Chemicals and Your Body

Mia Davis

Better living through chemistry? We're all becoming familiar with environmental costs, but what about the effects on both male and female reproductive health?

Whether it is a conscious concern or a subconscious acceptance, most Americans wouldn't think twice about the fact that chemicals are ubiquitous in our daily lives. A trip down the drugstore aisle, fifteen minutes of watching television, or a quick skim though popular magazines will all let you know that thanks to chemicals, you can hide your gray hair and make your lawn the envy of the neighborhood. Better living through chemistry …? Plastic makes it possible …? Well, yes, in some ways… but more and more we're seeing what chemicals are NOT making possible—like healthy, normal human and animal reproduction, for example, or a life free from cancer.

The 80,000 chemicals on the market find their way into our routines through our food, our water, our air, and the consumer goods that we use daily, from plastic water bottles to personal care products like make-up and shampoo.

The past two decades have brought a growing body of research that has found that the old adage (still in common use by the chemical industry) "the dose makes the poison" is actually quite far off. Chemicals commonly found in consumer products, (even in small amounts) can have remarkable effects on human and animal endocrine systems. Endocrine glands, which include the ovaries and testes, release carefully-measured amounts of hormones into the bloodstream. Americans ingest (or absorb) chemicals that mimic or inhibit this complex system on a daily basis.

Phthalates, a family of industrial chemicals found in baby toys and in nearly ¾ of personal care products tested in a 2002 study (PDF), have been linked to the feminization of baby boys, declining sperm count, and a deformation called hypospadias, a condition where the urethra occurs on the bottom of the penis instead of the tip. Recently, phthalates and other endocrine disruptors have also been linked to obesity.

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Dr Earl Grey, a senior scientist at the U.S. Environmental Protection Agency (EPA), has conducted numerous studies on the effect of low-dose phthalate exposure that is consistent with our real-life exposure. His work with lab animals reveals that male reproductive development is extremely sensitive to some phthalates, and that damage to the male reproductive system can begin in utero.

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Difficulty conceiving a child, a growing problem in the United States, and prolonged reproductive health problems are reason enough to worry about our constant exposure to phthalates and other reproductive toxins and endocrine disruptors. But the declining health of wildlife is another reason we need to make ourselves aware—quickly.

The bibliography of scientific studies listed on the Our Stolen Future website, (and in the book itself) reveals an alarming list of wildlife populations that appear to be impacted by the chemical burden in nature. The Florida panther, numerous species of frogs, Chinook salmon, and polar bears (as if they don't have enough problems) are all on the list of wildlife whose populations are likely impacted by endocrine disruptors. Wildlife populations have deforestation, climate change, human encroachment, smog, pesticides and other seemingly insurmountable threats to their health. We need to do our best to make sure that chemicals in consumer goods are not adding to the problem.

As is often the case, the European Union (EU) is far ahead of the United States on chemical policy. In 2003 the EU amended its cosmetics directive (76/768/EEC) to ban the use of chemicals that are known or strongly suspected of causing cancer, mutation or birth defects. The amendment went into force in September 2004 and bans 1100+ carcinogens, reproductive toxins and mutagens from cosmetics and other consumer products. Included in the list are tdi-2-ethylhexyl phthalate (DEHP) and dibutyl phthalate (DBP).

The U.S. Food and Drug Administration (FDA) on the other hand has absolutely no power to test the safety of personal care products before they go to market, and has only banned nine ingredients from these products. This is unacceptable, and needs to be changed.

After major public pressure from the Campaign for Safe Cosmetics, and because of the EU's ban, some major cosmetics companies have agreed to remove two phthalates (DEHP and DBP) from products sold in the United States. But we can't stop there. The Campaign is working to safeguard our reproductive health and the health of the environment by changing the market and the lack of government regulation. For more info, and to join our listserv, please visit the Campaign for Safe Cosmetics website.

Culture & Conversation Human Rights

Let’s Stop Conflating Self-Care and Actual Care

Katie Klabusich

It's time for a shift in the use of “self-care” that creates space for actual care apart from the extra kindnesses and important, small indulgences that may be part of our self-care rituals, depending on our ability to access such activities.

As a chronically ill, chronically poor person, I have feelings about when, why, and how the phrase “self-care” is invoked. When International Self-Care Day came to my attention, I realized that while I laud the effort to prevent some of the 16 million people the World Health Organization reports die prematurely every year from noncommunicable diseases, the American notion of self-care—ironically—needs some work.

