By Vicki Holmes MD, NCMP
Hot flushes are a common symptom experienced by menopausal women and can be described as a sudden feeling of warmth or heat in the body. Hot flushes may occur on their own but are often accompanied by night sweats or excessive sweating during the day.
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New on Staff
Let us introduce you to our two new physicians Renee Morissette MD, CCFP and Tracey Guselle
MD, CCFP, FRCPC and our new nurse, Brenda De Bakker, RN.
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Staff Retirement
Saying goodby to Vicki Holmes MD, NCMP and Sarah Nixon-Jackle RN, BScN, NCMP
By Donnelly Sellars, RD
Including a delicious recipe -
Roasted Carrot-Ricotta Hummus
These vasomotor symptoms (VMS) are experienced by women in a variety of forms:
* Mild: less than 5 minutes, warm, red face, uncomfortable
* Moderate: less than 15 minutes, warmth involving neck, ears, head, whole body, perspiration, clammy skin, dry mouth, tense muscles, tachycardia, irritation, agitation, embarrassment
* Severe: less than 20 minutes, warmth described as a raging furnace or burning up, weak, faint, headache, chest heaviness, extreme perspiration, prickling sensation over skin, heart irregularities, anxious, panic attacks
* Very severe: less than 45 minutes, boiling eruption, rolling perspiration, inability to breathe, faint/dizzy, leg/foot cramps, heart irregularities, difficulty functioning, distressed, nausea
As you can see, depending on how often they occur and how severe they are, they can be a major disruptor to one’s quality of life. The Study of Women’s Health Across the Nation (SWAN) is a large multi-ethnic study that followed 3,302 women for 15.4 years. These were women who had natural menopause, not on hormones. They were able to track their symptoms and identify four basic groups. For this study they included 1,455 women. They followed Estradiol levels, Follicle-Stimulating Hormome (FSH), smoking history, alcohol use, Body Mass Index (BMI) and anxiety.
Four groups were identified.
Interestingly, there were different characteristics that went with these different trajectories:
1. 27% had consistently low probability of Vasomotor Symptoms occurrence with a slight increase near the Final Menstrual Period (FMP).
2. 25.6% had a persistently high probability of VMS throughout the menopause transition. Women in the persistently high category had less
education, greater alcohol intake, poorer health, higher depressive and anxiety symptoms, and higher symptom sensitivity.
3. 18.4% of women experienced early onset symptoms that started well
before the Final Menstrual Period (FMP) but decreased immediately after the FMP. They were older age by the age they experienced FMP, had poorer health and were more likely to be anxious and depressed.
4. 29% of women had late onset VMS which started sharply after FMP and decreased later. These women were more likely to be black, smokers and less likely to be obese.
Unfortunately, this confirmed that most women experienced symptoms for longer than a decade! It also confirmed
the correlation of symptoms with Estradiol and FSH levels.
Obesity was more likely to be associated with early or persistently high VMS. Smoking was important in the late group having a direct effect on the hypothalamus area in the brain. Alcohol plays an important part in the consistently high VMS.
Fortunately, most of these symptoms respond to Hormone Therapy (HT) or estrogen therapy. However, not all women can tolerate HT or have contraindications to using it such as breast cancer or a tendency to form clots. Alternative medications such as antidepressants and Gabapentin can reduce VMS by 60%.
There is a problem with those with high levels of VMS that go on for many years. For a long time we were advised that women should stay on the lowest dose of hormones for the shortest period that was needed. We were relieved when the North American Menopause Society released a statement to extend the use of HT if the women were otherwise healthy and not experiencing side effects. Women not on HT who are more than ten years past their final menstrual period, have had blood clots in their legs or lungs, have known heart disease or liver disease are advised not to use HRT.
SWAN is doing a lot of work documenting women’s experiences, allowing us to take a more analytical approach to providing care for women. They are now looking at associations with early VMS sufferers and markers of cardiovascular disease. There is not a cause and effect relationship with hot flashes. However, it is important to pay attention to other risk factors for heart disease and take early preventative action.
