The elusive diagnosis

Why aren't we talking about endometriosis?

The elusive diagnosis

“Are you drinking enough water?”

My family doctor clicked through something on her computer, occasionally peering at me through wire-rimmed glasses. I was in her office for the third time in several years, attempting to get a medical explanation for what she scribbled down as “dysmenorrhea” — severe cramps that hit up to a week before my period began and intensified during it, sometimes rendering me incapable of carrying out daily activities.

“Yes, about four litres a day,” I responded. These kinds of questions were typical. By this time, she had prescribed me a variety of painkillers, advised me to improve my diet, and speculated that I might be out of shape, despite my membership on the cross-country team. None of this had done anything for my pain, and that day, I was determined not to leave her office without an ultrasound referral.

My dad knows all too well what it’s like to get a call from me, asking him to come to where I am collapsed on the sidewalk mere minutes from my front door, cramps eating through my stomach. Once, my mother came home to find me crumpled on the floor, crushing pieces of homework in my hands to distract myself from the all-consuming pain. And yet, none of this compared to the time when I was 12 and passed out in a mall on the first day of my period, the ache radiating from my lower abdomen to dull the rest of my body. Somehow, despite all of this, I was worried that what I felt was merely a figment of my imagination, manageable if only I were stronger.

I did manage to obtain my referral that day and to schedule an ultrasound appointment. A few weeks later, I received the report: no abnormalities found. In some ways, perhaps testing positive for something — anything — would have presented me with a sense of relief, because it would mean that I wasn’t overreacting. But in many other ways, had the doctors found something, it could have been the beginning of a life structured around a chronic, incurable, and often misunderstood condition: endometriosis.

The Department of Obstetrics and Gynecology at the University of California Los Angeles defines ‘endometriosis’ as a condition wherein “the tissue that makes up the uterine lining [in the womb] is present on other organs inside your body.” In other words, tissue from a woman’s uterus can crawl into her fallopian tubes, spread into her pelvic cavity, and even plant itself in her lungs. There, it builds up, breaks down, and bleeds just as normally-located uterine tissue does. Eventually, scar tissue develops to mesh internal organs together. Not all women with endometriosis suffer symptoms, but those who do report intense pain with or without their period and sometimes even during sex.

It’s difficult to understand the extent of the pain without experiencing it, but one woman who lives with the condition likened the sensation to being hit in the ovaries with an axe. Others have written that it feels “like my uterus is sitting on a bed of razor blades,” or “like someone is taking a cheese grater to my cervix.” On top of this, it comes with high rates of infertility; for women who want to have a child, their physical pain might be compounded by the emotional strain of being unable to reproduce.

FIONA TUNG/THE VARSITY

For a condition that one in 10 women live with, endometriosis is remarkably difficult to obtain a diagnosis for. Among those who are aware of its existence, this difficulty is notorious. For starters, the condition takes an average of eight years to be recognized by a physician. The reasons for this are various, grounded in both the medical and the social.

To begin with the medical, the condition’s symptoms are largely invisible; they’re also often misunderstood to be those of gastrointestinal, rather than reproductive, disorders. A laparoscopy, in which a tube probes the interior of the belly for out-of-place uterine tissue, is understood as the only definitive way to determine if a patient has endo. Due to the risks it carries as a surgical procedure, it’s recommended by physicians with caution.  

The barriers to diagnosing endometriosis are also incredibly social. Up until recently — and continuing today, depending on cultural context — strong taboos around discussing reproductive issues like fertility and menstruation have discouraged women from being open about their experiences. The consequences of this include reduced knowledge on the severity of symptoms, as well as increased difficulty for professionals to construct diagnoses. Compounding this is the physicians’ response to endometriosis symptoms. Suffering extreme period pain has been normalized to the extent that many health care providers won’t investigate it further. Instead, women are told to take painkillers — as I was — and to wait it out.

