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The Girlfriend's Guide to Health will be updated every Tuesday.... Stay tuned dear readers and let me rock your world.

Tuesday, July 31, 2012

The Power of Play

Happy Tuesday my girlfriends. May I say that I find myself in a rather festive mood these days. Why you ask? Perhaps it is the beginning of the arrival of the new fall lines in stores? Surprisingly, not so much.

Make no mistake, as my girlfriends know, I do believe accessorizing should be an Olympic sport. But indeed the chance to try on a new PRADA suit, although thrilling, is not the cause for my latest bought of joy. For yes, my sisters, my latest swell of joy is not due to London fashion week but indeed due to London 2012.

Oh my girlfriends, I do love me an Olympics. Summer or winter, it does not matter- like my fashion sense, I’ll take any season.

And so when Sir David Beckham suited up to bring the torch into Olympic stadium I was welling up like a girl.

It’s been 4 days now since the cauldron was lit with all the pageantry that the Brits are known for and the blush is definitely not of the English rose.

I am as attached to my television set as I am to my AMEX card. Oh the feel good moments keep coming. From the athletes entrance to the sporting moments, I am indeed in heaven.

Why just this morning my favourite barista asked me what was my favourite sport. And just like my shoe closet I find it impossible to decide.

Last night I spent 2 hours watching men’s synchronized diving with as much attention as I put into watching the fall ready to wear shows.  I sat through men’s ad women’s cycling (but of course) and even spent some time watching beach volleyball.

I am watching it all. I love the national pride, I love the joy of sport and I love the time difference that allows me to watch something at 3 am if I just can’t sleep.

But aside from the emotional gush, I stopped to ponder the fact that the Olympics really do have a power over us. What is it about? Is it the power of the emotional connection to people who are living their dream? Is it a sense of appreciation for what our bodies can do when we are blessed with good abs and financial backing?

Or is it as simple as the power of play.

Remember when we were kids and the world of sport was our oyster? When we came home from school and someone actually asked us if we wanted to play in the streets. The we got older and the world changed and the play became a forced undertaking that needed to be justified with purpose.

Now we find ourselves driving to gyms and working out and driving home. We do what we must and most of us forget about the joy of it all.

I submit to you here my sisters on this Olympic of days a call to action. I have undoubtedly written on so many occasions about the power of exercise to reduce a host of medical risks. In fact last week the LANCET published an entire issue devoted to the power of exercise at reducing the risk of developing a variety of diseases. For once, I will not go into detail with the science of it all. I will avoid the WHY and focus on the WHAT.

Forgive me for the deviation in format my sisters- but rest assured I’ll be back next week with evidence galore to rock your world.

In the meantime- my sisters…. Let’s get out there. Let’s use these Olympics games as an inspiration to see what we can do- to push ourselves beyond our expectations.

Why just yesterday I ran 26km- my longest training run this year. Sure, I can no longer feel my ass but yes, my heart is full.  Who knows what the future will hold.

If the world can pause for 16 days and rejoice in the play of it all than why can’t we? Now get out there my sisters and have yourself a fabulous week. Whether you run or cycle or even synchronize dive- take up the charge and get your fabulous selves active….Life is indeed for the living – and we are all waiting for our own moment of greatness. 

Tuesday, July 24, 2012

Performance Anxiety

A big shout out this week to one of my newfound girlfriends whom I met along my way to marathon. Not only is she fabulous, she gave me this week's blog idea! See what happens when you give me feedback, my sisters? It comes back to you ten fold. 

As my cyber sisters know I am currently training for the NYC marathon in November 2012 and girl is my ass tired. Why just this past Sunday a 23km left me feeling like Wonderwoman.

Recall my sisters that Wonderwoman first appeared in All Star Comics #8 in 1941. She was likely around 20 years of age which puts our Wondersister around her 91st birthday. Bitch likely needs a hip replacement. And so on Monday morning I can honestly say I felt like a 91 year old superhero in need of an artificial joint of some kind.

 But I digress.

All this running has got me thinking. A girl has no choice to engage her brain when you are spending hours on the road Forrest Gump style.

Like my outfits and choices in hair colours, I have good runs and bad ones. But I could not help but notice that some of these variations do indeed coincide with THAT TIME OF THE MONTH.

