Women's Health Today by Kathie Scrobanovich-Gambale

healthtoday womenâ&#x20AC;&#x2122;s

Fall 2009

Adios, achoos

Fight the flu

Catherine Bell having fun with the family page 10

Want fab abs?

Try these easy moves

Foolproof food advice The Christ Hospital 2139 Auburn Avenue Cincinnati OH 45219

non-profit org us postage Paid cincinnati oh Permit #5489

Two of Cincinnati’s

Most Preferred

Improving the Health of the Community

The Christ Hospital and Cincinnati Sports Club are partnering together to help improve the overall health of Greater Cincinnati residents. We’re bringing the health care expertise of Cincinnati’s Most Preferred hospital to one of the Midwest’s top health and fitness facilities – encouraging everyone to enjoy an active, healthy lifestyle. Together, we offer a wide range of health screenings, educational seminars and wellness programs at the Club. For a list of upcoming events, screenings and seminars, or for more information, visit www.CincinnatiSportsClub.com or www.TheChristHospital.com or call 513-527-4000.

Cincinnati Sports Club Two Convenient Entrances 3950 Red Bank Road Or 5535 Murray Avenue Cincinnati, OH 45227 513-527-4000

healthtoday women’s

F ALL 2 0 0 9

in this issue . . . 2

LETTER FROM THE FOUNDER

Follow these directions!

Could a clinical trial help you?

Healing chronic wounds

Protein plays an important role

Don’t suffer from uterine fibroids

Nonsurgical treatment can help

HEALTH HEADLINES

What’s making news in women’s health

Troubled waters

Protect yourself from UTIs

SEX & GENDER MATTERS

Migraines, pregnancy and stroke

Candid Catherine!

Actress Catherine Bell enjoys a kinder, gentler lifestyle

HEALTHY BITES

These strategies work!

Rx for trouble

Not taking your meds as directed

Seasonal heart dangers!

Don’t fall victim to these health hazards

Beat arthritis pain

Drug-free ways to feel better

Foiling the flu

Simple steps to stop the spread

HEALTHY MOVES

Use these moves for a tauter tummy

HEALTH SMARTS

What’s the connection?

8 steps to healthy holiday eating

Want fab abs?

Alcohol pop quiz

20 www.womenshealthexperience.com

healthtoday women’s

Letter from the founder

the magazine of the foundation for female health awareness

Follow these directions!

e’re all surrounded by signs, messages and signals telling us where to turn, what door to open, what food to buy … the list goes on and on. If you’re like me, you may feel society continually tells you what

to do, and you get a secret thrill from breaking little rules now and then. But directions do need to be followed when it comes to your health and medications. Read “Rx for trouble” on page 16 to learn how you can better follow your physician’s prescription recommendations and how to avoid prescription drug dependence, if that’s your concern. In this issue of Women’s Health Today, you’ll also find timely advice to help you avoid seasonal weight gain. The strategies offered in “8 steps to healthy holiday eating” on page 14 really do work—all it takes is a little thought and planning. With the autumn and winter months upon us, you’ll also want to learn how to fend off the flu. The tips in “Foiling the flu” on page 21 can help keep you and your family influenza-free this winter. These are just a few of the wide-ranging health topics in this issue of Women’s Health Today. I hope you find them all informative and useful. We aim

Founders

Mickey M. Karram, MD

Mona Karram

National Advisory Board

Professor of Obstetrics and Gynecology, Urogynecology Urology, Loyola University Chicago Stritch School of Medicine; Co-Director, Women’s Pelvic Medicine Center, Loyola University Medical Center Linda Brubaker, MD,

Vivien K. Burt, MD, PhD, Associate Professor of Clinical Psychiatry,

The David Geffen School of Medicine at UCLA; Founder and Director, Women’s Life Center, UCLA Neuropsychiatric Institute and Hospital Vivian M. Dickerson, MD, Associate Clinical Professor of Obstetrics and Gynecology, University of California Irvine; Director, Division of General Obstetrics and Gynecology, UCI Medical Center; Director of UCI’s Post Reproductive Women’s Integrative Health Center Tommaso Falcone, MD, Professor and Chairman, Department

of Gynecology and Obstetrics, The Cleveland Clinic Foundation; Co-Director, Center for Advanced Research in Human Reproduction and Infertility Sebastian Faro, MD, PhD, Clinical Professor of Obstetrics and

Gynecology, Women’s Hospital of Texas Nieca Goldberg, MD, Assistant Professor of Medicine,

SUNY Health Science Center, Brooklyn, New York; Clinical Assistant Professor of Medicine, New York University Thomas Herzog, MD, Professor of Clinical Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons; Director, Division of Gynecologic Oncology, Columbia University Medical Center, New York Barbara Levy, MD, Medical Director, Women’s Health & Breast

Center, St. Francis Hospital, Federal Way, Washington; Assistant Clinical Professor of Obstetrics & Gynecology, Yale University School of Medicine; Assistant Clinical Professor of Obstetrics and Gynecology, University of Washington School of Medicine Wendy l. wright, ARNP, FAANP, Adult/Family Nurse Practitioner; Adjunct Faculty, Fay W. Whitney School of Nursing, University of Wyoming T h e C h r i s t H o s p i t a l S T AFF

President and CEO Susan Croushore

to provide you with a variety of up-to-date and easy-to-understand articles with

Chief Operating Officer Victor DiPilla

each issue; let me know what other topics you’d like to read about. I’d love to

Chief Marketing Officer Heather Adkins

hear from you!

