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"...a revised edition of a benchmark book on women's health that provides cutting-edge information on such topics as the new fertility treatments; estrogen and menopause; and treatments for PMS, HIV, and other STDs."
1. Becoming a Partner in Your Own Health Care
2. How to Find a Competent Physician You Can Trust
3. Menstrual Cramps Are Real
4. Premenstrual Syndrome -- the Monthly Malady
5. Unpredictable Periods
6. Toxic Shock Syndrome -- Are Tampons Really the Cause?
7. The Hidden Disease -- Endometriosis
8. Why Can't I Get Pregnant? -- Understanding Infertility
9. Assisted Reproductive Technology (ART) -- Modern Answers for the Infertile Couple
10. How You Know You Are Pregnant
11. Miscarriage, Ectopic Pregnancy, and Abortion -- Do They Harm Your Body?
12. What Is the Best Contraceptive?
13. Menopause -- How to Demystify This Natural Process
14. Vaginitis and Sexually Transmitted Diseases (Including HIV/AIDS)
15. Fibroid Tumors and Ovarian Cysts -- Do They Mean Hysterectomy?
16. Fibrocystic Breast Disease and Other Breast Problems
17. Unnecessary Surgery -- When to Get a Second Opinion
The Bottom Line
Better Health Care -- You Can Make the Difference
Chapter 1: Becoming a Partner in Your Own Health Care
A Doctor Is Not a God
The doctor's phone was ringing, patients were flowing in and out of the waiting room, and the doorbell was being pressed once more. It was an afternoon filled with activity, charged by movement everywhere but within the doctor's inner office. There the bustle evaporated into quiet. Sunlight warmed the mahogany desk where the doctor, sitting with his patient, leaned forward to hear her words.
She was an articulate woman with self-assured eyes and an easy smile. Ten years before, when she was in her twenties, she had undergone an operation that she later learned was unnecessary. After that, she haunted the local library and voraciously read books about her body. She wanted to know what questions to ask whenever she had a quirk or an ailment, and she shopped for a doctor who, during a visit, would set aside time to listen and talk to her.
This resourceful woman became the rarest and best type of patient. No longer did she view the doctor as a god. Now she saw him as a partner, an educated mortal who would help her stay healthy. Calmly, she asked her doctor/partner the things she wanted to know about herself. As she spoke, she glanced toward her lap and a sheet of paper with her handwritten questions. She had learned to be relaxed, to use this mahogany desk as a bridge toward more information. And the doctor responded. His forward gesture diminished the distance between them and placed them in the throes of a new movement.
The beginning of a real partnership in health care is at hand. He is one of many competent doctors and leading physicians who are beginning to change, who are trying to talk to, and not at, their patients and listen to their complaints. She is among the growing number of women who are becoming extremely health conscious and well-informed, very sensitive to the signs from their bodies, and genuinely more expressive. The old doctor/patient relationship can be overthrown and replaced by the give-and-take understanding of people such as these who are committed to better health care for women. But the message must be allowed to spread through women's networks to every feeling person.
The thousands of letters I've received after my lectures and seminars on women's health care have shown me that when women dismissed what their intuitions told them about their own bodies and the treatments they were receiving, they were often left physically and mentally scarred. Discovering the despair that this lack of proper medical attention has caused has been heartbreaking. If women had been more informed about and more in tune with their bodies, many lives would have been free from anguish and changed for the good.
Until all doctors decide to descend from Olympus, women can receive the health care they deserve only by learning about the intricacies of their bodies, by beginning to trust their intuitions, and by becoming active partners in their own health care. When I heard Karen's story, a truly shocking event, I thought that no one incident could more clearly illustrate what happens when a partnership doesn't exist and a woman succumbs to fear, rejects her instinctive feelings, and becomes a victim of medical incompetency. If only she had listened to herself.
