The Story-teller in My Brain

When I was a child our family traveled a lot. My father was in the Air Force, and we moved every one to three years, so we would travel between homes. We always seemed to live far away from my grandparents, so during summers we would make the long trek back to California. When we lived in Spain, my parents were courageous enough to take seven children and my grandmother camping through Europe for a month each summer to connect with the history and culture of those countries.

We were normal children being given incredible opportunities. But as normal children we would often become bored and start bickering. My mother, at her wits end at times, turned to story-telling. She would tell the most magical and fantastic stories, with us kids as the heroes and heroines, of course. Her stories would spellbind us into a quiet, peaceful, cooperative state of mind. All of us children hold her stories as a very special part of our childhood.

Over the past year, as I've added the treatment of neurofeedback to my practice, I've been studying and learning about the anatomy, physiology, and overall processes of the brain. Research on the brain has exploded in the last 20 years as the discovery has been made that the brain has the capacity to change. For centuries the common scientific belief was that once damaged, the brain could never regain what it lost. Once the brain became emotionally ill it could never recover. However, now because of the knowledge that the brain is neuroplastic (meaning that the cells can change function) and that in some situations the brain cells can regrow, there is much greater hope for those with dysfunctional brains.

Today I would like to talk about the little story-teller in the left side of our brains. No bigger than the size of a peanut, we can allow this part of our brain to control our lives. Jill Bolte Taylor, Ph.D., described it in her book, "My Stroke of Insight: A Brain Scientist's Personal Journey."

Dr. Taylor is a neuroscientist, and was teaching neuroanatomy to medical students when she experienced a hemorrhagic stroke (bleeding into the brain), that damaged a good portion of the left side of her brain. She was able to experience first hand the progressive loss of function of parts of her brain that she had been teaching her students about. She feels that she was also blessed to have been aware of the latest research on the neuroplasticity of the brain, because that gave her hope of recovery. Even though it took eight years, with many major functions not returning for five or six years, she continually worked and practiced her brain and eventually regained all of her functions again; physically, cognitively, emotionally, and spiritually.

To many scientists still coming from the old view, this constituted a miracle, because once lost, the brain shouldn't be able to regain its function. But with the new research, the miracle was in her never-ending hope and her patient work and practice towards progress, not letting failure after failure get her down until the changes finally took place, and the incredible learning process she chose to experience as she re-gained her left-sided ego mind.

Dr. Taylor talks about one area that returned that she wasn't sure she was very fond of. This was the ability to weave stories. She relates, "This story-teller portion of our left mind's language center is specifically designed to make sense of the world outside of us, based upon minimal amounts of information. It...takes whatever details it has to work with, and then weaves them together in the form of a story....Our left brain is brilliant in its ability to make stuff up, and fill in the blanks when there are gaps in its factual data. In addition, during its process of generating a story line, our left mind is quite the genius in its ability to manufacture alternative scenarios....it's particularly effective at hooking into those circuits of emotion and exhausting all the 'what if' possibilities."

Because she had lost this part of her brain function for a time, as it returned she was able to observe how often her story-teller would come to conclusions with only a very little information. Because her right brain had become so developed because of the loss of her left brain, she was able to observe with humor all the stories that her left brain would come up with that allowed it to read things into the actions and words of other people that weren't actually there. She realized that her story-teller actually expected the rest of her brain to believe and act on all of the stories that it was making up. She realized that her left brain was doing the best job it could with the information it had so that it could survive in the world, but she also had to remember that "there are enormous gaps between what I know and what I think I know. I learned that I need to be very wary of my story-teller's potential for stirring up drama and trauma."

Dr. Taylor also realized that as her left brain manufactured stories that it promoted as truth, it would also repeat those stories over and over again, creating loops of thought that didn't want to quit. She realized that before her stroke these loops of thought often ran rampant and she found herself habitually imagining devastating possibilities. She realized that we "need to tend carefully the garden of [our] minds. Without structure, censorship, or discipline, our thoughts run rampant on automatic. Because we have not learned how to more carefully manage what goes on inside our brains, we remain vulnerable to not only what other people think about us, but also to advertising and/or political manipulation."

Dr. Taylor said that this story-teller part of our brain has the potential to be mean, worry incessantly, or be verbally abusive to self and others. It could be stubborn, arrogant, sarcastic, and/or jealous. It held the capacity to be a sore loser, hold a grudge, tell lies, and even seek revenge. This small piece of her brain could bring her into a downward spiral, that caused her chest to feel tight, her blood pressure rise, and increase the tension in her brow which gave her a headache.

She found that it was a choice whether to believe these stories and allow them to play their loop or not. She found that at times it was a constant effort to tend to the thoughts that would come and latch hold upon her, to "step to the right," (use the right hemisphere to see the situation with compassion towards herself and others), and to change her mind. But in making that constant effort, she was able to control her thoughts and keep herself in a more peaceful place than she had been before her stroke. "I wanted to leave behind any of my old emotional circuits that automatically stimulated the instant replay of painful memories. I have found life to be too short to be preoccupied with pain from the past."

Studies show that emotions, when they are not held onto, enter, affect the body, and leave in 90 seconds. She realized that she had no control over this thought/emotion for 90 seconds. So she consciously chose to feel that emotion, let it wash over her, internalize it for 90 seconds, but not act on it or lash out because of it. Then, if it lasted more than 90 seconds, it had become her choice to allow it to continue. This is when the story-teller would take over. So, at this point, she would thank it for expressing itself, and tell it to move on and out of her body, that she no longer needed it.

