51% #1691: Skin Care and Self Care
On this week’s 51%, we take a break to focus ourselves. Dermatologist Dr. Jean Buhac offers up some tips to better love the skin you’re in. Dr. Hida Nierenburg discusses how to ward off headaches and migraines this holiday season. And Dr. Sharon Ufberg speaks with author Elayne Fluker about the importance of asking for help, and how doing it all doesn’t have to mean doing it all alone.
You’re listening to 51%, a WAMC production dedicated to women’s issues and experiences. Thanks for tuning in, I’m Jesse King. We’ve got another trio of health-related discussions for you today. The holiday season can be a particularly stressful time for us all, and in between shopping, and work, and planning family occasions, it’s important not to let your health go to the wayside, and to ask for help if you need it (that’s something even I need to remind myself from time to time).
So that’s what we’re doing today. Our first guest is Dr. Hida Nierenburg, director of headache medicine at Nuvance Health. Dr. Nierenburg is double board-certified in neurology, and while headache medicine might seem like a pretty specialized field, she says it's certainly a much-needed one - especially during the holiday season. She says the holidays bring a perfect storm of migraine triggers.
What are common triggers for headaches and migraines?
So common stranger triggers for headaches and migraines: stress is a big one, doing a lot of things all at once. Certain foods for some patients, stinky cheeses, nitrates, certain seasonings. For some patients, too much sugar. Alcohols as well. Lack of food, lack of sleep, so especially going constantly. I always counsel my patients about triggers, and not everybody gets predictable triggers, but if you have predictable triggers you can avoid or minimize [them], so they don’t cause migraines.
What exactly is happening when someone's having a headache or migraine?
Regular headaches, a lot of people get, so it's more like pressure [in the head], and you don't get sick. When you have a migraine, it's a headache that makes you sick. Lights bother you, smells, noises, you get fatigue, nauseous, and it also can cause problems with concentration. Usually, the signal for migraine starts in the back of the brain – the area that controls vision, that's why some people see colors or shapes. The best way I explained it to my patients is that it's a chemical struggle in the brain. Arteries expand and they release pain-causing chemicals. Other arteries in the brain get activated that cause all the other symptoms with migraine, and this settles on a nerve called the trigeminal nerve, which is the nerve that carries sensation to the face – but it connects to pain pathways for head and neck pain.
So is it normal on some level to get headaches, or even a migraine from time to time? At what point do you seek treatment?
So migraines are less common. Regular headaches, tension type headaches, are the most common type of headache. 89 percent of people get it. Usually, migraines are a little bit tougher. We recommend someone to see somebody, because the pain can be very disabling. Actually, migraines are the second cause of disability in the world. So if you're having one migraine a month, but it's less than three days or four days, and it's making you miss work or school, then that is something you should see somebody [for], because a lot of times the over-the-counter medications do not work. Same thing with regular headaches. I see many patients with regular tension-type headaches, but they have been very frequent, over-the-counter medications don’t cut it, and if you're taking too much over-the-counter medications, sometimes it can make the headaches worse.
When you're looking at treatments for migraines and headaches, what are some of the treatments that you get?
So there's different classes of treatments that we have, and it's kind of like an art. Every patient is different. In the Headache Society, we always say no migraine patients are alike. So, we have oral medications. We have devices that help for breaking a migraine. We have injection medications. We may use Botox when people have more than 15 headache days per month. So it's always a different class of medications, and it’s a discussion with the patient about other conditions. They may have medication side effects – I have a lot of patients that tell me, ‘I don't want any medicines,’ and well, if you have high frequency migraines, it’s a little bit tougher to treat without medications, but there are options I tell my patients [so they] don't suffer. I have the conversation – if there's some supplements that can help, but if the supplements aren’t helping them I go to oral medication.
Can migraines be tied to any other issues or things that people should be worried about?
Sometimes with autoimmune conditions, but sometimes it's incidentally. When we see migraines and other [things] like seizures, it’s usually coincidence. Migraines are usually a silent disease, because patients look normal or [if you] look up imaging, it's normal, but we understand a lot about the pain and the severity of migraines.
