JH: Now that the election is over, and we know the worst about the economy (or least hopefully we do), we can get back to work and focus on day to day matters. And that means, as usual, our health. Time to stop making excuses about all the potato chips we’ve grabbed as we plop down in front of the TV to hear the latest polls, and about the new Ben & Jerry’s ice cream we’ve eaten every night for comfort as we try to deal with our checkbooks. And…

RM: Hey! Wait a minute – aren’t you forgetting something? What time of year is this? You know, the one you have a name for and always talk to your patients about?

JH: Oh, you’re right. It’s what I call the “Danger Season”: that period of time from Halloween until January 2.

RM: Why do you call it that? And how does this time of year impact on all those things we’re saying about getting back to work on health, eating better, walking?

JH: It’s absolutely the worst time of year for taking care of ourselves. The Holidays (which have become almost one long holiday), Thanksgiving, kids home from school, days off for shopping and gift buying, stopping for that double mocha latte and scone, candy canes at all the counters in stores, holiday parties, holiday cookies (love those Mexican wedding cookies smothered in powdered sugar), hot toddies, holiday dinners, weddings….

RM: Whoa! You’re really stressed out here!

JH: That’s why I call it the danger season: because of all the good cheer and easy food just sitting there for grabbing, it’s way too easy to rationalize forgetting all our healthy habits, and giving in to the easy life. Then in January, we are so out of shape and have gained so much weight, it is positively demoralizing. So, what do you suggest we do to avoid that?

RM: I do have tips, but too many to give all of them here. So, I will start by giving a few now, and adding to them in this blog as the weeks go by. Let’s start with:

• • Be aware that the upcoming 8 weeks can be dangerous to your health. Keep reminding yourself.
• • Be alert to your inner voice telling you “it’s ok to eat that holiday candy, just this once” and other destructive messages. Don’t listen to it!
• • Take action to avoid getting into difficult situations healthwise. For instance, give away or throw away the remains of that Halloween candy now, before you eat it all. Don’t leave bowls of goodies (candies and cookies) sitting out in your house because “it’s that time of year”; put them out only when company is coming. Look at your schedule closely: be realistic about all you have to do and the time it takes, and make a place for exercise.
• • Advocate for yourself. Don’t get that fattening holiday drink when you’re out with friends just because they insist that you do; stick with your regular skinny latte.

JH: Those are great. We’ll give more as these holiday weeks arrive.In the next blog, we’ll talk about some recent studies about docs prescribing placebos, more on exercise and breast cancer, and about an interesting study about which diets work the best.

Yes, we do strongly believe in the necessity of exercise to maintain our health, and this particular exercise – that of exercising the right to vote – is no exception. No matter what your beliefs are or which candidates or party you favor, your vote is crucial not only for the health of our country and of democracy in general, but for your own sense of wellbeing. This coming Tuesday, don’t forget to do all of your exercises – including voting!

More discussion on recent medical studies right after the election.

October is National Breast Cancer Awareness Month. This important initiative, and organization by the same name (NBCAM), was started over two decades ago to raise awareness about breast cancer in all women and their families. Over the years, the organization has evolved and made all issues related to breast cancer of year-round importance. NBCAM is comprised of professional medical associations – such as the American College of Obstetrics and Gynecology, the American College of Radiology, and the American College of Clinical Oncology; government agencies – such as the Centers for Disease Control and Prevention; and national public service organizations, such as the American Cancer Society, working together to increase the awareness of breast cancer, provide access to screening services, and share information about all aspects of breast cancer.

Encouraging women to increase their knowledge and to take control of their own health, NBCAM wants women to make sure to schedule an annual mammogram, practice regular self-breast exams, and take the prescribed treatment, including that for prevention and treatment, of breast cancer. The fact that this organization and the increased awareness of breast cancer has had a positive effect is shown by recent studies in which not only death rates from breast cancer have decreased, but also the number of new cases diagnosed with breast cancer has decreased in recent years. Most experts believe that these significant decreases are due not only to improved treatments, but also to the increased awareness by patients of their risks for this cancer; this has lead to more women getting screened regularly, and in cases where breast cancer may be present, having it detected at an early stage when there is the highest chance for a cure.

Robin and I agree completely with the philosophy of NBCAM. Please visit NBCAM’s website, a wonderful resource about your breast health throughout the entire year, and not just in October.  http://nbcam.org/index.cfm

In addition to the stress due to what’s going on in this country, I have had a fair amount of personal stress in my life lately. My dad recently died, my youngest son has gone to college and the nest is now empty and my job is changing and getting a whole lot busier. That has led me to this current blog topic….STRESS!