She began to treat her thoughts as children, teaching them what is appropriate and not appropriate. When they would latch onto painful or fearful thoughts and not let go, she would tell them that their time was up and they would have to leave. If there was a loop that was hard to break, she would give that loop a time limit when it could fully express itself and feel all it wanted, but then it would have to stop. She would set a time daily, like from 9:00 to 9:30 p.m., where that story-teller could tell all it's stories and get everything out, and then it would have to stop.

Again, this took constant effort and attention to the thoughts that were coming and emotions she was feeling. The effort to change the mind takes observation and practice. Otherwise the story-teller will take control and rule the mind and body, and the peace we seek will be impossible to find. But the rewards of such effort are tremendous. Every little bit of change and practice has a positive effect. Every bit of patience at repeated failure makes changes. Every thought of love and compassion works towards quieting our out-of-control story-teller. The story-teller has a purpose, to assist us in surviving when we don't have all of the data, but when it takes control, it can remove love from our existance.

Dr. Taylor concludes, "Nowadays, I spend a whole lot of time thinking about thinking just because I find my brain so fascinating. As Socrates said, 'The unexamined life is not worth living.' There has been nothing more empowering than the realization that I don't have to think thoughts that bring me pain. Of course there is nothing wrog with thinking about things that bring me pain as long as I am aware than I am choosing to engage in that emotional circuitry. At the same time, it is freeing to know that I have the conscious power to stop thinking those thoughts when I am satiated. It is liberating to know that I have the ability to choose a peaceful and loving mind (my right mind), whatever my physical or mental circumstances, by deciding to step to the right and bring my thoughts back to the present moment."

This concept has been a major part of my work as a physician: to assist people in changing their minds by changing their thoughts and emotions. It is possible to be different than we have always been, once we start doing the work, dealing with the pain of the past and letting it go, realizing we have no control over the future and letting it go, trusting that as we stop believing our story-teller that more compassion, peace and love will come into our hearts and we will be more open to doing what is for the highest good.

To me, this work is the purpose of our lives. We are here to learn to be like God, who is Love. As we change our minds, with patience and practice, those changes can become permanent and our own lives more peaceful and loving. And each one of us that changes allows others to change, and our personal ripple effect changes the energy of the world. This is the work of a lifetime, so we can afford to be patient with ourselves.

Until we meet again,
Dr. Judi

Trauma and the Brain

True love is often carved into a tree because the scar created in the bark will last forever. A couple can return years later and still find their proclaimed love visible for all to see.

Many of us have scars in our skin from childhood cuts and scrapes, or more serious burns or trauma.

But severe trauma, both emotional and physical, can create deeper scars that change the brain and can create chronic physical and/or emotional problems.

For a long time, scientists considered the brain unchanging after a certain age. However, newer research shows that the brain can create new brain cells and change nerve cell connections up until death. The changes are slower with age, but with the right stimulation changes can take place. This is called neuroplasticity.

When we experience physical or emotional trauma, the neural connections in the brain can change so there is a "brain scar," meaning that trauma becomes imprinted in the brain connections and the emotions and/or body keeps reacting as if it is in that trauma.

Consider the millions of inputs into your high-tech computer called the brain. If any of the imputs are flawed through "scarring" of the nervous system, then some of the output may also be flawed. The output may feel very real, and may even cause physical changes, but it is simply a result of the flawed neural input and output.

With emotional trauma, such as abuse, an accident that causes an acute fear of dying, war experiences, sudden death of a loved one, etc., the brain can go into a pattern that keeps reliving that trauma. Sometimes the reliving can be subconscious, resulting in panic attacks. Other times the person is conscious of constantly experiencing the trauma through thoughts, dreams, or "abreactions," which is a flashback of the trauma that actually feels like the person is experiencing it again. This is called post-traumatic stress disorder, or PTSD.

With physical trauma, such as a painful accident, surgery, or even dental procedures, a very low level pathologic impulse can affect the nervous system, and may reflex out at the same or a different level through the brain and autonomic nervous system. This can result in chronic pain, organ dysfunction, or at times an extreme dysfunction of the sympathetic nervous system called Reflex Sympathetic Dystrophy (RSD) or Complex Regional Pain Syndrome (CRPS).

"I sprained my ankle Dec. 14, 2007 and was diagnosed with RSD/CRPS. I am now 7 1/2 months post-injury and am dealing with the terrible pain of this condition. I would like to know what you know about this condition. "

RSD/CRPS is a chronic, painful and progressive neurological syndrome characterized by severe burning pain, pathologic changes in the skin, muscle and possibly bone, excessive sweating in the area of problem, tissue swelling and extreme sensitivity to touch. The syndrome usually develops in an injured limb, such as a broken leg, or following surgery. However, many cases of RSD involve only a minor injury, such as a sprain. And in some cases, no precipitating event can be identified. The pain becomes disproportionate to the inciting event. There may or may not be evidence of actual nerve injury. Pain may begin in one area or limb and then spread to other limbs.

Millions of people in the United States may suffer from this chronic pain syndrome. RSD/CRPS affects both men and women, and also occurs in children. It can occur at any age, but usually affects people between the ages of 40 and 60 years. RSD/CRPS appears to involve the complex interaction of the sensory, motor, and autonomic nervous systems, and the immune system. It is thought that brain and spinal cord (central nervous system) control over these various processes is somehow changed as a result of an injury.

Traditional western medical treatment often combines physical therapy to maintain mobility, medications to control pain, nerve blocks to block faulty neurological input, and psychosocial support to learn how to live with chronic pain. There is no belief that RSD/CRPS can be cured, though at times there are spontaneous remissions.

