Breast Cancer Awareness

“I love my breast, they’re fabulous” Samantha Jones – Sex and the City.

October is Breast Cancer Awareness Month, so it’s a good time to talk about mammography. Recently I spoke with a woman who had been weary of having mammograms.  Tired of all of the poking and prodding, she had had enough.  So she stopped having mammograms because she was convinced that she would never get breast cancer.  Sadly when she finally had a mammogram, after a lull of seven years, a lump was detected and she then became one of the “1 in 8” American women who are diagnosed with breast cancer each year.  Luckily – and it really was fortunate, she does not have disease outside of the breast.  If not for the mammogram her outcome may have been very different and she is blessed to be a cancer survivor, not a victim. Early detection saves lives. 

What should you know about mammography?

A mammogram is a radiographic image of breast tissue.  The actual process itself is uncomfortable for a few moments when the breast is pressed down.  It’s important to know that there is no need to be fearful of radiation exposure when you have the procedure done, as the exposure is similar to flying coast-to-coast in an airplane says breast radiologist Mimi Newell of Emory University’s Winship Cancer Center.

There are just a few simple rules to remember when you are going to have a mammogram.  1. On the day, if you wear deodorant, powders, ointments, or creams be prepared to remove it using underarm wipes for it can look similar to flecks of calcium and appear abnormal. 2. Avoid scheduling a mammogram the week before your menstrual cycle, so the breasts are not being pressed down when they are most sensitive.  3. Breastfeeding women should pump immediately before the exam.  4. Additional views will be need if breast implants are present, so as to not miss any part of the breast.   

It’s best to have all mammograms done at the same location in order for the radiologist to have easy access for comparisons, when necessary.  If you don’t have the mammograms performed at the same location, be prepared to sign a records release form in order for copies of films to be sent to the new radiology office.  Also, if cost is an issue, check with your local health department to find out if there are programs that would help cover the cost, or go to http://www.cdc.gov/cancer/nbccedp/about.htm for free screenings in your area. 

Finally, consider scheduling your mammogram and well woman exam the same time each year.  Make it your mission to remind sisters, friends, and family to have a mammogram.  It can be the difference between life and death.   Be well.

Who will take care of me in the hospital?

Patients admitted to the hospital have many concerns.  Paramount among them is, “Will my primary care doctor take care of me while I am in the hospital?”  If not, who will?       The answer is that when you are admitted to the hospital you will be under the care of a hospitalist – not your primary care doctor.  Let’s find out who these special physicians are and exactly what they do.  

Who: A hospitalist is a doctor who only works in the hospital.  A hospitalist has training in a medical specialty, for example, internal medicine, family practice, and pediatrics. 

When: Hospitalists coordinate patient care in the hospital.  In the same way surgeons and obstetricians are the experts on operations and babies, hospitalists are the experts on medical issues within the hospital setting.

Why: The need for in-patient physicians--hospitalists-- arose as changes in medicine made it increasingly difficult for primary care doctors to take time out of their hectic schedules to travel to the hospital and care for their patients. Additionally, hospital care is more complex, thereby creating the need for a physician dedicated to the care of “inpatients”.  Studies have shown that hospitalists provide timely, high quality care.  To be sure in a perfect world, your personal doctor would follow you wherever you go, irrespective of location – hospital or community. However it’s just not possible, given the complexities of medical treatments.  There must be an on-site physician to make the right decisions at the right time – which is whenever you enter the hospital, night or day. 

What: Among many other duties, a hospitalist talks to specialists, orders tests, admits and discharges patients, and works with myriad of healthcare workers including, but not limited to: nurses, social workers, and pharmacists.  The primary role of the hospitalist is to provide the best evidence-based care while simultaneously acting as the patient-advocate and guiding families through the intricate web of healthcare.

Your primary care physician (PCP) may not be aware that you are in the hospital.  Oftentimes it becomes impossible for the hospital to alert the PCP when patients are admitted. When you see your PCP at the post-hospital appointment, let your doctor know you were hospitalized and if possible request a copy of hospital medical records prior to office visit.

Hopefully, you won’t ever experience first-hand what a hospitalist does.  However, if you do, you’ll already know a lot about this burgeoning field of medicine. Be well. 

High Blood Pressure

A stroke is a devastating illness, and can be the direct consequence of hypertension. 

Imagine never again experiencing the simple pleasures of life:

·      Walking barefoot along the beach.

·      Licking an ice cream cone.

·      Swimming laps in the pool on a sunny day.

·      Talking trash while playing Bid whist.

·      Catching a ball with the grandchildren.

·      Baking a favorite pie.

·      Reading a novel.

·      Solving, at least attempt to, the Sunday crossword puzzle. 

·      Buttoning a shirt.

·      Pulling own pants up.

A seemingly insignificant, yet deliberate action can spark a cascade of terrible, life-altering events.

