boobs. again.

This post makes me want to go out shirtless, just to see what would happen. Would I get arrested in this country (i.e. the U.S.) if I went out without a shirt? How come women in Europe and other parts of the world don't have to cover their breasts in public, but we do? Why is a breast, in any form, perceived as obscene? Does "the public" not realize that the difference between a man's breasts and a woman's amounts to some adipose (i.e. fat) tissue and developed ducts and glands? Or that breast milk is technically classified as a kind of mucus secretion?

It's just a breast people! Yes, i said it: breast. Maybe I should shout it: B-R-E-A-S-T.

And now for the point: to all those who have issues with seeing breasts, whether on a billboard, a magazine cover, a nursing mom, or on the street, or wherever, I say: GET OVER IT!

Seriously!

But I'm guessing that the people who have a problem with it are probably not reading my blog. *sigh* So what are we to do? How do we educate/liberate people? How do we get the advertisements and messages portraying women as mere sex objects to stop? Why do we buy products that are advertised like this? How come the conservative rhetoric seems to overpower the liberal voice these days?

????

I think I need to move to a blue state. Then again, here's some food for thought: none of the states seem to be doing well when it comes to women's health, in particular. Did you know that the majority of the states are not meeting the minimum basic requirements for women's health? The picture is bleak. Why aren't more people outraged?

"family planning"

my mom forwarded an email to me about the recent appointment of Susan Orr, PhD, to head the Federal Family Planning programs at the Department of Health and Human Services. the message was rather tantalizingly incendiary, and while my personal beliefs meshed with their assertions, i was curious to know whether the piece was slanted. so, thanks to Google, i did a little research.

the liberal slant on this appointment is that it's yet another huge step backwards for women's reproductive rights because Dr. Orr proposed elimination of contraception coverage for federal workers' insurance plans. the conservative slant is that it's a positive movement toward affording a greater amount of choice to individuals, particularly in the form of what components of health insurance coverage they choose to elect.

but what does this office of Federal Family Planning do, exactly? i wondered. so i looked them up. after a bit of digging, i discovered that title x is the main "to do" of this governmental unit. given this, theoretically, their mission is the following:

Program Priorities

1. Assuring ongoing high quality family planning and related preventive health services that will improve the overall health of individuals;

2. Assuring access to a broad range of acceptable and effective family planning methods and related preventive health services that include natural family planning methods, infertility services, and services for adolescents; highly effective contraceptive methods; breast and cervical cancer screening and prevention that corresponds with nationally recognized standards of care; STD and HIV prevention education, counseling, and testing; extramarital abstinence education and counseling; and other preventive health services. The broad range of services does not include abortion as a method of family planning;

3. Encouraging participation of families, parents, and/or other adults acting in the role of parents in the decision of minors to seek family planning services, including activities that promote positive family relationships;

4. Improving the health of individuals and communities by partnering with community-based organizations (CBOs), faith-based organizations (FBOs), and other public health providers that work with vulnerable or at-risk populations;

5. Promoting individual and community health by emphasizing family planning andrelated preventive health services for hard-to-reach populations, such as uninsured or under-insured individuals, males, persons with limited English proficiency, adolescents, and other vulnerable or at-risk populations.

Sounds okay, right? I mean, I don't personally like the notion that they exclude institutions that do not provide abortion services while including faith-based institutions (seems to me that in order to be "neutral," they shouldn't allow either or should allow both), but I'm all for educating people about reproduction and providing health services, particularly in under served areas. I looked up their allocation of grant funds for FY 2006, and while some of the studies seem a bit unrealistic, others did seem like they'd result in some helpful information.

Here's the kicker, though. Any organization that applies for/receives a grant from the government under title X must agree to the following:

None of the funds appropriated in this Act may be made available to any entity under title X of the Public Health Service Act unless the applicant for the award certifies to the Secretary that it encourages family participation in the decision of minors to seek family planning services and that it provides counseling to minors on how to resist attempts to coerce minors into engaging in sexual activities

Um, is it just me, or does that sound like any applicable program has to teach abstinence and take away the rights of minors in order to be funded? *sigh*

I get that people are concerned about the appointment of Dr. Orr to this organization, but based upon what I've read, it seems like most of the funding has already been restricted and directed toward the conservative abstinence-only, family-centered approach. If she continues to support the current administration's conservative views, i suspect we're in for more of the same--a decrease in funding and support for any program that advocates something other than abstinence.

This isn't quite what bugs me most about the appointment, though. What I want to know is why someone with degrees in politics is running a branch of government that should, at the very least, be run by someone with training and expertise in public health, if not medicine? How will she be able to make educated decisions about policy if she can only rely on her own opinions to guide her? I dare say, it would be like putting me--a pacifist--in charge of the Army! ;-)

At any rate, it all makes for interesting debate. What do you think?

