Women Take Charge of Their Health

Health has become individualized like never before, down to genetic code or the unconscious mind. Eastside doctors are sculpting treatment and health plans to best suit the life their female patients want to live. We talked to a naturopathic physician that specializes in bio-identical hormone replacement therapy, a fertility hypno-therapist, a genetic counselor working on cancer prevention, and included a guideline to women’s health. We all have a vision for the life we want, and these specialists can help you accomplish it.

Can Hypnotherapy Boost Fertility?

— Shelby Rowe Moyer

One hour of hypnotherapy did the work of three years of weekly therapy for Rachel Moore, who decided to try it out while researching how to help her own clients make faster strides toward positive change. Moore, who’s Scotland-born and grew up in Canterbury, England, lived in Seattle for several years to obtain her master’s degree in social work at the University of Washington. She graduated in 2005 and moved back to London in 2011 to be closer to family. While working as a high school psychologist and counselor at a London university, she noticed her clients were changing, but progress was slow. Research in cognitive therapy led her to hypnotherapy and, after doing a session, she knew working with the unconscious mind was the key.

She enrolled in the Quest Institute in London to learn the methodology of hypnotherapy. Moore said cognitive hypnotherapy doesn’t include metronomic watches or cryptic phrases, like some people expect. Moore helps clients transition into a trance, something we naturally go in and out of all the time — think about the time you drove home but didn’t remember how you got there. And she uses visualization and “word weaving” to help clients connect their minds and bodies. Moore moved back to the Evergreen state in late December 2016, and practices hypnotherapy in Issaquah. She primarily sees in-person patients for fertility, although some come to her for trauma therapy, and life coaching.

425: Why did you want to practice hypnotherapy?

Moore: I mean, really it comes down to the level of change that people can accomplish, and all of us are driven — and we don’t realize how much — by our unconscious mind. Research differs on this, but its somewhere between 85 and 95 percent of what we do every day is driven by our unconscious. We have these unconscious influences gently guiding us. That’s fine most of the time. When that’s unhelpful, for example, is if we’re in this room and you notice a spider, and something in your past tells you this is bad news, and you can’t focus and you start to have a panic attack. That’s really unhelpful. Using cognitive hypnotherapy, we can bring you back to the reality.

425: Your work in fertility started with one of your friends. Tell us more about that.

Moore: One of my friends who was going through the (hypnotherapy) course with me was trying to get pregnant. She had gone through fertility treatment, and (the doctors) told her to give up. In the (hypnotherapy) session, we try to make sure there’s nothing in your unconscious that’s unsure. When we went there, we were both floored, and it turned out her unconscious was not onboard. She had a health condition — a serious one — and her unconscious was really scared that if she got pregnant, it would come back. So, she was resisting getting pregnant. The doctors told her not to do any more attempts, and she begged and pleaded to do one more. All you need is one egg, just one good egg. And she produced an egg, it fertilized, and she had a little boy. He goes to school; I see pictures on Facebook.

425: Are a lot of your clients already doing fertility treatment?

Moore: It’s always wonderful when they’re just starting out (trying to get pregnant). That’s very rarely what walks through my door. Sometimes that happens, and they get pregnant before treatment. Most women come to me after doing multiple (fertility) treatments.

425: What’s the process of hypnotherapy?

Moore: It’s very much tailored to each woman. Essentially what I’m working around is making sure the unconscious mind is onboard and that the body and mind are connected. Sometimes women spend decades saying, “Don’t get pregnant, don’t get pregnant, don’t get pregnant. OK, get pregnant.” So, it’s really important to strengthen the mind-body connection and communication. I use visualization because that’s powerful. Another way is also working with women around their emotional life. This is a very personal, emotional journey where women often feel like their bodies are given to doctors who are doing the most wonderful work that they can. I try to help women feel that this is a choice that they’re making, not something that’s being done to them.

425: What’s the success rate?

Moore: There’s different ways to report success, but the live birth rate is right around 83 to 85 percent. My goal for the other 10 to 15 percent of women is to help them have a Plan B that they’re excited about, even if it’s not their deepest desire.

425: How many sessions do your clients typically do?

Moore: It does vary a lot, but we start with an intake session, which is kind of a stand-alone. But after that, really the minimum is four to five. Women after they get pregnant like to come in and check in. Realistically, it’s about six to eight.

425: What do you enjoy most about what you do?