Karen was half undressed. She had started to peel off her navy blue leotard when she glanced in the locker room mirror. Now, with the top of her leotard dangling around her waist, she stared at her familiar, naked breasts. Her nipples practically touched the glass as she leaned toward her reflection. She wasn't imagining the lump. There it sat, high on her left breast, parallel to her armpit and directly below her collarbone. She pressed it with the index and middle fingers of her right hand. It wasn't mushy, like some of the lumps she had felt before her period. It was hard, round, and small, like a medium-size cultured pearl.
Usually, after teaching two exercise classes, Karen's face flushed to a radiant crimson. Immobilized in front of the mirror, she watched that rosiness fade to the color of a blanched almond. My God, she thought, but before her nervousness over the lump could escalate, she was distracted by Emily's sliding grip on her leg. Karen bent down and collected the four-year-old into her arms.
Has it really been four years since I left the dance troupe? Karen wondered to herself. She had intended to return, but when Emily was born with Down's syndrome, Karen, who was only twenty-six at the time, decided to stay home with the child. The experts had said that Emily was educable, and Karen wanted to give her the time and attention she needed for learning. Emily was so good-natured and cuddly that Karen and her husband, Don, eventually nicknamed her Precious. She captivated everyone, including the owners of the health club where Karen had started to work. They even allowed Karen to bring her to exercise and yoga classes. Karen considered herself lucky. She kissed her daughter on the cheek and tickled her behind the ear.
After she lowered Emily to the floor, Karen yanked a sweater over her head and finished dressing. She tried not to think about the lump. She would make an appointment with her gynecologist, ask him to examine her. She pressed the lump again. She was sure she had never felt anything like it before.
Karen is a pseudonym for a real, concerned woman. Since Emily was born she has been especially careful about her health because she feels particularly protective toward her daughter. If anything happens to her, Karen feels, Emily would suffer her loss severely.
The essence of her story, which I have momentarily interrupted, is well known by women. Gynecologists have heard many patients describe medical problems which they had thought were either "nothing" or "trouble" at first. Then something happened. Women listened to their bodies, but after they visited doctors, they listened to their doctors and those early body signals were forgotten. The medical checks-and-balances system tilted. Karen's destiny would have been different had she held her locker room feelings, disturbing though they were, in her mind.
Karen sat at the edge of the table, raised her arms over her head, and watched her gynecologist frown as he felt the lump from every angle. She was a young woman with no history of breast cancer in her family, but she knew those facts wouldn't save her from the disease. She also knew that the nugget in her breast matched descriptions of breast cancer symptoms that she had already read about in magazines. She wasn't surprised when her gynecologist sent her to a surgeon named Fielding for an opinion.
Dr. Fielding told her to take off her blouse and lie on the table. He could be positively sure that the lump was a benign cyst if he could aspirate it, draw out liquid from it with a syringe. Karen felt that she must have reached the outer limits of her courage if she could remain motionless on a table while a man injected a needle into her breast. Nothing happened. No liquid surged up through the needle. "It's cancer, isn't it," she said to Dr. Fielding, whose face, from her vantage point on the table, looked like a Mount Rushmore carving. "No, now don't jump to conclusions," he said. He appeared to have enormous girth, and his voice seemed to resonate with a commanding timbre. Of course he's right. I'm jumping to conclusions, she thought to herself.
"Well, we'll have to watch it, but I don't think you have anything to worry about," Dr. Fielding told Karen as she, now fully dressed, sat in his office. She watched him pull out a sketch of a breast from his desk drawer, pencil in a circle where her lump was located, and put the paper into her file folder. He asked her to come back in a year, and at that moment Karen decided to bury her sense of foreboding.
She continued to teach her classes. She was a former dancer and a health culturist who knew her body so well she could predict the arrival of her period practically down to the hour. She was aware of the lump's presence. Still there? Yep, still there, she would say to herself. Once in a while, when Emily grabbed her breast in play, she would shiver a little. Then she would remind herself of Dr. Fielding's words. Nothing to worry about. For Emily's sake, there should be nothing to worry about. When she and Don made love and he caressed her breast and felt the lump, she would joke about it. "I'm providing a new diversion," she'd tell him, but he wouldn't laugh. He wanted her to see another doctor.
