m3admin, Author at Women's Health of Augusta

A Healthy Thankfulness

I stepped off the bus apprehensive about the scene unfolding in front of me. The Infirmary or “Home for the Poor” as it was otherwise known, was a collection of dilapidated barracks housing abandoned physically and mentally ill men and women who were deemed to have no value to either family or society. The Infirmary was located on a purposefully isolated knoll in coastal Jamaica symbolically situated to reinforce their desire to forget its existence. The contrast surrounding its physical location was as stark as the dichotomy of the island itself. A lush forest populated with exotic fruit trees and bathed in rainbow colored foliage surrounded the ramshackle open aired barracks originally commissioned by Queen Victoria in 1898. On an island where five-star luxury resorts share the same zip code as cockroach infested hovels, the mocking beauty of the surrounding forest was in contradistinction to the decaying dormitory of the forgotten.
We were greeted gleefully (and a bit unexpectedly) at the door of the men’s quarters by a thirtyish Jamaican, physically mature but with the mind of a child. Richard had a toothless smile the size of the island itself as he exclaimed, “Oh boy, they’re here! Oh boy, they’re here!” in raid fire succession. His repetitive phrases were sincere and he instantly touched our hearts and calmed some of our apprehensions. We came to learn that Richard had been housed at the Infirmary all of his adult life, and his apparent inability to understand the destitution of his surroundings was counted as a blessing.

Entering the first cinder block building I was struck by numerous sensations all vying for attention. Visually the scene was disturbing: cot after cot of ancient bodies positioned as if trapped in their bed by some invisible barrier. The distinctive odor, one I had come to associate with hopelessness, was a mixture of urine, putrid food, and stale, unmoving air, and it covered the room like an unseen fog.

Our small band of church mission workers spent an hour in the Infirmary talking, praying, bathing and cleaning our hosts. Soon, we loaded up a few of the less ill and mobile onto our bus and made the short trip to the Jamaican beachfront frequented by the locals. There were no hotels, Tiki bars, or swimming pools, just a few kids and adults enjoying a respite from the oppressive heat. Those who were ambulatory walked arm in arm with their chaperone to the shoreline, while others were carried fireman style to the water. We sat in the cool, shallow waters of the Caribbean and spent the next few minutes rubbing soft sand on the resident’s life-weary skin, all the while hoping that they might forget for just a moment that they had to return to their reality.

Earlier in the day I had observed a skeleton-thin, talkative gentleman pacing to and fro among the cots greeting other residents all the while holding up an obviously grossly oversized pair of trousers. As I sat in the gentle cleansing waves with Zebe, the owner of the XXL pants, I asked him if he could have anything in the world – anything at all – what would he ask for? He took the question quite seriously and pondered it briefly then looked me in the eye and in his most thoughtful voice exclaimed, “A belt. Yes, I would very much like a belt!”

This is a time of year when we invoke thankfulness in an almost nonchalant fashion. I have to remind myself to punch through the complacency of abundance and rethink what it means to be thankful. We are bombarded with admonitions to be thankful for a free country, good health, and material comforts. All of these things are grand and worthy of thanks; however, thinking of Zebe reminds me that the things that I see as worthy of thanks are largely due to my perspective.

Regardless of circumstances, I can choose to be thankful. Tethering my appreciation only to objects or accomplishments is a set up for disappointment as those things may not always be present; however, if my basis for thankfulness is rooted in my ability to choose, then no circumstance can dissuade me. Choosing to be thankful for your good health (and your ability to change it if you are not satisfied) leads to joy, peace of mind, and goodwill.

I see the world through my own lens. In other words, where you are in the world, physically, emotionally and spiritually, colors how you understand thankfulness. If I had cancer, I would be very thankful for the anti-nausea medicine that follows the powerful chemotherapy; whereas, such medicine would not enter my thoughts otherwise. If I have all my worldly possessions stashed under a six by three foot cot, I am thankful for a belt. It is a matter of perspective.
Let us celebrate this season of thankfulness with an understanding and appreciation of our choices, and hopefully, this will lead us to action that will translate into healthy blessings for ourselves and others.

