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Fatigue

“I’m sick and tired of being sick and tired!”

“I just have no energy.”

One of the most common problems of the 21^st century woman is fatigue. I am not exaggerating by stating that well over 40% of women I see in my office complain at some stage of their life of excessive tiredness. Lack of energy is not a local phenomenon either (in spite of the claims of one woman who was sure that SRS had something to do with her low energy level. Of course this was the same gal who had been nabbed by aliens and forced to watch reruns of “Geraldo”). National statisti fatigue cs are equally as impressive. One study even went as far to claim that 30.3 % of adolescents experienced excessive fatigue (PEDIATRICS Vol. 119 No. 3 March 2007, pp. e603-e609)

The classification of fatigue runs the gamut from a transient mild tiredness to a debilitating lack of energy. One of the inherent problems in studying a condition such as this is the subjectivity of the diagnosis. Those who suffer with chronic fatigue are often perceived as malingerers and patronizingly dismissed. There is still reluctance on the part of many medical practitioners to legitimize chronic fatigue syndrome, the most extreme form of tiredness, as a genuine entity; however, this appears to be an area where the science is finally catching up with the clinical observation. As with any medical problem that is poorly understood, the treatment of excessive fatigue is varied, sometimes unconventional, and often unsuccessful. It is important to distinguish chronic fatigue syndrome from “garden variety” tiredness as they differ in numbers of symptoms and degree of disability. For many sufferers it comes down to how much the lack of energy interferes with normal day to day activities. The Center for Disease Control in Atlanta has set down certain criteria for physicians and researchers to use in making the diagnosis of chronic fatigue syndrome
. A CFS diagnosis should be considered in patients who present with six months or more of unexplained fatigue accompanied by other characteristic symptoms. These symptoms include:

cognitive dysfunction, including impaired memory or concentration
exhaustion and increased symptoms for more than 24 hours following physical or mental exercise
unrefreshing sleep
joint pain (without redness or swelling)
persistent muscle pain
headaches of a new type or severity
tender lymph nodes
sore throat

You can see from these symptoms that there is tremendous overlap with other common problems. We all may experience some of these problems some of the time. The key is the persistence and intensity of the problem and, importantly, no other medical or emotional troubles that serve as a cause.

There is hope! Since becoming a more universally defined syndrome, additional research has been done on ways to thwart this bothersome illness. Many of these treatments and suggestions also apply to the woman who has only mild symptoms. So whether you are unable to get out of the bed or just collapse at the end of a busy day, these pointers may be worthwhile pursuing.

First and foremost, get a good checkup by your doctor. Many medical conditions such as hypothyroidism, menopause, Lupus, depression, anemia, and sleep apnea have fatigue as a primary symptom. If you check out well with your doc, consider the following:

1. Check your sleep habits. We are a culture of sleep deprivation. It makes logical sense that if we don’t sleep restfully we will be tired the next day. I am amazed at the number of folks that forget this simple connection. Improve your sleep and your energy will rebound.

2. Force yourself to get off the couch. Multiple studies show the positive effect of exercise on energy level. You may be saying, “I would exercise if I wasn’t so darn tired!” It is tough, but forcing yourself to do something, even a good walk, will, over time, improve your energy level.

3. Garbage in equals energy gone. We are what we eat, and this applies to energy level. In fact, energy derives from the body’s ability to metabolize food. If we put molasses in our car’s gas tank, it won’t go far. If we put junk in our gas tank, we won’t go far!

4. Reduce stress. Stress magnifies everything! The more stress, the more your lack of energy. It’s as if the body tries to shut down to save itself from the stress. The more you can minimize stress, the more energy you will have.

I realize this is a very superficial treatment of very complex solutions, but maybe it can stimulate you to investigate these approaches on your own.

Healthy Tips

A celebration is often the result of an accomplishment, a special event , or honoring memories. These are good things, but do we really need the “special” to warrant a celebration? Wouldn’t it be great to be able to delight in the relatively mundane? Some of the happiest folks I know are those who relish just being able to get out of bed in the morning. We can celebrate our health, good or bad, by reflecting on what a true miracle it is that all these billions of cells are working in concert to allow us to walk, run, think, eat, love, write, and even occasionally complain. In celebration of simply being alive, I have compiled a list of healthy tips (or rambling recommendations) collected over the years to promote, extend, repair and rekindle your health. Let the celebration begin!