There are many alternative treatments that have been shown to have affect on RSD/CRPS. The most common are oxygenation therapies, such as hyperbaric oxygen treatment, hydrogen peroxide intravenously, and ultraviolet blood irradiation. These therapies seem to calm the nervous system and begin to heal the "scar."

Other treatments include specific frequency input, such as colored light, infrared therapy, low level laser therapy, magnetic therapy, and FMS (frequency specific microcurrent). There are studies that show that these therapies increase healing and often, over time, may even cure the problem.

We also use neurofeedback, which is a form of biofeedback that changes brain wave patterns. We perform a test called a Quantitative EEG (QEEG) which showes where brain wave patterns are abnormal, and use that information to create a neurofeedback protocol to change those patterns, which helps to "remove the scar." For more information go to www.vanguardbiofeedback.com.

If you are interested in learning more about healing emotional scars, click on "comments" below and Ask Dr. Judi!

Until we meet again,
Dr. Judi

My Father's Voice

My father, Jesse E. Stay, died a week and a half ago, a month shy of his 87th birthday. The funeral last week-end was a beautiful celebration of his life. He was a man who gave his life in service to his wife, his family, his country, his fellow man and his God. He was always moving, serving, and working around the house and the yard until he became too weak a few months ago. He loved to garden, but had to give up most of it a few years ago, though he still grew tomatoes. The fresh, ripe tomatoes were delicious all summer, and he made his famous tomato soup all winter from the tomatoes he canned. This picture was taken when he was 83, still a young man:-). He is holding an orange from his beloved orange tree, that he decided looked like him. He even put a sore on the "nose" celebrating the removal of a cancer from the end of his nose.

This last year had been difficult for him. My mother was very sick, and he waited on her hand and foot, tenderly caring for her when she wasn't able to do anything for herself. He did it lovingly, but he worried about her a lot. His mind was becoming old, and he began to forget a lot of things. When he was worried about Mom, his thought process became worse. Slowly she started improving, and then he started having his own physical health problems. But even to the end, when his mind was going, he would take care of Mom, do the dishes, take out the trash, and check on the tomatoes. When we were there caring for both of them, he would stand up and say, "I know I'm supposed to do something. I just can't remember what it is." We would tell him that everything was done, that he didn't need to worry about anything, and he would sit down again, still dissatisfied. He didn't know how to live life without working and serving. We were blessed that his dying process was relatively quick and very peaceful, with his wife and many of his children around him.

Each of his children were asked to take part in the funeral. Several of us were asked to share memories. There were so many memories that I had a difficult time deciding what I was going to talk about. Then I started hearing my father's voice. I started remembering all the things he had told me, had taught me, the sayings that were typical of him. Words like, "If you see something that needs doing, don't wait for someone else to do it, just do it yourself!" And "A mule would rather break his back with one trip than to take two." I remembered him teaching morse code while we did the dishes together. I remember him making his famous pancakes and saying "I don't hear any oohs and aahs." It was usually because our mouths were full, but we rapidly showed our appreciation for the featherlight, delicious taste in our mouths with dutiful oohs and aahs. And when I inched my way into the cold ocean as he rapidly dove into the waves, he would paraphrase Shakespeare: "A coward dies a thousand deaths but the brave die but once." So I talked on my memories of my father's words and how he assisted in shaping my life.

I've been considering the affect that the words we hear when we are very little have on us. I was very blessed to have the father I did. But when I was young, he was still learning how to be the best father, and he had a loud voice when we did something out of line. I don't remember being punished, though I know my mischievious little brothers received an occasional spanking reminder to be good. I do remember that sometimes I was afraid of him, just because I was small and he was big with a loud, sometimes angry voice. I don't blame him for anything, because I know he always was the best father he was able to be, and I have very little to complain about, but I wonder what affect his loud words had on me when I was tiny, and how that affected how I reacted later in life.

When we are born, our mind is open to every outside influence. We have no boundaries, and take in everything coming into us as our own. The emotions, words, actions of those around us, how those who care for us or who are in authority over us tell us we should act and what we should believe, all flow in without filtering and become part of our subconscious mind. We become programmed.

Throughout our lives, as we experience the world around us, those voices from the past become our own voice, telling us what is right and wrong, telling us how to be and how to act. If we were taught consistently with love and caring words, this can be a very positive influence. If we were taught with anger and criticism, we may find ourselves repeating that anger and criticism to ourselves whenever we make a mistake, or just beat ourselves up in general because those thoughts keep coming. Or we may find that the anger may come out and affect others. We may find ourselves repeating those words from the past to those we love, whether we want to or not.

I have found that when I have negative thoughts about myself or others, I get to take time and ponder where those thoughts are coming from. Are they the voices of the past, of parents or teachers, who in their best desires pointed out our shortcomings? Are they they words or feelings or limiting beliefs we picked up from those caring for us that they felt about themselves? Are they the voices of brothers and sisters, or the children, cruel at times in the schoolyard? I find that often my negative thoughts are not really my own, but voices from the past that I have made my own.

Once I realize this, a visualization serves me to begin to let these thoughts go. I visualize whomever I picked up these thoughts, feelings or limiting beliefs from standing in front of me. Then I tell them something like the following: "I appreciate all you have done for me in my life. However, at this time, these words (or feelings, or beliefs) that I picked up from you no longer serve me. I give them back to you, and ask God to bless you with them. I forgive you for any of these things that may have caused me harm. I know you loved me the best you were able to."

I then visualize the thoughts, feelings or beliefs as a color, and allow that color to gather and flow from me to that other person, until the color is gone. Then I send them the color I see as love flowing from my heart to their's, and I know that this connection never ends. It is a very peaceful and loving visualization, and has served me well in letting go of the things in my subconscious mind that do not serve me.