As for me, well, I don't know yet. I've got to go read a good five chapters of embryology before I can even begin to form a foundational knowledge of what, exactly, "family planning" means....

Breast Cancer Walk 2007

i'm happy to report that, thanks in no small part to many of you, the mwms group raised over $1400 for breast cancer today! :-) the photos tell all....

the multitude of walkers

mwms students making strides!

the group pose

on a brighter note: giving thanks

i want to give a big public thank you to the world's best realtor for sponsoring mwms's breast cancer walk! her donation not only helped us reach our goal, it put us over the top! i continue to be stunned by her generosity--who knew that in buying a home, you could also gain a wonderful, supportive friend? :-)

i have much to add to my blog this month about breast cancer--particularly about a new screening device that's just come on the market that's sure to help our efforts at early detection--but i really ought to go study now. i have to keep reminding myself that i won't be able to help anyone with any medical problems unless i get through medical school.

in the meantime, use the internet for good & educate yourself about breast cancer. and don't forget: guys, you're at risk, too!

factoid of the week: skin cancer

as i believe i mentioned in an earlier post, i've been making an effort to pay attention to material i come across during my studies that piques my curiosity or interest. i'm calling these little nuggets "factoids," for lack of a better term.

this week's factoid proved more difficult to study than i'd anticipated. it all began while i was studying the dreaded brachial plexus in lab on wednesday. our group went to look at this meshwork of nerves in one of the cadavers. it was the first time we'd seen one of the cadavers face up this year. for whatever reason, it's more difficult to see the ventral side of these bodies than the dorsal side. our group took it in stride, though, and began to make sense of the mass of nerves in the cadaver.

it's hard to tell what's what in a cadaver. the preservation process they undergo leaves the tissues looking rather like thanksgiving turkey meat--for the most part, all the tissues are the same color, and they're dehydrated, so they're not always in the same position as one would expect them to be. it takes quite a while to learn how to appreciate the difference between an artery and a nerve, as you can imagine--both look like beige string.

as we were reviewing the nerves and arteries in the brachial plexus, though, we noticed a large, brownish-red mass on one of the nerves. 'strange.' i thought. 'that shouldn't be there.' then as we were digging around in the cervical area, we found more of these masses. as we went through our studies, i wandered around to view the rest of the body, and then it hit me: this was the cadaver that had died of cancer. skin cancer, to be precise. the masses we saw were metastases. and they were spread *everywhere.*

friday, as i was sitting through yet another exceptionally droll administrative lecture, i went to a blog i'd heard mentioned on dr_couz's blog (gotta love the blog chain effect!) written by a woman with melanoma. in it, sarah, a woman who was born the same year i was, describes her battle with cancer. her blog is stunning. i highly recommend you read it, from beginning to end. now.

sarah's blog sent me to another, living with melanoma. between the two, i gained a whole new perspective on what it must be like to be a cancer patient, particularly a young one. some of what they experienced overlaps with my experience, and likely the experiences of anyone who has faced a chronic disorder that requires careful and consistent management; but their experiences run deeper than i could've ever imagined. i never really thought about what it must be like to live with a disease that you can literally watch eating you alive. i also had no idea it could spread so fast....

and that's what brings me to post about what i've seen and read: it's clear to me now that the signs of disease can be extremely subtle and that we need, more than ever, to pay attention to our bodies. i don't mean to suggest that we all become hypochondriacs--that would be counterproductive. but rather that we take time to really look at our bodies, to check in with them, to observe change over time, etc.

i read a post back in july by kevin_m.d. that, well, frankly pissed me off. it basically suggested that breast self-examination is a worthless tool for the detection of cancer. the post and linked article angered me not because i doubt the stated statistics, but rather because it implies that women should ignore their breasts. the trouble with this is that society tells us--particularly those of us who are women (and i say this not to be sexist, but i noticed that nobody's done a study on the efficacy of testicular self-exam in men*)--that we're not supposed to be in touch with our bodies.

doing breast self exams may or may not allow women to detect possible malignancies earlier than they would be detected by other screening measures. but they do give women permission to pay attention to their breasts. (you'd be surprised at how many people are afraid to look at their bodies--this concept of it being okay to look at oneself wasn't fixed with hand mirror parties in the late 60s, believe me.) and one bright physician, dr. christiane northrup, extends the concept further. in her book, women's bodies, women's wisdom, she recommends what she calls a "monthly self-care ritual." the concept is that a woman take time, once per month, to examine her whole body. the idea is not to look for tumors or cancer--the concept is to appreciate one's body and learn how it feels when it's well. When we're informed about our bodies--their anatomy, physiology, and their innate unique personal quirks--we're more in tune with them, and we're more likely to notice changes, good or bad!

i assert, as well, that such a monthly screening ritual is not just for women. men would benefit from doing this, too. again, not to seek out disease--but to know wellness.

