High Risk for Breast Cancer, Now What?
Breast cancer is leading cause of cancer death in women
- 2022, an estimated 287,850 new cases of invasive breast cancer are expected to be diagnosed in women in the U.S., along with 51,400 new cases of non-invasive (in situ) breast cancer. About 2,710 new cases of invasive breast cancer are expected to be diagnosed in men in 2022.
- About 5-10% of breast cancers can be linked to known gene mutations inherited from one’s mother or father.
- About 85% of breast cancers occur in women who have no family history of breast cancer.
What is High Risk?
Breast cancer increases with age. It is seen most commonly in women over age 50 but cases start to rise in the 40s. the average woman has about a 12% risk of a breast cancer diagnosis in her lifetime.
Factors that increase that percentage include:
- –Strong family history of breast and ovarian cancer. Breast cancer in 1st degree relatives increases risk–mother, sister or daughter.
- multiple family members
- family members diagnosed at age < 45
- male breast cancer
- — Genetic mutations. BRCA1 and BRCA2 are the most well known but other gene mutations are associated with increased risk.
- Individuals with hereditary risk for breast cancer may have up to an 85% lifetime breast cancer risk.
- –History of abnormal breast biopsy. Some types of atypical cells on biopsy you at a higher risk.
- –Dense breasts. Breasts comprised of more connective and glandular tissue and less fatty tissue have been associated with higher cancer risks.
- –History of chest wall radiation at a young age. For example, chest radiation for childhood lymphoma increases breast cancer risk
- –A risk assessment of greater than 20 percent lifetime risk of invasive breast cancer.
What tests should you get if you’re high risk?
For dense breasts
According to ACOG current published evidence does not demonstrate meaningful outcome benefits (eg, reduction in breast cancer mortality) with supplemental tests in women with dense breasts who do not have additional risk factors.
For BRCA gene carriers: aged 25–29 years
–clinical breast examination every 6–12 months and annual MRI.
–Magnetic resonance imaging of the breast with contrast is preferred over annual mammography from ages 25–29 years to reduce extended radiation exposure
#1 talk to your healthcare provider to develop an individualized plan
–This may include additional screenings like a breast MRI, or breast ultrasound
–You may consider prophylactic mastectomy
#2 make sure you continue your routine mammogram screening
#3 Breast awareness
–While monthly self-exam is also no longer recommended as an option for women of any age, if you feel a lump or difference in your breasts you should see your provider for further evaluation
Can I reduce my risk with lifestyle changes?
Studies have shown that combined hormonal contraceptive use specifically in BRCAcarriers decreases risk of ovarian and uterine cancer
Don’t smoke or quit smoking
Use alcohol infrequently
Get moderate exercise daily
Maintain a healthy weight
Breast Cancer Survival is Improving
While there is some variation in these rates based on race and ethnicity, women now being diagnosed with breast cancer have a better outlook than women diagnosed 10 years ago as analysis of tumors and treatments improve over time.
Source: https://www.cancer.org/cancer/breast-cancer/understanding-a-breast-cancer-diagnosis/breast-cancer-survival-rates.html
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Hair Straighteners Linked to Uterine Cancer?
The Study
- Study group: 33 947 women participating in the Sister Study participants aged 35-74 years who had a uterus at enrollment (2003-2009)
- Participants self-reported their use of hair products in the prior 12 months, including hair dyes; straighteners, relaxers, or pressing products; and permanents or body waves
- Researchers uses statistical methods to examine associations between hair product use and uterine cancer
BEYOND THE HEADLINES
LIMITATIONS OF THE STUDY
— “straighteners, relaxers, or pressing products” are reported as a group but these three use very different products and ingredients.
— women who used hair straighteners, relaxers, or pressing products had a higher BMI which is known to be a significant risk factor for uterine cancer.
— the authors make conclusions about risk to Black women in particular but Black women made up only 7% of the study population (12.9% of US population) and no differences were seen in the association by race/ethnicity.
— self-reporting causes a study to be vulnerable to recall and other biases.
WHAT WOMEN NEED TO KNOW
- –uterine cancer is uncommon—most women have a 1-2% risk over a lifetime.
- –uterine cancer is not the same as uterine fibroids which are benign tumors–not associated with cancer.
- –This study shows an association between product use and a medical diagnosis. It does NOT show that these products CAUSE uterine cancer.
