2018 Women's Health

WOMEN’S HEALTH YO U R G U I D E T O W E L L N E S S

What if I hate being in my fifties? What

f I have a major hot f lash in my meeting? What if

verything starts to sag? What if my husband doesn’t

hink I’m sexy anymore? What if my bones get brittle?

What if my estrogen dips and I get moody and nauseous?

What if I’m not ready for the senior discount? What if

his is the best

time of my l ife ?

Introducing the region’s most advanced new center dedicated to women’s health with state-of-the-art diagnostic tools and screenings designed for every stage of your life.

Where our team of experts who have seen it all are prepared for every what if.

Barnes-Jewish Hospital Washington University Physicians

CONTENTS

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10

ACTING FAST

WOMEN

How Krysta Owings overcame a stroke at age 25

R E A L LY A R E

4 MAKING MOTHERHOOD

DIFFERENT And including them in medical research is leading to breakthroughs.

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WORK

H E A LT H Y

Why it’s not up to moms to resolve work/family conflict

DISTRACTION

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WOMEN’S HEALTH

With curiosity, enthusiasm, and a sense of purpose, Marylen Mann has changed the definition of old age.

MOVERS & SHAKERS Advice on healthy, happy living from three successful St. Louisans

October 2018 stlmag.com

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WOMEN’S HEALTH

RESILIENCE

ACTING FAST How Krysta Owings overcame a stroke at age 25 up at dawn on Sunday for a horse show, sweating all

day—Krysta Owings was thrilled to have Monday off. She and her black lab, Willow, went for a morning walk. But as Owings eased into the day, she realized that her hands weren’t keeping up with her brain. “It was, ‘OK, hands, do this.’ Why aren’t they doing it? Oh, OK, now they are.”

She felt almost drunk, off balance. She ordered Jimmy John’s and asked the delivery guy to fill in the tip because her vision was starting to blur.

Not for one second did she think she might be having a stroke.

She was 25 years old, and her entire family was ridiculously healthy. No heart attacks, no major diseases; she couldn’t even remember a health scare.

But she couldn’t imagine what was wrong with her.

She called a friend and asked, “Do I sound OK?” “You’re talking kind of slowly,” the friend said. “How about we run you over to urgent care?”

Owings made a token protest but caved fast. By the time they reached the urgent care clinic, she was stumbling and couldn’t even manage to sign in. The doctor who examined her said, “Hmm,” and sent in another doctor…After a few more basic tests, a new urgency entered their voices. She needed to get to a hospital.

Now. By ambulance.

At the hospital, scans suggested an AVM—an arteriovenous malformation, a mutation of blood vessels that causes them to tangle. Owings’ mother called everybody she knew, looking for an expert, and found Dr. Gregory

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Zipfel, a Washington University neurosurgeon. Owings was transferred to Barnes-Jewish Hospital.

Meanwhile, her best friend from seventh grade was out of the country but flew home. “You’re crazy!” Owings said. “Go back!” But her friend wasn’t so crazy to be concerned. Owings did indeed have an AVM: It had burst, and blood was leaking into her brain, which was swollen. Every day, she lost more of her vision, more use of her left side, more ability to think.

Zipfel did a craniotomy, cutting out a piece of her skull, removing the tangle of vessels and spilled blood, then fastening a titanium plate. She woke up with “the worst headache in the world,” and it took a week of physical therapy before she could even walk again. When she looked at a clock, her mind stayed blank, unable to fathom what time it indicated. After physical therapy came speech therapy and occupational therapy. “Your brain has to rewire,” she was told. “It has to reconnect.”

As the days passed, Owings began to sense those connections reforming: “You actually feel it in your brain!

It’s like little sparks.” Now she’s back “100 percent,” she says—and then some. “Before, shyness stopped me from taking risks. Talking to a roomful of people, that was not me. But when it turns into something you care about, you’re not afraid.”

