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Scot: Back in May, we did an episode about migraines, and we learned that men who have migraines aren't likely to seek help or even know that they have them. It's Episode 78 with Dr. Karly Pippitt, if you want to check that out.

And just as I get done recording, I hit the stop . . . We know Troy has migraines. That was really the whole purpose. He hasn't really been doing anything for them. But Mitch was on the show as well, and just as I hit stop, Mitch goes, "Gosh, Troy . . ." Actually, do you want to play the part of Mitch, Mitch?

Mitch: No. I would like to see you play the part of Mitch.

Scot: You're like, "Gosh, Troy, I couldn't imagine what it'd be like having migraines for three days. I just have headaches that I have to go in a dark room for four hours, and can't interact with anybody, and have to close the blinds and roll up into a little small ball."

Dr. Pippitt: Totally normal. It happens to everybody.

Scot: And at that point . . . Dr. Pippitt, do you want to play the part of Dr. Pippitt?

Dr. Pippitt: I don't know. You're doing pretty good. I think you can keep going.

Troy: That was a pretty good impression.

Scot: Dr. Pippitt was like, "Mitch, you have migraines," after the whole episode about men having migraines that they don't even know that they have them sometimes, and they're less likely to seek help. So why didn't you think you had migraines, Mitch?

Mitch: A very almost meta situation of happening in the episode is the same as what was talked about before. I just assumed that it must not be that bad. I assumed that some men out there that are like, "Nah. I'm okay. This is just what happens," not realizing that having a headache for more than an hour or two is not okay, especially if it's bad enough you have to go curl up in a corner and just shut your eyes and whatever, then . . .

So that was the thing that was the most shocking listening back to the episode when I was editing it, is just like, "Man, am I dumb? Or am I just . . ."

Scot: You just sat through a whole episode of us talking about it and didn't realize until the end, until you were told.

Mitch: Right. And I guess that's just it. It's like, guys, if you are listening to this right now, and anything that we say sounds like it, just go talk to your doctor.

Scot: Yeah. They can help you.

Dr. Pippitt: Don't torture yourself.

Scot: Right. There's no need. You're not winning any awards by doing that. The bragging rights aren't worth it. Get bragging rights doing something else, doing something cool. I don't know.

Dr. Pippitt: And probably not just making yourself miserable, but potentially everyone around you miserable as well too.

Troy: Yeah, that's true.

Scot: When you don't do anything about them. So this is the update episode. We're going to have an update episode to find out if Troy went actually to his doctor and was diagnosed with migraines, and if he got any help, and then Mitch, as well, was going to make an appointment. So that's where we're at right now. Who wants to start?

Troy: I'll start off first since I was the first one that put myself out on a limb there on the episode since Mitch left me hanging until the end.

Scot, I was experiencing headaches about every month or so. They would come on usually after night shifts, like a day or two later, left side of my face, head. It would just feel miserable for, like, 48 hours. I'd feel sick to my stomach. I would just want to lie down and sleep. Light bothered me.

And this had been something I'd dealt with for years, and was just trying to treat it with Tylenol. I had read some stuff about ginger helping, and it did kind of help as well with the nausea, and I just tried to power through it.

So we did the episode, talked about it, and I resolved I was going to talk to my doctor.

So I did talk to my doctor. Went in there, told him everything, told him about the symptoms, told him about the podcast, told him about this discussion. He said, "Yep. It sure sounds like you have migraines." And so he prescribed medication for me. Since that time, I have had multiple opportunities to use that medication.

And it's funny, it was just this last weekend, I had three evening shifts in a row when I was getting to bed at 2:00 or 3:00 in the morning. And the first evening shift, everything was fine, and then the next evening shift, I got about halfway through it and it hit me.

Karly, I made the mistake of not taking medication then at work. I just didn't take it. I was just like, "Oh, I'm just tired. It's just a painful shift." And I think it was one of those things where my mentality was, "Just power through. Get through it in general, with the shift," and not getting as much sleep. Ugh, it hurt.

And the next day, I really felt it that morning. So I finally took medication that morning. Had to take it again a few hours later. Got through the next shift that evening, the third in a row of those late shifts, and then had to take medication the next day.

It was bad, but I was so glad I had the medication, because, otherwise, trying to get through those shifts, if I were just trying to power through that migraine those three shifts in a row, it would have been absolutely miserable. So it was a lifesaver.

The other times, I've caught it early. Took one dose the medication and I was good. No issues at all after that. But this was definitely a lesson in taking medication early.

Dr. Pippitt: I think it's okay, especially for that first time you take it, when you're at . . . It's a scary thing. You're at work. You have to think a lot for your job. It's pretty important that you're "on." And you don't know what the side effects of the medication are going to be. That's not to say that maybe you're not your best self when you have a migraine either, but still, I'm not going to chastise you too much because I can totally understand that. You're just a little worried about maybe "What will the response be?"

But you did do it the next day, and more importantly, you repeated your dose. I think sometimes people think, "Oh, well, if this didn't do the trick, then it's just not going to work." And you're absolutely right, it's unlikely to be as effective the longer you get into the headache, which is exactly what you experienced, right? In later headaches, you took it early and magic.

Troy: Exactly. But you can chastise me a bit because I had already had three migraines prior to this when I was at home, and I took it. And so I kind of knew how it felt. When I took the medication, I knew any side effects. So this was more just me being at work and being like, "I'm fine. I don't need anything." Even though I'd taken your advice and I had it in my bag, I had it there in my backpack, I just didn't take it. And I paid the price.

But that being said, it was a good lesson in taking it early. And even though I didn't take it as early as I should have, it was still effective even though I had to take a couple more doses.

Again, so glad . . . it's hard to say anything is a life changer. You don't want to just throw that term out here and there, but this truly has affected my outlook.

So often, I have looked at my calendar, and I have said, "Okay, I'm working a night shift. That's about when I'm due for a migraine. It's going to hit me two days later. What's scheduled that day? Okay, get ready for it. Brace yourself. Be ready for it. Be ready to take a bunch of Tylenol. Be ready to take ginger. Be ready just to feel miserable and get through it." And this has totally changed that, and it's a great feeling. It really has made a big difference.

Scot: Wow, that's awesome.

Dr. Pippitt: I couldn't be happier. I mean, baby steps. You got the medication on your person. You've done this. I mean, to be fair, how many years did it take you to finally talk to someone about this? So I'll give you that extra 12-hour cushion when you should have taken it sooner, given the time it's taken to get here in the first place.

Troy: Thank you. I have to add one other thing in this whole migraine story. Scot, we talk about genetics on our podcast as our "one more," our core four plus one more.

So my cousin listened to our podcast, happened to listen to the migraine episode. She sent me a text. She said, "I was listening to your podcast on migraines. Did you know we have a strong family history of migraine headaches?"

She said, "My grandmother's mother and grandmother both suffered from them." My grandmother told my cousin stories about how her mother and her mother's mother used to talk about needing to go lie down in a dark room because they were having a "sick headache." I mean, we're talking back in the 1800s.

Scot: Wow.

Troy: This goes back many generations. She said she's dealt with migraines from a young age, her sister, her brother, all my cousins there. So it would have been nice if I'd maybe gotten into my family history a little bit more with this issue, but clearly there's a pattern here. Interesting, though. It was great to hear from her. Great that she's listening, and really interesting to hear that from her and what she's had to deal with too. And obviously, she's been getting treatment for years.

Dr. Pippitt: And I think an important reminder to talk to each other about this. I mean, I don't know about your guys' family. Mine doesn't really sit down and share details at the dinner table, or holidays, or anything like that. But there are things that can make a difference in everyone else's lives, and maybe isn't as personal as other healthcare information, that would really make a difference in your family's lives too.

Troy: It really would. Yeah. Next time I get together with my family for anything, I'm talking about my migraines. So it'll be a fun Christmas dinner conversation.

Dr. Pippitt: Party at Troy's house.

Troy: Party at my house. Everyone, come on over. Let's talk about migraines.

Scot: And then, Mitch, did you go and see somebody about your headaches?

Mitch: I did, and I think it's kind of embarrassing in hindsight. Karly, love you, you're so great, but when I went to the doctor, the first thing . . .

