It’s that time of year again. With all the fall back-to-school preparations comes the medical check-up, including those routine immunizations –  making sure all those “shots” are up to date. 

Kids aren’t the only ones who need to keep up with routine immunizations.  We do too. Although there was a lull period after childhood and during young adulthood during which we didn’t really need any immunizations – other than perhaps tetanus shots – now that we’re in midlife and older, there are again many shots recommended to keep us healthy. 

One of the most effective and safest immunizations recommended for those of us 60 years old and beyond is the herpes zoster vaccine that protects against shingles, a disease associated with pain and disability that can last long after the acute stage is over.  In addition to those complications of the infection, having shingles may lead to a later stroke according to two studies.

One study* found an increased risk of stroke after an episode of shingles that occurred anywhere on the body. A more recent study** showed – in the one year follow up period after the episode of shingles – an even greater risk of stroke when the shingles occurred in one of the nerve roots supplying the eye, a disease known as Herpes Zoster Ophthalmicus (HZO). Furthermore, the risk of stroke remained the same whether or not the disease was treated with antiviral medication.

Bottom line: it is much better to avoid getting shingles than to get it and treat it.

The vaccine (Zostavax) lowers the chances of getting shingles by 50%, has been proven to be safe, well-tolerated, and is covered by Medicare.  But most of us are not getting it; one estimation states that only 7% of those eligible for the vaccine are actually getting it. Why is this?

One major reason is that we (your physicians) are not recommending it strongly enough, if at all. A recent survey*** of 598 family doctors and general internists in the U.S.,  showed that while 91% recommended influenza and pneumococcal vaccinations, only 41% strongly recommended vaccination against shingles. In addition, the perceived difficulty of reimbursement for the vaccine (from either Medicare or private insurance) was cited by over 30% of the physicians as a major barrier for recommending the vaccine.

If you’ve read our book, you know that we strongly advocate that we each take responsibility for our own health. This means educating ourselves about preventable diseases commonly associated with aging, and then advocating for ourselves.

Because this vaccine is officially recommended by the CDC, is safe and can prevent a painful and disabling disease in at least half of those receiving it, this is another of those instances where YOU need to ask your physician about it. I can tell you from my patients’ and from personal experience with the disease that this particular vaccine is every bit as important as the influenza vaccine or any of the others recommended.

Shingles is a disease that you’d rather not get if you have the choice. And in this case, you do.

* Stroke 2009; 40:3443

**Lin H-C et al. Herpes zoster ophthalmicus and the risk of stroke: A population-based follow-up study. Neurology 2010 Mar 9; 74:792.

*** Hurley LP et al. Barriers to the use of herpes zoster vaccine. Ann Intern Med 2010 May 4; 152:555

I have a question for you. If you were a Ferrari, would you let a mechanic who only worked on Ford Focus models take care of you? The answer is no. Ok, with that in mind, if you needed a colonoscopy to screen for colorectal cancer should you go to a general practitioner?

If you have a gastroenterologist in your community, I suggest you have him or her do your colonoscopy. The reason for this is that they are trained in doing the procedure and they know what to look for and what to do if they find something. General practitioners are trained in many procedures and do not have the specialized training.

An equally important reason is that a recent study has found that if one of the generalists vs. a gastroenterologist does your colonoscopy you are 39% more likely to need another procedure in a year.

If you have had a colonoscopy then you know that the preparation takes almost an entire day and is a time when you get to know your bathroom really well. Do you really want to go through the ultimate cleansing the following year? It is also quite expensive. So, it would be more cost effective to have a specialist do the procedure.

There are some communities where there may be no option to use a gastroenterologist. However, when you can you really might want to think about using one. It will probably be less painful all the way around.

Am J Gastroenterol advance online publication 24 August 2010; doi: 10.1038/ajg.2010.344

This is our third Labor Day to be writing this blog. At this bittersweet time  – bitter, because it’s the end of a hopefully restful summer; sweet, because it’s the beginning of the exciting activities of autumn  – we want to wish you an active, connected, peaceful, and meditative holiday weekend.