As you read this, you may find yourself feeling guilty because of what you may have created in your own children; what their open minds absorbed from us as they were little. We all do our best. We all make mistakes. I have done things that have created problems in my own children. Every child has mother and father issues. It's the way of life. I believe that if we chose our own families before we came to this earth, that we chose them as much for their weaknesses as for their strengths. It is learning from our own weaknesses and the weaknesses of those around us that allows us the greatest growth.

As we work hard to heal our own hearts, it is easier for us not to react from those voices, feelings and beliefs of the past. Then we create less problems for those around us. And as we begin to heal, it creates a healing energy that opens doors for those around us to heal as well.

I was blessed to have the father I did. His loud, sometimes angry words of my early childhood eventually changed to loving and uplifting words as I was a teenager. He worked continually on being a better person, and he was successful. As we seek, we shall find. That is a promise.

Until we meet again,

Dr. Judi

The Sandwich Generation

This image was taken at Chuck E. Cheese in Encinitas, California, where we were having a birthday party for my darling granddaughter Avery, the grand age of two years old. Her mother was suffering from severe morning sickness, and her daddy had a broken ankle, so I got the privilege of spending time playing with her for a couple of long weekends.

I remember long car trips as a child. My father was in the Air Force, and we moved a lot, and at times lived on the other side of the country from where my parents' families lived, so we often were in the car for days at a time. The children would fight over who got to sit in front, so my mother would often sacrifice and take the current baby and sit in the back seat of our station wagon, where no one else wanted to sit. She would have the cooler on one side and the baby on the other, and it seemed she would spend all day making sandwiches for us, sandwiched there in the back seat between baby and cooler.

The Baby Boomer women are now being called "The Sandwich Generation." With life expectancy increasing we have aged parents that often need our time, attention and care. And with the difficulty economy, increased prices of homes, increase in divorces, and normal trials of life, we often find ourselves caring for and supporting our children and grandchildren.

This blog was put on hold for awhile because I was fulfilling my own "Sandwich Generation" duties. Between a heavy work schedule, caring for the needs of ailing parents, problems of adult children and caring for grandchildren, I didn't find time for other things, like cleaning my house and writing blogs. Life just does that to you sometimes. What is more important than our relationships, anyway?

Women tend to take on the caregiver role for invalid parents and in-laws, husbands with a chronic illness, children who can't seem to make it independently, grandchildren who are left by working or non-functioning children, even friends and neighbors who are in need. The nurturing trait in women often brings a sincere desire to help, and we may have the feeling that if we don't do it, who will? Or, no one loves them as much as I do, so no one will give them the kind of care I will give them.

Too often, however, a caring woman becomes exhausted trying to do it all, and starts resenting her lot in life, those she cares for, and/or those who could also be helping but aren't. The duties and chores become overwhelming and her own physical and emotional health starts to suffer. She feels trapped in an unending cycle of duties and can't see any way out. The people she is caring for may seem ungrateful or even antagonistic at times. Often, because of the stress, she begins to experience severe fatigue, aches and pains, hormonal imbalances and depressive episodes. I often see caretaker women in my office in this state. Are relationships worth all of this?

Yes, they usually are, but there are always an infinite number of possibilities to bring greater balance into our lives so that we don't allow our own health to suffer because of our caretaking duties. I will give several suggestions here, but I encourage you to write in the comments section with your own experiences and suggestions, so that we can all learn from each other.

1. Let go of doing it perfectly. We often want to show our love by doing for others what they can't do for themselves, and we want to do it the very best way we can. But usually we can cut back in the time and effort needed if we are able to let go of the need to it perfectly. In all actuality, most of those we care for don't notice the difference when we go the extra mile, and they are just as happy with our "second best" as with our "best."
2. If you are caring for someone with a chronic illness, exhaust every resource for extra care. Most insurances won't volunteer what they will cover until asked. Get the doctor to write a prescription for an evaluation by a home health care company. They will be able to determine what the insurance will cover, and often it is more than you might believe. It may save you trips to the doctor, physical therapist, etc.
3. Take at least one day off from your caretaker role every week. Use another willing relative (often we don't realize how much help others will give until we ask), hire a babysitter (no, they won't do as good a job as you do, but your loved one will manage), ask for assistance from your church, call the senior center to find what support they can give, or hire a professional caretaker (sometimes they are not as expensive as you might have believed). We hired a professional caretaker to care for my parents five days a week, and my sister comes in two days a week. That was less expensive than an assisted living center, and my parents are more comfortable in their own home.
4. Enroll others into assisting with your other responsibilities: shopping, housecleaning, food preparation, washing clothes, etc. Often stores will deliver free or for a small fee when you shop for groceries online. It's ok to spend a little to hire someone to do deep cleaning once a week. Just look at it as an investment in your health.
5. Know your limits. If you are reaching the end of your rope, it may be time for someone else to take over, or to place them in a nursing home (there are good ones out there, if you keep looking). There may come a time when your children will have to find another babysitter for your beloved grandchildren. Know when to let go, which can be the hardest task of all. It's ok to say no, even when you love them.

We are each here to learn life's lessons. Sometimes we love the most by letting our loved ones deal with things on their own, and work through their own problems and issues, rather than rescuing them every time. I continually have to remind myself of this. I tend to be a rescuer. I find that asking the simple question, each time I am faced with another way to take care of someone, "What is for the highest good?", that usually I can care for them in a balanced and responsible way.

