St. Louis Magazine - October 2019 | Women's Health

WOMEN’S EXPERT ADVICE ON LIVING A HAPPIER, HEALTHIER LIFE

HEALTH GUIDE October 2019 stlmag.com

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WOMEN ’S H EA LTH GUIDE

TREATING BREAST CANCER LIKE A JOB When a doctor becomes a patient, she tackles recovery with steady intelligence— and a subtle shift in priorities. By Jeannette Cooperman

FROM THE DISTANCE of our monthly book club, I watched Dr. Tammy Ostapowicz, a retired obstetrician/gynecologist, recover from breast cancer. She seemed to grow lighter, softer, more fun; she added a bottle of good Champagne to her grocery cart every week; at restaurants, she ordered seafood and salads and ignored dessert. How much of this, I wondered, had come of her brush with mortality?

“None of it,” she says, blowing my story premise. “I never did eat much sugar. I was one of eight kids! I liked Tootsie Rolls; that was about it.” She brightens, tells me how her grandson just had his first Tootsie Roll.

I’m still waiting for a transformation story. Trying to help, she describes the cancer itself. It was the tricky kind, “triplenegative”: “When I left active practice, I’d never even heard of it. Triple-negative is defined by the characteristics it doesn’t have.” The tumor is checked for three kinds of receptors—estrogen, progesterone, and a hormonal growth factor. If one shows up, the hormone in question may have played a role in the cancer, and that can guide treatment.

Ostapowicz’s tumor tested negative for all three, and she didn’t have the BRCA gene mutation, either.

Researchers probably figured out triple-negative breast cancer by looking into the reason some people weren’t doing well, she adds: “Most breast cancers have a 98 percent success rate. This one has a 75 percent success rate. So you’re finding out that you’re not in that 98 percent, and you’re going to be blasted with chemo…”

She’d just had a nice clean mammogram four months earlier, so the news fell like a hammer. But she decided to treat cancer like a job—something to research, manage, solve—and not let it become her identity. “I’m practical almost to a fault,” she says, remembering her thoughts about how far she’d go in experimental treatment if the cancer came back.

“Wouldn’t I just as soon take that money and take our kids on a cruise versus putting myself through hell?”

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She found a few good wigs, learned to draw on eyebrows, put the people taking care of her at ease. “Oh good Lord, don’t worry about it,” she told one young man.

Often she never even mentioned her medical background, figuring it wasn’t relevant.

She was putting herself in their hands.

“If anything changed me, it’s this,” she adds, hoisting a fat folder of insurance paperwork to show me what a nightmare it is, even when you know the system.

I nod absently, unconvinced. She’s so damned stoic. I’ll have to press her family.

“She’s always been constant,” says her daughter, Michelle Thore. “She’s always been a fighter. She was quiet yet steadfast in her recovery. Hell, no one would have known she had cancer if it weren’t for the baldness and the port!”

As for the Champagne, it was already on her mom’s bucket list, Thore says.

“But if anything, the diagnosis made

sure that the bucket list would happen.”

Next, I call Ostapowicz’s husband, Dr. Steve Pisoni, who forced red roses on his unsentimental wife every week of her recovery. “It isn’t like it suddenly dawned on her that you only have one life,” he says. “You’re a doctor all those years; you get your nose rubbed in it. But she’s gotten more relaxed about what you might call small stuff. She pays even more attention to what’s important”—like their grandson. “I think she emphasizes love more than anything else.”

I repeat this to Ostapowicz. “Oh,” she says softly. The words remind her of David Foster Wallace’s famous Kenyon College commencement speech, and she finds it on her phone, reads me the ending, in which he emphasized “simple awareness; awareness of what is so real and essential, so hidden in plain sight all around us.”

And with that, her voice cracks, and her eyes fill with unexpected tears.

Photography by Kevin A. Roberts

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WOMEN ’S H EA LTH GUIDE

PLATE PROTOCOL

Dietitian Reshaunda Thornton wants you to love food again.

Here’s how. By Samantha Stevenson “Food is a constant in our lives,” says Reshaunda Thornton. She’d know: As a dietitian, she’s constantly helping people navigate their relationships with it. As part of her business, BetterVessel Nutrition, she consults with clients about ways to make sustainable changes. “Food is at every point in our lives,” she says. “Every time there’s a celebration, every time there’s a vacation. When good things happen, and when bad things happen: a death or a divorce; the highs and lows.” Over the years, she’s collected a few rules of thumb, many shared in her book, Play to Win the Food Fight. Although each client she meets is unique, she says, there are some basic tips that everyone can use.

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IT’S ALL ABOUT HOW YOU FEEL ABOUT FOOD. “Every person that you ask, someone has tried at least three different diets in their lifetime,” says Thornton, who emphasizes self-love and a healthy relationship with food. When diets don’t work, many people are left with a sense of defeat. “They’re feeling failure and are continuously struggling emotionally with body image,” she says. “Their relationship with food becomes sour. It’s this cycle.”

A BALANCED DIET Many women suffer from nutritional deficiencies, and though supplements are great, Thornton recommends adding these foods to your plate:

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VITAMIN D · Dairy products · Eggs (yolks) · Salmon · Cheese

YOUR CONSISTENCY MUST BE LIFE-PROOF. Between vacations, holidays, and the unexpected, people drop the ball. Then old habits and patterns return. “Life is always going to come with ups and downs,” she says. “If you let [good] food [habits] fall apart every single time, you’re always going to be going back and forth like a yo-yo.”

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SHOP THE PERIMETER OF THE GROCERY STORE. It’s the oldest trick in the dietitian’s handbook, and Thornton stands by it: “I call it strategy shopping.

On the perimeter, everything is fresh; there aren’t any preservatives. If you can pull it, grow it, or kill it, in my opinion, that’s unprocessed food.” While shopping, pick up these healthy snacks: fruit, nuts, pretzels or popcorn, and string cheese.