Active: so that you will begin, or continue, the regular physical exercise that is so necessary for the health of your body, mind, and spirit

Connected: so that you will begin, or continue, the relationships to others that are so all-important for the health of your body, mind,and spirit

Peaceful: so that you will begin, or continue, the intermittent periods of rest that are mandatory for the health of your body, mind, and spirit

Meditative: so that you will begin, or continue, the habit of setting aside time – in this hectic and rushed era in which we live – to reflect on issues that are important to you, a habit crucial to the health of your body, mind and spirit

We wish you a happy and safe holiday weekend.

Global warming, the economy, hurricanes, oil leaks, energy shortages, all of these things are current crises. There are some small things we as individuals can do but at times it feels it is all out of our control. Fortunately, there is a major crisis spreading all over the world that we can control. It is our weight.

Recent reports have pointed out the soaring obesity rates in Brazil. In the age group 20-24 50% of men and 48% of women are overweight. What happened to the girl from Ipanema? She can’t fit into her bikini anymore.

In England the rate of obesity surgeries for those with body mass indexes over 40 have increased 10 fold. With the flourishing economies in China childhood obesity is becoming a major issue as well.

In the world there are 1 billion people who are overweight and 300 million who are obese. It is time for all of us to take stock and take responsibility for our own bodies. It is important for us as citizens of the earth to reach and maintain fitness. If we don’t the world economy will be crushed from the medical expenses that result from the ever-increasing weight of the world.

Of course I know that you don’t really think that*, but it was the catchiest title I could come up with for this blog today. Especially since: 1) the media has been overloaded with news about the recall of eggs contaminated with salmonella; 2) I’ve talked about food contamination in several very recent blogs; BUT 3) given the magnitude of this latest problem, and its importance, it would be remiss for us not to comment on it here. So, if you’re bored to death with this topic, please bear with me just a bit longer. It is that important.

The current salmonella in eggs outbreak has caused the largest recall of eggs ever in the US; this week a total of over a half billion recalled eggs was reached. The good news is that the system for identifying and recalling contaminated food products is working.  The FDA, the CDC, The Department of Agriculture, and state public health officials are working together. Equally as impressive is the fact that, on August 13, 2010, one of the egg supplier firms voluntarily conducted a nationwide recall of shell eggs that it had shipped since May 19.

The bad news is that there still may be contaminated shell eggs out there not yet identified, in addition to other foods being contaminated. AND THAT IS ALWAYS THE CASE, EVEN WHEN  THERE  IS  NOT AN OUTBREAK CURRENTLY GOING ON.  So how do you protect yourself and your family?  Here are several easy rules to remember when handling fresh eggs.

1)Keep eggs refrigerated.

2)Cook eggs until yolks and whites are FIRM. This means that scrambled eggs should not be runny.

 3)Cook foods containing eggs thoroughly. Dishes containing eggs, such as casseroles should be cooked to 160 degrees F. Use a food thermometer.

For more specific ways to stay safe when buying, preparing and eating eggs, go to:

http://www.fda.gov/Food/ResourcesForYou/Consumers/ucm077342.htm

To review the ways to protect yourself from food poisoning in general,  go to

our blog on the subject:

http://www.smartwomanshealth.com/horn_miller_blog/?m=201006

For more information about the Salmonella in egg outbreak, go to:

http://www.fda.gov/Food/NewsEvents/WhatsNewinFood/ucm222684.htm

*Salmonella is a bacteria that can contaminate food, causing illness in those who eat the contaminated food. It was named after the pathologist who discovered it – Daniel Elmer Salmon – and  has nothing to do with the  salmon fish.

Summer is coming to a close and we are all going to be busy with work, children, school, holidays, you name it. So it is time to take stock and think about what is really important.

How many of us (women) really take care of ourselves? If you ask most women, they will tell you their priorities are the following: number one is our children, then our spouse, family members such as parents and siblings, our house, our pets and then….ourselves! Self-sacrifice is part of our genetic make-up as nurturers. However, if we do not take care of ourselves, we will not be able to care for anyone else! Let me suggest the following for both women and men:

• Find a physician or nurse practitioner who can be your partner in health. Sit down with this person and find ways that you can optimize your health and healing.

• If you are taking supplements, talk to your provider about them. It is possible that you may be taking some that interfere with your regular medicines or that you are taking way too much of a certain herb or vitamin.

• If you are opposed to taking a lot of medications, find ways to improve your health without them. A healthy diet and exercise can go a very long way.

• Sometimes, complementary therapy such as acupuncture and massage can help with painful conditions as well if not better than medication.