Is Health Care Reform Really Necessary?

Health care reform is about as hot a topic as pepper sauce on Texas armadillo meat. The pundits and politicians are bantering about like hens in a hen house clucking about this plan and that reform. It is politically and philosophically prudent to be on the side of some type of change in the health care system. No one disagrees that the system is unsustainable in its present configuration. I concur that the situation is dire; the patient is in cardiac arrest and something has to be done. However, I differ from many in believing that the solution is one that is simpler yet more impractical than a government take over. I realize that sounds somewhat contradictory – simpler yet impractical – so let me explain.

First, it is important to understand that we have two separate but intertwined problems: health insurance and health care. As I am not an insurance expert so I will only opine about health care. We will never cure this country’s ills without a strong dose of personal responsibility. The government, politicians, insurance magnates, and even doctors are not only inadequate to change the system but incapable of effectively bringing about change because the change has to begin from within. It has to come from the individual; the man in the mirror. The biggest healthcare crisis in this country is not cancer, AIDS, heart disease or lack of insurance; it is people not choosing to live their lives in a healthy manner. Until we as individuals start adopting the things we know to do to stay healthy, we will persist as a nation in need of sick care delivery instead of health care.

Part of the problem is one of education. For example, many feel that getting regular mammograms and doing self-breast exams are excellent preventive tools for breast cancer. They are not! They are simply tools of early detection. The cancer already exists when the utility of mammograms and self-breast exams are realized. These tools prevent nothing other than higher morbidity and mortality, which is a good thing! But we have to move back one level if we are to prevent breast cancer. For example, decreasing your body mass index (BMI) a simple measurement that assesses your amount of body fat, can reduce the occurrence of breast cancer 40%! Reducing obesity, stopping smoking, increasing your intake of fruits and vegetables, limiting alcohol intake; these are behaviors that all substantially reduce the likelihood that you will develop a breast cancer. Are mammograms and self-breast exams important? Of course, they are, but our focus should not only be on early detection but also prevention. There are multiple factors that go into disease development, many of which we don’t understand. My point is that, in general, a skinny vegetarian has a lower incidence of breast cancer than an overweight couch potato, and when you expand that to whole populations you begin to see how individual decisions can have a massive collective effect.

Another example from the field of women’s health is cervical cancer. The Pap smear revolutionized the care and treatment of cervical cancer in the 50’s as it allowed for the detection of the disease in it earliest stages. As time went by and research progressed it became apparent that a major cause of cervical cancer is infection with the Human Papilloma Virus. Pap smears can pick up changes in the cervical cells long before they develop as a cancer, but the Pap only detects the changes once they are there. Two things can prevent HPV infection (and thereby most cases of cervical dysplasia): an HPV vaccine and monogamy. Having multiple sexual contacts dramatically increases your risk of infection with HPV and thus greatly increases your risk of cervical dysplasia and cancer. Again, prevention is different from early detection. If you want to prevent cervical cancer, develop effective programs supporting vaccination, abstinence, and monogamy. How many politicians are willing to handle that hot potato?

These are but two examples illustrating that the answer to our health care crises begins at home. Providing health insurance to everyone will only reduce the number of uninsured, a noble undertaking, but it will do little to solve the problem of reducing and preventing disease. At the beginning of this diatribe I stated that the answer was simple; personal responsibility. I also said it was impractical. An individual has every right to live the life they choose. I have no moral authority to tell anyone that they must stop smoking, for example. They choose their lifestyle, but they, in turn, must take responsibility for their actions. Here is where the hypocrisy arises. We clamor for personal rights but we cower from accepting personal responsibility. Do we as a society have a moral imperative to take care of the sick and helpless? Absolutely! But that is paralleled by a moral responsibility of the individual to make decisions that improve their health. I am my brother’s keeper, but in turn, it is my brother’s responsibility to not embrace behaviors that jeopardize his health and my good will.