People who rarely spend time outside (elderly, housebound) are at a greater risk for osteoporosis due to a lack of vitamin D, which is increased in sun exposure. 400 IU a day in supplement form can help prevent brittle bones.

Taking 400 micrograms of folic acid a day before getting pregnant can reduce the likelihood of neural tube defects in the baby (spina bifida, etc.)

Exercise 30 minutes every day. The more and bigger the muscles used, the less time needed to achieve fitness (cross country skiing best, walking is good, using the channel changer is bad.)

The more colorful your meals the better. Bright colored fruits and veggies contain greater anti oxidants and other protective substances.

Use herbs (Black Cohosh) and vitamins (E) to control mild menopausal symptoms. Many are scientifically valid and may work for you.

It’s not brain surgery; to eat healthy go low fat, low sugar, high fiber and balanced.

Eliminate soft drinks. An extra can of soda a day can add 15 pounds in a year.

Almost half of all doctor visits are stress related. A great tool for stress management is regular, aerobic exercise.

The solution to permanent weight loss is not dieting, it is getting fit. Only muscles burn fat, and only muscles that are used!

If you are pressed for time, three ten minute exercise sessions can be as helpful as a single thirty minute segment.

Most women over twenty need to take some extra calcium (500mg) The better the bones before menopause, the better they are afterwards.

Eating habits are formed at an early age. Teach children as early as two to be aware of good and bad food choices.

Don’t focus on weight. Your per cent body fat and/or your Body Mass Index (BMI) are better measures of health. Throw away the traditional scales and get a device that calculates body fat and BMI. They are reasonably priced and accurate.

A good doctor will always encourage and support getting a second opinion…so in important decisions, do just that.

Don’t limit yourself by thinking that health is strictly physical. Wellness is a balance of mind, body, and spirit.

Don’t skimp on preventive care. The Pap test and mammogram have saved millions of lives.

If you have a strong family history of ovarian cancer (in mother or sister) demand a yearly sonogram and CA-125 blood test to check your ovaries. It is far from a perfect screen, but it is the best available so far.

Young women (ages 9-26) who are not yet sexually active should strongly consider getting vaccinated against the Human Papilloma Virus (HPV). It is the single biggest cause of pre-cancer and cancerous changes in the cervix.

Acupressure has been effective for the nausea associated with early pregnancies. The most common device used is “Sea Bands”, an elastic band that applies pressure to a point on the wrist.

Caffeine consumption is one of the leading causes of bladder problems in women. Eliminating caffeine from the diet may reverse symptoms of incontinence, frequency, and urgency.

Some women in the menopause need testosterone supplementation along with estrogen and progesterone to help with a lagging sex drive.

Many herbal medicines and treatments can interact with prescription drugs. When getting your yearly checkup, don’t forget to tell your doctor about any supplements or herbs you take on a regular basis.

Before any surgery, always stop taking Ginkgo, Ginseng, Garlic, or vitamin E. They can increase bleeding and lead to problems with the surgery.

Always bring two things to every doctor’s visit: a written set of questions and a list of your current medications.

20 percent of cancer deaths are related to obesity. Maintaining a healthy weight may be your best guard against developing cancer.

Aerobic exercise might be better for your brain than your body. Early studies show that exercise can cause damaged brain cells to regenerate, possibly thwarting diseases like Alzheimer’s.

The average person makes about 250 decisions about food every day and most people don’t have a clue as to what influences their choices. Consciously think about what you are eating and you will generally eat less.

A massage once a week can not only reduce muscle fatigue and soreness, but it can be just as good for stress management as a session with a counselor.

The quickest way to get fit with exercise is to WALC. Wind sprints (just periodically increase the intensity of the exercise) Aerobic (this type of exercise burns fat) Lift (lifting weights builds muscle, which in turn increases metabolism) Cross train (vary your exercise regimen and you will get fit faster).

We hope you’ll find these healthy tips useful!

Postpartum changes

It’s over. The baby is here! The excitement is only beginning, and then the reality sets in! Now the real work starts. Let’s look at some common postpartum concerns.

Breast feeding has undergone a resurgence over the past two decades and now a majority of women attempt it in the first few months after giving birth, and most are successful. Ideally, this is something that has been discussed and considered earlier in the pregnancy. If there is still doubt at this stage, discuss the pros and cons with your pediatrician.

