Women's Health and Lifestyle

Note to reader: This section has interesting and some important information bites that you may not have read elsewhere. It is in no way an exhaustive exploration of women's heath issues. In the near future we plan to add a "Wellness" section that looks at lifestyles affect on women's health. This section is sorted alphabetically by topic.

JUST WHEN YOU THOUGHT YOU WERE DOING PRETTY WELL 
According to a study in the Archives of Internal Medicine, only 3% of Americans hit all four points that add up to a “healthy lifestyle” – and these four points are 1. Non smoker, 2. Maintain a healthy weight, 3. Eat the minimum of recommended 5 servings of fruits and vegetables and 4. Exercise for at least 30 minutes, 5 times a week.   On the good side, 76% of Americans don’t smoke, on the not so good side only 40% of us maintain a good weight and less than a quarter of us get the recommended fruits and vegetables (23%) and regular exercise (22%).  About 14% of us hit three indicators, and 34% hit two. Hitting all four points has been shown in several studies to reduce the risks of heart disease and diabetes.  Not hitting these four points is a true contributor to the high cost of our health care.

Not surprisingly, women faired better than men – 4.2% of us hit all four points compared with 1.9% of men and higher income households (5%) and college graduates (5%) did slightly better.   Maybe this is why they revamped the food pyramid…
http://archinte.ama-assn.org/cgi/content/abstract/165/8/854

Bone Health

ONE HALF OF INDIVIDUALS OVER 50 ARE AT RISK FOR FRACTURES
from osteoporosis.  Any man or women with low bone mineral density (BMI) is at higher risk This article confirmed that black women with a lower bone mineral density also had a higher risk of fracture.  Differences became apparent when researchers compared the fracture rate of African American Women compared to that of white women with similar BMI’s – the fracture rate among black women was 30-40% lower, which is quite significant.  In other words, among black women and white women with the same profile and risk of fracture, the black women don’t incur non-spinal fractures at nearly the same rate.

Researchers are speculating that black women may have lower bone turnover, better repair, a difference in hip axis or bone size differences.  However, there may be biological markers that are shared by both groups women, like bone metabolism, more prominent in black women that may account for the lower rate.  Stay tuned, these women may very well hold a key to a better understanding.
http://www.4woman.gov/news/english/525474.htm

Newsletter May 2005

A CALCIUM/IRON BALANCE MAY MAKE BONES STRONGER
in women in the 40's - 60's according to a study conducted by the Universities of Arizona and Arkansas along with Columbia University. The study of 250 women showed that those who consumed 18 mg. of iron had the greatest bone density but this only held true for women who consumed between 800-1200 mg. of calcium per day - more or less calcium and that much iron did not appear to help. (8 mg are recommended for women who have stopped menstruating) The reason that iron plays a role is that it promotes the production of collagen, a central component of bone. The reason that the balance must be maintained is that calcium and iron can compete with each other for absorption by the body and too much or too little of one or the other can apparently throw things off. The mineral iron is particularly well absorbed when consumed with food that contains vitamin C. Iron can be toxic and cause constipation, so care should be used. One note: iron may simply be a marker for good bone protecting diet as many other nutrients are important for good bone health like vitamins D and K. Source: Tufts University of Health & Nutrition Newsletter January 2004

Newsletter May 2003

MENOPAUSAL BONE LOSS MAY BE CONNECTED TO HIGH BLOOD PRESSURE
An interesting study was published last month in JAMA. It theorizes that when a perimenopausal or menopausal woman loses bone mass, there is an increase in the amount of skeletal lead in our bodies. Lead exposures have been linked to hypertension and high blood pressure in older men. It is now suggested the same is most pronounced in post-menopausal women. For more information
http://jama.ama-assn.org/cgi/content/abstract/289/12/1523

Newsletter April 2003

Contraception

BIRTH CONTROL PILLS AND DEPRESSION
This is a single article that I came across this past month that impressed me the most.  I tend to respond strongly to things that we women know intuitively even though the science may say the opposite.  This is an example.  I’m not sure if there is a lot of science on this issue and we just haven’t seen it but it certainly doesn’t seem to me that occurrence of side-effects from the pill have been adequately addressed.   I certainly understand that one study doesn’t prove anything but I’m hoping more people notice this issue and we begin to move it in the right direction. 

As pointed out in this article, there has been anecdotal evidence that women taking the pill have a higher incidence of depression.  It is also a known fact that production of related hormones such as estrogen, progesterone and testosterone play a significant role relating to serotonin levels in the brain.  Serotonin levels are a known factor relating to depression.  Further, we know that hormone fluctuations during pregnancy and menopause can cause significant mood changes, how are birth control pills any different?  Are they not an artificial manipulation of hormones?  And let’s not forget that in some cases the change in mood is markedly for the better. Unfortunately, it appears that this is not the norm. 

This article highlights a study that was conducted in Australia as well as a survey the website conducted on it’s own having received an overwhelming amount of emails on the issue.  The Australian study found the following:

“Results showed women using the Pill had an average depression rating scale score of 17.6, compared to 9.8 in the non-user group. The women involved in the study were aged over 18, not pregnant or lactating, had no clinical history of depression and had not been on anti-depressant medication in the previous 12 months.”

The website survey found:

“57 percent of respondents reported mood swings, 63 percent were irritable, 65 percent experienced irrational crying, and 69 percent felt anxious and depressed after taking hormonal contraceptives.

Furthermore, of the 66 percent of respondents who stopped taking hormonal contraceptives because of side-effects, nearly two-thirds noticed partial or complete recovery from their symptoms.

Other statistics from the survey revealed that 73 percent of respondents stated hormonal contraceptives had a negative impact on their lives, and over 50 percent of respondents who were taking anti-depressant medication were doing so to treat depression that occurred after beginning hormonal contraceptives.

…Perhaps even more worrying than the number of survey respondents experiencing negative side-effects after taking hormonal contraceptives is the fact that nearly 70 percent of them claim they were not warned of the possible hazards by their doctors.

There is also evidence from the survey that indicated many women believe they were not taken seriously when speaking to their doctors about their symptoms. It appears that with no concrete medical evidence to prove otherwise, some doctors do not believe their patients claims of mental health problems experienced as a result of taking hormonal contraceptives.