Will we ever be a society of both free will and moral accountability? We must if we are to survive this health crisis.

Ovarian Cancer

Ovarian cancer is the fourth leading cause of cancer deaths in American women with about 22,000 diagnosed and 14,000 dying from the disease each year. About 75 percent of women with ovarian cancer are diagnosed with late-stage disease. Only 15-40 percent of women survive for five years after initial surgery that is performed to remove cancerous tissue from the abdominal cavity in combination with chemotherapy. While those statistics are frightening, it is even more vital to place them in context. A look at the most recent list of the top ten causes of death for all women reveals ovarian cancer nowhere near the top.

1) Heart disease 22.9%
2) Cancer 21.8%
3) Stroke 6.1%
4) Chronic lower respiratory diseases 6.0%
5) Alzheimer’s disease 4.7%
6) Unintentional injuries 3.7%
7) Diabetes 2.8%
8) Influenza and pneumonia 2.3%
9) Kidney disease 1.8%
10) Infection 1.5%

Statistics can be helpful in assessing real risk, but the bottom line for many women is that ovarian cancer is a frightening disease because often by the time it is detected, the cancer is relatively widespread. Most women have heard stories of a friend or family member going in for a routine checkup only to find they have a mass in their pelvis and dying shortly thereafter. The media has catapulted devastating stories of both celebrities and everyday folks to front page news thus fueling the fears. Notables affected by ovarian cancer such as Gilda Radner, Loretta Scott King, and Dinah Shore have made coverage of ovarian cancer front and center in media channels, and , while it has created some undue anxiety, it has, more importantly, raised awareness for regular checkups and signs and symptoms.
One of the major disadvantages in the fight to detect ovarian cancer early is the absence of an effective screening tool. Cervical cancer has been dramatically reduced due to the effectiveness of the Pap smear in identifying precursors of the disease which allow treatment long before the problem advances. Mammograms have increased the survivability of breast cancer by facilitating early detection thereby allowing treatment to ensue at the earliest of stages. Unfortunately there is no equivalent test for ovarian cancer. Currently doctors utilize a combination of ultrasound imaging and various blood tests to try to detect early cancers, but their utility is hampered by too many false positives and negatives. Research is ongoing to find a blood test or series of tests to help in the early detection of ovarian cancer, but that may still be years away.

It’s also important to make a distinction between prevention and early detection. Preventative practices reduce a woman’s risk of ever developing the disease while early detection facilitates early treatment, but does nothing to prevent the onset. For example, long term use of oral contraceptives reduces the risk of developing ovarian cancer by approximately 50 percent. This can be an effective preventative tool in at risk women. Getting more advanced imaging tests (like an MRI) may be helpful in high risk women, but it is strictly related to early detection and does nothing as far as prevention.

One of the best tools at a women’s disposal for assessing risk is family history. There is ample evidence that ovarian cancer runs in families, especially in those who carry certain genetic mutations. Some estimates say that up to 10% of ovarian cancers can be directly linked to such mutations, the most common being the BRCA 1 and 2. Doctors have become fairly aggressive in testing women with ovarian cancer and subsequently their family members for this gene variant as its presence warrants much more aggressive monitoring. Not everyone who has this gene will develop ovarian cancer; however, theyare at increased risk for this and other types like breast and colon.

Other possible symptoms of ovarian cancer are abdominal bloating, gastrointestinal disorders, urinary symptoms, unusual vaginal bleeding (especially in the menopause), and unexplained fatigue. A word of caution: as you can see, almost all women will experience one or all of these symptoms at some time. Rarely is it due to cancer, so simply be aware and use any symptoms as a reason to get checked.

A recent study indicates there may be an association between the fallopian tubes and ovarian cancer. There is evidence that some types of ovarian cancer may actually arise in the distal end of the fallopian tubes, which often encircle the ovary. Surgeons are much more aggressive now in removing fallopian tubes in hysterectomies to reduce the long term incidence of ovarian cancer.
Treatment of ovarian cancer is largely dependent on the degree of spread. It often involves surgery followed by chemotherapy. Almost 90 percent of women who are diagnosed while the disease is still confined to the ovary (stage I) survive for five years.