It may take forty-eight to seventy-two hours after delivery for your milk to actually come in. There are a few techniques to aid in this process such as warm water massage and the use of certain medications (Reglan). Consult your pediatrician or lactation consultant if you sense a problem or the baby doesn’t seem to be satisfied. A common bothersome complication for breastfeeding moms is sore and cracked nipples. There are various creams that heal and coat the skin, and nipple shields, available at most pharmacies, can be a life saver. In both mastitis (breast infection) and nipple cracking, it is recommended to continue breastfeeding. Persisting with breastfeed in these situations does not jeopardize the health of the baby.

If you had an episiotomy, vaginal tears, or lacerations, you will probably

experience some discomfort in the immediate postpartum stage. During your hospital

stay, you were introduced to the wonderful world of sitz baths. These warm, antiseptic cleansing baths will keep the area clean and promote healing. They can be continued at home as long as they help.

The “lochia” or vaginal bleeding and discharge after the delivery, may continue for four to six weeks. This is a mixture of blood from the uterine cavity and vaginal secretions. It is usually heaviest in the first twenty-four to forty-eight hours after delivery and slacks off steadily from there. If you are breastfeeding, you may see a temporary increase right after the act of breastfeeding as the uterus cramps and expels any remaining tissue. If you are concerned about the amount of bleeding at any time, don’t hesitate to call your physician.

One of the most common questions after delivery is, “How can I lose this weight?” In

our health conscience, “skinny is better” world this can become an obsession for some

women. Remember, it took nine months to put this weight on, it will not go away over

night. There are, however, some things you can do to speed up the process. If you had an uncomplicated vaginal delivery, you can begin walking as soon as you feel well and have the energy. Exercise is the key to healthy weight loss. You can resume an exercise program within a few days of delivery, especially if you maintained an exercise regimen during the pregnancy. There are always exceptions. If you had a large number of stitches from a tear or episiotomy, your physician may request that you temporarily limit your activity. If you had blood pressure problems or pre-eclampsia, you may need to postpone exercise. Before you leave the hospital ask your doctor about his recommendations for your activity levels.

The second component to healthy weight loss is proper nutrition. This is especially important for breastfeeding mothers. When you are nursing, you need about 500 calories a day more than you would normally eat in a non pregnant state. This is assuming you were eating healthy before you got pregnant. Eat a well balanced diet and focus mainly on fruits, vegetables, and whole grains. I generally tell new moms to continue to take their prenatal vitamins while nursing as it provides additional nutrients that you may not get in your diet. Drink plenty of water, a minimum of eight to ten 8 oz glasses a day. This is critical to allow for the production of adequate milk and is also important in promoting weight loss.

Another common question that arises postpartum is “When can I resume sexual relations?” Actually this is the most common question of the husband. This is not exactly paramount for most women at this stage. I had one patient who asked me to write her a note that she didn’t have to have sex for a year; however, it became obvious that this request was reflective of a relationship problem more than a physical problem. The leading causes of decreased libido after birth are stress and fatigue. Don’t fret this lack of desire as it is almost universal. It will vary as to when the desire for intimacy returns. I would discuss this openly with your doctor and husband as often communicating your feelings fosters understanding and compromise.

The birth of a child is God’s way of reinforcing that the world needs to continue. Embrace it with a heavy dose of both joy and responsibility.

What is She Thinking?

Have you ever wondered why your wife doesn’t appreciate your love affair with the remote control? Are men really from Pluto and women from Jupiter?

We may not come from different planets, but scientists tell us that many of the differences between men and women may actually stem from differences in brain structure. This variance leads to gender- specific behavioral traits. In addition, female hormones (estrogen, progesterone, and testosterone) can cause microscopic changes in cells which may influence perceptions and thought patterns.

Brain researchers report that the two primary reasons for gender differences are brain structure and hormones. These differences can lead to behaviors that can either help or hinder relationships. God designed the sexes to be different so as to complement each other, yet these gender-specific attributes may also lead to conflict and confusion for many couples. The good news is that we can also discover ways to live in harmony with our mates.

For decades scientists have known that the right and left hemispheres of the brain have different functions. It is well established that the left hemisphere predominately controls analytical, concrete, goal-oriented behavior, whereas the right side manages more spontaneous, emotional, and artistic actions. Most individuals, independent of their sex, have a dominant lobe that influences their personality.

These two hemispheres are connected by a large network of nerves called the corpus callosum. This superhighway permits the free transfer of complex information between the two lobes. When the corpus callosum is absent (as in some rare birth defects) or severed (by accidental trauma or as medical treatment for otherwise untreatable seizure disorders) the individual’s behavior and personality may become disjointed and unpredictable.

