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Steps To Women’s Wellness

What are the most important things that women need to know about their health and wellness? The answers may surprise you.



When we brought together a group of experts on women’s healthcare this past July, the conversation took a turn I didn’t expect.

The focus was less on specific diseases or syndromes, and more on psychological and social dimensions of health—the obstacles that stand in the way of wellness for Kentucky women.

This latest installment in our annual series of ways to improve Kentuckians’ health will take a slightly different tack from the others. In addition to talking about specific health conditions, it will look at some of the ways women approach healthcare as well as the obstacles.

It seemed especially appropriate because there was a fair degree of consensus on the idea that women tend to take on a special—and crucial—role in their families’ healthcare.

“Women are such a major determinant in when healthcare is going to be accessed to begin with, for themselves, for their family, and for their children or other loved ones,” says Dr. Stephen Houghland, the chief medical officer for Passport Health Plan. He calls them “the force multiplier” for a family’s wellness—if a woman takes an interest in her and her family’s health, it dramatically improves everyone’s wellness.

That said, here are six ways for women—and everybody else—to become healthier and happier.

Don’t neglect yourself in favor of others
Mary Johnson, clinical research administrator and project manager of the Kentucky Women’s Health Registry at the University of Kentucky, observes that when a woman visits a medical provider with a loved one, she’ll be a fierce advocate for the other person, pressing for answers to questions, and noting who does and doesn’t treat the patient with respect.

Women need to learn to do the same for themselves, she says: “You deserve the respect and consideration of that provider just as much as anybody else in your family.”

Lisa Capehart of Foster, an exercise physiologist, says that one of “the biggest health threats” that faces her clients (all of them women) is that, “Women don’t put themselves first on the priority list—or even on the list at all.

“Many of my clients say that taking care of themselves is selfish, everything else needs to come first,” Capehart says.

She counters with the analogy of airline attendants telling passengers that if the plane loses cabin pressure during a flight and oxygen masks descend, they should put their own mask on first before helping a child or another dependent with theirs.

In other words, if you’re not taking care of your own health, you may not be fully available to help the rest of the family. (There’s a reason we put this point first.)

Prenatal and postnatal care is critical
Evidence continues to accumulate about the importance of prenatal care, not just to the health of an infant, but also for setting the stage for a person’s healthfulness through childhood and adolescence.

(The Affordable Care Act requires health plans to cover prenatal care, along with breastfeeding “support, supplies, and counseling,” contraception, and other preventive services for women.)

The basics include having regular checkups with a medical professional as soon as you think you may be pregnant; taking vitamins with 400 to 800 micrograms of folic acid (which lowers the risk of certain spinal and brain defects); not smoking, drinking alcohol, or using illegal drugs; avoiding toxic chemicals, X-rays, and cat or rodent feces; eating a healthy diet, and getting seven to nine hours of sleep a night.

Dr. Rebecca Todd, an OB-GYN in Morehead, adds that it’s important for mothers to maintain a healthy weight during pregnancy. Mothers who are obese, she says, should gain only about 11 to 20 pounds (as opposed to the 25-35 recommended for normal weight women).

National groups, such as the March of Dimes, and statewide organizations, such as the Kentucky Hospital Association, have launched vigorous campaigns in recent years urging women to “go the full 40” so women carry their child for a full term of 40 weeks.

Todd says that, “There is significant brain development in the last few weeks of pregnancy that really will make a difference after a child is born.”

“There has been a general trend in the U.S. toward elective inductions and Caesarian sections before 39 weeks for reasons that were not medically necessary,” says Lisa Wallace, the director of Women’s and Children’s Services at St. Claire Regional Medical Center in Morehead.

“Research shows that women who deliver electively before 39 weeks without appropriate maternal or fetal indication are at higher risk for poor outcomes—their babies have more respiratory distress/failure, pneumonia, and death, and babies are more likely to be admitted to neonatal intensive care, staying in the hospital longer and at greater cost, which could have been prevented had they gone full-term,” says Wallace.