April 22, 2017

Distressed Desire

After the publication of my book, A Woman’s Guide to Hormone Health, I had the opportunity to speak around the country to audiences of women about some very “feminine” subjects. I was in San Diego speaking to a group called The Red Hot Mammas (sort of a cross between a menopause support group and a motorcycle gang) and during the question and answer session a grandmotherly octogenarian sheepishly raised her hand and asked, “Doc, my sex drive has driven off and I don’t have a map! What do I do?” I heard an audible “thank goodness” from several other folks in the audience as they wanted to ask the same question but didn’t have the courage of my blue haired inquisitor. Over the ensuing years I don’t think I have ever hosted a forum where this topic didn’t raise its libidinous head.

Next to questions about losing weight, a declining or absent sex drive is one of the top complaints heard in gynecologist’s offices nationwide. A recent report from the National Institutes of Health states that 43% of women will experience some form of sexual dysfunction at sometime in their life. A majority of these problems, especially in perimenopausal and menopausal women, is a lack of desire. Loss of libido is defined by the Diagnostic and Statistic Manual (the book doctors use to categorize diseases) as “persistently low sexual desire resulting in distress or relationship dysfunction, where lack of desire is not due to another condition or circumstance.” There are two important parts of this definition that are cogent to understanding the causes and treatments of this problem. First, the lack of desire must cause a problem either in the person’s psyche or in their relationships. So, for example, a woman with a low desire who is purposefully abstinent may not view that lack of desire as bothersome. Secondly, the low libido should not be due to a physical problem or medication. A common example of this in the menopause is the woman who experiences pain with intercourse due to vaginal changes in lubrication. It only makes sense that if it hurts, consciously or unconsciously, you are going to avoid intimacy like Republicans avoid taxes. Also various medications can have libido squashing side effects. For example, many of the anti depressants such as Prozac and Zoloft can flatten libido like a steamroller on asphalt.

The causes of a low or non-existent sex drive are legion, but they can generally be divided into four categories: physical, psychological, relationship, and hormonal.

Physical reasons include many nonsexual diseases such as arthritis, cancer, diabetes, high blood pressure, coronary artery disease and neurological diseases. Think of poor sex drive as side effects of these disease processes, and often once the physical malady is remedied, the libido returns. In addition, a glass of wine may make you feel amorous, but too much alcohol can spoil your sex drive. Any surgery related to your breasts or your genital tract can affect your body image, sexual function, and desire for sex. A huge secondary cause is fatigue. The exhaustion of caring for aging parents or young children can contribute to low sex drive.

I already alluded to the role of hormones, and any major hormonal shift such as menopause, pregnancy, and breast feeding can affect desire.

There are many psychological causes of low sex drive such as anxiety, depression, poor body image, low self-esteem, and a history of physical or sexual abuse. One of the most overlooked but common causes of poor libido is stress. This can be stress related to work, finances, kids, or just life.

We all know that much of a satisfying sex life originates as much above the neck as it does below the waist; therefore, relationship issues are huge in dissecting libido malfunction. For many women, emotional closeness is an essential prelude to sexual intimacy. If you are having problems between the sheets, don’t pull the covers over your eyes!

So what can be done about this tsunami of libido lack? Obviously if there is an underlying issue, such as medications or hormone problems, they must be addressed first and often sex drive creeps back. If stress and relationship issues are paramount then talking with a counselor skilled in addressing sexual concerns can help with low libido. Therapy often includes education about sexual response, techniques, recommendations for reading materials, and couples exercises.

In women suffering from painful intercourse, vaginal estrogen may markedly improve vaginal elasticity, lubrication, and response. Testosterone, present in females at a much lower concentration than males, has a libido enhancing effect for women; however, testosterone supplementation is controversial and should be closely regulated by a knowledgeable clinician.