Scot: Where's this going?

Mitch: Right. The first thing out of my mouth is like, "I'm on this dumb podcast or whatever, and I think I might have migraines." I don't know what man part of me took over to be like, "Sorry, I know better. Someone has been telling . . ." No. It's so dumb.

But I sat, and my lovely general . . . my PCP, she looked at me for a good . . . She's like, "Well, can you describe your symptoms?" And she just gave me this dead stare, and she's just like, "It sounds like you have migraines." And it was just like, "Yeah. Of course, I do." And she gave me some drugs.

Troy: You got the drugs.

Scot: You mean medication?

Troy: Medication. Yeah. That's what we prefer to call them, but yeah.

Dr. Pippitt: Potato, potahto.

Troy: Exactly.

Mitch: She just got me the rescue medication that you were talking about the last episode that we talked about this, and I have had . . . So she gave me two things. One, she wanted me do the rescue medication, and two, to start tracking. Like the diary of pain, this idea of, "What is causing these migraines?"

The good news, bad news. Good news is I've only had one since we talked. The medication worked spectacularly.

Dr. Pippitt: Awesome.

Mitch: I knew that I get this little bit of pain in the back of my head. It feels like a tension headache, but just keeps on cranking up. Took one of these pills, was fine. I felt a little oogie for, like, an hour, but it wasn't an all-afternoon event. And then I haven't had any since.

So my little pain diary, I've got nothing. I've got nothing over the last couple of months, so . . . I don't know.

Dr. Pippitt: I hope you haven't jinxed yourself now, right? Go knock on some wood or something.

Mitch: Sure.

Dr. Pippitt: Pull out the rabbit's foot.

Scot: How often would you have them before that?

Mitch: Once or twice a month.

Scot: Oh, wow. And we recorded back in May. So you've only had one since then?

Mitch: Yeah.

Scot: When it used to be once or twice a month.

Mitch: It's also when I stopped working my second job. I'm almost wondering if that was a big part of it.

Dr. Pippitt: I do love how often people come back and follow up, and they're like, "Oh, yeah. My migraines are totally better." And I'm like, "What happened?" And it's something exactly like that, like, "Left my spouse. Quit my second job," things that I can't generally recommend as treatment advice.

Troy: So did you have any side effects, Mitch?

Mitch: I was a little dizzy, to be honest. I just had a little bit of dizziness when I took it, but a little bit of dizziness for 15, 20 minutes is tons better than curled up in the corner, feeling like I'm going to die for a couple hours.

Troy: Interesting.

Dr. Pippitt: That's a good point, though, Troy, because if you . . . I will tell you the first rescue migraine medication I had, I didn't actually like how it made me feel. And so then I wouldn't take it, because I was like, "Well, is it worse to feel the side effects of the medication or the headache? I don't think the headache is quite that bad, so I'm just going to hold out," which then didn't really help anything either.

So it's important, if you do have side effects from it, that you tell your doc, because there are other things that you can take in that same class of drugs that often don't have those same side effects.

Troy: Yeah. And I haven't had any major issues. I find about 30 minutes in, my face will feel kind of tingly, and then the migraine just starts to dissipate, and it just feels like the medication is just there working its way into my brain, and making my face tingly, and making the migraine disappear. It's kind of a cool feeling. I kind of like it.

Dr. Pippitt: It is kind of weird when you're like, "Oh, my God." I mean, it's not even . . . I don't want to say a vise, like a tension headache, but you just start to feel it slip away as the medicine starts working. It's a really wonderful thing, especially when you're feeling really crappy.

Troy: It really is. It is a wonderful feeling. And I think for anyone who hasn't experienced migraines, it's hard to describe that sensation, but it's kind of consuming. It's just there, and it's just like you can't focus. You can't concentrate. You just feel sick. I feel like I have an illness, like I'm coming down with something. And just to feel that melt away, it's great. It really is a game changer, and so glad that you talked to us about this, and really convinced us to do something about it. So I'm very happy about that.

Dr. Pippitt: I'm just glad you guys did something. I mean, truthfully, this is the thing. People just think it's not that bad and they don't do anything about it. It sucks because it could be so much better for you guys.

Mitch: Well, that's the thing I wanted to mention. I thought I just had casual headaches, like no big deal. They're just something that happens when you get older. They're just something that happens when you're a person. And if you're listening to this episode right now, if you're out there and you're like, "I get headaches but they're not that bad," maybe you should just mention that you have headaches to someone. Mention it to your doctor, mention it to someone, because these drugs are kind of magical.

Dr. Pippitt: And mention it with some details. Maybe not this casual, "Hey, I think, maybe, I don't know." Just giving you a hard time, Mitch.

Mitch: It's okay.

Scot: And mention it to family members too. That might help you with your detective work.

Hey, Dr. Pippitt, do triggers . . . So triggers are the things that trigger people's headaches. They could be various things. Troy knows his triggers. Mitch hasn't figured out his yet. Are those hereditary as well? Do they tend to run in families?

Dr. Pippitt: That's a really great question. I think it would stand to reason that they probably do, but I don't know that I've ever had anyone specifically come up with that. I mean, I think the triggers are pretty . . . the common ones are common for most people, so hard to say. Is that just because it's a common trigger, or because it's the hereditary aspect of it?

Scot: Yeah. I thought that might be helpful with detective work. If somebody in Mitch's family is like, "Oh, I have them too, and these are my triggers," if that would shed some light. But you're saying it's common triggers.

I would encourage anybody to go back and listen to Episode 78 on May 18, 2021. But quickly, just mention some of those common triggers.

Dr. Pippitt: So Troy gave a really good example of one, when your sleep schedule is disrupted. So if you're not getting good sleep, you're staying up late, or you're sleeping in too much, or just too many hours of sleep, all of that is probably . . . That's one of the biggest triggers for people.

Alcohol. So particularly red wine, beer. Aged cheeses, or cured meats. So things like sausage, bacon, all the delicious stuff. Chocolate, unfortunately, can be a trigger for some people.

Scot: So Mitch mentioned that his diary, he really hasn't had . . . He hasn't had migraines, so he hasn't really been able to track down those triggers. And I know keeping a diary is pretty important. Explain how somebody might do that so then when they finally do decide to go in, like Troy and Mitch, that they've got all the information they need to provide to their doctor.

Dr. Pippitt: So, Mitch, did your doctor tell you to just mark down when you had headaches, or what other things are you supposed to note in your diary?

Mitch: One of the things that I was supposed to look for is when do I have headaches, what my general mood was around those headaches, what I had eaten that day on a day with a headache. And then they kept talking . . . I don't get it, but they kept talking about the aura, or the haziness, or the ooginess. I don't know what the word is. Like, "Do you have that pre-migraine feeling? And if you do, do the same sort of thing. What's going on in your sleep, your food, your mood?" I think that's it.

Dr. Pippitt: Yeah. Some things that I'll add to that would be things like how much physical activity have you had that day. On the diary that we print out, we talk about a couple of different triggers, so foods. We talk about other psychological stressors. So have you just had something really stressful happen in your life? Did someone die? Were you just sick? Do you have a big deadline at work? Things like that.

Weather, I don't actually put that down as something in the diary, but some people will notice that when a storm is coming in . . . In fact, the day that I had a migraine, I had had headache clinic the day before, and I ended up emailing the patient so we could connect virtually. And she was like, "Yeah, I think we're going to have a storm tomorrow." She messaged me the next day because it rained and was like, "I'm better than the weatherman. I'm telling you."

Troy: Wow.

Dr. Pippitt: And that's one that I think people sometimes feel a little like, "Am I nuts that I think that I can predict the weather, that it always happens with a storm?" But that's another really common trigger, just a change in the barometric pressure. So something else to think about watching for.

So to talk briefly about that aura that you're asked about, this is mostly . . . So the technical definition of an aura is a reversible neurologic symptom. So the vast majority of auras tend to be visual, and so people will describe this as either like a black dot or spot in their eye, that regardless of when you turn your head, you still see.

So all of us have done this when you've accidentally looked at something really bright, or looked at the sun, and then you look away. So it's just this like black dot that persists.