As always, there seems to be a thread through all the symptoms and diseases we face. Choosing a healthy lifestyle free of tobacco use, moderate use of alcohol and a lot of exercise can give us a better quality of life!
I saw a woman today who had only a few hot flushes - she is a rare one indeed!
Renee Morissette
MD, CCFP
"Renee Morissette is a home-grown family physician. She received all of her medical training in Saskatchewan. Her love of Saskatchewan has prompted her to work throughout the province, from small northern First Nations communities to bustling regional emergency rooms. She has a great passion for women’s health issues; so, she undertook six months of enhanced training in Obstetrics and Gynecology. She is proud to be bilingual
Tracey Guselle
MD, CCFP, FRCPC
I am a Family Physician and Clinician Teacher at West Winds Primary Health Centre. I grew up in Saskatoon and went to the University of Saskatchewan for my MD and Family Medicine residency. I worked in private practice for twenty years, and just started teaching Family Medicine residents last year. I live on acreage with my husband John, our four children and our many pets.
Brenda De Bakker, RN
The relationship between the nurse and her patient and its ability to influence the patient’s overall treatment is a large topic of study in nursing. The study usually focuses on how the nurse can impact the patient, but for myself, I can honestly say, I continue to be a nurse because of the impact my patients have made on me.
I have worked for the Saskatoon Health Region for 34 years (feels like 15 or 20 years). My first position was on an active medical unit which was a mixture of specialties including General Medicine, Respiratory, Infectious Disease, and Nephrology including the Kidney Transplant Service. My career then took me to Oncology, Day Surgery, Progressive Care Unit, and Gynecology Surgical Unit and most recently I have worked with the Women’s Health Centre since it opened in October 2010. Throughout this time I have been married and we were blessed with four great children and 2 ½ grandchildren.
The first time I heard of the Women’s Mid-Life Health Program was at an educational in-service lead by Dr. Vicki Holmes. Throughout the in-service women would nudge their friends and I could see their faces change as they recognized themselves in the symptoms she described. I know my mouth fell open repeatedly. I was so happy to realize I was not alone with these perimenopausal issues. The lecture finished with lots of questions and much discussion. It was wonderful to observe because when a topic brings about discussion … it is relevant. I am so excited to start working with the Mid-Life Team and look forward to meeting many women and share more discussions.
Off on the Road to Retirement
Vicki Holmes MD, NCMP
Of all the articles I have written over the years, this one has been the most difficult. It is my last article before I retire. I have been with this project from the beginning in 2001, first as a committee member, then the chairperson and finally as the physician who started the Women’s Midlife Health Centre. We began seeing women in 2003 in the outpatient area at St. Paul’s Hospital. We became the Women’s Midlife Health Program in 2011 when the Saskatoon Health Region began to fund our organization.
We formed this organization at the request of Dr. Olatunbosun, Head of the Department of Obstetrics and Gynecology. There were many disciplines involved in the planning, however the Health Region did not initially provide us with funding, although they provided space for us to see patients in the Ambulatory Care Services Department at St. Paul’s Hospital. Initially we received pharmaceutical support in the form of unrestricted grants. Then our annual Art Auction as well as personal donations sustained us through several years. One of the advantages of our very labour intensive Art Auction is that we truly became a community organization and developed a wonderful core group of volunteers. Another group of volunteers met for our “Lick, Stick & Stuff” work bees to prepare our newsletters for mailing. The energy, enthusiasm and physical labour of these women made our art auction, newsletter mail outs and public forums happen.
We have worked with such amazing people over the years.
• Linda Ponath was our first nurse. Dani Van Driel was our fearless leader, our first Executive Director who developed our constitution, obtained our charitable organization status and ran our first office. Executive Directors who followed Dani were Naomi Selent, Jo-Ann
Zazelenchuk, and Heather Macdonald. We had such dedicated Board members over the years, too many wonderful people to name them all.