Moore: It’s always fun seeing baby pictures in my inbox, because they’re all cute. I do love that. Let me think, is it the most fun part? I feel really privileged in the work that I do because women will really trust me and let me walk that journey with them. That piece of work is really special. It is super fun getting baby pictures, though, or (updates) that they’re crawling.

425: What’s the worst part, or the hardest part?

Moore: I don’t know who that 15 percent is going to be. For every woman that comes in, I’m trying to get them to be that 85 percent. What I don’t know is who I’m going to have to help to have a stronger Plan B. I don’t talk about statistics because you really do need just one good egg.

Catching Cancer

— Lauren Foster

She didn’t know at the time, but when Mercy Laurino was about 16 years old, she asked a question that set the course of her life’s work. Why had multiple women in her extended family died of breast cancer?

Her uncle said maybe there was something in the water where they lived in the Philippines — Laurino’s home country. But she was skeptical. If that were the case, why didn’t everyone get sick?

Laurino likes to ask questions, and they’ve taken her far in life. Today, Laurino is an inquisitive genetic counselor at Seattle Cancer Care Alliance (SCCA) who helps patients understand their genetic backgrounds to help prevent and treat cancer.

She compares her job to being a detective — she hunts for hidden clues as a means of saving lives.

But Laurino has hardly isolated her efforts to Seattle. About 10 years ago, she set out to launch the first Master of Science in Genetic Counseling degree in the Philippines. Because of her, a new generation of Filipino genetic counselors are conducting research, providing clinical care, and giving people a better chance at beating the odds.

Coming to America 

Laurino grew up on Cebu, one of the 7,000 islands that make up the Philippines. The white sand beaches and whale sharks that glide under the crystal blue waters on the southern end of the island make it feel like paradise. But Laurino spent most of the year in the city, studying with her head in a book. Her father was a civil engineer and had high expectations for his kids.

When she was a teenager her family immigrated to central Washington. They flew into SeaTac where her uncles, and aunts, and cousins lined up to greet them at the gate. They piled into their cars and drove east. Laurino’s perception of the United States had been molded by movies set in New York and Los Angeles. So, when they parked the car in Yakima, she couldn’t believe she was in America.

“I was like, this is not the United States. Where are all the tall buildings? What is this? There were taller buildings back home,” she remembers thinking.

But over the years, her family acclimated to the slower pace of the Yakima Valley. Her dad became a custodian and eventually a mailman. Her mom, who had been a math teacher, started working as a caretaker at Yakima Valley School, a facility for kids with special needs.

Laurino also started volunteering there. She met kids with different syndromes, which ignited a long list of questions: Why did they have the syndromes? What were the root causes?

The doctors at Yakima Valley School provided some answers that further fueled her curiosity. While she had planned to become a nurse, Laurino’s interest in genetics had caught fire. She had so many more questions to ask.

Climbing Mountains

In 2009, Laurino was climbing up Machu Picchu and feeling so sick she could hardly hold on to her water bottle. She had just left her life in Seattle, where she had a great job as a genetic counselor at University of Washington, to launch a genetic counseling training program in the Philippines. Climbing high into the Andes that day, she started to get nervous.

“I was suffering. The whole time I was talking to myself: ‘Why did I quit my job? Why did I do this?’” she said.

The idea of the program started back in 2007. She was at a genetic counseling conference in San Diego when she met Dr. Carmencita Padilla, founding director of the Institute of Human Genetics and the Newborn Screening Reference Center at the National Institutes of Health in the Philippines.

At Starbucks, Dr. Padilla told Laurino that the Philippines urgently needed a genetics-training program to help families. At the time, there were only seven geneticists for the Philippine’s population of 92 million people. But Laurino was hesitant to spearhead the program. She was young, only a counselor for about four years, and had no experience implementing educational programs. This seemed like a project too large for her — something better for her retirement years. But the need was now, and she accepted the challenge.

Before heading to the Philippines to get to work, she traveled. It was in Peru, feeling like hell on Machu Picchu, when reality set it. Behind her was a comfortable life she worked so hard to achieve, and in front of her was an enormous project she didn’t know would be successful. Plus, the altitude was making her woozy.

Then something caught her eye: a group of kids from a local village on the mountainside. They were happy and free. Laurino couldn’t help but wonder whether they had access to good medical care. How far away was the closest hospital? Did their families have access to newborn screening?