A woman’s brain contains an average of 40% more of these interconnecting nerve fibers: a veritable superhighway for the two sides of the brain in comparison to a man’s two-lane road.

How is this significant? It means that a woman can literally use her whole brain in a task, whereas a man is much more likely to use just one hemisphere at a time. This results in a woman being able to process many tasks at once, whereas a man tends to focus on conquering one task at a time.

Men and women also use their brains differently (when we use them). Fascinating studies utilizing state-of-the-art technology show that during identical tasks, women tend to use the right and left sides of the brain equally whereas men use one hemisphere more intensively. This female “whole brain” thinking, supported by the corpus callosum interconnections but not dependent on them, gives a physiological basis for the enigma of women’s intuition. Being able to use the whole brain in processing information allows women to perceive things in a broader sense and make conclusions based on a vast array of input. This sixth sense is founded on the “whole brain” thinking that takes input from a multitude of sources to produce uncanny and often unexplainable insights.

A woman’s brain has more nerve cells than a man’s in an area called the hippocampus, the area of the brain that is intimately linked to processing and expressing emotions. The hippocampus is also the switchboard for regulating the response to stress. This area is also very sensitive to the effects of estrogen, which partly explains the emotional changes seen with fluctuations in female hormones, i.e., puberty, PMS and menopause. Because women have more neurons in this switchboard, emotions are more closely linked to other behaviors, and stress is perceived differently

Hormones are nature’s messengers. They are chemicals that transfer information from one cell to another, in some cases even altering the structure and function of the target cell. The development of female brain function and structure is especially dependent on estrogen. As the female fetus develops, estrogen works its magic by altering brain structure and sensitizing receptors for the important neurohormone serotonin. Serotonin is the critical “mood messenger” hormone that is responsible for the expression of various emotions, including depression. Any alteration in the workings of serotonin can present as a clinical depression or anxiety disorder. Estrogen is closely tied to the function of serotonin and that is why women are twice as likely to develop clinical depression as men. This connection with serotonin also partially explains why fluctuations in hormones (as in puberty, postpartum, and menopause) can cause changes in emotions. For years, the male-dominated medical fraternity downplayed this episodic mood shift as largely due to external stresses: the “it’s all in your head” approach. We now know that it is all in your head, just in the literal sense, because of the interaction of estrogen with brain cells and serotonin.

One of the most important steps a man can take in helping his wife who is suffering the emotional trials and tribulations of PMS or menopause is to understand that these changes are real and based on both physical and emotional factors in addition to the stresses of her life situation. Fortunately, clarification of the roles played by hormone fluctuations and brain functions had also led to parallel discoveries of how diet, exercise, and nutritional supplements can correct imbalances to restore health and wholeness.

Adult onset acne

“Hey doc, my face looks like a war zone. I wouldn’t mind having the complexion of a sixteen year old if I could have the body of one also, but this is ridiculous for a grown woman!” Gladys was a victim of adult onset acne, and she was not pleased. She is not alone. Some experts estimate that up to 50 % of women over 30 suffer from some type of acne or acne like complexion disorders.

It is not known what triggers adult onset acne. The development of hormonal irregularities in the menstrual cycle may be a factor, or ovarian cysts may cause hormonal abnormalities that increase androgen productivity, resulting in acne breakouts. The classic situation is one in which a woman experiences irregular cycles, setting up an over production of estrogens and testosterone. These hormones stimulate oil production in the skin glands which in turn become inflamed and irritated. Sometimes these sebaceous glands continue producing a higher amount of sebum well into adulthood and thus acne infection continues even at that age. Androgens have also been associated with acne flare-up in women before menstrual cycles or sometimes during pregnancy. Whatever the cause, it is not wanted or welcomed.

Most acne treatments require prolonged care, from months to years. These treatments include topical creams and gels and/or oral medicines. Once improvement is achieved, a maintenance dose is usually necessary. Women who develop adult acne typically have the problem for years, frequently through menopause. The suspected hormonal disruptions that trigger adult onset acne are often treated by attempting to regulate the hormonal imbalance. The modalities used most in hormonal acne treatment are oral contraceptives and antiandrogens. (medicines that counteract the effect of too much testosterone in a woman’s system).

There are several simple things to do to minimize adult onset acne. Washing with soap and water once or twice daily is a good way to keep debris and oils from the day accumulating on the skin surface. Salicylic acid and benzoyl peroxide are both common over-the-counter treatments for acne. Benzoyl peroxide exfoliates the skin and the anti-bacterial agents in it clear the excess debris from the skin to help prevent infections.