Beyond this, there’s a well-recognized trend demonstrating that health care professionals take women’s pain less seriously than men’s. Experts acknowledge that women endure and declare pain more frequently and of greater intensity, but they are less likely to receive sufficient treatment for symptoms. Researchers Diane Hoffmann and Anita Tarzian of the University of Maryland found that gender bias prompts physicians to dismiss a woman’s pain, unless there is an explicit, objective reason not to. In other words, women detailing their pain are perceived as sensitive or hysterical, and are at risk of having physical ailments attributed to psychiatric conditions.

At different intersections, this difficulty is only exacerbated. Endometriosis is perceived to be a white woman’s condition, and women of colour suffer the consequences of this. “The symptoms present the same way, but the complaints that women of color bring to a provider aren’t taken as seriously sometimes, and they aren’t properly diagnosed,” Oluwafunmilola Bada, Associate Professor of Obstetrics and Gynecology at Howard University, told SELF Magazine.

Even if a diagnosis is obtained, there is no real cure for the condition as surgeries to remove the uterus and ovaries aren’t always effective, and pain can flare back up when temporary treatments are halted. Living with endometriosis is a daily affair that is drawn out over years. As sufferer and advocate Lara Parker put it, “chronic pain means chronic.” Living with a long-term condition, especially one that is so misunderstood, can bleed into all aspects of an individual’s life, with implications for their mental health, family, relationships, and career.

Endometriosis is slowly gaining ground in terms of awareness, which will hopefully prompt improvements in the way that it is addressed. Celebrities like Halsey and Tia Mowry have been vocal about their experiences; Girls Lena Dunham has also been transparent about her diagnosis. As a result, it’s not as obscure as it was 10 years ago. However, the persisting difficulty that women face when trying to have their pain understood, their health conditions recognized, and their symptoms managed can be incredibly damaging. It compromises their quality of life as well as the integrity of the health care system, which professes to serve everyone equally but far to go before this becomes evident in practice.

UTSC Chatime receives two significant Dine Safe health infractions, passes upon re-inspection

Toronto Public Health found employee hygiene, sanitation failures

UTSC Chatime receives two significant Dine Safe health infractions, passes upon re-inspection

On March 19, the Chatime at UTSC received a “conditional pass” from Toronto Public Health’s (TPH) Dine Safe program after being given two significant infractions for employee hygiene and sanitation, as well as two minor infractions for failing to clean the floors in its food-handling room and for failing to ensure sanitized equipment surfaces.

A conditional pass is issued when an establishment is found to have one or more significant infractions. Significant infractions are violations under the Food Premises Regulation that pose a potential health hazard.

The first significant infraction was for using the “handwashing station other than for handwashing of employees.”

The second significant infraction was for “fail[ing] to provide equipment for sanitizing utensils as required.”

As per TPH’s system, TPH re-inspects establishments that received a conditional pass within 24–48 hours. If the significant infractions are corrected, the establishment will receive a pass notice.

If the infractions are not corrected upon the first re-inspection, a second re-inspection will be scheduled at a later date. If after that the infractions still have not been corrected, then “a summons to court will be issued and a referral to Toronto’s Municipal Licensing and Standards Division may occur,” according to the Dine Safe website.

On March 22, Chatime passed the re-inspection with one minor infraction left for not maintaining clean floors in the food-handling room.

The Chatime at UTSC is located in the basement of UTSC’s Student Centre. As with all food vendors in the Student Centre, Chatime operates with the Scarborough Campus Students’ Union (SCSU) as the landlord.

There have been numerous food incidents at UTSC in the past, including a large, winged insect found in Asian Gourmet food at the Student Centre. A similar incident happened again with the same establishment a few months later, but this time, the visitor was a larva.

The Varsity has reached out to Chatime and SCSU President Nicole Brayiannis for comment.

On the hunt for the ‘runner’s high’

Track star-approved trails to convert the anti-runner

On the hunt for the ‘runner’s high’

There are very few pasttimes more controversial than a run.

On one side are the avid dissenters, those who profess that nothing could be more unpleasant than a jog around the block. These are the folks who tend to opt for taking the elevator over the stairs and are big fans of those moving walkways in airports.

The opposing camp, however, raves endlessly about the magic of a run in the park with such uninhibited fervour that you would think scuffed sneakers and blistered feet were addictive.