my factoid for the week was melanoma. my message(s) for the week? wear sunscreen. learn from the experiences of others. get to know your body. touch yourself! i promise you won't be sorry.

as one of my professors said this week: the lecture is over. now go learn something! :-)

* yes, i did look it up on PubMed, in case you're wondering.

picking up the thread: is it worth it?

first i must note that my beloved mac is finally back in my possession. i might not let it out of my sight again--that was one long tough week without it! i must thank the mac geniuses--they replaced both my fans, gratis. now the only periodic odd noise i hear is the sound of my cat, biddle, growling at the fed-ups man. did i mention that my cat thinks she's a dog? ;-)

....

i've spent a considerable amount of time lately pondering my pursuit of higher education. i'm not questioning the thirst for knowledge itself, mind you, but the actual paying-of-tuition / sitting-in-classes / eventually-getting-degree part of this whole journey to become a physician. choosing to delay my education for another year has left me feeling a bit depressed. this year, when (if?) i start medical school again, i'll be 30. i know chronological age is essentially meaningless (unless you're an actuary), but for some reason, i feel odd about this fact of turning 30. it's a petty thing, really--i'm experiencing that "always on the outside looking in on other's lives" syndrome that accompanies one of those life moments when everyone i come into contact with seems to have something that i want, yet lack. you know these people: they have the mcjob or the mchouse or the mcpartner or the mcbaby or the mcdog or...the real clincher for me these days...the mchealth. some people i come into contact with even have all of these things, including the mchappiness. i guess they got all the mcluck, too, eh?

the envy i feel probably stems most from having too much time to think. but recently, i realized that i'm not the only one gnawing on these feelings and issues, particularly as they relate to medical school and the sacrifice it entails. this is where i catch onto the thread--dr_panda_bear asked the question first, as far as i can tell, and dr_urostream mentioned it next--and so i might as well audibly voice the question that ricochets through the head of every med student as they hit yet another bump in the road: is it worth it?

it's a heavy question. one might think, based upon my recent "toad list" post where i ranted about some of the worst physicians on record, that i have a negative view of the medical profession. the truth is the opposite: i tend (to a fault?) to see the positive first. i'm a bit of an idealist in this way...and a tad gullible, i suspect, too. it's been difficult for me to answer questions posed to me about medical school and whether it's worth all the time/effort/energy/money/sacrifice/stress/etc. the other bloggers do a great job of addressing the issues in their posts--i wish i could write so cogently and analytically in response to the question.

....

when i ponder the question as to whether or not it's worth it for me to continue medical school, a certain experience comes to mind--the one that confirmed my convictions about being called to this career path. the story, i believe, speaks for itself:

when i first became interested in a career in medicine, one of my physicians, fertile_doc, hired me to work as the slave in his office for the summer. i spent most of my first few weeks on the job culling the thirty years of medical records and journals that were beginning to eat up all the storage space in the office. toward the end of the summer, though, i began doing more clerical work and having some interaction with patients.

the office was chronically busy, particularly on mornings when the ultrasound technician was present, as the majority of fertile_doc's practice surrounded treating couples with infertility issues and ultrasound plays a key role in this process. on one such morning, we were running a tad late. the waiting room was crowded and the staff was bustling about, trying to get all the phones answered, labs drawn, and insurance forms organized. i'd been assigned to "man the window," checking in patients and making sure charts made it to the appropriate spots on the racks for triage. and i was at the point where i was beginning to feel truly frazzled....

in the midst of this, someone knocked on the window. i groaned silently to myself; i'd thought all the morning's patients had been checked in already. what now? i was prepared to give my memorized, automaton directions to the bathroom, insurance policies, etc. i feared i'd strangle a drug rep if they appeared in the midst of our busiest hours. but i opened the window and was quite puzzled by what i saw. an elderly woman sat in a wheelchair with her husband standing behind her. they were definitely not the sort of people who'd show up for infertility treatment and i wondered as to whether they'd wandered into the wrong office. this was a situation that was going to require me to think. carefully.

"does fertile_doc work here?" the woman asked.
"uh...yes." i replied, still feeling puzzled.
"is fertile_doc here now?"
"yes" i replied. "do you have an appointment?"
"no" she said, "but i would like to speak to him."
"I'd be happy to schedule an appointment for you."
the woman looked at me--my confusion was no doubt clear by this point--and then struggled to pull herself up out of the wheelchair until she was standing. now eye-to-eye with me, she said:
"twenty-four years ago, fertile_doc detected my breast cancer during a routine exam. i survived because he discovered it early. i'm here because i would like to thank him."
she then carefully lowered herself back down into the wheelchair.