I encourage and welcome any other comments and suggestions. Now, back to making sandwiches :)

Until we meet again,

Dr. Judi

Hormones and Guilt

I was blessed to get a great price on a weekend cruise from San Diego to Cabo San Lucas. I decided to take my daughter, who is a single mother of three and under a lot of stress, and went with two other friends. We had a great time, so good, in fact, that at times I felt guilty that I hadn't been able to bring all of my children on the cruise. No matter that I couldn't have afforded it, no matter that they were all busy and it probably wasn't a good time for them anyway, no matter that they were all happy I was able to have a good time and that I was able to share it with Tina. The guilt was there anyway.


Yesterday my son invited me to his son's pack meeting that evening to see him receive an award. I got out of work late and was exhausted. It took at least 40 minutes to get to their house if there was no traffic. It takes me an hour and a half to get home from their house. I decided to go home and take care of myself, but immediately felt guilty. No matter that I would probably be late and miss the awards anyway. No matter that I had that same grandson over the weekend before to spend two nights for his birthday. I felt the guilt anyway.

Many of us women, and some men, though studies show it is much higher in women, tend to feel that we have to be all things to all people, that we have to do everything well, that we should sacrifice ourself for the benefit of others. And we feel guilty when we can't do it all, which is almost all of the time.

One of the things many women are feeling guilty about right now is the use of hormone replacement therapy (HRT) for their menopausal symptoms. For years women have been told that taking estrogen after menopause will help them, not only with relieving hot flashes and other menopausal symptoms, but that it will reduce osteoporosis, heart disease, and even help them keep their youth. They did discover that using only estrogen (in the form of horse estrogens) increased the incidence of uterine cancer, so they invented progestins (a man-made chemical that attaches to progesterone receptors) which, when taken with the estrogen, stopped that risk. Though some women had unpleasant side effects, most women felt much better on hormones, especially in relation to stopping hot flashes, reducing vaginal dryness, and especially assisting in regulating mood swings.

As discussed in the previous blog, in the last few years new studies have come out that show that taking estrogens (in the form of horse estrogen) and progestins increases the risk of breast cancer, heart disease, blood clots, dementia and stroke. Many doctors stopped prescribing hormones, and women were left to go through their menopausal symptoms without relief, feeling guilty that they had risked their health by taking them so long, but secretly wishing they could go back on. Others, who continued to take the hormones "because I would rather die of breast cancer than go crazy" now feel guilty for taking them.

These studies have been heavily scrutinized over the last 5 or so years, and at the American Society of Reproductive Medicine in Jan. 2008, guidelines were given on the use of HRT. According to this algorithm, HRT should primarily be offered to treat hot flashes. HRT should be recommended for those who are at low risk for cardiovascular disease and are within 5 years after menopause. HRT should not be the first choice when someone is 10 or more years past menopause. Transdermal estrogen (no first-pass effect, therefore less clotting effect) is the preferred delivery route. Treatment should be started with the lowest effective dose and preferably should last less than 5 years.

The problem with this is that this is just putting off the agony. It has been shown in studies that when HRT is discontinued, the symptoms return. So a woman may use HRT to reduce her symptoms for up to 5 years after menopause starts, but then she'll have to suffer with them.

There are other options to assist with the symptoms of menopause other than horse estrogens and progestins. Bioidentical hormones have been hugely promoted since Suzanne Summers recommended them in a recent book. Bioidentical hormones are natural hormonal preparations extracted from plants (for example, soy, or wild or Mexican Yam). They are called bioidentical because the molecules are identical to the molecules found in the human body, unlike the horse estrogens. They can be customized; women can tailor the dose to the severity of their symptoms. Bioidentical estradiol, estrone, estiol, progesterone, testosterone, DHEA and pregnenolone are all available and can be delivered by various routes such as tablet, cream, transdermal, sublingual, etc. They are often made into custom compounds by compounding pharmacists as prescribed by a physician. Many women have had great symptomatic improvement using bioidentical hormones.

However, these compounds have recently been criticized by the FDA and the medical community. Their complaints are that they do not have government approval because individually mixed formulations have not been tested to prove that they are absorbed appropriately or provide predictable levels in blood and tissue. Moreover, there is little scientific evidence concerning the effects of these hormones, and as the preparation methods vary from one pharmacist to another, and from one pharmacy to another, patients may not receive consistent amounts of medication.

The FDA admitted that no adverse event involving bioidentical estriol, the estrogen that is most prevalent in the commonly prescribed "Tri-Est," has ever been reported. In fact, a research study involving 15,000 women found that women who produced the most estriol during their first pregnancy had 58% less breast cancer over the next 40 years.

There have been studies on bioidentical hormones which show that they seem to have protective effects in that they do not increase cancer or cardiovascular risk, but the large studies which were done on the horse estrogens (Premarin), and progestins (Provera) or their mixture (Prempro), have not been done on the bioidentical hormones, so there is not unequivical proof that these compounds are safer.

Also, transdermal progesterone alone, without estrogen, long touted as protective against osteoporosis, has been shown in recent studies that, although it slightly slows the reduction in bone mass after menopause, it does not stop it.

However, if your menopausal symptoms are severe, and you are considering using HRT anyway, I believe that the use of hormones that are identical to your own is likely safer than using horse estrogens which are up to 1,000 stronger, or synthetic hormone-like substances that are unfamiliar to the body. Maybe this will help reduce your guilt :-) However, it is important to find a physician who is knowledgable in the testing and use of these products.

To read the compounding pharmacists concerns related to the new FDA rulings on bioidentical hormones go to http://www.iacprx.org/.