So she’s out there, educating others about what she’d never dreamed was possible. “Kids younger than 10 can have strokes,” she points out—and knowing that makes it easier to act fast. —JEANNETTE COOPERMAN

Photography by Jay Fram

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WOMEN’S HEALTH

WORK/LIFE BALANCE

MAKING MOTHERHOOD WORK Why it’s not up to moms to resolve the work/family conflict

BY SARAH KLOEPPLE

for her forthcoming book, Making Motherhood Work: How Women Manage Careers and Caregiving (Princeton University Press, February 2019), Washington University associate professor of sociology Caitlyn Collins interviewed 135 working mothers in the United States, Germany, Sweden, and Italy. She asked how they managed to juggle work and family life. After researching cultural attitudes and government policies, Collins found that the U.S. lags in support for working mothers. It’s not moms who need new strategies for balancing work and family, she concluded; it’s the attitudes and policies that need to change.

WHAT COUNTRIES HAVE MORE HELPFUL APPROACHES? That depends on what women want. Take parental leave: If women want a lengthy period of leave (up to three years) after childbirth, Germany is your best bet.

If women want to take paid parental leave after having a baby and would like their partner to do the same (sharing 480 days between them), Sweden’s policies best align. If women want a few months’ leave, Italy is your place.

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IF YOU COULD WAVE A MAGIC WAND, WHAT WOULD YOU CHANGE HERE? Without hesitation, I would implement universal, affordable, high-quality childcare. Study after study shows that quality early childhood care sets children up for success in life, which benefits us all. Our whole society (including businesses and the national economy) does better when children are raised well: It enhances parents’ ability to work

and improves children’s outcomes.

We lag far behind every other Western industrialized country in coming to this realization.

WHY? Mothers in the U.S. tend to blame themselves for their work/ family conflict. Mothers in Italy, Sweden, and Germany do not.

American moms thought it was their fault that they were stressed to the max and at their wits’ end, that they simply needed to try harder, read another parenting book or listen to just the right podcast, and they could “have it all.”

We need change at a societal level.

ONLINE: The difference a partner can make—and why the angst of work/family conflict is not inevitable.

WOMEN’S HEALTH

FITNESS

MOVERS & SHAKERS A D V I C E O N H E A LT H Y, H A P P Y L I V I N G F R O M T H R E E S U C C E S S F U L S T. L O U I S A N S

BY ALLEX SAMMULI PHOTOGRAPHY BY MATT MARCINKOWSKI

LORI CHALUPNY Head women’s soccer coach, Maryville University Chalupny is no stranger to intensive workouts and rigorous training. After winning Olympic gold and playing with the Chicago Red Stars, she returned to her hometown to coach the Maryville Saints. Though she spends most of her time “telling other people to run,” she remains active, often working out with others outdoors. She starts her day with a good breakfast, and for motivation, she heeds her own coaching advice: “Attitude is everything. You decide how you want to react.”

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SUE McCOLLUM Chairman and CEO, Major Brands “For a business owner, life can feel like a marathon,” says McCollum, head of the state’s largest premium spirits distributor. “Fitness and self-care are important.”

McCollum attends three onehour strength-training sessions each week at Kirkwood’s Central Institute for Human Performance, where she does strengthening and wellness exercises. McCollum also carves out time to enjoy the outdoors, often taking bike rides in Forest Park. And on days when she’s not with a trainer, she begins her mornings with a brisk jog on the treadmill and a cup of coffee.

October 2018 stlmag.com

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WOMEN’S HEALTH

FITNESS

SHIRLEY WASHINGTON News anchor, KTVI (FOX 2) Despite long hours, Washington makes time to work out. “Everybody should find at least 15 minutes a day,” she says, underscoring the importance of consistency. Her regimen includes squats, planks, cardio, and weightlifting. On extra-busy days, she might go for a bike ride or take a walk. She also likes to experiment in the kitchen, incorporating leafy greens into Southern cuisine to stay heart-healthy. And she emphasizes body positivity: “Don’t compare yourself to anyone else,” she urges. “How you see yourself is what’s most important.”