As such, they often mention the wondrous ‘runner’s high,’ a phenomenon much spoken of but little explained. The runner will enthusiastically describe the euphoric feeling of blood in your cheeks, wind beneath your feet, or any other consequence of running that still fails to exemplify the promised addictive excitement to a staunch opposer.

It seems like the kind of thing you have to feel to believe. So, if you’re an inquiring anti-runner looking to convert, or are just looking to shake up your running routine, we have a few suggestions. The Varsity spoke to U of T alum and former Varsity Blues track star Madeleine Kelly for her advice on some runs that will get you jonesing for your next fix.

“A route is as difficult as you make it,” says Kelly. “So I don’t know which of these is the most difficult. I can tell you a little bit about the surfaces.”

If you’re looking for a scenic, hilly jog, she recommends Riverdale Park: “There’s a track there, and then there’s also a great hill, so you can get hill work in your bag or get some speed training.” The closest major intersection to her favourite running spot in the park is at Broadview and Danforth Avenues.

If you’re interested in testing your endurance, Kelly says that the best place to get in a long run is along the waterfront. “The Martin Goodman Trail goes for [roughly] 30 kilometres, along the bottom of Toronto,” she says, and the views of Lake Ontario don’t hurt either.

Finally, if you’re looking for a calm, “sheltered,” meditative run, she suggests the Beltline Trail, a nine-kilometre scenic route along an old railway line running from west of Allen Road down past Mount Pleasant Cemetery, the latter being a surprisingly peaceful running spot in its own right: “The cemetery is also great if you want a workout: rolling hills, limited traffic.”

Kelly also encourages runners to hop on the ever-dreaded treadmill. “I see it as a training tool if the weather’s brutal, then in my opinion it’s a much better option than potentially wiping out.”

However, it’s never her first choice, and she concedes that she would “always go outdoors if [she] had the option.” The takeaway for discouraged newbies? Try a scenic route instead of a machine, and maybe you’ll find yourself lacing up your running shoes more often than you think.

Asking the real questions about intermittent fasting

Is the popular diet worth the trouble?

Asking the real questions about intermittent fasting

It seems like the past year has been riddled with vastly contradictory and — let’s face it — downright bizarre diet fads. With loud voices swearing by the demonization of carbs or fingers wagging at an imbalanced body pH — thanks, Tom Brady — knowing what to eat to stay healthy or to shed extra pounds has become more confusing than ever.

Among the Instagram-famous diet fads is intermittent fasting, hailed by the likes of J. Lo and Terry Crews for its relative simplicity among the abundance of complicated diets: eat as much as you want, but quickly! According to Harvard Health Publishing, intermittent fasting works by “severely limiting calories during certain days of the week or during specified hours during the day. The theory is that this type of diet will help decrease appetite by slowing the body’s metabolism.” This can mean anything from eating only within a strict 8–10 hour window every day to following the 5:2 method, in which the dieter eats normally for five days of the week and severely restricts caloric intake for two days.

Extreme? Yes. But does it work? Possibly — if you can keep it up. JAMA Internal Medicine cited a whopping 38 per cent dropout rate among participants of an intermittent fasting study. There is also a “strong biological push to overeat following fasting periods,” according to Harvard Health Publishing, which calls into question the long-term sustainability of the diet.

Restriction as an explicit facet of any kind of diet comes with its consequences: health care professionals have noted the potentially damaging mental side-effects of a diet focused only on what you can’t do, raising concerns that intermittent fasting may be a gateway to an eating disorder. Claire Mysko, CEO of the National Eating Disorders Association, told Mashable, “Not everybody who gets into this [fasting culture] is necessarily going to spiral into [an] eating disorder, but if you are at risk, this is a really triggering framing.” This could become an excuse to not eat at all, for example, in an era overwhelmingly saturated with expectations of physical perfection.

The final word is still out on whether intermittent fasting is the golden ticket to a six-pack, so as the internet continues to battle it out, maybe just skip the fried stuff and hope for the best.