KEY TAKEAWAY
The group using hair straighteners had a higher BMI and higher BMI is a major risk factor for uterine cancer. This could explain the association seen in this study.
Is Endometriosis the Reason For Your Pain?
What is Endometriosis
Endometriosis, pronounced, “end-o-me-tree-o-sis” can affect girls and women of all ages. It is estimated that between 2-10% of American women of childbearing age have endometriosis–~190 million women worldwide. The cause of endometriosis is still unknown. In endometriosis, tissue that looks and acts like tissue lining the inside the uterus (shed monthly as menstruation) is found outside the uterus, usually inside the abdominal cavity. Endometriosis will usually go away after menopause.
Symptoms
No symptoms at all
Pelvic pain (most common in women with symptoms). Pain usually gets worse over time and lasts longer over time. The amount of pain is not always related to the severity of the disease.
- –painful periods
- –chronic pelvic pain
- –pain during and/or after sexual intercourse
- –painful bowel movements
- –painful urination
Fatigue
Depression or anxiety
Abdominal bloating and nausea
Ovarian cysts that can be large and/or persistent
About 20% of women with endometriosis will have problems with fertility
Very rarely endometriosis can be associated with reproductive system cancers
Diagnosis
There is no single diagnostic test for endometriosis. Diagnosis can be made based on
your symptom history
findings at the time of surgery
response to a treatment
Treatment
Hormonal suppression
- –Hormones (pills, patches or rings, progesterone implant)
- –Hormonal IUD
- –Injectable medications Leuprolide acetate
- –Oral hormonal suppressing medication Elagolix (brand name Orlissa)
Acupuncture
Pelvic floor physical therapy
Surgery
Destroy or remove endometriosis implants (usually requires medication afterward for continued treatment)
Hysterectomy with removal of ovaries
Mild symptoms may be treated with over the counter pain medicines as needed
Suspect you have Endometriosis?
What You Can Do
Talking to Your Provider
Keep a symptom journal. This can be key to recognizing the pattern of symptoms
Speak up. Don’t just live with the pain
Learn more
If you have persistent pain contact your health care provider
Questions to Ask
What are the possible reasons for my pain?
How will you tell which one of those is my diagnosis?
What are the pros and cons of surgery to diagnose/treat my symptoms?
What are the pros and cons of medication to diagnose/manage my symptoms?
Can I resolve these symptoms with lifestyle changes (diet, exercise, therapies?)
What are treatment options for my pain?
What to Expect
At your first few visits you can expect to:
review your symptoms in detail including questions like when they first started, when you notice they are present and what makes things feel better or worse
talk about a list of conditions that are known to cause similar complaints
discuss options for ways to know what is causing your symptoms. This could include lab tests, radiology images like ultrasound, surgery or a trial on a medication
hear about making a plan for treating your symptom over time (even if the plan is not started on the same day)
Endometriosis is not the only reasons that women can have pelvic pain. Talking to your physician is important to getting the right diagnosis and treatment.
What is Endometriosis
Endometriosis, pronounced, “end-o-me-tree-o-sis” can affect girls and women of all ages. It is estimated that between 2-10% of American women of childbearing age have endometriosis–~190 million women worldwide. The cause of endometriosis is still unknown. In endometriosis, tissue that looks and acts like tissue lining the inside the uterus (shed monthly as menstruation) is found outside the uterus, usually inside the abdominal cavity. Endometriosis will usually go away after menopause.
Symptoms
No symptoms at all
Pelvic pain (most common in women with symptoms). Pain usually gets worse over time and lasts longer over time. The amount of pain is not always related to the severity of the disease.
- –painful periods
- –chronic pelvic pain
- –pain during and/or after sexual intercourse
- –painful bowel movements
- –painful urination
Fatigue
Depression or anxiety
Abdominal bloating and nausea
Ovarian cysts that can be large and/or persistent
About 20% of women with endometriosis will have problems with fertility
Very rarely endometriosis can be associated with reproductive system cancers
Symptoms
No symptoms at all
Pelvic pain (most common in women with symptoms). Pain usually gets worse over time and lasts longer over time. The amount of pain is not always related to the severity of the disease.