“I was so glad those kids were there because they kept me out of my head. I just kept thinking about them,” she said.

That was a turning point for Laurino. The moment she truly committed herself to the training program. There was no turning back now. It was a mountain worth climbing.

Testing the Program

Laurino started developing the master’s program by reviewing genetic counseling curricula from around the world. The program would have to not only teach the science of genetics, but also how to integrate it best into the existing health care infrastructure.

In January 2011, the training program was approved at the University of the Philippines in Manila. But challenges arose for new counselors to explain diseases scientifically in a culture where a good proportion of people have spiritual beliefs that shape their understanding of health.

Some believe diseases come from curses trapped in different homes. Others look to Mother Mary to heal the sick. And many in older generations never call a disease out by name because they fear if it’s spoken aloud, it will come back and infect someone else in the same household. It’s a concept that, although superstitious, lines up with the fact that a disease with a genetic component often affects multiple people in the same family.

“But if (the cause is) genetic — of course it will come back. So it’s interesting because the cultural (beliefs) sometimes parallel the hereditary,” she said.

With more than 80 different languages spoken in the Philippines, Laurino’s program recruits students from all over the country so they can return to their hometowns to teach and provide clinical care. Another challenge for counselors is that Filipinos often have a different concept of who is family.

“Family in the Philippines can be any family that lives in the same household,” she said.

It’s not uncommon for a younger Filipino to address unrelated elders as aunty and uncle. Separating blood relatives from in-laws and close neighbors can be a confusing and timely effort.

Nonetheless, the new genetic counselors freshly graduated from Laurino’s program are out meeting with families and making strides to secure healthy futures. Laurino was honored with the 2016 International Leader Award from the National Society of Genetic Counselors for her work in the Philippines as well as serving as the founding president of the Professional Society of Genetic Counselors in Asia.

Canceling Out Cancer 

Cancer prevention and treatment are about staying ahead of the disease — catching it before it spreads, or before it even starts.

In 2013, SCCA began offering genetic counseling services on-site. Previously, this service was only accessible as part of the cancer prevention programs which is now housed in the newly launched SCCA Wellness Center. Patients can take genetics tests to determine their likelihood of developing specific cancers. Laurino delivers the results, which can be complicated and nuanced. For example, women can be tested for a BRCA1 gene mutation which puts them at a higher lifetime risk, if found to have a mutation, of developing both breast and ovarian cancer. It’s the gene that actress Angelina Jolie tested positive for and the reason she opted to remove her breasts and ovaries for cancer prevention.

For people with cancer stemming from a gene with a disease-causing mutation, genetic counseling can help prevent a cancer diagnosis through awareness and preventive treatment. Years ago, Laurino had a patient who wanted to get tested because her mother died at a young age from breast cancer.

“She had a 2-year-old daughter at that time. I did her testing, and it came back that it was positive. Even though I felt bad (because) I’m going to tell her she’s positive, I kept thinking about that daughter. I want that daughter to grow up with a mom because she (her patient) did not get that chance,” she said.

Although Laurino spends a lot of her day thinking and talking about cancer, a disease that she’s lost family members to, she doesn’t tire of it. In fact, she wishes more people would talk about it. Getting out the word about cancer genetics is a part of her mission in life.

“My family and friends would sometimes joke and have a rule that’s like, ‘OK Mercy, you have one minute talking about genetics.’ And then I get cut off,” she said with a laugh.

Working for the Future 

In Laurino’s office, there’s a framed piece of paper that reads: “Keep standing for what’s possible.”

It’s something she heard at a conference once. When she got back to her computer, she typed it, printed it, and hung it on her wall.

She knows there are only so many people she can help save. She knows that current technology can only improve so much. But she also knows the future is full of possibilities.

That’s what keeps her asking questions.

Bio-Identical Hormone Replacement Therapy 101

— Shelby Rowe Moyer

Vicki Hewlett of Seattle has been doing bio-identical hormone replacement therapy (BHRT) for more than a decade, and said she’ll never give it up.

She first started doing hormone therapy when she was going through the typical symptoms of menopause — hot flashes, moodiness, decreased libido — that were keeping her from feeling like her best self.

Bio-identical hormones are synthesized in a lab, generally made from plant products, and are chemically identical to your own hormones. They can be administered through creams, prescription drugs, or rice grain-sized pellets inserted into the glute area.