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Photography by Matt Marcinkowksi

NOMINATE a NURSE

HOW HAS A NURSE IMPACTED YOUR LIFE? St. Louis Magazine is looking to honor nurses who go above and beyond the call of duty—whether it be a nurse ST. LOUIS MAGAZINE’S 2019

from a private practice, hospital system, or school; a nurse who specializes in home care, pediatrics, surgery, or education. Help recognize those who provide outstanding care by submitting a nomination for SLM ’s 2019 Excellence in Nursing Awards.

To make a nomination and for more information, visit STLMAG.COM/NURSES.

WOMEN’S HEALTH

RESEARCH

WOMEN REALLY ARE DIFFERENT AND INCLUDING THEM IN CLINICAL STUDIE S IS LEADING TO BREAKTHROUGHS.

BY JEANNETTE COOPERMAN

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until the 1990s, women were

regularly excluded from clinical trials because it was assumed that their menstrual cycles would introduce too much variability.

“That was the dogma,” says Dr. Jeffrey Henderson, associate professor of medicine at Washington University. “Then there was a sea change at the National Institutes of Health, and it was no longer regarded as legitimate. Now there’s more equity—but we still have an inheritance of studies and drug approvals based on men only.”

Slowly, as new results accumulate, we’re learning more about women’s bodies, men’s bodies, and the distinct differences between them. Men respond better to ibuprofen. (We’re still not sure what works better for women.) Pain-syndrome diseases—such as fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and interstitial cystitis—affect women more often, though we’re still not sure why.

Same with some autoimmune diseases, such as lupus and rheumatoid arthritis. Heart attacks present with very different, much vaguer symptoms in women. And in his work at the Center for Women’s Infectious Disease Research, Henderson has learned that the strains of Escherichia coli that cause urinary tract infections in men are genetically different than those infecting women. “Which surprised us,” he adds. “Nobody had ever thought to compare them.”

What causes these differences? “To some degree, with UTIs, it could be anatomical,” Henderson says, “but some researchers think men’s bodies respond differently to the presence of bacteria in the urinary tract. These bacteria are very clever: They have figured out ways to get around immune responses, and they may have

come up with different countermeasures in men and in women.”

The center focuses on UTIs because “they weren’t always taken as seriously as they should be,” Henderson says. “And that becomes a greater issue as these bacteria become resistant to antibiotics.”

The current mission is to find treatment alternatives. Not only are antibiotics losing efficacy, but they also strip our bodies of healthy and necessary bacteria.

That can lead to yeast infections or, more miserably, Clostridium difficile infection, which “almost exclusively shows up in people who’ve received antibiotics and which is intrinsically resistant to a lot of antibiotics.” There are still a few that work, and if they don’t, there’s (brace yourself) the possibility of a fecal transplant.

Doctors often use healthy spouses for these enema-borne transplants. “It’s hard to study, because there’s no standard stool donor,” Henderson says. “But in general, it appears to work.” The good bacteria hop out of the feces and colonize their new home, crowding out the C. diff.

“We obtained more than 100 fecal specimens from patients with and without C. diff., trying to understand if there’s some protective factor,” he adds. “I work with a mathematician who’s using the same techniques he used for looking at voting patterns in Congress.”

Next, the hope is to develop vaccines and “therapeutics that target bacteria more carefully, sparing the good bacteria.” Henderson calls them antivirulence agents, not antibiotics, because they don’t necessarily kill the bacteria. “They might carefully prevent it from colonizing the urinary tract,” he explains, “or from turning on dangerous functions while they’re there.”

Meanwhile, he’s studying UTIs to figure out why some E. coli strains do profound damage and others don’t. He grows various sorts of E. coli in a liquid medium, then analyzes the liquid to see what the bacteria secreted into it.

“We keep finding new things,” he says. “They’re very adept at modifying their environment— sometimes to steal nutrients from their host; sometimes to make white blood cells less effective at killing them.”

