Hopefully the decision whether to undergo a CPM is not a need or priority for you.
I am talking about a contra-lateral prophylactic mastectomy.
The diagnosis of breast cancer can be devastating for a woman and her family. The diagnosis carries with it the fear of dying a painful death, not living long enough to fulfill life’s dreams, all in addition to fear of disfigurement.
Treatment for breast cancer has advanced tremendously in the last several decades. Because of the ability to tailor effective treatment through genetic testing and hormonal receptor testing, women often have choices between undergoing a lumpectomy in place of a mastectomy. The difference between having a small amount of tissue removed, or the entire breast.
The staging of a woman’s breast cancer often dictates when a mastectomy is preferable over a lumpectomy. In some cases, with some factors contributing to the potential aggressiveness for recurrence, such as BRCA testing; removal of the non involved breast is recommended. But this is not the usual case.
It comes as some surprise to breast cancer experts that there is an increasing trend for contra-lateral prophylactic mastectomies in young women with early stage breast cancer. The reason is not known..
The fear of breast cancer can cause a women to desire surgery quickly, as in now. Many women immediately begin to consider having the non affected breast removed. CPM rates have almost tripled in recent years.
A recent study has looked at the benefit for contra-lateral prophylactic mastectomy (CPM), and benefits for the most part are few. Granted, researchers are looking at the end point of increased survival; which I guess is what it is all about. Will I live longer if my other breast is removed?
But what is the chance of cancer in the non-affected breast with a diagnosis of cancer? Between 3-9% of women with a non BRCA gene mutation breast cancer will go on the develop breast cancer in the healthy breast.
It is not the usual course, but it happens.
There are many types of breast cancer, and I review them extensively in this prior article. While having cancer of most any kind increases your risk of other cancers, one kind in particular is strongly associated with occurrence of other cancers. So strong that specialist strongly encourage women with the BRCA gene mutation to have a mastectomy of the non cancerous breast. While it is reassuring that this type of breast cancer is unusual and only accounts for 5-10% of breast cancer; the fear of recurrence in the healthy breast is a fear hard to dismiss if you have a diagnosis of breast cancer.
While many women will not get breast cancer, not screening is not an optimal way to avoid the issue.
Even if you are not at risk for breast cancer, I want you to do one thing for me.
Schedule your routine screening mammogram if it has been longer than a year. If you have dense breast tissue, talk to your provider about having a 3D mammogram for screening in place of routine mammogram. This is more sensitive and lessens false positive results, or abnormality scares.
And if you are at risk for breast cancer; definitely schedule a mammogram, probably a diagnostic or 3D mammogram for greater accuracy in screening.
Scary as it is, early detection decreases the chance of spread and perhaps invasiveness of disease through early treatment. We hope the early detection increases and lengthens survival, offering a cure.
Summer is here and the other day I was thinking of hitting the 4th of July clothing sales to get myself some new shorts. My legs aren’t great after years of standing all day, but it is hot here in the south. Around July, I often reach the point of not caring what my legs look like as long as I don’t look in a full length mirror!
Plus there’s that menopausal weight gain and body weight shift issue, and some shorts aren’t as comfortable as they were last year.
Growing older and seeing our bodies and figures change is tough for menopausal women. We usually figure out how to maintain our health and weight through our 30′s and 40′s, but then it all changes without us seeming to change anything!
Or have we changed a lot and just not been aware of it?
A recent study hitting the news reveals some shocking statistics: up to 51% of us women have no leisure time activity or exercise built into our lives! This is up from 14% in 1994; and felt to be the primary cause for obesity.
So it is not that we are actually eating more calories, although admittedly the calories we are eating may be of lesser quality. Our weight problem has more to do with moving much less than in past years. This can happen slowly and without us being aware of it. We get busier at work and at home, and we feel we can skip the exercise today. Today then becomes tomorrow, the next day and onward; until exercise is no longer a habit.
This slide into inactivity can happen quickly, and can easily be blamed on any number of reasons. There is really only one reason though, and it is not making movement and exercise a firm part of our routine. It is not that we are lazy, we just haven’t placed it high on the priority list and that list can be long.
Now that you have decided you do not want to be part of the 51% of women who don’t exercise, it is time to start making some changes.