There are also special tests that can test the metabolites of estrogen in your body. There are some metabolites that increase the risk of cancer and others that decrease the risk. This test will show how you break down the estrogen and if you're at higher risk. Even if you don't get the test, some of the things you can do to change your metabolites to the healthier type are: eat more cruciferous vegetables (broccoli, cauliflower, cabbage, brussel sprouts, etc.), take fish oil, eat ground flax seed, lose weight, exercise, eat soy. One study showed that mice who were bred to always get breast cancer didn't get breast cancer when they were fed fish or flax oil.

Other methods that may reduce your symptoms include plant based phytohormones. Soy is especially high in phytohormones, which attach to the hormone receptors in the body and help reduce symptoms. However, be aware that there is some evidence that soy may reduce thyroid function in some people if used over a long period of time. The herbs black cohosh, dong quai (Angelica sinensis), chaste berry (Vitex agnus-castus) and red raspberry leaves can also have hormonal effects. Acupuncture and Chinese herbs can be quite effective for some women. Homeopathic medicines can be useful. Though there is not one medicine to one disease in homeopathy, the most common menopausal remedies for hot flashes are Sepia and Lachesis. Supplements that have been shown to help are Vitamin E, Evening Primrose Oil, and Omega 3 oils. I will have another blog discussing osteoporosis later.

This is the end of my menopausal blogging at this time. Make sure, if you have any questions, to click on comments below and ask them!

"Finding Joy"

Assignment Four: Use remorse and let go of guilt. Remorse is a godly sorrow that brings us to strive to change ourselves and make amends. It lifts us, and allows us to feel better. Guilt is causes us to continually punish and belittle ourselves, but does not bring about change. Many people believe they have to hold onto guilt or they won't ever be better, but in reality it is BECAUSE they hold onto guilt that they don't ever get better. Holding guilt causes us constantly focus on the negative. What we focus on is what we attract to ourselves. It causes us to lose faith in ourselves, in others, and in God. Remorse allows us to build faith.

1. If you really have done something that has wronged someone, remorse assists in correcting it. There is often a feeling of "I feel badly that I did this. How can I make it better?" Ask yourself why you did it. If you can't figure that out, talk to someone or get professional assistance to discover your hidden motives for that type of behavior. Then make amends--to that person or people, to God, to yourself. Acknowledge what you have learned. Then LET IT GO! If you continue to hold onto the pain of what you have done, it becomes guilt. If you do it again, go through the same process again, and then LET IT GO!
2. Recognize the need to please. My guilt concerning my grandson was my need to please all people at all times. However, I am only human, and this simply is not possible.
3. Recognize your own needs. Often we sacrifice our own needs to the needs of others so often that we fail to even realize when we are going beyond our capabilities. Then we crash, either emotionally or physically.
4. Find time to nurture yourself. We are not required to run faster than we are able. It is important for us to recognize our limitations and take care of ourselves.
5. Create a win-win. Recognize when you truly need to nurture yourself. If you are like most of us, there will be demands on your time which may tempt you to sacrifice your needs for someone else. Often you can create an alternative which will satisfy both needs, though maybe not in the expected way. In this case, I will be seeing this grandson in a few days. I will have him tell me all about his experience in receiving this award, and be a part of it in that way. There may be other times when you choose to do this other thing. Then make it a point to make another time to nurture yourself, and KEEP YOUR PROMISES TO YOURSELF!
6. Be kind to yourself. We often treat ourselves more harshly that we do others. We call ourselves names and punish ourselves for little things. Our thoughts about ourselves are constantly negative, and we often don't feel that we deserve to do anything to nurture ourselves. Treat yourself as kindly as you treat others, and you will find yourself treating others even better!
7. Recognize the difference between selfishness and being self-loving. They are not the same thing! Selfishness is not wanting to give to others, or giving to self without any thought or care about the effect on others. Being self-loving is taking care of yourself so that you have the energy and ability to give to others. WE CANNOT GIVE WHAT WE DO NOT HAVE!

Until we meet again,
Dr. Judi

Hormonal Changes in The Change of Life

A new granddaughter entered my life last week, December Lynne Moore. I am so excited to have this new addition to our family; out of 17 grandchildren she is only the fourth girl.

My son and daughter-in-law already have 3 little boys age 5 and under; a new daughter will certainly change the dynamics of their family! Derrick, the oldest, is the little helper, and is doing what he can to help Mommy and his baby sister, and he asks frequently to hold her. Skyler at first didn't even want to see his sister. He's not sure about this new addition to the family that is taking Mommy's attention and he would rather ignore her. Collin, just two, has always had separation anxiety when either of his parents leave. As long as Mommy or Daddy stay with him, he seems ok having this toy baby around. But life has changed for all of them, and there is nothing any of them can do to change it back to the way it was before.

I've been without hot water for a week and a half. Something is wrong with the hot water heater. There were some problems so they couldn't get the part up until Friday. Then the part didn't work. They said they wouldn't be back until Monday. No matter how many calls I made, I couldn't get anyone to come up on Saturday. I'm still without hot water and I can't change it.

So many things happen in our lives, in our relationships, with our health, that no matter what we may do, we can't change. Things are out of our hands; we have no control over them. Going through "the change of life," or menopause, is one of them. We can't control the fact that our bodies are changing. But there are things we can do to make those changes easier to deal with.

As I said in the last blog, menopause is defined as that point in time when our periods stop permanently. Hormonal changes begin to occur before the actual menopause, and this period is called perimenopause, and may last from two to eight years.

Contrary to popular opinion, estrogen levels often remain relatively stable during perimenopause. They usually don't decrease until less than a year before the last menstrual period. During the menstrual years, the primary strong estrogen that the body produces is estradiol. During perimenopause, the primary strong estrogen changes to estrone, produced both in the ovaries and in the body fat. Estriol is another estrogen that is produced in fairly large amounts, but has a weaker affect on uterine and breast tissue. Estriol is the primary estrogen produced during pregnancy.

