heat sensations and sweating that take their breath away may mistake them for panic attacks.

Medications and cognitive-behavioral therapies now provide very effective treatment and management of mood disorders.  Like any illness, treatment for a mood disorder is easier when recognized early.   Also, like most other diseases, life-style changes can help.  There is strong evidence that exercise and a healthy diet improves mood. November topic is stress management and I will discuss life style and mood more in the next few weeks.

In Christine Northrup’s book, The Wisdom of Menopause, irritability and menopause is attrubuted to the “lifting of the hormonal veil”.  By this she means that the stopping of the monthly cycle of reproductive hormones which keep us focused on caring for others allows us to consider our own needs more clearly.  You may have a darn good reason to feel irritated!   A surly boss, unhelpful kids or husband,  a higher number on the bathroom scale?   If you are in a bad mood, consider why.  It may be just the motivation you need to change your life in a new and better direction.

Irritability is one thing, clinical depression or other mood disorders are another. If you are stuggling to get out of bed or having difficulty coping day to day then get help.  Talk to your health care provider about your symptoms.   If you thought you had an infection you wouldn’t hesitate to get treatment and a mental illness should be no different.  If you would like more information about women’s hormones and relationship to mood a good book is Women’s Moods: What every Woman Must Know about Hormones, the Brain and Emotional Health by Deborah Sichel, MD, Jean Driscoll MS,RN,CS.  The National Institute of Mental Health web site is another good source for information- www.nimh.nih.gov

written by Deborah McBain, CNM MSN