Dr. Cranquis' Mumbled Gripes

Using Emergency Contraception (while on the Pill)

Hey doctor! Hope your week is going well.
My boyfriend and I have been seeing each other for about 15 months and we have sex regularly. He always uses a condom and I’ve been on the pill (Ortho Tri-Cyclin) since I was 14, and I’m almost 21 now.
A couple times the condom has broken and we are pretty paranoid about not having kids. Each time it has, I always went to the pharmacy to get the Plan B pill. My boyfriend begs me to get it every time the condom fails, but I don’t really think it’s necessary since I’m already on the pill. Plus, emergency contraception is expensive. This is only happened twice, but I don’t know if it’s dangerous for me to keep taking Plan B when I’m already on the pill
If the condom ever breaks again, should I take emergency contraception just to be safe? Do you think it’s necessary since I’m on the pill? Can taking Plan B multiple times mess up my hormones? Thanks for your help :) 

Dear Uterus Securitus,

Let’s put this into terms that your boyfriend will understand easily.

• Using a condom (male or female) when the female is already faithfully using a hormonal contraceptive (pill, patch, ring, implant, IUD, etc) is like wearing a belt along with a pair of suspenders. Not strictly necessary, but it can’t hurt.
• Requiring that same woman to also take emergency contraception (such as Plan B, which is just a double/triple-dose of the same hormones that are in The Pill) if the condom breaks is like using a nail gun to make sure the pants are securely attached to your hip bones.

Seriously, though, it’s major overkill! In fact, even if you had already missed 1 dose of your daily pill prior to having The Condom-Destroying Sex, most literature does NOT recommend taking Plan B in that situation either!

Fun fact: in countries/cultures/situations where an Emergency Contraception (EC) pill isn’t available/allowed/whatever after unprotected sex, certain types of The Daily Pill can be MacGyvered into acting as Emergency Contraception by taking extra doses at certain time periods. Some details on that here.

Taking Plan B multiple times in your life won’t “mess up your hormones” or do any lasting damage to you, but if you’re taking it simultaneously with a daily hormonal pill, you will be exposing your body to more hormones overall, which I never recommend if it can be avoided.

In summary: the only extra pill needed in this situation is a chill pill. For your boyfriend. :)

***Pending Cranquis-Mails: 5; Inbox: Closed***

MANLY MULTIVITAMIN

I took a male One A Day multivitamin that was in my brother’s room for giggles and he screamed at me saying it was made specifically for men. Are these multivitamins that bad that if I take them I will produce more manly things (sorry for the lack for medical terminology) since I am a female? 

OH EM GEE! HOW DARE YOU INSULT ALL MEN EVERYWHERE BY USING A MEN’S MULTIVITAMIN! IS NOTHING SACRED TO YOU FEMALES ANYMORE? YOU GET THE RIGHT TO VOTE, AND THE RIGHT TO DRIVE, AND THE RIGHT TO WEAR JEANS… OUR MEN-ONLY MULTIVITAMINS WERE THE LAST BASTION OF MASCULINITY LEFT TO US! 

*falls off chair giggling* 

Sorry, that was the first thought that ran through my head, picturing your brother “screaming” at you for taking a MEN’S product. But, let’s approach this logically: go sneak in your brother’s room and get ahold of the vitamin bottle, then come back to the safety of your computer. Ok, you back? Read the ingredients — they’re probably similar to this list:

Calcium Carbonate, Magnesium Oxide, Microcrystalline Cellulose, Ascorbic Acid, Croscarmellose Sodium, Gelatin, Maltodextrin; Less than 2% of: Beta-Carotene, Biotin, Cholecalciferol, Chromium Chloride, Crospovidone, Cupric Oxide, Cyanocobalamin, D-Calcium Pantothenate, dl-Alpha-Tocopheryl Acetate, Folic Acid, Hydroxypropyl Methylcellulose, Lycopene, Manganese Sulfate, Niacinamide, Phytonadione, Polyethylene Glycol, Pyridoxine Hydrochloride, Riboflavin, Silicon Dioxide, Sodium Selenate, Soybean Oil, Starch, Stearic Acid, Thiamine Mononitrate, Triacetin, Vitamin A Acetate, Zinc Oxide.

Do you see “testosterone” in that list? No? That’s not surprising, since testosterone is a male hormone which is carefully regulated… since if a woman were to take testosterone, manly things would start to happen. And logically, with all the money to be made from a gender-change procedure and accompanying hormonal therapies, do you really think the pharmaceutical industry would allow an over-the-counter multivitamin company put ANYTHING in their products which would affect a person’s gender? :)

Naw, the reason you see “women’s” or “men’s” or “prenatal” multivitamins is because they contain slightly different ingredients (or sometimes, just different concentrations of the same ingredients) to better support that particular target audience’s metabolic processes and physiological needs. So have no fear: your ovaries are gonna be staying inside your body for the foreseeable future.