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YOUR GOAL AND PLAN OF ACTION HAVE TO FIT YOU . Though she admits that a dietitian’s role is primarily to teach clients, Thornton has found that just educating others isn’t always enough to help “people make the move forward.” It’s not just telling clients what they should eat, she’s learned; it’s telling them to do it in a way that fits their personality and lifestyle.

UNDERSTAND WHY YOU NEED TO MAKE CHANGES. “We know the difference between an apple and a doughnut,” Thornton says, “but for some reason, we’re not choosing that apple more than a doughnut.” Take a moment, she tells clients, and reflect on why—then think about how a healthy decision might be more beneficial.

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LOOK FOR A GUILTY FOOD ALTERNATIVE. Have a guilty pleasure? Figure out what you like about it, then look for it in a healthier form. Soda drinkers often just like carbonation, so she points those clients to sparkling water. Like the sweet taste? Try adding a flavor to your water.

DON’T QUIT COLD TURKEY. Instead, see where you can add and subtract. For example, rather than having a chocolate bar or brownie, switch it out for a breakfast bar or trail mix a couple times a week. “Transition by having it less and less often,” she says. “Over time, you might find yourself saying, ‘You know what? That brownie really isn’t all that good. I’d prefer to have this instead.’”

CALCIUM · Dairy products · Low-fat c heese · Fruit (for those who are lactose intolerant) · Fortified foods (mostly grain- based) · Soy products, such as tofu and edamame · Almonds IRON · Dark-leafy green vegetables such as spinach or kale · Beans · Dried fruits, especially strawberries

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WOMEN ’S H EA LTH GUIDE

SHOULDN’T I BE HAPPY NOW? Why many women find themselves depressed at major life turning points By Jeannette Cooperman

A GIRL’S BODY signals that she has become a young woman, able to bear a child. A young woman gives birth to a soft, tiny new human being. A middle-aged woman says goodbye to those complicated years of monthly blood and pain and worry.

You’d think these would be happy times, and for many, they are. But they’re also times of dramatic hormonal change that, when combined with genetic predisposition or sleep deprivation or stress, can trigger a serious flare of depression.

This may explain why, the world over, twice as many women as men suffer from depression—a gender difference that emerges at puberty.

Hormone levels rise and fall to prepare the body for fertility or its end, but they also influence brain systems connected to mood and stress response. One major

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risk factor for depression is family history, but genes aren’t sufficient cause, notes Dr. Cynthia Rogers, associate professor of psychiatry and pediatrics at the Washington University School of Medicine and director of the Washington University Medical Center’s Perinatal Behavioral Health Service. “In the right environment, people at more genetic risk might do just fine. There are also environmental factors—trauma, acute stress, chronic stress, lack of sleep, inflammation, diet, toxins.” Hunting for a single cause is pointless, because hormones interact in complicated ways with other physiological and psychological changes and predispositions.

Hormones also prompt the brain to release other compounds. Exciting new research, done in part at Wash. U., iden-

tified a neurosteroid that’s just been approved by the FDA as a medicine called Zulresso (brexanolone). The brain uses its naturally occurring form for damage control, alleviating the effects of stress during pregnancy. This hormone decreases at the same time progesterone does, at childbirth. That leaves some women, especially those with a genetic predisposition to and history of depression, vulnerable to postpartum depression (experienced by one in nine women in the U.S.).

In postpartum depression, not only has progesterone plummeted but also “your body has changed, you have this new being that does not sleep like a normal person and, if you’re breastfeeding, requires you for sustenance,” notes Dr. Denise Hooks-Anderson, associate professor of family and community medicine at Saint Louis University. “That’s a lot of pressure. And lack of sleep can cause your mind to go all kinds of places.”

She urges women to seek help from their mother, mother-in-law, sister, or friend, just so they can get a consistent four hours of sleep. Somehow women have gotten the idea they have to do it all alone, she says. “I don’t know how we came up with that. If you do have that village, please use it.”

When she sees teenage girls, HooksAnderson makes sure to take a thorough history and do a careful exam so she can rule out concrete causes: “I want to know if a teenage girl is being bullied. Is she getting enough sleep? Are there stressors at home; is there any abuse; does she feel safe? Kids are more stressed now—in some cases, to the point of suicide.”

Research also links many cases of first-onset depression to estrogen loss at menopause, though Hooks-Anderson more often sees irritability and insomnia.

To ease symptoms, she starts with “black cohosh, then certain antidepressants, and if symptoms are really severe, we talk about hormone replacement, which is the only thing that will completely ease the symptoms but does come with risks.”

And at every stage of a woman’s life, she checks the thyroid hormones, which affect almost every system of the body.

“It has to be at a sweet spot. If it’s too low, that can cause depression; too high, and it can cause anxiety.” She pauses. “We’re complicated beings.”

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WOMEN ’S H EA LTH GUIDE

A CUP OF TEA A DAY

Oolong tea may fight breast cancer, SLU researchers find. By Samantha Stevenson

SUPPLY & DEMAND As a recent study found, OB/GYNs in St. Louis are in high demand—and that demand is on the rise.

Last year, a national study ranked St. Louis as having the highest OB/GYN workload in the United States, with an average of 247.23 births per physician per year. The study, conducted by medical social network Doximity, also ranked St. Louis No. 7 among metro areas at the greatest risk for an OB/ GYN shortage and No. 4 among metro areas with the lowest percentage of OB/GYNs under age 40 (12.9 percent).

In other words, OB/GYNs are in high demand in St. Louis—and that demand may only increase in the years to come.

Aside from brain drain, many graduates are pursuing fellowships and become specialists, serving a small subset of patients.

In addition, a desire for work-life balance may have some doctors working part-time or preferring predictable hours.