The other fancy medical one is something called a scintillating scotoma, which basically is like a zigzag line across your vision, or even sometimes like a shimmer, like a heat wave, that just sort of persists in your vision the whole time.

You can get other aura. So some people get numbness. We sometimes talk about the march of migraine. So that numbness starts in your hand, moves up your hand into your neck and your face, and then the numbness will happen there. It's typically neurologic symptoms, pause, then headache follows, but doesn't have to be that way.

Mitch: What about sparkles, sparkles in your vision?

Dr. Pippitt: Tell me more about your sparkles.

Mitch: Little diamond-y, shimmery. And it goes away after a couple of seconds.

Dr. Pippitt: I want to say that . . . I'm trying to remember the time frame. I think it needs to last a little bit longer than that. Where does it happen in relation to the headache?

Mitch: I've never connected the two. But I'm afraid that I'll be doing the same thing I did on the last episode where we'll turn it off and I'll be like, "Oh, yeah. No. Totally. I've been getting auras all my life."

Dr. Pippitt: I mean, the issues with aura tend to be more around . . . So people with aura have a slightly higher risk of stroke, and it matters in particular for female-identifying persons who want to use birth control for some sort of contraception, just because we know estrogen also puts you at higher risk of stroke. So the two together, if you're someone who identifies as female and you have migraine with aura, you should not be using an estrogen-containing birth control.

Troy: Talking about this and just my experience personally with migraines and seeing people in the emergency department with migraines, migraines are just weird. They are just weird. Do you know what causes them?

Dr. Pippitt: I mean, definitely our understanding of many of these things has changed over time. These new drugs are targeted towards something called the calcitonin gene-related peptide. So we've known about that since the '80s as being implicated in migraines. So it comes from this trigeminal ganglia, and then that's also in the sensory nerve fibers in the meninges. So it is a potent vasodilator. See this is what I'm talking about. This is why you don't know that you want this in there.

Troy: I'm sorry I asked.

Dr. Pippitt: It's what causes the transmission of the pain signals from the meninges to the brain.

So I don't know that we know what it is that activates that trigeminal ganglion that then makes the CGRP get released. But if any of us . . . not you, Scot, but the rest of us, if we got an infusion of the CGRP, we would actually get a migraine. So that's what these new drugs are. They actually are a receptor antagonist or blocker from that.

Troy: Oh, okay. So people who don't have migraines don't have that receptor?

Dr. Pippitt: I think they have the receptor. I just don't know that . . . do you not respond to it?

Troy: Just not so sensitive.

Dr. Pippitt: Is there something else? Yeah.

Troy: Interesting.

Dr. Pippitt: Exactly.

Troy: It's great to hear because, yeah, that's always been my understanding, is migraines are a mystery. But it sounds like there's more and more understanding of what's causing it and treatments targeted specifically at that. So that's great to hear.

Dr. Pippitt: Absolutely. I always tell people it's a good time to have migraine because this is really the first time in a long time we've had any very specific medications for it.

Troy: Right. Yeah, that's great.

Scot: Just want to point out you said 12 sentences in a row before I finally understood one. I was just waiting to see how many of those sentences you could string along with those words.

Troy: Did you not pick up on CGRP, Scot? We've talked about it before.

Scot: Oh, have we? Okay.

Troy: I'm just kidding. Yeah.

Dr. Pippitt: I could have read the next line that was something about being a multimore of a G protein coupled receptor. I mean, this is why I had to pull it up. This is not stuff I talk about to people.

Troy: That would have brought it all together. If you'd only said that, then really that would have brought it home.

Dr. Pippitt: Yeah, it would have been like, "Oh, Karly, you're holding out on me. Geez."

Troy: Exactly.

Scot: You can leave out the most . . . you're burying the headline here.

Troy: "Now I get it."

Dr. Pippitt: Mitch, about your sparkles, though, the other thing I was thinking is we often think about . . . So migraine has very distinct phases. So there's the prodrome, or what happens before you get a migraine, when you get it, and then the postdrome. And so there are some symptoms that people get that can be seen as precursor signs or sort of a premonitory sign.

One of those is yawning. That's actually a really common thing that people have happen. Sometimes you have to go to the bathroom a lot, like just urinate more.

It's a funny question to ask people sometimes, like, "Hey, have you ever noticed that these things happen, or you have cravings for certain foods, and then the next day you get a headache?" And you probably wouldn't notice it. But then someone says it to you, and you're like, "Oh, my goodness. You're absolutely right." And those are different than aura.

That was the only thing I wanted to point out. And it might be something you guys watch for now if you see anything like that.

Scot: Dr. Pippitt, thank you for making both Mitch's life and Troy's life so much better. We appreciate that.

Dr. Pippitt: And yours, I hope, too, right?

Scot: Well, I mean, Troy actually . . . I never knew he had migraines because I don't know if . . . I never . . .

Troy: Yeah, I didn't talk about it.

Scot: Yeah, I didn't know if I just never interacted with him on those days. I knew Mitch did once in a while. But they never really impacted me directly, I guess, that I noticed.

So if you get a chance, go back to Episode 78 because it really is good. You can learn a little bit more about your migraines.

Dr. Pippitt, before we go, though, if somebody does not go back to that episode, how should we wrap this up? What's your message of hope?

Dr. Pippitt: I think the message is there is treatment for this. And don't think that you have to be . . . We keep teasing and joking about curled up in the corner of a dark room. If your pain is significant enough that it interferes with your life activity, it's worth getting checked out.

Scot: Or you just think about it, right?

Dr. Pippitt: Yeah.

Scot: That is interfering with your normal activity, I would think.

Dr. Pippitt: Absolutely.

Scot: And then I think one other thing I do want to try to tease out here before we go is, obviously, Troy is an ER physician, so he tried the medication beforehand because he didn't want it impacting his work. People that drive trucks, heavy machinery operators, people that are in those sorts of things, they might hesitate to get this medication because they don't want to be on medication when they're working. Is it safe for those types of environments generally? Can you generally find an option for somebody?

Dr. Pippitt: Yeah, generally. I would say most of these medications don't cause drowsiness. It's not uncommon for people to say that they feel drowsy, but it's hard to know, "Is that actually a medication side effect, or is it what the postdrome is?" I think most of us would actually say you feel a little bit wrung out after a migraine, and that could be why too.

Scot: Dr. Pippitt, as always, just so wonderful having you on the show. And I went to the U of U Health headache webpage, and there's a link to something called a questionnaire, a new patient's questionnaire. Does that include the diary, all that sort of stuff? Would that be a good resource for somebody to start?

Dr. Pippitt: This would be a great resource. I wouldn't say that it includes a diary, but does a really detailed history of what symptoms you experience, what medications you've tried. In addition to family history, there's a question about what medications have worked best for your family.

It's about 17 pages. It's pretty long. One thing I do like about it is it gives me the most detailed version of your history, and it really forces you to go back and look at . . . Especially people who've seen other providers and had lots of medications tried, it helps you know, "Okay, I think I've tried a lot of stuff, but look at all these other things on this list. There's still a lot of stuff on there."

Scot: And this could be a barrier in and of itself. I could see somebody going, "Oh, I'd rather deal with my migraines than do 17 pages." I mean, can you get away with coming to your doctor with a little bit less?

Dr. Pippitt: To your primary care doctor, absolutely. I will tell you it's a prerequisite for a headache clinic to get people in to do it, but for primary care, yeah. I mean, it'd be a reasonable thing to take a look at. And then bring a diary. You don't have to do anything fancy. There are apps. I just have it on the notes tab on my phone. That's what I do, is just put a little . . . I just mark the date when I have a headache.

Scot: All right. All in favor that Dr. Pippitt rocks, say aye.

Troy: Aye.

Mitch: Aye.

Dr. Pippitt: Aye. Do I get to agree too?

Troy: Yes, you do.

Scot: Aye. Dr. Pippitt, thank you for being on the podcast, and thank you for caring about men's health.

Dr. Pippitt: Absolutely. Thank you, guys. This is always such a pleasure.

Scot: Hey, it's Scot from "Who Cares About Men's Health." Thank you so much for making it all the way to the end. By the way, if there's somebody in your life that you think would find this episode, or any of our episodes, or this podcast useful, do us a big favor and let them know about it, whether it's online, sharing it on your social media platforms, or even if it's a face-to-face conversation or an email. That would be great. That would help us tremendously make sure that more men hear our podcast.

