Women's Health Guide

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News & Tips · Breast Cancer · inspiration · A Healthy Mindset · Fitness & Nutrition

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You

schedule

your

gallbladder

surgery.

You request two weeks off from work.

Your parents stay with you to watch the kids. Your surgeon makes one small incision in your belly button. You go home. You call work to say you need another week to recover. You’re left with scars. You get back to what matters.

YOU HA D THE DA V INCI ®

S I N G L E- S I T E ™ E X P E R I E N C E .

For a referral to a physician who performs da Vinci single site gallbladder surgery, call 1-877-311-3280.

To learn more about the benefits and risks of da Vinci surgery, visit WWW.DESPERESHOSPITAL.COM/DAVINCI

Potential risks include conversion to other surgical techniques and multiple incisions.

All surgery presents risk, including da Vinci Surgery. Serious complications may occur in any surgery, up to and including death. Other risks include injury to tissues and organs.

Risks specific to gallbladder surgery, including surgery with da Vinci, include pancreatitis (inflammation of the pancreas); urinary retention and hernia (bulging tissue) at the incision site.1,2 da Vinci Surgery with Single-Site™ Instruments is cleared for use in gallbladder removal, and for hysterectomy and ovary removal for benign conditions. Patients who bleed easily, have abnormal blood clotting, are pregnant or morbidly obese are typically not candidates for minimally invasive surgery, including da Vinci Surgery with Single-Site™ Instruments. Results, including cosmetic results, may vary. Patients should talk to their doctors to decide if da Vinci is right for them. Please refer to www.daVinciSurgery.com/safety for more detailed safety information.

All people depicted unless otherwise noted are models. © 2013 Intuitive Surgical. All rights reserved. Intuitive, Intuitive Surgical, da Vinci, da Vinci S, da Vinci Si, Single-Site, TilePro, FireFly, Skills Simulator, EndoWrist and EndoWrist One are trademarks or registered trademarks of Intuitive Surgical. All other product names are trademarks or registered trademarks of their respective holders.

PN 1003052rA 06/13 1 Wren SM et al. Arch Surg. 2011 Oct;146(10):1122-7. Epub 2011 Jun 20. 2 National Institutes of Health. Gallbladder Removal Surgery. www.nlm.nih.gov/medlineplus/ency/article/002930.htm

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December 2014 Women’s Health News & Tips

a healthy mindset

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Art That Gets Under Your Skin

Dr. Brett Prywitch uses X-rays to diagnose aberrations—but that hasn’t blinded him to their beauty.

Here Comes the Fuzz

Pregnancy brain, menopause brain, chemo brain… They all involve the same symptoms—and for good reason.

By Jeannette Cooperman

By Jeannette Cooperman

10

21

A Second Look

Mind Over Matter

SonoCiné technology can help detect cancer where mammograms can’t.

These games aim to save your brain.

By Sharon Lynn Pruitt

22

Breast Cancer

13

Open Arms

The TaTa Sisterhood carries on Tara Boland’s inspiring legacy.

By Stefene Russell

14

Filling the Gap

Gateway to Hope provides a lifeline for a once-overlooked population.

by Sharon Lynn Pruitt

inspiration

17

By Christy Marshall

Body in Distress, Head in the Sand

The “ostrich effect” can delay treatment and damage prognosis. But it’s a very human impulse.

By Jeannette Cooperman

Fitness & Nutrition

24

Buti’s in the Eye of the Beholder

St. Louis welcomes a new kind of yoga.

By Nancy Curtis

24

An App a Day

A personal trainer’s favorite fitness apps

By Nancy Curtis

Going the Distance

Triathlete Teri Griege never let cancer slow her down.

By Christy Marshall

Cover illustration by margaret berg

4 DECEMB ER 2014 |

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image courtesy of Dr. Brett Prywitch

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News & Tips

Tulip Explosion, made from brain scans

image courtesy of Dr. Brett Prywitch

Art That Gets Under Your Skin Dr. Brett Prywitch uses X-rays to diagnose aberrations—but that hasn’t blinded him to their beauty.

BY Jeannette Cooperman

If you’re a patient, X-rays can strike terror. Somebody in a white coat tacks one up, and boxed light glows through shadowy bones.

You see the empty darkness and mysterious gray structures that work silently on your behalf—and one little white spot that could be nothing, or certain death.