It is critical to remember that libido can’t be separated from the context of a relationship. Couples who learn to communicate in an open, honest way usually maintain a stronger emotional connection, which can lead to better sex.

March 31, 2017

Don’t go gently into that dark night

The worn out paradigm of aging as simply a time when our knees buckle and our belts won’t is rapidly and mercifully passing away. Some scientists estimate that of all the human beings that have ever lived to be sixty-five or older, half are currently alive today! The seventy-five and older age group is the fastest growing segment of our population. These are folks who are not satisfied with the status quo. They are not happy to go gently into that good night. We (and I must include my rapidly aging self) want to grow old with gusto. We want to come to the end of life with nothing left, knowing we expended every waking moment in a purposeful embrace of the miracles around us. We want to age without becoming aged!

In 1984 the MacArthur Foundation sponsored a study that assembled a group of scholars from several major disciplines to conduct long term research designed to discover what constitutes “successful aging”. They studied those folks who remained vigorous well into their seventh and eighth decades, and then experienced a “compression of morbidity”. In other words, they lived to the max and then had a rapid demise.

One of their key points was that there was not a way to prevent aging or reverse the aging process. Human’s will always age, that is a given of biological and cellular processes. The whole industry of “anti-aging” potions, pills and pundits is a misnomer; there is nothing that will stop aging. The key, and what they wanted to discover, is how some individuals age without the ensuing (some would say inevitable) “falling apart”. We tend to think of this as aging gracefully, yet I believe that is much too passive. We must, as the study found, take an active role in doing some things and avoid doing other things.

So what did these scientists conclude? They discovered that successful aging involved three major components: a low risk of disease and disease related disability, high physical and mental function, and active engagement with life. It was noted that these were by nature interrelated, yet each provided and independent variable that could be controlled. They further defined active engagement as having relationships with people and behavior that is productive. They were quick to point out that successful aging is largely a result of individual choices and behaviors and not genetics.

The researchers discovered many specific characteristics of people who “aged well”, and I want to summarize just a few of the most important behaviors they ascertained. For a more thorough reading of their findings I refer you to the book Successful Aging by Dr.John Rowe and Dr.Robert Kahn.

Here are my top ten keys to successful aging culled from the MacArthur Study and my own research.

1. Exercise. Whether you are 10 or 100, exercise is the key to getting and staying healthy. Surprisingly the studies indicate that only a minimum of exercise (20-30minutes a day) can have a marked effect in lowering your risk of a number of diseases such as cancer, diabetes, and hypertension.

2. Get regular check ups. One of the secrets to successful aging is either preventing risk factors or identifying problems very early. Both of these tasks are facilitated by regular exams.

3. Stay current on routine screenings. Somewhat linked to regular checkups, availing yourself of things like mammograms, Pap smears, prostate exams, colonoscopies, bone densities, and blood screenings can be a lifesaver and allow you to enjoy a disease free old age.

4. Don’t smoke. Enough said. You would have to be a total fool to not realize the damage that this does to your system.

5. Take an aspirin a day. The evidence is mounting that a 61 mg aspirin a day can reduce the incidence of heart disease, stroke and colon cancer, especially in older folks. Remember that some people should not take aspirin, so check with your doctor before starting something new.

6. Get appropriate vaccines. For older folks the pneumonia and flu vaccines are important as these infections are responsible for thousands of deaths every year in people over 65.

7. Eat fewer total calories. The studies are conclusive that decreasing your total calorie intake is associated with lower rates of disease and longer lives. Specifically try to increase the protein and reduce the fat, but keeping the overall amount of calories lower is the most important guideline.

8. Develop social networks. As the song goes, people who need people are the happiest (and healthiest) people. An expanding network of family, friends, church membership, and social activities have all been associated with longer, less sickly aging.

9. Stay mentally engaged. Retire only if you must and if you must, find something else to keep you mentally active and challenged.

10. Be continually productive. By that I mean participate in either voluntary or paid activities that generate goods or services of economic value. That is a broad calling, but studies indicate that those who continue to find purpose, find health.