Chief Nursing Officer Deborah Hayes Chief Medical Officer Berc Gawne, MD Editor Arin Kraemer customer service

For more information about services at The Christ Hospital, please contact Arin Kraemer at arin.kraemer@thechristhospital.com or (513) 585-3945. Women’s Health Today is published four times a year by The Christ Hospital, 2139 Auburn Avenue, Cincinnati, OH 45219, in conjunction with the Foundation for Female Health Awareness, PO Box 43028, Cincinnati, OH 45243. This is Volume 5, Issue 4. © 2009 by The Christ Hospital and the Foundation for Female Health Awareness. All rights reserved. The information contained herein is not a substitute for professional

Mickey M. Karram, MD PRESIDENT AND Co-Founder

medical care or advice. If you have medical concerns, seek the guidance of a healthcare professional.

Foundation for Female Health Awareness Dr. Karram and his wife, Mona, are the founders of the Foundation for Female Health Awareness, a nonprofit organization dedicated to improving women’s health by supporting unbiased medical research and educating women about their health.

Women’s Health Today magazine is part of Women’s Health Experience, the flagship program of the Foundation for Female Health Awareness. Women’s Health recycle-logo_2options_v2.ai Experience is a unique initiative aimed at connecting women with healthcare experts, as well as their local hospitals, to learn about important issues that may affect their health. Through Women’s Health Experience, Women’s Health Today magazine and www.womenshealthexperience.com, you’ll get objective, timely information. You can also sign up for free e-newsletters containing Printed With Soy Ink results Printed Soy Ink health news and ofWithmedical studies. Sign up now at www.womenshealthexperience.com. Please Recycle This Publication

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Women’s Health Today

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Could a clinical trial

help you? By Brandon Fletcher, BS, MS, PhD

o the words “clinical trial” bring to your mind risky treatments being tested on seriously ill patients as a last resort? If so, that image couldn’t be more wrong. Rather, a clinical trial can be a treatment option in which patients receive the gold standard of care. Clinical trials allow patients access to the latest treatments not yet available to the public. Some trials find new ways to prevent illness; others test new kinds of diagnostic techniques, surgery, medications or even devices.

? What to ask your physician ∆ What’s the trial’s purpose? ∆ What are my other options, and how do the benefits and possible risks compare? ∆ What’s required of me? ∆ Who pays for the treatment, and are there any reimbursements?

Why consider a clinical trial? Without clinical trials, new treatments and possibly even cures for diseases wouldn’t be discovered as frequently. By participating in a clinical trial, you take an active role in possibly improving your health and the future health of others. You’ll receive some of the finest care and most effective treatments known. Because of this benefit, some patients choose a clinical trial as their first treatment option. But clinical trials aren’t for everyone. Talk with your physician to determine whether a trial is right for you, and check your health plan to find out about possible costs. Medicare and many insurers cover the cost of routine care in qualified clinical trials.

Are risks involved?

It’s true that you may suffer side effects or a bad reaction to the treatment you’re receiving; however, the government regulates most clinical trials to ensure safeguards are in place. Before you agree to participate in a clinical trial, a detailed and informative discussion should take place about the benefits and risks of participating. Remember, too, that there are no guarantees and you always have the right to decline participation at any time. WHT

How to find a clinical trial Ask your physician if there are any clinical trials available to you. A great place to start your own search for a clinical trial is at www.clinicaltrials.gov. You can also contact local research centers, including The Christ Hospital Research Department at 513-585-1496, or visit www.TheChristHospital.com.

Brandon Fletcher, BS, MS, PhD, is the director of cancer research at The Christ Hospital.

www.womenshealthexperience.com

Healing chronic wounds Protein plays an important role By Rank Dawson, Jr., MD, FACS

s humans, our biological priorities are oxygen, protection from temperature extremes, water and nourishment. Most people and caregivers have a good understanding of the first three but may not understand the complexities of nourishment. This misunderstanding can have serious results in people who have chronic wounds.

often lead to serious problems, including urinary tract infection, pneumonia, skin breakdown in other areas of the body and muscle weakness. These conditions are further aggravated by protein loss, contributing to overall declining health and an increased risk of sepsis and death.