Testosterone levels usually do not fall during perimenopause unless there is excessive stress in a woman's life, at which time DHEA (precursor to testosterone) levels may fall, leading to less testosterone.

On the other hand, progesterone levels do begin to fall in perimenopause, often long before changes in estrogen or testosterone. This will often cause changes in the length, duration or heaviness of the periods, and is actually the most significant issue for many perimenopausal women.

All though reproduction is usually no longer an important goal during perimenopause, the "reproductive" hormones continue to play vital, health-enhancing roles in the body, evidenced by the fact that there are hormone receptors found in almost every organ of our bodies.

Among many other roles, estrogen, androgens (like testosterone and DHEA), and progesterone are important in maintaining strong and healthy bones and muscles and resilient vaginal and urethral tissue. Both estrogen and progesterone are important for maintaining a healthy collagen layer in the skin.

Progesterone is necessary for the body to make cortisol, the hormone that deals with physical and emotional stress, cortisone, the body's own anti-inflammatory, and aldosterone, which helps regulate fluid levels in the body.

Because the risk of heart attacks is much lower in women than in men until menopause, it has long been felt that these hormones played an important role in preventing heart disease.

Because of these reasons, for years women have been told that hormone replacement therapy (HRT) was the best thing for them as they reached the menopausal years, with the belief and sometimes evidence that there was positive effects on menopausal symptoms, cardiovascular disease, osteoporosis, vaginal and urinary symptoms, Alzheimer's disease, and possibly aging itself.

However, recent studies have discounted some of these effects. Most of these recent studies have used a combination of horse estrogens and synthetic progestins, (brand names Premarin, Provera, and Prempro). Premarin is made from estrogens from pregnant mare's urine. The principle horse estrogen in Premarin is called equilin, which is not found in humans. Equilin's effects on the lining of the uterus are up to 1,000 times stronger than the effects of human estrogen, and it also has much strnger effects on breast tissue.

Provera is a synthetic molecule that is similar to progesterone but not similar enough to call it progesterone. The molecule is called a progestin, meaning that it attaches to the progesterone receptors in the body and has a few progesterone-like effects. Studies have shown Provera to increase the risk of heart attacks, and it has several unpleasant side effects.

It has been shown that combination HRT with these "un-human" hormones seems to increase the risk of breast cancer, blood clots, stroke, and heart attacks. This has many women wondering how to deal with the symptoms of menopause and how to treat osteoporosis if they choose to not use or discontinue HRT.

It is important to remember that menopause is a natural process for the female body, and not a disease. Many women experience the cessation of their periods without any symptoms, receiving no treatment, and go on to live long, healthy and productive lives. Hormones continue to be produced (though in smaller amounts) in the ovaries, and may also be produced by the adreanl glands, body fat, liver, breast tissue, pineal gland and even hair follicles!

Whether or not a woman experiences symptoms during perimenopause and menopause depends on numerous factors, including but not limited to overall physical health, emotional and spiritual well-being, nutritional status, lifestyle and diet, how stress is dealt with, and genetics.

We will continue the discussion of hormone replacement therapy in the next blog, and talk about "bio-identical" hormones.

"Finding Joy"

Assignment Three: When difficult things or people seem impossible to change and life seems out of control, remember three things:

1. There are always an infinite number of possibilities.
2. Act, don't react.
3. I can always change my attitude.

I used to believe that when I came to a stuck place that I didn't seem to be able to change, I would only have one or two choices to make, and often neither of them would work. Then I learned from my friend, Hans, that in actuality there are always an infinite number of possibilities to work through problems. A simple example: I wake up to find my car won't start. I have a very important meeting at work. Living alone with no one else to drive me, the only choice appears to be that I will have to call someone to come fix the car and be late and miss the meeting. I'm stuck. I can't change the fact that my car doesn't work.

But if the meeting is that important to me, I can now put on my thinking cap and brainstorm. I think of every possible way I could get to work, whether they are practical or not. I could ride my bike, call a friend to take me, call a taxi, ask the repair place to take me, rent a car, call a co-worker to get me; or possibly I could call my work and rearrange the time of the meeting. or do the meeting over the phone on a conference call while the car is getting fixed, etc. etc. When I start to think of all the possibilities, suddenly the "unchangable" becomes possible.

When something seemingly bad happens that I can't change, I can either react to the situation with anger, frustration and fear, or act to resolve it or accept it. When I found out I wasn't going to have hot water for another four days, I reacted for a moment with anger. Then I decided to let the anger go and work on resolving it by finding another plumber. When I couldn't find a plumber to come on a Saturday, I started reacting with frustration. I decided to let it go and imagined myself as a pioneer heating my water for washing and bathing.

Then I began to see how very blessed I was, because unlike the pioneers, I didn't have to go out in the snow to the well for water. I didn't have to haul all the water into the house in buckets. I didn't have to chop the wood and build a fire to heat the water on. And I knew that this was going to end in four days. And my attitude about the situation changed, so I didn't have to hold onto the anger and frustration. Gratitude is the best attitude adjustment there is!!

Until we meet again,

Dr. Judi

Menopause and Letting Go

We have two dogs at our house. Bruce, pictured here sharing his food with a friend, loves playing "fetch" more than anything in the world. He will bring a stick, a ball, a piece of plastic, anything he can find, and lay it at your feet and implore you with his eyes to pick it up and throw it. Once you do, he'll never leave you alone. Playing "fetch" 24 hours a day would be his idea of heaven.