Starting with your activity level is a good place to begin. I want you to take these next steps.
Decide what you would like to try for exercise and schedule a time. Sign up for an exercise class either with or without a friend. Get out of the house first thing in the morning for whatever amount of time you can, and do something such as walking. Set an alarm on your watch or phone every 60-90 minutes and walk around the house or office; even run up a flight of stairs.
I absolutely know you will feel better with more movement built into your day. You may have to pick specific activities if you have an orthopedic problem, and I can make suggestions for you to discuss with your medical provider.
As for me, I admitted to myself that my shorts are fine and I will like them more if they are a little looser. I don’t need new ones. So I will be doing my floor exercises more faithfully at night while I watch the evening news.
There is no doubt that much of the world has a weight problem, and the associated diseases that come with being obese.
And there is no doubt that entering menopause causes us to gain weight, and this can be frightening when hearing about the statistics of illness associated with weight gain.
There is also no doubt that the primary reason for weight gain in our current times result from the type of foods available in terms of processing, the overabundance of unhealthy food; as well as the increasing sedentary and stressful lives most of us are living.
New guidelines for the UK address some of these concerns with the recent recommendation of decreasing the amount of free sugar consumed from 10% of recommended calories to 5%. This translates to 25 gm for women and 30 gm for men of added sugar. This recommended amount of consumed sugar is also the recommendation put forth by experts concerned with promoting health.
Added sugar is table sugar and sugar added into drinks and foods, along with what occurs naturally in juices, syrups and honey. 1 tsp is equal to 5 gms, so that is basically 5 tsp. of sugar daily as the limit.
Looking at the nutritional label can often tell you the content of sugar, it is usually named in grams.
This is helpful information for trying to limit sugar intake, but it quickly becomes obvious that it doesn’t amount to much sugar!
Additionally, recent studies have identified stress hormone receptors in our taste buds. It appears that when we are under stress, these stress hormones can make the sweet taste buds less sensitive. As a result, that afternoon cookie may not do it for you, so you reach for more. Sound familiar?
It appears that stress can trigger us to eat more of the sweet stuff for the same fix, even at such a simple level as our taste buds! It hardly seems fair.
Sugar is indeed part of our lives, and eating foods high in sugar directly hits our reward center. When stress is involved, this circuit often bypasses the control center of our brains.
How can we change something so innate and seemingly basic to our psyche?
Strengthening the control center is how. This is done through mindfulness and meditation, practicing substituting other comfort measures to employ when we are stressed. It is well documented that both of these practices strengthen the part of the brain that is responsible for conscious control. This is the prefrontal cortex, the conscious decision maker.
I recently decided to enact my own plans for substituting the mindless eating of food the minute I walk in the door from work.
I love the outdoors and so decided after spending all day inside, I would spend some time in the garden. Evening is a good time to water the plants, so that is what I try to do.
I also practice delay tactics by telling myself I can have those snacks I crave after I water the garden, if I still want them. The trick is getting by the food cabinets on the way to changing my clothes!
Weight control and weight loss at all ages, but especially that associated with aging requires being aware of the type of food we eat in terms of the level of processing with added fats and sugars. Along with this is the need to control stress and comfort food eating, as this type of eating is usually unneeded calorie consumption.
Here are some tips for decreasing foods that undermine your health goals:
- You can practice delay tactics by telling yourself to wait 5 minutes before eating that candy bar.
- You can identify the times of day that you are particularly vulnerable to mindless eating and devise a diversion; eg. talk to a coworker instead of walking to the snack dispensing machine
- Don’t buy anything in a box (or bag) to have at your house
- Substitute a serving of fruit, or drink a flavored seltzer water
- Make yourself have to physically go to a store to buy something sweet, the time it takes to do this my dissuade you from the errand
These are just a few tactics, write in with your own tricks fostering better eating! We can all use some help in improving our diet and health. The focus on food as pleasure continues as we age, and we just don’t seem to burn it off like we once did!
Its all about energy. The energy to live our lives, work our jobs, nurture our relationships.
Where does all this energy go at the end of long day, bad week/month or even year?
I am not talking about bite your fingernails or there’s a serial killer lose in my house fear. No, I am talking about the subtle undercurrent of fear we all have.