In other words, not only does my female cycle delegate my moods and my shopping habits- it also tends to influence how my rubber meets the road.

This very concept takes me back to my first ever running group in 2004. I should preface this by saying that running tends to bring out the most personal of conversations. I find the conversations held in running groups to be more intimate than those held in therapy sessions.

Don’t believe me? Try this one at home. Put a group of people together and make them run a 20km course. At about 8km in you will find that the talk invariably turns to body parts in some way.

Put a group of women in that same scenario and inevitably you have a full on discussion of our monthly bill, so to speak.

And so it was on a recent 22km run around Vancouver a couple of weeks ago. I was not there of course- I, like a cheetah- run alone. But my beloved likes to run with a group of delightful women from Vancouver, Ireland and New Zealand (you know who you are ladies- he thinks you are fab and finds your accents rather charming).

And so he returned from his Sunday morning long run with a question I had not expected to hear.

“Sweetie- the girls want to know what the effects of their period is on their running.”

And just like that, I had a Tuesday morning topic.

Having been involved in a few races in my time- I could speak to my personal take on the issue. I personally LOVE getting my period the morning of a triathlon. The next two hours are going to be grueling anyway- why not add sanitary napkins to the problem? I mean nothing says challenge like a tampon in you wet suit. No? Am I being too visual my girlfriends? Just tell me and I will back off.

In fact such a question is ever so timely with the Summer Olympics descending upon us.

My sisters will recall how much I LOVED Vancouver 2010. I cried like a girl at the whole ceremony of it all. London 2012 I suspect will have the same effect on me. There I will sit along with a collective world and hope for the best as individuals unite in the strength of their spirits and the power of sport and silence the world’s troubles for a few brief moments.

But I wonder? Will any of those female athletes get their period during those 16 days? And if she does…. Will it cost her the gold?

Let’s review the menstrual cycle for those of us who don’t have one or those of us who slept through high school biology….

There are four phases to a woman’s menstrual cycle that lasts on average 28 days.

Day 1-6 is the Menstrual Phase- insert blood here. The uterine wall sheds and well you feel like your pelvis is broken and everyone around you is annoying as hell.

Day 6-14 is the Follicular Phase- this is when the follicles (egg sacks if you will) start to grow in preparation for releasing an egg.

Day 14/15 is Ovulation. This is EGG DAY. Also known as the day many women track like a good shoe sale (if they are in the breeding mood)

Day 16-28 is the Corpus Luteal Phase (Or just Luteal Phase) when the uterus get ready for a fertilized egg to implant . No implantation? You go back to the menstrual phase and shed the lining.

In short the whole cycle is basically a communication between releasing an egg for fertilization and then setting up a favourable place for it to grow in the uterus. If you don’t use the favourable lining and implant a fertilized egg…. You lose the lining.

It’s kind of like a hormonal lay-a-way plan. You invest in a fabulous handbag all month- putting a deposit away to hold it for you. If you don’t buy the bag- you lose your deposit. Well… not exactly like a lay-a-way but I needed a flippant comparison and that’s what I came up with… in a pinch.

I myself find that I am most athletic in the few days leading up to my period- or my luteal phase. Perhaps it is because I am raging bitch at this point and need a safe and healthy outlet. Most runners I spoke with find that they are at their best right after their menstruation. And yet again my sisters- I realize that I am not like the rest of the planet…

According to a HOME GROWN study done right here in beautiful Vancouver and published in the Journal of Sports Medicine in 1993, there is considerable variation among athletes with regards to fitness and monthly cycles. Not only does it depend on the athlete, it depends on the athletics as well.

According to the study, which looked at retrospective surveys of female athletes, 37% to 63% of female athletes did not report any detriment to their physical performance during their cycle. (bitches)

Furthermore,  13% to 29% reported an improvement in their performance during menstruation. The best performances were generally seen in the immediate postmenstrual phase and in the first few days of menstrual flow.

Unfortunately this study has some inherent biases. Firstly the study was self reported and many women studied could not accurately state where they were in their cycles. Symptoms of premenstrual syndrome are often seen as detriments to performance and again in a  self reported study this can’t objectively be tested.

Interestingly  studies have shown that neuromuscular coordination, manual dexterity, judgement and reaction time for complex tests have been shown to be adversely affected in women with premenstrual syndrome or symptoms

When objective measurements were taken into account, there are indeed some variations in performance based on certain sports.