If you’re a radiologist, X-rays are a gentle, bloodless way to make the body give up its secrets.

And if you’re Dr. Brett Prywitch, they’re just a few steps from art.

As a kid, Brett used to draw the athletes pictured on the sports pages. When his grandfather came to babysit and sat still for hours, watching the ballgame on TV, Brett would sketch his portrait.

Art slid away during college and medical school. But Prywitch | D EC E M ber 2014 9

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News & Tips

A Second Look Women with dense breasts might consider more than a mammogram.

BY Sharon Lynn Pruitt Starting next month, healthcare providers across the U.S. will be required to notify women with dense breasts of their risk of developing breast cancer (four to six times higher than women with less-dense breasts) as well as screening options besides mammograms.

“If a woman has dense breast tissue, mammography is less effective than it is in a woman without dense breast tissue,” says Dr. Paula George, a radiologist at Midwest Breast Care, part of St. Luke’s Center for Diagnostic Imaging. “However, mammography is still recommended in these women, as many cancers will be detected on mammography, even in dense tissue. This is especially true for malignant microcalcifications, which are much better

seen on mammography than ultrasound.”

New technology, such as 3-D mammography or tomosynthesis, provides additional options, says George, adding that the center recently installed the technology. “This increases the cancer-detection rate and decreases the callback rates from screening mammography,” she explains. There’s also breast ultrasound, whether handheld or with the SonoCiné automated whole-breast ultrasound. “Both are effective in dense breast tissue,” says George. Studies have shown that supplementing a mammogram with an ultrasound—which requires no breast compression or injections—can as much as double the likelihood of detecting cancer in dense breasts.

image courtesy of Dr. Brett Prywitch

never lost his eye. He became a radiology resident, poring over X-rays, mammograms, and magnetic resonance imaging or computerized tomography scans. “There were so many images I’d never seen before, and they were just beautiful,” he says.

Slices of the brain had the perfect symmetry of a flower. The bones of the rib cage curved like the veins of a leaf. Blood vessels stood out white and pure against the dark cave of the lung.

“It’s nature,” Prywitch says simply. “It’s inherently beautiful. Maybe an abdomen looks grotesque to some people when the body is cut open, but to me, as a radiologist, it can look delicate and beautiful.”

By the time X-ray film went digital, he’d gone back to sketching and photography. A few years ago, his son showed him a few things in Adobe Photoshop, and he started manipulating images.

At first, he stayed with radiology’s black and white. He repeated images, ghosted them, drew on top of them. Then he began adding color. Tulip Explosion he made with sections of the brain. Godspeed, his blue outer-space depiction of Mother Earth, started with a mammogram. The Forest looks like a Gustav Klimt painting, with patches of sky in lapis lazuli blue, and golden trees made of tibias.

Art never colors Prywitch’s initial analysis. “My job as a doctor is to see, when something goes wrong, what’s going on with that particular component,” he says. “I go into problem-solving mode. But sometimes it sparks an idea on the other side of my brain, and in the evening…”

He creates.

He’s currently manipulating an image that suggests the tentacles of canGroucho Marx—a man cer invading of many parts the body. Next comes “a video where those tentacles kind of melt away or resolve, killing the cancer.”

His work’s beginning to draw attention, showing up in exhibits and on journal covers. Sometimes it’s dark, often wondrous, occasionally playful. He even replicated the comic relief of Groucho Marx: “His nose is part of a heart. His ears are from kidneys. His face is an MRI of the wrist, and the teeth are wrist bones.”

Groucho once said, “I intend to live forever, or die trying.”

But it’s a safe bet he never expected a doctor to confer this sort of immortality.

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On the Burner

illustration by margaret berg

St. Louis Magazine’s GUIDE TO WHAT’S HOT IN THE LOCAL DINING SCENE

12 DECEMB ER 2014 |

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Breast Cancer

Open Arms The TaTa Sisterhood carries on Tara Boland’s inspiring legacy.

illustration by margaret berg

By Stefene Russell In 2012, two weeks after Tara and Matt Boland learned that their fourth child was on the way, Tara received a diagnosis of triple-negative breast cancer, an aggressive subtype of breast cancer that often strikes younger women. Tara had 16 chemotherapy treatments during pregnancy, and healthy baby Sam was born in January 2013. As she prepared to undergo a mastectomy and hysterectomy, doctors delivered devastating news: Her cancer had metastasized.