I propose a shift in the use of “self-care” that creates space for actual care apart from the extra kindnesses and important, small indulgences that may be part of our self-care rituals, depending on our ability to access such activities. How we think about what constitutes vital versus optional care affects whether/when we do those things we should for our health and well-being. Some of what we have come to designate as self-care—getting sufficient sleep, treating chronic illness, allowing ourselves needed sick days—shouldn’t be seen as optional; our culture should prioritize these things rather than praising us when we scrape by without them.

International Self-Care Day began in China, and it has spread over the past few years to include other countries and an effort seeking official recognition at the United Nations of July 24 (get it? 7/24: 24 hours a day, 7 days a week) as an important advocacy day. The online academic journal SelfCare calls its namesake “a very broad concept” that by definition varies from person to person.

“Self-care means different things to different people: to the person with a headache it might mean a buying a tablet, but to the person with a chronic illness it can mean every element of self-management that takes place outside the doctor’s office,” according to SelfCare. “[I]n the broadest sense of the term, self-care is a philosophy that transcends national boundaries and the healthcare systems which they contain.”

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In short, self-care was never intended to be the health version of duct tape—a way to patch ourselves up when we’re in pieces from the outrageous demands of our work-centric society. It’s supposed to be part of our preventive care plan alongside working out, eating right, getting enough sleep, and/or other activities that are important for our personalized needs.

The notion of self-care has gotten a recent visibility boost as those of us who work in human rights and/or are activists encourage each other publicly to recharge. Most of the people I know who remind themselves and those in our movements to take time off do so to combat the productivity anxiety embedded in our work. We’re underpaid and overworked, but still feel guilty taking a break or, worse, spending money on ourselves when it could go to something movement- or bill-related.

The guilt is intensified by our capitalist system having infected the self-care philosophy, much as it seems to have infected everything else. Our bootstrap, do-it-yourself culture demands we work to the point of exhaustion—some of us because it’s the only way to almost make ends meet and others because putting work/career first is expected and applauded. Our previous president called it “uniquely American” that someone at his Omaha, Nebraska, event promoting “reform” of (aka cuts to) Social Security worked three jobs.

“Uniquely American, isn’t it?” he said. “I mean, that is fantastic that you’re doing that. (Applause.) Get any sleep? (Laughter.)”

The audience was applauding working hours that are disastrous for health and well-being, laughing at sleep as though our bodies don’t require it to function properly. Bush actually nailed it: Throughout our country, we hold Who Worked the Most Hours This Week competitions and attempt to one-up the people at the coffee shop, bar, gym, or book club with what we accomplished. We have reached a point where we consider getting more than five or six hours of sleep a night to be “self-care” even though it should simply be part of regular care.

Most of us know intuitively that, in general, we don’t take good enough care of ourselves on a day-to-day basis. This isn’t something that just happened; it’s a function of our work culture. Don’t let the statistic that we work on average 34.4 hours per week fool you—that includes people working part time by choice or necessity, which distorts the reality for those of us who work full time. (Full time is defined by the Internal Revenue Service as 30 or more hours per week.) Gallup’s annual Work and Education Survey conducted in 2014 found that 39 percent of us work 50 or more hours per week. Only 8 percent of us on average work less than 40 hours per week. Millennials are projected to enjoy a lifetime of multiple jobs or a full-time job with one or more side hustles via the “gig economy.”

Despite worker productivity skyrocketing during the past 40 years, we don’t work fewer hours or make more money once cost of living is factored in. As Gillian White outlined at the Atlantic last year, despite politicians and “job creators” blaming financial crises for wage stagnation, it’s more about priorities:

Though productivity (defined as the output of goods and services per hours worked) grew by about 74 percent between 1973 and 2013, compensation for workers grew at a much slower rate of only 9 percent during the same time period, according to data from the Economic Policy Institute.

It’s no wonder we don’t sleep. The Centers for Disease Control and Prevention (CDC) has been sounding the alarm for some time. The American Academy of Sleep Medicine and the Sleep Research Society recommend people between 18 and 60 years old get seven or more hours sleep each night “to promote optimal health and well-being.” The CDC website has an entire section under the heading “Insufficient Sleep Is a Public Health Problem,” outlining statistics and negative outcomes from our inability to find time to tend to this most basic need.

We also don’t get to the doctor when we should for preventive care. Roughly half of us, according to the CDC, never visit a primary care or family physician for an annual check-up. We go in when we are sick, but not to have screenings and discuss a basic wellness plan. And rarely do those of us who do go tell our doctors about all of our symptoms.