In the state of catabolism, a person’s energy consumption is greater than his or her caloric intake for 24 hours, causing the body to burn stored energy, protein and micronutrients. Catabolism can sometimes be triggered by a chronic wound, one which generally hasn’t healed within eight weeks. A chronic wound can weaken a person’s nutritional state because of the wound’s nutritional healing needs and the direct loss of nutrition through the wound’s drainage, however small. This increase in the body’s fuel needs may be greater than the nutrition available and can result in the body becoming depleted and catabolic. At this point, the body can no longer respond to the increased needs to promote wound healing. Catabolism doesn’t cause serious harm over a short period of time. However, in the case of a chronic wound, when this process continues it can

With a better understanding of the critical role protein nutrition plays in wound healing and disease prevention, you can better adjust your diet and improve your future health. Eating enough protein on a regular basis can prevent some of the problems that occur with wound healing. If you’re seriously injured, you should discuss with your physician taking oral supplements in addition to increasing your dietary protein intake. If your protein needs exceed your ability to eat, temporary tube feedings may be necessary. WHT

We’ll help you heal! Do you have a wound that won’t heal? The experts at The Christ Hospital Wound Healing Center are available for consultation. Call 513-585-4595 to learn more.

Rank Dawson, Jr., MD, FACS, is a plastic surgeon at The Christ Hospital.

Women’s Health Today

The importance of protein What is catabolism?

By Daniel E. Long, MD

Don’t suffer from

uterine fibroids N o n s u r g i c a l t r eatment can help

During UFE, an interventional radiologist inserts a catheter into an artery through a small incision at the top of the thigh (above). Using X-ray technology, small particles are injected into the artery (left), blocking blood flow to the fibroid, causing it to shrink.

terine fibroids affect 20 percent to 40 percent of women ages 35 and older. These noncancerous growths develop in the muscular uterus wall, and while they usually don’t have symptoms, they can cause heavy bleeding, prolonged monthly periods and extreme pain—symptoms that can have a significant impact on a woman’s life.

Illustration provided by Biosphere Medical, Inc.

Shrinking fibroids Uterine fibroid embolization (UFE) is a nonsurgical alternative to myomectomy (surgical fibroid removal) and hysterectomy (surgical uterus removal) to treat fibroids. During UFE, the patient is sedated and an interventional radiologist—a board-certified physician who specializes in minimally invasive, targeted treatments—inserts a catheter into an artery through a small incision at the top of the thigh. Using X-ray technology, small particles are injected into the artery, which block the flow of blood to the fibroid, causing it to shrink. Improvement of symptoms occurs, usually within one to two menstrual cycles. Fibroids shrink by at least 60 percent and continue to reduce in size for up to a year. The entire UFE procedure usually takes less than an hour. Some women can go home the same day; others remain in the hospital overnight for observation and to be treated for any discomfort. Many women resume light activities in a few days, and the majority are able to return to normal activities within a week. Of women treated at The Christ Hospital for

fibroids, about 90 percent who had excessive bleeding and 85 percent who had pelvic pressure, bloating and urinary frequency have had a significant decrease in persistent symptoms.

Is UFE for you? UFE patients enjoy shorter hospital stays, faster recovery periods and fewer complications than hysterectomy patients. Because it uses a minimally invasive technique, UFE can safely treat women with other health problems. Your gynecologist and interventional radiologist can help you decide if UFE is right for you. Ideal candidates include women past childbearing age who have troublesome symptoms and want to avoid hysterectomy. WHT

Fight fibroids! Board-certified diagnostic radiologists Daniel E. Long, MD; Joseph Bernstein, MD; and James Traiforos, MD, are here to help. To learn more about UFE or to schedule an appointment with one of our physicians, call The Christ Hospital at 513-585-1000.

Daniel E. Long, MD, is medical director of interventional radiology at The Christ Hospital.

www.womenshealthexperience.com

what’s making news in women’s health

healthhead Hot tea poses higher risk

he hippocampus—the part of the brain that’s necessary for certain types of memory—shrinks as we get older. But a new study from the University of Illinois and the University of Pittsburgh finds that exercise may overcome the brain shrinkage. Researchers tested the fitness levels of 165 men and women between the ages of 59 and 81. They also analyzed both sides of the hippocampus and tested participants’ spatial memory, and found a major link between fitness level, hippocampus size and performance on memory tests. Those who were more physically fit had a bigger hippocampus than those who were less fit. The message: Keep working your body to keep your brain working as you age.

Women’s Health Today

Keeping fit improves your memory

ike your tea steaming hot? You may want to let it cool down a bit before you sip. A new study in BMJ says that drinking tea that’s too hot may make esophageal cancer more likely. Researchers studied tea drinkers in northern Iran, which has a high rate of esophageal squamous cell carcinoma. They interviewed 300 people with the cancer and 571 healthy people. The participants answered questions about their tea-drinking habits, including how hot they usually drank their tea (very hot, hot, warm or lukewarm) and how long they let the tea sit before drinking it. Nearly all participants—98 percent—said they drank tea daily. Those who drank their tea very hot were eight times more likely to develop esophageal cancer than warm or lukewarm tea drinkers were. The problem is not the tea but the inflammation that occurs when you drink it too hot. To save your esophagus, let all hot drinks cool off for at least four minutes before sipping.

lines Sleep well for your heart’s sake

ou know that getting a good night’s sleep is

important for your health. But a new study shows that not getting enough sleep can actually raise your risk of high blood pressure. Researchers from Penn State College of Medicine found that people who have insomnia or who experience poor sleep have an increased risk for hypertension. The study looked at 1,741 randomly chosen adults who spent the night in a sleep lab. Seventy percent of the participants were normal sleepers who slept more than six hours a night; 8 percent had been dealing with insomnia for at least a year; and 22 percent were poor sleepers who had difficulty falling or staying asleep or had poor sleep quality. The results? Insomniacs who slept less than five hours a night were five times more likely to have hypertension than normal sleepers who slept more than six hours. Insomnia sufferers who slept five to six hours a night were 3.5 times more likely to have high blood pressure. The risk among people who had insomnia but slept for more than six hours a night was similar to that of the normal sleepers.