If you'd like to reach out, if you've got a migraine story you'd like to tell us, or a question, you can do so a lot of different ways. You can email us, hello@thescoperadio.com. You can send a Facebook message, facebook.com/whocaresmenshealth. You can even leave a voicemail at our listener line, which is 601-55SCOPE. That's 601-55SCOPE.

Thank you very much for listening, and thanks for caring about men's health.

So your daughter just had her first period. What's normal, what's not, and what to expect now.

A girl's first period marks her entry into womanhood. It's called menarche. And many parents, especially moms, seem to have a lot of anxiety and questions about it. Many moms readily admit to me that they have forgotten what periods were like when they started. So if something doesn't seem right, they get incredibly nervous that something is wrong with their daughter. Some worry that their daughter has started too early or too late. Actually, any time between ages 9 and 15 is normal.

Some worry that their daughter doesn't have a period every month like clockwork and that they need their hormone levels checked or some sort of treatment to make their periods regular. Well, it is hormones to blame for this. However, it's because hormones are still settling themselves out. It can take two to three years before periods become regular. If there is a family history of irregular periods, they might never be regular. And that's okay too. Parents really worry if their daughter's periods are not regular. But unless their daughter is sexually active or they go months between periods after having them for about a year, there really isn't anything to worry about. Irregular periods by definition happen either less than three weeks apart or more than five weeks between periods. Otherwise, they're normal.

Moms also get concerned about cramps. Sorry, but cramps are part of periods. Your daughter should not miss school or stop being physically active because of cramps. Being physically active has been shown to decrease cramps. I have parents wanting me to write letters so that every month their daughter can miss school during her period. Periods normally last 3 to 10 days. So that's a lot of school missed. I try not to do these letters and instead discuss ways to help their cramps. Over-the-counter naproxen really helps and so does a heating pad.

Some girls will even have nausea or vomiting with their periods due to hormone fluctuations. Treating them supportively with anti-nausea medicines can help.

Moms also get concerned about their daughter's becoming anemic. This does not happen usually. Girls normally lose between 30 to 40 milliliters per period. This is six to eight teaspoons of blood. So while it looks like a lot of blood during a period, it's not as much as it seems. If your daughter has something called menorrhagia, that is excessive blood loss and that is 80 milliliters or more of blood loss per period. And these girls normally pass blood clots that are larger than a quarter. These girls will usually soak through a pad or tampon every hour for several hours during the heaviest portions of their periods. They may also need double maxi pads for protection. If this is the case, then you should talk to your daughter's pediatrician about ways to help.

I often get asked by moms if their daughters could have endometriosis or fibroids or other gynecological issues. As a pediatrician, I can do basic period management and gynecology. I can do oral or injectable birth control to help with periods. But often the best thing for me to do is to refer my patient to a gynecologist if it's more than I can address. They are much better at diagnosing and managing female concerns.

Finally, moms also ask me if their daughters need Pap smears now that they have started their periods. No. That used to be the case, and it's pretty traumatic for a young girl. The current guidelines are if a girl is 21 or has been sexually active for three years, then they get a Pap smear, and that would be done by a gynecologist, not a pediatrician.

Bottom line, most period concerns are actually part of normal development. Your pediatrician can let you know when something is not normal and refer you to a gynecologist who sees teenagers for additional help when needed.

When you are expecting a baby, you have so many hopes for the future of your child. What if you learn that your child will have physical or developmental disabilities? I'll discuss your pediatrician's role in your child's care on today's Scope.

Often parents will ask me if I'm able to take care of a future sibling of one of my patients. The answer always is of course. Some parents will then get a little more quiet and say, "But my baby isn't normal." And I'm like, "Are any of us normal?" Seriously, if you've ever studied embryology and seen all the things that can go wrong during development, it's amazing any of us come out okay. When it comes to seeing new babies who may have some physical or developmental challenges, I honestly tell them I would be honored to be their new child's pediatrician.

When I was five, we moved to a house where the neighbors behind us had a son my age. His older sister had Down syndrome. In the five years that we lived at that house, his sister became one of my best friends. We would play school together, go to the pool together. She actually became a swimmer on the Special Olympics team. We did all sorts of things that friends do. Our families have kept in contact this whole time. And I've been so proud to see all she's accomplished.

I learned early on that just because someone has an extra chromosome and has some differences as a result, they're still an amazing person. They still have so much to offer. I mean, I was the asthmatic kid, allergic to everything. And I was in the school nurse's office all the time. So I also felt like I was a bit defective. We all are a little off in our own ways.

Parents are often overwhelmed when they have a new baby with special needs. And as their pediatrician, I serve as sort of a gatekeeper for all the specialists. My job is to take care of the well child visits, the usual colds and ear infections, and help manage some straightforward issues that most pediatricians are comfortable doing.

When a child needs a specialist, I know exactly who to refer them to. And the specialists and I coordinate together to make sure the child has all their healthcare needs addressed. It's called the medical home model. It's basically a community of doctors all working together, like a wheel with all the spokes of the wheel being the specialists, and the hubcap being the pediatrician. Depending on the needs of the child, the pediatrician also gets home health nursing involved or speech or physical therapists. Often we're the ones that fill out a lot of the paperwork for the insurance companies too and refill prescriptions for supplies if a child has a feeding tube or needs diapers long term.

Often one of the specialists is a pediatrician who has had additional training and certification in complex care management. That is someone I routinely refer my patients to, because they are an amazing resource and also help coordinate the specialists. They often try to make sure that a patient, if they are coming for a visit, have all of the specialists in the visit at once, so it's easier to make sure everyone is on the same page and can get extra help from dieticians, care manager nurses, and social workers if needed. Again, all part of the community of doctors caring for special needs kids.

Trust me, we as pediatricians love your kids as much as you do. And when they make certain milestones, we celebrate with you. I get so excited when I see my cerebral palsy kids walk into a clinic on their own. And I know that every child I see with Down syndrome means I'm guaranteed extra hugs that day. Special needs doesn't always mean limited, negative quality of life. Although their care will be certainly filled with challenges, it's our job as pediatricians to help you along your child's journey to reach their full potential.

Interviewer: Travis Nolan is an athletic trainer that works for the University of Utah Health Orthopedic Center and also works with high school athletes here in the valley. And the question today is if an athlete gets a fracture, should you always go get that x-rayed? Now, I threw on a trick word there, Travis. I said "always," right?

Travis: Yes, yeah, yeah.

Interviewer: So maybe not always. But first of all, you were saying that you've got stories of people who got a fracture, didn't get it x-rayed, didn't get it taken care of, and then it really impacted them later in their life. Give me an example of how that might happen.

Travis: I ended up coming in over this summer just to do some check-up on the school I work at and things like that, and this athlete pops in my room. And he wasn't really thinking about it much. He was doing some lifting and just experiencing some slight pain in his wrist. And he's like, "Hey, man. Is this normal? I took a little follow-on a couple of weeks ago." He actually did ended up going to see somebody. He was instructed to come back in if it wasn't getting better, and the athlete didn't do that. And so after evaluating it, I was pretty concerned for a fracture still present in his wrist.

And so we sent him back in. And I guess, long story short, since that second referral, getting him back into a doctor again, he has actually had four different surgeries on his wrist trying to restore normal function and trying to properly heal the bone that broke. And so he ended up breaking his scaphoid bone. And for those that have broken it or know about that bone, I'm sure they know the complications that can come from breaking that bone, and then it not healing properly because that bone can lose blood supply. And when that happens, it's called necrosis. And so part of that bone can sort of die off. He, to this day, still has trouble playing athletics. It has affected him in class, in school, writing, typing, so many aspects of his life, carrying things, lifting a backpack. And so he is definitely one of my big advocates when I have to tell other athletes to go get an x-ray, and he'll back me on that a lot of the time, so yeah.

Interviewer: So, for young high school athletes, are there some fractures that tend to occur more often that if it does occur, that is definitely a reason you want to go see somebody, ask for an x-ray? What are those kind of common fractures that could really give you problems down the road if you don't take care of them almost immediately?