I recently had my first really wonderful check-up with a new primary care physician who made a point of asking about all the “little things” leading her to encourage me to consider further diagnosis for fibromyalgia. I started crying in her office, relieved that someone had finally listened and at the idea that my headaches, difficulty sleeping, recovering from illness, exhaustion, and pain might have an actual source.

Considering our deeply-ingrained priority problems, it’s no wonder that when I post on social media that I’ve taken a sick day—a concept I’ve struggled with after 20 years of working multiple jobs, often more than 80 hours a week trying to make ends meet—people applaud me for “doing self-care.” Calling my sick day “self-care” tells me that the commenter sees my post-traumatic stress disorder or depression as something I could work through if I so chose, amplifying the stigma I’m pushing back on by owning that a mental illness is an appropriate reason to take off work. And it’s not the commenter’s fault; the notion that working constantly is a virtue is so pervasive, it affects all of us.

Things in addition to sick days and sleep that I’ve had to learn are not engaging in self-care: going to the doctor, eating, taking my meds, going to therapy, turning off my computer after a 12-hour day, drinking enough water, writing, and traveling for work. Because it’s so important, I’m going to say it separately: Preventive health care—Pap smears, check-ups, cancer screenings, follow-ups—is not self-care. We do extras and nice things for ourselves to prevent burnout, not as bandaids to put ourselves back together when we break down. You can’t bandaid over skipping doctors appointments, not sleeping, and working your body until it’s a breath away from collapsing. If you’re already at that point, you need straight-up care.

Plenty of activities are self-care! My absolutely not comprehensive personal list includes: brunch with friends, adult coloring (especially the swear word books and glitter pens), soy wax with essential oils, painting my toenails, reading a book that’s not for review, a glass of wine with dinner, ice cream, spending time outside, last-minute dinner with my boyfriend, the puzzle app on my iPad, Netflix, participating in Caturday, and alone time.

My someday self-care wish list includes things like vacation, concerts, the theater, regular massages, visiting my nieces, decent wine, the occasional dinner out, and so very, very many books. A lot of what constitutes self-care is rather expensive (think weekly pedicures, spa days, and hobbies with gear and/or outfit requirements)—which leads to the privilege of getting to call any part of one’s routine self-care in the first place.

It would serve us well to consciously add an intersectional view to our enthusiasm for self-care when encouraging others to engage in activities that may be out of reach financially, may disregard disability, or may not be right for them for a variety of other reasons, including compounded oppression and violence, which affects women of color differently.

Over the past year I’ve noticed a spike in articles on how much of the emotional labor burden women carry—at the Toast, the Atlantic, Slate, the Guardian, and the Huffington Post. This category of labor disproportionately affects women of color. As Minaa B described at the Huffington Post last month:

I hear the term self-care a lot and often it is defined as practicing yoga, journaling, speaking positive affirmations and meditation. I agree that those are successful and inspiring forms of self-care, but what we often don’t hear people talking about is self-care at the intersection of race and trauma, social justice and most importantly, the unawareness of repressed emotional issues that make us victims of our past.

The often-quoted Audre Lorde wrote in A Burst of Light: “Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”

While her words ring true for me, they are certainly more weighted and applicable for those who don’t share my white and cisgender privilege. As covered at Ravishly, the Feminist Wire, Blavity, the Root, and the Crunk Feminist Collective recently, self-care for Black women will always have different expressions and roots than for white women.

But as we continue to talk about self-care, we need to be clear about the difference between self-care and actual care and work to bring the necessities of life within reach for everyone. Actual care should not have to be optional. It should be a priority in our culture so that it can be a priority in all our lives.

Commentary Health Systems

Your Voice Matters: What I Learned Before Having Fibroid Surgery

Janna Zinzi

Since fibroids are a common experience for many women, especially Black women like myself, I want to share some learnings about navigating the health-care system so others facing a similar prognosis can feel empowered instead of frightened.

This piece is published in collaboration with Echoing Ida, a Forward Together project.

Having my uterine fibroids removed was one of the best things I’ve ever done for myself. Don’t get me wrong: I was scared when I went to my gynecologist to get an intrauterine device and instead was told I needed surgery. It took me almost two years to move forward with surgery and to actually find a gynecologist I trusted. I’m not casual about surgery, and I admit I’m often skeptical about the U.S. medical system. So I tried numerous alternative remedies to avoid surgery, but my fibroid tumors were too large for any of those alternative therapies to work effectively.