“Your tank is empty,” Hewlett said. “Why not fill it up with the same hormones your body is making? I’ve been on board for about 12 years.”

Since she’s been taking bio-identical hormone therapy, she’s noticed a big difference in her health. Not only have the hormonal symptoms of aging subsided, but she’s also staved off the advancement of her osteopenia — the precursor to osteoporosis — and her muscle mass has remained healthy.

About two years ago, Hewlett was referred to Naturopathic Physician Kate Kass, and said she is the most knowledgeable naturopathic doctor she’s been to.

Dr. Kass runs a private practice in Bellevue, primarily treating men and women who are going through hormone changes as they’re aging. Kass has worked in the naturopathic medical field — also known as functional medicine — for about 10 years, and has been practicing as a naturopathic doctor in the Seattle area for about four years.

She was inspired to go into the medical field after being diagnosed with celiac disease by a naturopathic physician after living with the symptoms until she was 26 years old. Starting in high school, she had unwavering fatigue, severe anemia, and the beginnings of osteoporosis.

“I don’t think I realized how poorly I felt,” she said. “I got passed along from doctor to doctor and eventually found a functional medicine doctor that found out I have celiac. What was happening was that I had so much inflammation gut stuff that I couldn’t absorb nutrients. It contributed to a lot of things I was feeling.”

Naturopathic physicians are trained as primary care doctors. The first couple years of the four-year medical programs are essentially identical to conventional medicine with training in pharmaceutical prescribing, anatomy, physiology, disease diagnosis, and standard of care, Kass said. Naturopathic training diverges from conventional medical school with more training in nutritional medicine, lifestyle interventions, and botanical medicine.

Women often come to her around perimenopause, which is the transition before menopause. They haven’t gone a full year without a period, but are experiencing hormone symptoms. Some women have insomnia, depression, anxiety, libido changes, intercourse changes, hot flashes, and changes in personality and weight gain.

“Women come in saying all the time that they don’t feel like they have control over their body anymore,” Kass said. “(They say,) ‘I used to feel like I could eat and exercise and my weight was reflective of that, and now there are all these changes and I feel out of control,’ which is scary for women.”

Hormone therapy for women can resolve a constellation of symptoms and, some studies have shown it reduces risk of osteoporosis, heart disease, breast cancer, dementia, and visceral belly fat. Estrogen is an energizing hormone that impacts mood, reverses vaginal dryness, vaginal tissue atrophy, and plumps the skin on our faces. It also protects against osteoporosis.

Progesterone is the first to decline during perimenopause, and replacement can help women feel more relaxed. Kass said it can be a “lifesaver” for women suffering from insomnia and anxiety during menopause. It also lessens heavy bleeding during menopause and protects the uterus, and helps ward off breast cancer.

Testosterone in women also declines with age and affects libido, vaginal dryness, bone density, mood, and energy.

When Kass first meets with clients, they do an hour-long consultation, going through health history, family health history, diet and lifestyle, and lab work. One of the key components to naturopathic medicine is treating the whole person. Kass takes into account how diet, exercise, underlying conditions, and even genetic codes can affect a patient’s well-being.

“For instance, a woman can come in with anxiety and sleep issues around menopause, and we can put her on hormone therapy, but let’s say she has something in her gut that’s creating other types of problems. We have a huge gut-brain connection,” she said. “If you have something going on in your gut, it can affect your mood, your energy, and cognitive performance.”

If hormone therapy is working, Kass said, she supports patients staying on them long-term or indefinitely. But there’s some debate about that. The North American Menopause Society suggests doing hormone replacements for the shortest amount of time, but a lot of functional medicine doctors disagree, Kass said.

“If a woman has osteoporosis, that’s not going to just go away because their hot flashes went away,” she said. “If a woman feels more energized and her mood has improved and her anxiety is gone, those could come back. It’s an individual decision for each woman.”

There are some scenarios where women shouldn’t be doing hormone therapy long-term. If a woman has a family history of estrogen or progesterone-receptor positive cancer, or has a clotting disorder, then the risks and benefits of BHRT should be discussed with a physician, Kass said.

Hewlett said it is working for her. While she said she’s never gone off them long enough to feel any negative effects, she does notice a difference between her and friends who aren’t doing hormone replacements therapy.

Kass strongly encourages anyone interested in BHRT to consult with a doctor who’s well-versed in the treatment. People don’t necessarily have to see a naturopathic doctor, but their doctor should be very knowledgeable about it. She also warns against buying hormones off the internet.