- –painful periods
- –chronic pelvic pain
- –pain during and/or after sexual intercourse
- –painful bowel movements
- –painful urination
Diagnosis
Diagnosis can be made based on
your symptom history
findings at the time of surgery
response to a treatment
Treatment
Hormonal suppression
- –Hormones (pills, patches or rings, progesterone implant)
- –Hormonal IUD
- –Injectable medications Leuprolide acetate
- –Oral hormonal suppressing medication Elagolix (brand name Orlissa)
Acupuncture
Pelvic floor physical therapy
Surgery
Destroy or remove endometriosis implants (usually requires medication afterward for continued treatment)
Hysterectomy with removal of ovaries
Mild symptoms may be treated with over the counter pain medicines as needed
Suspect you have Endometriosis?
What You Can Do
Keep a symptom journal. This can be key to recognizing the pattern of symptoms
Speak up. Don’t just live with the pain
Learn more
If you have persistent pain contact your health care provider
Questions to Ask
What are the possible reasons for my pain?
How will you tell which one of those is my diagnosis?
What are the pros and cons of surgery to diagnose/treat my symptoms?
What are the pros and cons of medication to diagnose/manage my symptoms?
Can I resolve these symptoms with lifestyle changes (diet, exercise, therapies?)
What are treatment options for my pain?
What to Expect
At your first few visits you can expect to:
review your symptoms in detail including questions like when they first started, when you notice they are present and what makes things feel better or worse
talk about a list of conditions that are known to cause similar complaints
discuss options for ways to know what is causing your symptoms. This could include lab tests, radiology images like ultrasound, surgery or a trial on a medication
hear about making a plan for treating your symptom over time (even if the plan is not started on the same day)
Endometriosis is not the only reasons that women can have pelvic pain. Talking to your physician is important to getting the right diagnosis and treatment.
Covid-19 Not Transmitted Through Breastmilk
We know that pregnant women are more likely to experience complications from Covid-19 infection but what about transmitting virus to babies? So far studies have found no evidence of transmission of Covid-19 illness to babies in the uterus. And today there is more hopeful news. Breast milk from mothers infected with Covid-19 isn’t likely to harm breastfeeding infants, a small new study concludes.
In a study published in Pediatric Research, scientists analyzed breast milk donated to a California repository from March through September 2020 by 110 women. Sixty five of the women tested positive for Covid-19, nine had symptoms but tested negative, and 36 had symptoms but were not tested. Viral RNA was found in seven breast milk samples from women who tested positive or had symptoms. None of the infants breastfed by these mothers developed Covid-19.
Covid-19 Not Transmitted Through Breastmilk
We know that pregnant women are more likely to experience complications from Covid-19 infection but what about transmitting virus to babies? So far studies have found no evidence of transmission of Covid-19 illness to babies in the uterus. And today there is more hopeful news. Breast milk from mothers infected with Covid-19 isn’t likely to harm breastfeeding infants, a small new study concludes.
In a study published in Pediatric Research, scientists analyzed breast milk donated to a California repository from March through September 2020 by 110 women. Sixty five of the women tested positive for Covid-19, nine had symptoms but tested negative, and 36 had symptoms but were not tested. Viral RNA was found in seven breast milk samples from women who tested positive or had symptoms. None of the infants breastfed by these mothers developed Covid-19.
Ten Reasons Why Trying to Get Omicron is a Bad Idea
Covid-19 Omicron
As numbers of Covid 19 infections continue to rise, the virus mutates to form variants. The most recent variant is named Omicron which is accounting for up to 30% of infections sampled. Omicron is tending to ward milder symptoms for most people. Some people are considering deliberately exposing themselves to Covid 19 Omicron expecting that they will have no or mild symptoms in hopes of ‘getting it over with’. This is a bad idea. A very bad idea. Find out why below.
Number 1
Mild is a relative term
- Significant fever, body aches, swollen lymph nodes, sore throats and heavy congestion are often reported in “milder”.
- If you are unvaccinated the numbers related to mild disease is less likely to apply to you.
- Even though this variant is less likely to cause severe disease or ICU admission, you may be in the minority and get severe disease
Number 2
Some people are more likely to get severe symptoms
- In the first 8 days in January 2022, over 4000 people in the US died in the from or with Covid-19.
- Five percent of those over 65 develop severe disease from Covid-19
- Individuals with conditions like asthma, high blood pressure, higher weight and many other chronic conditions are more likely to have severe disease
Number 3
You could spread the disease to others who may get a severe illness
- Omicron variant is so contagious that it is most likely that you will infect others before your get a positive test.
- There is no vaccine for children under 6
- Pregnant woman are at increased risk for complications from Covid 19
- Disease from Omicron variant results in significant hospitalization for 1/20 over 65.
