May 24, 2018

Dr. Jones: We know as women that the effect of trauma that happened to us when we were younger echoes throughout our biology and our psychology for many years if not, all of our life. What do we know about this? How can we look at it more carefully? How does it affect our health? This is Dr. Kirtly Jones from obstetrics and gynecology at University of Utah Health and this is "The Seven Domains of Women's Health" on The Scope.

Announcer: Covering all aspects of women's health. This is "The Seven Domains of Women's Health" with Dr. Kirtly Jones on The Scope.

Dr. Jones: Trauma, sexual trauma, psychological trauma, and even trauma to children, and trauma in utero, we become more and more aware of how trauma echoes through our health in many ways throughout our life. Today in "The Scope" studio, we have Dr. Leslie Halpern. Now, she is a doctor and a dentist and is here to talk about her interest in neuroscience and the long-term effects of trauma on women's health. Thank you for joining us in the studio.

Dr. Halpern: It's my pleasure to be here.

Dr. Jones: Tell us a little bit about your interest in women, health, and trauma.

Dr. Halpern: Well, within my own life, I have had suffered trauma indirectly, but it left an impression on me as both a female and as a healthcare provider. When I say that, I really talk about violence and abuse. My only sister at age 23 was brutally raped and murdered right before her wedding day. And it was very hard. It was very life changing, which makes sense when you're a family member.

Through my education, and with that experience and my passion for health, I became an oral maxillofacial surgeon. And I trained in an inner city, in New York. And there was another incident that sort of really kept my passion to look at victims.

There was a woman who came into our emergency room on a summer afternoon. Her husband had boxed bladed her face, and it took me several hours to suture her wounds. And I said to her, you know, "You don't have to go home. We have social services here and you can be safe with your family." And she said, "No, no. My husband didn't mean it. My children are home, and I know he loves me."

Well, when you're an intern in the emergency room you just say, well, you know, you spoke to the patient, you did your due diligence, and now, you're on to the next patient. Three days later I was on call and the head of the emergency room came in and said, "Dr. Halpern, do you remember Mrs. so and so?" I said, "Yes." He goes, "I want to show you something." Of course, I as an intern thought that there was something wrong with the wound.

He brought me into our trauma room and the patient was on the table with a sheet over her. Her husband basically finished what he started. And this really sealed my passion to make a difference. I was fortunate to be involved with a grant, a large grant from the Oral and Maxillofacial Surgery Foundation with my mentor, Dr. Thomas Dawson, who asked me to develop a diagnostic protocol.

Now, dentists are in the most pivotal position to diagnose patients, because 75% of the injuries are to the head, neck, and face. So it's intuitive to be able to apply our knowledge and identify more patients. We developed a protocol, which I'm very happy to say increased our prevalence rate of identification.

But you identify and everybody says, "Well, so what?" And this is in relation to your original comment about how does trauma impact the future. Well, violence and abuse is associated with chronic illnesses that can decrease a victim's lifespan. And my background as both a researcher and clinician has afforded my colleagues and I to develop grants in order to look at exposure to intimate partner violence and its effect on health.

We know that women and men react very differently to stress. And specifically the inflammatory cascades in women are more irreparable with damage than they are in men. And I see that in the maxillofacial injuries that I treat in men and women. And it gets again into sex and gender in medical treatment that women will respond differently. They present with different symptomatology than their male counterparts do. So the female model for a post-traumatic stress disorder is a more complex type of model, and you have to be more vigilant as a physician.

Dr. Jones: So when you have a new patient or someone or you as a woman are coming to see your physician, you don't always say this, "You have to understand this one thing about me. I was sexually abused or I witnessed trauma, and I've never been the same." They won't do that. They're hoping, like my conversations about sex, they are hoping that maybe you'll bring it up. But in fact, we don't always. We're interested in someone's heart disease or cholesterol. But it turns out that you found that the long-term consequences of these horrible events have effect on the heart and have effect on inflammation for the rest of a woman's life.

