This is the time of year that many of my patients dread because they know I will soon be giving them “the Talk.” And not just once, but probably every time I see them over the next 5 or so months. What is it about this particular discussion that makes them hate having to listen to it? Well, just listen to some of their comments after I’ve given them the Talk:

“Ooh, I hate getting that sticky stuff all over me.” 

“Ugh – way too greasy for me.” 

“I hate the way it smells.”

“Doing it is not worth the benefits.”

“It makes me look like I’m having a permanent hot flash.”

My own opinion is that they are all overreacting to using sunblock. (!!)  Especially given its benefits. Not only is using it religiously every day and anytime you are outside (rain OR shine) lifesaving in many cases, but it can actually prevent wrinkles. If you’re one of those women who like your wrinkles (I like some of mine), then look again at what else it does – it can prevent skin cancer which can be deforming and, in the case of melanoma, lifethreatening.

I think that there are two reasons that make people not want to use sunblock regularly. One is that they don’t know about all the newer products that are formulated so that it’s easy to wear: ie, not greasy or sticky or smelly, and doesn’t interfere with your makeup or make you look sweaty. The other reason is the whole topic of sunblock just seems to be too complicated. And, in a way, it is complicated.

So, I’m going to make it easy for you and give you a quick lesson on SUNBLOCK because I believe it is that important.We discuss it in much greater detail in our book if you want to learn more. Here goes – quick and easy:

1) Especially during the months of April – October (in this country), you need to wear sunblock on all  exposed skin when you are outside –     even for a short walk. That includes your face and lips, ears, neck, exposed chest, arms and hands, and legs/feet (something I always forget).

2) This goes for everyone – light-skinned and dark-skinned ladies (and guys).

2) Be absolutely certain that your sunblock is protective against ultraviolet rays of both types – A and B. The box and tube should be   labelled as active against “UV A and UVB”. In fact, the FDA is requiring labels in the very near future.

3) Don’t be stingy with the amount you use. Slather it on! The official recommendation for the amount necessary to be protected is at least 2 tablespoons on each area of the body that will be exposed to the sun.

4) Don’t wait until you’re outside to use it. Put it on at least 1/2 hour before you are exposed to the sun, and reapply at least every 2 hours, or sooner if you are swimming or sweating excessively.

5) Use a product with a sun protection factor (SPF) of at least 15. I generally recommend and use products with a much higher SPF – usually 40 or 50.

6) Know that there are two types of sunblock ingredients – chemical and physical. The chemical sunscreens actually interact with your skin to protect it from the sun; some examples are PABA, Parsol, and oxybenzone. The physical sunscreens simply form a barrier on top of your skin to prevent the UV A and B rays from getting to the skin iself; these are descendants of the old zinc oxide – remember the heavy white paste that the cute lifeguard at your pool wore when you were a teen?- and today are called titanium dioxide and other similar names. Both types protect well; the main difference is that the chemical sunscreens are more prone to cause allergic reactions of the skin, and the physical ones do not. I personally cannot wear chemical sunscreens because I swell and turn red anywhere I use it, not to mention the dreadful itching.

That’s it! The basics of what you should know about sunblock. Not so bad, was it? OK, now, use it!

P.S. You should actually wear sunblock all year round, but I will save that Talk for next October.

The story of castor oil is an interesting one. It comes from the seeds of the herb called Ricinus communis from Africa and India. My grandmother thought it was good for everything from constipation to achy joints.I thought it tasted horrible. In ancient Egypt it was used as a medicine and in the Middle Ages in Europe as well. The famous medical intuitive Edgar Cayce claimed it helped to heal lymph tissue in the small bowel and thus promoted tissue growth and repair in the body.

What is it being used for now? It might surprise you.Of course it is still used by some as a potent laxative. It is often used as a warm compress to promote lymph drainage in various body parts.

What is fascinating is that now oncologists are using castor oil to deliver chemotherapy to cancerous tumors. It is being used as a carrier for certain forms of chemotherapy. Unfortunately, it can cause allergic reactions. At the present time, scientists are studying ricin, which is a strong poison (the same compound used by terrorists) that comes from the castor bean. When combined with an antibody to protect healthy cells, it seems to be shrinking tumors in lymphoma patients.