Fear we cannot have the lives we want, or that something will interfere with the balance that we have created for ourselves. Fear that we will fail, fear that we will lose.
We keep our fears deeply hidden most of the time. Many people are masters at concealing their fears, some of us are working on our fears, so we may be more comfortable with the idea of living with fear. But we all have some degree of fear, very few of us are without it.
When a trigger hits us; we respond with anger, anxiety, tension. We can feel it when it happens within us, although we often want to blame the trigger and not ourselves and how we respond.
These fears we have drain us daily when we respond negatively to things, when something or someone triggers us. When we get drawn into the negative spiral our fears send us on.
That is where all the energy goes. That is why there is sometimes no energy left for what make us feel good and what is good for us. Then we make decisions that undermine us. No energy for exercise, reach for the bad food that comforts us, reach for a cigarette or a drink. We may even start a fight with someone we cherish, just to relieve the anxiety.
Then we are spreading our badness to someone else, the ultimate of negative spiraling.
Like many people, I often find I am out of the energy I need to do the things I want to do. I blame it on aging, doing too much, this or that stress depending on the week. Then I will come upon someone, often a patient, who is in their late 60′s to early 80′s. They have a sparkle in their eyes and a smile on their face, they are busy and active; sometimes still working full time! I think, THAT is how I want to be!
When I came upon a book about this very topic, The Untethered Soul; the title intrigued me, the cover drew me in. Who doesn’t need more energy, who doesn’t want to remain active and vital; engaged in life and seeking new ideas to try, not afraid?
Saving ourselves from ourselves takes being aware of our actions, even when in the midst. It takes deciding to tackle what we have been fearful of for years or even decades. Some of us can do this on our own, and some of us need help and guidance. Aging often causes us to confront our fears and worries, probably because we know we do not have an endless supply of time.
When we free ourselves from these boundaries we have placed; then we have the energy to truly grow. To work at becoming the person we wish we were! Think about it, read the book, talk to someone who can help. Work on what is holding you back from exploring, now may be just the right time for you.
What exactly are your habits and why are they important for change? Habits are what we do throughout the day; actions that govern our lives, often without us even thinking about it. Habits are what save our cognitive powers for the more important tasks of the day.
Most people think that focusing and strengthening willpower is what it takes to resist temptation, or to make a life style change. We often concentrate too much on willpower to make the changes we want. How many times have you told yourself in the morning: if I have enough willpower today, I will be able to resist smoking/sugar/sweets/etc; whatever it is you want to change.
Dr Kelly McGonigal states in her book “The Willpower Instinct” , that research has shown that the people who believe they have the strongest will power are the ones most likely to fail at resisting temptation!
They are the least self informed about where, what and why they fail temptation. By not knowing what their triggers are, they expose themselves to situations that will tempt them.
So how can we change our bad habits if willpower will not provide us with the tool we need?
Habits! Our habits are what we do without thinking, without expending energy to make a decision. Establishing firm and consistent habits is not as hard as you may think, and it is the cornerstone of making healthy changes.
As Charles Duhigg discusses in his book, The Power of Habits; habits influence everything we do throughout the day including how we get dressed in the morning, to interacting and working and continuing to whether we reach for food and a beer at the end of a day. We can change our habits repeatedly over time, in order to adjust to what we need at any given time of our lives.
Habits can help you change your life, or can keep you mired in the same routine that is creating the very problems you want to change.
Either way, if change is in your future to become your wanted future self; you must change your habits.
Start with one small change you want to make. Plan for it in your routine and imagine yourself doing this thing. Construct a routine around this habit, or the avoidance of this habit.
A personal example I will share with you involves my suspicion of vegetables. I am a health care provider, and I preach all day long about the power of healthy diet. I try to follow the example of my own words, but I admit I find it hard to eat my vegetables every day.
In searching for a habit that would some how allow me to increase vegetables, I came upon green smoothies. So I tried it for a week or so and realized I could handle raw spinach or Kale as long as it was pulverized and blended with some sweet fruit. To reinforce this habit, I leave the blender on the counter next to the sink and below the cabinet with coffee cups. Can’t miss it. I make myself buy the big tub of baby spinach and because I hate throwing out food; I am compelled to use it up every week.