Dr. Halpern: And it's all about how to approach the patient, number one. And many practitioners are very hesitant to approach patients and ask them, because they're too busy, they are worried about litigation, or they themselves have been victims of abuse and do not want to go back there again.

Dr. Jones: Oh, that's an interesting one.

Dr. Halpern: Yes. And it has been shown when many health practitioners are questioned around the country. So we try to do it indirectly. As I said previously, there are certain common chronic illnesses from cardiovascular disease to GI to GU to reproduction. And what we have tried to do with our group is to use some type of a diagnostic indicator that can help us follow progression of disease.

In the field of oral health, the advantage that we have is that we can apply a non-invasive method. We utilize saliva. Okay? And people aren't afraid to "spit in a cup." Some of the projects that I've done have looked at victims who have been exposed to intimate partner violence versus those that have not. And I've utilized cardiovascular disease markers just to get a trend. Okay? And what I found are significant differences not only between victims that show a positivity towards intimate partner violence, but differences between different ethnicities of women.

What I have seen in treating many women is that the cultural competency, if I can use that term, of violence and abuse within their community is a norm. My grandfather beat up my grandmother, my father beat up my mother, so it's okay that my husband does the same to me because this is part of their life.

Dr. Jones: So women talk about their hair differently than men, and they treat their hair differently than men. And it's often been the phrase crowning glory has been used to describe women's hair. But it turns out that we push out this hair for years if you have really long hair and you mentioned you've been using . . . some research using hair as a way of looking at these markers.

Dr. Halpern: Yes. I think hair is the hidden secret in a way because we also have looked at the amount of cortisol which happens to be found in the hair. Hair is a wonderful depot for cortisol isolation. Cortisol . . .

Dr. Jones: Cortisol is a stress hormone.

Dr. Halpern: Yes.

Dr. Jones: We make it normally. We make it differently throughout the day. But if we have three or four years of hair, one could maybe slice it up in little bits and say, "Oh, what happened to you in 19 whatever or 2005?"

Dr. Halpern: I've never thought of it as a timeline.

Dr. Jones: Oh, but I think it could be.

Dr. Halpern: But it gives me another idea for a grant.

Dr. Jones: Well, heavy metals, we know that people put heavy metals, which are toxic to our body, we put them in our hair. And then of course, what about women who color their hair? Maybe all those coloring, even women with natural hair or even women who color their hair, God forbid, anyone would look at my hair and figure out anything.

Dr. Halpern: That makes two of us. But yes, you know, that is definitely a truism. But, you know, we are looking for biomarkers.

Dr. Jones: Biomarkers.

Dr. Halpern: And the reason why we're looking for them because we want to try to determine an interventional strategy. And when you're an adult and you've been exposed to violence and abuse, the damage is done in a way. And you just try to intervene secondarily. But what we are now looking at is we're going back and looking at children. It is well known that children who are exposed to violence and abuse are susceptible to adverse health events sooner in their life than their counterparts who have not been exposed.

Dr. Jones: Right. They are more likely to have obesity, hypertension, diabetes, depression, suicide, substance abuse, difficulty in school. The list could go on and on. So, if you could figure that out in kids, because maybe the parents won't say or the kids won't tell, then we'd be able to help kids give words, help them, mindfulness maybe to calm. Who knows.

Dr. Halpern: Yes. And taking a sample such as a saliva and being able to map a temporal timeline of exposure to the marker that would allow for intervention would be a wonderful finding. And some of my colleagues are indeed doing that.

Dr. Jones: That's been very helpful, and I'm encouraging everyone to keep tuned because this is going to be an ongoing effort for all of us who take care of women and children and men. And I think what we try to do is identify people so we can build resiliency so that their health and they can rise above the issues that happen to them when they were younger. And their health can continue to be as strong as it can be given some very unfortunate situations that happened before. And I want to thank you for being here in the studio and thanks for joining us on The Scope.

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