“While it may be a little harder to recruit to St. Louis, I think the bigger issue is that it’s hard to recruit to Missouri in general, and particularly rural Missouri,” says Dr. Mary McLennan, a SLUCare OB/GYN and chair of the Saint Louis University School of Medicine’s Department of Obstetrics, Gynecology, and Women’s Health. In 2017, she notes, the American College of Obstetricians and Gynecologists reported that half of U.S. counties didn’t even have one OB/GYN. To bridge the gap, McLennan cites telemedicine as a possible temporary solution. The real change, though, might have to come from initiatives to keep young physicians working in the state after graduation, particularly in low-population areas.

TREATING A SILENT EPIDEMIC An oral antibiotic shows promise against endometriosis, according to a Washington University study.

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SAINT LOUIS UNIVERSITY researchers knew that tea, especially green tea, may help prevent various types of cancers. They also knew that oolong tea, which accounts for just 2 percent of the world’s tea (compared to 78 percent black tea and 20 percent green tea), is popular in the Fujian province of China and that Asian women typically have a lower incidence of breast cancer and, if they get it, less aggressive types. Then researchers connected that breast cancer cases and death rate percentages are lower than the national averages in the Fujian province. The pattern led SLU scientists and a visiting scientist from Fujian Medical University to explore how oolong tea could be a nontoxic preventative option.

In the study, published in the journal Anticancer Research, the five researchers documented treating six breast cancer cell lines (two ER- and PR-positive, one

HER2-positive, and three triple-negative) with different concentrations of green, oolong, black, and dark tea extracts. Their findings? Green and oolong tea extracts prevented breast cancer cell growth in all six cancer cell lines, whereas those infused with black and dark tea extracts showed little to no difference.

“It’s very meaningful,” says Yifan Tu, an assistant professor of hematology and oncology at SLU and one of the study’s authors. With straightforward baseline tests like these, she says, “the hope is to just give some idea and to guide further for the experiment if needed. Next, maybe going to mouse models, then human experiments.”

Oolong tea as a preventive measure is “very doable…and doesn’t cost too much money,” Tu says. “You can cook tea—you don’t have to have a pharmacist make tea for you.”

Globally, more than 176 million women suffer from endometriosis, an incurable disease in which the tissue that makes up the uterine lining grows on or inside other organs, often resulting in painful inflammatory lesions. In April, Washington University researchers published a study in the journal Human Reproduction showing that the broad-spectrum antibiotic metronidazole reduces the size of those lesions in mice. Further, the research indicated that the bacteria found in the gut microbiome could help accelerate or stop endometriosis’ progression. The next steps include a pre-clinical trial, which could prompt researchers to move forward with a clinical trial.

Principal researcher Ramakrishna Kommagani says the study’s original goal was to determine how gut bacteria, or microbiota, might be connected to endometriosis, but researchers may have also discovered an affordable treatment option: “a simple oral antibiotic,” as Kommagani says. “I think that’s very encouraging.”

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Erol Amon SLUCare Physician Group SSM Health St. Mary’s Hospital–St. Louis Division of Maternal and Fetal Medicine 1031 Bellevue Ave., Ste. 400 St. Louis, MO 63117 314-977-7455

Daniel J. Baumann SSM Health Medical Group–OB/GYN 3555 Sunset Office Dr., Ste. 107 St. Louis, MO 63127 314-238-9000 Michael W. Bebbington Washington University Physicians Center for Outpatient Health Fetal Care Center 4901 Forest Park Ave., Ste. 703 St. Louis, MO 63108 314-747-6539 Scott W. Biest Washington University Physicians Center for Outpatient Health Division of Minimally Invasive Gynecology 4901 Forest Park Ave., Ste. 710 St. Louis, MO 63108 314-747-5470

John K. Appelbaum Missouri Baptist Medical Center Department of Obstetrics and Gynecology 3015 N. Ballas Rd. St. Louis, MO 63131 314-996-5000

James P. Boedeker SSM Health Medical Group–OB/GYN 3555 Sunset Office Dr., Ste. 107 St. Louis, MO 63127 314-238-9000

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Jessica N. Bowers SSM Health Medical Group–OB/GYN 3555 Sunset Office Dr., Ste. 107 St. Louis, MO 63127 314-238-9000

Breton F. Barrier MU Health Care Missouri OB/GYN Associates 2325 Smiley Ln. Columbia, MO 65202 573-817-3535 James A. Bartelsmeyer Mercy Clinic Maternal and Fetal Medicine Medical Tower B, Ste. 2007 621 S. New Ballas Rd. St. Louis, MO 63141 314-991-5000

Craig W. Boyd Signature Medical Group Allied Associates Ob/Gyn Tower A, Ste. 101 621 S. New Ballas Rd. St. Louis, MO 63141 314-569-2751 Igor Brondz SSM Health Medical Group–OB/GYN 400 First Capitol Dr., Ste. 201 St. Charles, MO 63301 636-669-2332 Robert John Brown SSM Health Medical Group–OB/GYN 1475 Kisker Rd., Ste. 200 St. Charles, MO 63304 636-498-5870

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Alison Cahill Washington University Physicians Center for Outpatient Health Women’s Health Center 4901 Forest Park Ave., Ste. 710 St. Louis, MO 63108 314-454-8181 E. Cristian Campian SLUCare Physician Group SSM Health St. Mary’s Hospital–St. Louis Division of Urogynecology 1031 Bellevue Ave., Ste. 400 St. Louis, MO 63110 314-977-7455 Chadwick T. Caudill Southwest Women’s Health 13131 Tesson Ferry Rd., Ste. 210 St. Louis, MO 63128 314-842-5583 Michael Chen BJC Medical Group Contemporary Women’s Healthcare 20 Progress Point Pkwy., Ste. 100 O’Fallon, MO 63368 636-344-3105 Octavio R. Chirino Mercy Integrative Medicine and Therapy Services 15945 Clayton Rd., Ste. 230C Ballwin, MO 63011 636-256-5200 Camaryn Chrisman Robbins Washington University Physicians Center for Outpatient Health Women’s Health Center 4901 Forest Park Ave., Ste. 710 St. Louis, MO 63110 314-362-4211 Amber R. Cooper Vios Fertility Institute Medical Tower A, Ste. 676 621 S. New Ballas Rd. St. Louis, MO 63141 314-266-2062

