Saturday, 25 March 2017

When You Need Medical Help Fast

In medical emergencies, it can be crucial to seek help quickly. As an RN, I’ve seen instances where getting immediate care can make all the difference.

For some injuries and illnesses, there is a short window of time during which medical treatment should be administered. Once that window closes, the chances of successful treatment shrinks. In medicine, it’s known as the “golden hour.”

Here are some guidelines on recognizing emergencies and getting help quickly:
Seek treatment within 3-4 hours

If the flow of oxygen-rich blood to a portion of the brain is blocked, a stroke occurs—and brain cells can begin to die after just a few minutes. Sudden bleeding in the brain may also cause a stroke. Symptoms include sudden weakness, paralysis or numbness of the face, arms or legs; trouble speaking or understanding speech; and trouble seeing. A stroke is a serious medical condition requiring emergency care. It can cause lasting brain damage, long-term disability or even death.
A drug called tissue plasminogen activator (or tPA) is injected into a vein in your arm, and can break up blood clots in the arteries of the brain. But it must be given within four hours to be effective. It should be given as soon as possible.

If you suspect you or someone else is experiencing the symptoms of a stroke, dial 911 immediately. Don’t drive to the hospital or let someone drive you—medical personnel in an ambulance can begin this lifesaving treatment on the way to the emergency room.
Seek treatment within 72 hours
Symptoms of this temporary form of facial paralysis caused by a swollen, inflamed or compressed nerve that controls the facial muscles vary from person to person. They may include twitching, weakness or paralysis on one or both sides of the face (though the latter is rarer); drooping of the eyelid and corner of the mouth; drooling; impaired taste; or excessive tearing in one eye. Symptoms usually come on suddenly and reach their peak within 48 hours. Bell’s palsy can occur at any age but is less common before age 15 or after age 60. Among the 40,000 Americans afflicted each year, Bell’s palsy is more common among those with diabetes or upper respiratory ailments like the flu or a cold.

Though most people eventually recover, it can cause long-term facial disfigurement. That’s why it’s important to seek treatment (at an urgent-care center or the emergency room of a hospital) fast—within 72 hours of the onset of symptoms. Oral steroids can reduce inflammation and restore function of the affected nerve.
Seek treatment within 72 hours
Tetanus is a serious bacterial disease and potentially lethal infection. The tetanus infection, which is fatal in one of every 10 cases, can cause painful muscle contractions, especially in your jaw and neck muscles, and can interfere with your ability to breathe. It’s commonly known as “lockjaw.”
The tetanus vaccine can protect you against developing the infection, for which there is no cure. You may develop tetanus if you have been contaminated with dirt, animal feces or manure through a deep cut or puncture wound. Seek help within 72 hours if you haven’t had a booster shot within 10 years or aren’t sure of when you were last vaccinated against tetanus. Treatment includes a shot of tetanus immune globulin along with a standard booster.


Seek treatment immediately if it suddenly rises and stays that way
If your blood pressure registers a systolic reading (top number) of 180 mm Hg or higher or a diastolic reading (bottom number) of 110 mm Hg or higher for more than a few minutes with repeated checking, it’s considered a hypertensive crisis and you should seek immediate emergency medical treatment.
Symptoms include chest pain, shortness of breath, back pain, numbness or weakness, change in vision or difficulty speaking. When blood pressure rises quickly and severely, results can include stroke, memory loss,heart attack, damage to the eyes and kidneys or loss of kidney function. To lower your blood pressure, you’ll most likely be treated with an adjustment of your oral medications.

Seek immediate treatment

Flashes of light or floaters (small bits of debris that look like spots, hairs or strings) in your eyes or darkness over part of your visual field that occur suddenly or in great numbers may signal a possible retinal tear or detachment, when the retina pulls away from the layer of blood vessels it needs to provide it with oxygen and nourishment. Although it’s painless, it can lead to vision loss and requires immediate medical attention by an ophthalmologist.

You’re more at risk if you have a family history or retinal detachment, are older than 40 or have had a previous severe eye injury or trauma. Treatments include surgery or a procedure that injects air or gas into your eye (known as pneumatic retinopexy), draining and replacing the fluid in the eye, or cryopexy, where the surgeon applies a freezing probe to the outer surface of the eye directly over the retinal defect.

What about non-emergency situations? 

When it’s not an emergency, you have more options. For times when it may not be convenient to see your doctor, but you don’t need emergency care, there’s LiveHealth Online. It’s a quick and easy way to see a doctor 24/7 for face-to-face video conferencing. What a great resource! In fact, we at HealthyWomen like it so much we’re offering a free coupon for your first visit.

So You Think You Can’t … Cut Your Risk of Diabetes?

Heart disease, stroke, cancer, obesity, arthritis and diabetes: what do these have in common?
They’re all ubiquitous chronic diseases and conditions. They’re also all costly. But most importantly, they are among the most preventable of all health problems.

Because November is American Diabetes Month, I think it’s important to create awareness for a disease whose costs are estimated to be a staggering $255 billion. Out of that, $176 billion is for direct medical costs and $69 billion for decreased productivity. Unfortunately, unless people do their part to stop diabetes from growing, one in three American adults will have it in 2050, according to estimates by the American Diabetes Association.

There are way too many people dealing with diabetes: nearly 30 million children and adults in the United States. And because it’s the leading cause of kidney failure, lower limb amputations (other than those caused by injury) and new cases of blindness in adults, prevention is key.

Note: An important distinction between type 1 and type 2 diabetes is that type 1 (when the body does not produce enough insulin) is usually diagnosed in children and young adults (it was formerly known as juvenile diabetes). Just 5 percent of the people with diabetes have this type.

In addition to the 30 million people who have already been diagnosed with diabetes, there are another 86 million who haven’t been diagnosed—yet. They have prediabetes, which puts them at risk for developing type 2 diabetes.

That’s why I think it’s important for you to become alert to prediabetes. If you know you have it, it may be in your power to save yourself from progressing to the next step: type 2 diabetes. Prediabetes is really like an early warning system. After all, knowledge is power, and with this power you may be able to save your health.

It’s possible you are unknowingly living with prediabetes, since there are no clear symptoms of it. Someone with prediabetes has a higher than normal blood sugar level, but not high enough to be diagnosed as diabetes. In addition to raising your risk for diabetes, prediabetes puts you at  higher risk of developing other serious health problems, including heart disease and stroke.

It’s important to know if you have prediabetes. Not everyone who has prediabetes goes on to develop type 2 diabetes, but there are things you can do to help. For some people, early treatment can return their blood glucose levels to a normal range.

If you have prediabetes, make sure to get checked for diabetes every year.
Risk Factors
You’re more likely to develop prediabetes if you:
Are age 45 or older
Are African American, Hispanic/Latino, American Indian, Asian American or Pacific Islander
Have a parent, brother or sister with diabetes
Are overweight
Have high blood pressure or take medicine for high blood pressure
How low HDL cholesterol and/or high triglycerides
Are a woman who had gestational diabetes (diabetes during pregnancy)
Have been diagnosed with polycystic ovary syndrome (PCOS)
The American Diabetes Association offers a simple Type 2 Diabetes Risk Test.
A few simple lifestyle changes can lessen your chances of being diagnosed with diabetes or delay its onset.
Here are some changes you can make:
Cut back on calories and saturated fat.
Lose weight, if overweight. Research shows that you can lower your risk for type 2 diabetes by 58 percent by losing just 7 percent of your body weight. For someone who weighs 200 pounds, that weight loss translates to 15 pounds.

Exercise. The U.S. Centers for Disease Control and Prevention recommends getting at least 150 minutes each week of physical activity, such as brisk walking.