Rather than falling despondent, Tara founded the TaTa Sisterhood (tatasister hood.org), a foundation devoted to supporting women diagnosed with triple-negative breast cancer. The idea got its start when nurses in Mercy Hospital St. Louis’ intensive-care unit raised funds to help the Bolands take a vacation and defray escalating medical costs.

Matt says Tara was determined to help other women going through the same thing.

At first, though, she wasn’t into founding a nonprofit. “I don’t want to have to deal with all the paperwork—if I want to buy someone flowers or a massage or just spoil them, why do I need to prove that to someone?

I’m just going to do it myself,’” Matt recalls her saying. But when people began asking to donate large amounts, she changed her mind, seeing an opportunity to create dramatic long-term change. “You know what?

It’s probably going to be worth that extra work,” Matt remembers her saying. “And

we’re gonna need some help.” Tara found that help in her network of friends.

Tara died on April 10. By that time, her foundation was going strong.

At press time, the TaTa Sisterhood was working with 17 women. “Sometimes, the support we provide is just informational,” Matt says. “We get people who are newly diagnosed connected with women who have already gone through this journey. Some people need financial help. And some folks’ needs change. We’ve been able to tailor our support.”

TaTa Sisterhood also raises money for research, and the board is fundraising to

expand its services. “We are adding three or four women each month,” says Matt, a.k.a. “Head TaTa.” And what does a Head TaTa do? “I try to get out of the way as much as possible!”

Matt says. He then adds, “My job is be the point guy. And it helps to be that person who had an idea of Tara’s original vision.

“Many times, when we’re sitting around going, ‘How do we handle this? What do we do next?’ we ask ourselves, ‘What would Tara do?’ And that’s pretty easy when you’ve known her for so long. She’d say, ‘Focus on taking care of the people.’” | D EC E M ber 2014 13

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Breast Cancer

Filling the Gap Gateway to Hope provides a lifeline for a once-overlooked population.

BY Sharon Lynn Pruitt

Gateway to Hope founders Dr. David Caplin and Dr. Marlys Schuh

thing they need to maximize their chance of beating a breast-cancer diagnosis.”

In the beginning, they estimated the organization would help one patient per month. By the end of this year, however, the organization will have helped nearly 600 patients during its existence. Today, the nonprofit’s network includes about 150 providers across the region. Nurse managers coordinate treatment plans and connect patients with the appropriate care, ranging from mastectomies to chemotherapy to radiation therapy. And in some cases, financial assistance can help with rent, utilities, and prescriptions.

For Boxdorfer, the nonprofit provides gas cards, so she can travel from her hometown of Dexter to St. Luke’s Hospital, where she

receives treatments. At press time, she had completed eight rounds of chemotherapy and was scheduled for a bilateral mastectomy and radiation therapy. “Without Gateway to Hope, I don’t know that I would have been able to get treatment,” she says.

“They have truly been a lifesaver for me and my family.”

Stories like Boxdorfer’s are why the organization was created nearly a decade ago. “If we can help rewrite the stories, so the endings are positive—rather than what we saw in the past, when Gateway to Hope wasn’t here to help patients—then we’ve been successful,” says Caplin, who hopes other communities will adopt the nonprofit’s model. “To me, that is the reward—to see the patients do well.”

photography courtesy of gateway to hope

Carla Boxdorfer thought it was a cyst.

Then the lump in one of her breasts began to grow and to ache. She decided to see a doctor. On May 29, she received the diagnosis: Stage III metastatic invasive ductal carcinoma. Boxdorfer and her husband both worked full-time, but neither of their employers provided health insurance, she says. Following a friend’s suggestion, she contacted Gateway to Hope.

The St. Louis nonprofit fills a vital gap in the healthcare system: Certain women who are diagnosed with breast cancer make too much to qualify for free healthcare, but don’t make enough to afford insurance.