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Sara Crowder Mid-Missouri Gynecologic Oncology 1605 E. Broadway, Ste. 260 Columbia, MO 65201 573-442-2221 Michelle R. de Vera Women to Women Health Care 8888 Ladue Rd., Ste. 220 St. Louis, MO 63124 314-644-3336 Jeffrey Dicke Washington University Physicians Center for Outpatient Health Women’s Health Center 4901 Forest Park Ave., Ste. 720 St. Louis, MO 63108 314-454-8181 Shelby M. Dickison Washington University Physicians Center for Outpatient Health Women’s Health Center 4901 Forest Park Ave., Ste. 710 St. Louis, MO 63108 314-362-4211 Michael B. Dixon St. Gerard Obstetrics and Gynecology 10004 Kennerly Rd., Ste. 386B St. Louis, MO 63128 314-842-7910 Erin M. Dumontier BJC Medical Group Ob/Gyn Associates 3844 S. Lindbergh, Ste. 210 Sunset Hills, MO 63127 314-525-0420 Fred B. Durer BJC Medical Group Women’s Health Care 3009 N Ballas Rd., Ste. 360C St. Louis, MO 63131 314-576-0930 Kevin O. Easley Mercy Clinic GYN Oncology 607 S. New Ballas Rd., Ste. 2350 St. Louis, MO 63141 314-251-4260

David Eisenberg Washington University Physicians Center for Outpatient Health Women’s Health Center 4901 Forest Park Ave., Ste. 710 St. Louis, MO 63108 314-362-4211 Alaa A. Elbendary Saint Louis Gynecology & Oncology 11652 Studt Rd. St. Louis, MO 63141 314-991-5445 Raymond T. Foster Sr. MU Health Care Missouri Center for Female Continence and Advance Pelvic Surgery Keene Medical Bldg., Ste. 306 500 N. Keene St. Columbia, MO 65201 573-817-3165 Jennifer M. Goldkamp SLUCare Physician Group SSM Health St. Mary’s Hospital–St. Louis Department of Obstetrics, Gynecology and Women’s Health 1031 Bellevue Ave., Ste. 400 St. Louis, MO 63117 314-977-7455 Brian S. Gosser St. Joseph Obstetrics and Gynecology 1747 Smizer Station Rd., Ste. 1 Fenton, MO 63026 636-861-2125 William Mark Grant Womens’ Wellness Center Center for Maternal Fetal Care Broadway Medical Plaza 4 1705 E. Broadway, Ste. 300 Columbia, MO 65201 573-817-0810 Diana L. Gray Washington University Physicians Center for Outpatient Health Women’s Health Center 4901 Forest Park Ave., Ste. 710 St. Louis, MO 63108 314-454-8181

Rosanna Gray-Swain BJC Medical Group West End Ob/Gyn 1110 Highlands Plaza Dr. E, Ste. 280 St. Louis, MO 63110 314-286-2620 Gil Gross SLUCare Physician Group SSM Health St. Mary’s Hospital–St. Louis Division of Maternal and Fetal Medicine 1031 Bellevue Ave., Ste. 400 St. Louis, MO 63117 314-977-7455 Andrea R. Hagemann Washington University Physicians Center for Advanced Medicine Alvin J. Siteman Cancer Center 4921 Parkview Pl., 13th Fl., Ste. C St. Louis, MO 63110 314-362-3181 Richard A. Hartman SSM Health Medical Group Kirkwood OB/Gyn 816 S Kirkwood Rd., Ste. 100 St. Louis, MO 63122 314-686-4990 John T. Hoff SLUCare Physician Group SSM Health St. Mary’s Hospital–St. Louis Department of Obstetrics, Gynecology and Women’s Health 1031 Bellevue Ave., Ste. 400 St. Louis, MO 63117 314-977-7455 William L. Holcomb SSM Health St. Joseph Hospital–St. Charles Maternal & Fetal Care Center Medical Office Bldg. 1, Ste. 210 330 First Capitol Dr. St. Charles, MO 63301 636-947-5615

M. Brigid HolloranSchwartz SLUCare Physician Group SSM Health St. Mary’s Hospital–St. Louis Department of Obstetrics, Gynecology and Women’s Health 1031 Bellevue Ave., Ste. 400 St. Louis, MO 63117 314-977-7455 William E. Houck Obstetrical Associates of St. Louis South Medical Bldg., Ste. 750 224 S. Woods Mill Rd. Chesterfield, MO 63017 314-576-9797 Sonali Jain SSM Health Medical Group–OB/GYN 3555 Sunset Office Dr., Ste. 107 St. Louis, MO 63127 314-238-9000 Gregory L. Jewell Signature Medical Group ObGyn Physicians– Ballas 621 S. New Ballas Rd., Ste. 695A St. Louis, MO 63141 314-872-7400 Mark J. Jostes Suburban ObGyn 3009 N. Ballas Rd., Ste. 366C St. Louis, MO 63131 314-569-2424 Emily Jungheim Washington University Physicians Fertility and Reproductive Medicine Center 4444 Forest Park Ave., Ste. 3100 St. Louis, MO 63108 314-286-2400 Ming-Shian Kao SLUCare Physician Group SSM Health St. Mary’s Hospital–St. Louis Division of Gynecologic Oncology 1031 Bellevue Ave., Ste. 400 St. Louis, MO 63117 314-977-7455