My hope is that there is more honesty about just how strong the pill is and that it is more than just a contraception.  It is a fact that more women are diagnosed with depression than men, and it may not be our genetic makeup or our culture.  With 10 million women using the pill, it may be our birth control.  Having said that, the focus should not be a “blame game” but as the researcher from Australia states, “We hope to improve the quality of mental health care for women, and improve the development, understanding and use of contraception.”

THE GOOD NEWS
The Women's Health Initiative (WHI) study mentioned above is also looking at birth control use and it looks like we finally can feel confident that they are safe. This is good news for the 16 million of us American women who take birth control pills. This study is the largest ever, including 162,000 participants and the results are contrary to some previous studies that suggested an increased risk of breast cancer and heart disease. In fact, according to this study, there is an 8% risk benefit of ever having cardiovascular disease, strokes, or high blood pressure along with an 7% risk benefit for any type of cancer. My only question is if long term use of the pill affects fertility at all (good or bad)…didn't see anything on that in this study.

Newsletter November 2004

THE IUD IS LOOKING MUCH BETTER
Believe it or not, I do remember my babysitter talking about how bad an IUD was. I worshipped my babysitter when I was a kid - there wasn't a word she said that I missed! In 1975, the Daikon Sheild was recalled for causing thousands of uterine infections and dozens of deaths. According to the Alan Guttmacher Institute, only 2% of women in the U.S. used an IUD in 2002, however in the rest of the world, it is the most popular form of contraception (outside of sterilization) used by 85 million women. (Planned Parenthood).

There is a new willingness by American women to try and IUD for a few reasons. Younger physicians don't remember the bad days, it looks nothing like the old one and there's a bit of a backlash from younger women in response to the news about hormone replacement therapy (HRT). 59% of women chose the Pill in 1996 and 51% in 2002. The new IUDs are called Mirena or ParaGuard - they are shaped like a T and not larger than a quarter. They also sport some real advantages. First, it's the most foolproof contraception and it is easily reversible. Coming off the pill can take many months to be fertile again, while with an IUD it's almost immediate. Second, it's a lot cheaper -- $175 to $400 including follow up visits depending on insurance and can last 5-10 years. Third you don't have to remember to take a pill, or experience the weight gain that is so common. For women on the later years of their reproductive life - it works incredibly well for heavy bleeding.

On the down side, there are some health risks that include ectopic pregnancy, pelvic inflammatory disease and inflammation of the fallopian tubes. While the old IUD had a tail that trapped bacteria and the new one is much less likely to do so, it's not recommended for women who aren't monogamous. It's called the "birth control for moms" both for the monogamous reason and that the insertion procedure is easier for women who have had children. (more pliable cervices).

For the full story go to www.wsj.com (Wall Street Journal) and type in the author's name Hope Glassberg or you can email her at hope.glassberg@wsj.com. The story appeared in the Personal Journal Section, August, 3, 2004 front page.

Newsletter August 2004

THE MORNING AFTER PILL DELAYED
We reported back in January that that FDA had recommended overwhelmingly in a vote of 24 to 3 to approve a morning after pill for over the counter purchase. See http://www.oonahealth.com/newsl_jan04.html. It has now been delayed with conservatives lining up to encourage the FDA to change it's mind. The conservative's concern is that wider use could result in increased promiscuity and sexual transmitted diseases. Advocates say the science shows nothing of the kind. There is also some concern about teenage use of the treatment. For more information go to:
http://www.washingtonpost.com/ac2/wp-dyn?pagename=article&node=&contentId=A38015-2004Feb12&notFound=true

Newsletter March 2004

THE MORNING AFTER PILL
An advisory board of the FDA has recommended by an overwhelming majority to make the "morning after" pill available without a prescription. Known as "Plan B" women, who fear an unwanted pregnancy could take immediate protective measures on their own without consulting a health-care professional. It is that process that many women described in testimony as cumbersome, expensive and time-consuming. Plan B consists of 2 progestin pills that work best taken within 72 hours of intercourse at 12 hour intervals. It reduces the risk of pregnancy by 89%. Scientist believe that the resulting surge of hormones interferes with ovulation or prevents the embryo from implanting into the uterus. FDA often follows the advice of its advisory board and the final ruling is due in early February. For google search results, go to
http://www.google.com/search?hl=en&ie=UTF-8&oe=
UTF-8&q=%22morning+after%22+pill+and+FDA

Newsletter January 2004

Energy and Stress

KEEPING ENERGY ON TRACK
Sometimes I find that winter can be a little depressing - all my energy is spent dragging out the coat into the grey days. Even though we are approaching the end of the season, here are some of the highlights of what I've found helpful. To create and sustain energy, the writings are split into three categories, 1. Lifestyle, 2. Food and its effect on blood sugar, and 3. Ample nutrients i.e. vitamins and supplements.

Newsletter March 2004

FREE NEWSLETTER ABOUT WOMEN AND STRESS
To me, stress is one of those things I know all too well, yet I'm not sure I really understand that much about it. So I was really happy to see the experts from the National Women's Health Resource center explain the issue in some detail. They include some different definitions, managing techniques as well as some resources. For a free issue go to
http://www.healthywomen.org/content.cfm?L1=2&CID=93&Blist=19

Newsletter August 2003

Scientists believe that these herbs work by supporting the adrenal glands and thus helping to access more energy to eliminate toxic byproducts. A lot of them also seem to work with an or enhance white blood cell counts. My favorites are ashwgandha, Echinacea, Astragalus and Reishi mushrooms. I'm also a big fan of Vitamin C. For a full explanation of these herbs and more on adaptogens go to: http://www.herbsforhealth.com/10_03/adaptogens.html

Newsletter January 2004

Exercise

NEVER TOO LATE
There goes that excuse! Researchers reported back from analyzing data from the WHI study that exercise at any age will help reduce the risk of breast cancer, no matter when they begin. Since age is a factor of increased risk, this is really good news for women that are post menopausal. The decreased risk is about 20%, which is not insignificant. Moderate exercise such as swimming or cycling five times a week had the greatest impact. For the abstract on the study go to: http://jama.ama-assn.org/cgi/content/abstract/290/10/1331

Also, if you exercise with a reliable partner, it's not only built in "show up" motivator but will most likely increase your performance. I know that a lot of runners do this. Alive magazine reported a study published in Medicine and Science in Sports and Exercise that studied mothers and daughters. They showed up for 70-77% of their sessions (the 70% is if they worked out at home) and mothers increased performance on all levels from muscle strength to endurance to flexibility. Daughters improved their muscle endurance. For more information go to:
http://www.alivepublishing.com/home/index.php?page_type=article&topic_id=
144775&article_id=6593&site_id=24&go_id=2&take_id=6

Newsletter January 2004

A KEY TO FITNESS SUCCESS
If you consider how much you shell out for the sneakers and the gear not to mention the investment of time, you may want to insure that investment by buying a heart monitor. They usually run about $70. It's really the best way to make sure that you are "in the zone". The problem is that most people believe they are working out harder than they do. Even if you are training hard, you may not be training smart - training smart means that you'll have less chance of injury, burn more body fat, and ultimately better results. One word of caution, if you take a class, make sure you're far away from the next monitor - if they are the same brand and model, it may read the person next to you!