Dr. David Caplin, a plastic surgeon with Parkcrest Plastic Surgery, had seen too many patients succumb to the disease. Dr. Marlys Schuh, a surgeon at Mercy Hospital St. Louis, shared his desire for change. So in 2005, they launched Gateway to Hope, creating a network of physicians and facilities willing to donate free care. “It’s for patients who otherwise would have no place to turn,” says Caplin. “We’re meant to be a lifeline that gives them access to every14 DECEMB ER 2014 |

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House Call

illustration by margaret berg

St. Louis at home entertaining, design and real estate

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inspiration

e

going the distance Triathlete Teri Griege never let cancer slow her down.

illustration by margaret berg

By Christy Marshall

During an early-morning breakfast at the Saint Louis Club, Teri Griege picks up the business card of Dr. Ronald DePinho, president of The University of Texas MD Anderson Cancer Center, the Houston-based mecca for cancer treatment. She handles it as if it were a winning lottery ticket, carefully tucking it into her purse.

“I’m keeping this,” she says. “This could save my life.” Griege is dressed in a bright-red lace dress, so you can’t see the port in her chest, the one used twice a month for her chemo treatments.

Less than a week later, she walks into Siteman Cancer Center’s West County branch. She says hello to the receptionists, the pharmacy tech who mixes her chemo, doctors, nurses, other patients… She speaks to each one, asking about children, a sick father, a recent wedding, a bike race. She inquires whether one tech brought his famous brownies.

“These people are just fantastic,” Griege says. “I’ve watched them get married, get divorced, have kids, suffer tragedies, and enjoy wonderful things. They are your lifeline.”

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inspiration

of surviving more than five years: a paltry 6 percent, according to observed survival rates from the American Cancer Society.

“Mortality has a way of shattering our reality and resetting the scales,” Griege writes in her new book, Powered by Hope, coauthored with local writer and fellow marathoner Amy Marxkors.

“It is a sudden and startling realignment… We become aware of our own smallness. We become aware of our own transience. We become very, very human.”

It wasn’t Griege’s first life fight. In 1993, she conquered alcoholism, with the help of rehab and Alcoholics Anonymous. What she gleaned from that experience, she says, helped her fight cancer later. “I learned the skills on how to deal and cope, to take it a day at a time, to turn it over to God, and to have faith,” she says.

“Really, the 12 steps are just the ultimate guideline for living.”

After her cancer diagnosis, Griege continued to train, all the while dreaming of competing in an Ironman World Championship in Kailua-Kona, Hawaii. “They choose about three or four inspirational athletes from around the world,” she says. “I sent in my story, and it was like winning the lottery.”

Thirty-five friends and family members watched her compete.

They created T-shirts emblazoned, “Team Teri. Powered by Hope.”

Her oncologist, Dr. Benjamin Tan, didn’t object. “He always trusts

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images courtesy of Finisherpix, two harbors press

She pulls a Diet Pepsi out of a small refrigerator and grabs two heated blankets before heading to the bay where she’ll receive her treatment. The hospital feels more like the Griege den than a sterile institution where people fight for their lives.

An athlete, Griege runs marathons. She’s conquered what the sport’s devotees reverently refer to as the six majors: Chicago (2002), Boston (2007, 2008), New York (2011), Berlin (2012), London (2013), and Tokyo (2014). Then, as if slogging 26.2 miles wasn’t enough of a challenge, she started training for Ironman triathlons in 2006—adding a 2.4-mile swim and a 112-mile bike ride to the run. The time limit: 17 hours.

In 2009, while training for an Ironman competition, Griege noticed some rectal bleeding. At first, she didn’t worry. She assumed it was related to the long bike rides, arduous workouts, and anti-inflammatories. But when the bleeding didn’t stop, she mentioned it to a friend and fellow triathlete who’s a gastroenterologist. He suggested a colonoscopy. When she got one, the doctor immediately saw multiple tumors: Griege had Stage IV colorectal cancer. It had also metastasized into two large tumors on her liver.

More than 140,000 people in the U.S. are diagnosed with colorectal cancer each year, and more than 50,000 die from it, according to the Centers for Disease Control and Prevention. Griege’s chance

images courtesy of Drew Selman, Halflife studio

“I don’t train for time or speed now. I train because I love to do it…

And because I still can.”

images courtesy of Finisherpix, two harbors press

inspiration

me. He knows I wouldn’t put myself in harm’s way, and he is very in tune with specific patients,” Griege says. “I think he knew that if he said, ‘You can’t bike; you can’t run; you can’t go,’ that would just kill my spirit.”