Baby, it’s time to quit

ometimes, it’s the pressure of a looming deadline that triggers the necessary motivation to change a bad habit. Pregnant women who smoke now have such a deadline: Quit smoking by 15 weeks and you can reduce your risk of preterm delivery and a too-small baby, according to a study in the online journal BMJ. Smoking during pregnancy is known to increase the risk for miscarriage, ectopic pregnancy, premature birth, small babies, stillbirth and neonatal death. Researchers evaluated more than 2,500 pregnant women, 10 percent of whom still smoked and another 10 percent of whom had quit. Eighty percent of the women didn’t smoke. The women who quit smoking by 15 weeks were found to have the same rate for preterm birth and low-birth-weight babies as the nonsmokers. But the women who continued to light up past 15 weeks had higher rates of such complications. Pregnant or not, ask your physician to help you find a program to quit smoking ASAP.

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Troubled waters P r o t e c t y ourself from UTIs

p to half of all women will experience a urinary tract infection (UTI) in their lifetimes. These infections can occur anywhere in the urinary system, including the kidneys, bladder, ureters (the tubes that carry urine from the kidneys to the bladder) and urethra (the tube that transports urine out of the body). Simple anatomy makes women more prone to UTIs than men. A woman’s urethra is shorter, so bacteria don’t have far to travel to the bladder. Some women, such as those who have diabetes, kidney stones or a chronic illness that affects the immune system and who take medications that lower immunity (such as cortisone), face an increased risk of UTIs.

Be good to your bladder These self-care measures can help you avoid UTIs: • Drink plenty of liquids. Fluids, especially water, help flush bacteria from the urinary tract. Studies show drinking cranberry juice helps make the bladder wall slippery, preventing bacteria from sticking. (If you take blood-thinning medication, check with your physician before drinking cranberry juice.) • Get your vitamin C. It increases acid in your urine, discouraging bacteria growth. • Don’t hold your water. Delaying a trip to the ladies’ room keeps urine in the bladder longer, allowing bacteria to grow. • Wipe this way. Wipe from front to back after using the toilet to stop bacteria in the anal region from entering the urethra. • Wear cotton underwear. Avoid tight-fitting clothing and nylon underwear that trap moisture and let bacteria thrive.

Women’s Health Today

Telltale signs See your physician if you have any of these symptoms: • burning with urination • strong, persistent and frequent urges to urinate • urine that’s cloudy, dark, bloody or strong smelling • pain in the lower abdomen or back • fever or chills

Don’t suffer in silence! If you suffer from recurring urinary tract issues, consider seeing a specialist. Call 513-585-1000 to find a Christ Hospital urologist near you.

• Empty your bladder after intimacy. This can help flush away bacteria that might have entered the urethra. • Avoid irritants. Skip feminine deodorant sprays, douches and powders. WHT

sex & Gender matters The latest findings on women-specific health from the Society for Women’s Health Research By Sarah Keitt, MPH

Migraines, pregnancy stroke

W h a t ’ s t h e c o nnection?

or many women who suffer from migraines, pregnancy can be a period of relief from their headaches. Studies have found that preexisting migraines diminish or disappear in 42 percent to 98 percent of pregnant women. However, new, persistent or worsening migraines during pregnancy can signal a serious problem that could result in a stroke. A study recently published in BMJ found that migraines were associated with a 15-fold increase in pregnancy-related stroke. A stroke, or brain attack, occurs when blood flow to the brain is disrupted either by a blockage (an ischemic stoke) or by bleeding in the brain (a hemorrhagic stroke), causing brain-cell death and brain damage. For young women, stroke is a rare phenomenon, occurring in fewer than 11 of 100,000 women each year.

• heart disease • high blood pressure • history of migraine headache • caesarean section • older maternal age • smoking • vasoreactivity (changes in the function of blood vessels to the brain)

What to do? What does this mean for a pregnant woman with either a history of migraines or a new onset of migraines with her pregnancy? More research is needed to fully understand the risks of migraines during pregnancy. In the meantime, pregnant women should make their physician aware of their migraine history. Abnormal clotting can be treated with blood thinners, and pregnant women with migraines can be monitored closely for preeclampsia, a potentially life-threatening condition characterized by high blood pressure and protein in the urine. For women who do suffer a pregnancy-related stroke, no data suggests a risk of recurrent stroke in subsequent pregnancies. However, women who’ve had a stroke and are contemplating another pregnancy should be assessed for treatable risk factors. WHT

Stroke risk factors Pregnant women, however, have a three- to 13-fold increase in their stroke risk. Risk factors for pregnancy-related stroke include: • abnormal blood clotting • alcohol and substance abuse • multiple gestations (twins, triplets, etc.) • diabetes

Learn more! The Society for Women’s Health Research is a nonprofit research, education and advocacy organization that works to improve women’s health through sex-specific research, education and advocacy. To find this article and more of the latest news and research on women’s health, visit www.womenshealthresearch.org.