Newsletter February 2003

Fibroids and Endometriosis

"I WISH I KNEW"
This is what a number of American women are saying that about a safe and relatively new treatment for fibroids. (not new enough for an M.D. to claim ignorance) Fibroids are the number 1 reason that women have hysterectomies in this country and anywhere from 60%-80% of the women who hear about this procedure, got the information from someone other than their doctor or the internet. This treatment, called UAE for uterine artery embolization, is an outpatient procedure that uses local anesthesia. UAE cuts the blood supply to the uterus, causing the fibroid to shrink. Like any surgery, it is not without risk and it is not for women who would like to have children. However, the risks and cost do appear to be lower than a hysterectomy that requires general anesthesia and a much longer recovery time. The major downside to this surgery as I read it in comparison to a hysterectomy is that in 20% of the cases the fibroid returns after three years. The reason that many in the medical community believe that women aren't being told by UAE is that it is not performed by a gynecologist but a specialty radiologist - meaning the gynecologist could would lose the income from performing a hysterectomy. (Average fee is $2000) American women are becoming leery of these type of procedures. Physicians perform surgery for fibroids and other conditions 650,000 times per year (200,000 of these are hysterectomies) -this rate is three to four times as high as European countries. Although complications for hysterectomies are low, the surgery is linked to other problems such as weight gain, depression, sexual dysfunction and high blood pressure.

For more information: Wall Street Journal front page August, 24, 2004 "Silent Treatment Hysterectomy Alternative Goes Unmentioned to Many Women"
and http://www.alive.com/home/index.php?page_type=article&topic_id=
144668&article_id=6308&site_id=24&go_id=2&take_id=6&PHPSESSID=
ad42d8a34f32d6d298bb48db7e97e0ae. (This is a Canadian Magazine with some good insight about hysterectomies, just a note that I don't necessarily agree with bio-identical hormones being safer.

Newsletter September 2004

Hysterectomy

HOLD THE SCAPLE
Tara Parker-Pope of the Wall St. Journal (Tuesday February 25, 2003, Personal Journal) reported some very important news concerning hysterectomies. While a hysterectomy is almost always a necessary operation for women with certain cancers and pre-cancer conditions, the most common reason for the procedure is to treat heavy bleeding, usually caused by fibroids. (non-cancerous uterine growths). Based on a study by the Journal of Obstetrics & Gynecology, as many as 70% of the 500 women they followed received hysterectomies that may have been avoided. Alternative options include surgical removal of the fibroids, using heat to destroy the uterine lining, a method that cuts off the fibroid blood supply, focused ultra sound, and the drug RU-486. Ladies, know your options and get second and third opinions. Although this is a paid service at the Wall St. Journal, it may be worth it if you are suffering. www.wsj.com Perhaps if you email Ms. Parker-Pope at healthjournal@wsj.com, she'll reply.

Newsletter March 2004

Heart Health

FOR PREVENTING A HEART ATTACK OR STROKE,
ASPIRIN HAS A DIFFERENT EFFECT IN WOMEN 
A low dose of aspirin taken every other day is thought to reduce the risk of  a heart attack.  According to a study published in the New England Journal of Medicine last month, for women, the benefit of this regime is more for preventing a first time stroke.  For men, aspirin reduces first time heart attacks but not strokes.  Further, the benefits for women under the age of 65 are limited, so it’s important to consider the risks such as an increased risk of bleeding. The warnings about bleeding are quite serious.  Typically, studies involving heart treatments have only included 10% to 15% women.

For more information see:
http://content.nejm.org/cgi/content/abstract/352/13/1293
or go to www.wsj.com and type in Ron Winslow (author) in the search – you’ll see the head line but it’s $2.95 for the piece.  It appeared Tuesday, March 8 front page of the Personal Journal section

Newsletter April 2005

PERSONAL ON-LINE HEART HEALTH EVALUATION
While there is no substitute for a good relationship with your doctor, it certainly doesn't hurt to know more about your own heart condition -- especially if you consider that heart disease is the number one killer of women. We discovered this on-line interactive tool that looks like a good place to evaluate and or re-evaluate your own situation. Being informed makes for a better discussion with your doctor. The tool is called "Heart Profilers" and the provider is the American Heart Association. The only down side is that it can be a little time consuming and may take some patience. For more information go to: http://www.americanheart.org/presenter.jhtml?identifier=3000416

Newsletter November 2002

Immunity System

I HAVE NO TIME FOR THIS
I always say that when I get a cold or a flu - as if any one does have time for it. Well, if you are trying to ward off a cold or flu, or feel as if you are most of the season, there are a group of herbs you should know about. They are called adaptogens. To be in the adaptogen class of herbs, the herb must be safe and not put any further strain on the organs. It must also help to restore balance to the system regardless if a condition has depleted the system or there is an excess in the system. Scientists believe that these herbs work by supporting the adrenal glands and thus helping to access more energy to eliminate toxic byproducts. A lot of them also seem to work with an or enhance white blood cell counts. My favorites are ashwgandha, Echinacea, Astragalus and Reishi mushrooms. I'm also a big fan of Vitamin C. For a full explanation of these herbs and more on adaptogens go to: http://www.herbsforhealth.com/10_03/adaptogens.html

Newsletter January 2004

Mammogram and other diagnostic tests

ONE OF THOSE HEADLINES
I think I had this clip on my desk for six months; it’s a Wall Street Journal headline that said that only 6% of women where scrupulous in getting a yearly mammogram. It raised more questions for me than answers. 