In fact, Tan and his wife flew to Hawaii to see the race. So did Marxkors, who had met Griege only two weeks before that while interviewing her for the local Fleet Feet Flyer e-newsletter.

Although Griege encouraged Marxkors to make the trip to Hawaii, the writer felt like the odd woman out. “Why crash a wedding when you can crash a Hawaiian vacation?” Marxkors jokes.

She knew no one beyond Griege. In fact, Griege’s mother, Laverne Francisco, then 87 years old, couldn’t remember Marxkors’ name.

“I called her Running Girl Runs,” Francisco says, noting the moniker was apt: Marxkors was spending a lot of time running while preparing for the Rock ’n’ Roll St. Louis Marathon.

Marxkors says she’s learned much in the process of writing the book and spending time with Griege. “Teri has been a visual example of the successful application of hope,” she says. “She represents the power of gratefulness, of being present, being genuinely interested in others, in not making excuses, and what it is like to be extraordinary. She’s taught me to enjoy the present—and how to be a troublemaker.”

In fall 2013, the cancer metastasized to Griege’s lungs; colon cancer often travels to the liver and then the lungs, Griege explains.

She underwent bilateral lung resections.

Asked to reflect on her cancer odyssey, Griege says, “I really feel like I have something cool happen to me just about every single day. If we do another book, it’s going to be called God Winks, and

it’s going to be like 85 chapters of those little stories that happen all the time, those things that before my diagnosis, I never would have been awake enough to see or realize.”

Except when she was recovering from surgery, Griege never stopped training. “The longer I’m at this, the less efficient and slower I get,” she says. “That’s a consequence of long-term treatment.

“I don’t train for time or speed now,” she adds. “I train because I love to do it and I want to show other people that just because you are diagnosed, it doesn’t mean you have to crawl up and sit in a corner. And because I still can.”

Griege also works tirelessly to help others with the disease. This past summer, she and her husband, Dave, founded the nonprofit Powered by Hope (poweredbyhope.org). Cancer patients are presented with a medal that’s just a bit smaller and a tad lighter than the Ironman version, as well as a coin. One side reads, “Together we are powered by hope,” and the other carries the foundation’s logo. The medal hangs from a multicolored ribbon, to represent all kinds of cancer.

“Doctors, nurses, and social services identify patients who could use the support,” Griege says. “We give them the medal. We tell them we’re survivors, and they are survivors. It only takes a couple of minutes. Sometimes they want to talk; sometimes they don’t.

Sometimes we cry.”

The program is currently in place at Siteman Cancer Center and Mercy hospitals, and Griege hopes to expand to St. Luke’s Hospital, Missouri Baptist Medical Center, and eventually nationwide. To make the organization self-sustaining, friends and family members can buy the medals.

“How cool would it be that when you are diagnosed, a friend gave you this?” Griege says. “You’ve just entered the biggest race of your life, and not everybody gets to ring the bell or put a finale to any of this. This medal is a symbol of hope.”

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a healthy mindset

here comes the fuzz Pregnancy brain, menopause brain, chemo brain… They all involve the same symptoms— and for good reason.

W

hen our brain stumbles or goofs, we revert to playground tactics: “Hey stupid! Chemo brain!” or “There goes Mommy brain again…” All we know is the life situation that’s responsible. We’re not sure why it zapped our next-door neighbor’s name from consciousness, locked our keys in the car, stole the movie’s plot, and screwed up our to-do list. But we know when it started.

If you’re brave enough, picture a woman in the throes of menopause. Her brain feels like a spent dandelion, and she’s lost the ability to multitask that got her through an MBA, a rise to the executive offices, and three kids. One of those kids is currently pregnant, and her brain has gone as fuzzy as her mother’s. They have trouble showing up at the same restaurant. When they finally

manage it, they talk about Aunt Alice, who’s going through chemo and suffering from the same mental fog.

All three women are having trouble with memory, concentration, word-retrieval, focus, and clarity. There could be any number of possible causes: stress, insomnia, depression, pain, anxiety, infection…

There is, however, a single, powerful common denominator in their three very different situations: decreased estrogen.

During pregnancy and breast-feeding, estrogen drops and progesterone rises. During menopause, estrogen decreases. “And in chemo, you will also have decreased estrogen,” says Dr. Mitul Shah, a SLUCare obstetrician and gynecologist who’s on the faculty at Saint Louis University School of Medicine. “If you are younger and take chemo, the ovaries are hit first, because, like your hair,

illustration by margaret berg

BY Jeannette Cooperman

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a healthy mindset

they have the most rapidly dividing cells. So in all three situations, what’s common is lack of estrogen.”