Sarah Keitt, MPH, is program manager for the Society for Women’s Health Research in Washington, D.C.

www.womenshealthexperience.com

Women’s Health Today

Candid Catherine! Actress Catherine Bell enjoys a kinder, gentler lifestyle

atherine Bell, a self-described “tough chick,” is happy exploring new territory on screen and off. While many admired the exotic actress as hard-hitting Marine Corps attorney Lt. Col. Sarah ‘Mac’ MacKenzie on “JAG” for 10 seasons, Bell has since segued into the gentler role of mother Denise Sherwood, an Army nurse emerging from her shell on Lifetime’s hit drama “Army Wives.” Offscreen, she’s settled into a more leisurely lifestyle at her restored 19th-century home in Charleston, S.C.—where “Wives” films—with screenwriter husband Adam Beason and 6-year-old daughter, Gemma. Bell and Beason once enjoyed skydiving, bungee jumping and hopping on one of their nine motorcycles, but now that she’s a mom, Pilates, golf and wakeboarding have taken center stage. “I used to like taking risks,” admits Bell, “but I wasn’t an adrenaline junkie; I took safety seriously. I’m just a firm believer in living life to the fullest and trying everything at least once. I love life, no matter what I’m doing.” continued on page 12 >>

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continued from page 11

Switching gears Being mom to Gemma is what’s responsible for Bell’s kinder, gentler approach to life. “Motherhood has changed my life so much. Gemma has made me realize how much fun it is to be a kid, with that innocent sense of wonder and excitement. Now I blow Bell (second from left) with “Army Wives” costars Drew off steam and get excited playing golf,” Bell laughs. Fuller, Brigid Brannagh and Kim Delaney With a 40 handicap, the 5-foot-8-inch London-born, fun. “I made a pomegranate drink that I found in a California-bred actress finds the game frustrating but says a beautiful day on the links is well worth the anxifood magazine for one of our gatherings,” Bell says. “It was all fun, but still simple.” Her health secret is ety. She’s even the motivator behind an “Army Wives” moderation. “I eat less pizza, fewer heavy carbs, fewer golf tournament. “We had 75 people sign up last year. giant platefuls of food. I follow an 85-percent healthy Nearly every cast and crew member played, some for the first time,” she says. Golf has even become a famdiet and indulge myself 15 percent of the time on my ily affair. “We got Gemma a Barbie golf-club set and favorite chocolate, cookies and peanut butter sandshe loves it. One of our favorite family-time activities wiches,” she adds. To keep her energy high on long is going to the golf course and hitting balls,” says filming days, Bell reaches for a turkey wrap with veggies and mustard instead of a cup of java. “It Bell. “We’re also into boating, a big deal around gets very hot and humid here, so if I need a Charleston. I love wakeboarding, and Gemma loves inner tubing.” And instead late afternoon pick-me-up usually it’s an of her former kickboxing, martial arts electrolyte drink with vitamin C,” she Gemma has made says. “And I might have a half-cup and boxing exercise routines, Bell me realize how much of decaf; I just won’t have six cups relishes her Pilates sessions. “I do a fun it is to be a kid, combination of Pilates and weights or triple shots of full-force caffeine with that innocent and sometimes I’ll hit the bag if I anymore.” sense of wonder and have some extra time,” she says. excitement. But don’t let the 41-year-old bruPicture-perfect pastimes nette’s beauty deceive you. Her “tough Taking advantage of the slowerchick” persona has come in handy: Several paced living of her new locale, Bell says years ago, an unknown attacker in an elevator she’s still busy, but not like her days back in grabbed Bell. “My instincts kicked in and I backLos Angeles. “Here, my time off is my time,” she says. “In L.A., you have to drive 45 minutes to handed the guy in the face. I didn’t know kickboxing get anywhere. In Charleston, there aren’t as many disthen and had no other training,” says Bell. “When it comes down to it, don’t mess with me!” tractions. But every weekend there’s something to do, like visiting great parks and festivals, biking around Simply healthy downtown or chasing Gemma on one of the local Bell’s been holding her own since she began a beaches.” modeling career at age 17, which ended after a fourA well-rounded mom, Bell balances her physical month stint in Japan. “I became depressed over there activities with artistic pastimes. “Photography is one of my favorite hobbies. I like carrying a camera around,” and began to eat way too much, gaining 20 pounds. she says. “And I want to get back into painting. I used But when I returned, I ate healthfully and exercised oils for years, so now I’m trying acrylics. It’s fun and a regularly again,” she says. Working with a nutritionist for several years, Bell says her staples include lots great way to de-stress. of vegetables, fish, more lean meats like chicken, and “My coping mechanisms have evolved over the regular backyard barbecues. “I’m not a fancy cook,” years,” Bell adds. “I confront each day by saying, she admits, “but I make burgers, chicken and color‘OK, here’s what I have to get done and here’s how I’m going to do it.’ Some days it works better than ful grilled vegetables. Simple foods, but yummy.” others, but I’ll just look ahead to the next day.” WHT Oftentimes, her coworkers join in on the backyard

