Hi, I’m Dr Dani.
These are my thoughts from articles and posts I’ve written in the past.
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Why I respect hormone pellets but will never prescribe them.
Hormone pellets, those little beads that a provider will place under the skin of your butt after cutting a small hole, every three months, infused with estrogens or testosterone or both, to make you feel like a champ, are not my favorite. Pellets work for some. Those who love them, think they are the best thing since sliced bread. I, on the other hand, take a more tempered approach.
Pellets have their place. At the turn of the 21st century, when the confusing results of the Women’s Health Initiative (WHI) sent many providers running away from hormones, pellets were an option for women to treat their perimenopausal symptoms. They were expensive. At times, they were the only option. Pellets were the counterculture solution when mainstream medicine was inadequately addressing women’s mid-life health. Pellets found alternative formulations and delivery methods that mainstream pharmaceutical companies weren’t providing.
So what’s my objection? After 25 years, pellets are still expensive. They tend to be cash only, uncovered by insurance. Pellets are still injected every three months. I have yet to see a protocol for what to do with old pellets and scarring. Pellets are still understudied compared to current hormonal treatment alternatives. They are still not FDA approved.
Now, evidence based medicine and mainstream pharmaceuticals have had a quarter century to catch up. While studies on women’s health are still far behind where we would all like it to be, the amount of research in perimenopausal medicine that continues to be published is enough that I became a specialist just to stay on top of it all! We now know that estradiol behaves very differently in the body than ethinyl estradiol. We know that synthetic progestogens affect certain tissues more than micronized progesterone. We have found that oral estradiol and transdermal estradiol get processed through the liver at highly variable rates.
Pellets are no longer the only option. For many women, they are not even the best option. While mainstream pharmaceuticals are not always the best option either, at least they can be stopped quickly. I don’t place pellets because I cannot adjust or remove them after. If you have a bad reaction or side effects to pellets, we would just have to wait it out. No thank you.
You have options when it comes to your health.
What are the best ‘weight loss supplements’?
Weight loss in our mid-life gets hard for several reasons. First, our caloric needs get lower. We lose muscle. Our sleep becomes disrupted by night sweats and changes in our circadian rhythm that come with hormone changes. We're fatigued. We're less active. Our carb cravings go up. We become more insulin resistant and our sugars spike and crash more than before. For so many reasons, we gain weight without changing a thing in our diet or exercise, just because our body is aging and our hormones are changing. No weight loss supplement will ever be effective enough to compensate for all these changes without significant compensatory changes in diet and exercise that balance out these numerous mid-life changes.
That being said, there are lifestyle changes that can help. Moderate dose (1-5g) supplementation with creatine can help maintain muscle mass, bone density, and more recent research suggests that this protein may also help brain fog, but whether it is safe for everyone to routinely supplement for this purpose is still controversial. Too much creatine can cause kidney damage and individuals seem to process creatine at different rates. There is currently not enough research to recommend a standard creatine supplementation dose. Most meat eaters get enough creatine through red meat, poultry, or fish. I usually tell my patients who are vegetarian to try 1-2g a day at first and see how they feel. Also, please ensure any supplements you purchase are from a reputable source with recurrent Quality Assurance testing, as one of the biggest risks with supplements is quality and contamination.
I also generally recommend fiber and probiotic supplements to my patients if they cannot get enough fiber or probiotic bacteria consistently in their diet. The healthiest sources of fiber are, of course, going to be vegetables and some fruits. The best sources of probiotics are live culture yogurts. Fiber supplements are easy to find at most grocery stores. Live culture probiotic capsule supplements can get much more complicated. I have not consistently been able to recommend a probiotic supplement that seems to work for everyone.
Why do I recommend fiber and probiotics for weight management? Because gut health has a disproportionate effect on how our body packs away fat. They make us feel full longer. They help stabilize blood sugars. Not only do these two supplements keep us regular and keep the bloating down, but they also affect the diversity of our gut flora and support healthier gut bacteria.
More important than any supplement, is a healthy diet that focuses on maintaining a low glycemic index, balanced macronutrients, and is high in nutrient dense whole foods. That combined with an active lifestyle with balanced strength training and cardio helps us all maintain a healthy weight.
An open letter to the friends and family of someone being treated for breast cancer
Your job is to show up and check your baggage at the door.
Your relationship with her hasn't changed, but in so many ways it has. She may have been your pillar of strength before, but you need to be hers now. Look up Crisis, Ring Theory. This is scary, but its scarier for her than for you.