Remember, the goal is not just to live long, but to live long and well!

March 8, 2017

Estrogen and the Brain

A middle aged woman came into my office the other day telling a tale of woe that sounded like a bad country song. Her husband was fooling around, her son was in prison, her daughter was pregnant, and her dog had the mange! She said she was depressed and then commented, “I suspect it’s my hormones.” I looked at her incredulously and told her it had nothing to do with her hormones. It was her life!

Hormones, or lack thereof, have been blamed for everything from hot flashes to homicides. While the mystery of female hormones in particular are ripe with misinformation, we are learning every day of the impact of estrogen, progesterone and testosterone on the female body and mind. In previous columns I have expanded on the use of hormones in the menopause, the impact on PMS, and the importance in PCOS but I want to address some recent findings on the amazing interaction of estrogen in particular on the female brain.

A study out of the University of Southern California has come to the conclusion that women have better brainpower after menopause if they had their last baby after age 35, used hormonal contraceptives for more than 10 years, or began their menstrual cycle before turning 13. For years obstetricians have talked of the risks involved with having a baby after 35, yet over the past decade the number of women giving birth in their third and forth decades has dramatically increased. Now this study helps offset many of those fears by reassuring women that if they are older mothers they may actually be smarter later in life! Roksana Karim, lead author of the study and assistant professor of clinical preventive medicine at the Keck School of Medicine of USC, states, “the study provides strong evidence that there is a positive association between later age at last pregnancy and late-life cognition.”

The authors speculate that this effect is due to surges of estrogen and progesterone experienced by mothers during pregnancy. Interestingly, this beneficial effect seems to exists for women who had additional estrogen exposure during various times in their life, like with birth control pill use and early onset of puberty. Much has been made of the known risks of prolonged estrogen exposure like breast cancer and uterine cancer, but the effect of estrogen on the brain has been less publicized.

Estrogen has long been known to effect such brain functions as memory, mood, and mental state, showing, in many incidences, a profoundly positive impact. For example, there are noted to be many estrogen receptors in the areas of the brain responsible for memory and both naturally produced estrogen and estrogen taken as a medication has been shown to improve memory. Some of the most exciting research to date is looking at the impact of estrogen in reducing the onset or progression of neurodegenerative diseases like Alzheimer’s and senile dementia. It is way to early to make any assumptions about using estrogen therapeutically for these problems, but it looks promising.

Don’t worry guys, what is fascinating about some of this research is that the positive effect of estrogen on brain function applies to males also. In rat and monkey models, aging males given estrogen showed improvement in mental functioning and a decrease in brain cell deterioration. Granted, there are a number of problems associated with men using estrogen, so the hope is that the research will lead to the development of treatments that will maximize the benefits and minimize the downsides.

Whenever hormones are often touted as a treatment for anything, caution is to be advised. These are powerful substances that have multiple and profound effects on many body systems. All we have to do is look at relatively recent past history to understand the consequences of acting too aggressively. In the 50s and 60s estrogen was marketed as a “feel good” pill that kept a woman sexy and young for decades. Only later did we learn of the risks involved, and as a result many women developed diseases as a direct result of unopposed estrogen use.

I’d like to think that medical researchers and clinicians are wiser today and are looking at these exciting developments through the lens of unintended consequences. If there is a way to improve memory, reduce dementia, help depression, and decrease the incidence of Alzheimer’s disease using estrogen, then full speed ahead with the caveat that the negative side of the equation be adequately explored.

As we all learned in medical school, “First, do no harm.”