❝

Women’s Health Today

❞

YWouromen’ Update in s Health PRESENTED BY

A biweekly radio program Sundays, 8:30–9 a.m. on 101.9 FM

Hosted by Mickey Karram, MD President and Co-Founder, Foundation for Female Health Awareness Director of Urogynecology, The Christ Hospital, Cincinnati

Join Dr. Karram and his colleagues from The Christ Hospital as they explore topics essential to your health.

Free audio from past programs available now at

www.WomensHealthExperience.com, including: Routine Screens and Health Maintenance for Women

Infertility Awareness

Guests: James Wendel, MD, ObGyn Lisa Larkin, MD, Internist

Guests: Michael Scheiber, MD, MPH, FACOG, Reproductive Endocrinologist Lizzie West, Donor Coordinator

Breast Cancer

Colon Health

Guests: Jennifer Manders, MD Director of Oncoloplastic Surgery James Cornwell, MD, Interim Medical Director of Women’s Imaging Center

Guests: Michael Kreines, MD Medical Director of Gastroenterology Bradley Davis, MD, Colorectal Surgeon

H1N1 Swine Flu Update

Guest: Bruce Corser, MD Sleep Medicine Specialist

Guest: Corwin Dunn, MD Infectious Disease Specialist

Allergies Guest: Reid Hartmann, MD Family Medicine Physician

Skin Cancer Awareness/ Prevention Guests: Susan Kindel, MD Dermatologist Brandon Fletcher, PhD, Director of Cancer Research

SPONSORED BY

Sleep Disorders

Endocrine Disorders Guest: Amanda Denney, MD Medical Director of the Diabetes and Endocrine Center

Heart Matters Guests: Jay Schloss, MD Electrophysiologist Ian Sarembock, MD Interventional Cardiologist

in conjunction with

Healthy bites

8 steps

The stra se tegi work es !

to healthy holiday eating

Women’s Health Today

his holiday season will be different. We promise. In fact, with our help, you’ll enjoy the goodies and the parties, yet you won’t feel bloated and worried about the toll on your heart and body. It’s still early in the season, so you’ve got time to plan. Strategy— not denial—is the key to success.

Take stock. Begin with Thanksgiving and

work your way through January 1. What do the “holidays” mean to you and your family? Grandma’s peanut butter cookies, Mom’s potato pancakes with sour cream, Aunt Gloria’s meatballs? Write it all down.

Look for the stars. Review your list and

highlight what’s naturally healthy. Be thankful for Thanksgiving, for example. Turkey topped with gravy but minus the skin is an American Heart Association-approved entree. Is fish part of your holiday tradition? Indulge!

Skinny it down. Transform sweet-potato

pie into a side dish of freshly baked sweet potatoes with a touch of cinnamon. Replace the beef in Uncle Joe’s New Year’s Day chili with ground turkey and red beans. Try our hints (see “Healthful hints,” below), study cookbooks and magazines that have a health conscience and learn some culinary tricks. You’ll be surprised at how much flavor is retained by making clever substitutions.

Create new favorites. If your table groans

under the weight of buttered rolls and creamed onions, replace one of those heavy hitters with a platter of roasted winter vegetables. Exchange a dozen cookies for low-fat

meringues flecked with chocolate chips. Look to the season’s harvest of cranberries, apples, pears, brussels sprouts, pumpkin and squash for inspiration.

Practice portion control. If you can’t

eliminate it or make it more healthful, limit it. Put a dollop of Grandma’s must-have giblet gravy on the side of the plate and dip your turkey in it for taste. Enjoy half a cup of eggnog, but only on Christmas Eve.

Keep the rest lean and green. Don’t

squander precious calories on a stale, storebought cookie during a Wednesday coffee break. Follow proper dietary guidelines amid the festivities and you’ll buy yourself flexibility for special indulgences.

Party on. Be a good guest and offer to pre-

pare a dish for the next event. Whip up a low-fat yogurt dip and cut up some crunchy crudités, or prepare an angel food cake and a winter fruit compote.

Eat out with savvy. Favor restaurants that

offer whole-grain breads, salads and seafood. Portions are often oversized in restaurants, so split an entree with a friend or order an appetizer as your main meal. WHT

Healthful hints Ñ Egg substitutes or egg whites

often work just as well as whole eggs. Experiment with one whole egg and two egg whites for every two eggs in a recipe. None of your guests will be the wiser!

Ñ Replace sour cream in recipes with plain nonfat yogurt or nonfat sour cream.