For example, swimmers have shown a premenstrual worsening of performance times with improvement in the menstrual cycle. This does make sense because progesterone is highest in the premenstrual period and this hormone has been shown to increase perceived exertion.

Cross country skiers were found to have a similar picture with their best performance being immediately post ovulation and post menstruation.

As for runners? I suspect the same is true.

As for what to do in these times… the evidence is pretty clear. Suck it up my sisters… this too shall pass. We are women after all. If we can walk a few miles in four inch heels we can run a couple of dozen with mind numbing cramps, No?

And so my sisters, with the science before us it becomes pretty clear- whether you are planning for a race, planning for a family, or just planning for a fabulous outfit…. It best to coordinate your cycles. After all, my girlfriends, haven’t we all learned at one time or another that a great performance really is our best weapon.  

Tuesday, July 17, 2012

I Walk the Line

Summer is upon us my sisters. Here is the sun and the sand and the sea and we all know what that means??? Strappy sandals.

Yes, my girlfriends with the onset of the fabulous weather and the warmth of the world upon us comes the need to polish my toes and indeed put my best foot forward.

My girlfriends know all too well how I feel about the footwear. I do love me a fabulous Italian platform or stiletto. I embrace the leather ties that bind and savour every step I take.

I love the feel of a good four inches beneath my toes and the possibility of where any new pair of shoes will take me.

Any day can be made better with a good pair of heels and the perfect attitude.

Yes I know I am perhaps a bit flippant and perhaps a little materialistic when I say that a great pair of shoes really can change my mood.

I have long thought about my love of great footwear.  I don’t think I’m alone in my love of stylish shoes.

A survey done in USA Today in 2009 showed that the average woman owns 17 pairs of shoes and that 39% of women consider themselves a “shoe person”. See my sisters? I’m more the rule than the exception. Why do women love shoes? Simple- if they do not fit it is not your fault. Show me a pair of skinny jeans that can make that same claim.....

As a doctor who wears 4 inch heels to practice medicine I am often asked by my patients (and my sisters) whether my fabulous footwear is indeed a gift or a curse to my future lower joints?

Let’s examine the evidence my girfriends….

We will begin with those bastards at Harvard Medical School, who in 1998 started the whole rampage against the 4-inch heel.

Dr. Casey Kerrigan published a study in the Lancet about the effects of high heels on the biomechanics of the knee and ankle. The study consisted of 20 healthy women who were comfortable wearing heels who were then placed in heels and asked to walk at a comfortable speed for 10 metres across a floor.

The biomechanics of their knees and ankles were measured and plotted against the same readings they had while walking barefoot. There was a significant increase in the stress at the knee and the ankle compared to walking barefoot in these women.

The findings confirm that wearing high-heeled shoes significantly alters the normal function of the ankle. Because of this compromise, compensations must occur at the knee and hip to maintain stability and progression during walking.

These findings suggest that most of these compensations occur at the knee. Now, I have known this for years. Ever since I strapped on my first pair of heels and tried to walk the kitchen floor I realized that I was going to have to learn to walk all over again.

HOWEVER… like anything worth having in life, you put in the effort…. Hour upon hours of practice, clenched butt cheeks and a decent swagger have made me the 4-inch woman that I am today.

The Harvard study however finds that this compensation MAY over time increase the work of the quadricep muscles, prolong the strain through the patella tendon, and prolong the pressure across the knee joint.

Therefore this may lead to increased arthritis and patello-femoral syndrome. However the study did not make any full conclusions.

As for the Harvard study, I realize I am being a bit emotional, but I do have some questions:

Is Dr. Casey Kerrigan a man or a woman? Casey is one of those ambiguous names like Kelly or Adrian or Jesse (or even Ali). Are you a chick or a dude?

This makes a difference. No sister I know would shamefully attack the temple. Casey, if you are in fact a woman than I surmise you have never owned a pair of Jimmy Choo strappy sandals and should spend some of your Harvard hard earned cash on said shoes immediately.

They WILL most definitely change your research focus.

However Dr. Kerrigan, if you are a man…. One small piece of advice which I tell my beloved regularly…. DON’T MOCK THE SHOES….. I don’t come into your Harvard house and piss all over your bookshelves. Don’t come into my closet and take away my sunshine….