Many E. coli are especially good at binding to the iron in our bodies because they need it to survive.

Yet some patients manage to hold on to their iron. How? “We’ve found a protein that’s secreted by your body when you have a UTI,” Henderson says, “and this protein will bind iron.” It works well for some people, not for others. His team analyzed the urine of those who’d defeated the E. coli and found a pH difference, as well as compounds that come from diet but are modified by bacteria in the gut. “There’s a whole ecosystem here.”

Even more excitement rippled through the lab when Henderson’s team found a secreted molecule that no one had described before. “We went back through the literature and found a match: a compound a German chemist had made a decade earlier, while he was trying to develop antivirulence bacteria. Nobody knows it was a natural product made by bacteria in the urine!”

The chemist was delighted to learn that bacteria can secrete their own version of the antibiotic he was designing. It’s more precise than anything in our pharmacopeia, laser-focusing on a single bacterium that targets people who’ve received a lot of antibiotics.

The hope is that we can learn to do the same.

October 2018 stlmag.com

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WOMEN’S HEALTH

REFLECTION

HEALTHY DISTRACTION With curiosity, enthusiasm, and a sense of purpose, Marylen Mann has changed the definition of old age.

BY JEANNETTE COOPERMAN

the challenge s started

early: A fencing accident in girlhood left Marylen Mann with lifelong lymphedema. She’s since used all sorts of subterfuge to outwit gravity. Too much standing at a cocktail party? She’ll find a creative excuse to move around or prop up her foot on a chair. Only those close to her—such as her

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sweet-hearted second husband, Frank Jacobs, who tugs off her compression mold every night and has demanded a nurse’s cap— know why Mann, an art collector with exquisite fashion sense, avoids dresses. “I don’t want to be defined by my health problems,” she says firmly. “You have to treat it like a sitcom.”

Mann believes in humor. She’s needed to. Her first husband died when her boys were teens, and she spent 19 years widowed before meeting Jacobs. In 2011, her 45-year-old son and confidante, John, died of brain cancer. She poured out her feelings to her husband and good friends. “It’s the bottling up that’s destructive,” she says. Mann then threw her energy into projects that her son had cared about, such as Lift for Life Academy.

She had her own projects, too.

Appalled that kindergarten crafts and bingo were the main options for older adults, Mann founded Oasis in 1982. The program spread across the nation, lighting up retirees’ brains with philosophy, arts, history, current events, new skills, and her own strong emphasis on health and volunteer tutoring.

Now, she wants to reach those who don’t show up. “Everywhere I go, people say, ‘My husband retired, and now he just sits,’ or ‘My mother’s not interested in anything anymore,’” Mann says.

“Loss—of routine, of identity— brings isolation.” Everybody’s solution is different, she adds. “Take an inventory: What did you love doing but have to stop? What have you always wished you could try? What would be an adventure?”

A 2007 delegate to the United Nations Conference on Economics and Aging, Mann has received two doctorates of humane letters and this fall will accept the Missouri History Museum’s Thomas Jefferson Award.

Meanwhile, she’s learning bridge and developing a new Oasis program on hospice and palliative care.

The other night, the idea of “a one-day university” woke her from a sound sleep. She grins, gives a little shrug. “I feel very strongly that we are here to make this a better place,” she says, “and if I’m figuring out how to do that, I’m not focusing on myself.”

Photography by Kevin A. Roberts

Personalized Women’s Care is Your Best Medicine SM

When it comes to women’s health, it’s important you feel comfortable with your specialist. Our OB/GYN team is approachable and compassionate. And, they have access to the most advanced tools to provide you with the comprehensive care that you need. As part of BJC HealthCare, our OB/GYN specialists work alongside the area’s leading hospitals and breast health centers, backed by the research and technology of one of the top health care organizations in the country.

Find a Doctor Today BJCMedicalGroup.org 1.855.36.BJCMG (25264)

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