Prenatal care shouldn’t begin only after conception—women should access what medical professionals call “preconception” care, so they’re already healthy when the embryo begins to grow. (Folic acid 400 mcg, for example, a B vitamin that helps prevent major birth defects of the spine and brain, is recommended daily at least 30 days before becoming pregnant.)

Once the child is born, the American Academy of Pediatrics recommends breastfeeding from the very beginning to at least two years, or as long as mother and baby both want to continue. Breastfeeding is not only a free source of nutrition with many benefits to both mother and child. It improves the baby’s overall health and promotes mother/child bonding.

According to Wallace, breast-fed babies have a 20 percent lower risk of dying before 1 year of age. Breastfeeding also improves cardiac health and resistance to illness, and reduces the risks of cancer, respiratory illnesses (such as asthma and allergies), diabetes, obesity, and high cholesterol later in life.

Todd says it’s also important for a mother to get postpartum care—coming to doctor’s visits, and if necessary, using contraception to maintain the recommended 18-month to two-year gap between pregnancies. (Contraception, like lactation supplies and consultation, is covered under the Affordable Care Act.)

So one of the healthiest things to do for yourself and to improve your child’s future is to take advantage of prenatal and postnatal care.

Back to the basics
It is not rocket science. The basic steps women and others need to take to improve their health are widely understood but it bears repeating:

Eat more fruits and vegetables and fewer processed foods; substitute whole grains for white, refined ones; reduce fat, sugar, and salt.

Lead a more active, less sedentary life. The Office of Disease Prevention and Health Promotion, within the Department of Health and Human Services, recommends at least 150 minutes a week of moderate aerobic activity or 75 minutes a week of vigorous aerobic activity, spread out throughout the week, for substantial health benefits; plus muscle-strengthening activities at least twice a week. For more information go online to

Avoid tobacco and illegal drugs; limit or eliminate alcohol consumption.

Get regular healthcare—yearly physicals and recommended screenings for your age. “Health doesn’t happen in a doctor’s office—health comes from the way you live your life, ” says Dr. Deborah Ballard, an internist who practices in Louisville.

She cites Centers for Disease Control and Prevention (CDC) statistics saying that 80 percent of diabetes, hypertension, heart disease, and 40 percent of all cancers are due to preventable lifestyle factors.

Poor nutrition and obesity, lack of exercise, tobacco use, and excessive drinking are major causes of the chronic illnesses—cardiovascular diseases, cancer, diabetes, and stroke—that kill the most Americans.

Capehart emphasizes that lifestyle changes do not (and should not) have to be undertaken in bulk: “You don’t have to do an overhaul of your life to achieve wellness. You can just take one baby step at a time.”

She mentions a client who lost 35 pounds in six months and started feeling much better, from two simple actions: cutting out sodas and walking 15 minutes at lunch every day.
Educate yourself
One of the strongest correlations in health data is the one between a highereducation level and better health.

Johnson with the Kentucky Women’s Health Registry, which collects health data on women throughout the state, says that women who received some college education or more are healthier individuals than women who didn’t get out of high school—a pattern that shows in obesity levels and for major diseases such as diabetes, heart disease, and cancer.

The trend holds nationally. CDC statistics show that the life expectancy of American women without a high school diploma is 8.6 years less than those with a bachelor’s degree or higher; women 25 years of age and over with less than a bachelor’s degree were more likely to be obese (39 percent-43 percent) than those with a bachelor’s degree or higher (25 percent), while obesity prevalence among adult males did not vary consistently with level of education; adults with a high school diploma or less are more than three times likely to smoke than
college graduates.

Passport Plan’s Houghland says that medicine is moving away from a paternalistic model, instead of “the physician (saying) ‘This is what you do,'” to the doctor taking on a consultant role, in which he or she presents options for the patient to choose from.

And in that sort of relationship, the patient’s ability to analyze information—the ability education hones—is crucial.

Reduce stress now
One of the words that came up again and again in our roundtable was stress.

“If you really want to focus on the root cause of why people are sick, it’s the chaotic, dysfunctional, stressful life that people live,” Ballard says—what she and others call “the Jerry Springer life.”