One-third of American adults have high blood pressure - hypertension.   Hypertension is blood pressure greater than 140/90.  If you consume more than 1 teaspoon salt each day, are obese, don’t exercise, drink in excess of 2 alcoholic drinks daily, and/or have a mother or father with hypertension you are at risk.  Twenty-five to thirty million Americans with hypertension are on anti-hypertensive medications but still have blood pressure greater than goal (140/90).  That’s dangerous!  High blood pressure is a silent killer.  You feel fine even as damaging changes are happening to your body.  Uncontrolled hypertension causes strokes, heart attacks, kidney failure, and impotence.  Stroke patients can be left with the inability to talk, walk, or eat without assistance.  Hypertension also can cause heart disease that could lead to impotence.  Here’s one more one more sobering fact: high blood pressure renders the kidneys nonfunctional and urine is no longer produced – leaving waste materials in the body without a way to exit.   This necessitates hemodialysis (dialysis).  Dialysis is a 3-4 hour, three times a week, life-preserving treatment, only reversible with a kidney transplant.

I have heard every excuse in the book for not getting-on or staying-on anti-hypertensive medications.  “I ran out of medicine”.  “The pills made me feel funny”.   “My blood pressure is only high when I am at the doctor”.  “I am using a home remedy”.  None of these excuses will make much sense to you or your family if you land in the hospital with a stroke or heart attack.  Taking anti-hypertensive medicine should be like brushing your teeth; you do it everyday without thinking about it.  And, if you have the option of putting your medications on automatic refill – do it, so that you won’t run out.  But if you run out of medications while away or after your doctor’s office hours, find a retail health care clinic that will do a one-time refill.  Do not just stop taking your medications!  Remember to talk to your doctor if you experience side effects.  Once on medications, check your blood pressure weekly at the supermarket, pharmacy, or local fire station.  Write down the numbers and take those to your next doctor’s appointment.

The choice is yours – stroke, heart attack, dialysis, or impotence?  Or take your medicine!  It should be a pretty easy decision.  Be well. 

Food as Medicine

Eat your vegetables!  Remember how our mothers told us this repeatedly during our childhood?    We understand that’s what we should do, but how do we incorporate 3 cups of fruits and vegetables, as recommended by USDA, into our busy lives?    That’s seems like an awful lot.  But, there are easy ways to add more fruits and vegetables to our diet.   Keep in mind that eating our vitamins and minerals, as opposed to swallowing pills, is the best way to achieve a balanced diet.

Think of fruits and vegetables as nature’s whole food box of goodness -- a package of tasty nutrients.  Scientists continue to uncover the benefits of vegetables and fruits; only a fraction of nutrients have been identified and their health effects demonstrated.  Here are a few examples: edamame (soy beans) contain isoflavones which have been implicated in lowering inflammation, a product of stress; carrots really do help us see, since they contain Vitamin A and beta-carotene;
dark, leafy vegetables – turnip greens, spinach, and kale – contain antioxidants and fiber.  Fiber is our friend, because it absorbs water into the gut and fights constipation.
What exactly is a single serving?  It equals 1 cup of raw/cooked vegetables/fruits or 2 cups of raw leafy greens.  Here are some examples of single servings:

32 grapes                                           ¼ cantaloupe  

3 medium plums                               8 strawberries

3 broccoli spears                               2 medium carrots

16 baby carrots                                 2 stalks of celery

½ acorn squash                                1 medium grapefruit

Sometimes the “rap” against eating fresh fruits & vegetables is that they are expensive and inconvenient.  Purchasing fresh fruits and vegetables in season will help reduce your grocery bill.  Plus, locally grown produce is good for the environment because it reduces the distance from farm to table.  With fall in the air, it’s time to bring squash, cauliflower, apples, and pomegranates to the plate.  However, when time is an issue, go down the frozen foods aisle at the market and purchase store brand-frozen veggies -- without sauce.  These can go into the microwave for a quick, nutritious side dish.  Try to keep an array of herbs in your pantry to season your vegetables.  Be careful with the salt and butter – too much can be harmful to your health.  Roasting with garlic and onion gives flavor without expanding your waistline.  

Did you know that studies have found that people who eat more fruits and vegetables weigh less and have lower rates of heart attack, stroke, and cancer.   So aim to have your plate look like a rainbow with half of the plate consisting of two or three colorful vegetables and the other half should be whole grains and lean proteins.  That’s a healthy plate of delicious food!

If you are not eating 3cups of fruits and vegetables daily, don’t worry!   You can start today by adding just one more to your diet - maybe carrots or celery as a snack.  Nothing happens overnight, healthy eating habits take thought and planning. But, once you’ve begun, you’ll be on your way to creating healthy families and a lifetime of good eating.  Let food be your medicine.  Our mothers were right!  Be well.

Back to School

Football is back, Labor Day is fast approaching, and school beckons.  It’s back to school time!  Playtime is over!  I hear parents everywhere breathing a sigh of relief wile their children moan.   As summer ends and fall begins, and children return to school, it’s time to think about the health of the entire family including: immunizations, heat safety, exercise, and food.