In need of a better answer I went looking further. Good news about Science, my sisters- you can always find some sort of study to support your belief system if you look hard enough.

And so I could rely on data from the United Kingdom that places a well-needed platformed heel up the ass of this controversy.

Researchers at Warwick University and Oxford Brookes University investigated the stiletto controversy with the help of 111 women aged 50 to 70, of whom 29 were awaiting knee replacements. Women were asked to report about their taste in shoes, weight, activity levels and other risk factors for arthritis.

The final study, published in the Journal of Epidemiology and Community Health in 2005 found no evidence to suggest wearing high heels was linked to knee problems. Indeed, the statistics suggested women who regularly wore 3-inch heels were less likely to be suffering from arthritis.

Factors that did influence a women’s risk of arthritis were being overweight before 40, doing demanding physical work and having previous knee injuries. In fact, there was a link between regular dancing in 3-inch heels and a reduced risk of knee problems.

Women were also shown pictures of 38 different types of shoes and asked if they had ever worn a particular type regularly, either for work, socially or dancing.

Some 55.2 per cent of the women with knee arthritis regularly wore 3-inch heels, as did 67.1 per cent of women with no pain.

In other words…. If you wear heels you have a fifty percent chance of them killing your knees.

Having spent more than half my shopping hours in the shoe departments of many a respectable store means I am willing to flip that coin….

Finally, Dr. Margaret Thorougood, the lead investigator of this study can be quoted as saying, ““Women who smoke, are overweight and do a lot of heavy housework such as scrubbing are more likely to develop painful knees and arthritis later in life. But women who wear stiletto heels will be reassured to learn that their choice of fashion-before-comfort footwear will not lead to knee joint problems and may even prevent them.”

Ladies…. Let us pray to the goddess that Margaret lives a long and fabulous life filled with guilt free chocolate ├ęclairs and a phenomenal metabolism.

May Dr. Margaret be inducted into the sisterhood hall of fame. Can I please my sisters get an Amen? In the name of Manolos everywhere…. Amen.

Tuesday, July 10, 2012

Fashion Foreward

It’s Tuesday dear girlfriends and what better a day than today for us to have a heart warming chat about my favourite topic??? Fashion. I must say, my sisters I rather enjoy our time together, where we sit and sip a coffee and braid each others hair and gab about everything from REAL HOUSEWIVES to real LOUNBOUTINS to real breast implants and all the paradoxes in between.

I’ve grown accustomed to our weekly meetings, sniff , in a sentimental way. And as my girlfriends know I am, anything but, sentimental. So shall we start the week off again with a little chat about every doctors staple? The Little White Coat.

Let me state it plain my girlfriends, this doctor does not own a little white coat. In fact I would argue that my work outfit go to item is indeed a little black dress and some fabulous 3 inch kitten heels.

NOTE: I am aware that 3-inch heels would by no means qualify as “kitten heels” according to any fashionista- but for a woman who insists on wearing 5 inch platforms at all times- anything lower really is a small cat.

So let’s talk about that Little white coat? I have never been a fan. In my medical school days I remember getting my first white coat. We wore them at first in CLERKSHIP- our last year of medical school when we were required to see patients full time. Our clerkship coats were the shorter variety. The were a stark white poly-cotton blend of fingertip length that fit you like a tent and hit you just at the hips.

I was , my sisters, a chubby clerk. No need to argue- I’ve worked it through. As such my clerkship coat only served to make my hips look even larger than my brain.

By residency we graduated to an official long white coat and well… let’s just say… it did nothing for me. A white poly-cotton boxy fit? Not my best look.

As my sisters know, I have never been one to mock an outfit or to shy away from any article of clothing. I am after all a slave to fashion. But the white coat, despite its history never really did it for me.

Let’s be clear. Clothing really does influence how we perceive an individual. The white lab coat first made its appearance in the 1800’s. Prior to that, lab coats were beige (perish the thought) and worn in…. you guessed it… labs. Doctors instead wore black.

According to my sources black was chosen as the clergy wore black at the time. If you ask me, black, is an excellent colour. Thank heavens my profession had the foresight. Black is slimming, fashion foreword and hides the blood stains quite nicely.