Although castor oil has been around for ages it can cause problems and even death if not used properly and if given to pregnant and nursing women and small children and animals. It can cause abdominal pain, nausea and vomiting, and allergic reactions. Long-term use can result in fluid and electrolyte imbalances.It is important to talk to your doctor if you might want to take castor oil or use it as a compress.There are risks but who knows what other uses are in store for this very old herb?

No, this blog isn’t about that dream of falling off a cliff that many people (including me) occasionally have. Nor is it about the bestseller that was so popular when we were younger, Fear of Flying by Erica Jong, although this blog does have to do with traveling. My recent traveling, to be exact.

You know that gap between the inside and the platform that looms before you as you get on or off the train? I’m terrified of it. Absolutely terrified. In fact, I can be cool and calm and relaxed as I walk toward the train, and then get panic-stricken the moment I see that gap.

Why? I’m afraid of falling. 

Now you might think that this is because I don’t want to end up under the train tracks, which would be understandable (but impossible since I am much wider in both directions than the gap). Or, if you saw the episode called “Subway” in December 1997  on that wonderful TV series Homicide: Life on the Streets, you might also think you understand why I’m afraid of the gap. In this episode, a man gets wedged between the train and the concrete wall, either by accident or after having been pushed (which is why the detectives are called in) and his death is certain.

But it’s not just the gap I am afraid of falling into. I’m frightened by falling down even two steps. I’m afraid of tripping on a flat surface and falling. Now you might wonder why: is it because I don’t want to dirty my clothes or skin my knee as I did when I used to rollerskate? Or because I’m self-conscious and don’t want to appear clumsy and stupid?

Actually it’s none of those reasons. I’m frightened because of all the patients, friends and loved ones I’ve seen suffer the consequences of a “simple” fall. Bruises that don’t heal but go on to cause the skin overlying them to slough off and become infected; fractures of bones in the arms, legs, pelvis, and even face; damage to the eyes; even strained muscles that cause one to be bedridden, which then leads to clots in the leg veins that go to the lungs. All of these things can occur after a “simple” fall, and do. It turns out that falls are not simple at all.

Researchers from The Centers for the Disease Control and Prevention (CDC) looked at data from emergency rooms and from death certificates and found that: falls are the most common cause of hip fractures;  in 2003 alone, nearly 14,000 people over the age of 65 died as a result of falling; falls are the leading cause of death from injuries in people in this age group (that’s some of us); and that about 20% of falls result in serious injuries that can result in serious disability.

So, you can now see why I am so afraid of falls.You should be too. And, you should help to raise awareness about this usually-preventable health risk. We discuss recommendations to help prevent falls in our book. In addition,the CDC has put out brochures about how to prevent falls, especially in us older people. For more information, go to: http://www.cdc.gov/HomeandRecreationalSafety/Falls/index.html

We had the great pleasure of meeting some of you today at the BEA in New York City! We were thrilled to be asked to autograph our book there and be a part of this wonderful happening. Safe Travels to all of you who were there. We’re both heading to our respective homes and will blog again in June…this coming Monday! (Can you believe June is here?!)

It is now officially summer. That means that not only are white pants and white shoes ok to wear (LOL), but also that the barbeques and beach get-togethers will get under way. While you should enjoy this time of year and the frequent social events that the weather allows, you should also not forget about your health, which is so easy to do while having a good time.

No – this blog is not about limiting the amount of alcohol you drink or the amount of food you eat (though we’ll talk about those – again – in future blogs); this one is about smoking cigarettes. And for a change, not just about your smoking, but about the smoking of others. We don’t usually presume to give health advice to other than our readers, but in this case, the smoking of others affects you too.

We’ve all heard that being exposed to the smoke from someone else’s cigarette, cigar, or pipe – even if we do not smoke ourselves – can be dangerous to our health. Because of the many toxic chemicals contained in the secondhand smoke, it is a risk factor for many of the same diseases that smokers get, such as lung cancer, heart disease, and stroke. It has also been associated with lung diseases, such as asthma and bronchitis,  growth abnormalities in infants whose pregnant mothers were exposed, chronic coughing, irritation of the nose and eyes, dental cavities, and even irritability. Any exposure to secondhand smoke, no matter the amount, is unsafe.