Tri-campus Gym Breakdown: Athletic Centre

How to stay active at the Athletic Centre

Tri-campus Gym Breakdown: Athletic Centre

The Athletic Centre (AC) stands as a large red and beige brick at the corner of Harbord Street and Spadina Avenue, accessible for students and Toronto residents alike. Classes, training sessions, and drop-in programs are available to all members throughout the week.

The building hosts more activities, people, teams, and classes than I will be able to list. Even though indoor track season and a wide assortment of activities at the AC can create a sometimes hectic environment, it goes to show that the gym is incredibly well-used. National swim meets and track meets have been hosted by the AC. Olympic and professional athletes go through its doors to use the facilities.

It holds an Olympic-sized pool, a smaller pool, three different basketball gyms, a gymnastics room, a dance room, a fencing room, squash courts, ping-pong rooms, and spacious locker rooms. Members of the AC create a welcoming mix of young and old people who get to come together and use the facilities to gain strength, play games, swim, run, and much more.

Starting at the third and highest floor is the field house: a large room with a 200-metre track surrounding four full-sized basketball courts. On the edges, there are various workout machines that are almost always available for use.

If you want to play basketball, volleyball, tennis, or attend drop-in classes like Zumba, be sure to check the AC’s online schedule and look at some class reviews in The Varsity.

If you’re into basketball, after 4:00 pm, there is almost always at least one court available for basketball, but on Monday through Thursday after 7:00 pm, there are always intramural basketball games while classes are in session.

Also, before waltzing onto the court, be careful and look both ways! There are often incredibly fast members of the track team sprinting, older gym members trotting, or young children running on the track, none of whom you want to bump into.

On the edges of the field house, there are several mysterious big yellow doors. Most of them lead you outside of the building, so to all the explorers reading this: be warned, for you may end up outside in the cold wearing your gym clothes. If you have any other questions or concerns about using the field house, you can always consult a blue shirt for assistance.

The second floor has an additional basketball gym where the varsity basketball and volleyball teams used to play before the Goldring Centre for High Performance Sport was built. The gym now hosts the badminton program, field hockey practices, and various other programs and teams throughout the week. In addition, there is the Clara Benson student lounge, a dance room, and many offices.

The first floor welcomes guests with friendly staff at the help desk where there is a customer service desk to talk about membership, a café, a lobby with couches, and the pool gallery. However, the strength and conditioning centre is the cornerstone of the first floor.

This is where people go to improve their strength using a wide array of push, pull, and lifting machines. There are plenty of free weights and benches for nearly everyone to use the weight they need. This part of the gym tends to get very busy, but most exercisers are very cooperative and friendly when asked to share equipment, so feel free to communicate with your fellow gym-goers.

Staff members in red shirts keep track of how many people are in the room and ensure that people are using equipment properly and wearing close-toed shoes. When it gets full, they will post a sign telling members that they are at capacity, and members must wait until some people leave. Unfortunately, there is no natural light, and the lighting is very white, which can turn some gym-goers away.

The sweaty smell and stuffiness can become overwhelming, so if some of your workout can take place elsewhere, I recommend retreating upstairs to the field house. Or you can take advantage of women’s only hours or quiet hours to make your workout experience more peaceful.

Once again, if any challenges arise or if you have general questions while working out, staff members are certified physical trainers and will always be happy to give some workout advice or act as a spotter.

Finally, we enter the basement. The basement has both men’s and women’s locker rooms, which include showers and steam rooms. This is also where to go when accessing the pool deck. Also hidden along the east side of the building’s bottom floor are the fencing and gymnastics rooms, which I will not attempt to explain how to get to.

As a basketball player, occasional exerciser, and staff member at the AC, I am incredibly grateful for the recreational space that it has provided me, and for the friends I have met while playing and working there throughout my years as an undergrad.

Disclosure: Isaac Consenstein works at the AC.

The importance of stretching

Here’s what to do after you finish a workout

The importance of stretching

After hammering out your cardio, lifting weights, and giving your all at the gym, don’t leave without giving your body the proper cool down it deserves. Proper stretching is easily overlooked, but it is just as important as the main workout itself.