• Sarah Nixon-Jackle has been there through it all, starting with the planning phase and eventually came to be so much more. She became the nurse/NAMS certified menopause practitioner, public speaker, liaison with Osteoporosis Canada and creator of the Hot Flashes Newsletter. Sarah also caringly and professionally provided ongoing information
and guidance directly to women regarding their symptoms.
• Kathy Leite is our calm, organized, thorough, creative secretary, manager, soul mate who now holds the organization together.
• Lynda Derksen from Hidden Attic has been our webmaster and creator of brochures and design for the art auction. Heather Bacon has been my Hot Flashes newsletter editor.
This organization would not have succeeded if it had not been for our
dedicated board members, our art auction committee, our community partners, and a special thanks to Wendy Verity and Judith Martin who participated in the Metabolic Syndrome study.
Imagine how difficult it is to leave such a remarkable group of women and men who have created a centre that is a respectful, understanding and problem solving space for women to come to when they are struggling to deal with difficult medical problems that hit us at midlife.
So now I feel that I can leave, knowing that women will be well cared for, future doctors will be well trained, future patients and the public will be educated under the guidance of Dr. Donna Chizen, Dr. Renée Morissette and Dr. Tracey Guselle. The new nurse joining the team is Brenda de Bakker.
I wish I were 10 years younger so that I could continue with this inspiring journey. However Ron, my husband of 46 years, after supporting my efforts to help so many women with their mid-life health issues, is looking forward to finally being my number one concern. He is a patient man indeed!
To all the incredible people who have made this journey with me, I thank you all so much for all those years of shared purpose, dedication and accomplishment!
Fare Thee Well
Sarah Nixon-Jackle, RN, BScN, NCMP
I, too, am off for new life adventures after 11 years as the nurse with the Women’s Mid-Life Health Centre. It has been truly a pleasure and an honour. I have been offered many wonderful opportunities in my nursing career and this was one of them. As a Public Health nurse working in the Older Adult Wellness Program,
shifting to work with mid-life women was a natural extension.
The choices we make in mid-life that affect our health determine, to a great extent, how our older age will play out. We have opportunity to make choices for a healthy aging. Helping and facilitating women to learn about and implement those changes was exciting for me. Many thanks to
Saskatoon Public Health for first lending me to the planning stages of the mid-life health program and then to support my expanded role beyond older adult programming to work more fully within the mid-life health program.
In 2011 when the Women’s Mid-Life Health Centre became a funded program of Saskatoon Health Region (SHR), we moved to Saskatoon City Hospital to work with the Women’s Health Centre. Here we found a great home working in a designated women’s
centre. What a joy to work with other programs, learn from colleagues and
expand our program. We have benefited
greatly, as have our client patients.
Some of the joys and opportunities I have had in this program have been:
• Providing information to women in many communities in our province, speaking at Women’s Wellness Days throughout Saskatchewan, from Kenosee Lake (Sun Country) to
Athabasca Health Authority and so many health regions and communities in between.
• Seeking out community and health-related resources to assist women generally and specifically to meet their health needs. Some days I truly felt like a detective as I searched out resources.
• Meeting wonderful women. I am in awe of the women we see in clinic who are choosing to change their health behaviours and see dramatic changes for the better!
• Standing beside women who struggle
to make it through each day until life becomes “right” again, until they get their joy back.
• Enjoying the camaraderie of so many colleagues in the SHR and community partners who are
passionate about the health of women by investing their time, energy and dollars to promote and advance
women’s health.
• Pursuing new information from the most reliable resources to expand our practice. The conferences I have attended and committee members I have worked beside have been tremendous.
• Looking forward to going to work
every day (perhaps not at -40 degrees,
but most days!).
Thanks for the memories, the support and the encouragement to be a better person.