We don’t know much more than that, because we’re only now beginning to understand how estrogen affects the brain. “That’s where all of the research is happening,” Shah says. We do know that there are many estrogen receptors in the parts of the brain that control working memory. We know that estrogen plays a role in circulating blood to the brain and maintaining brain volume. We know that estrogen has anti-inflammatory effects, protecting nerve cells from damage and smoothing their growth and repair. And we know that decreased estrogen affects the hypothalamus, which plays a role in the release of serotonin and other neurotransmitters.

So even without fully grasping the complex underlying mechanisms—let alone the spikes and ebbs in fluctuating hormones—it’s easy to appreciate how an overall drop in estrogen could fog a woman’s brain for a while, until her body recalibrates.

After chemo, it can take several years for a woman’s periods to resume and her cognitive fog to dissipate. If pregnancy causes cognitive symptoms, they usually go away when lactation ends and periods resume. With menopause, Shah’s noticed that lean, flat-chested patients who are used to lower levels of estrogen don’t suffer many symptoms, and neither do heavy patients whose bodies can draw a little extra estrogen from fat. It’s the middle group whose course she’s never sure how to predict. They may have no symptoms at all, they may have symptoms for about five years, or they may have symptoms for the rest of their lives.

Some women, troubled by severe cognitive symptoms, have tried medications formulated for Alzheimer’s disease or attention deficit disorder. Shah says she’s tried estrogen replacement with patients who have severe menopause symptoms and no cancer history, and she’s tried serotonin-focused drugs like Prozac for patients whose mood swings were keeping them from focusing.

“About half of each group found improvement,” she says.

During chemo, pregnancy, and breast-feeding, though, replacing estrogen isn’t an option. “We don’t have much to offer,” she says.

“We just have to tell them it’s going to end soon!” Otherwise, Shah says, the remedies are practicality: making lists, jotting reminders, getting plenty of sleep and exercise—and having patience.

What about men? They have brains, too. If estrogen plays such a key role, how do they remember, focus, and concentrate without it?

Actually, men’s testosterone and fat convert to estradiol in the body, just as estrogen does. Compared to a menopausal woman, a man may have more estradiol. If their hormone levels drop or fluctuate, though, you don’t hear about fuzzy-brain syndromes as often. “I don’t know about men,” Shah says. “Maybe they don’t complain about it, or they have different coping skills.”

By stereotype—but also by brain physiology—men tend to be more linear, keeping their projects in tight mental compartments instead of juggling several tasks at once. “I think maybe they don’t get as affected,” Shah remarks, “because they’re not trying to do as many things at once!”

mind over matter These games aim to save your brain.

As a person who struggles to remember names and faces—or why I just walked down the hall—I find Lumosity (lumosity.com) to be nirvana. The games are built around the cognitive areas of speed, memory, attention, flexibility, and problem-solving. The intended result: improved concentration, memory, and verbal reasoning.

The games are fast, fun, and frequently frustrating. Matching colored shapes is a snap. Getting little trains into the correct train stations is OK. But solving math problems in split-second time can be a nightmare.

Lumosity costs anywhere from $11.95 per month to $239.96 for a lifetime membership. Competitors like Brain Metrix, CogniFit, and Cambridge Brain Sciences have cropped up as well. As the field has grown, naysayers have questioned just how much the games can “reclaim your brain,” as Lumosity boasts. John Grohol, founder and CEO of the website Psych Central, denounces the games as “snake oil.” I signed up anyway—my brain could use a tuneup. —c.m.

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Body in Distress, Head in the Sand The “ostrich effect” can delay treatment and damage prognosis.

But it’s a very human impulse.

By Jeannette Cooperman

A

young woman with breast cancer decides not to have chemo because she can’t face losing her hair. Another gets a diagnosis of multiple sclerosis and refuses to take a drug that can slow the disease’s progression. College students get their blood drawn, then pay a fee of $10 to have it poured down the sink rather than face the chance of testing positive for herpes.