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January 9, 2017

Be Thankful and Be Amazed

We take a lot for granted. In these months devoted to celebrations and new beginnings, take a moment and ponder your own amazing human body. Now many of you may wish you had a sturdier chassis, a bigger motor, a smaller bumper, or a flashier exterior, but the reality is that the model you operate within is nothing short of extraordinary. Consider the following:

The average human brain has about 100 billion nerve cells.
Nerve impulses to and from the brain travel as fast as 170 miles per hour.
Your stomach needs to produce a new layer of mucus every two weeks or it would digest itself.
It takes the interaction of 72 different muscles to produce human speech.
The average life of a taste bud is 10 days.
The average cough comes out of your mouth at 60 miles per hour.
Relative to size, the strongest muscle in the body is the tongue.
Human thigh bones are stronger than concrete.
Our eyes are always the same size from birth, but our nose and ears never stop
growing.
The average human blinks their eyes 6,205,000 times each year.
Your skull is made up of 29 different bones.
The average surface of the human intestine is 656 square feet .
15 million blood cells are destroyed in the human body every second.
The average human will shed 40 pounds of skin in a lifetime.
Every year about 98% of the atoms in your body are replaced.
Every human spent about half an hour as a single cell.
There are 45 miles of nerves in the skin of a human being.
The average human heart will beat 3,000 million times in its lifetime and pump 48
million gallons of blood.
During a 24-hour period, the average human will breathe 23,040 times.

As a physician I am perpetually in awe of our incredible body. Even when it doesn’t function well, such as in disease, it has an uncanny ability to attempt to rectify the malady. While the rest of the universe spirals away towards increasing chaos and entropy, the human body strives for homeostasis. Modern medical and scientific research has explained many of the previously unknown mechanisms driving this tendency towards self preservation; however, there is still a vast depository of components and interactions that are still wrapped in a cloak of mystery. Even knowing how something works on a cellular level, like the immune system or the blood clotting cascade, can only give one pause to contemplate the precision and perfection it embodies.

Understanding the physical properties and dynamic interaction of our body is only a small part of what makes us human. We are so much more than our physical beings. The mind and spirit of each person is so amazingly unique and pervasively interactive that they have to be praised and acknowledged along side the biochemistry. Ever since man could ponder he has speculated about this interaction between mind, body, and spirit and those much wiser than I conclude that this triumvirate so intertwined as to be enmeshed. The only logical conclusion is that true health is a balance of these three entities. You can be physically fit but emotionally tattered, or you can be a spiritual giant and physically decrepit. To fulfill the miracle that is your health, a balance must be achieved.

The ancient Greeks knew that balance was the ideal. Socrates, prior to his Hemlock cocktail, said, “Everything in moderation, nothing in excess.” This advice is often overlooked in our contemporary society where we are often defined by our excesses. Get more bling – run farther – close more deals – take more vitamins – all promulgating the idea that more is better. It’s not, especially when it comes to your health. For example, eating balanced meals of moderate calorie intake is more healthy than either eating too much, too little, or too restrictively. It is hard for me to accept, but even exercising to an extreme can have some negative consequences. Severe emotional extremes, high highs and low lows, is actually a psychological disorder. Embracing balance is the best way to allow mind, body, and spirit to flourish.

Let me give you a personal example to illustrate this point. I like to run marathons and, in the midst of training, inevitably I will come down with a cold. This happens almost always after a long training run when my body hasn’t had a chance to recover and it’s resources are devoted to damage control instead of immune surveillance. A healthier approach would be to take the necessary rest days between long training runs to allow my body to compensate. Sometimes taking my own advice is akin to getting a root canal with pliers!

For many, good health is a choice. Choose wisely.

December 28, 2016

Diabetes and Sex

Here is some more uplifting statistics. Women who have had gestational diabetes or have given birth to a baby weighing more than 9 pounds are at an increased risk for developing type 2 diabetes later in life. The prevalence of diabetes is at least 2 – 4 times higher among African American, Hispanic/Latino, American Indian, and Asian/Pacific Islander women than among white women. The risk for diabetes also increases with ag e. Because of the increasing lifespan of women and the rapid growth of minority populations, the number of women in the United States at high risk for diabetes and its complications is increasing.