- Some people who are immunocompromised or allergic cannot be vaccinated and remain vulnerable to infection
Number 4
You could get long Covid
- “Long Covid” can last weeks to months after you have a negative test.
- Symptoms include shortness of breath, severe fatigue, fever, dizziness, brain fog, diarrhea, heart palpitations, muscle and abdominal pain, mood changes and sleep difficulties.·
- Severe forms of long Covid can damage lungs, heart and kidneys, as well as your mental health.
- Some people are not able to carry out their usual activities because of these symptoms
- There is still a lot medical science does not know about preventing or treating long Covid.
Number 5
You will still need to be quarantined for any positive result.
- Public health and medical experts still recommend quarantine while you are actively shedding virus even if your symptoms are mild
- Most employers will want you to stay away from work and close interactions with others even if symptoms are mild
Number 6
You can get Covid 19 more than once
- Immunity from getting Covid 19 infection offers reasonable levels of immunity for about 1-3 months
- Some people will not build up any significant immunity after native infection
- Some studies suggest reinfection is more likely with Omicron than with previous variants
Number 7
It’s not all Omicron
- The omicron variant is currently spreading rapidly but the other variants are still in the population.
- You won’t know which one you get.
Number 8
Financial consequences may significant.
- Most people can’t afford to be away from work for an extended time.
- A brief trip to urgent care or a short hospital stay can have significant cost
- We are already seeing the workforce consequences of the pandemic on business, supply chains and prices.
Number 9
More Covid cases stress all social systems
- Nearly a quarter of hospitals are reporting a critical staff shortage as Omicron drives a rise in Covid-19 cases
- Hospital resources shifted to care for Covid 19 are not available in other areas of hospitals. This means those who have to go to the hospital for any reason may experience delays or reduced services.
- Increasing numbers of people away from work lead to breakdowns in many supply chains and long term delays.
Number 10 Fear the next variant
- The more we allow this virus to replicate (infections) the more variants will continue to emerge
Then next variant could be more contagious and more deadly than any we have seen so far.
Ten Reasons Trying to Get Omicron is a Bad Idea
Covid-19 Omicron
As numbers of Covid 19 infections continue to rise, the virus mutates to form variants. The most recent variant is named Omicron which is accounting for up to 30% of infections sampled. Omicron is tending to ward milder symptoms for most people. Some people are considering deliberately exposing themselves to Covid 19 Omicron expecting that they will have no or mild symptoms in hopes of ‘getting it over with’. This is a bad idea. A very bad idea. Find out why below.
Number 1
Mild is a relative term
- Significant fever, body aches, swollen lymph nodes, sore throats and heavy congestion are often reported in “milder”.
- If you are unvaccinated the numbers related to mild disease is less likely to apply to you.
- Even though this variant is less likely to cause severe disease or ICU admission, you may be in the minority and get severe disease
Number 2
Some people are more likely to get severe symptoms
- In the first 8 days in January 2022, over 4000 people in the US died in the from or with Covid-19.
- Five percent of those over 65 develop severe disease from Covid-19
- Individuals with conditions like asthma, high blood pressure, higher weight and many other chronic conditions are more likely to have severe disease
Number 3
You could spread the disease to others who may get a severe illness
- Omicron variant is so contagious that it will be very likely that you will infect others before your get a positive test.
- There is no vaccine for children under 6
- Pregnant woman are at increased risk for complications from Covid 19
- Disease from Omicron variant results in significant hospitalization for 1/20 over 65.
- Some people who are immunocompromised or allergic cannot be vaccinated and remain vulnerable to infection
Number 4
You could get long Covid
- “Long Covid” can last weeks to months after you have a negative test.
- Symptoms include shortness of breath, severe fatigue, fever, dizziness, brain fog, diarrhea, heart palpitations, muscle and abdominal pain, mood changes and sleep difficulties.·
- Severe forms of long Covid can damage lungs, heart and kidneys, as well as your mental health.
- Some people are not able to carry out their usual activities because of these symptoms
- There is still a lot medical science does not know about preventing or treating long Covid.
Number 5
You will still need to be quarantined for any positive result.