Get active. Aside from formal exercise, take measures to be more active. Choose the spot in the parking lot farthest from the entrance; take the steps instead of the elevator; pace rather than sit while you’re talking on the phone; and if you work in an office, get up to talk to a coworker rather than sending email.

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Have Fun Getting Healthy

Are you tired of hearing the pleas to get out there and exercise for your health? Yeah, I know. While I happen to be one of those people who actually likes going to a gym, I know so many people who say that’s boring, tedious, mind-numbing work.

Lest you take me for a total hero, there are plenty of days when I do have to push myself to go. I’m not always rah-rah … but I get through (usually) by reminding myself I’ll leave there feeling much better than when I walked in.

Just because it might be tough to get out there and invade the gym, that doesn’t give you license to play couch potato. Or, if it’s too late and you’re already playing couch potato, how about getting up the next timeDancing With the Stars is on and joining in?

Dancing, studies show, has many advantages for your body and mind. Step by step, here’s what dancing can do for you:
Shed pounds
Strengthen your bones
Increase your aerobic fitness and flexibility
Increase your muscular strength
Improve your muscle tone, balance and endurance
Improve cardiovascular condition
Protect against dementia

Increase energy
Strengthen your immune system
Think about it: have you ever seen anyone frowning while dancing?

While visiting the award-winning spa Rancho La Puerta last week, I got in touch with my inner child by immersing myself in the various dance classes they offered. Dancing brought back that long-forgotten joy I experienced years ago by letting loose and allowing my feet and rhythm guide me.
With the myriad and countless choices at The Ranch, I was reminded that there is way more than just the gym to get fit and feel good. “Follow your bliss and the universe will open doors where there were only walls,” said American mythologist and writer Joseph Campbell, in a very fitting quote that is posted on the spa’s website.

Do something you love while getting fit. Have fun! Play volleyball or other team sport. Splash in the pool, settle down on a yoga mat and stretch your body. Pick up a tennis racket or even a hula hoop; go for a hike or tour your own city; take on tai chi; beat a drum; pick up some weights; hop on a bike; get dirty in your garden or challenge yourself to a half-marathon. Even the drudgery of housework can be a workout if you put on your sneakers and turn up some energizing music while you vacuum and scrub!

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Join the Fight: Stand Up to Lung Cancer

At 28 years old, I was naively unaware as I sat in my doctor’s office. She wanted to discuss the results of my recent CT scan, ordered after a chest X-ray, which had come after several months of coughing, wheezing and shoulder pain. Perhaps, looking back, I should have been more worried. But as a young, healthy former college athlete, what did I have to fear?

Apparently – a lot. That day, my doctor told me I had a tumor the size of a golf ball in my right lung. A biopsyand several other tests revealed that it was Stage IV lung cancer.

As if having a golf-ball-sized tumor in your lung does not make breathing difficult enough, learning it’s there in the first place does. I felt blindsided. I had never smoked or been around second-hand smoke. I’d always been active and healthy. It made no sense. How did I get LUNG cancer?

That was more than two years ago and in that time I’ve come to learn a lot about lung cancer thanks to theBonnie J. Addario Lung Cancer Foundation (ALCF). For starters, I learned my diagnosis is not unique. Lung cancer is the number one cancer killer among women. Throw out all your ideas that this is only a smoker’s disease. Lung cancer does not discriminate. Anyone at any age, any gender or nationality can get it. Most often, the face of lung cancer is women and an even more alarming trend, YOUNG women just like me!

The ALCF is finding out why never-smokers under the age of 40 are getting lung cancer through the Genomics of Young Lung Cancer Study (GoYLC). This first-of-its-kind study will look at tumor samples from young patients like me, in the hopes of clearing up the confusion about smoking and lung cancer, and finding better, more effective treatments for all lung cancer patients, young and old.
Due to the incorrect stereotype of lung cancer patients, most diagnoses occur at Stage IV. At this point, treatment – and survival – becomes much more difficult. The misguided belief that only smokers get this disease is quite literally killing us.

Funding for lung cancer research still lags far behind other cancers. Lung cancer receives $1 for every $22breast cancer receives. Yet more people die from lung cancer than breast, prostate, and colon cancercombined. This disease is violently attacking us, yet somehow we continue to turn a blind eye.

Fortunately, breast cancer funding has paved a path of success. Survival rates have increased to more than 80%. Meanwhile, lung cancer survival rates are at a mere 16 %, and at Stage IV, only 1 to 2 %. What if we could increase the lung cancer survival rates to 80%? It would save 128,000 lives a year in the United States. Imagine the difference that would make.

I am blessed. I have endured eight rounds of chemotherapy, 28 rounds of high-dose radiation, and the removal of my entire right lung. But I am alive. Most are not. This year, 160,000 people will lose their lives to this disease. November is Lung Cancer Awareness Month. It’s time to make a change – I ask you to join me. Donate to the battle. Inspire others to do the same. Let’s fight together and put an end to lung cancer.

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The Scary Truth About Hospital Stays

You may have heard horror stories about mistakes that happen in hospitals. You may even have experienced them.
And you may be familiar with the statistics:

Up to 440,000 patients who go to a U.S. hospital each year for care suffer some type of preventable harm that contributes to their death, according to a Journal of Patient Safety report in 2013.
That makes medical errors the third-leading cause of death in this country, following heart disease and cancer.

The actual number could be much higher because the tool used to measure errors doesn’t account for things like treatment that should have been provided or diagnostic errors.

As shocking as these numbers are, they also don’t include less serious errors, which don’t lead to death.

Anyone who has ever spent time in a hospital has probably witnessed these types or errors, as I did while staying with my sister, Marie, during her recent hospital confinement.

I won’t name the Tennessee hospital where my sister underwent emergency surgery for a blocked colon, because the kinds of things that happened there are likely typical of small community hospitals everywhere. And, based on a quick scan of the scores given to hospitals by, mistakes occur in both large and small facilities alike. (For the record, the hospital where my sister stayed received a “C” from the website; one would hope for better, but in emergencies, you don’t always have a choice.)

What can you do? 

In cases where you or a loved one must be hospitalized, one of the most important things you can do is have someone stay as an advocate and caregiver for the patient. This is especially true for those who are too young or old or disabled to speak for themselves. But, it’s helpful for everyone, even someone like my sister, who is a veteran of hospital stays and isn’t afraid to ask for the care she wants or needs.
In my sister’s case, her daughter arrived soon after her emergency surgery. Three weeks later, she is still by her side, helping her navigate through recovery, wound care, ostomy management, physical therapy and preparation for chemotherapy and ongoing cancer treatments. I and other relatives also were there for the first 10 days, alternating spending nights in the hospital chair by her bed.
Here are some of the problems we encountered:
Wrong meds
Thankfully, Marie knew what medications she was supposed to be taking and on what schedule, because several times the nurses brought her meds she wasn’t supposed to get.
Meal tray mix-ups
After Marie’s release from ICU, her surgeon ordered a clear liquid diet for the first couple of days and then a soft foods diet. Her first five meal trays were completely wrong, filled with things she wasn’t supposed to eat. Since when did Salisbury steak and grilled chicken breast become “soft foods”? Once she was on a normal diet, her meal choices, which she selected to be easy on her stomach, were often ignored. Fortunately, family and friends helped get replacements for the inedible meals.

