Top Five Health Concerns Affecting Women:
Cancer, Heart Disease, Maternal, Reproductive and Mental Health a Roundtable Discussion

Cindi  

Thank you, Christy and everyone! It always makes me so excited when I see everybody here together on the screen in front of me and I just get thrilled to listen to the information that you’re going to give us as well as our community. So thank you for being here.

We’re going to dive into our first question. The increasing number of Internet users and the over abundance of information accessible to those users makes what we’re doing right now the discussion altogether with collaborative women’s health care providers so important. We are striving to fill the gaps in public knowledge of these issues and provide accurate information.

So let’s start talking about the top women’s health related concerns. What are they? Our compiled list after looking at numerous resources, as Crissy just said include cancer, heart disease, maternal health, reproductive health, which includes STDs STIs, HIV UTIs as well as mental health which includes depression, suicide, anxiety, etc.

So let’s begin by discussing cancer and heart disease, we’re going to tackle them together in this first question. According to the CDC, heart disease is the leading cause of death for African American and white women in the United States. Among American Indian and Alaska, native women, heart disease and cancer cause roughly the same number of deaths each year for Hispanic and Asian or Pacific Islander women, heart disease is second only to cancer as a cause of death.

When we say heart disease, we’re referring to several types of heart conditions, including coronary artery disease and heart attack. The most common cancers affecting women are breast, cervical, and some skin cancers.

How do you see cancer and heart disease affecting the women you work with? And based on your specialty? What do you do to support these women?

Nicole Wallace  

Well, I can speak as a licensed clinical mental health counselor, oftentimes, I’ll see people after they’ve been diagnosed. And so they’re dealing with the emotions that come with a diagnosis or dealing with changes in their family or their abilities, and things like that. And so we try to provide support around coping skills, about dealing with life transitions, about expectations, family dynamics.

Kerry Jones  

So I can speak to this a little bit too. As a dietitian, I didn’t mention that I specifically see women during fertility, pregnancy, postpartum, and kids. So this isn’t really a topic that honestly comes up that often in my practice, I’m sure that Christy can attest to this, that there’s a lot of dietitians that specialize in this area who can help those women. And typically, the things that would be kind of talked about would be prevention from a healthy diet and lifestyle.

In my practice, we do breastfeeding, which has been shown in research to help kind of reduce the risk of breast cancer. So really supporting mom’s goal to breastfeed and know all women can’t breastfeed. But that is her goal, and that is what she’s working on trying to support her so that we can hopefully get her that benefit of decreasing her cancer risk later on.

Christy Maloney  

Yeah, Kerry, I agree. Like with the different specialties, it’s not something that I see all the time, either, but I will say, when we do you see cancer or heart disease, that kind of thing. A lot of times we will see women blame themselves, you know, “I didn’t do it, right.” “This is my fault somehow,” that kind of thing. And then, you know, what we also see is a lot of anxiety, of course, right?

Like with any of those diagnoses, and you know, as a dietitian, especially, we see a lot of like, “oh, I have to make a 180 lifestyle change, and absolutely everything I do and right now,” and it becomes really overwhelming. So, you know, for us, we really try to support from the perspective of, how can we help make changes that are going to be beneficial to the treatment of your heart disease, your cancer, whatever you have going on, but not feel unsustainable and manageable and even more overwhelming when that’s coupled with the diagnosis. 

Cindi  

Dr. Durney, I’m actually going to put you on the spot.

Dr. Holly Durney  

Well, that’s good, because I was about to unmute.

Cindi  

I was actually going to ask you from your perspective, because being a physical therapist, your specialty is in pelvic floor rehabilitation. But I can only assume that you perhaps have worked with some women who have undergone surgeries in terms of cervical, uterine, ovarian, etc. Do you have anything that you can talk about?

Dr. Holly Durney  

Probably the most common is just post mastectomy. There’s a lot of discomfort and pain, post surgery there. And then if women decide to get the augmentation afterwards, in order to have that they actually put the implant underneath the PEC muscle, and that can cause the shoulder to freeze and some issues there.

And so probably most commonly, with this population, I see post breast cancer and surgery their pelvic floor wise, there may be I know that there’s some pain and discomfort afterwards either, especially if there’s some radiation involved, there can be some muscle guarding and pelvic pain associated with that.

Imagine if there’s some hormone changes from a uterine cancer, that there’s some tissue changes there in the vaginal tissue. And so women’s health in PT can certainly help with that in terms of understanding the body changes and then just being able to help the tissues change because the body is different now post surgery but most commonly personally I see post mastectomy, but I do know as a field, physical therapy can help and all in all of these veins for any secondary issues that may arise from the treatment from the mainly from the surgeries like you said.