Recently, a new danger has been found in being exposed to secondhand smoke – cognitive decline, or, a decline in the brain’s abilities to think and process information. 

A recent study in England (British Medical Journal 2009 February 12;338:b462) looked at 4809 nonsmoking adults over the age of 50, and measured in the saliva the amount of a breakdown product from nicotine which is a marker for exposure to secondhand smoke. Those study participants who had been exposed to secondhand smoke were statistically more likely to perform poorly on neuropsychological tests, or, tests of cognitive function, than were participants who had not been exposed to secondhand smoke.

The negative effect of smoke from tobacco products on brain function has been known to occur in smokers for years. This study was the first time that the same effect was found in nonsmokers exposed to secondhand smoke.

This study should not only make us grateful for the increasing number of smoke-free places in our environment, but will also give us more ammunition to use against our family and friends who smoke. Tell them that they are not only hurting themselves by smoking, but their loved ones too.

I have not been able to watch Michael Moore’s movie “Sicko” in its entirety. It is now playing on the cable channels and I could see it for free, but I just can’t do it. Why you might ask? Although I agree that our medical system is tragically flawed and due to implode at any moment, there was a very important piece missing from that movie.You might want to call it the “elephant” in the room. Michael Moore himself appears to be overweight and out of shape. Did he address that in his movie?

Where was personal accountability? Sometimes things happen. Cancer is one of those things. It is the result of many factors that are often out of our control (not smoking however which is in our control), but what about taking responsibility for one’s own health? Many diseases can be prevented with a healthy diet and exercise. We have the unhealthy habit in this country of blaming others when something goes wrong. What about looking within? We have great technology that can do amazing things such as opening arteries in the heart to prevent heart damage from a heart attack and removing plaque from the arteries that feed the brain to prevent damage from strokes. Even with all of this technology the true ability to prevent disease and keep things from getting to the point of needing it comes down to lifestyle choices. If you exercise, eat healthy, maintain a healthy weight, quit smoking or never start, have your blood sugar and blood pressure and cholesterol under control odds are you will not need it!

I see patients all of the time who are fatigued and achy and angry that despite optimizing their hormone levels and vitamin levels they are still tired. When I ask them whether they have incorporated exercise and healthy living into their life they say “no”. What more can be done? What will it take to turn on the light of understanding? I am still trying to find the answer to that question. Each person is different, but it is a beautiful thing to watch when a patient figures it out. I am sorry it doesn’t happen for everyone. It needs to, and I challenge Michael Moore to find that answer to that question for his next movie!

When I had my hysterectomy two years ago, my doctor really wanted to take my ovaries at the same time. The reason was that it would prevent ovarian cancer. Fortunately, I had done my own research and found that the ovaries still had value post-menopause. I would not allow them to be removed.

About a month ago,the results of a research study done as a collaborative effort between John Wayne Cancer Institute and Harvard Medical School affirmed my decision.They studied 29,380 women. Over sixteen thousand women had a hysterectomy and bilateral oopherectomy or ovary removal. Over thirteen thousand had a hysterectomy without oopherectomy. The women were followed for 24 years.What the researchers noticed was that although the women without ovaries were at decreased risk for breast cancer and ovarian cancer, they were at increased risk for heart disease, stroke and lung cancer when compared to the women with ovaries in place.This resulted in a higher risk of death from these diseases as well.The risk of dying from ovarian cancer was 0% in those without ovaries and although not 0% it was low in the women with ovaries as well (.26%)

When you consider that 14,700 women die from ovarian cancer and balance it off with the fact that 326,000 women die from heart disease and 86,900 die from stroke each year, it is not a good idea to have women lose their ovaries without balancing the risks and benefits. It makes sense to take the ovaries of those women at high risk for ovarian cancer due to a family history or those who carry the BRCA1 and BRCA2 gene mutations. Otherwise, there is no reason to have them removed. Be informed, make good decisions and stay healthy!