Travis: Yeah, the ankle. So whether or not it's from twisting your ankle, getting it caught up in a pile, or if you're a basketball athlete, very common to come down on top of somebody's foot after you jump up into the air, and then any kind of fracture around the ankle bone. So whether it's a small chip off your tibia or fibula, those are sort of common when it comes to spraining your ankle. And most of the time, why doctors recommend x-rays for ankle sprain is because you can get . . . whether it's a small piece of your ligament sort of pulls off a little piece of bone, that's a common area to fracture as well.

The other area of the body that is another big one to go get checked out is called the base of your fifth metatarsal. So that's on the outside of your foot there. And that's a special bone because it's sort of just like the one on our wrist where if we don't catch it in time, it can also go through that sort of necrosis. And it's called a dancer's fracture, actually, because it happens in dance quite frequently. And so that's one of those areas where if you do have pain on the outside of your foot sort of near the . . . we call it the base of our fifth metatarsal. If you have pain in that location, that's a very important one to go get evaluated and x-rayed because it can go through that necrosis process.

And then also, they actually are seen quite often in the military. They're called marcher's fracture. So it's at second or third metatarsal in your foot, and that's the same thing. It's going to be those repetitive stress motions. So whether it's marching, running, jumping, that's another very common area in athletics or the sports world to see a fracture in.

Interviewer: So I noticed that these common fractures in athletics that you believe should be x-rayed seem to be around the wrists, ankles, and the feet, the smaller bone.

Travis: Yeah.

Interviewer: Yeah. So those are the ones that if you don't get them looked at, x-rayed, follow your doctor's instructions can really kind of mess things up in the future for you not only in athletics, but in regular life as well. And I'd imagine a lot of those you don't even know that there's a fracture. You probably . . . just pain. You thought maybe just strained something or sprained something. Is that accurate?

Travis: When athletes have a bigger emotional response, it's pretty easy to convince someone, like, "Hey, we should go get an x-ray on this," like, "You're in a lot of pain right now." It's more time those athletes that they're able to tolerate it. They're sort of pushing through it, they're playing with it still, or they come in and they're, like, "Dude, this is something I can deal with." And you have to have that conversation and you have to educate them on, "Hey, look. It's not about you missing a couple of games." This is about your long-term health, especially for those important areas, whether it's the scaphoid, the base of the fifth. There are some areas in your body where if you don't get them checked out and treated properly, they will cause long-term complications. You will have to get multiple surgeries on them in order to try restore normal function in your body.

Interviewer: And if the athlete is experiencing that, how much time do they have to go get the x-ray? Now, I know at University of Utah Health, we have a walk-in orthopedic center, which is great because you could just walk in, tell somebody what's going on, and they could do an x-ray right there. If they need to have a couple of days in order to arrange that, did you have a couple of days to do that or you really want to get it checked sooner than later?

Travis: Yeah. So can you wait overnight? Sure. Should you wait the entire weekend and then maybe go get it checked out on Monday? Those are some things that I probably wouldn't recommend unless you've been advised and it's already been evaluated by somebody, but make sure you're getting evaluated by a professional that can give you recommendations on, "Hey, this is one of those high-risk areas and this is why I would go get an x-ray tonight instead of waiting over the weekend."

updated: December 8, 2022
originally published: March 3, 2021

Announcer: Is it bad enough to go to the Emergency Room, or isn't it? You're listening to "ER or Not?" on The Scope.

Interviewer: All right. Here, you get to play along with "ER or Not?" Today's scenario that we're going to run by Dr. Troy Madsen, who's an Emergency Room physician at University of Utah Health, is higher than normal blood pressure. So here's what happened. It's an individual, has one of those blood pressure cuffs at home, for whatever reason, routinely monitors their blood pressure, and one day gets a reading of about 160 over 100. ER or not?

Dr. Madsen: So, first, let me clarify this by saying, high blood pressure, absolutely, go see your doctor. But in this kind of scenario, if you're not having any other symptoms, and again, emphasizing that, no other symptoms, you don't need to go to the ER. We very often will see people in the ER who come in with exactly this sort of thing that happens. They have a blood pressure cuff at home, or they go to the grocery store and check their blood pressure, and it's, say, 160 over 100, or 180 over 110.

Interviewer: And, as a reminder, what's normal?

Dr. Madsen: So, you know, a normal blood pressure would be, say, 120 over 80.

Interviewer: All right.

Dr. Madsen: Or something within that range. You know, most people, healthy people, are going to have something around there.

Dr. Madsen: So, you know, they'll rush right into the ER, thinking, "Wow, if I don't get in right now, I'm going to have a stroke, or something really bad is going to happen." Oftentimes, you know, we'll check some tests on them, make sure things are okay, but quite honestly, a lot of those tests we're doing, primarily, because they're in the ER and we want to say, "Hey, we're offering something. We're going to make sure this stuff's okay."

But unless you're having some symptoms with that, let's say:

• chest pain
• confusion
• stroke-like symptoms (arm weakness, numbness, trouble speaking)

Interviewer: All right. And what would you do then, at that point, because that still can be very concerning to people.

Dr. Madsen: Absolutely, and it can be, you know, often, in those scenarios, when someone gets that high blood pressure, what I'll do is just let them relax in the room, turn the lights down, come back in 30 minutes, we'll recheck their blood pressure, and it's, let's say, it went from 180 down to 150 or 140, I'd say 90% of the time, that's what happens. So if this happens to you and you don't have any other symptoms with it, it's just, it's really not a reason to have to rush into the ER where you're going to have to wait in the waiting room forever, sit in a room, maybe get some tests done, sit around for several hours, and then, at the end of it all, we say, "Go follow up with your doctor."

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: September 7, 2018
originally published: August 28, 2017

Interviewer: You like guys, but you think you might also like girls. It's a personal question, but how do you figure out your sexual orientation and what's considered normal? We're going to talk about this right now on The Scope.

Announcer: Questions every woman wonders about her health, body, and mind, this is "Am I Normal?" on The Scope.

Interviewer: We're talking to Dr. Kirtly Parker Jones. She's the expert on all things woman. Dr. Jones, we have a letter here from an audience member that's a little bit younger than our typical listeners. She's 16 years old. She's never had sex. She says that she is confident that she likes guys, but she might also like girls. But she doesn't really know what her sexual preference is because, again, she's never had sex. She's wondering, is this a normal thing to be experiencing?

Dr. Jones: Okay. Well, first of all, I'm glad she emailed, but I hope she also has somebody that's safe to talk to. But let's talk about normal again. So sometimes normal is a scientific number, and sometimes normal is a cultural construct, meaning the culture tells you what's normal and what's normal when culture may not be normal or another. And when it comes to sexual preference or sexual identity, it's both a scientific number, and I can give you some numbers, and it's neither because, in fact, we live in a multi-cultural society and people don't always tell the truth, so we may not even have the right numbers.

But let's just do some numbers. The scientific number, which isn't very scientific, is about 4% of people, 18 to 45, identify as gay, lesbian, bisexual, or transgendered, meaning not straight. Now, about 7% of millennials will tick that box as "Not straight" and about 12% of Americans in this age group have had some same sex sexual encounter. So normal, we consider anything that at least 10% of the population would be, so we're struggling here because a lot of people don't tell, so the "Don't ask, don't tell" has been around a long time both in medicine and how do we begin to actually get this information.

Now, the cultural, when it comes to normal, it's really very difficult to know what normal is because one culture or subculture may consider one thing as okay. And often, we use the word "normal" as what we think as okay, so that a lot of people would do things that we think are not okay, like have sex outside your marriage, that's like not okay. It's so common that it's normal by numbers. So I don't know what normal is, but you are certainly, this young woman is not alone.

In young people, particularly young women, sexual preference is rather fluid, meaning the kind of people someone might want to have sex with kind of changes a bit, a bunch. The old paradigm, the old way of thinking was that you were born one way or the other and you need to just pick one. You're either gay or you're straight, and you need to stick with it. But in fact, we're finding more and more that, once again, particularly for women, it's not so simple.