Stress is one of those things that is a natural part of life. And one of those things that can show up physically with new, or worsening, symptoms. Some of us handle it better than others. There are various types of stress. There is acute stress that you feel when you are in danger and that provokes a “fight or flight” response, otherwise known as an adrenaline rush. There is intermittent acute stress that is a hallmark of those with the type A personality. These are people who are stress junkies and thrive on deadlines and rushing around. Finally, there is continuous or chronic stress. This can be seen in people who are oppressed either by a job, relationship or a government.

The most dangerous form is chronic stress. After time, those with this type of stress get so used to it they don’t even notice it. The continuous outpouring of stress hormones can lead to obesity, diabetes, heart disease, stroke and even cancer.

It is important that you recognize stress in your life and that you do something about it, especially since there are so many ways to relieve stress. I advise starting with a healthy diet (avoid the urge to devour carbs), exercise is key, and then find ways to relax: read a lighthearted book; listen to soothing music; lay on the sofa holding your dog, and pet her nonstop. There are also complementary medical therapies (CAM) such as massage and acupuncture that can help. Meditation and yoga are great ways to relax and manage the stress response. Some may need the help of a therapist. There are chapters in our book, which go into much greater detail about all of these stress-busters including diet, exercise, and CAM therapies

Regardless of which route you choose, it is important to pay attention to your body and if you are chronically or even intermittently stressed get help and stay healthy.

We finally managed to be on the same coast at the same time recently when we were asked to do an interview about our book on AARP Radio, also known as Prime Time Radio.  It will air the week of October 7, 2008, on one of your own local stations. To find the station and time our interview will air in your area, go to:

http://radioprimetime.org/radiostations.htm

Then go down to the middle of the page to the purple title, “Find your Station quickly.”  Look for your state in the alphabetized menu, click on it, and the list of stations carrying AARP Radio broadcasts, and the times, will show up.  We believe you will find our interview informative and entertaining, so please join us!

Dr. J: In two recent studies in The New England Journal of Medicine, results were reported about the use of CT scans in screening for colon cancer, and about how long we should wait between colonoscopies to screen again. Is this new info?

Dr. R: Not really, virtual colonoscopy or CT colonoscopy can be a very good study. If someone is averse to having a regular colonoscopy or can’t afford a regular colonoscopy (virtual is cheaper), it can be a valuable screening tool. There are a couple of things to keep in mind. First, the test is only as good as the radiologist who reads it. It takes experience to read them correctly and there is a learning curve. Secondly, if something is found, the patient will need a colonoscopy for biopsy and treatment and the whole prep has to be done all over again. Finally, virtual colonoscopy is good for picking up large lesions that stick out but may not be as good for lesions that are flat. I think that having the CT colonoscopy every 5 years is a reasonable interval for that reason and until we have a large group of radiologists experienced in reading the studies. Colonoscopy is still the gold standard evaluation for now. But, virtual colonoscopy is a good option for some.

Now one for you. What’s this I read about the fact that more people have HIV in the US than anyone thought. Were the numbers wrong before? Can’t they count??!! Do we need to be worried?

Dr. J: Not to worry. First of all, the figures released by the Centers for Disease Control and Prevention have never been based on actually counting the number of people who have HIV. Why is this? Quite simply, we don’t know how many people in this country actually have the infection because it is not mandatory in many states for patients or their doctors to report that they have the infection. So, the numbers have always been estimated by very complex methods. This time was no different, though the method of calculation was newer. Even the Director of the CDC admitted that she found the method used to calculated the estimated number of people with HIV extremely complicated. So, despite what the lay press reported, the number of people with HIV is not on the rise.

However, these numbers do indicate that the transmission of HIV has not decreased much in the past ten years, which also means that prevention efforts in some communities have not been successful.

So, yes, we need to be still be concerned about this sexually transmitted infection – even at our age – but not panicked. We address this issue at length in Chapter 6 of our book.

Dr. R: Whew! Can we take a break now?

Dr. J: Absolutely. To our readers: enjoy your week and don’t forget to make taking care of yourself a priority!

Dr. J: Enough gabbing in this month’s blogs about our philosophies. We promised to keep our readers up to date with the huge amount of new medical research findings that appears daily, sometimes hourly. So, I’ll ask you the first question. I read in a recent issue of the Journal of the American Medical Association (JAMA) that, in a large national study of over 1500 adults, Bisphenol A (BPA), a material commonly used in hard plastic beverage and food containers and in metal can linings, was associated with increased rates of diabetes, heart disease, and elevated liver tests. Soon after the results were released, the FDA defended the safety of BPA to an expert panel. Who are we supposed to believe? Do we now have to stop eating or drinking anything that comes in plastic containers or metal cans? Was this even a good study?