First, according to the National Breast Cancer organization -- 70% of all breast cancers are found through self exam.  That leads me to believe that 30% at most (likely less as a small percentage must be found other ways, like in an MD’s office) are found through mammograms.  Okay.

Second, a mammogram can detect breast cancer up to 2 years before it can be felt.  So, if a mammogram can detect a cancer that can not be felt, shouldn’t a greater percentage than 30 be found by mammograms?

Back to the Wall St. Journal headline – if only 6% of women are getting regular mammograms it could make sense that 70% of breast cancers are found through self exam.  Stay with me here – it turns out that this 6% number does not accurately describe the state of women and mammography’s.  As you will see by the USA Today article referenced, the more accurate statement is that over the past 10 years, only 6% of women have gotten yearly mammograms on time every year.  The truth is that many of us are getting them around that date but may miss it by a month or so mostly because no one sends us those reminders.  In any one year, 55% of women 40 and over have gotten a mammography and 70% of women have been screened within the past two years.

Then, in my mind, if 70% of us are getting mammograms within the two years that a mammography can detect it, this 30% detection rate is very low.  I’m not a statistician, maybe 30% isn’t low, but it certainly seems low.

Turns out, it has a lot to do with the person who is reading the mammogram.  Further, if your breasts are fibrous or cystic, it’s even more difficult to read.  Not too reassuring I know – and how can you be confident that the radiologist is a good reader?  

Here’s my 2 cents.  Ask how many people take a look at the film. Where I go, it’s two. The more eyes the better.  If it’s only one, it may not be a bad idea to have your GYN take a look at the mammogram as well.  Ask how the radiologist evaluates the film.  It’s very important that the physician compare this years mammogram to last years in order to look for any changes.  Don’t lead them to the correct answer.  If they don’t compare this year to last year, find someone else. And perhaps when the MD is meeting with you, you can ask them to put the film up and look at it with you. (along with the prior year) Question everything you see – at worst you’ll get an education.  Do they look at it with a magnifying glass?  Would that help?  I really don’t know – but I would think it would.  Also, if you have really cystic breasts, they should also be doing a breast sonicgram as wll.    

Where I live, it’s a minimum three month wait for an appointment – so these radiologists are booked beyond belief.  I’d like to believe that they schedule appointments in a way that lends the practice to accuracy of those in the waiting room.  I’m not sure. It never hurts to remind them in a kind and understanding way that you are putting tremendous trust in their judgement.  When they walk in and say “Everything is fine,” I do not feel it’s out of line to say “Good, please explain to me what that means exactly.” 

Remember, no one takes care of you like you and while more women die of lung cancer, breast cancer and skin cancer are the most common.  And while we obviously must trust the professionals we sign up with, this is one area that deserves some extra alertness on our part. 

Oh by the way, what some women do to remind themselves about getting a yearly mammogram is to associate it with a birthday or yearly event like the start of the school season.
http://www.usatoday.com/news/health/2005-02-25-mammogram_x.htm

Newsletter March/April 2006

CERVICAL CANCER AWARENESS AND VACCINE
January is the awareness month for Cervical Cancer.  I just had a follow up pap smear and when I had to put the feet in the stirrups, I quipped “My favorite part”… by which my MD replied, “Oh, let’s call the psychiatrist.”  At least he made me laugh.  Needless to say, a vaccine sounds great to me and I’m sure to most of the readers of this newsletter.

Here are the facts as I see them:

• Cervical cancer is one of the most common cancers that affect a woman’s reproductive organs.  While it is very treatable if detected early, more than 10,000 women find out that they have invasive cervical cancer every year and nearly 4,000 die from it.  It is caused by various strains of the humam papillomavirus (HPV) – a sexually transmitted infection. 

• Worldwide, about 500,000 new cases of cervical cancer are diagnosed each year, resulting in 250,000 deaths.  In developing countries, it is the leading cause of cancer related deaths among women.

• There are over 80 types of HPV. Approximately 30 types are spread sexually; about half of these have been linked to cervical cancer.
  
  
• Most of the time the body is able to fight the infection. Almost everyone has had HPV at some time in their life.
  
  
• If a woman’s body doesn’t rid itself of HPV, the virus may cause cervix cells to change and become precancer cells. Most cells with early precancer changes return to normal on their own. Sometimes, the precancer cells may turn into cancer if they are not found and treated. Only a very small number of women infected with HPV will develop cervical cancer.
  
• 11% of American women have do not get regular screenings and 20% of American women haven’t had a pap smear in the last three years.  I hope that you are not one of them.

• Regular screenings greatly reduce the chance getting cervical cancer.  It is preventable and curable when detected early.

• Early cervical cancer shows no symptoms.  Symptoms generally appear after the cancer is invasive.  This is why testing is so important.

The Vaccine

• A vaccine may be available as early as next year.  This vaccine will target one strain of HPV – HPV-16, responsible for about 50% of all cervical cancers.  Most recently, the vaccine has shown to be very successful in preventing 94% of viruses for a period of four years.

• The vaccine is now targeted towards younger women before they are sexually active – ages 16-21.  It is unclear what the effects of the vaccine would be for women who have been sexually active.  For now, it is generally assumed that the vaccine is not effective.

• It is unclear just how long the vaccine will be effective.

• It has been suggested that boys should also get vaccinated – although I have not seen anything trials being held on boys.

• Pap smears will still be needed as HPV-16 is only one strain that causes cervical cancer.  Also, pap smears provide information about the progression of any cervical cancer and must be used as a back up.  It is estimated that even if the vaccine is 100% effective that it would be 30 years before a pap smear is not needed.

• There is a political component to this vaccine.  Some groups are protesting the vaccine saying that it encourages young people to become sexually active.

