Showing Migraines Who's Boss

At least one in four women suffer from migraines, a staggering number with a not so flattering history. Women who suffered from migraines in the past were considered incapable of coping with stress or suffering from hysteria. Luckily, this ignorant perception was quickly shattered once individuals realized that migraines were debilitating headaches with causes outside of "women being women." Although the exact specifics are still unknown, factors like genetics and environment are known to play a definite role. Also, changes in the brainstem, trigeminal pathway, hormonal influences with hormones like estrogen and serotonin have all been associated with migraine development.
The good news is that instead of curling up in your bedroom, void of any light, there are things you can do every day to prevent or at least reduce the extent of your next migraine! The first is by watching your diet; there are certain foods that may trigger migraines, including aged cheese, salty foods, excessive sweetness, wine, and caffeine. Stress, bright light, changes in sleep cycle and environment can also be triggers. So what can you do, you ask?  Eating these trigger foods in moderation is ideal in conjunction with a high ketone diet. A ketogenic diet is a low carbohydrate diet that helps reduce migraines by blocking high concentrations of glutamate, which is found in migraines and epilepsy. Moreover, the healthy fats found in this diet may also lower cholesterol, hitting two birds with one stone.
Regular exercise also can help to prevent migraines, especially aerobic ones like walking, swimming, and cycling. Ultimately, leading a healthy lifestyle with a regular schedule can greatly help to ameliorate migraines. Here's to beating migraines one day at a time!


Meghana Pisupati
IHS 2018

Cancer Screening in Transgender Individuals

Last year, one of our 4^th year Pathway students (Kelly Guttman) created a very informative presentation on Cancer Screening Health Disparities Among Transgender Patients – a topic worth revisiting here.  Many transgender individuals have had negative experiences with the healthcare system, often due to discrimination and lack of provider knowledge.  Many healthcare providers don’t know how to screen transgender patients for potential cancers so they are often overlooked.                                                                                                                                                                                   Bottom line:  If they have the “part” (e.g. breast, cervix, prostate), check it!

CERVICAL CANCER

Approximately 80% of transgender men [female-to-male (FTM) patients] have a uterus and cervix and therefore need screening.  Unfortunately, being transgender has been associated with 37% lower odds of being up-to-date with recommended cervical cancer screening.  Inadequate Paps have been over 8 times higher among transgender men, likely due to a combination of factors including histological changes induced by testosterone and patient/provider discomfort. 

BREAST CANCER

Approximately half of transgender men have surgery to remove their breasts while 80% of transgender women [male-to-female (MTF) patients] use estrogens to help grow the size of their breasts.  MTF patients taking exogenous estrogen and androgen antagonists develop breast tissue histologically identical to that of a cis-gender female.  Although studies have failed to show that MTF patients taking exogenous estrogen have an increased risk of breast cancer, there have been cases so individuals still need to be screened.  In addition, for transgender men who have undergone mastectomies, providers need to be aware that not all breast tissue may be removed, especially in a nipple-sparing procedure.

PROSTATE CANCER

Transgender women should be given all the same information provided to cis-males and be allowed to make an informed decision regarding screening.  Although guidelines for prostate cancer screening have changed and prostate-specific antigen (PSA) is no longer routinely recommended, it’s important to note that in the setting of prolonged estrogen exposure, as is the case with many transgender women patients, the PSA may be falsely low and therefore especially unreliable as a screening tool.  Rectal or transvaginal (if a neovagina has been created) exam of the prostate is recommended. 

 

SUMMARY

The American College of Obstetricians and Gynecologists recommends the following:

For FTM Patients - age appropriate screening for breast and cervical cancer unless complete mastectomy or hysterectomy has been performed.  Patients on androgen therapy who have not had a hysterectomy may be at increased risk for endometrial and ovarian cancer and should have a bimanual pelvic exam as recommended.

For FTM Patients - age appropriate screening for breast and prostate cancer

                                                     What you can do for a transgender patient

                                                             Create a welcoming environment.

                                 Be knowledgeable, non-judgmental and don’t make assumptions.

                Have an open discussion with patients about their cancer screening needs and schedule.

                                                                                                                   Judith Wolf, MD  Associate Director, WHEP