- Public health and medical experts still recommend quarantine while you are actively shedding virus even if your symptoms are mild
- Most employers will want you to stay away from work and close interactions with others even if symptoms are mild
Number 6
You can get Covid 19 more than once
- Immunity from getting Covid 19 infection offers reasonable levels of immunity for about 1-3 months
- Some people will not build up any significant immunity after native infection
- Some studies suggest reinfection is more likely with Omicron than with previous variants
Number 7
It’s not all Omicron
- The omicron variant is currently spreading rapidly but the other variants are still in the population.
- You won’t know which one you get.
Number 8
Financial consequences may significant.
- Most people can’t afford to be away from work for an extended time.
- A brief trip to urgent care or a short hospital stay can have significant cost
- We are already seeing the workforce consequences of the pandemic on business, supply chains and prices.
Number 9
More Covid cases stress all social systems
- Nearly a quarter of hospitals are reporting a critical staff shortage as Omicron drives a rise in Covid-19 cases
- Hospital resources shifted to care for Covid 19 are not available in other areas of hospitals. This means those who have to go to the hospital for any reason may experience delays or reduced services.
- Increasing numbers of people away from work lead to breakdowns in many supply chains and long term delays.
Number 10 Fear the next variant
- The more we allow this virus to replicate (infections) the more variants will continue to emerge
Then next variant could be more contagious and more deadly than any we have seen so far.
New Year, Improve You(r Mental Health)
New Year, Improve You(r Mental Health)
Many people make New Year’s Resolutions–promises to lose weight, exercise more or save more money. Unfortunately most of these resolutions don’t make it past January. The new year is a good reminder that you can make a fresh start. This year, instead of making goals that sound great but that are unlikely to happen, consider some simple steps that can help you feel better and be better every day. Keep reading below for 10 tips to make this year different.
Start with your mental health
Add a mental health workout to your day
- Incorporate a mindfulness daily to help you refocus on the present
- Meditate on a regular basis—a session can be as short as one minute
- Change your self talk by adding affirmations
- Start a relationship with a trained therapist
Do something outside
Walk, run or sit. Sunshine and fresh air are stimulating and good for us
Add a movement routine
–Walk 15 minutes away from home or work and walk back
–Dance along to a YouTube video
–Standing is better than sitting, moving is better than standing
Try to incorporate vegetables in every meal
(sorry corn and potatoes are not vegetables)
You may not like Brussel sprouts, try leeks. No to carrots, how about watercress
Start with one vegetable every day and work your way up to one vegetable with every meal (yes breakfast too.)
Start a daily gratitude practice
–Start or end each day with a brief gratitude meditation
–Write down something you’re grateful for in a journal
Ask for, and accept, help.
Going it alone is not a virtue. It is stressful and lonely and a lot of work
- Is your partner doing all he/she could be in your household
- Could you use a financial advisor to help you budget and plan
- Talk to your licensed health care provider about your changing body
- Consider help from a trained therapist or mental health professional
–Take a break from the news
–Use the internet for directions only (not for self-diagnosis)
–Stop obsessing about your weight—throw away your scale
–Leave guilt and shame in 2021
–Be kind to others and yourself
New Year, Improve You(r Mental Health)
New Year, Improve You(r Mental Health)
Many people make New Year’s Resolutions–promises to lose weight, exercise more or save more money. Unfortunately most of these resolutions don’t make it past January. The new year is a good reminder that you can make a fresh start. This year, instead of making goals that sound great but that are unlikely to happen, consider some simple steps that can help you feel better and be better every day. Keep reading below for 10 tips to make this year different.
Start with your mental health
- Incorporate a mindfulness daily to help you refocus on the present
- Meditate on a regular basis—a session can be as short as one minute
- Change your self talk by adding affirmations
- Start a relationship with a trained therapist
Do something outside
Walk, run or sit. Sunshine and fresh air are stimulating and good for us
Add a movement routine
Walk 15 minutes away from home or work and walk back
–Dance along to a YouTube video
Standing is better than sitting, moving is better than standing
Try to incorporate vegetables in every meal
(sorry corn and potatoes are not vegetables)
You may not like Brussel sprouts, try leeks. No to carrots, how about watercress
Start with one vegetable every day and work your way up to one vegetable with every meal (yes breakfast too.)
Start a daily gratitude practice
–Start or end each day with a brief gratitude meditation
–Write down something you’re grateful for in a journal
Ask for, and accept, help. Going it alone is not a virtue. It is stressful and lonely and a lot of work
Is your partner doing all he/she could be in your household
Could you use a financial advisor to help you budget and plan
Talk to your licensed health care provider about your changing body
Seek out a trained therapist or mental health professional
–Take a break from the news
–Use the internet for directions only (not for self-diagnosis)
–Stop obsessing about your weight—throw away your scale
–Leave guilt and shame in 2021
–Be kind to others and yourself
Covid-19 (mRNA) Vaccine for Pregnant/Lactating Women??