Slow nursing response

Because of her ileostomy and her large abdominal incision, my sister needed a bedpan for several days after surgery—and she needed it frequently and urgently. When she buzzed for assistance to get on the bedpan, the nurses often didn’t show up. Her daughter or I had to assist. One particularly busy night, the nursing assistant didn’t appear for nearly four hours. (The harried nursing assistant on duty that night told us that the other assistant who was supposed to work with her on the 7 p.m. shift had quit at 6 p.m.—and there weren’t a lot of replacements available on Super Bowl Sunday.)  We became so accustomed to helping that we stopped buzzing and just tended the bedpan ourselves.
The worst event happened one morning when my sister’s ileostomy bag came unsealed and started leaking. She buzzed for help. After a 10-minute wait, I went looking for a nurse. It took 20 minutes before someone came, by which time my sister and her bed were a huge mess, and she was in tears, fearing that if the fecal matter contaminated her abdominal wound, it could cause potentially fatal sepsis.  This leads to the next problem …

Inadequately trained staff

The nurse who came apparently didn’t know how to clean and repack my sister’s wound, so she enlisted another nurse’s assistance. They did the best they could, but we could see that they had not cleaned the area thoroughly or packed the wound tightly, despite the agonizing two hours that they worked on my sister. When the hospital’s one wound care nurse arrived later that morning, my niece asked her to please check the wound packing. She found fecal matter still under the wound bandaging and had to re-clean and repack the wound.

Communication breakdowns

Anyone who’s ever been in a hospital likely recalls experiences like these: Surgeon instructions to the patient aren’t clear and she’s not up to asking questions. Doctors fail to enter orders into the electronic records in a timely manner. Nurses don’t give meds on schedule, causing unnecessary pain. One shift doesn’t tell the next shift what is going on. A doctor wants to release a patient, but no rehabilitation facility is available. The list goes on … and it happens everywhere.

The staff members at this hospital were generally friendly and helpful and likely doing the best they could, given the levels of staffing and training. But, I’m extremely grateful that my niece could be my sister’s number one advocate and protector, and that I and others could help when needed. Marie’s personal physician visited her in the hospital nearly every day and served as one of her biggest advocates and a go-between with the hospital staff.

My sister also is fortunate to have many, many friends. They called, sent cards, visited, brought food, ran errands and sent flowers—so

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Why Smiling Feels So Good

I’ve never really been fully aware of my facial expressions until I recently caught a glimpse of myself in the mirror. I wasn’t feeling particularly gloomy or angry or even a wee bit sad. But the mirror reflected otherwise. The corners of my mouth were turned downward, and anyone who didn’t know me might think I was unhappy, unfriendly, annoyed or a combination of all three.

Why did I look so glum even though I wasn’t feeling that way? Or was I really feeling that way and just not being honest with myself?

The truth of it is that gravity is pulling parts of us down, whether we like it or not, and our mouths are not exempt. The corners of our mouths simply begin to droop along with the rest of us as the years rush onward.

Maybe it’s because I just had a so-called major birthday, but these kinds of things are on my mind lately. Yeah, maybe it’s a wee bit shallow, but I’m not apologizing for caring. It’s bad enough that body parts droop, but I’d like to keep my face looking pleasant and satisfied, and apparently the corners of my mouth have a lot to do with that.

After doing a bit of online research, I found that there are cosmetic solutions for the famous corner-of-mouth-droop—Botox or cosmetic fillers. Don’t get me wrong, I’m not opposed to anything that makes you feel and look better, but since Botox and fillers are both pricey and temporary (in my opinion, better saved for the “bigger” issues, like crow’s feet and wrinkly foreheads), I’m convinced there has to be a  cheaper way.
Onward. I stumbled on a page about doing facial exercises (aka “facercise”). All you need to do, believers say, is devote eight minutes of each day to a regimen of various exercises for your face—and presto, change-o! Just like you can tighten your sagging butt with simple exercise (NOT), so can you achieve tightening and rejuvenation of your face simply by working on your facial muscles.

There has to be a better way. Aha! I got it!
Try smiling. (Am I brilliant or what??)
No, really—science backs me up on this.
For one, smiling is contagious. It’s hard not to smile back at someone who smiles at you. And that contagion is a natural paying-it-forward, right? If more people smiled, I suspect that more people would smile. Or something like that.
For another, in times of stress, studies, have found that smiling helps mitigate anxiety and even lowers yourheart rate.
Add to that the endorphins that are released when you smile (and especially when you laugh). They’re the euphoric, feel-good hormones that reduce your perception of pain.

Smiling can actually trick your body into thinking you’re in a good mood. Along with doingKegel exercises when I’m waiting at a red light (if I remember, that is), I also try to remind myself to smile. It’s truly amazing how my mood is instantly lightened by such a simple act.

When I think about it, there really are a lot of reasons to smile—and they’re not just everything I’ve just mentioned in the above paragraphs.
Here are 10 things that made me smile today:
The sun is shining.
The weather is still warm (even though it’s mid-October).
I am healthy.
I’m immersed in doing what I love.
I had a killer workout at the gym.
I made myself a homemade soy latte with my new Keurig Rivo machine and saved both a trip to Starbucks and over $4! If I continue to do this daily, I’m $28 richer for the week, $112 for the month, and $1,344 for the year! I’ll recoup the cost of the machine ($199.99) in no time.
I just spent a wonderful week celebrating my birthday with family and longtime dear friends.
I took a lovely and fragrant bubble bath.
I talked to my mom and exchanged emails with my children and husband.
I will get a chance when I’m finished working to go outside and take a walk.
OK, now it’s your turn. If you tell me what makes you smile, you’re bound to make me—and everyone else reading this—break out into one big smile.

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HPV Vaccine: Pros and Cons

The science on vaccines is clear: They save millions of lives and protect our children from the pain and damage that measles, mumps, rubella, polio, tuberculosis and more can cause. So when my son’s doctor suggested he get the HPV vaccination, why did I hesitate?

HPV is different than the other aforementioned diseases because it’s not passed by casual contact. It’s not highly contagious in the way that measles can infect a person two hours after the germ carrier leaves the area. HPV is transmitted only through intercourse and oral sex, so it doesn’t seem as random.
If one contracts HPV, it’s not apparent immediately and might never be an issue. Most HPV infections go away on their own within two years. Plus, there are more than a hundred strains of HPV, and the vast majority pose little risk for genital warts, cervical cancer, throat cancer and a variety of other rare cancers. It’s statistically unlikely my son will ever need the protection offered by the vaccination.
Still, cervical and throat cancers are killers. Radiation and chemotherapy have severe side effects. Genital warts aren’t deadly but … yuck.

Vaccinating my son would help protect him and every woman he ever becomes intimate with. And my hope as a parent is that he would always want to provide all the safety he can to a woman (or partner—not judging!) with whom he’s intimate. When I had the sex talk with him (there were actually several as he matured), safety, caring and commitment were always part of the conversation.
Why wouldn’t he have the vaccination?

There are reports of side effects, very bad side effects. As I tracked down the reports, nearly all were anecdotal. I couldn’t find any scientific research indicating serious adverse side effects. Various branches of the U.S. government have assured the public that no serious adverse events could be linked directly to the HPV vaccine. Do I trust my government? Yes, but some other countries are reviewing the vaccine. Japan withdrew its recommendation, but teens could still get it if their parents asked.

The HPV vaccine was first introduced only for girls starting at age 9. The recommendation to include boys came a few years later when my son was nearly 20 years old. As I hesitated and researched, he aged out of the recommended age group (21 years old for males; 26 for females).

Easy to say now, but I regret not encouraging him to get the vaccinations. Vaccinations are part of the social contract we make as part of society. This is one of those cases where the greater good wins out, even though a few—a very few—people will have an adverse reaction.
What level of guilt will I feel if he contracts throat cancer? What pain will he feel if his beloved suffers from cervical cancer? My hesitation means I will always worry, and my son’s future love(s) will have a risk they should not be asked to take. I could have saved my son from the risk of that particular guilt. He could have avoided putting a person he cared for at risk. Isn’t that what we do for our loved ones?