Children have their shots for the new year, are your immunizations up-to-date?  Shots are not just for children.  Adults and the elderly need an annual flu shot to prevent spreading virus to family and co-workers and missing days at work.  Grandparents have you had your pneumonia and shingles (zoster) vaccines?   Whooping cough (pertusis) is back.  There are whooping cough outbreaks in communities across the country.  Adults talk to your physician about getting a pertusis booster which protects infants, in particular from risk of death.

If you have allergies to bees/wasp stings, is your epi pen current?  Make certain you have refills of daily medications. You don’t want to run out of blood pressure meds, asthma inhalers, or birth control pills -  it’s bad for your health.  Make your life easier, have your medications mailed to your home.

In many parts of the country it’s still hot out, so heat safety is important.  As children return to school encourage drinking water and playing in the shade to prevent heat stroke.  Having a piece of fruit with breakfast is easy and tasty source of water.  Put sunscreen on children as they leave the house and tuck hats in backpacks and encourage their use at recess.

Summer fruits and vegetables are still plentiful and create a colorful, healthy plate.   You really are what you eat.  Remember to eat 9 fruits and/or vegetables every day.  Pack your favorite fruit in lunch bags along with carrots, celery, jicama, or sugar snap peas, for an interesting twist on lunch.   Freeze beverages or include freezable ice packs to keep food cold.  Avoid lunches with mayo-based sauces and spreads since they can easily become warm and cause diarrhea and vomiting.   After school snacks are another opportunity for more fruit or veggies.  Make sure children drink water when they come in from playing. Jazz up water with citrus fruit or cucumbers to add a bit of interest.  Oranges, plums, and celery are good sources of vitamins and water.  

School schedules can help jumpstart your workout routine and involve the entire family.  Walk 10,000 steps every day.  Use the “medicine” of a daily walk with your family, to reduce amount of traditional medications you take.  Initiate evening family walks to reconnect with each other.

Studies show that families, who dine together eat more fiber and vegetables.  Plus children get better grades and have reduced rates of substance abuse in adolescene.   Create a tech-free meal policy - no cell phone, iPad, or Gameboy - fosters conversations and strengthens the family unity.  Family meals are a perfect time to reconnect at the end of the day and stay engaged in the lives of your children.  Be well.  

Sleep

Are you chronically tired?  Do you hit the snooze button multiple times in the morning? When was the last time you awoke feeling refreshed?  Sleep is critically important, but we sacrifice it all of the time.  Think back to vacations, when you could sleep-in until you woke naturally.  Remember how wonderful that feels?  We all need sleep.   Sleep is an opportunity for the body to recharge and fortify for the next day.  When we sleep our heart rates, blood pressure, and breathing slows down.  

In general, adults need eight hours of sleep per night.  American adults do not get enough sleep and, as a consequence, are frequently sleep deprived.   Sleep deprivation occurs when you experience less than eight hours of sleep on successive nights – or, on occasion, when you get no sleep at all.   Missing two hours of sleep- time every night for a week is the equivalent of missing two full nights of sleep.  You can’t make up sleep once lost!  

Sleep deprivation causes poor memory and decision-making, crankiness, and carbohydrate craving.   Our brains say yes we can do this -- drive a car, jaywalk, or use that new power-saw out in the yard.   But, when we’re sleep deprived, our vision and physical reaction time can be off by just a  fraction --  and that can make all the difference in the world.   It’s been found that accident rates increase when people are sleepy.   Chernobyl, Three Mile Island, and the Exxon Valdez events were all linked to operator error in which sleep deprivation was identified. Not many of us control nuclear power plants or steer oil tankers, but we do drive cars.  A two-ton vehicle can drift off of the road in a blink of a sleepy eye.  

Poor sleep causes high blood pressure, heart disease, and large waistlines.    Ever crave a doughnut or pancakes after being up all night?  The post-club/prom visit to Roscoe’s Chicken & Waffles for that late night fix is biological.  The body has been up way too long and is now releasing hormones that cause it to crave calorie-dense foods: waffles, fried chicken, greasy hamburgers.  The body is saying “feed me, I am under stress”.    One way to deal with the stress is a power nap.   It’s a great pick me up and can help you feel restored.  There’s nothing better than a nap under the dryer at the hair salon or catching a few ZZZs on the plane between overhead announcements.

With a little practice we can all get a good night’s sleep.  Good sleep habits include going to bed and arising at the same time each day and leaving the energy drinks, coffee, tea, and caffeinated beverages, alone after five P.M.   Exercise helps you wind down and de-stress, but not too close to bedtime as it can have the opposite effect. Watch what you eat for dinner, heartburn and indigestion can interfere with restorative sleep.  Be kind to yourself and don’t over-schedule activities.  Keep your bedroom quiet and dark.  If your cell phone is at your bedside, move it so you are not interrupted by blinking light or sound.    Set the sleep timer on the television so you can drift off when the TV is still on.  Drink a glass of warm milk; it has tryptophan which enhances sleep.  Lavender aromatherapy is also relaxing and can help to induce sleep. So can counting sheep or blessings.   Sleep tight.  Be well.