Ñ Evaporated skim milk serves

Ñ Substitute low-sodium chicken

Ñ Chill soups and stews after

Ñ Cook with little or no fat—boil,

Ñ Boost herbs, seasonings and

stock for oil and butter in stuffings, gravies and sauces. broil, bake, roast, poach, steam, stir-fry or microwave.

Ñ Trim off the visible fat before

cooking meat and poultry; drain off fat after browning.

cooking. Skim off the hardened, risen fat before heating. veggies when cutting down on fat and salt. When lowering fat in desserts, increase “sweet” spices such as cinnamon, nutmeg and vanilla.

Ñ Toast nuts before you use them, for extra flavor.

as a low-fat alternative to cream in many sauces.

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Rx for trouble N o t t a k i ng your meds as directed

ne in three American adults who take medications regularly don’t follow their physicians’ prescription treatment orders. Are you one of those noncompliant patients? If so, you could be putting your health—and life—in more danger than you think. Many people have legitimate reasons for wanting to stop taking their medicine. But, “the decision to stop taking a drug or skip doses is one you must make with your physician and pharmacist,” says Gayle Cotchen, PharmD, lead pharmacist with the Magee-Womens Hospital of University of Pittsburgh Medical Center. Following are some reasons why you may not be complying with your treatment and ways your healthcare provider and pharmacist can help you overcome them.

❝ I feel fine.❞

❝ I can’t tolerate the side effects.❞

Stopping your medicine too soon can cause your symptoms to return or your condition to become worse. Certain medications, especially those for asthma, migraine prevention, depression, epilepsy, high blood pressure and some heart conditions, must be continued even when you’re feeling well—that means they’re working. Ask your healthcare provider if a lower dose can be prescribed.

Your medication may cause drowsiness or jitters or impair your ability to drive or work. Your provider may be able to adjust your dosage or prescribe a different medicine that’s just as effective but doesn’t have the side effects, or recommend taking your prescription at a different time of day. “It can take several tries before you and your team can determine the right drug and the right dosage level for you,” says Cotchen.

ASK THE EXPERT Featuring Gayle Cotchen, PharmD

Q: I ’ m h a v i n g a p r o b l e m w i t h m y p r e s c r i b e d m e d i c a t i o n . Who do I talk to about it?

A: Your pharmacist and physician, together with you, work best as a unified team. Keeping that in mind, you may want to begin the discussion with your pharmacist, who can be more easily accessible than your physician. If your pharmacist doesn’t have a simple solution readily available, he or she may contact your physician to resolve your problem. Your pharmacist may also recommend you seek immediate attention if the situation presents a serious health risk. Be honest and straightforward when discussing your concerns about your medication with both your physician and pharmacist, so they can better help you. 16

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Prescription drug dependence: Don’t let it happen to you If you have a chronic disease or health disorder, medication is most likely part of your treatment program. Unfortunately, some of these—including painkillers and antianxiety drugs—have the potential for misuse or abuse. When you use prescription drugs incorrectly over too long a period, you run the risk of becoming dependent or addicted. Either way, prescription drug misuse may lead to cognitive impairment, debilitating falls and even car accidents. That’s why it’s important to recognize the problem—whether in yourself or in a loved one.

Avoidi ng addicti on

❝ My prescriptions are too expensive.❞

Your provider may be able to substitute a generic or less expensive version, or may suggest pill splitting. Some pills can be purchased at double the dosage you need and cut in half to last twice as long. “Sometimes, two of the medications a patient is taking are available in one combination pill, with only one co-pay,” says Cotchen. Your provider or pharmacist may also recommend patient-assistance programs to help pay for your drugs.

❝ I can’t keep track of all my medications.❞ You may find it difficult to organize several medications you need to take throughout the day. “The more often medication needs to be taken, the more difficult it is for patients with busy lives to comply,” says Cotchen. Look into a pillbox with day and timeof-day slots or even alerting alarms. Your pharmacist also may have some helpful suggestions.

You generally don’t have to worry about becoming addicted if you follow your physician’s instructions on when and how to take your medication. It’s also important to: • Keep your physician informed about your health and any medication side effects. • Consider your family history. If a family member has had trouble with addiction or you’ve had a problem in the past, you have a greater risk of becoming addicted. • Be aware of physical changes, such as depression, sedation, confusion, slowed breathing, irritability or restlessness. Sudden clashes with friends or family may also be a sign something’s wrong. If you feel you may be addicted, ask your physician for help. He or she may be able to wean you off the medication, prescribe less-addictive medicine in its place, or refer you to a support group or therapist for help with depression or anxiety.

❝ My medicine’s not helping me.❞ Just because you don’t feel a difference doesn’t mean there isn’t one. Some medicines take a long time before you feel an improvement. Your provider has ways to monitor your medicine’s effectiveness, such as ordering blood tests, X-rays or other lab tests. WHT

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Seas❤nal heart dangers! Don’t fall vic tim to these health hazards

he holiday season is fast approaching—and so is an increased risk for heart attack. During November, December and January, more people die from heart attacks than at any other time of the year, according to Duke University researchers. Don’t let the winter take a toll on your heart. Avoid these four seasonal pitfalls:

❤

Too much food and too little exercise.