After my procedure, I realized how I had accepted ongoing physical discomfort due to deep fear and mistrust of the U.S. medical system. Since fibroids are a common experience for many women, especially Black women like myself, I want to share some learnings about navigating the health-care system so others facing a similar prognosis can feel empowered instead of frightened.

Despite the fact that uterine fibroids are pretty common, they aren’t discussed in high school health class; women often learn about fibroids from other women in our lives who have experienced them. The U.S. Office of Women’s Health reports this is especially true for African-American women, who are three times more likely to have them than their white counterparts.

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So what exactly are uterine fibroids? As WebMD puts it, fibroids are composed of “renegade muscle cells that come together to form a fibrous ‘knot’ or ‘mass’ within the uterus.” They are often benign, noncancerous growths that develop during childbearing years and especially after age 30. Doctors categorize them based on their location within the uterus: submucosal fibroids are located just under the uterine lining, intramural fibroids lie between the muscles of the uterine wall, and subserosal fibroids extend from the uterine wall into the pelvic cavity.

According to the National Institutes of Health, about 70 percent of white women and 80 percent of African-American women have fibroids by age 50.

Symptoms can vary but frequently include heavy periods, prolonged bleeding, bloating or fullness in the abdomen, painful sex, and even constipation. All of these factors play a role in the affected person’s decision on whether to have the growths surgically removed, and what type of surgery is best.

Medical research organizations and doctors themselves admit that the medical establishment is still learning about fibroids and trying to understand what causes them and why Black women are disproportionately affected. I was particularly interested how a provider approached those unanswered questions when choosing a gynecologist to help me understand all of my options.

A gynecologist first diagnosed me in 2010. Specifically, my doctor told me that I had multiple fibroid tumors, including an orange-sized one that I should monitor. When I returned to her four years later, once I had health insurance again, I was shaken up by her advice to get a myomectomy (surgical removal of fibroids from the uterus). Since the orange-sized fibroid had tripled in size, I was concerned about making sure it didn’t come back post-surgery, but there was no discussion of that. While surgery was commonplace to her, I was scared about having my uterus cut open, the six- to eight-week recommended recovery period, and what all this would mean for my fertility and my work and personal life.

I was 33 at the time, so I resolved to give myself a year to see if I could shrink them without surgery. If nothing improved, I’d get them removed by age 35, when fertility typically starts to decline. I have my own mistrust and skepticism in the way Western medicine is practiced in the United States, where it’s based in capitalism and not always in people’s well-being. Thus I take surgery very seriously and want to be sure I’ve tried everything else in my power to manage my health before choosing that option.

Also, I didn’t have a gynecologist whom I trusted to hear my concerns or was open to my use of holistic methods. My family and friends listened and let me talk through my feelings and worries, but I was still afraid. I researched what surgery would mean for my body, especially my reproductive health, and spoke with herbalist and healer friends. Over the course of the year, I drank weekly herbal infusions and took numerous daily supplements like DIM and vitex. Then I made specific dietary and lifestyle changes after seeing Dr. Michelle Gerber, a naturopath doctor and midwife. I made a significant out-of-pocket investment for these things that weren’t covered by health insurance. Dr. Gerber tested my estrogen levels, which none of my providers had requested up to that point, to see if that was causing fibroids, but my levels were normal.

Although I didn’t have severe symptoms like pain and heavy bleeding, I felt full and uncomfortable like I was carrying something that wasn’t healthy. With the support of my naturopath doctor, I began to look for a gynecologist who could help me figure out my surgery options and also would listen to my concerns. This is when I realized that we as patients need to know what questions to ask.

When faced with a major health decision, it’s crucial to make sure you’re getting all the information you need to make an informed choice. Sometimes it is so overwhelming that you don’t know what you need to know or what you should ask your doctor. Issues like our reproductive health and fertility can bring up a lot of emotions because they have implications on our future plans and desires. Facts can help inform the emotion.

According to Dr. Caryn Johnson, an obstetrician and gynecologist in Atlanta, the most important questions to ask your gynecologist are: “Do I need to have treatment for the fibroids, and what treatment options are available?” (Full disclosure, she is my cousin.) Caryn told me that many women with fibroids are asymptomatic, and observation may be all that is necessary.

“Women should be clear [with themselves and their provider] about what their fertility desires are in the short term and long term,” she said. “For women with symptoms, the conversation should be about fertility and preservation of the uterus so that a more focused discussion on treatment option can be made.”

Caryn also said that size, location, and symptoms are all important factors that are used to guide treatment because “it’s not one size fits all.”