All the best,
Sarah
Nobody likes bland food. Whether it’s just a little salt and pepper or experimenting with curry or ginger, seasonings make our food taste so much better. Did you know that some herbs and spices are also good for your health? It’s a win-win!
Many herbs and spices contain antioxidants that protect our body’s cells from damage. Dietitians of Canada describe antioxidants best when they say “Just for a moment, think of your body as a car. It can rust when metal in the car reacts with oxygen. If you cover it with a protective coating, it doesn't rust as quickly. For the body, antioxidants are that protective coating. They protect your body's cells from damage caused by pollutants, smoke, unhealthy diets and the normal aging process.” Antioxidants have been shown to help protect against heart disease, certain cancers and other conditions related to aging.
So which Herbs and Spices have the most Antioxidants?
Oregano
This herb is widely used in Mediterranean and Mexican cuisine. It also has the highest antioxidant content of the leafy green herbs like basil and rosemary. One teaspoon of dried oregano has as many antioxidants as one cup of sweet potatoes. Oregano is multipurpose; it can be used in pasta sauces, salad dressings and pizza sauce. You can also use it to season soups and meat.
Turmeric
This is a bright yellow spice that adds a mild curry flavor. Its active compound is called curcumin, and often sold as a dietary supplement. Curcumin has been the focus of quite a bit of research over the years because of its potential to protect against diseases like cancer, arthritis, heart disease and Alzheimer’s. Turmeric can be added to a variety of dishes to add a hint of curry flavor. It goes great on vegetables and in rice as well. It can also add flavor and color to pickles, mustards and chutneys.
Cinnamon
Cinnamon is considered to be one of the first known spices. It has a very potent antioxidant effect, and some studies suggest that it can help increase insulin sensitivity in people with diabetes.
Cinnamon is generally used in sweet foods; it can be added to oatmeal, yogurt, apples, peanut butter or even coffee or tea. It also goes great on sweet potatoes or can add a nice flavor to a pumpkin or squash soup.
Other herbs and spices that contain antioxidants include cloves, ginger, rosemary and sage!
Roasted Carrot-Ricotta Hummus
from Dairy Farmers of Canada
Attending any potlucks this holiday season? This would be a great, healthy dip to bring! Serve with pitas, crusty bread or raw veggies.
Servings: 8
1 tbsp / 15 mL olive oil
½ onion, chopped
2 minced cloves garlic
1 tbsp / 15 mL fresh ginger, grated
½ tsp / 2 mL ground turmeric
½ tsp / 2 mL mustard seeds
½ tsp / 2 mL coriander seeds
½ tsp /2 mL chili powder
1½ cups / 375 mL carrots, sliced
1 can / 398 mL chickpeas, rinsed and drained
¼ cup / 60 mL lime juice
1 cup / 250 mL ricotta cheese
salt and pepper
Preheat oven to 425 °F (220 °C).
In a large bowl, mix olive oil, onion, garlic, ginger and spices. Add the carrots and toss to coat. Spread onto a parchment lined baking sheet and roast in the oven for 20 minutes or until carrots are tender. Let cool.
In a food processor or blender, process chickpeas along with roasted carrots. Add lime juice and process until a smooth purée is obtained.
Stir in ricotta. Add salt and pepper to taste. Enjoy!
Nutrition Information:
Calories 144 k/cal
Protein 6 g
Fat 6 g
Carbohydrates 14 g
Fibre 3 g
Sodium 213 mg
Bree Rutten, B.ScP.T.
Pelvic Floor Physical Therapy
Assessment and individualized treatment for women with:
- Bladder or bowel leakage
- Pelvic organ prolapse or pelvic heaviness
- Pelvic pain, chronic low back or hip pain
- Pregnancy or pre/ postpartum concerns
Specialized care is provided in a quiet, holistic environment
Specific exercise programs for the pelvic floor and core muscles