Things changed by the end of the 19th century with tremendous progress in public health and sanitation. Recall that before that, you rarely could get anyone to wash their hands… let alone if they were sticking them into you. Once the germ theory became well known- meaning that it became widely accepted that most infections could be prevented with good antiseptic technique- the medical field became focused on being more scientific and evidence based.

Remember that before the late 19th century, you could get a medical degree in about a year and there were very few standards of practice.

And so as medicine strove to be more scientific the lab coat seemed like the perfect symbol for this new scientific age and this new philosophy. White, after all is the colour of hope, both before and after Labour Day and so white was adopted as the colour of the doctor’s coat.

Surgeons in fact became the first to wear the white lab coat. It became wide spread in the early 1900’s and by mid century was the standard fare. To this day many medical schools still have a “white lab coat ceremony” where you receive a white lab coat upon entrance to the school.

Although we never had a ceremony in my medical school- it was understood that whenever you saw patients- you had to wear a white coat.

The minute I finished my residency…. I burned all traces of it.

I should say that aside from the rather unflattering look of it all, I find the coat only serves to separate me further from patients. We live in a world where patients WANT their doctors to be people too. Put on a white coat and the dynamics change- and not necessarily in a good way. What I wear is a large expression of who I am and I have never felt that I needed to conform (no shit) to certain norms in order to be more effective. Not at work and certainly not in life.

Turns out, many of my colleagues agree with me. According to a study published in the Journal of the American Medical Association in 2011, only 1 in 8 doctors still wear a white lab coat. Most pediatricians and psychiatrists NEVER wear one- the practice was long abandoned in these specialties as it was thought to frighten patients.

Paradoxically a number of surveys show that patients actually prefer the white lab coat because it helps them identify the doctor. As for me? I prefer to open my mouth and introduce myself to the patient- I verbally identify myself and then they can spend the next few minute admiring my outfit while they let it sink in that yes… this chick really is a specialist. Who knew?

In Britain the white lab coat had officially been banned. Who would of thought that the Brits who always love a good ceremony would do away with the ceremonial garb? Turns out, a further study in the BMJ showed that white lab coats impeded docs from washing their hands and increased the risk of hospital based infections. See? Not only is that white piece of shit unflattering? It’s a death trap. There you have it my sisters…. Again I am ahead of time. I hear the bells ringing – the death knoll for the white doctors coat and I can’t help but smile a little sigh of victory.

I’ve said it before and it remains ever true… Good fashion really is the best medicine. 

Tuesday, July 3, 2012

Mothernature? Motherfunhouse!

It’s been raining a lot my dear girlfriends. I know, I know I live in Vancouver. It rains here. But it is July. Yes I realize I am complaining about the weather my sisters but I am in the midst of a two week holiday/staycation and in the words of Anne Peebles "I can't stand the rain" (sing it with me my girlfriends, you know you want to)

Now I have never been one to bitch about the weather. Having grown up in Winnipeg I spent many of my formative years either freezing my face in winter or having it eaten by mosquitoes in summer. As such I've always felt that Vancouver weather, despite its misgivings was a gift to any prairie girl. 

You can’t shovel rain and having spent much of the 1970's waiting for public transport during prairie winters I am a fan of weather that allows only for a light trench-coat and a few smartly planned layers. Nothing ruins my winter buzz more than sensible boots with rubber treads and a poufy down jacket that adds 20 pounds and makes me look even more “hippy”.

That being said it's freaking July. I am truly tired of hearing how fabulous the weather is in the rest of the world. Friends and family from other places routinely call and offer their condolences over our shitty summer as though there has been a death in my meteoric family. 

Oh yes and it has been a shitty summer. At this very moment it is 12 degrees celcius and raining. It's July. Yes I am belabouring the point. 

As many of my girlfriends know I am an avid cyclist- riding my fair streets for ass and country and I must admit the constant spray in my face (and up my back) is getting to me.

Sure I am well equipped with a fabulous rain suit that does in fact make me look like a cross between a superhero and a city maintenance man and yes it does keep me relatively dry. Add to that the fact that I have this crazy ethnic hair that seems respond very well to a good dosing of rain and bike helmet and the advantage that “Bed-Head” is still very much “in”. In fact this rain has really not been something to complain about in the past. Truth be told, I have always loved the rain.