After 3-4 months of this, it is firmly imbedded in my morning routine. Low and behold, my husband, who hates vegetables even more than I do; drinks them also!
Forming a new habit involves a commitment to this habit, as well as setting triggers and tools in place to help you with your commitment to this habit. With regular practice and focusing on the positives of this change, you just might find yourself sauteing broccoli for dinner!
There is no doubt that the menopausal transition can cause you to feel tired, bloated, heavy and quite honestly ugly.
There is a lot that is changing but truthfully how we look changes slowly; but it can feel as if we are aging over night. We wake up one morning and feel there are tons more grey hairs and wrinkles. Even more distressing is the feeling that we have gained 5 or 10 pounds overnight, while we slept!
While most of these feeling are from the intricate interplay of hormones, it may be time to revamp your diet. Food metabolism can change during menopause; and this often leads to the bloating, fluid retention and weight gain the we menopausal women experience.
Detoxing, or cleansing can help feel as if you have reset the thermostat a bit. But how to detox? I am not talking about detoxing from alcohol or recreational drugs, I am talking about detoxing from what you eat and what you drink.
There are many programs, products and diets that you can find in stores and on the internet that can help with detoxing. The truth is though, you do not need something fancy to detox or cleanse your system.
Detoxing basically involves a program to eliminate waste and toxins from your body. Your body naturally does this daily, and a cleansing program is merely increasing these processes.
First there is increasing urination and bowel movements. This moves toxins the kidney has filtered through urination, and that the bowel and liver have eliminated through stool. Increasing water consumed to up to 2 qts daily, and fiber intake with vegetables, fruits and whole grains; will do both of these, naturally.
The next part of your body that helps with detox is your skin. Increased sweating will help move toxins through your skin and lymph system. Saunas can help you sweat, so can exercise.
Your lungs are also a part that helps with cleansing. Breathing deeply and more quickly as what is needed with exercise, will help cleanse your lungs from the toxins you breath. This also help with improved blood circulation.
Many programs or diets include spices and foods that help with increase of metabolism, such as cayenne pepper. Exercise is another way to increase your metabolism.
You may like detoxing or cleansing through a program because it gives you specific steps to follow. The issue I have with many detox program as it is very restrictive caloric-ally. This severe calorie restriction can cause you to feel tired, and irritable. While you may lose weight, you can quickly gain it back. Any cleanse or detoxing that involves taking laxatives seems suspect to me, as elimination should happen naturally and through the diet.
The Master Cleanse is a popular one I see patients using a lot. It involves drinking a lot of water flavored with cayenne and lemon, eating fruits and vegetables, juicing for a day or so. You do not have to take fancy supplement, just a multivitamin. You are told to do this for 5 days only as it is very restrictive in food choices. It also involves a sea salt flush, which I am not sure how healthy this is.
Looking at these diets, it comes to mind that they are the basic backbone of how we should be eating any way. You can end up cleansing in a more limited way daily, through drinking lots of water, eating foods high in natural fiber, exercising vigorously to cause you to breath heavier and sweat.
You don’t need a special program, or super restrictive diet that leaves you feeling grumpy and tired.
Cleansing you body daily with non processed foods that are low in sugar and high in fiber, drinking plenty of water, and exercising; is not only a healthy lifestyle change, but a helpful way to beat the menopause blahs!
A recent announcement from the FDA came as no surprise to those of us following the changing guidelines for PAP smears. The FDA has approved the use of HPV high risk DNA detection as a sole screening tool for women!
Over the past decade or more, much research into the role of HPV has been performed. This has yielded the information that the majority of cervical cancers arise from the activity of the Human Papilloma Virus on the cervix. Prolonged inflammation from an active HPV infection causes changes on the cervix which can lead to cancer.
Most likely your recent PAP smears have included a test for high risk HPV DNA activity. This is a virus that is acquired through sexual activity, and most of us have been exposed to this virus at some time of our lives. The vast majority of us suppress the virus and it lies dormant, never causing a problem. A smaller percentage of us however, do not suppress the virus efficiently enough, and it becomes active from time to time.
Enough activity over enough time from the high risk strains of HPV can place us at risk for cervical cancer.