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Even a Hysterectomy May Not Protect Against Ovarian Cancer

Did you know it’s possible to get ovarian cancer even after you’ve had a hysterectomy? I learned the hard way. My sister, who had a hysterectomy about 10 years ago, just received a diagnosis for a type of ovarian cancer.

If you have a partial hysterectomy, which removes your uterus, or a total hysterectomy, which removes your uterus and cervix, your ovaries remain intact and you can still develop ovarian cancer, according to the Mayo Clinic.

If, like my sister, you have a total hysterectomy with salpingo-oophorectomy, in which your cervix, uterus and both ovaries and fallopian tubes are removed, ovarian cancer is less likely but still can occur.

The details are confusing—surgeons talk fast and don’t like to slow down for patient explanations—but my sister’s surgeon says she has primary serous carcinoma, which looks and acts much like ovarian cancer and likely originated from ovarian cells.

As he explained it, when a woman undergoes a hysterectomy and has her ovaries removed, some ovarian tissue may be left behind. Ovaries are not well-formed organs like our liver or kidneys. They are soft tissues that can (and do) come apart when you try to remove them. When pieces are left behind, some cancerous or precancerous cells may grow from that tissue. In some women, the ovarian cells migrated to the peritoneal area during menstrual cycles before the ovaries were removed and became cancerous later on. It’s also difficult to tell whether the cancer is coming from ovarian or peritoneum cells—and it doesn’t much matter. It is treated the same.

My sister’s cancer appeared suddenly, without warning. Two weeks ago, she started having severe abdominal pains. At first she thought it was a stomach virus or food poisoning. But, after two days of worsening symptoms, her internist sent her to the emergency room. The ER doctor wanted to send her home with a stool softener, but my sister, being the strong-willed woman that she is, refused to leave.

When a doctor examined her the next morning, he found a mass on her colon and decided to do an emergencycolonoscopy. But, the mass was pressing down so hard on her colon that he couldn’t do a colonoscopy. The procedure suddenly became emergency removal of her entire colon because the mass had pinched off the tissue and killed it.

Once the surgeon got inside her abdominal cavity, he discovered cancer cells throughout her abdomen. As he described them, they were sticky blobs of cells that were gluing her organs together. He removed what he could in what was becoming a lengthy and complex emergency surgery.
He was not sure she’d pull through the surgery, but, thankfully, she did. We’re still getting answers and are a long way from winning the battle against cancer. But we’re extremely glad that she’s lived to fight it.

I’ve learned a lot about ovarian cancer in the past week, and the most important thing I’ve learned is that it’s very important to get an early diagnosis—but there’s no screening test for women at average risk for ovarian cancer.

There are risk factors that would encourage your health care provider (HCP) to be more vigilant in looking for ovarian cancer, so know your risk factors—and let your HCP know if you have any.
These are risk factors for ovarian cancer:
A “first-degree” relative (mother, sister or daughter) who has or had ovarian, breast or gastrointestinal/colon cancer
Age; most cases occur in women 60 and older
Eastern European Jewish ethnicity (Ashkenazi)
Mutation in the BRCA1 or BRCA2 gene
Personal history of breast, endometrial/uterine or colorectal (colon) cancer
Have never been pregnant or had trouble giving birth
A high-fat diet
Early start for your periods (before age 12) or later-than-average menopause (after age 50)
Of all risk factors, the most significant is a family history of breast and/or ovarian cancer. However, it’s important to keep risk factors in perspective. Most women with risk factors for ovarian cancer will never get ovarian cancer. And most women with ovarian cancer do not have any strong risk factors for the disease.
The symptoms of ovarian cancer (particularly in its early stage) are often not obvious or intense, but if you have known risk factors, you should definitely talk to your HCP if you notice any symptoms. Symptoms of ovarian cancer include:
Pelvic or abdominal pain, pressure or discomfort
Vague but persistent gastrointestinal upsets such as gas, nausea and indigestion
Frequency and/or urgency of urination in absence of an infection
Changes in bowel habits
Weight gain or loss; particularly weight gain in the abdominal area
Pelvic or abdominal swelling, bloating or a feeling of fullness
Back or leg pain
Pain during intercourse
Vaginal bleeding or abnormal vaginal discharge
Ongoing fatigue
If you or your HCP suspects you may have ovarian cancer, or you have a very high risk of developing it, you may undergo certain diagnostic tests, including imaging tests, biopsy and blood tests.

Your HCP may order a blood test that checks for CA-125, a protein found in the blood of many women with ovarian cancer. However, other conditions, including normal ovulation, endometriosis and pelvic inflammatory disease can also raise CA-125 levels. And some women with ovarian cancer may have normal levels of CA-125. Because of these problems, the CA-125 test is not recommended for women at average risk of ovarian cancer.

Because my mother died of breast cancer and my sister now has ovarian cancer, I know that I have significant risk factors. I will talk to my doctor about what testing is right for me. As with most cancers, early diagnosis is the key to survival.

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Are You Taking Care of Your Heart Health?

February is the month to honor your heart and make sure it stays healthy year-round. I learned more about heart health from the American Heart Association (AHA) Go Red for Women Campaign and wanted to share it with all of you. Boomer girls are especially prone to heart disease after menopause because ourestrogen levels decrease causing a whole lot of ruckus in our body.

While heart disease and stroke kill one in three women, the good news is that 80 percent is preventable.

So what are you doing to take care of your heart?
I talked with Dr. Suzanne Steinbaum, attending cardiologist and Director of Women and Heart Disease at Lenox Hill Hospital in New York City, to learn more about menopause and what boomer girls can do to stay in tip-top shape. Here are excerpts:
Q: How does menopause impact heart health? 
A: “Menopause is so fascinating,” said Dr. Steinbaum. “It is about the closing out of our time to reproduce. Estrogen levels decrease and the benefits of estrogen decline. Blood pressure rises. LDL—the bad cholesterol—rises. Research has shown that 10 years after menopause has occurred that heart disease increases because you no longer have any estrogen left in your body.” (Ugh! This is depressing. I feel like I may need to eat all those heart-shaped chocolates I just bought for L. Isn’t dark chocolate good for the heart?)
Q: What can menopausal (and post-meno) women do to prevent heart disease?
A: “First, train for menopause like you are training for a marathon,” said Dr. Steinbaum. “It’s really about maintaining a healthy lifestyle.” (A marathon! A marathon! I can barely run a mile these days.)
Q: If I can’t run a marathon, how can I maintain a healthy heart?
A: Dr. Steinbaum shared the three key components of a healthy lifestyle:

♥ “Exercise is the best medication to keep cholesterol down,” said Dr. Steinbaum. “You need a combination of exercise, including cardiovascular exercise where you get your heart rate up—30 minutes five days a week is recommended, such as rapid walking, jogging or Zumba. You can do cardio workouts in 10-minute increments throughout the day.”

To calculate your cardio-workout heart rate, use the following equation: (220 – your age x .85)
(OK, got it! Looks like I may have to get back on the treadmill or start walking on the track. Maybe I should study to be a Zumba Gold instructor after I finish my yoga training. How am I going to fit all this cardio exercise into my schedule in addition to yoga and bicycling? Glad stretching and relaxation exercises are important too. Forget about sleeping. Not to worry—with no more estrogen in my body, I won’t be sleeping for long periods anyway.)

♥ “Maintain a healthy diet and healthy weight,” said Dr. Steinbaum. (I told Dr. S that my cholesterol is very high, inching up to 275 last year. I told her I can’t tolerate statins and that my triglycerides are low, and my HDL, the happy cholesterol is high, so my ratio of HDL to LDL is good. My mom had high cholesterol and my dad died of heart disease and diabetes so genetics are not on my side. I went on Zetia, which is not a statin, but helped to lower my cholesterol a few years ago. Dr. S suggested some functional foods to consume that can help decrease LDL, including salmon rich in omega-3 fatty acids, avocados, olive oil and whole grains.)