The Crohn’s and Colitis Foundation of America and Shire have joined forces to support a “virtual” march to raise awareness about, and funds for, research on Inflammatory Bowel Disease (IBD), which includes Crohn’s Disease and Ulcerative Colitis. This is a free program that lets Facebook users take virtual steps around the National Mall in Washington, D.C. 

To learn more about this innovative and fun fundraiser, and to join it, go to:

http://www.ccfa.org

Melanoma is the deadliest form of skin cancer. There will be over 68,000 new cases in the US this year. The major risk factors for melanoma include a family history, exposure to UV rays of the sun especially early in life, light eyes and hair, and age greater than 20.

When melanoma is caught early it is very curable.The key is to recognize it and have it removed. The typical characteristics to look for are the A, B, C, D and E’s.

A is for asymmetry. If you look at a mole and it looks asymmetrical it is time to have it checked out.

B is for border. If the border is irregular and not smooth it needs to be evaluated.

C is for color. Moles that are purple, multiple colors, or black need to be checked out.

D is for diameter. If it is greater than the size of a pencil eraser top, it needs to be checked.

E is for elevation. If the mole is raised and bumpy it is abnormal.

If you have a skin mole that is oozing, scaling and/or growing it is important to have it evaluated. Sometimes moles are in places that you might not expect. They can be in the eye, scalp, and even on the bottom of the feet. In African Americans, melanoma can be mistaken for a wart on the hands or feet. That is why we recommend that you have a dermatology exam every year. A dermatologist will recognize those moles that are suspicious and remove those that need to be evaluated.

If you have anything that concerns you please go and get checked. Our motto: When in doubt check it out!

Surprised that we’re still talking about the swine flu here? After all, the media has given the topic a bit of a rest, and many articles are even saying that this particular virus is “just like any other flu virus” and that the outbreak we’re hearing about is “like the normal winter flu” and that all the hype about a pandemic was overdone.

Don’t believe everything that you read. First, there’s nothing “normal” about any flu virus – this one or any other. Yes – one or more of them usually hits us every winter,but that is no reason to make light of any influenza outbreak.Why? Because if you become complacent, you’ll forget all those good habits that you read about to prevent the spread of this, and other, respiratory infections. So, while we still think you shouldn’t panic, you should also not make light of this swine flu outbreak. In fact, a U.S. federal official stated just this week that the infection is spreading so quickly that they may stop counting cases.

Here’s what we know now. This swine flu virus is being referred to as “novel influenza A (H1N1).” It is, in fact, a new flu virus, which is originally of swine origin. Because the virus causing the epidemic now is new, most people have little to no immunity to it. This is the reason that experts are expecting more hospitalizations and more deaths from it. However, it does not seem to be causing a serious illness in as many people as was originally feared; the illness it causes in most is relatively mild. A rapid laboratory test for this virus is now available; as of today, there have been 3009 lab-confirmed cases, and 3 deaths in the U.S.

It is spread from person to person through contact with infected respiratory secretions; the most common way one becomes infected is through being exposed to a sneeze or cough of an infected person. The symptoms it causes are just like those of the winter flu and include fever, cough, sore throat, body aches, fatigue, and headache. Unlike most of the other flu viruses, however, this one also can cause gastrointestinal symptoms, including nausea, vomiting and diarrhea.

One more thing. It is thought that this virus will make another, more forceful appearance this coming fall. It is hoped that a vaccine against this particular influenza virus will be available then.  However, even though you may avoid getting infected with it now, you may not be able to avoid it next fall.

What can you do about that now? Easy. Take care of yourself now, and try to keep, or get, in the best shape you possibly can. To do this requires the Big Three we always talk about: eat nutritious foods, exercise regularly, and sleep well and enough. Now do you see what biking has to do with the swine flu?! If you start right now doing regular bicycling, you’ll not only have fun and get healthier now, but you can help yourself prevent the flu next fall!

To review what you should do to avoid getting infected, and what you should do if you do get the symptoms, re-read our prior blogs on the swine flu. For daily updates on this H1N1 flu and further tips to avoid becoming infected, go to:

http://www.cdc.gov/h1n1flu