Retinoids are a class of molecules in the vitamin A family. The retinoids are potent against acne because they stabilize abnormal growth and death of cells in the sebaceous follicle. These abnormal growth cycles are believed to play a key role in the formation of blackheads, whiteheads, and other acne. The danger in retinoids is that they cannot be used by pregnant women or women who might be getting pregnant because of the high rate of serious birth defects in unborn children.

Topical and oral antibiotics are used together with other agents. Topically, antibiotics neutralize the skin-based bacteria and, when used with other agents, help deplete the excess sebum or oil secreted by the sebaceous glands, allowing acne spots to heal without infection.

Oral contraceptives prescribed for women are based on their ability to regulate hormones. A birth control pill stimulates the production of a protein that binds testosterone, thus reducing the androgen’s ability to affect oil glands.

Occasionally, adult onset acne can be confused with a condition known as rosacea. Although it is not exactly acne, its red-faced, acne like appearance can cause many physical, psychological and social problems if left untreated. In a recent survey by the National Rosacea Society, nearly 70% of rosacea patients said that this skin disorder lowered their self esteem, and 41% of patients said that they avoided social contact or functions because of their skin disease.

The cause of rosacea in unknown and there is no cure, but with available medical help this skin disorder can be controlled and minimized. Its typical symptoms are redness on the cheeks, nose, chin or forehead, small visible blood vessels on the face, bumps or pimples on the face, and watery or irritated eyes.

Whatever the cause, whatever the result, if adult onset acne is cramping your style, see your doctor because there is help.

Too Pooped to Play

“I’m sick and tired of being sick and tired!”

“I just have no energy.”

One of the most common problems of the 21^st century woman is fatigue. I am not exaggerating by stating that well over 40% of women I see in my office complain at some stage of their life of excessive tiredness. Lack of energy is not a local phenomenon either (in spite of the claims of one woman who was sure that SRS had something to do with her low energy level. Of course this was the same gal who had been nabbed by aliens and forced to watch reruns of “Geraldo”). National statistics are equally as impressive. One study even went as far to claim that 30.3 % of adolescents experienced excessive fatigue (PEDIATRICS Vol. 119 No. 3 March 2007, pp. e603-e609)

The classification of fatigue runs the gamut from a transient mild tiredness to a debilitating lack of energy. One of the inherent problems in studying a condition such as this is the subjectivity of the diagnosis. Those who suffer with chronic fatigue are often perceived as malingerers and pa
tronizingly dismissed. There is still reluctance on the part of many medical practitioners to legitimize chronic fatigue syndrome, the most extreme form of tiredness, as a genuine entity; however, this appears to be an area where the science is finally catching up with the clinical observation. As with any medical problem that is poorly understood, the treatment of excessive fatigue is varied, sometimes unconventional, and often unsuccessful. It is important to distinguish chronic fatigue syndrome from “garden variety” tiredness as they differ in numbers of symptoms and degree of disability. For many sufferers it comes down to how much the lack of energy interferes with normal day to day activities. The Center for Disease Control in Atlanta has set down certain criteria for physicians and researchers to use in making the diagnosis of chronic fatigue syndrome. A CFS diagnosis should be considered in patients who present with six months or more of unexplained fatigue accompanied by other characteristic symptoms. These symptoms include:

cognitive dysfunction, including impaired memory or concentration
exhaustion and increased symptoms for more than 24 hours following physical or mental exercise
non-refreshing sleep
joint pain (without redness or swelling)
persistent muscle pain
headaches of a new type or severity
tender lymph nodes
sore throat

First and foremost, get a good checkup by your doctor. Many medical conditions such as hypothyroidism, menopause , Lupus, depression, anemia, and sleep apnea have fatigue as a primary symptom. If you check out well with your doc, consider the following:

I realize this is a very superficial treatment of very complex solutions, but maybe it can stimulate you to investigate these approaches on your own.

Menopause or Mental Pause?

Aileen blew into my office like a Summer storm. “Help me, I’m a poster child for Hormones from Hell!” After catching my breath, I assured her that there were many ways of dealing with the ravages of hot flashes, dry skin, mood changes and forgetfulness. I started by reinforcing that menopause is not a disease. Inaccurately and unfortunately there is a pervasive sense that menopause is the “ultimate and inevitable bad experience” for aging women. I jokingly explained that women were not designed to self-destruct at fifty!