Now, go put that bottle back in your brother’s room. And if you ever catch him taking your prescription birth-control pills, DO yell at him: those things have female hormones, and could really jack (jill?) him up if he kept at it!

***Pending Cranquis-Mails: ZERO; Inbox: Still closed; Cranquis has been out of town this weekend, so he might re-open the inbox Sunday evening November 6, otherwise sometime on Monday November 7. Further announcements to come.***

VOICE TROUBLE?

Hey Cranquis!

I am a (was?) a singer. I noticed that my vocal range was seriously cut down when I was pregnant, but I just attributed the change to having a rather large little mooch crowding up my organs and squishing my diaphragm. However, after I gave birth to said little mooch (who is recently a year old! Sorry for the proud mama moment), my voice took a turn for the worse. My voice cracks now when I try to sing and sometimes talk, I sound like a pubescent boy! It’s really embarrassing and hasn’t let up in the past year at all.

My question for you: what in the world happened to my voice? Can it be fixed?? 

Hey now, no need to apologize for being a proud parent! If that’s your lil’un in your Tumblr icon, he/she sure is kay-ute! If I wasn’t so gol-darned stubborn about hiding my identity on this Tumblr, y’all would be forced to endure an unending barrage of Baby Cranquis pictures! (Seriously, at last count my iPhoto contains 1,600 pictures of my 16-month old son. Dat’s a lotta picshures.)

But I digress. Now let’s clarify your question — there can be crucial differences between “losing your vocal range” and “having a pubescent-like cracking voice”. Both can be caused by the hormonal changes which take place during and after pregnancy (particularly in women who breast-feed: lady-hormones linger longer while lactating!). Along with the “crowding of the diaphragm” effect, the blood vessels into the sinuses become a bit dilated and congested, causing changes in vocal tone and range.

Your cracking/hoarse voice is a bit more concerning. Causes could include simple irritations from acid reflux or post-nasal drainage, or more troublesome problems like vocal cord nodules or vocal cord paralysis. Vocal cord nodules and cysts can happen to anyone, but more often to people who sing or scream a lot. Vocal cord paralysis can happen from viral infections, masses, surgery, or trauma. An ENT evaluation might be useful to evaluate for these. (And not to frighten you, but persistent voice change/hoarseness can also indicate laryngeal cancer — which an ENT can also evaluate for.)

Can a hoarse voice be fixed? Depends on the cause: possible treatments would range all over the place (acid-reducing meds, sinus rinses, voice rest [HA! Fat chance for a momma of a 1 year old!], speech therapy, singer’s vocal therapy, surgery, other options). So you may want to discuss this with your primary care doc, and consider getting a ENT consult. Good luck, and enjoy that cute bebeh.

***Pending Cranquis-Mails: 3; InBox: Closed***

What a fascinating question! You’ve got me curious: are you just asking “for the heck of it”, or do you plan to apply this knowledge as part of a diabolical scheme to take over the world by lowering the intelligence of 90% of all humans to less than that of a lab rat? (If so — too late. ZING!) 

Oh well, regardless of your nefarious plans, here’s the list I came up with (without doing any Googling to refresh my memory — ooh, hey, that could be another cause of decreased intelligence: over-reliance on the internet to do your memory-storage for you!). Physiologic ways to lower your intelligence:

• Concuss yourself repeatedly — Every concussion increases your chance of suffering Traumatic Brain Injury and subsequent deficits in scholastic performance. (Yay, American football!)
• Increase the pressure of the CSF around your brain — Your brain floats in a bony vat filled with Cerebro-Spinal Fluid, like a manatee in a pressure chamber filled with snot. (And the award for Most Apt yet Least Appealing Metaphor goes to…) If the fluid pressure goes up (either by over-producing it, or by blocking the normal exit portals into the spinal column), and the body can’t compensate by reabsorbing or slowing production of CSF, the poor manatee brain gets squooshed upon. This is, obviously, bad for brain business.
• Eat lots of cholesterol, salt, and fat, then sit back and wait for all sorts of different strokes to happen: Ischemic strokes to block blood supply, hemorrhagic strokes to unleash a flood of devastating blood directly into the brain tissue. What-choo talkin’ about, Circle of Willis?
• Let your hormones go wacky. By “hormones” I mean “all the fun chemicals controlled by your endocrine glands.” Screw around with the default settings for your thyroid, pancreas, adrenal glands, and see what happens! Have you ever seen someone trying to function while hypo/hyper-glycemic? Fun times!
• Let the wrong ones in (to your brain). Parasites, bacteria(e), virus(es), fungus(uses) — they all love to eat, squish, liquefy, over-heat, and generally muck-up your brain tissue. Encephalitis, brain abscesses, meningitis, parasitic cysts… isn’t nature just awesome?
• Hyperhormonal Peri-Pubertal Mammarophilia(tm). (Technically not a disease, just a normal stage of growing up — but DANG, teenaged Me made some stupid choices under the influence of Raging Hormones + the nearest pair of breasts.)
• Probably others that I can’t remember, but which my Constant Readers will probably mention in the reply or Disqus sections. (Me, lazy? How dare you! Why I oughta… eh, who am I kidding, I’m gonna go play video games now.)