There are numerous surgical options such as myomectomy, uterine fibroid embolization, and endometrial ablation. If surgery is recommended, Dr. Gerber suggested to me that women ask how important it is to have surgery immediately to assess if there’s time to explore other options for treatment. She also recommended that patients ask how large their fibroids are, how fast they are growing, and if there’s a minimally invasive surgery that will preserve fertility, if that’s desired.

“As any surgery can affect your health in terms of scar tissue or infection, and if fertility is important to you, then you have to ask how leaving it or removing it will affect fertility,” Caryn said.

I also learned that it was important to do your own research, in addition to asking doctors about what each surgery entails, including the pros, cons, and risks.

Armed with these questions scribbled on paper, I felt prepared when I visited my new gynecologist. She started our conversation by saying matter-of-factly that because one of my fibroids was very large, I could hemorrhage during surgery and need a hysterectomy (complete removal of the uterus). I cried. While I appreciated her honesty, her delivery did not comfort me. Needless to say, I didn’t see her again.

Fortunately, the next doctor I saw, via a friend’s recommendation, answered my questions and listened to my concerns. She also was honest about the risks of hysterectomy but was clear that she never had to perform one during a myomectomy. She also talked to me about the scar, where it would be, and what it would look like, which was important to me. I eventually scheduled my surgery with her—with a bit of fear, but mostly confidence.

That experience taught me that it’s our responsibility as patients to advocate for ourselves. We have to ask questions and state our concerns. There’s no shame in walking away from a doctor who isn’t listening or isn’t treating you with respect. And particularly as a Black woman who knows the history of unwanted or coerced sterilizations that have plagued communities of color, I have learned how important it is to have honest and clear communication with my doctors. Peace of mind before major surgery is important to healing.

I also must note that I was able to get this procedure thanks to my excellent health insurance. It was frustrating trying to find a gynecologist randomly from a list of those in my area, but I was blessed to get a good recommendation. However, even after I scheduled the surgery, I still had to advocate for myself.

On the day before my procedure, I got a call from the hospital that my surgery needed additional approval. My doctor’s office had confirmed weeks before that I didn’t need this additional authorization, but the insurance company misspoke. I was angry and frustrated because I’d taken time off work, flown my mother across the country to help take care of me, and done all the “right” things. Though I was able to get the surgery a week later, had I done it over, I would have asked the insurance company to confirm that all the necessary authorizations were handled.

Additionally, it’s important to have a gynecologist who will advocate for you. My doctor shared with me that during the surgery, her assisting surgeon wanted to cut me vertically down my stomach as opposed to the bikini line incision promised to me. The assisting surgeon said that the fibroid was too large to approach it any other way. My doctor told him that she would not do that because it was not necessary and furthermore wasn’t what she and I talked about. Who knew that would even be a conversation in the operating room?!

Make sure that you have had clear communication with your doctor and that you are in agreement of the details of your surgery. Make your wishes known even if they are cosmetic. Your doctor should always let you know what the potential complications are, but be clear about what they will do to honor your safety and wishes should those arise.

One of the best resources I found when preparing for my myomectomy is this blog post from a woman in the United Kingdom who had a similar procedure. Her tips were invaluable, particularly her essential shopping list, including oversized “granny panties,” and peppermint tea. Her experience helped me know what to expect as I recovered after surgery.

When speaking with other women who have had various types of fibroid removal surgeries, one major final piece of advice I received was to give myself time and space to recover. I agree; recovery looks and feels different for everyone. So make sure you have someone there to look after you, and that you don’t try to rush the process. Sleep and rest is not negotiable! It also helps to have good doctors and nurses (and family and friends) who care about your recovery and check in on you. Make sure you have someone who can help you with basic things like getting out of bed, showering, and eating for the first few days at least. Create a Netflix queue, and get some coloring books to make lying in bed more fun. Have someone cook you nutritious meals with fruits and veggies, or set aside some money to have them delivered. Be kind to yourself.

I was blessed to have a smooth surgery and quick recovery. My fibroid was the size of a small watermelon and weighed 2.5 pounds, so good riddance! I attribute the success to my gynecologist; my naturopath doctor; my mother, who cared for me after surgery; and my meticulous preparation.

I recognize that I am one woman with one specific story. However too many women, particularly Black women, are affected by fibroids but are nervous about what to do. We suffer in silence even if we have the means to take care of our health. Sometimes it’s fear that stops us from taking care of our health, but often the fear is much worse than the reality.

Know that you are not alone. Know that your desires and your voice matter. Know that with patience and knowledge (and, admittedly, health insurance), it is possible to get the care you deserve.