• Attitude is everything. Our mind is very powerful. Harnessing your power through therapies such as guided imagery can help with general health, pain, sleep, and can act as a powerful adjunct to cancer treatment.

• Laughter and fun is very therapeutic. It is important to honor that part of yourself. When I ask patients to name three things that they do for fun or that they enjoy and they cannot name them, it is very telling. Finding things to do for fun doesn’t have to cost money. It could be just sitting outside and enjoying a beautiful day or watching a funny movie.

• Nurture your spirit. It could be through prayer or meditation, or something as simple as taking a nature walk.

Don’t you think it is time to put yourself first on the list? If not now, then when?

I know you’re expecting me to talk about my spiritual awakening after reading the above title. But this blog is about the physical aspects of yoga. In fact, a very physical aspect – pain.

When my trainer at the gym left to pursue another career some months ago – after 4 successful years of getting me to come to the gym AND do strengthening, balance, and flexibility exercises there regularly – I was at a loss. Being motivated to do regular physical activity is a problem for me.

It was around this same time that a lovely yoga and Pilates studio opened in my neighborhood. I figured that if I got myself onto a schedule of going to classes there , then it was just one step more to keep up my cardio workout. So, I enrolled and went to my first class, an intermediate Ashtanga yoga session.

Now, I’ve practiced yoga positions before, though not in a long time. But I’m fairly flexible and had no trouble keeping up with the different postures during the class. Things were going swimmingly (I use that word because I was literally swimming in sweat) until we got to Downward Facing Dog and I surprised myself by squealing out in pain as my palms hit and pressed down into the floor. Especially the right palm just beneath the bottom of the thumb.

What in the world? I thought. I’ve never noticed pain in my hands before. My mind automatically switched into doctor mode, and I figured that I had stretched the ligaments or tendons between my thumb and forefinger when I had swooped down and picked up my own little 9 pound downward facing dog several days before . Having a quick satisfactory explanation, my immediate problem became what to do about this particular pose, and the ones after it that required pressure on the palms. Unfortunately, the pain was so severe that for the rest of the class I could only take part in those postures that did not require my hands to be in that position.

Fast forward two weeks. I was still having aching now in both palms,worse in the right hand. So, while I was accompanying my husband for his preoperative visit for carpal tunnel surgery, I mentioned the pain to the hand surgeon, thinking he’d confirm my diagnosis of a tendon or ligament or muscle strain and would tell me it would clear up in a few weeks.  He grabbed my hand, pressed down in the exact spot that hurt causing me to grimace, and said that he was sure I had arthritis of the CMC joint. Then he did an xray which proved it. And then he said it was one of the most common joints to get arthritic in older people.

The CMC?  (That’s “carpometacarpal” ). I’d never even thought about that joint since medical school. It’s the one connecting the base of the thumb to the bones in the wrist and plays a crucial role in the function of the thumb. In some studies, degenerative arthritis (inflammation caused by wear-and-tear) of the CMC joint is up to 20 times more common in older women than in any other group.  Like arthritis in other joints, it responds for a time to anti-inflammatory medications, but can become progressively severe in which case it can be debilitating resulting in severe pain, decreased range of motion of the thumb and decreased hand strength. It can even make simple tasks at home – like turning the doorknob or twisting open the lid of a jar painful and difficult. The good news is that in recent years a successful surgery has been developed to treat it in the most severe of cases.

So what about me and yoga? After getting over the shock of being called, yet again, an “older” woman, I did the usual things one does for arthritis, including a brief course of anti-inflammatory meds, heat to the area, and rest.  My pain is better for the moment, and I think I’ve accepted this diagnosis as one that will be with me for the longterm, as well as the fact that this is an age-related problem. That last realization may have been the hardest part of the entire experience.

I learned something else important in that same class. But that’s another story for another day and another blog.

A recent study done in England has found that it would be cost effective to have statin drugs as condiments at fast food restaurants for those who choose to have cheeseburgers and milkshakes. I am speechless, which for me is quite unusual. I have often joked to my patients that it is not okay to eat their twinkies with their statin drugs. Personal responsibility for healthy eating and exercise is so important when it comes to wellness. This suggestion to me flies in the face of common sense and points out why we are having an obesity epidemic.