Menopause is a normal, natural transition, and it is vital for women to view it with a positive perspective. That simple understanding is the cornerstone in building a plan to thwart the symptoms of “the change.” But it is equally important to realize that not everyone has a problem with menopause.

As a physician, my experience treating menopausal women is that there are some universal similarities in women’s experiences, but because of every person’s unique physiology and life journey, this time in a woman’s life is very individualized.

I am a “recovering traditionalist”. I was trained in the old school approach to menopause (which means drugs, and if that didn’t work, more drugs). In almost thirty years of practice I have found that many women are not satisfied with their options and many discover that their “treatments” are worse than their symptoms. Especially in this age of “estrogen panic” where the media (and many physicians) has touted misleading and confusing advice on hormones, many women are looking towards alternative treatments for their symptoms. One woman put it well. She said, “Physicians have a duty to give a woman the best care they can provide, especially their options. However each person is ultimately responsible for his or her own health. We, the patients, need help, guidance, and a listening ear.” Those were powerful and challenging words.

The general dissatisfaction among women is amplified by the observation that only 17% of eligible women in the US are taking some type of hormone replacement and up to 80% of women who start on hormones stop them after two years! The needs of women are not being met! This problem with compliance is due to poor communication and fear. After all, treatment of symptoms is not limited to simply taking a drug. Successfully navigating the potentially turbulent waters of menopause requires a more comprehensive approach.

Herbs, complimentary teachings, diet, and exercise all should be discussed along with hormones. The main caveat surrounding these modalities is that they must be held to the same standard and scrutiny that safeguards traditional hormone replacement.

The major problem in meshing the traditional and complimentary approaches to health is a mistaken perception of mutual exclusivity. These treatments can coexist and be complimentary.

I am saying that choice and personal responsibility are keys to unlock a joyous menopause.

This is an opportunity to live with passion and fulfill your life mission. This is a time to take stock of the past and choose your path for the future. The choice is yours. It is a choice that is difficult if not impossible to make wisely without sound information and guidance

Men and Women are different

Men and women are different. I realize this may not be a ground breaking revelation but aside from certain anatomical variations, the differences are not always noticeable.

https://youtu.be/gWt6DW8I4Ao

Women certainly have a different hormonal milieu than men, and some of the internal variations can be directly attributed to such; however, laying everything at the feet of the hormonal hooligans is both simplistic and unfounded. In other words, men and women are not solely their hormones, but a complex interaction of gender specific, unique physiology. Let’s look at some examples.

Women are at a greater risk of developing problems from alcohol use than men. This applies to simple health risks as well as severe consequences. The National Institutes of Health state that, based on current research, female alcoholics have death rates 50 to 100 percent higher than those of male alcoholics, including deaths from suicides, alcohol-related accidents, heart disease and stroke, and liver cirrhosis. Even though there are more male alcoholics than female, the women fare worse overall. This is related to how alcohol is metabolized in the female system. Women are more likely to develop liver damage from excessive alcohol consumption even when compared to similar intake for males. In addition, having more than 2 drinks a day can increase the risk for breast cancer for a woman. Why do these differences exist? In general women have less body water than men of similar body weight, so that women achieve higher concentrations of alcohol in the blood after drinking equivalent amounts of alcohol. In addition, women have smaller quantities of the enzyme dehydrogenase that breaks down alcohol in the stomach. A woman will absorb about 30% more alcohol into her bloodstream than a man of the same weight who has consumed an equal amount. There is a push by many organizations, especially on college campuses to educate women as to these differences. The consequences later in life can be substantial.

For years medical research on heart disease and risk factors was done exclusively on men. The vast majority of major work done in the earlier decades purposely excluded women for reasons ranging from potential pregnancy to volunteer recruitment. What resulted is a plethora of data that is extremely useful, but biased. Only with the advent of multiple studies including women have researchers realized that heart disease risk factors, occurrence, and prognosis are different for men and women. Heart disease has taken a back seat to breast cancer, for example, largely due to media attention and breast cancer awareness programs; however, heart disease is the leading cause of death in women over 50. A woman is more than ten times as likely to die of cardiovascular disease as she is to die of breast cancer. This is partly due to the fact that the survival rate for breast cancer is quite high, whereas over 40% of women do not survive their first heart attack. Women’s hearts are anatomically different from men, and they also function differently. A woman’s heart on average is smaller than a man’s, and it also tends to have smaller blood vessels supplying it. Researchers from Columbia University and New York Presbyterian Hospital believe that women also have a different rhythmicity to the pacemaker of their hearts, which causes them to beat faster. These same researchers believe that it may take a woman’s heart longer to relax after each beat. Some surgeons also hypothesize that the fact that women have a 50 % greater chance of dying during heart surgery than men could be related to some fundamental difference in the way women’s hearts work. These differences have led to a bias in how physicians viewed heart symptoms in women. Several studies indicated that if a woman and a man presented to an emergency room with identical symptoms, the man would be more likely to be evaluated for heart problems than the woman. Luckily with the new data, this trend is reversing and early disease is being suspected and detected in women, hopefully reducing both death and disability.