Twelve months after her final visit, she returned to Dr. Fielding. This time he didn't aspirate the lump. He just felt it, said it hadn't grown, and told her he'd see her in another year. So Karen never paused in her activities. When she wasn't doing leg lifts or demonstrating yoga breathing, she was singing Sesame Street songs to Emily.
During the holidays, Karen feasted a bit too heartily and gained five pounds, but she amazed herself by dieting and losing more than she had anticipated. Ten pounds disappeared in four weeks. She hadn't been so slim since her dancing days. She felt lithe and sexy. One night she and Don made love in that indescribable way only two people who know each other very well can share. But afterward he looked troubled. With his head on the pillow and his gaze toward the ceiling he said, "There's another lump. Lower this time." Karen's right hand went to her left breast and she felt it. Her weight loss had made the second lump obvious.
Dr. Fielding reassured her that the second lump was probably nothing to worry about either, but he might as well take it out. He performed a biopsy on Karen in the office. While he was operating he kept saying that the lumps looked like nothing more than "little fibrocystic tumors." "I'm only sending this to the lab for procedure's sake," he mumbled.
When Karen returned to have her stitches removed, Dr. Fielding was as even-tempered as ever. The last suture out, he told her the incision had healed beautifully. Then he walked to the sink behind her to wash his hands. As she was midway through buttoning her blouse, she realized that Dr. Fielding was talking to her. She could hardly hear him over the sound of running water. And he was facing the wall to boot. He was telling the wall something about "bad cells." He was soaping his hands and garbling the word masectomy.
"What?" she cried out.
And finally he turned off the faucets, pivoted around, and repeated himself. "The lab found some bad cells. I'm afraid that we'll have to schedule you for an operation to remove the rest of them. You'll have to have a masectomy," he said, and walked into his adjoining office.
Karen lay back on the table and cried. He hadn't even said cancer. Didn't he think she knew what she had? For almost two years she had been walking around with a fatal disease. Letting it spread. She could have died. Maybe she would die right now. Who would watch over Emily? What would Don do? Why hadn't she taken care of this sooner? Seen another doctor? Why had she believed this Dr. Fielding? That day in the locker room she'd known it was bad. She'd known, but she'd let a cloud of fear cover her perceptions.
Karen underwent a modified masectomy, including the removal of two positive lymph nodes. If she had received the right treatment sooner, there might not have been any lymph node involvement at all. But these days, two years after chemotherapy and radiation treatments, she's still a star instructor at the health club, a loving mother, and she's becoming an optimist again. She says she won't feel really super, though, until she passes the five-year mark. (Then, her survival rate will officially change, because the odds are good that cancer won't return after five disease-free years.)
At the time of her relationship with Dr. Fielding, Karen had been fearful of her body's basic warning: a visible, touchable lump. She chose to transform Dr. Fielding's words into sacred scripture, when her instincts had told her that this lump was definitely something to worry about. Right from the start, she had intuited bad news.
Karen's success as a dancer and as an exercise instructor depended upon her body's fitness. And like a broker evaluating the Dow Jones Index, she could gauge the importance of every little and big change in her body. She recognized when she should slow down and when she should push herself harder. She really hadn't needed a doctor to tell her that the lump was an ominous sign; she had seen a portent of illness in the locker room mirror.
On her first visit to Dr. Fielding, however, this remarkably aware woman suspended her awareness. After the aspiration episode, she suppressed the throbbing knowledge in her brain and clung to the words of an incompetent physician — a man who knew less about her body than she did. She was understandably scared, but she allowed her fear to override her intelligence. In a moment that was crucial to her well-being, Karen relinquished her role as a partner in her own health care. She listened to and abided by one man's judgment. And by permitting Dr. Fielding to become a god of sorts, Karen set up that old-fashioned kind of doctor/patient relationship that continually blocks better health care. The meeting of a woman and her doctor should be a time for sharing.