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Is Narcissism Bad for Your Health?

While it’s true that the recipients of the most annoying of the narcissist’s traits—an inflated sense of self-importance, an overwhelming need for admiration and a lack of empathy toward others—suffer emotionally, the narcissist himself actually suffers physically from higher levels of the stresshormone cortisol. This hormone can lead to health problems like high blood pressure and heart issues.

At least that’s what a 2012 study found when researchers looked at the role of narcissism and gender (narcissism seems to be more prevalent among men) on cortisol levels in a sample of 106 undergraduate students. Why narcissism is not  physically taxing on women could be because “men who endorse stereotypically male sex roles and who are also high in narcissism may feel especially stressed,” said the study’s coauthor Sara Konrath, in a University of Michigan press release.

Perhaps it’s the pressure of trying to keep up a front: narcissists, although they come across as conceited, boastful or pretentious, often feel fragile and humiliated on the inside.

According to the Mayo Clinic, some symptoms of narcissistic personality disorder include: believing that you’re special; failing to recognize others’ emotions and feelings; taking advantage of others; fantasizing about power, success and attractiveness; and exaggerating your achievements or talents.
Does that sound like someone you know or have known?

This got me thinking about narcissism, a buzzword of late. If I’m not reading about it, I’m hearing about it from people I know (“Oh, him? He’s a total narcissist.” “I can’t stand her—she’s always talking about herself, her looks and how much power she has. Totally narcissistic.” “My ex-husband? He was such a narcissist. That’s why our marriage fell apart.”)

Throughout my life, I’m sure I’ve met and known narcissists, but I never really labeled them as such. Instead, I thought of them as preoccupied and selfish, with an overwhelming need for attention.

So I turned to the real expert on narcissism—no, not a narcissist herself, but someone who has studied them and written extensively about the subject, Meredith Resnick, a licensed clinical social worker turned author. Meredith was kind enough to answer some of my questions on the subject. Perhaps if you have dealt with, or are dealing with, someone with narcissistic personality disorder, this may give you some deeper understanding into the narcissist (or even yourself):

How do you define a narcissist?

Meredith: The term narcissist is often used to describe individuals who are rude, selfish, self-centered and cold. Not all people with those traits are full-blown narcissists. Many narcissists can also be quite charming, deceptively so. But, because narcissists are always shape-shifting, you never know what you’re going to get. Lack of empathy is a key trait of the individual with full-blown narcissistic personality disorder. Individuals with narcissistic traits can be very difficult as well, without the official diagnosis.

In writing about narcissism I’ve received a lot of email. It seems that a lot of women in midlife realize their partner is a narcissist, or has narcissistic traits, and they wonder why they were attracted in the first place.

Why does it sometimes take until midlife to realize this is happening, and what can the individual do about it?

Meredith: First, the why: It seems to me that one reason it takes many until midlife (sometimes longer, sometimes shorter) to fully realize what’s going on is because so much time spent in earlier life is focused on the question, “How can I make this relationship work?”
This leads us into the second part of the question—the what. There is absolutely nothing wrong with the above question except that one person alone cannot make a relationship work. And, for many of us, when we’re younger, we hear this question—often without realizing it—as “How can I fix the relationship?” When asked this way, what’s lost or forgotten is the self, the individual who is asking the question. Recovery from the effects of narcissism involves the asker of that question—”How can I make things work in this relationship?”—turning the question around, at least as a start, and asking: “What do I need to do to take care of my own self that does not depend on the other person?”

In what ways can being involved with a narcissist affect your health?

Meredith: As I write in Surviving the Narcissist: 30 Days of Recovery, “Life with a narcissist can take us to emotional places we never thought we’d go and, once there, never believed we’d survive.” The stress, the a***y, the pain of not knowing what will happen next, not knowing if or how the narcissist will ostracize you is bad enough. But living with someone who lacks empathy one minute and charms you the next to keep you from leaving him/her is confusing and exhausting. It is impossible for the non-narcissist partner to understand the emptiness/internal black hole/emotional cavity that provokes the narcissist (or those with multiple narcissistic traits) to act this way, but until they accept this, they will again and again try to fix the person and the relationship, which ultimately causes themselves the most distress. Some of this di***s is the result of the narcissist’s unconscious projection of his or her own inadequacies on the other partner—and the other partner (the non-narcissist) absorbing it (also unconscious).

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Beauty Alert: The Scoop on Botox and Juvederm

I used to say that I came from a family of vain women.

My dear and very attractive grandmother, born at the turn of the 20th century, valued her beauty so greatly that she’d go off on a “vacation” and emerge weeks later looking rather refreshed and rejuvenated. As I got older, I quickly caught on that “vacation” was merely her clever moniker for “face lift.”

And my mother, a beauty in her own right, followed suit when she got to be a woman of a certain age.
But now that I’m that woman of a certain age, I’ve come to realize that it’s not vanity, really, but rather, it’s taking pride in the way we look. It’s even more than that. It’s the desire to look as youthful on the outside as we feel on the inside—full of vigor, energy and life.

It’s unfortunate that many times an observer won’t look deep enough to figure out that what’s on the outside doesn’t always match the inside. (But that’s better saved for another discussion.)

I’m hardly alone in my feelings; otherwise, why would there be a record $12 billion  spent in 2013 on surgical and nonsurgical cosmetic procedures, as reported by the American Society for Aesthetic Plastic Surgery? Of that, $5 billion was spent on nonsurgical procedures, like Botox and facial fillers.
Curious, I recently met with board-certified plastic surgeon David Shafer, MD, who has a thriving surgical and injectable practice in midtown Manhattan to get his take on the subject. He gave me the inside scoop on Botox Cosmetic, Juvederm and Juvederm Volunma XC.

All About Botox

Botox is the first FDA-approved treatment to soften dynamic lines and wrinkles of the glabella—that’s the area between the eyebrows that can sometimes cause you to look angry or distressed (when you’re not even close to feeling that way). Botox Cosmetic is also the only neuromodulator approved to treat crow’s feet—and I think we all know what those are. Some like to call them “laugh lines,” but you can get them from more things than laughing (like repeated squinting or frowning). Effects with this quick 10-minute procedure with no downtime can last most people anywhere between three to five months. The results appear gradually over a few days, softening the dynamic wrinkles around the eyes.

How Botox Works Its Magic

Botox acts to decrease the signal transduction between the nerve and muscle, softening the muscle action and thereby relaxing or smoothing the overlying skin, Dr. Shafer explained. It’s been on the market for more than 12 years, and it’s the number one–selling prescription treatment in the country for these areas. “Competitors (like Dysport) have a similar effect, but different dosing, different distribution once injected, with different effectiveness.”

You’ll see gradual results about three to five days after the injection, and there are no restrictions after the treatment except for a rather obvious one: Don’t go for a face-down massage immediately after the treatment. After several hours, the product is well incorporated. Many people sneak in a treatment on their lunch hour or on their way home from work, with no disruption to their activities.
While some might feel nervous about the name “toxin,” Dr. Shafer explained that the amount used for cosmetic treatments is infinitesimally small. “In fact, any medication in large quantities could be ‘toxic,’ so it really is just a matter of semantics,” he explained. The effects are always temporary and leave no lasting effect.

All About Juvederm

Both Juvederm and Juvederm XC are fillers composed of hyaluronic acid that can add volume to your face. Why would you want to add volume? With aging, volume naturally declines, leading to sagging skin and deeper wrinkles. As the midface deflates, the loose skin starts to create folds and creases (such as those nasolabial folds around the mouth and the “marionette lines” and jowls in the lower face).