So some people, all their lives, will have a preference for one or the other or equally for both, but some people move from one sexual preference to another through their adolescence. A young woman may have a very close personal friend and that person might be gay or might not be gay, and what becomes a very personal relationship starts to feel like a romantic relationship. So for many women, and particularly young women, it's more about the relationship, the person, than it is about the sex. So we tend to, as women can, inflate our romance and our relationship with sex, whereas men do that a little less than women.

So the most important thing is if you don't know right now, don't tell, meaning you don't have to commit right now. This is an important thing for you to talk about and think about, but you need to find someone you can talk to. And most importantly, you need to be safe. So the place that I wouldn't talk about it is all over school or even with one person at school unless you think that person is really safe.

Interviewer: You put a lot of emphasis on making sure that she has someone that she can talk to. Why is that so critical?

Dr. Jones: The important reason to talk through how you're feeling and work with someone that you feel safe with is because in many cultures, and I don't know the culture of this young woman, being gay is considered not okay. And so many young people who find themselves with same sex attraction, that brings with it an enormous layer of guilt and "I am not okay" and self-loathing.

We know that gay and lesbian and transgendered children, young people, adolescents are more likely to commit suicide. We know they're more likely to use drugs and alcohol. And part of this is the alienation they feel from themselves and their family. So I want these people, these young people to be safe, and being able to talk to through it with someone who understands that they're going to grow, they're going to feel more comfortable with themselves as they get older, whichever path they take, will be helpful and keep these young people safe.

So who do you find who's safe? Now, it could be that you have a parent who's safe. Or in this case, it might be an auntie or someone that you know. It could be a counselor because more and more high school counselors are becoming very familiar and very comfortable in talking to young people about sexual identity and sexual choice and the fluidity that people experience in high school.

If you don't feel that this is a safe place for you to talk out your concerns and grow with them, there are several churches that welcome gay, straight, bisexual, transgendered, and queer people of all kinds. I would say that the Metropolitan Church and there are Metropolitan churches all over the country. The Unitarian Church is often very welcoming and the pastors in those churches are trained to help people talk about how they feel. So you need to be safe.

So the question is, and the answer is, whether or not you're normal and I don't think that's really the question, is that you are okay and you are not alone. You are in really good company.

Announcer: Want The Scope delivered straight to your inbox? Enter your email address at thescoperadio.com and click "Sign Me Up" for updates of our latest episodes. The Scope Radio is a production of University of Utah Health Sciences.

Interviewer: You notice that you're not actually the same height as you were maybe a decade ago and you're wondering if maybe this is normal or not. We'll tell you, up next on The Scope.

Announcer: Questions every woman wonders about her health, body, and mind. This is "Am I Normal?" on The Scope.

Interviewer: We're talking with Dr. Kirtly Parker Jones. She's the expert on all things woman. And today on "Am I Normal?" I have a question not from me specifically, but I've noticed that my mom, I think she is shrinking.

Dr. Jones: Oh!

Interviewer: I think she's getting smaller and smaller.

Dr. Jones: She is? That's so sad.

Interviewer: Is this normal?

Dr. Jones: Yes, it is. In fact, there are really two kinds of normal shrinking, one which is pretty okay and one sort of not so okay.

Interviewer: Okay.

Dr. Jones: So I've noticed the same thing. My sons stopped growing, I'm sure, 10 years ago or 15 years ago, but I am getting smaller and smaller as I get older and older. So what makes us tall? Well, we're tall because of the length of our leg bones and we're tall because of our back. And our back is mostly made up of our vertebrae, which are kind of like building blocks. But in between those building blocks are our discs. And the inter-disc space gets kind of squished down. Over time, as you get older, the discs get flatter. Everybody's discs, like a pillow, like your favorite pillow, which on the job . . .

Interviewer: And it's getting flatter and flatter.

Dr. Jones: We keep getting flatter and flatter and you need a new pillow. But I'm afraid I would love to have a disc . . . actually, I'd like to have 15 disc transplants, but you can't have that. So that's the major reason that men and women tend to get smaller with the age and women more markedly. Now, the second reason, remember that our long bones really don't shrink that much. There is some cartilage between the knee, but it doesn't contribute too much. So mostly, it's our spine.

Interviewer: So it's all the back.

Dr. Jones: It's all in the back. So what happens is imagine that we have a square block that's made of really hard wood. But it gets thinner and thinner and then it collapses. So that vertebra itself may collapse. So if the vertebrae itself start collapsing, that can be a problem because sometimes it collapses evenly. So it's a square that kind of gets squished a little. But sometimes, and more commonly, it collapses unevenly, meaning the front part of that square, the square that points front collapses in the back. So it makes kind of a triangle. And that's why you see more older women than men, but some older men, their back is all curled over.

Interviewer: I noticed that, yeah!

Dr. Jones: Right. So they're shorter because their vertebra have squished. But they're also now all bent over and that can certainly cause pain. So a squished or collapse vertebrae can cause pain. But when you're all squished over then you have to kink your neck to look up and then it can cause neck problems. And when you're all kind of kinked over, that means your balance isn't so great and you're more likely to fall. And, of course, if your bones are all that thin and you fall, then you break something else.

So the first kind of squishing is very common and it usually isn't all that harmful, although it can be because keeping your bones aligned is really important. Those vertebrae are supposed to sit like blocks on top of each other and not slip sideways. Anyway, our disc space getting smaller is perfectly normal. Having vertebral collapse is very common as we age, particularly in the very elderly.

But it's not healthy. So what do we do about that? In fact, for women, we should be watching our bone density from the time we're young. And I'll consider you young. We should be thinking about our bone density and we make our bone strong by using them, by stressing them, giving them enough calcium, and giving them estrogen because estrogen for men and women makes their bones strong.

But as we may go to menopause, it's work to keep your bones stronger because we don't have estrogens anymore, although some women take estrogens. It's recommended that women, by the time they're 65, get a bone density. And if their bone density is decreasing in their vertebrae, then we encourage women to consider taking medications that slow bone loss. Because the kind of shrinking that's asymmetrical, that causes shrinking in our vertebral boxes, that's not healthy and can make you feel sick and it can make you fall and then you break something else. So, yeah, your mom shrinking, isn't she cute?

Interviewer: But that's normal.

Dr. Jones: But you're going to shrink too.

Interviewer: I am going to shrink, apparently, according to you.

Dr. Jones: You're going to shrink too. But you have many, many years ahead of you. But you want the okay shrinking of your discs and not the breakage of your vertebrae. So the answer is, yep, we're going to get shorter. Your mom is getting shorter and that's probably normal.

Interviewer: Want the Scope delivered straight to your inbox? Enter your email address at thescoperadio.com and click "Sign me up for updates of our latest episodes." The Scope Radio is a production of University of Utah Health Sciences.

Interviewer: Your partner is suddenly not interested in sex anymore. Something is wrong, but you don't know what. Is this normal? We'll find out next on The Scope.

Announcer: Questions every woman wonders about her health, body, and mind. This is, "Am I normal?" on The Scope.

Interviewer: We're talking today with Dr. Kirtly Parker Jones. She is our expert on all things women. And, Doctor Jones, we got an email today from one of our listeners and she asked, her husband or her boyfriend, she just said partner isn't feeling anymore for sex. He's not interested. She knows she is normal, but is he normal?

Dr. Jones: Okay, as a woman gynecologist, I'm not sure about my standing here on this guy thing, but as a reproductive endocrinologist, a specialist in infertility and hormone problems, the issue comes up in my practice. So let's get to the "is he normal" part. Remember, we talk about "not normal" as being what is experienced by less than 5% of people. Not normal is sort of like not very common. Women and men have the unrealistic expectation that when it comes to sex, men are always ready, willing and able, but population studies suggest that about 20-25% of men said that they are not interested in sex at some times. And that would make your man normal, meaning lack of interest in sex is common.

Now, lack of interest is more common in women than men, with about 40% of American women saying in the past year there was a period of at least two weeks when they weren't interested in sex. Now, when it comes to men and women, there is no normal when it comes to the frequency or interest, as the range is all over the map. So we can use a decrease in interest or libido as a decrease in what the man had experienced before. So the causes of decreased libido in men are largely the same as in women. And let's go through some of those.