Sarah L. Keller Washington University Physicians Fertility and Reproductive Medicine Center 4444 Forest Park Ave., Ste. 3100 St. Louis, MO 63108 314-286-2400 Chi Y. Kim Missouri Baptist Medical Center Department of Obstetrics and Gynecology 3015 N. Ballas Rd. St. Louis, MO 63131 314-996-5000 Laurie A. Klabi Signature Medical Group Healthcare Group for Women Bldg. D, Ste. 600 3023 N. Ballas Rd. St. Louis, MO 63131 314-567-7018 Claudia C. Krasnoff Suburban ObGyn 3009 N. Ballas Rd., Ste. 366C St. Louis, MO 63131 314-569-2424 Christine Ladd Suburban ObGyn 3009 N. Ballas Rd., Ste. 366C St. Louis, MO 63131 314-569-2424 Donald H. Lange Mercy Clinic Ob/Gyn– Sunset Hills 10777 Sunset Office Dr., Ste. 200 St. Louis, MO 63127 314-842-4802 Paul G. LaPoint Obstetrical Associates of St. Louis South Medical Bldg., Ste. 750 224 S. Woods Mill Rd. Chesterfield, MO 63017 314-576-9797

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Š2019 SSM Health. All rights reserved. ACC-SYS-19-606703 8/19

My doctor

listens and understands.

Selecting the right primary care provider is one of the best things you can do for your health and right now we have several area providers accepting new patients and offering next-day appointments. At SSM Health, we believe knowing you better as a person helps us treat you better as a patient.

We listen and learn to provide you and your loved ones the compassionate care you deserve.

Visit ssmhealth.com/GetCare to locate a primary care provider near you or to schedule an appointment.

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Cherie A. LeFevre SLUCare Physician Group SSM Health St. Mary’s Hospital–St. Louis Department of Obstetrics, Gynecology and Women’s Health 1031 Bellevue Ave., Ste. 200 St. Louis, MO 63117 314-977-7455 Fah Che Leong SLUCare Physician Group SSM Health St. Mary’s Hospital–St. Louis Division of Urogynecology 1031 Bellevue Ave., Ste. 200 St. Louis, MO 63117 314-977-7455 David J. Levine Mercy Clinic Minimally Invasive Gynecology Medical Tower A, Ste. 499 621 S. New Ballas Rd. St. Louis, MO 63141 314-251-7650 Edward S. Levy SSM Health Medical Group Kirkwood OB/Gyn 816 S. Kirkwood Rd., Ste. 100 St. Louis, MO 63122 314-686-4990 Scott A. Lieberman SSM Health Medical Group–OB/GYN 12277 DePaul Dr., Ste. 305 Bridgeton, MO 63044 314-344-7585 Julio Ricardo Loret de Mola SIU Fertility and IVF Center 751 N. Rutledge St., Ste. 0100 Springfield, IL 62702 217-545-8000 Jerry L. Lowder Washington University Physicians Center for Outpatient Health Women’s Health Center 4901 Forest Park Ave., Ste. 710 St. Louis, MO 63108 314-747-1402

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Becky K. Lynn SLUCare Physician Group SSM Health St. Mary’s Hospital–St. Louis Department of Obstetrics, Gynecology and Women’s Health 1031 Bellevue Ave., Ste. 200 St. Louis, MO 63117 314-977-7455 George A. Macones Washington University Physicians Center for Outpatient Health Women’s Health Center 4901 Forest Park Ave., Ste. 710 St. Louis, MO 63108 314-454-8181 Tessa E. Madden Washington University Physicians Center for Outpatient Health Women’s Health Center 4901 Forest Park Ave., Ste. 710 St. Louis, MO 63108 314-362-4211 Margaret Marcrander Mercy Clinic OB/Gyn Medical Tower B, Ste. 4017 621 S. New Ballas Rd. St. Louis, MO 63141 314-872-9192 Carolyn Martin Mercy Clinic Maternal and Fetal Medicine Medical Tower B, Ste. 2007 621 S. New Ballas Rd. St. Louis, MO 63141 314-991-5000 L. Stewart Massad Washington University Physicians Center for Advanced Medicine Alvin J. Siteman Cancer Center 4921 Parkview Pl., 13th Fl., Ste. C St. Louis, MO 63110 314-362-3181

Leslie McCloskey SLUCare Physician Group SSM Health St. Mary’s Hospital–St. Louis Department of Obstetrics, Gynecology and Women’s Health 1031 Bellevue Ave., Ste. 400 St. Louis, MO 63117 314-977-7455 Daniel S. McDonald SSM Health Medical Group Kirkwood OB/Gyn 816 S. Kirkwood Rd., Ste. 100 St. Louis, MO 63122 314-686-4990 Mary McLennan SLUCare Physician Group SSM Health St. Mary’s Hospital–St. Louis Division of Urogynecology 1031 Bellevue Ave., Ste. 400 St. Louis, MO 63117 314-977-7455 Colleen P. McNicholas Planned Parenthood of the St. Louis Region and Southwest Missouri 4251 Forest Park Ave. St. Louis, MO 63108 314-531-7526 Denise A. Meckler BJC Medical Group Ob/Gyn Associates 9450 Manchester Rd., Ste. 206 St. Louis, MO 63119 314-725-9300 Diane F. Merritt Washington University Physicians Center for Outpatient Health Women’s Health Center 4901 Forest Park Ave., Ste. 710 St. Louis, MO 63108 314-273-4724 Jennifer A. Meyer Missouri Baptist Healthcare Center Women’s Care Consultants Bldg. D, Ste. 120 3023 N. Ballas Rd. St. Louis, MO 63131 314-432-3669