Cindi  

Do you also focus on people that have had heart disease or may be recuperating from any type of heart conditions?

Dr. Holly Durney  

Personally, no. Post COVID, we actually did a continuing ed course about how COVID has affected condition, overall condition and deconditioning. And you actually follow up with very similar protocol with heart disease in terms of being able to condition a patient, if there was actually a heart surgery, same thing, like you have scar tissue over the heart.

But in terms of actual heart disease, there’s a branch of physical therapy that does that actually, in the hospital like cardiovascular physical therapy, I wouldn’t say it’s in the vein of women’s health, necessarily, but there is there are things that I can do to advise in order to just help understand the changes in the body and then just to build up general conditioning for the patient.

Cindi  

Sure. And then going over to Maris, you work as a doula specializing in all these different areas. Have you run into women who have gotten pregnant perhaps after going through a cancer diagnosis and going through chemotherapy and radiation? Or have you worked with anyone that has had any type of heart condition?

Maris Feeley  

We have had clients who have experienced history of cancer or who work with or are pregnant with heart conditions, for example. And it definitely can impact both their experience of pregnancy and their relationship to their autonomy with their body as well, in pregnancy, which is something that we work really hard with families make sure that they feel they’ve got body literacy and that autonomy and that empowerment over their body and making choices, which I think especially for clients with difficult health histories, especially anything like cancer or heart disease, that might be more difficult, or that’s where wonderful therapists work definitely comes into play in terms of feeling the capacity to reclaim that.

I also want to call in that I think related to women’s health overall, we see this a lot with patients whose experiences have been with more, you know, difficult health histories, is this idea that there is I want to second, that idea of ownership over it as if like, well, if I had examined myself more like we put this onus on women to like prevent their own health sometimes or like to invent difficult health histories and see it a lot with fertility. We see a lot with managing pregnancy, which I know when we talk about maternal health later on comes in, like how much we put this individual onus on women to, you know, prevent negative health outcomes. When it really is systemic, it comes down to education and body literacy, and their doctors and providers.

Letting them know what for example, a heart attack feels like when you’re a woman versus a man and the fact that we we have this default, like older white men as our health map. And that doesn’t apply to so many women experiencing other health outcomes. And so I think we do a lot of unlearning of that, in addition to having clients with these difficult health histories.

And knowing you know what pain feels like in the body and hardwiring the brain around that when it comes to labor and delivery, which are very different kinds of pain.

Charryse Johnson  

Can I also add just in having worked with individuals who have been managing cancer, and heart disease, even different elements, the support they need looks different at different stages.

So the level of emotions and overwhelm that they’re going to experience in the beginning when they’re in shock, you know, is crisis intervention on one hand, and then at each stage, as we talk about as their body changes, or as they look at, Okay, I was a young person and had cancer and now that I’ve gotten past this, is it okay for me to reproduce? If I have a child, then there’s an escalated concern around what am I genetically passing to that child? Is that right? Is that wrong?

What kind of potential barriers and then the element that I often see show up at least in terms of the therapy space is, there are a lot of women who feel inconvenienced by a diagnosis of cancer and heart disease in that essence of I don’t have time for this. What will my family do without me? One of the biggest aspects of support can even be a matter of helping them give themselves permission to focus on their health, because they’re very wired and geared towards I am here on Earth and my soul in this role in life is to take care of everyone else. So there’s a lot of guilt, not only about what did I do wrong, but everyone else is now going to have to do things that they’re used to me doing. And I feel bad.

Even though it’s life threatening, there’s a very real aspect of them not feeling well. And so there’s a lot of emotions, and then that really creates identity dynamics that they also have to work through. And sometimes the family has to work through because the whole family system may need to renegotiate, in order to give mom adequate room space, to take that autonomy, and unlearn her role in the family so that she can take care of herself.

Cindi  

Such wonderful points from all of you. Thank you so much. Actually, our two nutritionists, Kerry and Christy, both alluded to this earlier. And so we’re just going to dive into that a little bit deeper.

Right now, you talked about prevention of heart disease and cancer using nutrition. And most often, when you research heart disease and cancers, the following lifestyle risk factors have been cited as potentially increasing the chance of developing these illnesses, which include alcohol use, smoking, high weight or obesity, limited exercise, poor diet.

Practitioners often turn to these behaviors as a primary concern of ailments and focus change for an afflicted individual is to redirect them back to changing any of those particular areas.

How is this an accurate directive by healthcare professionals? And in what ways is it leading women astray?

