Search for tag: "decisions"

Announcer: Covering all aspects of women's health. This is the Seven Domains of Women's Health with Dr. Kirtly Jones on the Scope.

Interviewer: Dr. Jones. This wasn't me. This was a woman who actually said this. And when she said it, it seems so kind of crazy that I'm like "Could that really be?" And so I thought I'd come to you. But this woman said women should not make decisions during PMS. And science has actually shown, she said, that you can do a brain scan and see chemical changes in the brain. So you shouldn't accept a proposal, you shouldn't buy a car, you shouldn't make any big decisions during. Is that true?

Dr. Jones: Well, I've heard that guys after their sports teams win shouldn't make a big decision either. So let's have a discussion about recognizing your brain's state and when you should make emotional decisions or a financial one.

First of all, many women actually who have periods don't have PMS. We do know that the brain is different the first half of the menstrual cycle when you're making an egg to the second half of the menstrual cycle when you've hatched the egg and you're making a lot of hormones call progesterone. And progesterone falling, meaning as you get closer to your period, four, five days can affect some people's brains in a negative way. And you can study mice and rats and do some studies with them.

Now I think the more important question isn't whether or not women shouldn't make decisions. Meaning only menopausal women should be elected to office and only menopausal women should run businesses. Perhaps no men should run any of these because we know that men's testosterone levels go up and down. So men who go to a sports event and their team wins, their testosterone takes a big bump and that can lead to increased gambling, increased risk taking, and increased hostility. And the guys who lose, their testosterone makes a big drop.

So I think more importantly than talking about women and PMS is talking about emotional intelligence. And I want to introduce the RULER Project, R-U-L-E-R. The Yale Center for Emotional Intelligence has encouraged us with a program that's brought into the schools for children, but we're all children when we're emotional.

So let's talk about making decisions when you're sleepless, when you're hungry. I should never make food decisions when I'm hungry. And in fact, there's a term in my family called "hangry." Which is the way you feel when you're hungry and it's not a good thing. I never went to clinic without the right amount of caffeine and food in my tummy because I didn't want to my irritable.

But I am emotionally intelligent, at least I think I am. Because I recognize, understand, can label my emotion, can express it appropriately and regulate it. So that's the RULER. When you're making decisions about getting married or buying a car or whatever, our lives are not smooth.

We have different amounts of food in our tummy, alcohol in our brain, sleep under our belt. We have had relationships with our kids that might have affected the way our moods are. It's not that we shouldn't make any decisions, we should just be thoughtful and mindful about the way our brains are working.

Interviewer: And take into account how those situations might be affecting our thinking.

Dr. Jones: Right. So yes, women might have PMS. Not all women do, but some women do. But men have road rage whether they recognize it or not. So I think all of us have our brains in different emotional states. So let's go over the RULER again.

One is recognize. When you're feeling something irritable, snarky, sad, anxious, happy, one should be able to recognize the emotions in yourself and others. You should understand that's the U that causes and the consequences of these emotions. So I understand if I'm PMSy and I get irritable because the dishes haven't been done, that it's about the dishes but my coping mechanism isn't so great and it's time for me to sit in the bathtub for a while.

Interviewer: Or I as a man, say I'm in a high-stake situation and have just won a victory whether it's in the office room or a sporting event, that maybe the decisions I make after that might be tending towards gambling and risk taking and I should consider that.

Dr. Jones: Exactly. Exactly. It's helpful if you can label the emotion in yourself and others. So being able to recognize an emotional state and label it, gives you a word around which you can start to decide whether this is an emotional state that is safe for making a car decision.

You should be able to E, express your emotion appropriately. So when you're having this emotion, it's helping to let others know how you're feeling. "I'm feeling irritable because you have not done the dishes again. Now I know it's before my period and I get a little crankier, but you should still do the dishes." Well, not exactly like that but sort of like that.

So E is express your emotions and R is regulate it. So that's the important thing. When I know that I'm PMSy, thank God I'm not anymore. So I can rule the world because my hormones are the same everyday unless I haven't eaten and then I get hangry. So regulating your emotions now that you know what it is.

