What Women Want to Know

How old should my daughter be before I get her immunized for HPV?

This is an excellent question and we commend you for you for keeping up on this important topic.  HPV, human papilloma virus, is the virus responsible for all abnormal Pap smears and most cases of cervical cancer, as well as cancers of the vagina, vulva. It is a sexually transmitted infection for which there is no cure and is not completely preventable even with condoms. Every year about 12,000 women are diagnosed with cervical cancer in the U.S. and about 4,000 women die from it. (CDC). Fortunately, with regular Pap testing and treatment most women who are exposed to the virus (the majority of women) will not develop cervical cancer.

There are over 100 different strains of HPV some of which are considered high risk for cancer. Of the current approved HPV vaccinations, Gardasil helps to protect against 4 important strains of HPV and has been widely used and studied.  This vaccination immunizes women against 2 high risk strains of HPV that cause 70% of cervical cancers and 2 strains that cause 90% of genital warts.  Warts do not develop into cancer and are completely benign, but they are bothersome and this is why the vaccine includes protection from some strains.  The vaccine is highly effective, but doesn’t protect against all strains of HPV or completely prevent cancer.

The HPV vaccine is currently approved for use in women age 9-26.  (Studies are being done on the benefits of vaccinating men to minimize HPV in the population and whether women over 26 years old can benefit.)  The key is to get immunized before contact with the virus, as is the case with all other immunizations.  Typically around age 11-12 is a good time to think about immunizing your daughter, [click to continue…]

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This morning my husband and I were discussing how quickly the summer went by and how we cannot believe that our daughter is a “big” first grader and that our son is now in preschool.  I guess that silly cliche; “They grow up so fast” is really true after all.

As I wrap my head around the idea of another school year starting, it seems like the perfect time to reflect on one of greatest gifts that I can pass on to my children…the skill of becoming independent.  As parents, it can be such a challenge to try to foster autonomy in our children.  Somehow, we feel that we are being a loving parent by doing things for our children.  Yet, several studies have found that when parents often do for children what they could be doing for themselves, children eventually develop a wide range of negative feelings including helplessness, frustration, and resentment just to name a few.

I recently watched The Push, a powerful video clip by international business speaker David McNally.  McNally’s story is a beautiful reminder of the importance of teaching our children independence.  He begins by talking about how an eagle gently coaxes her offspring towards the edge of a cliff and as she does, her heart quivers with conflicting emotions as she feels their resistance to her persistent nudging.  The eagle asks herself, [click to continue…]

My husband and I never argued until we had children. We disagreed but never argued. I feel that he is at times very hard on our children especially when it comes to sitting at the dinner table. For example, my husband only wants the children ages 2 and 3 to use their right hand and always use a utensil unless it is finger food. If one of them is sick then they usually want to sit in my lap while they eat which he disapproves. The older one wanted me to help feed her while I was feeding the younger one back when he couldn’t feed himself yet. How do you handle situations where we just can’t agree on setting the standard while dining? It’s so bad that our marriage is in jeopardy. I feel like I read a lot of parenting materials and he gets an article about parenting in The Wall Street Journal every now and then which he shares with me. Any help would be greatly appreciated.

Your great question reminded me of a quote I once read from infant development specialist Magda Gerber:

“When we deal with children we are not merely one person.  We are at least three people.  We are parents of our children…we are children of our parents and…we are adults with our own interests and needs.  Often these ‘three people’ within us do not agree and may have different ideas…about what should or shouldn’t be done.”

Now add these three additional “people” within your husband and its’ no wonder things can get stressful at times!  [click to continue…]

I have 2 children 2 years and 5 years and I feel that my PMS depression is getting worse since they were born. I suffer from very angry bouts on certain days in the middle of my periods and more recently I suffer from these during the time I have my period. It is uncontrollable anger and sadness and I just feel like crying. I can’t explain how angry I feel and I feel now that it’s affecting my life and my children. I feel very down a lot, have lost my self confidence. I went to a doctor to get a medical check and the only thing she found was under-active thyroid which can also cause depression, I am on tablets now but I don’t notice any change in my moods. A friend of mine said she had PMDD which affected her life badly and now she is on medication Prozac and it’s much better but it makes her sleepy. Please I would like some advice.