For more information:
http://www.pbs.org/newshour/bb/health/july-dec02/cancer_11-21.html
http://www.cancer.gov/clinicaltrials/results/cervical-cancer-vaccine1102
http://www.cnn.com/HEALTH/library/DS/00167.html
http://www.cdc.gov/cancer/nbccedp/info-cc.htm
http://www.washingtonpost.com/wp-dyn/content/article/2005/10/30/AR2005103000747.html

Newsletter January/February 2006

NEW TEST TO HELP DECIDE IF CHEMOTHERAPY WORKS FOR
HALF OF BREAST CANCER SURVIVORS
Following surgery, many women struggle with the decision of whether to follow it up with chemotherapy. The issue is that only a small number of these women will benefit, while all will put themselves at risk of nausea, blood clotting and infection -- not to mention the psychologically damaging effects of hair loss. As an individual, how do you know if you are one of the ones that chemotherapy works for? There is new test, called OncotypeDX, and while we wish this test could be given to all women with breast cancer, it's only valid for those whose breast cancer is estrogen sensitive, has not spread to the lymph nodes and the woman takes the drug Tamoxifen. (50% of women diagnosed with breast cancer) This test shows that it can predict which tumors were most likely to return after surgery. The higher the score, the most likely the cancer will return AND the most likely the woman will respond to chemotherapy. For more information go to:
http://www.msnbc.msn.com/id/6692665/
or the study in the New England Journal of Medicine:
http://content.nejm.org/cgi/content/abstract/351/27/2817

Newsletter January 2005

A VACCINE FOR CERVICAL CANCER is very close
While several companies are competing to make vaccines to protect against cervical cancer, GlaxoSmithKlein began a new trial this past May of 15,000 women that will involve long term follow up for its vaccine to prevent the infection of papillomavirus virus, or HPV. (probably the last trial phase before approval) HPV is the virus we get pap smears for and it can lead to cervical cancer. Between 70-80% of women are exposed at some point in their lives, but most are harmless and clear up on their own. More than 70% of cervical cancer cases are caused by two high risk strains of the virus -- the vaccine is 100% effective for these strains. It is 91.6% effective for low risk strains. 4,000 American women die each year from cervical cancer along with 250,000 worldwide. This vaccine would have the most effect in the developing world where women do not get pap smears. Shots would be given to young girls before they become sexually active.

Newsletter December 2004

WOMEN AT RISK OF GENETIC BREAST CANCER
need to know this. It's not recommended yet, but the research is showing that women who may be carriers of BRCA1 or BRCA2 gene mutations will get better detection by an MRI compared to a mammogram. In a study out last month in the Journal of American Medical Association, a Canadian group looked at all ways of detecting breast cancer including ultra sound and clinical breast examination. Following a Dutch study that found similar results, 17 cancers were detected with an MRI in a group of 236 women vs. 8 in the mammography. 7 were detected by ultra sound and 2 by breast exam. Regular MRI screening for these women is not being recommended yet because it has not been determined if the tool actually lowers the breast cancer mortality rate. Maybe someone needs to explain that to me, hasn't it already been determined that early detection is what it's all about?
For more information go to
http://jama.ama-assn.org/cgi/content/abstract/292/11/1317

Newsletter October 2004

OVARIAN CANCER SIGNS
Ovarian cancer can be difficult to detect since the symptoms are common in women that do not have a malignancy. It's important to note that a mass growing in an ovary could be benign (non-cancerous) as well. A study published in JAMA in June highlights that we should be looking for the severity and the frequency of these symptoms. Further, if a mass is growing, the symptoms seem to come on recent. Looking at women in clinical practice who came in for treatment - on average most women had 2 of the following recurring symptoms: back pain, fatigue, bloating, constipation, abdominal pain, and urinary symptoms. The women with cancer typically experienced symptoms 20 to 30 times per month and felt them more severely. Probably most importantly, the combination of bloating, increased abdominal size, and urinary symptoms was found in 43% of those with cancer but in only 8% of those without cancer. For the full study go to:
http://jama.ama-assn.org/cgi/content/abstract/291/22/2705?
maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=
ovarian+cancer&searchid=1091737888628_6056&stored_search=
&FIRSTINDEX=0&journalcode=jama

Newsletter August 2004

IS AN MRI BETTER THAN A MAMOGRAM?
Doctors are beginning to recommend an MRI either instead of or in additiona to a mammogram. At $1600-$1800 out of pocket, does it really give you better information about your breast health? Dr. Susan Love states her opinion at http://www.susanlovemd.com

Newsletter March 2004

CERVICAL CANCER VACCINE
The vaccine for cervical cancer made headlines this past month. At first, if you thought like we did, it seems like this new vaccine this would stamp out the virus that causes cervical cancer and put an end to the PAP test. It turns out, that while the vaccine could benefit women's health, it is not near the eradication of cervical cancer we'd like to see. We think Time Magazine explains it well. http://www.time.com/time/magazine/article/0,9171,1101021202-393737,00.html

Newsletter December 2002

Pregnancy

FOR THE LITTLE ONE
in the tummy. It’s been my experience that most MD’s are not as up to date as they could on the nutrition end of things.  Maybe your doctor is fabulous and I just overstepped myself here, but it’s simply not my experience.  I haven’t eaten fish since I got pregnant -- mostly because I can’t remember which ones are okay – I know that tuna is out for mercury, salmon is out for PCB’s, is Halibut or Striped Bass okay?  I can’t remember – I always say that I’ll print out a list, but I forget.  The party line is that one can of tuna a week is fine, but I’m not doing that.  What if my can got more mercury that the “average”? We are talking about a heavy metal and a fetus. Besides, for the first trimester – I couldn’t stand the smell/sight of fish. 

So what’s the deal here…There are two types of Essential Fatty Acids -- omega-3 and omega-6. (they are called “Essential” because the body can not manufacture them itself)  Most Americans get plenty of Omega 6 – which is in just about all the vegetable oil that we consume – like safflower and corn. (I’m not talking any bad fats here – they are HARMFUL)  For optimum health, the key is to balance Omega 6’s to Omega 3’s at a ratio of 1:4.  Omega -3’s are mostly found in fish oils and flax seed.  Fish oil contains EPA (eicosapentaenoic acid) and DHA docosahexaenoic acid). Most fish oil supplements are 18% EPA and 12% DHA, or a total of 30% omega-3.

A lot of people have heard of the benefits of Omega 3’s and the role they play in heart health and skin health but I want to focus here on the “little one”.  (my step father calls her “Catchatory”, as in Chicken) 

Fats make up sixty percent of the brain and the nerves that run every system in the body.  And your brain sends chemical messengers throughout the body, telling each organ what to do.  Prostaglandins are a hormone-like substance that are a very important part of these chemical messengers.  It is essential fatty acids that produce prostaglandins.  This all stands to reason that good fats = good brain health and development. 

Why Omega 3’s are so key is that when the body is deprived of the essential fatty acids that they need to grow – the cells develop a fatty acid that may actually be harmful.  These acids have been found to be elevated in those that suffer from depression or ADD.  It’s generally a result of too much hydrogenated fats or omega-6 fats –adding omega-3 actually reduce the effects of bad fats or too much omega-6.
 