Laura Moore St. Luke’s Hospital Department of Obstetrics and Gynecology 232 S. Woods Mill Rd. Chesterfield, MO 63017 314-434-1500 Caroline Morgan Women’s Health Care West Medical Bldg., Ste. 68 226 S. Woods Mill Rd. Chesterfield, MO 63017 314-576-0930 Jeffrey S. Mormol Professionals in OBGYN 3844 S. Lindbergh Blvd., Ste. 125 Sunset Hills, MO 63127 314-842-0340 Dorothea J. Mostello SLUCare Physician Group SSM Health St. Mary’s Hospital–St. Louis Division of Maternal and Fetal Medicine 1031 Bellevue Ave., Ste. 400 St. Louis, MO 63117 314-977-7455 Karuna Murray Women’s Oncology Care Walker Medical Bldg., North Tower, Ste. 325 12855 N. 40 Dr. St. Louis, MO 63141 314-989-9244 David G. Mutch Washington University Physicians Center for Advanced Medicine Alvin J. Siteman Cancer Center 4921 Parkview Pl., 13th Fl., Ste. C St. Louis, MO 63110 314-362-3181 D. Michael Nelson Washington University Physicians Center for Outpatient Health Women’s Health Center 4901 Forest Park Ave., Ste. 710 St. Louis, MO 63108 314-454-8181

Randall R. Odem Washington University Physicians Fertility and Reproductive Medicine Center 4444 Forest Park Ave., Ste. 3100 St. Louis, MO 63108 314-286-2400 Kenan R. Omurtag Washington University Physicians Fertility and Reproductive Medicine Center 4444 Forest Park Ave., Ste. 3100 St. Louis, MO 63108 314-286-2400 Jay Padratzik Mercy Clinic OB/Gyn Medical Tower B, Ste. 4017 621 S. New Ballas Rd. St. Louis, MO 63141 314-872-9192 Meera R. Patel BJC Medical Group Ob/Gyn Associates 9450 Manchester Rd., Ste. 206 St. Louis, MO 63119 314-725-9300 Carlton S. Pearse Women’s Health Care West Medical Bldg., Ste. 68 226 S. Woods Mill Rd. Chesterfield, MO 63017 314-576-0930 Diane M. Petersen SLUCare Physician Group SSM Health St. Mary’s Hospital–St. Louis Department of Obstetrics, Gynecology and Women’s Health 1031 Bellevue Ave., Ste. 400 St. Louis, MO 63117 314-977-7455 Timothy Philpott Missouri Baptist Medical Center Women’s Care Consultants Bldg. D, Ste. 120 3023 N. Ballas Rd. St. Louis, MO 63131 314-432-3669

Blase J. Pignotti West County OB/GYN Specialists Medical Tower B, Ste. 75 621 S. New Ballas Rd. St. Louis, MO 63141 314-251-7564 Aaron J. Pile 10135 W. Florissant Ave. St. Louis, MO 63136 314-521-1444 Matthew A. Powell Washington University Physicians Center for Advanced Medicine Alvin J. Siteman Cancer Center 4921 Parkview Pl., 13th Fl., Ste. C St. Louis, MO 63110 314-362-3181 Carolyn Pryor SSM Health Medical Group–OB/GYN 12277 DePaul Dr., Ste. 503 Bridgeton, MO 63044 314-344-7700 Jamie L. Puckett Boonslick Medical Group–Obstetrics & Gynecology Medical Office Bldg. 3, Ste. 100 201 BJC St. Peters Dr. St. Peters, MO 63376 636-916-8200 Jodie Rai Women’s Healthcare Consultants Bldg. C, Ste. 352 3009 N. Ballas Rd. St. Louis, MO 63131 314-395-8192

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Roxane M. Rampersad Missouri Baptist Medical Center Center for Women’s Wellness Bldg. D, Ste. 450 3023 N. Ballas Rd. St. Louis, MO 63131 314-996-6000 Valerie Ratts Washington University Physicians Fertility and Reproductive Medicine Center 4444 Forest Park Ave., Ste. 3100 St. Louis, MO 63108 314-286-2400

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Amy J. Ravin SLUCare Physician Group SSM Health St. Mary’s Hospital–St. Louis Department of Obstetrics, Gynecology and Women’s Health 1031 Bellevue Ave., Ste. 400 St. Louis, MO 63117 314-977-7455 Angela Reining Missouri Baptist Healthcare Center Women’s Care Consultants Bldg. D, Ste. 120 3023 N. Ballas Rd. St. Louis, MO 63131 314-432-3669 Margaret Ann Rempe Signature Medical Group Healthcare Group for Women Bldg. D, Ste. 600 3023 N. Ballas Rd. St. Louis, MO 63131 314-567-7018 Ann Marie Rockamann Signature Medical Group Healthcare Group for Women Bldg. D, Ste. 600 3023 N. Ballas Rd. St. Louis, MO 63131 314-567-7018 Amy H. Ruggeri Mercy Clinic Women’s Health Medical Tower A, Ste. 499 621 S. New Ballas Rd. St. Louis, MO 63141 314-329-0894 Andrea Sample SSM Health Medical Group–OB/GYN 12277 DePaul Dr., Ste. 305 Bridgeton, MO 63044 314-344-7585 Caren P. Schaecher BJC Medical Group Women’s Health Care 3009 N. Ballas Rd., Ste. 360C St. Louis, MO 63131 314-576-0930