The Problem
Pregnancy changes how the body functions including the heart, lungs and immune system
YET
No pregnant/lactating women (or children under 16) were included in vaccine trials to date
AND
Medical societies and the CDC are recommending that pregnant and lactating women who are at high risk be offered vaccination
WITH NO DATA AVAILABLE
Pregnant and lactating women are ‘free to make their own decision” according to experts
Facts to Consider
Vaccine Facts
- Both available mRNA vaccines are >90% effective
- Vaccine administration lead to few short term risks in trials
- No known contraindications to offering vaccine to pregnant women
- Vaccine contains no live virus
- mRNA causes your own cells to make a virus protein and stimulate an immune response
- mRNA does not enter the nucleus of your cells or affect your DNA
- mRNA breaks down quickly
Known Risks
An estimated 330,000 pregnant or lactating women are health care workers many with risk of Covid 19 exposure
Studies show pregnant women are more likely than their non-pregnant counterparts to develop severe illness
- increased risk of intensive care admission
- needing mechanical ventilation
- increased risk of preterm delivery
Unknown questions????
- Is the effectiveness of the vaccine different in pregnant women (immune system and metabolism are changed by pregnancy)
- Does the vaccine cross the placenta?
- What is the effect of the mRNA on developing fetal cells?
- Could vaccine cause maternal immune system to attack fetal cells?
- Is the vaccine found in breast milk?
- What is the effect of the vaccine on the developing newborn (the newborn immune system is not fully developed)?
Decision Making
Talk to your doctor about your individual risk of
- disease exposure and likelihood of becoming infected
- baseline health (more health conditions pose higher risk of disease complications)
- history of allergies to medications or vaccines
- ability to avoid infection without vaccination
Concerning Issues
- The purpose of clinical trials is to give the public the assurance that therapies offered are safe and effective. Yet in 2020, pregnant women are now in the position of making a decision without any such data.
- While recruiting pregnant/lactating women can be challenging, these studies could/should have been carried out concurrently.
- It would have been unconscionable to carry out trials entirely left out an ethnic group or women as a whole, yet pregnant/lactating women were entirely excluded from these trials.
- In Britain, regulators have advised against offering the Pfizer-BioNTech vaccine to pregnant people or those who are breastfeeding. They also warn that “women of childbearing age should be advised to avoid pregnancy for at least 2 months after their second dose.”
- History has shown us that biology can be surprising
–Thalidomide in the 1950-60s was thought to be safe by the standards of the time and used to alleviate nausea in pregnancy. The drug interfered in fetal limb development.
–From the 1930s-197os, DES (Diethylsilbestrol) was prescribed to prevent miscarriage, it had no effect on the women who took it but affected the female fetuses carried by those women causing an increased risk of vaginal cancer.
Studies that include pregnant women and those under age 16 are said to be planned to start in the first quarter of 2021
Many of us are reeling today from the graphic images of the death of George Floyd. That police officers were the perpetrators has rightfully engendered sadness, disgust, fear and outrage. I struggled this weekend with my own thoughts and emotions. Many put their feelings in internet posts and memes. Some took their emotions to the street in protests. Many are looking for ways to help. Beyond appropriate consequences for the officers, I find myself trying to find answers to the questions what do I want to come of this? What are the next steps?
I’m not sure of all the answers but a few things occur to me. As a doctor society and individuals give me power over their health and, like it or not, that power comes with a duty of care. I am obligated by
- the duty to give my patients complete and accurate information
- the duty to assume that my patients want to be well and don’t want to be harmed
- the duty to respond appropriately to their complaints once I hear them
- the duty to operate in good faith for their wellness
- the duty to take care of them without judgement based on my own values
Anyone reading these will have the thought “of course”. So why don’t we hold police officers to this same standard? We instill them with the power to detain us at will, to limit our freedom, to injure our bodies.
Police obligations to protect should be as great as their power to restrict?
While I understand that the job of policing is risky and somewhat unpredictable, I think we can agree on a few things.