The most rapid brain growth occurs during the first year of life, with an infant’s brain tripling in size by their first birthday.  During this time period the brain will consume 60% of the energy ingested by the infant.  Again, it makes sense that getting the right kind of fat greatly affects brain development – and if mother’s milk is any indication – consider that 50% of the calories of mother’s milk is fat.

There are some new studies that back all of this up – one that was published in Jan. 2005 of Pediatric Research.  This was an animal study, not a clinical one, but one that showed interesting relationships between DHA and brain development.  Another had to do with vision – Omega 3’s are also associated with good eye development and neural development – this was published in September 2004 in the Journal of Nutrition.

But the logic is enough for me.  I take 200mg. a day of both DHA and Omega 3.  I like and trust Nordic Naturals – they make ones that are “deodorized” so I don’t get the back lash from others I’ve tried. 

She has no excuse now not to be the genius she’s expected to be!  (yes, I’m kidding). For more info:
http://www.softecare.com/Ingredients/omega-3_fetal_development.cfm
http://www.askdrsears.com/html/4/T040900.asp
http://www.meg-3.com/LifeStage/Pregnancy.asp

Teeth/Oral hygiene

TEETH AS WHITE AS SNOW
There is nothing like a greeting with a bright white smile but are we doing any long term harm to our teeth? Well for once, something we do in vanity appears to be safe. According to the Academy of General Denistry, we are more interested in the color and shape of our teeth than the health of our teeth and cosmetic dental procedures are driving the $15 billion a year cosmetic dental industry led by the over 50-crowd with the most disposable income. It's nice to know that it is relatively safe with the most common side effect being tooth sensitivity, which usually goes away. Also, ten years out, it does not appear to that there is much of a difference between treated and untreated teeth. A couple of things to keep in mind, if you do bleach your teeth, spring for the money and go to a dentist to get fitted for a tray, the over the counter ones have some efficacy issues. Also, stick with a10% carbamide peroxide. It may take a little longer but all the research points to the safety at this level. Also, there are now methods to help bleach teeth that have been damaged by tetracycline. For more information, see About.com's
http://dentistry.about.com/library/weekly/aa101900.htm?terms=teeth+bleaching
http://dentistry.about.com/library/weekly/aa070199.htm?terms=teeth+bleaching

Newsletter December 2003

Miscellaneous

HEALTH CARE IS BECOMING A CENTRAL ISSUE FOR WOMEN
According to a recent Kaiser Family Foundation report, 27% of non-elderly women and 67% of uninsured women delay or went without care they needed because they could not afford it.  In 2001, the numbers were 24% and 59% respectively. 

While just 55% of women spoke to their MD's about diet, exercise and nutrition, less than 1/3 talk to their doctors about sexual history and specific issues such as STDs and HIV.  Mammography and pap smear rates are down slightly from 73%-69% and 81% to 76% respectively.  This is at a time when nearly 40% of women have a chronic condition such as diabetes, asthma or hypertension that requires ongoing medical attention. (the number is 30% for men) In addition 23% of women report that they have been diagnosed with depression or anxiety - over twice the rate of men at 11%. 

This also seems to be a reflection of the type of care that women are receiving - as it is a "relationship" that a woman establishes with her health care professional.  She may not be offering to discuss personal and important health matters, but it begs the question, "Is anyone asking?" 

For more information go to
http://biz.yahoo.com/prnews/050707/sfth009.html?.v=16

TALKING TO YOUR DOCTOR
about alternatives is very important, especially since many women shy away from doing this.  It’s mostly due to fear that our doctors won’t understand or won’t approve.  But in all honesty, the practioner really does need to know what we are taking and their reaction to our point of view is information that we need.  I’m not trying to suggest that every health care professional agree with us, but I am suggesting that we should be heard and that we should listen to their degree of knowledge on the subject.  As an example, I am confident that I am pregnant due to acupuncture and herbs.  I did go to a fertility specialist but declined drugs etc as a first choice.  From my own research I found that the success rate of acupuncture (along with herbs) is quite comparable if not better to IVF (depending on the issue, I had no known issues besides age).  It can also be used with IVF to further the success rate of that procedure.  I must admit that the fertility specialist’s attitude toward acupuncture and herbs (Oöna PMS1) was at best discounting and at worst disdain -- but it said more about him than me…why?  He knew very little if nothing about it.  I really like this woman, Kat James, take on alternatives and talking to your doctor.  I hope you agree.
http://www.informedbeauty.com/talk2doc.shtml

Newsletter June 2005

FOR US WOMEN WHO ENJOY THE WHITE WINE
There does seem to be something about women and their white wine… I'm not sure what it is, but if we keep it to a glass or two, it appears that those of us who drink a LITTLE may be healthier in the long run. It's not just wine, but the consumption of a limited amount of alcohol. The benefits are the same for men. According to the Wall Street Journal, scientific research keeps coming up that a small amount of alcohol each day is better than not drinking at all. Those women who have six or seven drinks a week have significantly higher bone density than teetotalers. The best drink for osteoporosis? It's wine (phytochemicals) for women, beer (silicon) for men. What else does a little alcohol help? There's a 37% lower risk of a heart attack in men who have a drink a day - 34% lower risk of developing diabetes for both men and women, 40-60% lower risk of a stroke and 42% lower risk of dementia. There is a down side - small amounts of alcohol can increase the risk of oral cancer, esophageal cancer and a slight increase in colon cancer. Breast cancer risk is closer to 30% higher for women who drink. Overall, though it appears that there are more benefits than harm. One note that it's important to be clear on, this is not a free ticket to "just one more" at Friday Happy Hour - for women who go above three drinks a day, (for men, it's three or four) they put themselves are a much higher risk for other alcohol-related problems and any benefit we just talked about is virtually eliminated.