Doctors aren't gods and women aren't really mystified by their bodies. Even the women who were relegated to menstrual huts once a month by horrified tribesmen, even they surely knew they were healthy. If Karen had relied on her instincts, she would have thought I need a second opinion when she heard Dr. Fielding tell her that she had nothing to worry about and that he didn't want to see her for a year. She would have sought the right kind of care and avoided two years of harboring dangerous cancer cells and unrelenting emotional strain.
Whenever Emily touched her breast, Karen had shivered not so much from pain as from fright. She was afraid that she would have to face what she knew was true. She didn't want her husband to talk about seeing another doctor. Yet if she had consulted a different physician, she might have stopped the disease at a less worrisome stage. Early on, another breast specialist could probably have performed a lumpectomy to remove the lump, and then a plastic surgeon could have corrected any disfigurement with reconstructive techniques. The cancer might have been halted without the need for a mastectomy and chemotherapy, and Karen might not be anxiously awaiting the fifth anniversary of her surgery.
It's tragic, but Karen suffered the all-too-common double misfortune of not heeding her body's messages and of encountering a man who didn't do his job. There were clear mistakes made by Dr. Fielding. Even if he thought the lump was benign, he should have explained fibrocystic breast disease to Karen and told her to monitor the lump at home. A fibrocystic breast lump would have been slightly painful to her touch, and after her next menstrual period it would have changed shape and become less sore. In fact, it might have diminished in size and completely disappeared due to the hormonal changes brought on by menstruation. If Karen had kept a close check on the lump and if it had remained the same after her period, had not become smaller, and if Dr. Fielding were acting responsibly, he would have asked her to come back to the office for another examination. He never should have allowed her to go for more than two months without reexamining her breasts. Dr. Fielding had already aspirated the mass and discovered the lack of fluid. The solidity of the lump should have caused thoughts of cancer to spring into his mind at the start.
As was particularly clear in Karen's case, many doctors cannot face cancer, so a woman has to be courageous enough to accept what her body is telling her. During the two years that Karen was under Dr. Fielding's care, he never discussed the possibility of cancer with her. A capable physician, feeling the hardness and the contour of Karen's lump, would have been highly suspicious. If a doctor cannot absolutely rule out the disease, and especially if he thinks cancer is likely, he sends a woman for a mammogram and a possible proper biopsy. Yet even when Karen's biopsy finally made cancer impossible to hide from any longer, Dr. Fielding still tried to avoid it. He turned his body away from hers, faced a wall, ran water into a sink, and mumbled her need for surgery into the air.
Now, it's possible that if Karen had visited the doctor with a companion who would have been her patient advocate, the facts might have come out sooner. An advocate can take a more objective position and ask questions a patient may forget. Dr. Fielding might have responded differently to an advocate than to his patient. So while a woman is learning to trust her body awareness and to become more assertive in the way she gets information from her doctor, she might ask her partner or a friend to come along when a health concern is at the forefront.
Every woman who confronts a Dr. Fielding who does not discuss her condition with her should find another doctor.
A Woman And Her Doctor, The New Partnership
Women can be their own health protectors without suffering through life-threatening scares like the one Karen survived, but with knowledge. It's time to remove the blinders from both sides of this partnership. Women are no longer Victorian maidens and doctors don't have to examine them under covers anymore. It isn't necessary for gynecologists to be as remote as historian Carl N. Degler, author of At Odds, tells us they were in the 1800s: "Most physicians, throughout the nineteenth century, in order to avoid any charges of impropriety, bent over backwards not to appear too familiar. As a result, lights were dim during the examination, and the examination and delivery were by touch only; if instruments were used they had to be manipulated under covers! One male writer even pointed out proudly in justification of modesty, that one of the greatest male obstetricians had been blind!"1 Dr. Fielding, with his impaired mental vision, acted like a man of the last century.