Is there a difference between the way migraines might pop up in women versus men?
Usually they're about the same. Actually, migraines before puberty, they're more common in boys, and after puberty [they’re more common in] women. [But] men still get migraines. Usually there’s a particular migraine that women get that is PMS migraines, migraines around the menstrual cycle. Those tend to be a little bit more disabling or more severe, [with] body pains, cramps. But other types of migraines could be just the same as men, too.
As people are planning for the holiday season, what are your tips for making plans in order to help avoid migraines?
So definitely buying gifts can be stressful, so plan ahead, online shopping. Other things like be aware of the foods that they might be serving in a place, certain alcohols if people want to drink, try to be well-rested. Part of what the headache doctors say [is] we want people to enjoy life at the fullest without migraines interfering with your life. So [if] you have a lot of triggers that not always you can avoid, then we recommend starting daily medications or preventive medication or something, to have something handy as needed.
Our next guest is Dr. Jean Buhac, a board-certified dermatologist who has been operating out of her practice, in Saratoga Springs, New York, for more than 20 years. She’s quite an accomplished person, who first got her Bachelor’s degree in economics at Cornell University before diving into her passion for medicine and pursuing her medical degree from Tufts University School of Medicine. She credits her many professors and her faculty peers at the University of Iowa hospitals and Mass General Hospital with sculpting her into the dermatologist she is today. At Saratoga Dermatology and Medical Spa, she treats patients of all ages, races and genders for a range of complex skin conditions and anti-aging procedures.
What issues do your patients usually come to you with?
I see all ages, and I see a ton of skin cancer every single day. A lot of pre-cancers, which are called actinic keratosis, and quite a bit of melanoma. People think that anything that's raised is a problem – however, an important take-home message is that moles that are flat are usually the problem. And they may not even itch, so melanoma’s very visual. You would typically observe a mole and it will not have a nice, uniform color, or nice, even edge to it. What typically happens is, if you're watching something over time, that particular lesion would take on additional characteristics where it's growing outward in its diameter. And then it gets an irregular edge, maybe a shadow, and it gets different colors. It’s not symmetric, it’s very agated. Those [signs] are really important. I mean, people need to look at their entire skin surface, look with a mirror, check their backs, their feet, their hands, the scalp. So we do a full skin check to make sure that they have nothing that's evolving. But [with] early detection, it's the most curable cancer that we have today. And the other two types of main categories of skin cancer are basal cell cancers, which typically arise like a pimple that doesn't heal. So we tell patients, if anything lasts for two months or more, to go and have that investigated. It can also look like a patch of eczema. So anything that's a flat, pink, scaly patch, [you] shouldn't assume that it's just a little patch of dry skin if it's still persisting, despite over-the-counter use of cortisone, or any appropriate treatment of eczema. If it's still there [you need] to have that checked. And then the third would be squamous cell cancer. Those can look warty: they're red, they can be very tender. All of these that I've just mentioned are typically seen on the sun-exposed areas of the body.
How early should people start looking at these things?
As a matter of fact, I did a biopsy on an 11-year-old boy today. So melanoma can occur as young as that. And I've seen young women who have done tanning booths in their early 20s. With melanoma, anyone is a candidate for good skin check. But the people that should be more aware or pressing to get in for a check would be those with large numbers of moles. I know for individuals, sometimes they think freckles are moles, but if they're not sure, they shouldn't try to stay at home and decide for themselves. They should talk to their primary care doctor, or reach out to a dermatologist for a visit. Or if there's a family history, of course, if there's a family history of melanoma, or even basal cell / squamous cell [cancer], because a lot of these will cluster and people have more than one type of cancer as well.
You mentioned tanning booths. Are there any other kinds of activities that can contribute to skin cancers?
Smoking, excessive smoking. There’s environmental factors that play a role. Sun exposure is the most common and the biggest reason why people develop skin cancer. Starting at an early age, putting the SPF 50 on, reapplying every couple of hours, using protective clothing, avoiding the high peak [of the day] from like 10 a.m. to 2 p.m. or 10 a.m. to 3 p.m., and protecting the skin is most important. And that is the most major anti-aging cream or therapy that we have – sunscreen. You know, if you start early and you do it, that's like the best anti-aging cream, as well as protecting against skin cancer.