First I want to commend you for being so proactive about your health and well-being by taking the time to see your doctor and write in to us. I know this is not easy to do amidst your busy parenting schedule and the difficult symptoms you’re having. Many of the symptoms you are describing can also be present in thyroid disease, so I am glad you were evaluated for that and are on the proper medications.

I wrote a lot about PMS (premenstrual syndrome)/PMDD (premenstrual dysphoric disorder) in a prior PMS article. These disorders include many of the symptoms you describe, occur anytime up to about a week or two before your period starts, and the symptoms are usually gone by the fourth day of your period. Common symptoms include: fatigue, irritability, bloating, anxiety/tension, breast tenderness, bad mood, depression, change in appetite, acne, oversensitivity, swelling, anger, crying easily, feeling of isolation, headache, forgetfulness, gastrointestinal symptoms, poor concentration, and uncommonly hot flashes and heart palpitations. Also, I’m not sure of your age, but perimenopause can often present with irritability, mood changes, depression and agitation. Of course we cannot make a diagnosis from your question without a full evaluation in person, but you may be suffering from PMDD and/or depression from the symptoms you describe.

It can be debilitating and can make it tough to perform everyday activities, let alone taking care of the kids and work duties. I will defer to my prior PMS article for you to review an extensive list of options for treatment for this. Certainly at this point I recommend seeing a health care professional who is well versed in treating depression and PMDD. For PMDD your Ob/Gyn can care for you and write a prescription for medications. A good psychiatrist or psychologist is best for depression, but many Ob/Gyn’s and Primary Care doctors are well versed at evaluating for the common symptoms of depression and starting a prescription while you are looking for the right person to see for counseling and care.

For depression, [click to continue…]

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Tonight was Molly’s Exhibition Night at school where the students showcase their work. Molly has been talking about this night for weeks and could hardly contain her excitement this afternoon. It was a magical evening as Mike and I listened to Molly talk about her research book on insects, why she chose to draw two noses on her Pablo Picasso self-portrait, and how her 5th grade buddy helped her with the wire mobile that was hanging from the ceiling. I was amazed at what my daughter was able to articulate and as I sit here tonight and reflect on the evening, I think what made the event so inspirational for our whole family is that my daughter was the one who was talking, reflecting out loud, and then sharing more thoughts.

Right now I am grateful for all that I learned from my daughter this evening and I know I owe a huge thanks to all those who have taught me about the art of listening. Two of my favorite parenting authors, Adele Faber and Elaine Mazlish, write beautifully on the topic and helped me as a parent to realize that I don’t need to bombard my children with questions in order to show them that I am interested in what they are doing. That simply giving them my full attention will do much more for them and allow them to think constructively for themselves. As I’ve practiced this skill, I’ve often found myself literally opening my mouth about to say something before I’ve realized that what my child really needs from me in the moment is not my opinion or my advice, but just an empathetic ear. By the way, I have found that this [click to continue…]

So we’re back at the dinner table for part two of the family and food series. By now some of you may have had a chance to think about what you want (and don’t want) the family mealtime to look like. My guess is that one goal most of us share is to sit down as a family at least a few times a week, which is a great start. Research shows how important regular family dinners are to raising healthy children. Children who eat dinner with their families do better in school, develop better lifelong eating habits and are less likely to abuse alcohol and drugs. Dinnertime also becomes a great way to establish what is being served to our families and reconnect with each other about the day.But although this may sound wonderful in theory, we parents know that the challenges always come in the practice. For example, what happens during this family meal we so lovingly prepared when our three year-old takes three bites of something (probably not the green veggie but the garlic bread) and then gets up to go play? Or when our nine year-old yells, “Yuck, I hate this (food we just spent time and effort making) and I’m not eating it!” In other words, how do we put this mealtime vision into practice?