Christy Maloney  

I can go first on that just from a nutrition perspective. Charryse is like, “Yeah.” So of that we know that excessive alcohol use causes cancer. We know that smoking causes cancer. We know that getting a variety of foods in your diet and movement are very health promoting behaviors.

The place where I kind of get frustrated with the medical field is that it you know, so often, when we go to the doctor, we’re dismissed with losing weight. Eat better, move some, lose some weight, and it doesn’t fully address the complaints that we come in for. It doesn’t get women adequate testing they need for complaints that they’re presenting with, which causes a lot of misdiagnosis or diagnoses way too late in the game when it could have been caught at an earlier time or, or helped, you know, earlier before it had gotten worse.

I think that, again, just kind of the weight stigma of going to the doctor, and always being told lose weight, lose weight, lose weight, lose sight of complaints, and it’s fairly dismissive.

If we actually want to affect change, it’s getting clients to a dietitian. It’s getting clients to a PT that can help with mobility. It’s referring them to a substance abuse facility or smoking cessation program. You know, those are the things that I see. And that’s definitely one of my passion projects is to kind of help people understand that, from my perspective.

Kerry Jones  

I think that’s a great point. And I just want to jump on as a dietitian, because I feel like we share the same thought. I agree. I think prevention is important. I mean, I think the statistic is something like 42% of cancers are preventable. But we need to make sure that the recommendations that we’re giving about prevention are not solely weight focused, like Christy mentioned, because there is Health at Every Size, but also that are culturally appropriate, because there are some things that when we think like, Oh, poor diet.

White rice is the first thing that comes to my mind, that’s a very cultural thing. That people they’re like, Oh, well, that’s bad, you should be having brown rice. That’s just one simple example. But we need to make sure that the recommendations we’re giving are truly appropriate and culturally sensitive as well.

And also, just to touch back on the guilt that you guys talked about previously. Yes, 42% is preventable. But that means 58% isn’t. So we need to also make sure that we’re taking that into account and really supporting the mental health of these women as well.

Dr. Holly Durney  

And for me, in my profession, I have the weight conversation, but I tend to assume that there’s maybe something else that’s causing the weight issue, right?

So you don’t just say well, you need to exercise more. Well, maybe their back hurts and their knees hurting they can you know, so I have found that to be very beneficial, at least in my profession to really just try to meet the patient where they are and just say, “Hey, I I know you want to move and I know your knees hurt so we’re gonna get your pain better so that you can move,” you know, because just sitting with a doctor and saying, Well, your knees hurt because if you lost weight, they would hurt less. And so if I can’t walk, what am I supposed to do? And making that assumption that they’re just not trying.

There may be a reason as to why and then trying to help attack that reason with them as like their helper and their advocate instead of just assuming that they’re not doing it or that they haven’t tried something. So that’s what’s been helpful to me to acknowledge that, yes, you know, losing weight would be helpful to you. But let’s talk about how, at least from the physical point of view, how can I help you achieve that.

Charryse Johnson  

And then likewise, you’re going to have situations where even though we’re talking about the concept of highlight obesity, limited exercise, you know, what about the individuals who hear those same diagnoses where weight is not an issue, right, who are also in a situation of going, I have had the opportunity to eat well, and I move. And so I don’t understand how I got here.

But then kind of going back to where we started, we do live in a society and in a country, just within the US and globally, as well, where diet is a privilege. So we don’t often take into account the access that an individual may have.

So someone may go to the doctor and go, you’re, you know morbidly obese here, and this is happening in this dynamic, here’s what you need to do, and that appointment is over. And there’s often not any additional resources around a dietitian, a PT, a therapist, or anyone to say, and here are some individuals that you can reach out to, that can work with you and help look at your life. Look at the concept of your integrative health, because environmental factors influence stress, stress is influencing appetite. Appetite is influencing sleep, then we’ve got epigenetics, history of trauma, and all of those dynamics, interconnect and kind of load their, you know, genome and gut microbiome, which can increase the likelihood that they have all of these dynamics. And that’s not common knowledge. So someone is then left with that major piece. And that’s where it becomes harmful.

Because you have an individual who now feels like, if I were thin, this wouldn’t be happening. So it can be costly, because we’re putting too much onus on the visual aspect of what is being seen without taking time to treat the whole person. And really look at is this also an individual who has a history of child loss, and has had a significant number of changes in terms of body composition, based on those complications? And how is that impacting their mental health and the way they show up with food, so it just reduces it down to a very minute dynamic that doesn’t look at the whole picture, it can leave a person feeling helpless.