A natural reaction to things that are difficult or scary is to withdraw. We tend to rationalize ways in which that person doesn’t really need us or doesn’t want to hear from us. She does. And if she doesn’t, she won’t answer the phone. It's still important that you called. The best phone calls I received during my treatment were those in which we didn’t even talk about cancer, just menial everyday stuff. It made me feel normal. Sometimes, she is more afraid of bringing everyone else down, so its your job to show her you’re stronger than that. That her cancer won’t end your relationship. The hardest part about going through cancer treatment wasn’t the cancer treatment. It was sometimes feeling like I was going through it alone, or worse, seeing how my cancer was hurting my friends and family.
You don’t have to understand everything. Your job is just to show up.
An open letter to the work colleagues of someone being treated for breast cancer
Going through cancer treatment is hard in ways you can’t imagine, so don’t.
Stop trying to imagine what she might be going through and ask. Your imagination will run wild with the hurt and trauma you think she might be going through, but no matter what you imagine it is probably inaccurate to what she is actually experiencing, especially moment to moment. Yes, she may have a hard time dealing with just losing her hair, but she probably cried about it yesterday and today she just wants to get the finance report done.
Your job is to be present in this moment with her. Ask her how she is doing. Don’t be offended if she says she’s doing great. She might be doing great at this moment because she just found out the cancer is shrinking. She might also not be doing great, but doesn’t want to waste anymore of her time and energy devoted to her cancer. It is healthy to focus on other things sometimes. Your job is to help her maintain her sense of competence at her job.
That being said, do ask just once a project if she’s up to taking on everything she did before. She might not be. There will have to be some accommodations made for fatigue, emotional and mental strain, medication breaks, regular food breaks, etc. But only ask once, and then let her tell you what she needs. It gets really tiresome having people second guess your abilities all the time.
Extra love is always welcome. Extra smiles. Small gestures and gifts. Checking in regularly. She needs your support, so feel free to give it; Just ensure that your own fears about how you would feel in her situation do not leak through.
Menopause is so simple, but it's so complicated.
Menopause is the end of a woman’s reproductive life. Simple. Ovaries stop releasing viable eggs. That’s it. Women have been going through menopause for as long as we have lived beyond our reproductive years. Menopause itself has never killed anyone. It’s a natural process. It’s puberty backwards.
So why is it so hard?
The changes that come with perimenopause affect every cell in our body. They are as diverse as people are. One woman has ringing in her ears; Another has a new itch on her elbow; Still more experience sweating, fatigue, difficulty sleeping, and mood swings, but not all. The most common perimenopausal symptom is “I just don’t feel like myself”. How do we treat that?
We start with listening.
Solving complex problems begins with truly understanding them. How does estrogen affect my tendons and skin? Where does testosterone come from in women? What is the hypothalamus and why does it connect my ovaries and my body temperature?
Menopause is complicated. It is a multifaceted process that takes years, with many phases, that usually requires a multipronged approach. Navigating the mid-life transition necessitates an understanding of the whole person. What are my goals? What is most important to me?
This takes time.
What my oncology friends have taught me about evidence-based medicine
Evidence-based medicine used to be a buzz word in the 90s. By the time I went to medical school in 2007-2011, it was the aspirational standard of care. Our job as new medical students was to learn as much of the mainstream research that was available and digest it into the practice of medicine. Some older mentors would speak about the ‘Art’ of practicing medicine, but that wasn’t on the multiple choice test, so this was difficult to cram into the study schedule.
After having cancer myself, I appreciate the room that the ‘Art’ of medicine holds for the unknowns in science.
Evidence can only get us so far. My oncology friends practice this every day. They treat the person in front of them. We can only reference the science we have available today. If there isn’t a study that applies to this specific circumstance, we have to rely on the standard of care, treatment availability, ethics, partnership with our patients, and our own wisdom. For perimenopausal medicine, that wealth of knowledge is lagging far behind.
Treating perimenopausal symptoms is the ‘Art’ of medicine.
I view myself as a personal healthcare consultant. It is my imperative to be the expert on the current body of knowledge. In addition, I have the wisdom of experience as I’ve journeyed with numerous women down this path. But do I have the ‘Right’ answer? No!
As your consultant, I listen to your goals, what is currently affecting your quality of life, and what you’ve already tried, then we discuss your options. Then you choose what direction you want to head next.