a few minutes later, i watched as this woman thanked fertile_doc for
what he'd done. most physicians i'd known treated breast exams as a perfunctory part of the physical examination. it's another one of those areas in which technology (in this case, mammography) often replaces good hands-on examination in medicine. but fertile_doc always took this portion of the exam seriously, taking time to really look and feel for lumps and changes in breast tissue. now i knew why he did so. it was a profound lesson.

as i watched this frail woman give fertile_doc a hug, i discovered something even more profound: fertile_doc had given this woman more time--time to be with her children, her husband, her loved ones...time to live. with one small, attentive act in the midst of an everyday job, fertile_doc made a huge difference in this woman's life.

it was in that moment, watching this interaction unfold, that i realized that there was nothing more meaningful i could do with my life than follow a career that had the potential to give even one person an extra minute, day, month, year, of quality life.

is anything worth more than that opportunity?

....

the answer for me, to the question "is it worth it?" is a simple resounding yes. in spite of all the bullsh!t that surrounds medicine these days, I believe it is a privilege to become a physician.

....

to all those physicians who have taken care of me, my loved ones, and even (especially?) the homeless jane & john does on the street: thank you for choosing to make the sacrifice, to dive in, & serve by example to show students that the pursuit of medicine is, indeed, worth it.

rant ii: the government versus a woman's body

the supreme court released its decision re: partial birth abortion today. i wish i could provide a direct link to the court document, but it's a rather large pdf file, and i have nowhere on the web to store it myself. so if you're interested in the nitty gritty of what i'm about to say, you may want to go read that document first. now has a link to it in their news section, as do several other news pages and organizations.

if you've been reading my blog, you know by now that i consider myself a feminist. i tend to agree with liberal politics, primarily because i'm an academic at heart and i'm always questioning everything. (my favorite question growing up: why?) i believe that conventions are made to be questioned and analyzed, not reflexively followed. i also am an exceptionally sensitive person, one who holds life dearly enough that she's been known to run into traffic to save a turtle about to meet its demise by attempting to cross the street. i cried when someone killed the wasps outside my house recently, even though i was afraid of them (i don't like pain and therefore avoid critters that sting/bite/want to eat me). basically, i'm a big mush--my heart is always on my sleeve and, no matter how hard i try, i cannot conceal this fact.

that having been said, i struggle with the issue of abortion. i feel that life is sacred. i've always been fascinated by childbirth and i know i'll likely end up focusing my career on women's health. *and* i have a strong respect for women's bodies and their choices about what happens to their bodies. so although i don't think i could ever have an abortion myself (<--i'm a little biased because i have fertility problems and it would be pretty darn hard for me to get pregnant without medical intervention), i think every woman has a right to choose. i also acknowledge the fact that, given my interest in women's health care, i may be trained and/or asked to perform this procedure. this fact scares me, but i acknowledge the reality, nonetheless. i cannot imagine the suffering that an unwanted child must endure throughout his or her life. i also don't think any woman should be forced into poverty or put her life in jeopardy for a fetus. it's my opinion, plain and simple.

when i first heard about partial birth abortion, i was incredibly disgusted. the description of the procedure seemed absolutely horrific to me and i couldn't understand why anyone would ever want to have that kind of an abortion. then i read the supreme court ruling.

if i'm understanding it correctly, a partial birth abortion involves delivering the fetus to a certain point and then killing it. in contrast, other types of late-term abortion involve dis-membering the fetus in utero and then delivering it. knowing what i know about science (remember, i just studied embryology and neuroanatomy, among other things), if i had to choose between someone whacking me on the head to kill me versus tearing me to shreds, i'd choose to be whacked. it's not even in the realm of being contestable--one act causes immediate death, the other is pure torture. but what did the courts just do? they just prevented physicians from performing the "humane" form of abortion while permitting them to torture fetuses via the alternate method. they say they're trying to preserve the sanctity of life--how on earth does this decision uphold that sanctity? seriously! can anyone follow the logic here? or did they simply make the decision so ambiguous as to prevent providers from performing any late-term abortions? hmm....

i really don't understand how the same government that has allowed us to invade other countries where we are killing innocent children and that allows our children to access guns so that they can kill each other can take a stand against killing a fetus that cannot survive outside of its mother. i also don't understand how our government can refuse to allow sex education to be taught in schools. if they don't want women to have abortions, then why aren't they teaching pregnancy prevention? if they're professing abstinence as a "cure" to prevent pregnancy, then why is the government (in some states) requiring young girls to be vaccinated against sti's? if they truly believed in their abstinence programs, there would be no need for the vaccinations. oh, wait--that's right--boys can have all the sex they want and spread around the sti's while girls have to remain abstinent until marriage wherein they get exposed to sti's because the guys were sleeping around--that's why we're mandating the vaccines, right?

i swear, if it weren't for the right to free speech, i think i'd be on the next plane out of this country. until the government takes away my right to rant, though, they'll just have to deal with me screaming from my blogspot.