“Just because it comes from something that’s quote-unquote natural, doesn’t mean they’re not powerful,” she said. “They’re still powerful products. Anything that can have an effect can have a side effect. That’s what I always tell women. You can’t just use these things with impunity or buy them off the internet.”

Hormone therapy is a personal decision for everyone, but her main goal is making sure patients are living the life they want.

“We talk a lot about wellness for people, and that means something different for everyone,” she said. “Wellness to me means freedom to do what you want to do. The freedom to go to work every day. The freedom to go for a hike or a run if you want to. The freedom to be present with family and friends, and have the energy to spend time with family and friends. … What it really means is having the freedom to do what they want to do and to have their health.”

Healthy Living

— Margo Greenman

From heart disease to bone density, women’s health concerns vary from those of men. We talked to some local experts to learn specifically what women should be doing to ensure good health into their golden years and beyond.

Benjamin Franklin famously said, “An ounce of prevention is worth a pound of cure,” and it’s a saying that still rings true today. Kimberlee Van Der Kolk, a nurse practitioner at Overlake Medical Clinics Issaquah Primary Care, says prevention is key.

Prevention, Van Der Kolk said, isn’t one-size-fits-all and can vary depending on a woman’s family history. However, all women, Van Der Kolk said, can benefit from regular physical exams, a diet rich in fruits and vegetables, exercising often, and getting plenty of sleep.

“The American Heart Association recommends at least 150 minutes of exercise per week,” said Van Der Kolk, “and it needs to be vigorous exercise.” Additionally, Van Der Kolk said most women would be surprised how many fruits and vegetables the average woman should consume daily.

“We recommend that women follow the guidelines from the government,” she said. “And the website myplate.gov shows a nice illustration of what a typical American diet should look like.”

Van Der Kolk also said it is recommended that women get, on average, eight to 10 hours of sleep per night.

“Getting enough sleeps helps decrease (risk of) heart disease, stroke, and hypertension,” she said. “And it actually helps control your weight, because if you’re sleeping enough, you’re not up eating.”

Avoiding tobacco might seem obvious, but less obvious might be the guidelines for alcohol consumption. “The alcohol guidelines have also changed,” said Van Der Kolk, “in that they’re recommending even less alcohol for women.” Van Der Kolk said women should limit alcohol consumption to no more than one alcoholic drink per day and no more than three alcoholic drinks per week. “By following that guideline, it drastically decreases your chance of breast cancer,” she added.

Another key component of prevention, Van Der Kolk said, is keeping stress to a minimum. Rather than reaching for a glass of wine after a stressful day, Van Der Kolk recommends hitting the gym instead.

“When we exercise, there are actually chemicals released in the body that help fight depression and anxiety,” she said. “Regular exercise also keeps your blood pressure under control and helps you feel better overall.”

Van Der Kolk said other methods for managing stress include meditation, mindfulness, and taking time out of each week to do something special for yourself, like visit with a friend.

When left unmanaged, Van Der Kolk said, stress can contribute to heart disease, which is the number-one killer of women in the United States.

According to the American Heart Association, 1 in 3 women dies from heart disease in the United States each year. However, even though most women are aware of the dangers of heart disease, too few take steps to lower their risk.

Internal medicine doctor, national Go Red for Women spokesperson, and American Heart Association national board member Dr. Mary Ann Bauman said the most important thing a woman can do to protect herself against heart disease is to know her numbers.

“Know your blood pressure, know your blood sugar, know your cholesterol, know your family history, and know your body mass index,” said Bauman. “And the next best thing to do is really start to change those things that you can change. You can’t change your genetics, but you can certainly exercise and eat a healthier diet.”

Another way women can take charge of their heart health, Bauman said, is by joining Go Red for Women.

“Go Red for Women is such a great source,” said Bauman. “And what we found is 89 percent of women who join Go Red make at least one healthy lifestyle change. And that’s terrific. It means that women are being educated. Women are connecting with other women. And it means that they are taking this to heart, so to speak. It’s really been remarkable to see that happen.”

While healthy lifestyle changes and routine physical exams are no guarantee that a woman won’t develop cancer or heart disease at some point in her life, these preventative measures can have a profound impact on a woman’s overall health and longevity, helping her to live her best — and hopefully longest — life.

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