"Fetch" requires several things of a dog. First, they have to chase after and find whatever is being thrown. Next, they have to bring it back to the thrower. Third, they have to let it go so the thrower can throw again.



Now Zeke also loves playing "fetch," but he lacks one of the skills necessary for a good game. He and Bruce will compete in this game, seeing who can get to the stick first. When Zeke gets it first, Bruce becomes very agitated, because he knows the game has ended. Because Zeke hasn't learned how to let go. He chases, fetches, brings it back, and then holds onto it. Letting go is too scary for him. He might lose it to Bruce if he lets go. But because he won't let go, the game and the fun ends.



Letting go is an integral part of life, even in nature. Clouds become so filled with water they have to let go of it. That water feeds the spring-time trees, allowing the leaves to bud and flowers to blossom. The flowers let go of their petals to turn into fruit, the trees let go of the fruit so they can bear more in the future. Then they let go of their leaves so that they can have a period of rest. Letting go is part of the cycle of life.



Our hands are so miraculous. There are a multitude of tasks, way too numerous to mention, that our hands can accomplish. But think what would happen if our hands could pick something up, but couldn't let it go. We would be stuck. When we refuse to let go of things in our lives, we become stuck. The game ends.



Menopause is a time time of letting go. We women get to let go of the cycles of our physical creative powers. This is a time when we also may need to let go of the image we have created about ourselves. Generally, around the time of menopause, our lives as well as our bodies are also changing. "The Change" is often not understated!



This may be the time frame when many of us are also letting go of one of the most important roles we have played, that of mother. Children are leaving the home; they don't need us in the same way anymore; they don't want our advice; their energies are on their studies, their jobs, their relationships, their own new families. We may find ourselves alone more. We may have to redefine ourselves as life shifts around us. We may begin to see, whether we have children or not, that the expectations we had out of life, out of our relationships, or even out of ourselves, are not coming to fruition. We may find ourselves letting go of these long-held expectations.



One of the changes most of us rejoice in is the letting go of the monthly bleeding. Menopause is defined as the time when there has been no menstrual periods for 12 consecutive months and no other biological or physiological cause can be identified. It is the end of fertility, the end of the childbearing years. Unlike men, who produce sperm "on the spot," so to say, women are born with a certain number of eggs in their ovaries. As the eggs begin to "run out," the hormone levels naturally begin to drop, causing the changes present in "perimenopause."



Perimenopause is a period of time before actual menopause, which begins about 6 years before the natural menopause. This is a time when the levels of hormones produced by the aging ovaries fluctuate, leading to irregular menstrual patterns (irregularity in the length of the period, the time between periods, and the level of flow) and hot flashes (a sudden warm feeling with blushing). Other changes associated with the perimenopause and menopause include night sweats, mood swings, vaginal dryness, fluctuations in sexual desire (libido), forgetfulness, trouble sleeping and fatigue. Except for the bleeding, many symptoms can carry over into the menopausal period for a time.



Natural menopause occurs when the ovaries naturally begin decreasing their production of the sex hormones estrogen and progesterone. Induced menopause occurs if the ovaries are surgically removed or damaged by radiation or drugs. Due to the abrupt cutoff of ovarian hormones, induced menopause may cause the sudden onset of hot flashes and other menopause-related symptoms. A "simple" hysterectomy (when the uterus but not the ovaries are removed) before natural menopause should not affect the production of sex hormones and so not cause menopause (unless the nerves or blood supply to the ovaries is damaged during the hysterectomy), though, of course, there will be cessation of bleeding.


In the western world the average age for menopause is now 51. Natural menopause can, however, be in a woman's 30s or 60s. Factors influencing the time of menopause include heredity (genetics) and cigarette smoking. Smokers (and former smokers) reach menopause an average of 2 years before women who have never smoked. High levels of physical and/or emotional stress can also cause menopause to start earlier. High levels of stress may also stop a woman's bleeding cycles even if she is not menopausal, so it is important to test any early cessation of bleeding.


There is no relation between the time of a woman's first period and her age at menopause. The age at menopause is not influenced by a woman's race, height, number of children or use of oral contraceptives.



Usually the symptoms and cessations of periods are adequate to "diagnose" menopause, but if there are questions, usually a blood test measuring the follicle stimulating hormone (FSH) and the luteinizing hormone (LH) is done. These levels become very high when the estrogen and progesterone levels drop.



On the next blog, we will discuss the pros and cons of hormone replacement therapy, both traditional and bio-identical.



"Finding Joy"

Assignment Two: identify the stuck places in your life and determine what is important to let go of in order to move forward. These may be in the areas of health, relationships, spirituality, jobs, home, etc.

Some of the things I've had to let go of:

• the expectation of having someone always there to take care of me; I've found joy in being independent.


• the expectations I've placed on some of my children; I am learning how to love at new levels, how to love and respect my children and all of my relationships exactly how they are.


• the idea of being really thin again; after bearing six children, I appreciate and love my body the way it is and work to maintain it in the best health possible.


• the belief that my children want my advice on how they raise their children; I've come to the realization that God gave their children to them and not to me for a purpose:-)


• the belief that I have to sleep 8 hours night in order to function; before I let go of this belief I was tired all of the time. When I chose to let go of it, I found that I can function fine even if my menopausal body doesn't give me 8 hours of uninterrupted sleep.


• the belief that I have to be spiritually fed by others; I found that my spirituality comes from within, and all life and every event can be an opportunity for spiritual growth.


• the belief that I need other's approval and love to be good enough and to be happy; I now realize that my worth and my happiness depend solely on me.

Until we meet again,

Dr. Judi