Hope that helps! Remember me on the day you assume control of the world!

***Pending Cranquis-Mails: 2; In-Box: Closed — but while you’re waiting, you may wish to check out the free TumblrMSG program, which I will be test-driving during the next Open In-Box period in a few days!***

Tough to say, Cramp Counselor — but the recent change of pain, including mood swings and headaches, sure doesn’t sound right to me either!

It could be that you’ve just become over-sensitive to the hormones in the birth control — but what about endometriosis? If your body is growing additional areas of hormone-sensitive tissue, this could make your menstrual pain worse. A doctor could evaluate you for this with blood tests, a pelvic exam, and an ultrasound or CT scan of your pelvis/abdomen.

Or what about ovarian cysts? A pelvic exam and ultrasound would show this.

These diagnoses might not fit all of your symptoms, but I think you should ask your doctor about them and discuss what else to try for your problem. At the very least, you may need to try changing or discontinuing your hormonal birth control for a while. Perhaps using a hormonal birth control to completely skip 3-6 periods could help? Good luck!

***Pending Cranquis-Mails: 7; Ask Box: Still closed — that lazy Cranquis is still on vacation until the last week of July.***

Hmm — well it sure sounds like your body is quite hormone-sensitive, Pogo Yo-Yo Bungee Jumper! And with the presence of these emotional “swings”, I don’t think you can just chalk up your year-long amenorrhea (absent periods) to being “highly athletic.” A medical evaluation, including a physical, blood testing for thyroid/blood sugar/female hormone(?) disorders + some screening for psychiatric issues like depression and anxiety, is at the top of my advice list!

Good luck…

***Pending Cranquis-Mails: 12; Ask Box: Closed until Cranquis comes home from vacation, last week of July.***

Hola, Igor the Irritable! Glad you’re enjoying the blog — and I think your hunch is worth considering! (Get it? Igor? Hunch? Eh… sorry.)

Did your doctor consider Polycystic Ovarian Syndrome when she did your work-up? Did she check your sex-hormone levels? Did she talk about getting an ultrasound of your ovaries? You sure have a lot of symptoms that sound like they could fit with PCOS, or other metabolic/hormonal syndromes (Cushing’s, adrenal hyperplasia, others):

• Hair and skin problems
• Libido issues
• Mood changes or fatigue? (Not sure what you mean by “being crank in the morning.”)
• Family history of being overweight

If you have irregular or absent periods, or if you have had problems with unexplained weight gain, you really should talk to your doctor about PCOS, or consider getting an endocrinology consult. Good luck!

***Pending Cranquis-Mails: 13; Ask Box: Closed while Cranquis is on vacation in France, returning last week of July.***

Well, Clot or Not, I don’t know what effect (if any) hormonal oral contraceptives (OCPs; The Pill) would have on your neurocardiogenic syncope (vasovagal). But first off, be aware that there are non-hormonal methods for effective birth control, and that the condom method can be reliable if used correctly (although these methods are statistically not as “baby-proof” as the hormonal methods).

And another thing: the D-dimer is used as a part of determining your “chance” of having a blood clot at the time of the test, but it does NOT conclusively prove that you have a clotting disorder. As this excellent (and funny) blog post from Life in the FastLane describes, there are many other causes for an elevated D-Dimer besides “having a clotting disorder”, including some causes which are not pathological (being elderly, African-American, pregnant…).

So, that being said — your doctor should review your risk factors for hormonal birth control, and might do some blood testing based on your D-Dimer history (but it probably wouldn’t be a D-dimer test; more likely a PT/PTT or other tests which measure your body’s clotting-pathway function). While all of the hormonal methods are considered highly-effective (see that chart I linked), all hormonal contraceptives have greater chances for side effects than non-hormonal methods. So you and your doctor must decide what risks are acceptable to you, and then pick a contraception method accordingly. Good luck!

***Pending Cranquis-Mails:16; Ask Box: Opening after 1 more question!***
 

Well hello again, Lunar Rover — well I agree, I think your weight gain is at least partly due to the hormonal Oral Contraceptive (OCP) you’re taking. And looking back at your prior question, I wonder if part of the reason that you’ve gained so much weight is because you were skipping the placebo/sugar pills in order to skip your periods? Your body didn’t get any vacation from the hormones, so it had more hormonal stimulus to continue gaining weight!

If you stopped using hormonal methods of birth control, I would expect your weight to drop some — but I don’t know if you’d go back to your baseline weight or not. After all, you ARE fighting against your genetics too! Stopping all hormonal methods could help, but that would also mean having your period every month again — so I guess you have to decide which outcome is more important to you. Again, I encourage you to discuss your contraception/menstrual-related concerns with your doctor, since you’ve got a lot of factors to consider here. Good luck!

***Pending Cranquis-Mails: 27; Ask Box: Closed***