You probably won't find any blind obstetricians in delivery rooms today, but you might run into a lack of communication between a woman and her doctor, and that in itself is a kind of blindness that leading physicians are trying to cure. The best doctors are now realizing that they can give women the most complete medical care only if women are well-informed. A smart doctor won't automatically prescribe the pill to a woman if she wants birth control; instead, he'll explain all the different forms of contraception, and together they'll decide what suits her needs. An informed woman will want to feel in control of her body, will take time to listen to the latest findings, and will become one half of a better health collaboration.
Of course, the idea of a woman's having a command of herself did not evolve easily in America. When a woman talked about taking "control of her body" in the nineteenth century, she meant that she said no to her husband once in a while when he wanted sexual intimacy and she didn't. In older, European societies, women were bolder sooner. They were more conscious of their sexual options, the intricacies of their bodies, and their health. Openness between a woman and her doctor happened many years ago. In fact, not just women but men and women were encouraged to learn more about medicine from their European doctors.
During the first half of the twentieth century, birth control champion Margaret Sanger let people know that sexual pleasure and procreation could be separated, and American men and women began to grasp their physical choices. The women's liberation movement, which began in the late sixties, spawned important books like Our Bodies, Ourselves2 in the early seventies, and women began to understand their right to be heard. They also enjoyed a deeper comprehension of their bodies and their power. But equality in the doctor's office still hadn't happened.
Letters Of Fear, Fight, And Frustration
Although contemporary women have influenced the medical establishment and many physicians have been happy to regard their practices as doctor/patient partnerships, there's still a great dilemma at hand. A doctor must always ask himself, "What is the right treatment?" and a woman must seriously consider, "Am I getting the right treatment?" Like the creaking of a time-worn building, the question "What is right" is constant. For every woman the answer comes with an understanding — of her body and herself.
My hope was that the publication of my first book, It's Your Body: A Woman's Guide to Gynecology,3 would foster that understanding and would arm women with enough information to find the most impeccable care for themselves. However, the thousands of letters I received as a consequence of that book have shown me that many women are full of questions no one has ever answered, and that the lack of proper medical care is frightening, much worse than I had ever imagined. Some of the letters describe medical ignorance and malpractice so severe they have altered the course of lives. I cannot help but be deeply touched by so many moving stories and searching questions.
...My doctor really neglected me. After the cesarean section that brought me my daughter, I was semiconscious in my hospital bed...pneumonia following the operation. For the first week my doctor never came to my room. I only saw him on the eighth day, when he took out my stitches from the cesarean. In ten days I left the hospital...I never had regular periods anymore and I began to hurt all the time. My doctor said nothing was wrong. After two years of pain I went to another doctor who said that the incision from my cesarean had not healed. My uterus and ovaries were infected...I was twenty-five years old and I had to have a hysterectomy. Now I can't ever have any more children...Why wouldn't a doctor notice that a patient hasn't healed? I know my husband would really like to have a son. Why, why, would a doctor do something like this?
— B.L., Phoenix, Arizona
...After five years of taking birth control pills, I became infertile. There were D & Cs, tests, hormonal medications, laparotomy and laparoscopy, and finally my doctor told me I had a tipped uterus. He repositioned it surgically, but according to my present doctor, this operation was not only unnecessary but the source of my continued infertility and abdominal pain. Due to poor postoperative procedures there is much scar tissue on my ovaries and surrounding areas. Intercourse always hurts....What do I do? I'm thirty-three and this new doctor says I should undergo a hysterectomy at thirty-five if I do not become pregnant. He says that hysterectomy will be the only real end to my pain. I am confused and worried about my future and my life....My husband and I are in the process of adopting a child, so pregnancy is not so important, but I am living in great distress.