You can express it, you can give a name to it. You can say, "You know what? Before I make this emotion about having this discussion, before I make this statement about the dishes, I'm going to go walk outside for a little bit and look at my favorite stars. And then I'll come back."

So whether you make decisions, whether you're sleepless, hungry, had a fight, whether your moods are up and down because of your own mood state, or because of your hormones, you should RULER and measure your emotions so that you could have a more effective dialogue with yourself and with others.

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Dr. Jones: When women have had breast cancer surgery, the major surgery such as a mastectomy, they are often looking forward to living their lives and getting their body back. What are the new steps and what are the things that we have here at the Huntsman that will really help them make this difficult decision? How do we make the decision, and who is the team involved?

We are in the office of Dr. Agarwal here at the Huntsman Hospital with a beautiful view out the back door of people living their lives. I want to talk about how women who have had mastectomies make the decision to live their lives going forward as they make the transition from a cancer victim to a cancer survivor. We're talking about breast reconstruction here with Dr. Agarwal, plastic surgeon and reconstructive surgeon here at the Huntsman Hospital.

Let's talk a little bit about women who request the bilateral mastectomy. Of course, there are women with BRCA mutations, mutations that increase their risk of cancer. They don't have cancer yet, but both of their breasts are going to be involved so that's pretty easy to understand. How about if a woman has breast cancer on one side and wants the other one done? Does insurance pay for that?

Dr. Agarwal: Not always. We're seeing an increased demand, if you will, in patients who want to have the contralateral breast removed. A lot of times, this is driven by fear of developing cancer in the other breast. Oftentimes, it's driven by the desire to have symmetry and it's not a guarantee that your insurance will pay for this. More and more, we're seeing that insurance wants to really focus on the breast that has cancer and may not always pay for removal and reconstruction of the other breast.

But any time a patient has these concerns or desires to have both breasts removed, it requires a good discussion with their doctors, their oncologists, their surgeons because while things like symmetry may be improved in some cases, there are also potential consequences to having your other breast removed. You lose sensation of an otherwise normal and healthy breast. Just like with any other surgeries, there is the risk of potential complications by adding more surgery time or more operations.

Dr. Jones: And if women are young enough that they might want to consider having children if they get past their diagnosis and are cured, then they couldn't breastfeed if they have bilateral reconstruction and that has to be discussed. There is so much on the Internet about the pros and cons, but are there other women that someone can talk to? Do you have support groups of women who have made decisions and how they worked through their decisions? How do women go about finding out more information?

Dr. Agarwal: There are definitely support groups here at the Huntsman Cancer Hospital. There are teams of patients who have offered their services to other patients because they've gone through this process in the past and they give the whole picture, the good and the bad of going through this process. Throughout the Salt Lake community, there are organizations that provide a lot of information to patients, including Susan Komen's Foundation. So there are definitely support groups. I think that it is a very personal decision in the end and I think that a frank conversation with your medical team and your family is important when finally making these types of decisions.

Dr. Jones: Let's talk briefly about nipple reconstruction. I've heard that you have an amazing tattoo artist here at the Huntsman who might be able to even tattoo a nipple or are you using other tissues for nipple reconstruction?

Dr. Agarwal: First of all, we do have a great tattoo artist here at the University of Utah and Huntsman Cancer Hospital, but there are different ways of reconstructing a nipple. We can actually use some of a patient's own tissue to create the nipple itself and then tattoo the areola around it. And another option is to purely use tattooing. Some of the tattoo artists can create 3D tattoos of a nipple, which looks amazing. They look like real nipples that have projection even though they're flat on the surface of the skin.

Dr. Jones: That must be very gratifying to have the ability to give a woman that gift, not only as a reconstructive surgeon to give the gift of having symmetry and a self-image that will carry her forward as she works through her recovery but even having the ancillary staff that can help her through that like the tattoos and the counselors and therapists and all of the people, a whole team that can take care of people.

Dr. Agarwal: It's absolutely gratifying to see a patient go through this process and come out feeling whole again and feeling like they can get past or move beyond their initial diagnosis of cancer, and that's really the goal is to help them move forward in life.

updated: June 8, 2021
originally published: October 22, 2015