Most would agree that men and women think differently. This may have a physiologic basis as research indicates that men’s and women’s brains are structurally different. There are variations in grey and white matter, which leads to differences in things such as verbal abilities and connectivity between the two sides of the brain. These anatomical peculiarities can lead to a number of behavioral differences once thought to be social or environmental.

It’s important to understand there is no advantage or disadvantage with these variations, it’s just that being aware of the differences may help in promoting each individual’s health.

Brain Food

“I’m not kidding; it’s Miracle-Gro for the brain!” The statement reminded me of some ridiculous infomercial infecting late night TV. In this case however, it was generated from the mouth of a world class neurobiologist, so I took notice. He was speaking of a substance called Brain Derived Neurotrophic Factor (BDNF). What immediately intrigued me was he claimed that BDNF was the link between exercise and improved brain function. For years I had read articles in both the medical and running journals touting the psychological benefits of fitness, yet here was proof that fit folks were happier folks. Dr.John Ratey, a clinical professor of psychiatry at Harvard, outlined in his amazing book “Spark: The Revolutionary New Science of Exercise and the Brain” how exercise increased the production of BDNF which in turn stimulated nerve cells to grow and connect in the Hippocampus, a tiny area in the brain responsible for a number of high level functions. This growth of new cells actually translated into better memory and quicker learning. He went on to claim that certain other chemicals were released by exercising muscles that improved functioning in the amygdala, the emotional center of the brain. The implications of this and other research are monumental.

Twenty-five years ago when I was in medical school we were taught that we were born with a set number of neurons (brain cells) and there were no more to be made…period. I remember joking in college about taking another late night excursion to the disco (yes, I am that old!) to “kill some brain cells” with Singapore Slings and Jack and Coke. We didn’t fret about the wholesale slaughter of brain cells as we all knew from biology class that we only used 20% of our brain anyway. In our way of thinking, that gave us a pretty good cushion! It was the unlucky folks born with fewer brain cells, and we all knew a few of those, who had the most to fear. We were wrong on all accounts. Now research is proving that new brain cells can be created, and formed in areas that have a major effect on cognition and emotions. Don’t take this as permission to guiltlessly get plastered; I don’t need to tell you of the disastrous effects of that, but it does open the door for medical miracles. The study of such alphabet soup as BDNF, IGF-1, and VGEF and other neuropeptides has given hope to developing successful treatments for senile dementia, Alzheimer’s and Parkinsonism. Medicine is not there yet, but we can conclude that getting fit by exercising regularly can reduce the incidence of these diseases as well as certain cancers and diabetes.

The great news is that you don’t have to train for a marathon to reap the benefits of fitness. The studies indicate that a brisk walk for 45 minutes three to four times a week can elicit these life enhancing outcomes.

One of the most exciting applications of this knowledge is illustrated by the Naperville school district. A middle class suburb south of Chicago, Naperville has been the focus of a real-life experiment documenting the benefits of fitness in kids. It is no surprise that kids who are active are more physically fit than their sedentary counterparts, but what has been found in Naperville is that these fit kids are also smarter! Over the past seventeen years the school district, consisting of 11 elementary schools, five junior high schools and two high schools, has made physical education an integral part of the school day (unlike the national average where only 6% of high schools have a daily PE program). Their gym class is not your typical dodge ball, basketball, softball curriculum (the average student in the typical hour long PE class spends 16 minutes actively moving). It is a program that promotes and measures fitness, not competition, and grades based on effort, not ability. They regularly run or ride bikes using donated treadmills and stationary bikes measuring effort by heart rate monitors. And they do it at a lower cost per student than comparable school systems! The results have been amazing. In 2002, 97% of entering freshmen were at a healthy body mass index (BMI) as compared to the national average of 65% and most striking was the impact that fitness had in the classroom. In that same year 96% of the eighth graders took the Trends in International Math and Science Test, an instrument designed to compare student’s knowledge level in different countries around the world. On the science part of the test the Naperville students scored the highest…in the world! Through a strict and comprehensive analysis it was shown that regular physical activity and fitness level correlated with the academic success of the Naperville students!