One, lack of novelty. The frequency of sex is more a function of age of the relationship than the age of the partner; everyone knows that. Newlyweds or new relationships are run more hot than long-term relationships.

Number two, stress. For men and for women, the stresses of daily life cloud the brain and you have to have a pretty empty brain to be completely focused on sex. Depression is also common in men and women and can be a major suppressor of sexual interest.

Three, partner conflicts. Women can be pretty verbally judgmental of their partners. And an unsupportive relationship is a turn-off. If your partner is angry with you, he might be less interested.

Four, lack of sleep and kids. And they go together. Having a bunch of kids in the house, particularly young ones, can preoccupy both men and women.

Number five, poor body image. Women understand this, but men can be affected by body image issues that make them feel somewhat insecure. Yes, guys can be insecure and that may decrease their interest.

Number six, alcohol use and abuse or drug use and abuse. A little may be a relaxer in the alcohol field, but more than a little on a regular basis will turn off desire for women and men.

Number seven, medical problems and medications. Interest flags when someone isn't feeling well and some medications are directly affecting libido, such as some blood pressure medications and some ant-depressions.

And number eight, then one all women assume first and worry about the most, infidelity. Is he getting his sexual needs met elsewhere, either in reality or in virtual reality?

Interviewer: So those are the things unique to women. How about men, do they have anything unique to them?

Dr. Jones: Oh, yeah! One that affects men and women is sleep apnea, but it's more common in men than women and it can lower testosterone. And it's compounded by obesity. Second is erectile dysfunction. Women tend not to have that problem. If a man's had problems with erectile less function, it can lead to concerns about the ready, willing, and able part and make men more reluctant to initiate sex. Three, aging. Aging alone in men can decrease libido and testosterone.

Interviewer: But they don't have what many women have. They don't have menopause, right?

Dr. Jones: Well, there is something out there called andropause. Now, it's not an acute event like menopause. It's more a decline in androgens. And a decline in androgens with aging is normal, but there is this whole thing about anti-aging therapy that some clinicians out there in practice, practice medicine that is not exactly traditional medicine, where they try to "normalize" levels of hormones, including testosterone, to the level of a 20-year old, even though you're 70. Now, whether that is wise or not is another issue.

But testosterone deficiency actually isn't very common. The normal range for testosterone is large and men at the lower end of the range can have normal libido. Remember, when it comes to sex, normal is just another setting on the dryer so it's hard to talk about normal. But testosterone deficiency is not nearly as common as advertisements would make it out to be and not nearly as common as prescriptions for testosterone would indicate.

Now, they are chronic medical conditions and obesity and sleep apnea and aging that can lower testosterone, but only a few men actually have this testosterone deficiency. However, testosterone is a medical problem and can have the side effects of other medical problems. It's worth getting a test if a guy brings it up with their health care provider. By the way, a good clinician asks questions about sex as a routine part of healthcare.

Interviewer: So what's a girl to do? What's her option here?

Dr. Jones: Well, it's a touchy subject and a male partner might not want to talk about it with you or his guy friends. Being supportive in a relationship is always important unless there are some behaviors like alcohol or drug abuse that can't be supported.

Ask him if he's feeling okay these days. Tell him you miss your closeness in bed. Is he sad or mad? Does he have new worries or concerns you might help with? If he's having a sexual side effect of a new medication, ask him if he wants to talk to his doctor about it. If he isn't feeling well, has gained or lost weight, is snoring a lot, maybe he want to see his primary care provider and have a discussion. It's a difficult discussion, but be brave. Even if you might not like the answers, if this is an important relationship to you, and you care about this person, it's worth the effort.

Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, you be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.

Interviewer: Sweating. But not just sweating, walking up the flight of stairs and sweating like you just ran a mile, sweating. Is it normal? We'll find out next on The Scope.

Announcer: Questions every woman wonders about her health, body and mind. This is "Am I Normal?" on The Scope.

Interviewer: We're talking today with Dr. Kirtly Parker Jones. She is the expert in all things woman. I know sweating is normal, but is it normal to walk up a flight of stairs in 10 seconds and start sweating?

Dr. Jones: Well, my grandfather used to say that horses sweat, men perspire, and women are all of a glow. So women are very sensitive to sweating. Although in the past 20 or 30 years with the rise of women athletics, thanks to Title IX, it is okay for women to get sweaty.

Interviewer: It is okay to get sweaty.

Dr. Jones: It is okay to get sweaty. So if you're sweating, the question is, "Is it hot outside? Are you nervous? Are you exercising?" All of those are good reasons to sweat. Sweating is our way of cooling ourselves off. However, there are people who have conditions where they sweat too much. It's hard to quantify because here in Utah, you can sweat . . .

Interviewer: It's just hot all the time.

Dr. Jones: It's hot, but it's dry. So you can be sweating a fair bit and it kind of dries up. I went to visit my brother in Malaysia and I sweat off my arms. My arms sweat. So it depends on where you are. Now, there is a condition called hyperhidrosis. Now this fancy word means sweating too much.

Interviewer: Okay. I figured.

Dr. Jones: About 5% of people have it. It usually runs in families and it can be unexplained or sometimes it can be explained by medical conditions or medications you take. In the kind that runs in families, A, in the history it kind of runs in families: You have a sweaty family. And two, it usually starts after puberty. These are folks that just sweat a lot. There are people who sweat primarily from their hands and feet and there actually are medications that can help people not sweat so much from their hands and feet. When you sweat from your feet all day, that's kind of sloshing around in your shoes. And putting your hand out to shake a sweaty hand is just not cool.

Interviewer: No, it doesn't sound hygienic either.

Dr. Jones: No, no, no. So if you feel like you're sweating excessively, and this is new for you, it's important maybe to talk to your clinician because there are conditions like diabetes, there are conditions like hyperthyroidism, where your thyroid is overactive. There are conditions, such as heart disease, that can make you sweat too much. There are some medications that can make you sweat a lot. Some anti-depressants can do that. Some anti-hypertensives can do that.

There's another troublesome thing called nighttime sweating. So people who have night sweats, now this is not menopausal women, we'll talk about menopausal women in just a sec. But nighttime sweating, when people wake up just completely soaking their sheets and they're not menopausal women, that is a sign that you probably need to see the doctor.

Now, if you're walking up the stairs and it's 105 degrees outside, well good for you. You can decide whether you want to go for an antiperspirant, or deodorant or both to help you with your sweating.

Now, with menopause, women can get night sweats and hot flashes that make you sweaty. Some people just get red, but some people break out and sweat all over. This is something that is episodic. It may happen every 90 minutes, it can happen more often, it can happen in the middle of the night. We have some medium to excellent treatments for menopausal sweating.

Interviewer: So, ladies, if you're walking up the stairs and you're sweating, that might be normal. But any other time, if you're sweating too much or all the time, that's a sign that it's not normal and you need to go see a doctor.

Dr. Jones: Right. This is a time to see your physician because you might be hyperthyroid, you might have diabetes, you might have a heart condition. So if you feel like you're sweating and your heart's pounding, this is a problem and you really need to see your clinician.

Announcer: TheScopeRadio.com is the University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com

Interviewer: So your periods are too much, too little, they're just weird. They're not normal or at least you think they're not normal. We'll find out if they really are or not next on The Scope.

Announcer: Questions every woman wonders about her health, body, and mind. This is "Am I Normal?" on The Scope.

Interviewer: We're talking today with Dr. Kirtly Parker Jones, she's the expert in all things woman. Dr. Jones, women everywhere have this question. "Is my period normal? Because I think I might be having too much bleeding down there, too little bleeding down there? How do you compare it to something?"

Dr. Jones: Right. And I'm sure you sit around with your girlfriends and talk about exactly what color it is, what it looks like, how many pads you've used.

Interviewer: Of course.

Dr. Jones: Well, anyway, so here's the scoop. At the beginning of reproductive life, meaning somewhere between the ages of 10 and 14 when you're starting, everything is normal because everything is weird. So they can skip a bunch, they can be one day of spotting, they can be 14 days of bleeding. It's totally unpredictable and when you get dizzy it's time for your mom to take you to the doctor.

Interviewer: So at that point, weird is normal.

Dr. Jones: Weird is normal.

Interviewer: Perfect.