Eek—acid!!?? “This is a technical molecular classification,” Dr. Shafer said. “Rest assured, there is no ‘acid’ effect with these products.” Hyaluronic acid is a natural molecule of the skin, found throughout the entire body. And due to its biocompatibility, the chance of any reaction or allergy is very low, he assured me.

Effects can last up to two years.
How Juvederm Works Its Magic
Juvederm is most commonly and successfully used to soften the areas around the mouth and nose, thus giving the face more contour and a subtle “lift” of sorts. “A balance is achieved between adding enough volume to smooth the wrinkles, while not adding too much to look unnatural,” explained Dr. Shafer. The focus is to address the 3-D structure of the face; it’s not just about smoothing a wrinkle or filling volume.
Because of Allergan’s manufacturing technology, there is minimal swelling after injections, and results can be seen immediately. (Nothing like instant gratification, huh?)

OK, here’s what a lot of you want to know:
Is it Painful?

Because Botox uses the smallest needle available, and Juvederm uses the second smallest, “Most patients do not require any topical anesthetic. However, I offer this if they want it. An alternative is placing some ice on the area of injection immediately prior to injection.” Even better, Juvederm XC products have lidocaine added to them; this locally acting anesthetic begins to work immediately upon injection.

By the way, if you haven’t already figured it out, I can vouch for this: It’s surprisingly UN-painful!
Yes, like the generations of women before me, I like my looks to reflect my inner zest. Now you know my secret (but not all my secrets).

But in all fairness, I will be honest and say no, I was not away on vacation. And cosmetic treatments aside, there is a lot of truth about living a totally healthy lifestyle for the whole look-good, feel-good package: “Patients also need to eat healthy, stay well-rested and well-hydrated, not smoke and have a good daily skin-care regimen,” said Dr. Shafer.

I couldn’t agree more. And if my grandmother were alive today, she’d be nodding her head right along with me—but keeping it still while the doctor worked his magic with the incredible tools available today, like Botox and Juvederm.

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The Surprising Way You Can Get the Flu

No matter how many times you wash your hands or how conscious you are about not touching your face, seasonal influenza—the flu—has a simple way of sneaking into your system: through conversation.

That‘s right: the flu can spread by talking. 
Viruses spread through droplets, which commonly transport via sneezing and coughing, but experts believe that they can also spread when people are chatting. If you‘re thinking you just won‘t talk to anyone who is seemingly sick, that‘s not the best defense either. You see, most healthy adults may be able to infect other people beginning one day before symptoms develop. So unless you‘re planning to hibernate this flu season, you really should consider getting a flu shot, which the Centers for Disease Control and Prevention (CDC) recommends every year for nearly everyone aged 6 months old and older. 

Here are 5 Reasons You Should Consider Getting a Flu Shot Every Year:  
Strength in numbers. When more people get vaccinated against the flu, fewer people are affected and less flu can spread through the community. Pay it forward!

Flu strains can change each year. Because flu viruses constantly change, the formulation of the flu vaccineis reviewed each year to keep up with changing flu viruses. Even if the virus strains are the same from year to year, antibodies induced by the vaccine decline over time.

A flu shot cannot cause influenza. Flu shots contain either “inactivated” viruses or no flu viruses at all. Nasal spray vaccines contain live viruses, but they are weakened and cannot cause influenza in healthy individuals. Different side effects can be associated with the flu vaccine, but they are mild and short-lasting, especially when compared to flu symptoms. 

Having the flu is just plain awful. In general, the flu is worse than the common cold, and symptoms such as fever, body aches, extreme tiredness and dry cough are more common and intense. Colds are usually milder and generally do not result in serious health problems, such as pneumonia, bacterial infections or hospitalizations. 

You may have several flu vaccine options! Be proactive about your health by learning about the flu and about the vaccines available to help protect you. There are several flu vaccine options available for the 2014-2015 season that are made to help protect you from either three (trivalent) or four (quadrivalent) types of flu viruses. The CDC and the American Academy of Pediatrics recommend the nasal spray vaccine for children ages 2 to 8, if it is available; if not, the shot is recommended. The nasal spray is an option for all healthy people ages 2 to 49 who are not pregnant. There are also egg-free vaccines for people with egg allergies. You should talk to a medical professional, such as a pharmacist or a doctor, about the vaccination that‘s right for you. 

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Can You Prevent Breast Cancer?

Those three words hold so much power. They’re life-altering in too many ways to measure. They’re words that every women hopes they’ll never have to hear.

And as a survivor who has heard those words, I’d like to be able to say that you’ll never, ever have to hear them.
But there’s no sure way to do that.

What I can do is tell you ways to reduce your risk—and be aware enough (or in some cases, lucky enough) that if you do get diagnosed with breast cancer, it will be found at an early stage, where it’s typically more treatable.

While there are many factors that influence your breast cancer risk, there are also factors that are unknown or out of your control. But it’s worthwhile to know the things that might be alterable … being proactive and taking charge of your health might be a comfort in and of itself, don’t you think?
Keep a healthy weight. Those extra pounds boost your risk. Postmenopausal women who are overweight have a higher risk than those who are normal weight. The more fat cells a woman has after menopause, the higher her blood levels of estrogen—which travels through the blood as estradiol—will be. Obese women have about three times the circulating levels of estradiol compared to lean women. Extra pounds can also increase the risk of recurrence in women who have already had breast cancer. Here’s a way to assess your weight from
Curb your alcohol. The more you drink, the higher your risk. The CDC advises limiting yourself to no more than one alcoholic drink per day.
Move your body. Exercise definitely counts: women who are physically active have a lower risk than women who are the least physically active—up to 25 percent lower. And it also matters for women who have already been diagnosed: there’s growing evidence that physically active women have a lower risk of dying of breast cancer. Try to get 30 to 60 minutes of moderate to vigorous exercise each day.
Limit CT scans where possible. Also known as CAT scans, they can expose you to way too much ionizing radiation. How? A CT scan of the abdomen exposes the body to 400 times more radiation than does an ordinary chest X-ray.

Choose your foods wisely. Foods that have been linked in some studies with a lower risk of breast cancer include vegetables, fruit, poultry, fish and low-fat dairy.

Get screened. When to screen? It can get confusing, since not everyone agrees on mammogramguidelines (which, as you’re probably aware, are always changing). The U.S. Preventive Services Task Force recommends women begin screening at age 50 (and repeat the test every two years), while the American Cancer Society and other organizations recommend screening at age 40 (and repeat the test annually).  And screening might be recommended even earlier if you’re at high risk. That’s why you and your doctor need to talk and decide together what’s best for you. Here’s a helpful fact sheet on mammograms from the National Cancer Institute.

Ironically, my birthday falls in the same month as Breast Cancer Awareness Month. So, I get to make as many wishes as I want!

My wish for you: May you never have to face a diagnosis of breast cancer. Another wish: If you do get diagnosed, may it be early and treatable. My last wish: That you do everything you can to ensure your breast health.

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Drying Up in Menopause

As the autumn air grows colder and my body continues to age, I find myself drier and drier these days. The air conditioner is in the off position and the heater is turned on, but that’s not the only reason my body is drying up from top to bottom.

Health in Your 50s: Everything You Need to Know

My Eyes:Â “Your eyes are very dry,” said my ophthalmologist, Dr. V, during my last visit. “It comes with age, as do the floaters that you are experiencing in your left eye.” Thankfully, my retina was not detached and my floaters are much better, but my eyes are still dry, dry, dry.