1) A ‘dealbreaker’ list. A list of things that if done will forfeit all your rights and privileges as an officer e.g. kneeling on a person’s neck, shooting someone in the back, using force on someone restrained and on the ground, not calling for help when someone asks whether you think the ask is credible or not. We can fight over what should be on the list and the list should be short, but I think smart thoughtful people can come up with an appropriate list.
2) A list of crimes that do not merit an immediate armed, police response e.g using fake money, buying a loose cigarette, people barbecuing in the park. You can think of others I’m sure.
3) Completely external agencies to investigate cases of police misconduct.
4) Mental health care and support as a regular part of policing—not optional or episodic. We don’t take mental health seriously in this country and I think policing is a stark example of the error of our ways (military veterans demonstrate another). The job of policing involves trauma on a regular basis, responding to car accidents and gun violence, seeing bodies broken and bloodied and responding to situations that endanger their own lives to name a few. It is not hard to see how this constant level of stress and anxiety would have long term effects. Mental health support should not be left to the choice of the individual or be given only for an ‘incident’. It should be an integral part of keeping officers ready for duty.
This is only a start. There are other great ideas out there and I’m sure some of them are better than these. So my next steps will be to invite you to add your ideas for what you want to see. Your ideas don’t need to be clear or well thought out. Write them down. Add them to the conversation. I will also reach out to my local and national leaders and representatives. They need to hear from all of us. I don’t want to see one more life lost. Let’s get started.
One last note as I close. You may disagree with all of these ideas but our disagreement should be the start of the conversation not the end. Let us all speak up together and #dosomething!
Minimizing Your Risk of Infection
Even staying home your risk of infections is not zero but there are things that increase risk, some that don’t make a big difference and things you can do to decrease risk.
More infected people in a population means more possibilities for contact with virus from people who are symptomatic or asymptomatic
Virus Transmission--The Science
To be infected by a virus you have to be exposed to the virus (the virus has to be present in the room, someone who is positive with symptoms or who is shedding virus without symptoms)
And
The virus has to get inside your body (breathe it in or rub it in your eyes or mouth with unwashed hands)
And
There has to be enough virus in your body to cause an infection (a lot of virus in a short time, or small amount of virus over a long period of time)
Anything that increases or decrease one of those will change your risk
What to Avoid
- Physical contact with droplets from someone known to be positive for COVID 19 (cough or sneeze or elbow bump)
- Long periods in closed spaces with other people even with face covering (non medical)
- Contact with surfaces exposed to virus (desktops, keyboards, door knobs, bathroom surfaces)
- Going to work when sick—an uncovered cough or sneeze from an infected person can infect an entire room
- Environments that are enclosed, with poor air circulation and high density of people (movie theaters, restaurants, classrooms, event venues?)
Decreasing Your Risk
- Measures that track and isolate infected people (and their contacts) reduce the risk that someone uninfected will come into contact with them)
- Cough or sneeze into a tissue and discarding it immediately
- Hand washing for at least 20 seconds and often
- Avoid touching face (especially eyes and mouth)
- Clean surfaces regularly
- Stay at least 6 feet apart in well ventilated areas for short periods of time
- Avoiding things that increase risk
Indoor enclosed environments, where you are in close contact with people, account for 85% of ALL infections.
Things That Probably Don’t Make a Big Difference to Risk
- Outdoor activities like walking, biking or hiking (not in groups)
- Going to the grocery store (wash hands before and after, stand 6 feet apart, keep the trip short)
- Short–<5min–close conversation without a face mask (but why stand that close anyway, personal space is important)
****A special note on face covering****
(assuming you don’t have enough N95 masks to wear one daily. If you do, please donate them to a health care facility.)
- Most face coverings used by the public will not prevent viral infection if the viral load is high
- Correctly wearing a face covering can be helpful if you have to be in an enclosed space with other people for more than a few minutes or in close proximity (store clerk, receptionist)
- It is best o avoid this situation in the first place wherever possible
- Don’t allow the presence of face coverings to give you a false sense of security.
- Remember A small amount of viral exposure over a long time = a large amount of viral exposure.
You Are Not Alone
According to the American Psychological Association, up to 1 in 7 women are diagnosed with postpartum depression and up to 4 in 5 experience feelings of sadness after birth. These mood changes can be a worsening of preexisting conditions or due to the many changes pregnancy and birth cause in a woman’s body. Regardless of the cause many women feel alone in navigating their way to diagnosis and treatment.