Newsletter January 2005

TEENS AND ANTIDEPRESSANTS
The FDA is clearly concerned about this. With the sole exception of Prozac, that has been approved for young people, the agency will likely ask for label revisions on antidepressants after a hearing later this month. At issue is a report back in March that links higher suicidal thoughts to antidepressants for teens, 1.78 times more likely than placebo. At that point, physicians were asked to monitor their young patients very closely. The problem the FDA had with this study is that it lumped all the antidepressants together - there may be different results for different drugs. At risk could be at least 5 million youths between the ages of 12-17 -- that is the number of prescriptions written in 2002 for just Zoloft, Paxil and Wellbutrin. British regulators have specifically called on doctors not to prescribe these drugs with the sole exception of Prozac. Families and physicians are encouraged to stress individual and family therapy for a period of time before turning to drugs. Interestingly… this is expected to have almost no impact on the $12 billion US market for anti-depressants. This is making me want to read that book "Prozac Nation" -- $12 billion?!! For more information go to: http://www.californiahealthline.org/index.cfm?Action=dspItem&itemID=101012

Newsletter September 2004

VOTING HAS NEVER BEEN MORE CONVENIENT
In case you didn't know, I certainly didn't - at least 24 states now allow anyone to mail in an absentee ballot for any reason. The remaining 26 states require some sort of a reason from an approved excuse list, but many have widened the list of excuses. Virginia, for instance, grants a mail-in ballot to anyone who says they have a long working day of 11 hours that includes a commute. In addition, most local election officials have traditionally looked the other way if people stretch the truth about their travel plans. The Wall St. Journal has published a chart of websites for every state where the absentee ballot can be located on-line (in September 2nd Personal Journal section article called "Cast a Ballot From the Couch: Absentee Voting Gets Easier") or you can go to www.johnkerry.com or www.georgebush.com and go to their Register to Vote sections/ absentee ballots. Why stand in line and get into a political argument if you don't have to? P.S. BIG REMINDER, if you do decide to vote from your armchair, remember to sign everything properly - most need to be signed in two places, and use a dark pen, preferably a felt tip -- your vote may not be counted if it's not properly signed or can't be read clearly.

Newsletter September 2004

BEING PREPARED
I must admit, I don't have the disaster kit together and considering where I live (NYC), I better get on it. When you think about all that could happen from biological to a car bomb, it's good to have a sense of what we should do when but apparently only about 10% of us have a solid plan. Looking into this a little further, most if it is common sense, but it doesn't hurt to review. My 2 cents, be sure to have a transistor radio on call that works - it's difficult to respond properly if you don't know exactly what's happening. Keeping up with the all the batteries can be chore (they should be replaced every 6 months) but it can make all the difference. Also, confirm that you and your loved ones have a plan in case it's impossible to get cell phone service and not a good idea to go home.

First: the Disaster Kit: (A three day supply)

• A gallon of water a day per person
• Food
• First aid (bandages etc), prescriptions, eye glasses, sunscreen, soap
• Flash light and radio with extra batteries, can opener and/or
  a multi purpose Swiss Army knife
• Plastic sheeting and yes, duct tape
  (in case you need to make yourself shelter or seal)
• One change of clothes per person
• Dust Mask with a N95-rated particle filter
• Potassium iodide
  

For more information on this go to www.ready.gov, www.americaprepared.org, and www.redcross.org. The Red Cross offers a course.

For a report on how to respond to different types of terrorist attacks go to www.rand.org. The report is $15 but there is summary you can download for free. There are a few basic things we can keep in mind if it is a biological or chemical attack.

1. Purchase a dust mask with a N95-rated particle filter. It will protect against fall out. Duct tape and plastic sheeting can also help to seal off any openings in a shelter.
2. If it's radiological, avoid inhaling dust at all cost - cover your nose and mouth with a shirt if you have to.
3. Nuclear - head for the basement or even better a nuclear shelter. Second best are the upper floors of a multistory building
4. Chemical - find fresh air as quickly as possible - use your dust mask and seal shelter ASAP. You want to remove clothes when you are safe and shower if possible.

For more information about various exposures etc. go to www.bt.cdc.gov

Some other interesting facts:

1. Experts don't think we should stock up on Cipro or other antibiotics, they have a short shelf life and depending on the agent - can make matters worse.
2. A better one may be potassium iodide, a five year shelf life and can protect against thyroid cancer that may occur under nuclear or radiological exposure.
3. Hospitals in Boston and New York have been shipped thousands of smallpox vaccinations and antibiotics in case of an attack.
4. Gas masks aren't recommended. Experts say they need to be on before an attack or within a minute which is impractical. This is confusing to me, why is a dust mask a good idea and not a gas mask? I'll have to read those reports.

Source: Wall Street Journal July 20, 2004 and August 3, 2004

Newsletter August 2004

WHAT ABOUT THOSE SELF-TANNING LOTIONS?
We know how bad it is for us to bake in the sun - but who wants to look like a pasty white London Banker all summer? Have we really come a long way from the orange tint of QT? The answer is yes, and even though these products haven't been on the market long enough to know for sure, the way they work seems to make sense in terms of safety. A few points:

1. Make sure you buy a self tanning lotion that contains the active ingredient DHA or dihydroxacetone. DHA is a colorless sugar that interacts with dead surface cells in the epidermis, and stains the skin darker. Because it only interacts with the surface, as dead skin naturally sloughs off, so does the lotion and the color - so needs to be reapplied within a week. This is also why it is most likely safe. Unlike getting a suntan, it does not break down the DNA in skin cells. It's best to try a couple of different brands - some notable ones are Aveda, Clinique, Origins and Clarins.
2. Avoid "bronzers" "tanning amplifiers," "tan accelerators," "tanning promoters," "tanning enhancers," and "tanning pills." Many of these products interact with the sun to help create a faster tan, so they can accelerate skin damage. The "tanning pill" contains cartenoid, chemical canthaxanthin that is found in carrots - not only has this been associated with hepatitis and skin conditions, but that orange look you get from eating too many carrots is not exactly what I think you were looking for.
3. It's a challenge to get it right. First, you will need full even coverage, which in my judgment takes talent or a second pair of hands. Tanning lotions work best if you shave and exfoliate before applying - and apply a day before you need it. It may take a full 24 hours. Moisturize dry rough areas and go lightly around knees, elbows and heels because this is where the cream digs in and you may end up darker in these areas. Finally, even if you do it all right, you need to give your skin time to absorb the cream without staining your clothes - about an hour.
4. If you still feel up for it, it's a great way to get a tan. But do remember it is not a substitute for sunscreen. You are not all of a sudden Mediterranean - so don't forget the 30.
   http://www.skincancer.org/artificial/sunless.php
   http://chemistry.about.com/library/weekly/aa022602a.htm