And to top all this off, when glucose isn’t under good control, a woman’s sex life can suffer. If your sugar is up, your libido may be down! Most of us associate diabetes and sexual problems with hubby, and indeed it is (hence all the TV commercials), yet women are effected, albeit somewhat indirectly also. Diabetes educator Ann Albright, PhD, RD says, “It’s not diabetes per se that harms your intimate life. It’s the complications of uncontrolled blood sugar levels that cause problems for both men and women — the only difference is that many women simply aren’t as aware of this complication as men are.”

This problem was not widely recognized until a landmark study in 1971 showed, “35% of women with diabetes reported being unable to have an orgasm during intercourse, compared to just 6% of the women who didn’t have diabetes.” The mechanism was thought to be a decreased lubrication that may arise from elevated blood sugars. This dryness may mimic what is commonly seen in menopause where lubrication also declines which results in decreased sensitivity and even pain with intercourse. Let’s face it, if it hurts it’s hard to find pleasure.

Another area affected is the tiny blood vessels that supply the vaginal and vulvar area, especially in the region of the clitoris. These vessels can become damaged by high sugars and limit the sensitivity and response from these areas. This results in both a decline in response but a definite decrease in desire. Prolonged elevation in blood glucose can also lead to nerve damage called neuropathy and this can also affect the pleasure sensation.

Women with diabetes are also prone to two types of medical problems that also can interfere with intimacy: Yeast infections and urinary tract infections. Whenever I see a patient with recurring infections, I always check for diabetes. Frequent infections can make sex uncomfortable and unfortunately the longer you go without, the more painful it may be to resume.

Dr Albright also reminds women that “The demands of the diabetes itself can affect you emotionally and if you’re a woman the stress of those demands is simply more likely to play out in the bedroom.”

So what is a woman to do? If you think this may be an issue with you, talk about it. Not to just anybody of course, but mainly your husband and especially your doctor, both your internist/endocrinologist and your gynecologist. Many of the problems can be reversed by better sugar control. There are both over the counter and prescription medicines that can enhance lubrication and increase tissue sensitivity. If you are having problems between the sheets, don’t pull the covers over your eyes! Remember, sexual functioning and libido are complex and multifactorial so focus on the big picture, get it out in the open, and ask about solutions

December 12, 2016

How to Age Successfully

The worn out paradigm of aging as simply a time when our knees buckle and our belts won’t is rapidly and mercifully dieing. Some scientists estimate that of all the human beings that have ever lived to be sixty-five or older, half are currently alive today! The seventy-five and older age group is the fastest growing segment of our population. These are folks who are not satisfied with the status quo. They are not happy to go gently into that good night. We (and I must include my rapidly aging self) want to grow old with gusto. We want to come to the end of life with nothing left, knowing we expended every waking moment in a purposeful embrace of the miracles around us. We want to age without becoming aged!

In 1984 the MacArthur Foundation sponsored a study that assembled a group of scholars from several major disciplines to conduct long term research designed to discover what constitutes “successful aging”. They studied those folks who remained vigorous well into their seventh and eighth decades, and then experienced a “compression of morbidity”. In other words, they lived to the max and then had a rapid demise.

One of their key points was that there was not a way to prevent aging or reverse the aging process. Human’s will always age, that is a given of biological and cellular processes. The whole industry of “anti-aging” potions, pills and pundits is a misnomer; there is nothing that will stop aging. The key, and what they wanted to discover, is how some individuals age without the ensuing (some would say inevitable) “falling apart”. We tend to think of this as aging gracefully, yet I believe that is much too passive. We must, as the study found, take an active role in doing some things and avoid doing other things.

So what did these scientists conclude? They discovered that successful aging involved three major components: a low risk of disease and disease related disability, high physical and mental function, and active engagement with life. It was noted that these were by nature interrelated, yet each provided and independent variable that could be controlled. They further defined active engagement as having relationships with people and behavior that is productive. They were quick to point out that successful aging is largely a result of individual choices and behaviors and not genetics.

The researchers discovered many specific characteristics of people who “aged well”, and I want to summarize just a few of the most important behaviors they ascertained. For a more thorough reading of their findings I refer you to the book Successful Aging by Dr.John Rowe and Dr.Robert Kahn.