It’s called information aversion, or the ostrich effect. And physicians see a lot of it. Dr. Florian Thomas, a professor of neurology at Saint Louis University School of Medicine, has a patient with MS whose father flies her to another city for hyperbaric oxygen treatments because she doesn’t want to take meds. “There is no scientific evidence whatsoever that hyperbaric oxygen has any effect,” Thomas says. “It has…a Web presence.”

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images courtesy of saint Louis university school of medicine

a healthy mindset

images courtesy of saint Louis university school of medicine

a healthy mindset

Medicines developed since 1993, on the other hand, “have changed the landscape of MS”—and the earlier they’re taken, the better the outcome. Yet people still delay and rationalize, because their illness seems manageable at that moment.

“To some degree, a benign neglect of one’s own health is a good idea,” Thomas concedes. “That may give me the strength and confidence and optimism to approach every day Dr. Florian well. On the other Thomas hand, it’s dangerous if I think I’m doing OK and I forgo treatment.”

As a neurologist, he also sees patients who’ve had strokes or spinalcord injuries. Their condition’s already done its damage; the future can only be an improvement. But for people with chronic or degenerative diseases, “the future is unpredictable,” he says. “A person goes to sleep at night not knowing what the next day will bring. And people respond very differently to that kind of uncertainty.”

The risk of denial is sky-high when you’re young. Maybe you’ve just launched your career, and now you’re happily thinking about starting a family. You don’t want— can’t even comprehend—news that could crush those dreams. And you’re still suffering from what Thomas calls “the immortality delusion. I only started using a bicycle helmet when my first child was born.”

Later in life, a woman’s previous life experiences can make her chary of knowledge or treatment. How she feels about herself and her future will shape her response to a diagnosis. So will her thought patterns, optimism or pessimism, resilience or rigidity. Does she feel desperate to control

every aspect of her life, yearn to completely abdicate responsibility, or strike a balance, gathering information that will help her learn her body? Is she passive, fatalistic, slow to confront bad news?

“I implore my patients not to tell me about their relapses three months later,” Thomas says, “after they have digested their symptoms and their memory has played tricks on them.”

Men are notoriously bad about seeking medical care, but women often minimize or ignore their own symptoms because they’re so busy taking care of loved ones—or because they’re afraid of losing a relationship.

“There are horror stories of the supposed loved one closing the door handle on the other side of the house,” Thomas says.

“There is, unfortunately, scientific evidence that men are much more likely to desert their loved ones than the other way around.”

In addition to his M.D. (and a Ph.D. in microbiology), Thomas holds a master’s degree in psychology, and Dr. Henry Nasrallah he uses those skills when he sees a patient panic.

“The goal is to reduce the suffering from uncertainty through knowledge,” he says.

“And by sharing that uncertainty with others.” It’s immensely reassuring to talk to someone else who’s grappled with the same miserable or embarrassing symptoms.

Dr. Henry Nasrallah, chair of the Department of Neurology & Psychiatry at SLU School of Medicine, says, “Insight is obviously the antidote.”

But what turns us into ostriches in the first place?

“Although we don’t have a gene for it yet— it’s hard to study—I am definitely sure it is inborn and encoded in all of us,” he says.

“Denial is a very natural, very common, almost ubiquitous human trait. But if your parents teach you to understand things and not rush to judgment, you might have less of it.”

Denial can be temporarily helpful, a way to adapt and survive, Nasrallah notes—if, that is, you’re alone in the jungle with a broken ankle. Denial is a carryover from the times when life really was nasty, brutish, and short, and you needed an almost insane optimism to forge ahead.

“I’ve seen patients coming in with a Stage IV fulminant tumor oozing out of their breast, and we ask them why they didn’t come in sooner, and they say, ‘Oh, I thought it would just go away.’ And I believe them,” he says. “They really have this irrational belief that it somehow will regress, even though it just keeps growing.”

Physicians have to learn to break news gently, without destroying hope. They have to give plenty of information—and be sure not all of it is grim or terrifying.

“Patients routinely misunderstand statistics,” Thomas says. “A side effect that affects 1 in 1,000 is different from one that affects 1 in 20.”

As for patients, they have to learn their own bodies, and they have to learn to reach for help and information.

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Fitness & Nutrition

Buti’s In the Eye of the Beholder St. Louis welcomes a new kind of yoga.