Mental and Behavioral Health Information and Resources
Postpartum Support International (PSI– Arizona Chapter PSI Support Coordinators are volunteers who offer caring and informed support and resources to moms and their families including area resources such as groups, telephone support, and reliable services that are available for no charge. Their website lists local events, training, and volunteer opportunities. They also provide information and resources for area providers who are caring for pregnant and postpartum families dealing with postpartum depression, postpartum anxiety and other mood disorders associated with pregnancy and postpartum.
The Arizona Warmline The 24 hour warm line is provided for moms, family members and friends that need help understanding more about what you or your loved one is going through. These are all volunteers that have been there, completely understand postpartum mood disorders and what you might be going through. We can help you find hope and resources to get the help you need in your area. You can call the AZ Warm Line 24 hours a day at 888-434-MOMS (6667) or email azwarmline@gmail.com, and a volunteer will call you back between 8am and 8pm every day of the year. Se habla Espanol!
Terra’s Place Terra’s Place for Maternal Mental Health and Family Wellness is a therapy group (located in Tempe, Arizona) that specializes in diagnosing and treating Perinatal Mood and Anxiety Disorders (PMADs). We use evidenced-based and trauma-sensitive therapies including Hypnosis, Interpersonal Counseling, Cognitive-Behavioral Therapy, and Mindfulness-Based Stress Relief. All of Terra’s Place licensed therapists have completed Postpartum Support International’s certificate training in diagnosing and treating Perinatal Mood and Anxiety Disorders (PMADs), and our work focuses on moms and families. Contact by phone 855-4-TERRAS (855-483-7727) or email info@terrasplaceaz.com
Marc Community Resources Marc Community Resources, Inc. is a free service that provides mental and behavioral health information and resources to help navigate through the Arizona mental health system. Their referral coordinator can help you locate the professionals and organizations best able to assist you.
NAMI Arizona Statewide Family Support Groups (outside Maricopa County) are free monthly meeting of caregivers of individuals with a mental illness where family members can talk frankly about their challenges and help one another through their learned wisdom. These meetings are facilitated by trained NAMI members in affiliates across Arizona. Call 480-994-4407 for Information & Resources.
Postpartum progress checklist
Sometimes you don’t know where to begin. Jumpstart the conversation. You can download this form, print, and take this with you to your doctor!
Symptoms to Watch Out For
Your “baby blues” don’t get better. You may cry every day the first week after getting home with your baby but by week two you should feel better. If you’re still sad, anxious or even hopeless weeks later, and the feelings are getting worse, let someone know.
Constant thoughts of sadness or guilt All these are normal once in a while is normal but if you spend most of your time crying, anxious or feeling guilty these may be among the first signs of postpartum depression.
Loss of interest in things you enjoy. If nothing seems fun interesting anymore—favorite movies, foods, friends, your partner—talk to your doctor about these changes in mood and habits.
Trouble making decisions. Being too tired to think straight can be common in the first few days but if you are having a hard time deciding, or caring about basic activities like whether or not to get out of bed, take a shower, or change your baby’s diaper, these may be early signs that something concerning is going on.
You are terrified you won’t be a good mom. Every new mom worries about whether she will do a good job. But if you are having constant doubts about yourself as a mother could mean something else.
You just can’t rest. Of course sleep patterns change with a new baby. But if you can’t relax even when your child is napping, or you know the baby is safe and taken care of, that’s likely something other than the sleep disturbance a new baby brings. On the other hand you may find yourself wanting to be asleep most of the time. This is worrisome too.
You have thoughts about harming yourself, the baby or others. Thoughts like these are definite signs of postpartum mood disorders that need treatment. If you’re having any kind of suicidal thoughts, this is an emergency. Call your doctor or the National Suicide Prevention Lifeline at 800-273-8255 immediately to get help.
If you or a loved one is facing a Behavioral Health Crisis, call the Crisis Line for your area. A crisis is any situation in which a person’s behaviors puts them at risk of hurting themselves or others and/or when they are not able to calm the situation without trained assistance. The Crisis Line can connect you to in-home supports within 2 hours in most areas of Arizona:
Maricopa County and Pinal Zip Codes 85120, 85140, 85143, 85220, 85240, 85243: 800-631-1314
Apache, Coconino, Gila, Mohave, Navajo and Yavapai Counties: 877-756-4090
Cochise, Graham, Greenlee, La Paz, Pima, Pinal, Santa Cruz and Yuma Counties: 866-495-6735