Newsletter June 2004

IT'S A GREAT AND DUE VICTORY
for working moms but when I read this, I couldn't believe that this hadn't been settled 10 years ago. In a New York federal appeals court, a judge ruled that it isn't necessary to prove that men in similar jobs get better treatment to prove discrimination, it is enough to show that mothers are being taken less seriously than women who don't have children. The judgement basically says that "motherhood" and the stereotypes that are associated with it (like women having children and leaving their jobs) is itself gender discrimination. Many advocates believe that women never get to the so called "glass ceiling" because they are stopped long before by the maternal wall. The judge made clear that this has nothing to do with what is expected of a woman at work, like leaving early without permission to pick up a child, but it is illegal to assume that hiring a mother would necessarily lead to this. This decision isn't binding beyond the Second U.S. Circuit o f New York, Connecticut and Vermont but is likely to influence other cases. For more information go to wsj.com and type in the authors name Jon Vuocolo or email him at jon.vuocolo@wsj.com. This article appeared Wednesday April 18th in the Personal Journal -- page D3.

Newsletter May 2004

DISTURBING NEWS
Lung cancer has surpassed breast cancer as the leading form of cancer in women by nearly 20,000 patients a year. While the number of lung cancer cased among men have decreased in 1990-2003, the number for women climbed a surprising 60% and now kills more women each year than breast and ovarian cancer combined. These findings were published the Journal of the American Medical Association last month. It isn't clear why lung cancer may be striking so many women and many different theories are emerging (like we metabolize carcinogens differently, our DNA doesn't repair the damage, hormone differences) but what is clear is that it can not be fully explained by women's smoking habits. While 85-90% of all men and women who get lung cancer have smoked in their lives, many of those diagnosed today have quit decades before or were the "occasional" smoker. 10-15% have never smoked, and of those women appear more likely to get lung cancer than men. Lung cancer has a five year survival rate of only 14%. For more information go to http://jama.ama-assn.org/cgi/content/abstract/291/14/1763 for the abstract. The full article needs to be purchased or ask you doctor.

Newsletter May 2004

KEEPING A NEW YEAR RESOLUTION
I hope you haven't forgotten about your New Years Resolution. Apparently fewer than 20% of New Years Resolutions are realized and most are broken within 2 weeks. Yikes! I have to admit, most of what I've seen written on this subject I found stale, like "make a record and examine it" - yea right. Then there's the Five Stages of Change" a theory by a bunch of doctors that I thought was as insightful as "watch your step" after you've already tripped. But I did come across this one article that I feel has some teeth and I hope you find the advice as grounded as I do. I've linked it below but here's some highlights:

1. Know what you want by being clear and positive - instead of saying "I want to lose weight" say "I want more energy" or "I want to be able to wear that dress".
2. Recognize that good things require that we pay a price. That will make you more conscious when you are making every day choices - remembering that it is a price you are willing to pay to achieve your goal. The key is to focus on the outcome in ways that are achievable for you - in small steps.
3. Train don't try. If you put yourself on some kind of schedule and keep to it, chances are that you will have a success sooner and it encourages your to continue. The idea here is not to put yourself in a situation where you "think too much" and begin to fall off achieving your goal.
4. Be prepared for setbacks. It's okay to eat through your entire birthday week or miss the gym a couple of days. Think of it as normal part of making progress and have a plan of how you will handle this to get back on track.
5. Find support. And recognize those that don't support you. When you battle alone, it's easy to give up.

Here's the url - this writer had plenty of examples and great insight. I love when I feel encouraged.

http://www.alivepublishing.com/home/index.php?page_type=article&
topic_id=144871&article_id=6949&site_id=27&go_id=2&take_id=6

Newsletter April 2004

FROM SEA TO SHINING SEA
No sea shines without fish life. I knew this was an issue but wasn't sure which fish were endangered. Women put organic produce on the map so I'm sure we could save more of the oceans by just asking basic questions to restaurant personnel and store owners, like how they choose their fish. Cod, Atlantic halibut, bluefin tuna Chilean sea bass and swordfish are all endangered due to catching methods, coastal development and pollution. We can bring these species back by simply giving them a rest like the "Give Swordfish a break" campaign. Fish that have sustainable stocks include Albacore tuna, Artic char, Catfish (farmed), Caviar, Clams (farmed) Dungeness crab, Halibut, Lobster, Mahi mahi, mussels (farmed) oysters (farmed), wild Salmon, Bay scallops, wild shrimp , stripped bass (farmed) and Tilapia (farmed). For more detailed information go to: http://www.environmentaldefense.org/seafood/fishhome.cfm
or www.mbayaq.org.

Newsletter March 2004

IF YOU ARE SINGLE AND THAT LITTLE BLACK DRESS IS GATHERING DUST
It may be time to consider dusting it off. According to Psychology Today, between 1970 and 1996, the number of women living alone doubled to 14.6 million, and the number nearly tripled for men, jumping from 3.5 million to 10.3 million. The good news is that there is so many of us, the bad news is apparently none of us go out! The article quotes a study that says 50% of 18 year olds go out at least once a week compared to 25% of 32 year olds. I hate to hear what they'd have to say about 40+ year olds. Be that as it may, the article has some good advice. So give it a read, dust yourself off and get ready for mating season. http://www.psychologytoday.com/htdocs/prod/PTOArticle/PTO

Newsletter March 2004

HMMMMM....
There has always been wide spread speculation that the pharmaceutical industry has sponsored the creation of new "diseases" - arguably menopause being one of them. The British Medical Journal has published an article using sexual dysfunction in women as a clear example about how drug companies look to build markets and race to create medicines. For some interesting fireside reading, go to http://bmj.com/cgi/content/full/326/7379/45

Newsletter February 2003

SAVE MORE MONEY
Last month we told you that we were attending the National Foundation of Women's Legislator meeting. While a lot was spoken about (like how the sleeper issue of the fall election was Health Care -- #1 on the minds of women and candidates didn't talk about it), there was something mentioned that we'd like to pass on. It turns out that many FLEX PLANS MAY PAY FOR OONA if it is recommended by a physician. Many of you have physicians that have recommended Oona -- or see physicians that would be interested in recommending it. Make sure to check this out.

Newsletter December 2002

That's it for this month! As always, check out our website for lots more information at www.oonahealth.com.

In Good Health,
The Oöna Team
Questions or comments? Write valerie@oonahealth.com

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