A PAP smear takes a superficial scraping of cells from the cervix and looks for abnormal looking cells. An HPV test indicates whether the virus is active at the time of the PAP smear.
A positive HPV test and a normal PAP smear would indicate active virus but no inflammation of the cervix. This sort of result indicates the necessity for regular yearly screening, looking for inflammation from prolonged HPV activity.
A negative HPV test and normal PAP smear indicates no activity and no abnormal cell. This normal result often means a PAP and HPV can be done every 3, or even 5 years. The process from HPV activation to a cancer is felt to be slow, often years. Therefor, most gynecologic professional societies feel this is a safe interval.
A positive HPV and an abnormal PAP smear indicates the virus is active and causing damage to the cervix. In most women, this abnormality will correct itself as the immune system activates to suppress the virus. In some cases however, the immune system cannot suppress the virus and it goes on to cause pre-cancer and the cancer cells of the cervix.
Detection of high risk DNA activity is the factor that often drives decision making on the screening interval for PAP smears. So it makes sense that a test using only this modality will become available and recommended.
This gives women and their providers an option for screening. It is important to realize however, that a recommendation from the professional gynecologic societies has not been evident yet.
The PAP smear still has a place in women’s screening. It can detect uterine problems that a HPV DNA test would not pick up. Whichever screening test you set your heart on for this year, remember that a pelvic exam is still recommended yearly. Not undergoing a PAP smear does not mean you do not need a yearly exam!
Sleep is powerful medicine and as our sleep deprived society continues, research continues to reveal to us how lack of sleep is seriously affecting our health.
A recent study published in the Journal of Clinical Endocrinology and Metabolism supports the importance of sleep. A study performed in Taiwan involving over 1300 people diagnosed with Obstructive Sleep Apnea revealed that these patients had more than twice the rate of osteoporosis compared to an equal group without a diagnosis of OSA. All other potential contributing factors were eliminated or adjusted for.
Osteoporosis is a significant health risk for all aging women, and many men. It can lead to hip fractures and immobility, further declining our health. The reduced amount of oxygen distributed to the bones during the poor sleep associated with OSA was felt to be the causative factor.
Obstructive Sleep Apnea is a problems often associated with aging and the relaxation of supportive structures within the throat and mouth. This loss of support can cause obstruction of the breathing airway as we sleep, lessening the amount of oxygen that reaches our lungs and as a result, our blood stream. This lower oxygen can then cause the heart to work harder to deliver oxygen to our tissues for metabolism. Lower oxygen means less healthy metabolism, including in our bones.
The researchers of this study admit that although the exact mechanism of this increased incidence of osteoporosis is not known, there still appears to be a high association between OSA and osteoporosis that is important to keep in mind.
Helping to improve your life style to avoid both OSA and osteoporosis includes a healthy plant based diet to control weight, as well as ensuring consumption of calcium and Vitamin D. Smoking cessation helps improve the function of lungs. Exercising will do the same as well as control weight and help stimulate bone forming cells to lay down new calcium.
If you have OSA, or poor sleep that includes snoring; it is important to be evaluated and treated. This will decrease stress on the heart, improve lung function, improve sleep quality and energy; and now to help preserve healthy bones!
Knee pain is perhaps the most commonly expressed joint pain in the over 40 population that patients discuss with me in the clinic. What to do about the problem can be challenging for people.
Osteoarthritis is a wearing down of the cartilage in the knee joint, usually from overactivity over a life time. It is often aggravated by prior sports injuries when young, as well as being overweight. It is said that more than 27 million people in the US have osteoarthritis, with the knee being the most prominent joint affected.
Many people have enough destruction of the knee joint that a knee replacement is the only choice left due to extreme pain and immobility.
Most people however, are best treated with less major therapies, including physical therapy and arthroscopic surgery. Arthroscopic surgery is performed by an orthopedic specialist and involves inserting a tiny tube into the knee joint. Through this fiberoptic tube, the different components of the knee can be seen and sometimes repaired.
While many people have arthroscopic surgery for their knee problems, there have been several trials suggesting this does not really give a person much benefit for treatment of OA of the knees. Physical therapy has been shown to relieve the pain of OA, but an optimal treatment regimen has yet to be standardized.