Dr. R: This study, looking at the association of BPA in the urine and the incidence of heart disease, diabetes and other illnesses, suggests an association. In other words, there may be a connection between exposure to BPA (usually from plastic bottles) and some diseases, but this study doesn’t prove it. The study looked at a set group of people who were part of a large health and nutrition survey done nationally, which studied many other behaviors and outcomes as well. Is it possible that people with diabetes and heart disease drink more water out of bottles and metal cans? And that that is the reason there is more BPA in their urine? Or, is BPA the cause of their illnesses? The only way to know is to follow two healthy groups of people who are similar, have one group drink out of bottles and cans that have BPA and have the other group avoid it and see which group gets more disease. That probably isn’t going to happen. Therefore, we may never know the answer. So, my advice is to find BPA–free water bottles and cans and not take any chances in the future.

Now here’s one for you. I saw a recent report, in the same issue of JAMA, that nearly ¼ of all women in the US have at least one “pelvic floor disorder”, especially as they get older. Good grief – another floor to take care of? I know you like to mop, but what aboutthose of us who don’t? Seriously, what does this mean and do we need to be concerned?

Dr. J: Not to worry at all. Pelvic floor disorder is a medical term which includes the symptoms of urinary incontinence, fecal incontinence, and prolapse of the pelvic organs, which we know(some of us personally!) is common in women as they get older, and which we discuss in detail in Chapter 7 in our book. What happens literally is that the muscles that are located on the “floor,” or at the bottom, of the pelvis, weaken and no longer support the bladder, the rectum, and/or the female reproductive organs. Here’s the thing about this study, though. We already knew these were common disorders associated with aging, this study simply quantitated the numbers of women in the US with these complaints. Very interesting to me about this study is that although the researchers confirmed the factors that we’ve always known put us at risk, including multiple childbirths, being overweight, and getting older, they found that getting older by itself – without having those other risk factors – can lead to at least one of the disorders in many women. In other words, even if you haven’t had several children or are not overweight, you are still at risk for getting urinary or fecal incontinence just by the passage of years. The good news is, as we discuss in Chapter 7, there are many things you can do to correct these problems, without having to resort to surgery. I think we’d better call it quits for now. All this talk about drinking fluids and the pelvic floor is making me…

-More discussion of recent medical research to follow!

Last year around this same time, as Robin and I were madly writing away, we were also working with the talented staff at our publisher to come up with a title for our book. I was carrying around a little spiral notebook, and constantly jotting down words and phrases immediately as they came to me for possible use in a title. And there were endless emails of endless lists of ideas shooting back and forth. At one point, I even got out a thesaurus (an abbreviated one of course) and paged through lists and lists of adjectives.

One day, during this time, I was looking after my 8 year old neighbor while her mother was at work, and she naturally became curious about all the time I was spending at the computer and about all the books scattered all over the room. And asked what I was doing. So I told her that my friend and I were writing a book, which of course prompted many more questions – why were we doing it, what was it about, who was it for. After I answered these, she asked what the title was going to be and I told her we didn’t know yet.

So, she immediately said that she had one: “ It’s Your Health, But We Help.”

I laughed, told her it was a great idea, and promptly went back to my thesaurus and other books and computer.

Finally, after months of trying to come up with a title, we realized that what would help the most, as it always does, was to go back to the basics – why we were writing the book in the first place.

We were trying to accomplish several things at once with our book, all based on what we had learned from our own patients over the years. One thing we were trying to do was simplify the huge amount of complicated medical information flying around out there; to pull out the pieces relevant to women in midlife and older, and get down to the basic health issues that all of us need to know in order to best take care of ourselves in the twenty-first century.

We were also trying to prioritize those issues so that you, our readers, would learn which ones simply had to be taken care of regularly or immediately, and which did not. Especially given the state of the healthcare environment today, in which doctors and other clinicians are not able, even though we’d like, to spend the lengthy amounts of time with each patient that we used to. That time just isn’t available anymore. But, that’s another story/blog.

Back to our book. We had two focuses: to make you aware of the most common diseases that occur as we grow older, and of how to prevent them; and, because no matter how well we take care of ourselves we all get sick at some point, to let you know what symptoms indicate true health emergencies and what you should do about them.

But, even with all of the above in our book, we knew one thing for sure, the one thing that we’ve learned from our patients over and over again. That is, that no matter how much information we give or recommendations we make, each of us has to want, and to decide, to do the things that are necessary to stay healthy as we grow older. Our book can only be your roadmap; you’re driving the car.

You now know, of course, what title was chosen. And we’re very pleased with it. But when we need something that sums up our philosophy and that of our book, shorter than its title, we’ve got our “soundbite”:

It’s Your Health, But We Help.

I had a hard time deciding what to blog about this week because Robin’s blog from last week is so beautiful, and about such an important and personal issue, there is no other topic that could follow it. It truly stands on its own in the long list of issues that face us as we grow older.

But, to keep this blog rolling (no pun intended), I needed to find another topic on that list. So I came up with something that is near and dear to both Robin’s and my heart, is discussed nonstop throughout our book, and is relevant, to me at least, to this past holiday weekend.