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Evelyne Gabriele Schuetz Boonslick Medical Group–Obstetrics & Gynecology Medical Office Bldg. 3, Ste. 100 201 BJC St. Peters Dr. St. Peters, MO 63376 636-946-3089 Katherine M. Scolari Childress SLUCare Physician Group SSM Health St. Mary’s Hospital–St. Louis Division of Maternal and Fetal Medicine 1031 Bellevue Ave., Ste. 400 St. Louis, MO 63117 314-977-7455 Mitul Shah SLUCare Physician Group SSM Health St. Mary’s Hospital–St. Louis Department of Obstetrics, Gynecology and Women’s Health 1031 Bellevue Ave., Ste. 400 St. Louis, MO 63117 314-977-7455 Becky Shelton Mercy Clinic Women’s Health 1000 Des Peres Rd., Ste. 300 St. Louis, MO 63131 314-919-2600 Sarah B. Shores Signature Medical Group Allied Associates Ob/Gyn Tower A, Ste. 101 621 S. New Ballas Rd. St. Louis, MO 63141 314-569-2751 Jaye M. Shyken SLUCare Physician Group SSM Health St. Mary’s Hospital–St. Louis WISH Center 1035 Bellevue Ave., Ste. 205 St. Louis, MO 63117 314-768-8230

Jennifer H. Smith Consultants in Women’s Health Care 3023 N. Ballas Rd., Ste. 440D St. Louis, MO 63131 314-432-8181

David L. Super Mercy Clinic Ob/Gyn– Sunset Hills 10777 Sunset Office Dr., Ste. 200 St. Louis, MO 63127 314-842-4802

Kent L. Snowden Mercy Hospital St. Louis Saint Louis Associates in ObGyn Medical Tower A, Ste. 584 621 S. New Ballas Rd. St. Louis, MO 63141 314-993-6401

Premal Thaker Washington University Physicians Center for Advanced Medicine Alvin J. Siteman Cancer Center 4921 Parkview Pl., 13th Fl., Ste. C St. Louis, MO 63110 314-362-3181

Tammy Sonn Washington University Physicians Center for Outpatient Health Women’s Health Center 4901 Forest Park Ave., Ste. 710 St. Louis, MO 63108 314-362-4211

Jeffrey B. Thompson Obstetrical Associates of St. Louis South Medical Bldg., Ste. 750 224 S. Woods Mill Rd. Chesterfield, MO 63017 314-576-9797

Andrew C. Steele SLUCare Physician Group SSM Health St. Mary’s Hospital–St. Louis Division of Urogynecology 1031 Bellevue Ave., Ste. 400 St. Louis, MO 63117 314-977-7455

Michael Thomure SLUCare Physician Group SSM Health St. Mary’s Hospital–St. Louis Division of Reproductive Endocrinology and Infertilty 1031 Bellevue Ave., Ste. 400 St. Louis, MO 63117 314-977-7455

Holly L. Steiner Washington University Physicians Center for Outpatient Health Women’s Health Center 4901 Forest Park Ave., Ste. 710 St. Louis, MO 63108 314-362-4211 Andrea L. Stephens St. Luke’s Hospital Women’s Care of St. Luke’s 226 S. Woods Mill Rd., Ste. 55W Chesterfield, MO 63017 314-542-4953 Eric Strand Washington University Physicians Center for Outpatient Health Women’s Health Center 4901 Forest Park Ave., Ste. 710 St. Louis, MO 63108 314-362-4211

Tracy M. Tomlinson SLUCare Physician Group SSM Health St. Mary’s Hospital–St. Louis Division of Maternal and Fetal Medicine 1031 Bellevue Ave., Ste. 400 St. Louis, MO 63117 314-977-7455 Amanda S. Trudell BJC Medical Group Town & Country Perinatology Bldg. C, Ste. 351 3009 N. Ballas Rd. St. Louis, MO 63131 314-996-6800 Jacqueline S. Turner BJC Medical Group West End Ob/Gyn 1110 Highlands Plaza Dr. E, Ste. 280 St. Louis, MO 63110 314-286-2620

Dionysios K. Veronikis Gynecologic and Reconstructive Surgery Medical Tower B, Ste. 2002 621 S. New Ballas Rd. St. Louis, MO 63141 314-251-6753 Karen A. Voegtle BJC Medical Group Women’s Health Care 3009 N. Ballas Rd., Ste. 360C St. Louis, MO 63131 314-576-0930 Laura K. Vricella SLUCare Physician Group SSM Health St. Mary’s Hospital–St. Louis Division of Maternal and Fetal Medicine 1031 Bellevue Ave., Ste. 400 St. Louis, MO 63117 314-977-7455 Corey A. Wagner Mercy Clinic Minimally Invasive Gynecology Medical Tower A, Ste. 499 621 S. New Ballas Rd. St. Louis, MO 63141 314-251-7650 Daniel G. Wagner Obstetrical Associates of St. Louis South Medical Bldg., Ste. 750 224 S. Woods Mill Rd. Chesterfield, MO 63017 314-576-9797 Donald Gregory Ward SLUCare Physician Group SSM Health St. Mary’s Hospital–St. Louis Department of Obstetrics, Gynecology and Women’s Health 1031 Bellevue Ave., Ste. 400 St. Louis, MO 63117 314-977-7455 Gary M. Wasserman Mercy Clinic OB/Gyn Medical Tower B, Ste. 4017 621 S. New Ballas Rd. St. Louis, MO 63141 314-872-9192

David L. Weinstein Consultants in Women’s Health Care 3023 N. Ballas Rd., Ste. 440D St. Louis, MO 63131 314-432-8181 Denise Willers Washington University Physicians Center for Outpatient Health Women’s Health Center 4901 Forest Park Ave., Ste. 710 St. Louis, MO 63108 314-362-4211 Barry I. Witten The Sher Institute for Reproductive Medicine 555 N. New Ballas Rd., Ste. 150 St. Louis, MO 63141 314-983-9000 Francisco P. Xynos SLUCare Physician Group SSM Health St. Mary’s Hospital–St. Louis Division of Gynecologic Oncology 1031 Bellevue Ave., Ste. 400 St. Louis, MO 63117 314-977-7455 Pericles Xynos SLUCare Physician Group SSM Health St. Mary’s Hospital–St. Louis Department of Obstetrics, Gynecology and Women’s Health 1031 Bellevue Ave., Ste. 400 St. Louis, MO 63117 314-977-7455 Patrick Yeung Jr. SLUCare Physician Group SSM Health St. Mary’s Hospital–St. Louis Department of Obstetrics, Gynecology and Women’s Health 1031 Bellevue Ave., Ste. 400 St. Louis, MO 63117 314-977-7455 Casey Younkin HSHS St. John’s Health Center SIU OB/GYN 1100 Lincolnshire Blvd., Ste. 200 Springfield, IL 62703 217-545-8000

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400945 BJH

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Paris had Madame de Staël and Gertrude Stein. St. Louis has Lana Pepper.