Researchers recently collated data from 48 different studies in which PT was compared to other non-exercise interventions for OA of the knees. It was found that the most beneficial treatment included a physical therapy program consisting of aerobic and resistance exercise with specific target at quadriceps (thigh) strengthening, supervised 3 times weekly for at least 4 weeks.
What does this mean for you if you have OA of the knee?
The idea of exercise to improve your already aching and painful knee, may seem like something you do not want to do. Perhaps you think surgery is the easier route, but now there is data to indicate that this is not going to be beneficial for you.
While going to physical therapy 3 times weekly may present some obstacles for you, such as time and money; there are often ways to deal with these issues.
The flip side to not doing PT is the cost of not exercising because of pain, with the resulting impact on your health. Additionally, most of us can skip a few extra things we do in the course of a week, and save that money for the PT session. Most PT offices open early and stay open late to accomodate people with rigid work schedules.
Ask your provider about physical therapy if you have OA of the knee, before going the route of surgery. Most reputable orthopedic surgeons will suggest this first, before doing arthroscopic surgery. Working hard to improve your knees will pay off well in the long run!
March was the designated month for colon cancer awareness; and what could be more timely than news of a new method for screening awaiting approval by the FDA. The American Cancer Society states that over 140,000 new diagnosis of colon cancer occurred in 2011 alone, with up to 49,000 deaths. Similar statistics noted for 2013 and are expected for 2014.
If you are over 50, or have a family history of colon cancer; your medical provider has most likely spoken with you regarding the importance of a colonoscopy. This is an important conversation given the above statistics.
In the event you have studiously avoided any talk with friends or family regarding this often dreaded procedure; I will take a moment to review it for you! Polyps are the usual precursors to colon cancer, and when discovered early and removed; can prevent cancer from occurring. Colonoscopy is the best way for this to happen, often called “the gold standard” for colon cancer detection.
Colonoscopy is a procedure where a long tube with a fiberoptic lens at the end in inserted moved upwards through your large bowel to the end, where the appendix is or was. The specialist is looking at the walls of your large bowel, searching for abnormalities. If any are found, the area can be biopsied or a polyp removed through tools inserted through a channel of the endoscope.
Sounds lovely, right! Thankfully, you are usually asleep for this procedure. As you can imagine however, your bowel walls must be clean so that abnormalities are not hidden by waste-that would be stool. The colonoscopy is actually the easier part, it is the cleaning process that can be more challenging.
Having worked for over 10 years for the division of Gastroenterology at Duke Medical Center, I am well aware of the benefits of colonoscopy. I observed and assisted with hundreds of colonoscopies, and I am a major advocate for this procedure. In the hands of an experienced colonoscopist, it is extremely safe.
In my role as a medical provider, I have instructed countless patients regarding the ease at which this procedure is often done. What I did not realize, despite many conversations with people; is how loathsome the clean out can be! When I personally experienced this, I understood clearly, the reluctance with which many people approach this procedure!
This new test is potentially an exciting screening tool for low risk people to use, possibly in place of colonoscopy. It detects the presence of DNA, or genetic code, shed by polyps and cancers into the stool. It is potentially far more accurate than stool guiaic testing, which only tests for the presence of blood in the stool.
Co-author for this study, Dr. Steven Itzkowitz, also director to the fellowship training program at The Icbahn Medical School at Mount Sinai; excitedly states what a breakthrough this test is. “That kind of result is really unprecedented for a non-invasive stool based screening” speaking of the 90% accuracy the study found with test subjects.
Better yet, this test is done in the privacy of your home! Before you get too excited, this test is not yet available for wide spread use. So if you have been holding out hope for a more comfortable test, one is on the way!
Do not hold out for this test though, if you are experiencing blood in stool, a persistent change in the size or shape of stool, abdominal,pelvic or rectal pain. These may all be signs of colon cancer and need immediate evaluation, especially if you have a family history of colon or rectal cancer.
As a medical provider, I recommend routine screening and feel it is easily tolerated. However as a person who now undergoes these invasive routine screens, I fully understand the reluctance!
Hopefully you will get a 10 year reprieve as I did, if there are no polyps!