“As long as you are engaged in that kind of dynamic, you cannot make a health behavior change,” she says. “You can’t make good changes in your diet, you can’t adopt an exercise program—you certainly can’t stop smoking.” It also contributes to substance abuse.

But it’s not simply that stress gets in the way of healthful behaviors.

The physical problems that can be caused or exacerbated by stress, according to the American Psychological Association, include migraine headaches, arthritis, asthma, heart and blood vessel problems, diabetes, gastrointestinal problems, and problems with menstruation, premenstrual syndrome and disorder, and the effects of menopause.

Stress seems to exacerbate a patient’s experience of pain. “They may have the same disease process as someone else, but they tend to rate their pain higher,” says OB-GYN Todd. “The interventions we do don’t tend to work as well.”

Dr. Joyce Spurgeon, director of Women’s Mental Health at the University of Louisville Medical School, points out that people have different physical reactions to stress—one might have trouble sleeping, another feel stomach pains. And similarly, different women may find different paths to managing their stress.

Talking to someone—a friend, a counselor, or other professional—is one of the basic ways of dealing with stress. So is maintaining healthy habits, and avoiding drugs and alcohol. Spurgeon frequently recommends exercise (for the release of endorphins, the “feel-good” neurotransmitters, plus the other health benefits) and various practices that might be called meditation or mindfulness, from sitting silently for five minutes a day to contemplative prayer.

Partner with your physician
Too often, Houghland says, people just want a pill to cure a condition such as high cholesterol or depression, and ignore the other steps they need to take—exercising and eating better in the first case, therapy in the second.

“One of the biggest fallacies is that people don’t understand how important it is for them to remain engaged in their own healthcare,” he says. “It’s not magic, it just can’t happen without them doing something—often, them doing a lot.”

And while his model for the doctor-patient relationship is of a consultant rather than the doctor-knows-best of the past, he says that with some patients, the doctor needs to push and be more “directing.”

That’s why establishing a good relationship with a primary care physician is so important, he says, because by knowing a patient, the doctor can gauge the proper tactic to take with her.

Louisville internist Ballard says prior to the first visit, she has patients fill out an eight-page questionnaire that fills in everything that might affect their health—physical activity, diet, alcohol and tobacco use, how they sleep, their level of stress, the quality of their relationships, degree of safety, and other factors.

Then she talks through it with the patient. “All I have to say is, ‘Based on what we’ve already discussed, what do you think you need to do?’ And most of the time, they’ll already know.”

Then she asks them to suggest first steps to address the problem. The result is that the patient is the problem-solver, choosing actions “that are already consistent with their own wishes and beliefs.”

Ballard says she doesn’t expect all patients to have the same level of intellectual or medical understanding, but she does expect them to have “a genuine interest in trying to get well, and an openness to accept that wellness mostly comes from the way you live your life, not from the pills you take or the surgeries you have.”

Violence against women
The statistics are jaw-dropping: one in every four women has experienced domestic violence during her lifetime; nearly one in every 10 has been raped.

Abuse against women “is at epidemic proportions,” says Marta Miranda, president and CEO of the Louisville-based Center for Women and Families.

Assaults create an immediate, and major, health problem—a CDC study found that in 1995 the direct medical and mental healthcare of intimate partner violence against women was $4.1 billion ($6.4 billion in 2014 dollars).

But the trauma continues to affect victims for years afterward. Trauma is stored in the body and the psyche; therefore, it impacts both long after the immediate crisis is resolved.

“We know that people who go through that type of terrible trauma develop all kinds of terrible chronic health problems, many of them relating to pain,” says Dr. Deborah Ballard, a Louisville internist. She lists migraines, irritable bowel syndrome, chronic pelvic problems, and reproductive issues as lasting effects of abuse.

And the psychological repercussions are profound. “Violence—we know it rewires the brain,” says Chris Owens, director of the Louisville Metro Office for Women. “It makes it more difficult for people to make decisions. You can’t have self-determination if you’re in a place where you’re not able to make decisions.”