That goes into one of my next questions. What would you say, overall, is a good example of healthy skincare, or a skincare regimen? Because if I go on Instagram, I see a billion different things talking about like face serums or combinations of lotions to use and stuff like that, and it always makes me wonder what's a good way to go about it.
Now, that's a good question. I think we're over-burdened with way too many products out there. There's basic guidelines on certain categories of things that have been proven, and researchers out there that show they are effective. So that's the main thing [to focus on], because anyone can put on their label “improves the appearance of,” but what we're really interested in is that it could help increase collagen, it stimulates collagen production, and helps with fine lines. Those categories will basically be vitamin C, which is an antioxidant, retinols, especially tretinoin, which stimulates collagen protein. Glycolic acid. But I think people should adhere to, like I said earlier, the SPF 50. And good moisturizers that are oil-free are suitable for everyone. There are other people with different types of skin conditions that benefit from certain products if they have rosacea, that are geared for sensitive skin. And there's lists of those: Cetaphil, Cerave, you know, the very common ones that are out there.
Would you consider rosacea more of a medical condition or more a cosmetic concern?
Well, that's very interesting how some of the diagnoses in dermatology can be interpreted in different ways. You know, there's that spectrum. So rosacea is a medical condition – they can get bumps and pimples, nodules, pustules, that can be disfiguring. It's on a spectrum, everyone's different. Some people just have mild redness. So there's different ways of approaching it. There's topical prescriptions, and oral prescriptions, as well as laser applications that can help minimize the appearance of the blood vessels on the face.
I'm also just thinking about other reasons people might come in, maybe like acne or for anti-aging treatments?
Yes, we see a lot of patients with acne. There's genetic components and stress components that play a role, as well as things that they eat, you know, there's inflammatory foods and junk food and whey protein. I see some athletes, they'll take whey, and then they'll get this real large nodule or cystic acne breakout. So we have to approach each one individually. And there's adult acne. There's such a spectrum, but there's multiple different treatments that are available out there that can really help. And so anyone with acne suffering at home, I feel bad for some people that they don't get the attention [they need], because they could be left with scarring, long-term scarring.
What are some of those different treatments?
Well, as I mentioned, tretinoin is good for wrinkles. But it also, initially, has been for acne: it helps with blackheads and whiteheads. And there's another medicine called Differin which is over-the-counter. It used to be a prescription. There's those topicals, topical antibiotic lotions, benzoyl peroxide and salicylic acids are used. And then we do oral antibiotics, more from an anti inflammatory standpoint, as opposed to really treating the bacteria. But I educate my patients, so they understand the importance of using their medication, because some expect, “Oh, I can do this for a few weeks, and I should get better.” It's very important, so they don't waste their time, that they understand that they have to invest that time. And after probably about six to eight weeks, that's when things really start working.
To get to the topic of anti-aging, at what point do you usually start seeing patients for things like that?
You know, it could be mid-20s, because they see a lot of images on social media, and they want the nicer, fuller lips, or they feel they should look differently than they are. Up to people who are 80/85, who I might counsel with them and say, “You know, this might not make that much of a difference.” And they'll say, “Well, I just want to look, like, 75.” So everyone has their little way of approaching things and what really bothers them. So I really listen carefully. Although we can give advice as to the global appearance in skincare from our professional point of view, I really listened to what bothers them the most so I can put it in perspective – because sometimes there are patients who maximize something that's very minimal. But I don't want to minimize their complaints, do you hear what I'm saying? And practicing medicine is a combination of art and science. We have the knowledge, the scientific knowledge, on how to approach an aging face. But I think the art is, how far do we take it? And how much is too much. Which I think brings on another philosophical question: I mean, do we do it at all? Our whole society is geared toward producing new anti-aging things, but I think there comes a time when it needs to be a combination of acceptance, and maybe treatment alleviating some of the signs of aging that are reasonable. And having a discussion is really important with patients, to see where they're at. I talk to patients and I say, “Listen, if you really want that Botox, let's go ahead and do it. And you can do it for as long as you want, if you're going through a hard time right now accepting what things look like. At some point down the road, it might be that you don't even want it anymore.” But so many times I have people who have spent a boatload of money, and then they come to the appointment. And I have to tell them, “Well, you know, there's nothing proven behind what you just purchased. But I can tell you that these certain things are really helpful for your skin, if you wanted to start with this.” And so people can end up investing too much in something that may not be therapeutic for them.