— G.D., Columbus, Ohio
I am twenty-three years old and working toward my master's in business administration, but sometimes, during my ovulation and period, I am in so much pain I cannot study. The tears run from my eyes uncontrollably....When my ordeal began two years ago I went to a gynecologist who told me that he didn't know what was going on, said it was all in my mind. I finally sought out a gynecologist here in Boston and he diagnosed endometriosis and put me on contraceptive pills and painkillers. Still, the pain during ovulation and menstruation is almost too sharp to bear. I sometimes find I'm clutching myself around the stomach in the middle of a class....Now my doctor says that pregnancy might end the endometriosis, and perhaps I should consider having a baby. I have aimed my life toward a career and I am not even married. Isn't this suggestion extreme? If I have the child maybe I should ask the doctor to raise it!
— R.V., Boston, Massachusetts
I am an enlisted female soldier, and in all my eight years of service I have yet to find a good, efficient, reliable, military doctor....So many females are ruined for life because of these quacks....Several female soldiers have had miscarriages because they were given medication to start their periods when they had tubal pregnancies. The doctors had told them they weren't pregnant....Instruments used during examinations have caused miscarriages....Many women have had infections after operations because instruments have not been properly sterilized....Either these doctors are not trained as efficiently as civilians or they just don't care.
— P.Y., Miami, Florida
I am thirty-three years old and I am suffering with endometriosis. I've never been able to conceive a child, though I have tried for years, especially after my doctor did major surgery and scraped everything out. That was six years ago. Three years ago he suggested a hysterectomy. I don't want to have surgery but I need to find some relief. I am in a lot of pain during ovulation and for one week with each period. Is there a drug that might help me? Is there anything that might help me?
— C.K., Little Rock, Arkansas
I am eighteen years old and just married. I have had herpes type I ever since I was a little girl. Nobody ever told me that it was a type of STD. I read about it in school and really freaked out. My doctor just tells me not to worry. Will I still be able to have a child? Is it contagious? Why won't someone give me a straight answer?
— S.T., Des Moines, Iowa
I'm twenty-one years old and I've been on painkillers for three years. I've had surgery six times, had a total of six bleeding cysts removed, had a tubal infection, and I still have scar tissue and adhesions on my tubes, ovaries, and large intestine. My doctor wants to remove my female organs because I am always in so much pain, and intercourse is almost unbearable. He's afraid I'm going to become addicted to the painkillers, too. I've had three or four opinions and they're all the same — my organs must go. Is there anything I can do? I have one child but I always thought I'd have more than one. Please help me.
— E.N., Albany, New York
I've been married almost two years and I'm twenty-four years old. Before I was married I only had sex with one man other than my husband, but that other man really got around. Now that I am a married woman you can imagine my embarrassment to have blisters around my vaginal area. My husband has never had sex with anybody else, and I think I may be giving him herpes. I think the blisters that come and go are herpes blisters, but my doctor can't give me a definite answer. What can I do? Did I get herpes before I got married? Why are they coming out now?
— A.H., Milwaukee, Wisconsin
The suffering of these women brings me sorrow, but the thoughtlessness of their doctors causes rage. There are never enough questions a woman can ask about her body, and she deserves a doctor who is willing to answer every query. By talking to, not at, each other, women and their doctors are involved in an ongoing movement toward better health care.
"Women and men have the right to know the subtleties of their bodies. With these letters as my forum, personal questions, secret questions — and I hope, your questions — will be answered. And everyone's goal will be the same — excellent health through shared information.
Copyright © 1982 by Niels Lauersen, M.D.
Copyright © 2000 by Niels Lauersen, M.D., Ph.D., and Eileen Stukane
Posted August 30, 2009
I Also Recommend:
This book teaches women how to be their own advocates, that no doctor is a God and about all conditions women can face.
This is a book that no woman should be without!
Best of health!