Well, it’s certainly not what I would’ve said 20 or more years ago, or even 10 years ago for some of you readers, that is, labor – you know the kind that you do in the Delivery Room?! No, most of us are well past that kind of labor. I’m talking about another kind of labor; at least it’s labor to me, and I’m sure is to some of you out there, though it isn’t to Robin and those like her. Curious?

It’s exercise. Or working out or physical activity or whatever you want to call it. To me, exercise is labor. For those of you who have already read our book, you’ll know that the importance of it is discussed throughout the entire book. You may have even been surprised, as we were, that these days the necessity of regular exercise is not just a nice thing to do, it’s a “must-do.” We include many research studies that prove that people who do regular exercise as they get older stay healthier than those who don’t. And we also include our individual exercise regimens in the book. (Robin’s, at least, is truly a regimen.)

You also know if you’ve read our book, that there are different types of exercise that are important, each of which works in different ways, that we must do to stay healthy. These are: cardio (or aerobic), strength training, balance, and flexibility exercises. Of these, the one I truly hate, the one I consider to be hard labor, is the cardio type of exercise. Even though I say in the book that I’ve found some tricks to make me keep doing it regularly, I intermittently still have trouble.

I’m in one of those “having-trouble-sticking-to-it” phases right now. This Labor Day, cardio exercise for me is really a labor. Instead of just going outside and walking, or getting on my stationary bicycle and pedaling, or turning on some music and dancing around, I am currently spending all my time dreading those things.

Followed by talking myself out of doing them. “It’s going to rain in a few minutes, so why go outside now” OR “I just washed my hair, so why do I need to get all sweaty now” OR, best of all, “Oh dear, I’m so behind in my mopping/checking emails/brushing the dogs/exfoliating my skin that I just can’t spare the time now” Any, or all, of these sound familiar to you?

And, no, I don’t want a pep talk from those of you who are exercise machines (this means you, Robin). I would to love hear if any of you out with this same problem have come up with a permanent way to prevent this phase, this cycle of allowing the negative tape about exercise to play constantly in our brains. I haven’t. Not in all these years of trying to exercise regularly, probably since my 20’s, have I come up with a permanent solution. (I’m actually hoping that writing this now will pull me out of the phase this time – embarrass me out of it, in fact!)

So, until I hear from one of you out there with this issue who has found a way to beat it, I’ll continue cycling through these phases (and I don’t mean on the exercycle), spending more time making excuses to avoid it, and beating myself up about why I’m not doing it, than I would if I just did it. (Nike is right on.)

And, I’ll let you know if writing this blog about my problem actually helps to solve it.

As a baby boomer, I have joined the ranks of many of my brethren and can say I am part of the “sandwich” generation. I have children who are teenagers and I am helping them to leave the nest. I had a parent that needed my help to fly and leave his nest as well. How many of you have similar stories to the one I am about to tell?

On June 19, 2008 I lost my father. I would say that he died, but he wouldn’t let us use that term. He preferred that we say he “transitioned”. My father was an amazing man. He lived life with integrity and purpose. He was 84 years old and his mind was as sharp as ever. He had renal failure and had been on dialysis. His body was getting weaker and weaker and he finally decided to stop the dialysis. This allowed him to “transition” on his own terms. Once again his strength and dignity prevailed.

Having now gone through the experience of losing a parent and being there for the transition, it has caused me to look at how we see and experience death in our culture. I realize that each person needs to be allowed (whenever possible) to die on his or her own terms.

My father had expressed his wishes to my family and me well in advance and we were able to discuss them with him and understand what he wanted. He also put these wishes into a legal document known as a living will. In his, he put me in charge. At the time, I didn’t realize how important that was. But, when the time came, I had to act.

I felt like Shirley MacLaine in the movie “Terms of Endearment” when she was fighting for pain medications for her daughter who was dying. I had to scream for morphine for my father when his lungs started to fill up with fluid. Fortunately, after quite a bit of drama, he was able to get what he needed and I honored the promise that I made to him. His transition was peaceful and I am happy that he got what he wanted. In the wake of all this is a massive amount of grief, which is a natural part of life.

I share this story so that it will allow you to pause and think about whether you have a living will. Have you discussed the issues of death and dying with your loved ones? Although many of us live as if we will never die, that is one of those things that is inevitable for all of us.

Although death is never easy, knowing what my dad wanted and knowing that we were able to provide it both with the living will and details of his funeral that he planned ahead of time, made things better somehow.

Death is a natural part of the cycle of life. It is okay to talk about it and to address it when it is staring you in the face. But, it is also important to say all the wonderful things you want to say and understand the wants and needs of others before an emergency situation develops.

Hug your children, your parents, your brothers and sisters and your friends. Tell them you love them as often as you can. That is what my father taught me. I am glad I was able to tell him that many times before his grand transition!