There are a lot of tempting foods in our world right now for some of us. Many are not healthy. There are 2000 calorie milkshakes, 700 calorie coffee drinks and 1700 calorie appetizers. As much as we may want to have them, it is time for us all to stand up and say “No!” We adults should know better. It’s one thing if you’re a child and you need to learn that you can’t have everything that you want. But, come on adult world. You cannot have fatty foods along with your statin and think that is okay!
Statins are great for those with high cholesterol and who are at risk for heart attack and stroke. For those who really don’t need it the risks may outweigh the benefits.

The secret to a long, healthy life is eating a healthy diet and exercising. Take a pass on the cheeseburgers and milkshakes with the statin chaser and just live well.

Do you eat salsa or guacamole any chance you get? Although there are many healthy aspects of these two foods, recent information from the CDC presented at the International Conference on Emerging Infectious Diseases in Atlanta on July 13 of this year shows that there are not-so-healthy aspects as well.

A new report from the CDC reveals that salsa and guacamole are two very significant sources of food-borne illnesses. In fact, the rate of food-borne illnesses – causing anything from a mild stomach ache to life-threatening organ failure – has more than doubled for salsa and guacamole served in restaurants. The CDC specifically reported that:

• Out of 136 salsa or guacamole outbreaks, 84% occurred in restaurants and delis.
• Salsa and guacamole outbreaks accounted for 1.5% of all food establishment outbreaks between 1984 and 1987; that figured jumped to 3.9% between 1998 and 2008.
• Poor storage, such as temperature, were reported in nearly one third of the salsa and guacamole outbreaks.
• Food workers were the source of contamination in 20% of the restaurant outbreaks.

Why is this? Because both foods are made using fresh ingredients – fresh avocado in guacamole, and fresh tomatoes, onions and peppers in salsa – there is a chance that they will spoil and bacteria, such as salmonella, will set up housekeeping if these ingredients are not properly stored and refrigerated.  In restaurants, salsa and guacamole are prepared in large batches, so that even a few bacteria which have taken up residence the spoiled ingredients of these foods can infect many people.

Should you give up eating your favorite foods? Being aware that any foods made with fresh ingredients have the potential to cause a food-borne illness is the first step in the battle against food contamination.  When you prepare these foods at home, be careful to always refrigerate and store not only the fresh ingredients, but also the prepared guacamole and salsa, properly. And when you go to restaurants and think about ordering either of these foods, consider ordering something else not made with fresh ingredients, or ask when the guacamole or salsa was prepared and if your waiter has tried it today.

Now, what about frozen mice? A recent article in the New York Times* stated that there has been a recall of millions of the frozen mice used for feeding snakes and other exotic pets. Why? Because of salmonella outbreaks traced directly to frozen mice sold over the internet by a company in Georgia. And why should we worry if our pet python gets salmonella? Actually, it’s the humans who are getting salmonella simply by handling the frozen mice and not washing their hands or cleaning the countertop afterwards.  So, yes – you even have to be careful with some pet foods!

Please see one of our past blogs for more information on, and ways to avoid food-borne illnesses:

http://www.smartwomanshealth.com/horn_miller_blog/?p=477

*Friday, July 30, 2010 pg 1.

A recent study done in England has found that when those over 50 are diagnosed with HIV they tend to be diagnosed later in the stage of the disease and die sooner than those who are diagnosed under age 50. Although there are not that many Britons diagnosed with HIV after age 50, the number is increasing more quickly in the older set as compared to those under 50.

Another study found that men who used drugs such as Viagra and Cialis for erectile dysfunction were twice as likely to become infected with sexually transmitted diseases as those who did not use the medication. The medication most likely did not cause the increase, but rather the increased frequency and numbers of partners that caused the infections.

The soaring divorce rates as well as the ability to be sexually active into our golden years is probably contributing to the increase in HIV disease. Although birth control is no longer an issue for the baby boomers and beyond, it is still important to practice safe sex including the use of condoms. If you are out in the dating world regardless of your age you need to have an HIV test yearly. The reason? The earlier HIV is found the better chance you have for a normal healthy lifespan. Remember this! Achieving a ripe old age does not protect you from HIV or any STD for that matter. Heed the advice that many of us tell our kids, ” be safe, and always use condoms!”

24 August 2010 – Volume 24 – Issue 13 – p 2109–2115
doi: 10.1097/QAD.0b013e32833c7b9c
Epidemiology and Social