The first place to start, [click to continue…]

Recently, we answered readers’ questions on the CA 125 test for detecting ovarian cancer. Today we will follow up with a discussion on the early symptoms of ovarian cancer and some of the risk factors and protective factors. Ovarian cancer is the most common cause of death among the gynecological cancers. The most common type of ovarian cancer usually is diagnosed when a woman is in her 50’s. Typically, ovarian cancer does not present with obvious symptoms until a late stage of the disease, when the prognosis is poor. Fortunately, it has been recently discovered that there may be early symptoms of ovarian cancer that if recognized, could hopefully detect it at an earlier stage and improve survival.

Early symptoms can include: bloating, pelvic or abdominal pain, difficulty eating or feeling full, and urinary symptoms (urgency or frequency). If these symptoms are new, persistent, a change from your normal body, worse than expected, or if you have more than one symptom, it is worth seeing a gynecologist for a closer history and physical especially if the symptoms have been present daily for more than a few weeks.(1) Your gynecologist will take a close history, perform a full pelvic and abdominal examination, and may consider an ultrasound and CA 125 test depending on the findings. The good news is that most patients who present with one of these common symptoms do not have ovarian cancer.

Some of the main risk factors for ovarian cancer include: [click to continue…]

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I’m wondering what you think about time-outs? We’ve tried them in our house and they don’t seem to be working very well with my son but frankly, I just don’t know what else to do. Do you have any suggestions?

Thank you so much for your question and for sharing that time-outs have not been producing the results you were hoping for in your family. If you’re like me, time-outs seemed like a natural thing to try because it is such a widely accepted form of discipline in our society. So, I’d like to commend you for being reflective and for recognizing that time-outs may have some serious flaws.

Parenting experts Adele Faber, Elaine Mazlish and Alfie Kohn are all in agreement when it comes to the topic of time-outs. What all of these authors suggest is that we ask ourselves what do we hope to accomplish with time-outs and is it working? For instance, if we send our son to time-out because he hit his sister, what is our son thinking during time-out? Is he sitting in time-out thinking, “Now, why did I do that? Look at how upset my sister is. I wonder what I could do differently next time.” Chances are that our son is not doing that kind of emotional homework that we would hope he would do. Time-outs (and the use of any type of punishment) usually produce strong feelings of anger, frustration, resentment and a desire for revenge. So, what our son might really be thinking is, “I’m so mad! Mom didn’t even see what Susie did to me! Next time, I’ll make sure Mom doesn’t see me when I give Susie what she deserves!”

So, when we look at it that way we see that while a time-out may be effective at stopping undesirable behavior in the moment, it really fails to address what is going on underneath the behavior which is why we often have to give time-outs over and over again. In other words, [click to continue…]

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How do I get my kids to eat healthy things without setting up battles at mealtimes? I have tried bribes, punishment and threats, but nothing seems to get them to eat the right things. I also feel so stressed and guilty that they are learning some of these bad eating habits from me and my husband.

I often say in my parenting classes that the three things in life we humans do everyday that no one else can force us to, are eat, sleep and go to the bathroom. Do we really want to make these power struggles with our children? However, the issues surrounding feeding and mealtimes including the pressures of providing our family with a healthy diet, concerns over whether our children are eating enough, and our own habits and relationship with food, are often so emotionally charged, that struggles are often difficult to avoid. For this reason, I am devoting two articles to this very important issue. This week, I’ll discuss how to set an overall goal towards healthy family eating and next time, I will share some guidelines and specific nutritional information to help us towards this goal.

The May issue of Oprah’s magazine has an entire article devoted to healthy family eating. It cites some very interesting studies that have found that family interactions and relationships can have a major influence on eating and weight gain. Specifically it discusses how we can unknowingly set up habits of emotional eating with our children by using food to either bribe or reward, (as in, “if you stop crying, I’ll give you a lollipop”). This in turn can lead to unhealthy eating habits by both parents and children where food is used to numb sad emotions or to trigger “reward centers” in the brain that can cause us to overeat-particularly unhealthy things (my mind immediately jumped to the “cheese and cracker reward center” in my brain that kicks in after a long day). [click to continue…]