BY JEANNETTE COOPERMAN PHOTOGRAPHY BY KEVIN A . ROBERTS

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His musical Merrily We Roll Along has returned to the stage, and Stephen Sondheim has invited Lana Pepper to the opening-night party. She’s stunned, and she knows he’ll be thronged with fans, so she barely expects a nod—but they wind up chatting all evening. When she says, “I see you value friendship the way I do,” he leans forward. “I just looked back at my body of work,” he says, “and I think it’s all about friendship.”

A few times, Sondheim breaks off to chat with various celebrities. Pepper recognizes J.T. Rogers, whose play Oslo was just staged in St. Louis. Dazed, she turns to the woman seated next to her, a stranger until that evening, and whispers, “How did I get here? My mother grew up in a house with dirt floors!”

Technically, the journey was straightforward: Pepper was president of the Saint Louis University Library Associates board for years, and she hosted a dinner for Sondheim when he flew in to receive the organization’s 2018 St. Louis Literary Award. Hearing that he drank vodka, she was dismayed—“All we had was rotgut”—and raced out to get something finer. That evening, Sondheim poured himself a glass of white wine. “But you drink vodka!” she exclaimed in dismay, and he shook his head sadly: “Can’t drink that anymore.”

Pepper nodded. “We’re in the age of subtraction,” she said, and they fell into a long conversation about aging, giving up little indulgences, losing friends, facing death. Later, he asked if she’d made up “the age of subtraction” herself and warned that he might steal it.

Now, as he chats with Rogers, she thinks about the arc of her own life, and her favorite Sondheim lyrics come back to her: “Bit by bit, putting it together/Piece by piece, only way to make a work of art.” Her first bit was her childhood in Boss, Missouri, and the one-room schoolhouse built of thick-mortared gray stones as a work project during the Depression. Eight grades, one teacher. All she remembers learning is how to teach the younger kids to read. She begged her parents hard

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to send her to Salem, a bigger high school. The Sunday after graduation, she moved to St. Louis.

What she wanted was this: music, drama, compelling ideas, interesting people to talk to, and dinner someplace besides White Castle, where her high school boyfriend took her with a flourish when he snagged a job at the Chevy plant in St. Louis. If he hadn’t dumped her, she’s dead sure she would have wound up living “in a kid-filled trailer in my parents’ backyard,” not starting the St. Louis Shakespeare Festival, directing plays, organizing galas, and flying to New York to hang with Stephen Sondheim.

Pepper isn’t religious; her dad was the only professed atheist in Boss. (Also the man all the Christians turned to when they needed help or mercy.)

Her life doesn’t feel predestined to her, or even

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“First of all, you need a good foundation.”

porous enough for divine intervention. As far as she can tell, the forces at work have been love, grit, and the kind of optimism that creates luck.

Everything that happens to you, she believes, is the upshot of a lot of tiny decisions made along the way. “Every moment makes a contribution,” as Sondheim put it. “Every little detail plays a part.”

The woman next to her smiles, maybe a little too politely, at the “dirt floors” remark. Pepper is used to people not knowing quite how to respond to her directness. It’s weird, and sometimes a little lonely, moving between such different worlds—especially when you’re the sort to blurt the honest truth. There have been so many times she could easily have held it back, faked a background she never had.

Except, the way she got here was by being herself.

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Lana’s mother warms a blanket on an enameled wood stove—fancy for the country, a Heatilator. Wrapping it around Lana, who’s just learning to walk, she carries her upstairs to bed. The added warmth is necessary: The only heat on the second story comes from the chimney. But the memory of being swaddled in that blanket will warm Lana for the rest of her life.

Their next house, her dad builds himself, board by board. Her mother glories in it, sweeping and polishing in supreme contentment. She’s not especially curious about the larger world, just happy to be running her own house. One of the prettiest girls in Boss, she married late, because she had to keep house for 12 brothers. She hadn’t even gone to grade school, because she had no shoes. The house she grew up in had cracks in the wall so wide that the snow blew in, and they’d wake up with icy white flakes on their blankets.

Lana’s dad reads like he’s starving and books are steak and potatoes. He fills all available space with newspapers and magazines, understands history, worries about current events. His daughter catches his enthusiasm but isn’t yet sure what to do with it.

He runs a general store in Boss, and he brings Lana whenever he drives to St. Louis to buy dented canned goods at the salvage store. Her little nose wrinkles and she laughs in delight when they drive Continued on p. 124

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Join us for an

Open House Sunday, November 3 | 1-3pm

Grades PreK-8

Grades 9-12

501 Bacon Avenue St. Louis, MO 63119

2845 N. Ballas Road St. Louis, MO 63131

Our individualized programs are designed to empower unique learners by building confidence and a foundation for success.

Come tour our schools, visit with our faculty and staff, and hear life-changing stories from our current families. No reservations necessary - we look forward to seeing you!

(314) 968-3893 | miriamstl.org

One of a Kind OPEN HOUSE: A TASTE OF FORSYTH Saturday, October 26 9:30–11:30am AGE 3–GRADE 6

ForsythSchool.org 6235 Wydown Blvd. | St. Louis, MO 63105 Wydown-Forsyth Historic District

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EARLY CHILDHOOD OPEN HOUSE Saturday, January 11 9:30–11:30am

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