Something that I've read a lot about online is “pre-juvenation,” about younger people trying particular treatments to, I guess, help ward off the signs of aging a little bit further if they can. Am I getting that right?
Well, I think they may initiate some anti-aging treatments earlier, because then there'll be some benefits where they're not trying to play catch up to it. But if they simply…if you think about it, there's intrinsic aging, which is internally preprogrammed, how our genes trigger our aging as we get older. But extrinsic is from the sun. And so SPF, sunscreen is the most effective “pre-juvenation,” anti-aging treatment across the board. If they start simply with just doing that, and maybe like vitamin Cs, which are antioxidant. No excessive alcohol, eating a more plant-based diet, avoiding hormone-infused meat products and milk, dairy of that nature. That would go a very long way.
Our last guest today is the host of the Support is Sexy podcast and the author of the new book, Get Over ‘I Got It:’ How to Stop Playing Superwoman, Get Support, and Remember That Having It All Doesn’t Mean Doing It All Alone. Elayne Fluker says ambitious women in all areas of life, whether they’re at home, in the office, or in the classroom, too often feel like they’re not allowed to ask for help - and that mindset can actually hold us back, and stress us out. Fluker shared her tips with Dr. Sharon Ufberg, co-founder of the California-based personal development company, Borrowed Wisdom, for her 51% segment, “Force of Nature.”
Ufberg: How did this book come about?
Fluker: I attended a workshop in 2015, I want to say. And during that time, I saw a reflection of myself and other people in that workshop who were struggling with asking for – actually, two things, Sharon: love and support. So not even just support – love and support. When I say struggling, I mean, like, boohoo crying, “Don't make me do it. I don't want to ask,” or, “I don't know how to ask.” And it was really my first time saying, “Oh, I think I have that problem, too.” But this was something I really wanted to carry with me, this idea of embracing support as something positive, as it not being something that's a weakness, or something to shy away from. And I started saying this phrase, “Support is sexy,” thinking of support in a different way: “Support is sexy. Support is sexy.” And when I would say it to other women, especially women entrepreneurs, or women who were doing just different things in our lives – this was in New York at the time, so we have that whole hustle mentality, and sometimes don't even pause to think about how support could show up for us – I would see these women light up. And that's when I thought, “Maybe there's something to this whole ‘support is sexy’ thing.” And then that evolved into eventually me doing the podcast called Support is Sexy, and then ultimately writing this book, Get Over ‘I Got It,’ because I found that most of us ambitious women have what I call “I got it” syndrome.
Ufberg: What exactly is the “I got it” syndrome? Explain that a bit more to me.
Fluker: It’s something that's almost like a trigger response for some of us. We don't even think consciously about how much we're turning support away. Whether that is, I should say, literally someone coming to us and saying, “Can I help you with that? Is this some way I can support you? Do you need some version of that?” or something simple, like a serendipitous moment in the street where someone could possibly support you with something – and we're so quick to turn it away. So it's not even just saying, “I got it” to other people. Sometimes we're stopping the universe from coming into our lives and helping things work things out, because we're so focused on how we're going to manage it or do it. We'll “handle it,” right? “I'll make it happen. I'll handle it.” Well, you know, what you might be suffering from is “I got it” syndrome, and pushing the opportunity, but more so even possibility away, by saying this.
Ufberg: How do you see shifting the idea of getting the support they need, for ambitious, high-energy women entrepreneurs?