Completing a stretch sequence after a workout has its benefits, and your muscles will thank you for it. Cooling down after a workout brings your body back to a natural climate, while also helping to relax your heart rate. By dedicating five or 10 minutes to low-intensity stretching or activity, you’ll be giving your body some additional time to recover.

For a cool down, consider light stretching or walking for five minutes until your heart rate falls below 120 beats per minute. Stretching should be held for 10–30 seconds, and the key is to remember to breathe.

Stretching properly after a workout will not prevent pain entirely, but it will minimize muscle soreness. Stretching helps eliminate lactic acid that the body produces when muscles are exhausted, which in turn relaxes them.

When muscles are used repeatedly in a workout, they quickly tighten, and light stretching is a way to relax them and prevent injury. In addition, through the cool down, you can gain increased muscle flexibility by targeting muscles that will generate a greater range of motion. You can also prevent injury by relaxing the contracted muscles.

The process of cooling down is just as important as warming up, as stretching also relaxes your mind and relieves stress. Furthermore, it is a way to be more aware of your body and respond to its needs after working out.

The year of you

Five steps to making a positive outlook permanent

The year of you

What if I told you that you had the power to make 2019 the year of you? Ultimately, your outlook on 2019 can only shift when your mindset does. A properly fuelled body and positive mindset will work wonders for an overall state of healthy well being and mental health.

To improve your mood, mindset, and achieve peak productivity, here are five things you should turn into habits this semester.

A positive outlook starts with you.

1. Be positive

Research shows that the way in which we think about ourselves can have a powerful effect on the way we feel. According to Psychology Today, “when we perceive our self and our life negatively, we can end up viewing experiences in a way that confirms that notion.” Be patient with yourself and write down realistic steps to achieving personal goals.

2. Exercise

Go out and be active! Dedicate a minimum of 30 minutes a day to physical activity and your mind and body will feel refreshed. While working out, our bodies release stress-relieving and mood-boosting endorphins, making exercise a powerful way to relieve stress, anxiety, and depression.

3. Go to bed on time

Research has shown that not getting enough sleep has a negative impact on mood. Caffeine is just a temporary fix for not dozing off in class, and I’m sure a lot of us can relate. Maintaining a pattern of sleep and a technology-free hour before bed can make a huge difference.

4. Take a break

While the life of a student is an extremely hectic one, it’s important to take a few moments to breathe and relax. Utilize study breaks and listen to the needs of your body and mind. When you feel stressed or overwhelmed, take the necessary time to breathe.

Taking a step away from whatever is stressing you out will result in you coming back to the issue more clearheaded.

5. Be social. Laugh!

People function better when they have strong social ties with friends and family. Positivity is contagious when you surround yourself with the right people. Create lifelong memories and be sure to laugh as often as possible, as laughter can reduce stress and increase your ability to learn.

Menstruation frustrations

A cycle of quiet suffering on campus

Menstruation frustrations

Several days ago, I was having a conversation with my friends about the worst bathrooms we have seen so far at U of T, and while some of the characteristics that came up were expected — such as laughably-bad lighting, poor design, and lack of hygiene — a recurring theme also emerged: most of the bathrooms mentioned were not designed with menstruation in mind.

Whether it is dim lighting or cramped space, these spaces are already frustrating on a regular day, but when it comes time to deal with all of your period blood, the ridiculousness of the situation becomes even more evident. Since these unpleasant and tough situations only come about once a month, it seems much easier to just forget about those problems entirely.

This perspective is often shared by those who don’t see the value in investing in better bathrooms or creating better policies. In high school, my friends and I would have issues keeping up with school events and exams while dealing with our periods, but we were advised to “just deal with it,” since the ‘issue’ would go away in a few days and then we could forget about the problems until next month. But the real systemic issues never go away: somebody is always going to be menstruating, and members of the community will continue experiencing the same problems day by day unless the problems are addressed.

Although the taboo surrounding menstruation has lessened quite a bit over the last few decades and conversations surrounding it have become quite normalized, important changes have yet to be made with how the topic is handled. One would expect U of T to be better at this than other institutions, given its work on inclusion and its position as a global leader, and yet it still fails to have the most important conversations surrounding menstruation and provide appropriate avenues for support.