Flexibility has never been my strong suit. I have taken a few yoga classes in the past, but most of my experience has been in the privacy of my own living room, watching a Sunrise Beach Yoga DVD. So I didn’t know what to expect when I signed up for Buti Yoga, a newcomer to the St. Louis fitness scene.

When I entered Flex Studio (3139A S. Grand, Ste. 201, 314-669-4645, gatewayflex.com), instructor Holly Wilson assured me that I had nothing to worry about. As other women trickled in, I observed a wide range of body types and ages, from early twenties to sixties—a good sign, I hoped.

After finding a place at the back of the room, I listened as Wilson explained the class was “not a place for judgment or competition—we’re here to feel empowered, confident, and feminine.” Wilson started the 60-minute class with a few basic poses and rhythmic breathing before moving to the real workout, a fusion of yoga, tribal dance, and plyometrics. Most of the Buti movements are variations of yoga poses, but with cardio: downward dog, but with hip rolling and leg swinging, then jumping to a squatting pose, then jumping back to downward dog.

An App a Day

Jeremy Koerber, a personal trainer at Integrated Wellness Concepts (integratedwellnessconcepts.com), shares some of his fave health and wellness apps. —n.c.

My participation was more of an attempt than a follow. There were a few times I got a little woozy and had to take a breather. As we went along, Wilson suggested alternatives for those with similar limitations. “It’s OK if you need to take a knee,” she said.

Once the workout was over, though, the experience gave me a sense of clarity and

Calorie Counter & Diet Tracker

by MyFitnessPal Free. Available for iOS and Android “It makes you face the truth about what you eat, so you can make the necessary adjustments to your nutrition.”

empowerment. “It’s definitely hard,” says Wilson, who’s a pulmonary function technologist at Saint Louis University Hospital. “It’s not like running on the treadmill, but there are really no beginning or advanced levels of Buti. It’s all about having a huge network of women at all levels of fitness who are there to support each other.”

Nike+ Running Free. Available for iOS and Android The GPS-enabled app can track your runs. “I love competition and motivation,” Koerber says. “This app provides both.”

illustration by margaret berg; images courtesy of MyFitnessPal, nike+ Running, Interval Timer

By nancy curtis

Interval Timer–Timing for HIIT Training and Workouts Free. Available for iOS “This app helps my wife do kettlebell movements and other intervals in the living room while the kids are napping.” 7

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ch1432_

Extraordinary Experience There’s something special happening at Christian Hospital’s Northwest HealthCare.

You can find it in the compassion of our emergency department staff and the convenience of our Graham Road location. You can even see it in the rapid results from our imaging and lab facilities. We’re using our extraordinary experience to create extraordinary experiences, every day.

Visit ChristianHospital.org or call 1.877.747.WELL (9355)

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When was your last

mammogram?

Early detection is your best tool in the fight against breast cancer. Do something for yourself and the people you love: Schedule your mammogram today.

MAMMOGRAMS MADE EASY

MAMMOGRAPHY GUIDELINES

St. Luke’s Women’s Center – Chesterfield Valley 6 McBride & Son Corp. Center Dr., Suite 102 Scheduling: 636-530-5505

St. Luke’s Hospital supports the American Cancer Society recommendation: annual mammograms beginning at age 40. No physician order required.

Age 40 and over • Annual screening mammogram • Annual clinical breast exam by a doctor or nurse • Monthly breast self-examination Age 20 to 39 • Clinical breast exam by a doctor or nurse every three years • Monthly breast self-examination

St. Luke’s offers 4 convenient locations for screening or diagnostic mammograms, plus mobile mammography: St. Luke’s Women’s Center – St. Luke’s Hospital Newly renovated 232 S. Woods Mill Rd., East Medical Bldg., Suite 200 Scheduling: 314-205-6267 or visit stlukes-stl.com

Midwest Breast Care - an affiliate of St. Luke’s CDI (Creve Coeur) 450 North New Ballas Rd., Suite 250 N Scheduling: 314-567-4449 St. Luke’s CDI – WingHaven® (St. Charles County) 5551 WingHaven Blvd., Suite 60 Scheduling: 636-625-4434 Mobile Mammography Van View calendar at stlukes-stl.com Scheduling: 314-205-6267 or 888-357-3432 Area women who are uninsured may be eligible for free mammograms and ultrasounds. For more information, call St. Luke’s at 314-205-6267.

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