Fluker: Well, one of the things that I like to do to remind us all to remember to even ask for support, because sometimes I will say we're all moving on autopilot. We have so much to do, we have so much to accomplish, or people to serve, or things to do at work. There might be reasons that we don't pause for a moment and think about this. But I encourage any woman listening, pause and think about the word “HELP.” And I use that as an acronym to remember that H: having it all doesn't mean doing it all alone. So just as you just said, some of us feel like we have to do it all. Well, is that true? Or is that a belief? Sometimes it's the belief that we have to do it all alone, or it's the belief that no one shows up for us. Or it's belief that no one else will do it like “we can.” Having it all doesn't mean doing it all alone. You don't have to prove that you can do it by yourself. And a lot of times getting support will help you do it even better. The E in “HELP” is ask empowering questions. So when you're looking for support, it’s not, “Why am I so stupid? Why can’t I do this? Why haven't I figured this out?” A more empowered question might be okay, “This is something I want to accomplish, or even check off my to-do list. What are the ways that I might be able to get support for this? Who was someone who might have done this before? Who could give me some advice?” Whether that's someone you know personally, or someone you look up on the computer – we have access to almost everybody and everything now. But what are the questions you're asking yourself? The L is to “live that question.” So this is something I learned from this woman, Patricia Moreno. And it's this idea of - especially again, as ambitious women, as go getters, we're women who have the answers. A lot of us are paid to have the answers, or people come to us because we have the answers. So it is tough for us to imagine living a question, being in that space of openness, of asking, “How can I get support for this? What are some things that I might be missing that could be helpful to me?” And then not necessarily knowing, at least right away, how to answer that question. I wrote down in my journal a bunch of questions that I'm living right now. And I did not answer them, which is the hardest thing ever. So live the question, and also let go of the answer. Again, we don't want to get into a space of, “This is something I want to do. This is how I'm going to tightly manage this. This is exactly how it's going to happen.” That's not to say don't have a plan. Of course, you want to have a plan. But what if there's some opportunity for support that comes from somewhere else? And then the P is “believe in the possibilities.” So you can't do all those other things and then not believe it's possible for support to show up for you in ways you might not even be able to imagine.
Ufberg: I think it's so important for women to read a book like yours so women can see that successful, ambitious women don't have to do it all alone. Can you speak for a moment on the particular challenges women of color face regarding asking or getting the support they may want or need?
Fluker: Yes. I think as a Black woman, I can speak to my own issues, experience, and some of the women that I know, and then women of other cultures. A lot of us were taught to be seen and not heard – [some are] even from descendants of enslaved Africans. My parents, for example, grew up in the South in the 1930s. By the South, I mean Alabama. So they certainly were taught to be seen and not heard, sometimes not even be seen. My mother, a story I share in the book talks about how when she and her siblings, as children going to the shoe store, they weren't allowed to try on shoes. Or I've heard other people's parents [say] that you weren't allowed to try on that hat, because you were Black, and they didn't want you to try on anything and then put it back on the shelf. It's a racist policy, and it sounds like a simple thing. But those kinds of things impact you, as a young person [and] as a person of color. And there's all kinds of experiences that many have had in those kinds of situations, where you might be afraid to ask – literally, afraid, in their case – to ask for something that you want. And then that kind of transfers over in generation over generation. Something that I like to quote now, or mention, is some research that I've been looking at from Maria Yellow Horse Braveheart, who was a social worker, clinician and researcher who talks about historical trauma, and how the multi-generational trauma experienced by certain cultural groups can be passed on to each generation. That's something that I think applies in the same way to asking for support. She first explored it for Native Americans, then you think, as I said, about descendants of slaves, Holocaust survivors, and descendants of Holocaust survivors, and Japanese Americans who were interned during World War II. So there's a lot of different groups of us, culturally, that might have a reason that asking for support wasn't something that we witnessed, and [it’s] something that we literally have to learn how to put into practice. But it's my hope that women – my book is for all women who feel like they are trying to do it all, figure it all out, and do it all alone – for us to be able to acknowledge that this might be a reason, or this might be where this comes from. But I encourage you to make a change, because it is as you said, not just about success, but this is about support for your peace of mind.
51% is a national production of WAMC Northeast Public Radio. It's hosted by Jesse King, our executive producer is Dr. Alan Chartock, and our theme is "Lolita" by the Albany-based artist Girl Blue.