On a small scale, it’s generally much easier to have conversations about menstruation face to face, but even that approach has its own difficulties. How comfortable can it be to approach an old, male professor to talk about your bodily functions? In any case, these face-to-face conversations are nearly impossible at U of T, where classes are being taught to over 90,000 students every semester, making staff members even harder to communicate with and access.

But why are we even having these conversations? Why can’t we “just deal with it” and move on with our lives? Shouldn’t we be used to it by now? Can’t we just go to the doctor and get our problems permanently fixed? Why is menstruation such a big deal?

Well, periods can range from merely irritating to debilitating, and they don’t stay the same from month to month, much less throughout one’s lifetime. Along with a loss of blood, accompanying symptoms include headaches, exhaustion, cramps, nausea, light-headedness, and even fainting. There are several options to deal with these effects, such as birth control pills or painkillers, but the fact of the matter is that for many people, menstruation is difficult to endure, and no matter how many times they experience it, there’s still no guarantee that they’ll be prepared.

What are the systemic challenges that can be expected for someone getting their period at U of T? Let’s say that you go to the bathroom half an hour before the beginning of a midterm, and you’ve been feeling a bit off all day. You realize that you’ve gotten your period early and you’re completely unprepared: you don’t have anything to stop the flow and you’re freaking out in your stall. While U of T bathrooms have sanitary waste disposals for period products, some bathrooms don’t have operable pad and tampon dispensers, with some appearing to have been around since the dawn of time.

So, instead, you can ask a friend, or even a stranger, if they happen to be carrying a tampon or a pad. But this isn’t high school; your friends might be in a class on the opposite side of campus or there might not be anyone around. If you want to buy period products, you’ll likely have to go to the nearest drugstore, since they’re not nearly as easy to get on campus as free condoms and lube. As a last resort, you may be left relying on paper-thin toilet paper, an option that is used far too often, even in today’s day and age.

Now that you’ve successfully staunched the flow, you start feeling those dreaded cramps, and nausea on top of that too. What can you do? Perhaps you can buy some painkillers and ginger tea, but your midterm is now in 15 minutes and you know that it might take up to an hour for those cramps to go away, even with the painkillers. If you take the midterm, there’s a chance you’ll screw something up because of the pain, but there’s also no guarantee that you’ll be able to take a makeup test.

It’s generally more likely that you’ll be allowed to reschedule the test last-minute if the class is a small one, but for larger classes, you might run into trouble; some courses require valid documentation to be sent within 24 hours of a missed test. This documentation should either be the equivalent of a doctor’s note or a note from your college registrar, and missed labs require a doctor’s note. It’s easy to see why this system is flawed: doctor’s notes can be bought and faked; some doctors give notes too easily, while others never give them; and ultimately, pain is difficult to prove in any circumstance.

It’s challenging to figure out how the rules should be fixed, since a balance should be maintained between not encouraging people to lie about their pain, while also helping those who really are experiencing it. In terms of solving these bathroom problems, all bathrooms on campus should meet certain standards. All stalls should contain proper sanitary waste disposal, and functioning pad and tampon dispensers. For such a necessary part of daily life, menstruation products are quite hard to find, and U of T certainly isn’t making it any easier to get them where they’re most needed.

How should we start addressing these concerns? First, we should acknowledge the problems and ask students and staff what changes they want to see across campus. Then, the bathrooms on campus should be improved, starting with those in colleges and buildings with higher foot traffic. Course and testing policies concerning sudden illness should be updated, and U of T should explicitly outline what measures should be taken when conflicts arise between schooling and personal health issues, such as those brought about by menstruation.

It’s important to realize that most of the people dealing with these issues are female, and failing to address them would mean giving half the students at U of T, around 45,000, a systemic disadvantage. The issues aren’t going to go away by themselves, and it’s incredibly easy to forget about them unless it happens to you. Once you start noticing flaws in U of T’s system, though, it’s impossible to stop, and every time you count yourself lucky for not being stuck bleeding in that dark, cramped bathroom in the basement, you’re neglecting to realize that your inaction only means that someone else will experience it instead.