Dr. Jones: At the end of reproductive life, meaning when people are going through the perimenopause, those years before the periods stop, abnormal is normal.

Interviewer: Okay.

Dr. Jones: You can have spotting for two days, you can have 10 days of flow, you can skip months. It's normal.

Interviewer: So at the start and the beginning.

Dr. Jones: Right.

Interviewer: Weird is normal.

Dr. Jones: Weird is normal. Now in-between times, it's different. So in-between times you are expected to kind of get into a rhythm. Except when you're pregnant or breastfeeding or using something for contraception, you should be using something for contraception if you don't want to make a baby. However, let's talk about what's normal. The time between periods from the first day to the first day should be about 21-35 days. Other experts say 24-38 days. I'm an inclusive woman, and an inclusive doctor, so I'll say 21-38 days. So if your periods come about 21-38 days apart, then they're normal.

It's not okay when you start having more than 20 days variation. That usually means you are kind of skipping some periods. Now that can be okay, but you may want to talk to your clinician about that. Now how much is too light? Less than two days is light. But there's usually not a problem with being too light, really, unless you're trying to get pregnant.

Interviewer: Right.

Dr. Jones: So light is good. Remember all bets are off when you're on some kind of hormonal birth control. These we're talking about are natural periods.

Interviewer: How about too heavy?

Dr. Jones: More than seven days can be too heavy. Some people say more than 10. Now we're talking about flow, not kind of spotting days. Now how much is too much? If you are passing clots that are as big as your fist, that is too much.

Interviewer: That feels painful. That sounds painful.

Dr. Jones: Yeah. Right. That's too much. If you are passing clots and soaking through heavy or heavy day's protection every two hours for several hours at a time, so you are soaking all the way through, that's too much. In terms of an amount, anything between 5ccs, which is like one-quarter teaspoon, to 80ccs, which is several ounces, is normal. But women don't really have a way to measure it. So if you're passing clots that are bigger than a finger and this goes on for several hours with your periods, then that's too much and you should talk to your doctor.

What color is okay? Everything from red to brown to black is okay. Now red means the blood is coming out flowing right out onto your protection, so it doesn't get a chance to spend any time in the vagina. But the normal healthy acids in the vagina make it turn dark. Some people say, "Oh, my blood is black or it's dark." That's okay. It just means you're not bleeding very much.

Interviewer: My mom, even still now, she tells me that when stuff comes out of you, it's your body's way of cleaning itself up. In a way, you should feel good that things are coming out. It's the most bizarre thing, but it's her way of making me feel better about myself.

Dr. Jones: Well, bless her heart. That's actually been the way many cultures interpret bleeding so bleeding is good. Some cultures isolate women during their periods. They have to go to a special hut. They can't sleep with their husband in the same bed. For some cultures and faiths, it's considered dirty. For some, it's considered cleaning. The reality is we don't know why evolution invented the period.

Interviewer: There's no scientific proof that this is my body cleaning itself?

Dr. Jones: No not really.

Interviewer: Cleansing.

Dr. Jones: Yeah, it's a good evolutionary guess, but then why don't other animals do it? So only primates, those are gorillas and chimpanzees and some monkeys and humans, have periods. Other animals may bleed a little bit, but so little you just don't see dogs walking around with pads on. In fact, when you go to the zoo, you don't even see gorillas walking around with pads on. So humans are kind of unique in how much they bleed, but we have a lot more sex than anybody else so maybe there's more to kind of fix up. As long as it's somewhere between 20 and 28 days, 21 and 28 days, and 2 to 8 days, and you're not passing big clots, it's probably okay.

Interviewer: So I'm weird, but that's a normal thing.

Dr. Jones: Yeah, you're pretty weird, but if it worries you, talk to your clinician.

Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.

Interviewer: You just got home after your breast cancer surgery. What should you expect and what should concern you? That's next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists that you can use for a happier and healthier life. You're listening to The Scope

Interviewer: When it comes to getting home and after your breast cancer procedure, what's normal and what's not normal and what should you expect? Hopefully we'll make this next part of your journey a little less scary. Dr. Cindy Matsen is a breast cancer surgeon at Huntsman Cancer Institute. She's going to help give you some idea of what to expect after you get home after your breast cancer procedure. So a woman gets home, what's normal? What's not? Let's start with what's normal.

Dr. Matsen: So what is normal is that regardless of the type of procedure you have, whether you have a mastectomy or lumpectomy, you will have some pain. That's a fact of surgery. So we make sure that we send you home with some pain medication to help with that. You should take the pain medication if you're feeling like you're having more pain than you can handle with something like Tylenol or ibuprofen. If you're ever having a dramatic increase in your pain, we want to hear about that, because that could be a sign that something abnormal is happening and we want to hear from you.

Interviewer: Generally, is it just a couple of different possibilities if you're getting a lot of pain? I mean, what is that abnormality?

Dr. Matsen: So usually if you're getting a lot of pain, it's a sign of bleeding or infection. Early on, it would typically be if you have a lot of swelling and pain we would be worried about bleeding. If you're having a lot of redness and swelling and it's further out from surgery, then we would be more worried about infection.

Interviewer: Everyone experiences pain differently. On a scale of one to ten, I mean how do you even determine if the amount of pain I'm feeling is abnormal?

Dr. Matsen: Right. So what I tell most women if they have a lumpectomy, is that they will probably be sore, not necessarily out of control pain just soreness, for a couple of days. In fact, they will only need the narcotic pain medication for a day or two at most. If women have a mastectomy, especially with reconstruction, they will need pain medication for a longer period of time because that's a much more painful procedure.

Interviewer: Because it's a lot more invasive, you're doing a lot more stuff.

Dr. Matsen: Right, it's a bigger surgery. It's a bigger incision, and it's not necessarily the bigger incision that hurts but just the surface area that is involved. And with reconstruction, especially if it's an expander that's placed behind the muscle, that's quite painful because it's stretching the muscle. So most women, that's where most of the pain is from. It's not actually from the mastectomy, but actually from the reconstruction.

Interviewer: I would imagine that of course, you should always consult your doctor and in this podcast here we're just talking about possibilities, but if there's ever any concern, probably pick up that phone. Is that what you would recommend?

Dr. Matsen: Absolutely, and we always provide women with phone numbers that give them access to someone 24/7, so if you're ever concerned, you wake up in the middle of the night and you feel something really abnormal, we have someone available to talk to you about that.

Interviewer: All right, so we've talked about pain, what are some of the other considerations?

Dr. Matsen: So the two main considerations that we have after surgery are the two things I mentioned with the pain are bleeding and infection. If you ever have an abnormal amount of swelling, we want to hear about that. Typically, if you call us and you say, "I'm having a lot of pain and a lot of swelling," we're going to say come in so we can take a look and see what's happening. If you're ever having fevers and swelling and redness, those are signs of infection and we want to hear from you then too because we're going to have you come in so we can take a look and possibly start you on antibiotics.

Interviewer: And are there differences if you've had a lumpectomy or a mastectomy as far as other things that you should be concerned about?

Dr. Matsen: There are differences. The main difference is that with a mastectomy, you go home with drains in and those drains have to be emptied a couple of times a day and you have to keep track of how much is coming out. If you ever see changes in the fluid, either in what it looks like or how much is coming out, we want to hear about that as well because that could be a sign that something has happened or changed that we need to hear about.

Interviewer: What are some common misconceptions when women get home? Like kind of like false alarms, if you will.

Dr. Matsen: I think the biggest thing is most women with a mastectomy and the drains get very concerned about the drains and the drain output is supposed to go down over time, but they'll be concerned that if it's going down that something bad is happening. And that's actually not, that's a normal part of the process. Your body makes fluid after surgery and as your body heals and those spaces closed down, the fluid will decrease with time.

Interviewer: All right, any final tips or any final thoughts on this topic?

Dr. Matsen: The biggest thing is that for most women, they've never had surgery before. They have no idea what to expect. We try to give you an expectation for the things to look out for, but if there's ever anything that you're concerned about, ever anything that you feel like may not be normal, we want to hear from you.

Interviewer: Better to make that phone call than go on the Internet and try to find out for yourself.

Dr. Matsen: Absolutely.

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