According to WebMD, dry eye is a natural part of aging, especially after menopause. (There we go, the “m” word. I knew it.) “Computer use can also contribute to dry eye. I suggest you use eye drops three times a day,” said Dr. V.  She recommended I buy Systane, which are artificial tears. I put a few drops in each eye—morning, noon and nighttime. Ah, I can see clearly now.

My Face: “Your face needs a good vitamin C replenishing mask,” said my esthetician, as she examined my dry skin. My face was glowing after my facial, just glowing. I bought Skinceuticals Hydrating B5 Masque to use at home—can’t wait to try it. I also like the new RoC Multi Correxion 5-in-1 Daily Moisturizer that I received from the Johnson & Johnson PR account executive. (Psst … I think the breakthrough Hexinol technology is breaking through my face and providing added moisture back into my skin. Such incredible technology! Now if it could quickly get rid of all my wrinkles, that would be a good thing too.)

My Hair: “My hair is very dry from the hair dryer,” I said to my hairdresser. She suggested I use Moroccan oil after I wash my hair. I bought the Moroccan oil and recently tried Redken Diamond Oil as well. I usually put a few drops of oil on my fingertips and rub the oil all over my hair and scalp. Don’t use too much oil or you will have bed head—flat, flat, flat.

My Vagina: “Your vagina is very dry,” said my gynecologist as she examined me during my yearly checkup. WebMD says that vaginal dryness is another common symptom of menopause—and close to one out of every three women experiences it while going through “the change.” It becomes even more common after menopause. (There we go again—the “m” word. I knew it.)

“You won a free bottle of new Trojan Lubricants Continuous Silkiness,” said the PR representative at the BlogHer Conference. I hid it in my suitcase because I feared it might not make it through airport carry-on security—didn’t want any guard shouting, “Menopausal woman here! Menopausal woman here, with lubricant in her suitcase.” (No, no, no. My lubricant was going home with me and my dry vagina.)

My Legs and Feet:Â Dry and flaky, dry and flaky. The Perimenopause Blog says, “A little moisture goes a long way. Particularly if you’re inclined, to take really hot showers. The heat extracts moisture and makes a bad case of the itches even worse.”

So dear autumn, bring on the chill. I’m ready for the change of seasons. I have tons of good moisturizers to choose from. Menopause may have dried up my body, but it’s far from brittle. Like the brilliant colors of the changing leaves, I plan on keeping my body (and my mind and spirit) as vibrant as ever during my life after 50.

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Friday, 24 March 2017

What Would You Do to Avoid the Flu?

How far would you go to avoid getting colds and the flu? HealthyWomen wanted to know, so we surveyed our readers and nearly 500 of you responded. We’re happy to report that the survey takers seem to be a health-conscious group of women who are willing to look after their health.
Here’s a look at what they said.

Nearly two-thirds of the 494 respondents said they got a flu vaccine this season. This is the single most important thing you can do to avoid getting the influenza virus. The Centers for Disease Control and Prevention (CDC) recommends a yearly flu vaccine for everyone age 6 months and older. Even though this year’s vaccine is reportedly not as effective as some year’s in preventing flu, it still can minimize the severity and length of the symptoms if you get the flu.

A whopping three-fourths say they wash their hands more frequently in the winter. This helps to avoid getting or spreading germs. While hand washing is always important, it’s more so during flu season.

More than three-fourths continue their exercise routines and take vitamins or supplements. This boosts your immune system and helps ward off winter illnesses.

Nearly three-fourths report eating a balanced diet with lots of fruits, veggies, whole grains and lean protein. Providing your body with proper nutrition helps boost your immune system, bettering your odds for a healthy winter. Only 28 percent of us confessed to regularly giving in to our cravings for mac and cheese and other comfort foods in winter. That takes willpower.

Thirty-five percent said they’d consider wearing a mask in any crowded place. Respondents were almost evenly divided on this topic. Masks do help avoid getting or spreading germs but 45 percent said never, no way, would they wear a mask. Twenty percent said they’d be willing to wear a mask on an airplane. Maybe the makers of the new fashionable face masks are on to something!

Nearly one-third say they keep their distance and avoid hugs, handshakes and close proximity when possible. It’s true that the flu can spread by talking, as well as through direct contact, so keeping your distance is not necessarily a bad idea. However, it’s not always realistic. Thirty-six percent say they never worry about contact, 15 percent say they avoid times when crowds are the worst and about 18 percent hunker down for the season and won’t go anywhere that’s not absolutely necessary.

Forty-two percent say they regularly wipe door knobs, phones, remote controls and other frequently handled devices to avoid sharing germs. The rest? Nope (though maybe that percentage goes up when we know a family member or coworker is sick).

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Does Your Health Insurer Know Best?

Have you ever wanted to try a certain medication or treatment, only to discover that it wouldn’t be covered by insurance? That’s because insurers follow a practice of step therapy to help control costs. 

Step therapy, also known as “fail first,” requires a person to “fail” on one or more drug approved by the U.S. Food and Drug Administration (FDA) before the insurer will cover another medication that may be preferred by the person or their health care provider. Some insurers also require that a person tries and fails on one or more prescription medications not approved by the FDA for the condition being treated, a practice known as “forcedoff-label prescribing.” 

Off-label prescribing occurs when a physician prescribes a drug that is FDA-approved for a use other than the condition for which it is being prescribed. For example, medicines approved to treat depression may be used to treat chronic pain.

The practice is legal and commonly practiced. In fact, one out of five prescriptions is written for off-label use, according to the Agency for Healthcare Research and Quality. Some, understandably, argue that step therapy and, particularly, forced off-label prescribing transfers decision-making from health care professionals to insurers. 

Here is an example of how a typical forced off-label prescription scenario could play out.
Condition: Moderate to severe hot flashes

Desired medication: Newly FDA-approved, nonhormonal prescription medication called Brisdelle.
Forced off-label process: The only other approved treatment for hot flashes is hormone therapy, which some women are unable or unwilling to use. Insurance will require women to try and fail on non-approved FDA medications before trying Brisdelle, which restricts their options and may delay their relief. 

What can you do? If you are concerned about being forced to try medications that are not FDA-approved for treating hot flashes (or other conditions) or you want to help ensure prompt access to medications that are FDA-approved, contact your insurer, legislators, state insurance commission and state attorney general’s office to let them know that forced off-label prescribing is not acceptable—and may not be in the best interest of your health. 

There is hope. Three states—Maryland, New Hampshire and Vermont—recently passed laws restricting forced off-label prescribing to protect patients and return decision-making to the health care providers.

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Why Walking Is Good for Your Health

Rumi, the 13th-century mystic poet, was fond of saying, “Beauty surrounds us, but usually we need to be walking in a garden to know it.”

I get it. So many times I whiz back and forth in my car, covering the same areas time and time again. It’s not until I get out there on my feet and slow down with a walk that I’m able to notice and take in the beautiful and minute details of my surroundings.

I don’t know about you, but lately, walking is on my mind a lot more than it’s ever been. Why? Well, for one thing, ever since I purchased a FitBit (in case you’ve been living under a rock and don’t know what that is, it’s a device worn around your wrist that measures your steps), I’m a lot more mindful of getting my steps to 10,000 a day (inspired by the Surgeon General’s recommendation to accumulate 30 minutes of activity most days of the week).

Suddenly, I don’t mind getting up off the couch to fetch something in another room or getting up in the middle of the night to go to the bathroom or parking my car in a faraway spot in a parking lot. It all yields more STEPS!

And for another, all this dire news about how dangerous sitting is to your health (when the majority of my day is spent sitting in front of my computer, writing) scares me. “It’s the new smoking!” headlines scream.