The message is clear. For adults and kids alike, regular aerobic exercise is not only good for the body, but it is great for the mind.

Ovarian Cancer

For women, ovarian cancer is a frightening malady because of its insidious nature. It’s been called a silent killer because once symptoms appear, the disease is often widespread. The key to overcoming this fear is understanding the reality of the disease and dispelling myths.

The American Cancer Society states, “Ovarian cancer ranks fifth in cancer deaths among women, accounting for more deaths than any other cancer of the female reproductive system. A woman’s risk of getting ovarian cancer during her lifetime is about 1 in 75. Her lifetime chance of dying from ovarian cancer is about 1 in 100.” Juxtapose this with the most common cancer in women, breast cancer, where a woman’s lifetime risk is 1 out of 8. Even when you consider total cancer deaths, ovarian ranks low compared to breast, lung, and colorectal. So indeed ovarian cancer is a fierce adversary, but realistically there is a much lower incidence of this type of cancer than many others.

One reason ovarian cancer is so feared is its delayed presentation of symptoms. Unlike many illnesses which telegraph their appearance early with notable symptoms, ovarian cancer often doesn’t produce noticeable problems until relatively late in its development. And when it does, the symptoms are nebulous and rarely initially recognizable as ovarian in nature. For example, a common symptom of ovarian cancer is abdominal bloating. Unfortunately, this same symptom can be associated with everything from bad sushi to irritable bowel syndrome. Common symptoms associated with ovarian cancer include:

Fatigue.

Upset stomach.

Back pain.

Pain during sex.

Constipation.

Menstrual changes.

Abdominal swelling with weight loss

As you can see, virtually all women will experience at least one of these symptoms intermittently. The distinguishing factor often is a persistence or continual worsening of symptoms.

Unlike the Pap smear for cervical cancer, there are no good screening tests for ovarian cancer. There is some evidence that a combination of various blood tests and a pelvic ultrasound may suggest an early ovarian cancer, yet these have not yet been shown to be useful enough in a low risk population to be promoted as a screen for everyone. Certainly these tests (and others like a CT scan) can help steer the diagnosis in someone with unexplained symptoms, but we are still woefully lacking in a universal screening test for ovarian cancer.

There are some folks who are at a higher risk for this disease and therefore warrant closer monitoring. Risk factors for ovarian cancer include a family history, menstruating at an early age (before 12), having not given birth to any children, a first child after 30, menopause after 50, and having never taken oral contraceptives (taking birth control pills actually reduces the risk of ovarian cancer). Of special interest is the genetic relationship between various female cancers like breast and ovarian. About 10 to 15 percent of women diagnosed with ovarian cancer have a hereditary tendency to develop the disease. The most significant risk factor for ovarian cancer is an inherited genetic mutation in one of two genes: breast cancer gene 1 (BRCA1) or breast cancer gene 2 (BRCA2). These genes are responsible for about 5 to 10 percent of all ovarian cancers. Eastern European women and women of Ashkenazi Jewish descent are at a higher risk of carrying BRCA1 and BRCA2 mutations. Since these genes are linked to both breast and ovarian cancer, women who have had breast cancer have an increased risk of ovarian cancer. These can be detected with a blood test and many insurances will cover this in high risk women. There is an ethical debate regarding someone who tests positive for these mutations. Do you prophylactically remove the ovaries as a preventative tool? There are no clear cut answers at this stage as not everyone who has these mutations will develop cancer. The utility in this knowledge allows the individual to make a rational decision based on a variety of factors.

Treatment of ovarian cancer is often a combination of surgery and chemotherapy. Much of the treatment depends on the extent of the disease noted during the surgical removal of the cancerous tissue. This cancer tends to spread both by local growth in the pelvis and through the bloodstream and lymphatics, so it can metastasize or reoccur in distant parts of the body. There have been advances in treatment, especially in chemotherapeutic agents, and one of the most exciting ares of research is in various immunological techniques. These approaches literally label the cancer cells with tags that allow a chemotherapeutic agent to selectively attack the bad cells while leaving the good cells alone. Many women are successfully propelled into remission with these and other techniques, so there is expanding hope as research develops.

Ovarian cancer is a serious and scary disease, but it is not the death sentence it once was.

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