Miranda points to groundbreaking research, the Adverse Childhood Experience Study (ACES), which shows the lasting effects of trauma. ACES shows that significant childhood trauma increases the risk for a number of adult health conditions, including alcoholism, drug abuse, depression, suicide attempts, smoking, sexually transmitted disease, physical inactivity, and severe obesity.

Miranda believes medical personnel need to be educated about the effects of trauma on the body. Individuals who’ve suffered trauma from domestic or sexual abuse, she says, need to get themselves in a safe place, away from the abuse, and “do the psychological work” of understanding how the abuse has affected them.

Abuse Resources

SAFETY ALERT! Computer history can be monitored. If you are in danger, call one of the hotlines listed below.

Kentucky Cabinet for Health and Family Services Family Violence Prevention Resources Branch, search for “Family Violence Prevention” for link to resources on abuse, including child and elder, rape crisis centers, and spouse abuse shelters. provides a comprehensive list of hotlines, including:
Abuse Hotline (877) KY-SAFE1 (877-597-2331)
Child Abuse/Adult Abuse Hotline (800) 752-6200
Spouse Abuse Hotline (800) 544-2022

Kentucky Domestic Violence Association
The Web site includes a list of the state’s 15 shelters for victims of domestic violence (click on “Victim Services” tab).

National Domestic Violence Hotline
(800) 799 SAFE (1-800-799-7233) or (800) 787-3224 (TDD)

Kentucky Association of Sexual Assault Programs
The Web site has a map showing the locations and phone numbers of the state’s 13 rape crisis centers.

RAINN—Rape, Abuse, & Incest National Network
(800) 656-HOPE (1-800-656-4673)

Recommended women’s health screenings

Preventive actions FOR ALL AGES
• Physical checkup yearly, including height and weight
• Check blood pressure every two years (if history of high blood pressure, yearly)
• Fasting blood glucose test (Hemoglobin A1C) every three years to test for diabetes
• HIV screening for pregnant women and high-risk individuals *1
• Monthly skin self-exams *2
• Dental checkup and cleaning every 6 months
• Seasonal flu shot

• Sexually active individuals should be screened for chlamydia yearly until age 25 *3
• Pap smear at least every two years if you are sexually active *4
• Beginning at 35, check thyroid levels every five years
• Beginning at 20, cholesterol screening every five years
• Comprehensive eye exam every two years (annually for contact lens wearers)
• Routine hearing test every 10 years
• Meningococcal vaccination for young adults planning to live in group housing

• Fasting cholesterol screening (lipid panel) every five years
• Routine mammogram every two years
• Pap smear every three years
• Check thyroid levels every five years
• Comprehensive eye exam every two years (annually for contact lens wearers)
• Routine hearing test every 10 years

• Fasting cholesterol screening (lipid panel) yearly
• Have a colorectal screening—discuss options with your doctor *5
• Routine mammogram every two years
• Pap smear every three years
• Contact lens wearers and all over 61 should have an annual eye exam; 50-60, every two years
• Check thyroid levels every five years
• All over 61 should have yearly hearing test; 50-60, every three years
• Beginning at 60, shingles vaccination

• Have at least one bone density test
• Check thyroid levels every five years
• Fasting cholesterol screening (lipid panel) yearly
• Have a colorectal screening—discuss options with your doctor
• Routine mammogram every two years
• Pap smear if doctor or nurse recommends
• Annual eye exam
• Annual hearing test
• Shingles vaccination

Source: Kentucky Women’s Health Registry,
1. Risk factors for HIV include multiple sex partners, a partner infected with HIV, intravenous drug users, and recipients of blood transfusions 1978-1985.
2. Check moles for color changes, size increases, or changes in texture and outline.
3. Older people should be screened for chlamydia only if exposed or if they have a change in sexual partners.
4. Women 30 with three consecutive negative Pap smears and no special risk factors may move to an every-three-years schedule.
5. Colorectal screening options include a colonoscopy every 10 years, a flexible sigmoidoscopy every five, or a fecal occult blood test annually.



Read more tips for healthy living by clicking Women’s wellness extras.

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