Scary.  who is the director of the Mayo Clinic/Arizona State University Solutions Initiative, as well as the inventor of the treadmill desk (would love one of those!), has even written a book on it (Get Up!). I haven’t read it yet, but plan to.

Another health pioneer who is all for walking is wellness guru  who says that putting in 45 brisk minutes a day is “quite simply the best practice I can imagine for a lifetime of health.”
Among walking’s benefits, he lists:

Longer life: A study of some 8,000 men published in the New England Journal of Medicine found that over 12 years, walking two miles a day dropped the risk of death by nearly 50 percent. Walking seems to be particularly protective against cancer. The walkers cut their risk of death from cancer during the study period by about 65 percent.

Lower weight: Several studies have shown that walking from 8,000 to 10,000 steps a day—roughly four to five miles—is highly effective as a means of weight loss.

A better brain:Â The National Council on Aging found that walking 45 minutes daily at a rather brisk 16-minute mile pace significantly boosted cognitive performance in people over age 60. Another study found that walking 40 minutes three times weekly slowed the normal, age-related shrinkage of the hippocampus. This part of the brain consolidates short-term memory and is one of the first regions to be damaged in those who have Alzheimer’s disease.

Dr. Weil suggests that even though walking is a gentle exercise, you need to put some effort into it to get the real benefit. “You should be able to cover about three miles in 45 minutes,” he says. “You should breathe more quickly, and notice a slightly elevated heart rate but still be able to carry on a conversation.”

How about making it a team effort? Vionic, the footwear company, is working with Dr. Weil and celebrity trainer Juliet Kaska and sponsoring a super-easy way to get your walking in with a campaign that officially kicks off on February 1. You can sign up to improve your health and well-being by pledging to walk 30 minutes for 30 days by clicking here. It’s the next best thing to a personal trainer or having a little voice inside your head gently urging you onward every single day.

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So You Think You Can’t … Stay Up-to-Date on Breast Cancer?

October is the month I inevitably think about getting older (yes, I’m a Libra baby), and the month that surrounds us not only in glorious fall foliage colors but a color particular to a disease: breast cancer.

So many things have changed since my own breast cancer diagnosis in 1988. One thing that hasn’t changed is the rate at which breast cancer is diagnosed in U.S. women younger than 35 (I was 34 at the time of my diagnosis). That has remained stable at around 2.4 percent for the past 20 years.

Today, about one in eight U.S. women—just over 12 percent—will develop invasive breast cancer over the course of her lifetime. The good news is that rates in the United States began decreasing in 2000, after increasing for the previous two decades.

The bad news? Even though death rates have been decreasing since 1989—with larger decreases in women under 50—over 39,000 U.S. women were expected to die in 2013 from the disease.
And like the seasons, facts are always changing. It can be tough to keep up. Here are some current breast cancer facts from
Breast cancer rates for women in the United States are higher than those for any other cancer, and the death rate from breast cancer is second only to lung cancer.
White women are slightly more likely to develop breast cancer than African-American women. Yet, overall, African-American women are more likely to die of it because the tumors are usually found at a later and more advanced stage when there are fewer treatment options.
Asian, Hispanic and Native-American women have a lower risk of both developing and dying from breast cancer.
Your risk of breast cancer is almost double if you have a first-degree relative (mother, sister or daughter) who has been diagnosed. About 15 percent of women who get breast cancer have a family member diagnosed with it.
About 85 percent of breast cancers appear in women who have no family history of the disease, due to genetic mutations (not inherited mutations) that occur as a result of aging and life in general.
Inherited gene mutations are linked to about 5 percent to 10 percent of breast cancers. Most common are mutations of the BRCA1 and BRCA2 genes inherited from your mother or father.
Your risk of being diagnosed with breast cancer (and having it recur after treatment) are higher if you’re overweight or obese, compared to women who maintain a healthy weight. This is true especially after menopause.
Regular moderate or intense exercise four to seven hours per week has been shown by research to lower your risk of breast cancer.
Other links to possible breast cancer risk include exposure to chemicals in foods (including cured and barbecued meats), water and plastic.
There are things you can do to help prevent breast cancer. Tune in next week to find out what they are.

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Which Weight-Loss Program Works?

There are Weight Watchers, Atkins, South Beach and Paleo. There’s Jenny Craig, Nutrisystem, the Grapefruit Diet, Skinny Bitch Diet and more.

Hundreds of thousands more.

In fact, there are so many that Americans spend an estimated $42 billion each year on weight-loss foods, products and services.

With so many diets out there, and so many people wanting to lose weight, how do you know which diet is right for you?

So many people are tempted to go on fad diets that promise quick weight loss—those 20 pounds you gained over a year, gone in just two weeks!—but there are some things that are important to know.
First things first. You need to slow down and realize that there are a few components to a healthy weight-loss program (note the word “healthy”).

To succeed at losing weight, you need these four things:
A reasonable and realistic weight loss goal. It’s best to aim for losing one to two pounds a week, says the Mayo Clinic.

A reduced-calorie, nutritionally balanced eating plan.
Regular physical activity. Government recommendations for adults are two hours and 30 minutes (150 minutes) each week of moderate-intensity aerobic activity (like brisk walking), plus two or more days of muscle-strengthening exercises.
A behavior change plan so you can stay on track with your goals.
This is not breaking news, but many people ignore these facts:
Calories count; so do portions.
Nutrition counts, too.

Just a small amount of weight loss yields big health benefits, like lowering your risk of heart disease, for example.

Your goal should be to develop good habits that will carry you through your lifetime. A short-term “diet” means you’re either “on” it or “off” it. Think instead of changing your way of life and becoming a “healthier” person.

Have a discussion with your health care professional before you begin.

Keep in mind that studies show it’s easier to stick with a weight-loss plan when you have some form of social support, whether it is a diet/workout buddy or a structured group, like Weight Watchers.
Think about people you know who have managed to lose and keep (that’s the harder part) the weight off. “Successful losers”:

Get regular physical activity.
Reduce their calorie and fat intake.
Eat regular meals, including breakfast.
Don’t let small slip-ups turn into giving up and a large weight gain.

In short, the reality of it is that virtually any healthy diet will work—if you stick to it. So, pick the one that will be easiest and least challenging to stick to, say researchers of a study that found just that. But it’s important that the diet, whatever it is, meets all of your nutritional needs.

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Saturday, 4 March 2017

10 Essential Vitamins and Nutrients Every Child Needs

As parents, we often worry about whether our children are getting the essential vitamins and nutrients they need to stay healthy and active. Eating a well-balanced diet definitely helps.

But let’s be realistic: Spinach and milk don’t always win at mealtime, sometimes it’s important to supplement a healthy diet with a multivitamin, like Star Warsâ„¢ brand Gummy Vitamins by NatureSmart. They are available in three Complete Multi-Vitamin formulations, with over 10 essential vitamins and minerals for health, growth and development, and an Immune Support formula.*

When your child takes a daily vitamin, you can be sure they are getting:
Vitamin A – Supports eye health and healthy vision.*
Vitamin C – Supports immune health.*
Vitamin D – Assists in the absorption of calcium and phosphorus from the diet, which aids significantly in building and maintaining strong bones.*
Vitamin E – Encourages healthy metabolic function to fight against free radicals and oxidative stress.*
Vitamin B-6 – Plays a part in energy conversion, and supports the production of red blood cells.*
Vitamin B-12 – Is involved in the normal formation of blood cells and DNA synthesis and renewal.*
Biotin – Is involved in making carbohydrates available for energy.*
Iodine – An essential component for the functioning of thyroid glands, which in turn have a significant influence on the metabolic processes in the body.*
Zinc – Plays a role in the normal functioning of the immune system, and is needed for cell division and growth.*

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