I love being able to run outside all winter long without worrying about a wind-chill and how long it will take for my face to freeze off.

But again... it's July. I have a Roberto Cavalli caftan that has yet to see 2012 and my Spring and Summer fashions are not getting as much air time as they deserve. 

In fact lately I am finding that the last 10 months have taken their toll and I am jonesing for a little ray of sunshine. I blame Celia. Allow me to explain.

Celia is my new bike. Correction, Celia is THE bike to end all bikes. Celia (Italian for HEAVEN) is a goddess. (thanks for the Italian lesson my sisters)

A black, red, white and blue piece of fabulous machinery Celia is lighter and more comfortable than Bella. P.S. Don’t tell Bella- she will only become resentful and I need a bike to ride in the winter when the rain is REALLY bad.

That being said- I was really looking forward to me and Celia having many a sunny day ahead of us. Not so- heads up world- we’re soaked. In the words of B. J. Thomas’s classic- “raindrops keep falling on my head”….  Sing it girlfriends, you know you want to.

So I could not help but wonder if all this cloud cover was indeed clouding my mood as well?

Here’s the interesting thing about darkness and light. Our brains have a physiological response to shades of grey. 

When our eyes detect darkness, a small gland in the brain called the pineal releases melatonin, which establishes sleep cycles. When we detect light, melatonin production subsides and its happier hormonal sibling, serotonin, takes over to promote wakefulness and help elevate mood.

Some of my sisters may have heard of the term- Seasonal Affective Disorder or SAD. Research on SAD has been focused on the brain's response to darkness and light, as the condition has been linked to the shortened daylight hours of winter. SAD has indeed been recognized as a disorder in the DSMIV (the holy bible of mental illnesses) and I am not disputing its existence.

But I wondered if there was evidence that weather affects mood in those of us without SAD? Can the saying be true? Can we really see clearly now the rain has gone? Do the dark clouds really have me blind?

Turns out… not so much.

A variety of research has been done to explore the effects of weather on mood and cognitive function. Summary judgement, girlfriends…. Very little effect. There are a few hallmark trials, albeit of questionable design that show very little effect of weather on cognitive function and mood.

Firstly, A study published in 1997 out of Scandinavia found that people who lived in sunny places were no more miserable than those who lived in rainy ones. Further data came forth in the years 2000-2005 to show that variations in temperature in countries did nothing to affect mood and productivity. I won’t give you all the details- just take my word for it- the science does not support a warm heart and a clean head.

Finally a large-scale trial published in 2008 by the American Psychological Society out of a group in Berlin showed little effect of weather variations on emotions in over 1200 Germans.

The study examined the effects of six weather parameters (temperature, wind power, sunlight, precipitation, air pressure, and photoperiod) on mood (positive affect, negative affect, and tiredness). Data were gathered from an online diary study of 1233 people linked to weather station data, and analyzed by means of multilevel analysis. The results revealed main effects of temperature, wind power, and sunlight on negative affect. Sunlight had a main effect on tiredness and mediated the effects of precipitation and air pressure on tiredness. The effect however was minimal at best. The effect of weather on mood as well was small.

Windy, cool and darker days seemed to have just a slight negative effect on mood, with many subjects reporting that they felt tired or sluggish.
The problem with this study is that it can be very subjective and really at best, it strains to draw any consensus. From the range of responses the study's subjects recorded in their journaling, the researchers determined in the end that "people differ in their sensitivity to daily weather changes." Really? No shit.
So, there you have it. Another day- another rainy dark and gloomy day.... in July. Motherfunhouse. Sorry for the profanity my sisters but my bike shoes are soaking wet. 

Know that just getting this off my rather flat chest has helped to heal the splash marks. That and my constant music references and repetitive mentioning of July have made my OCD a little more benign. Thanks for listening my sisters and perhaps by the time I return to work next week the sun will indeed shine again. And so off I go for another ride in the rain safe in the knowledge that humidity is good for my curls and bitching although necessary at times… is not to be made into a habit. As J.D. Thomas says… (sing it with me girlfriends)

“Cryin’s not for me- cause I’m never gonna stop the rain by complaining… because I’m free. Nothing is worrying me.”
Amen my sisters, Amen.