Too much alcohol and smoke exposure.

A little indulgence on special occasions is OK, but don’t entirely abandon your healthy lifestyle. Substitute lowfat or nonfat yogurt for mayonnaise in dips and dressings. Replace some of the bread in your stuffing recipe with chopped vegetables. Put on your sneakers and head for the mall to combine some holiday window-shopping with speed walking.

Drinking too much alcohol can raise the level of some fats in the blood and increase the risks of high blood pressure, alcoholism, obesity, stroke, suicide and accidents. More parties during the holidays may mean more exposure to secondhand smoke, which has been linked to cardiovascularrelated death and disability.

❤

Stress and anxiety.

Exposure to germs. Crowded malls, school plays, indoor parties, visiting relatives: It’s no surprise that respiratory infections like colds and flu are more common during the winter months. People with heart disease have increased risk for dying of complications from the flu—so get a flu shot if you’re at risk! In addition, cut your chance of coming down with a cold or the flu by washing your hands frequently, getting enough sleep and making sure other family members are up to date on their vaccinations. If you do get sick, be cautious if you have high blood pressure and are taking cold medicines. Decongestants can raise your blood pressure. WHT

People who have coronary artery disease are susceptible to chest pain when exposed to the cold. Arteries constrict in cold weather, causing less blood flow and oxygen to reach the heart. In addition, the exertion of strenuous snow shoveling can put you at risk for heart attack, especially if you’re out of shape. Another cold-weather risk is hypothermia—when your body doesn’t produce enough heat to stay warm. People who have cardiovascular disease can be at risk for fatal heart arrhythmias (heartbeat irregularities) if their core body temperature drops too low.

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Family conflicts, traveling, shopping, cooking and parties can make it seem impossible to relax, as can worrying about how to pay for everything. Acute and chronic stress may contribute to high blood pressure, so it’s important to head it off. Relaxation techniques like deep breathing or a yoga class may help. Accept your limits and don’t aim for perfection.

Your heart and the weather

❤

❝

A little indulgence

special occasions is on

OK, but don’t entirely abandon your

healthy lifestyle.

❞

Your heart and daylight Can shorter winter hours contribute to cardiovascular disease? Studies have suggested that people who have vitamin D deficiencies may be more prone to heart attack, stroke and heart failure. Because sunlight helps our bodies produce vitamin D, some experts suggest that less sun exposure during shorter days may put people at higher risk for heart disease. But don’t run off to that tropical island just yet—you can get much of the vitamin D you need from food. The American Heart Association recommends you get your vitamin D from fish such as mackerel, sardines and salmon; cod liver oil; milk; and fortified cereals. Ask your physician how much vitamin D you need and whether he or she suggests supplements.

Stay heart-healthy! The Christ Hospital offers HeartAware, a free assessment to determine your heart disease risk. Find out your risk by visiting www. TheChristHospital.com, or call 513-585-1000.

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arthritis pain D r u g - free ways to feel better

hen two of three popular prescription arthritis drugs were pulled off the market several years ago, arthritis sufferers were left to scramble for alternative pain relief. The anti-inflammatory drugs known as COX-2 inhibitors were found to increase heart attack and stroke risks. Other nonsteroidal anti-inflammatory drugs, or NSAIDs, are still available, but their tendency to cause stomach irritation rules them out for many people. Other pain-relief options exist, but while some therapies do work, others are ineffective. If you suffer from arthritis, you probably need to take a multipronged approach to reduce your pain, such as incorporating a good diet, exercise and nondrug interventions like meditation. Talk with your physician before trying any therapy or supplement, since some treatments can cause unwanted—and sometimes dangerous—side effects. Ask your physician about these options:

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Don’t bend down to pain! To learn more about your physical therapy options including Pilates, call The Christ Hospital Physical Therapy Centers at 513-585-REHAB.

Beat

Transcutaneous electrical nerve stimulation (TENS) delivers safe, low-volt electrical currents through electrodes taped on or near painful areas, using a small, batteryoperated device. TENS can provide short-term pain relief by blocking pain messages to the brain and modifying pain perception. A massage therapist can ease joint pain and stiffness by kneading or stroking the affected area. Regular massages can improve sleep and boost your body’s production of natural painkilling hormones called endorphins. Supplements such as chondroitin sulfate and glucosamine may help lessen osteoarthritis pain. Herbal supplements containing turmeric and ginger may reduce inflammation and pain. And the Arthritis Foundation reports that S-adenosyl-methionine (SAM-e) increases joint flexibility and decreases pain. Acupuncture uses fine needles that stimulate points in your body to release endorphins and fight inflammation. Acupuncture may be especially helpful in relieving knee pain from osteoarthritis. Healthy fats in your diet, like omega-3s, may ease rheumatoid arthritis symptoms and reduce the need for medication. These fats can be found in coldwater fish such as salmon, tuna and sardines; flaxseed and canola oils; and fish-oil supplements. Meditation can ease arthritis pain and relieve the stress that can lead to flare-ups. Meditate by sitting quietly and letting your thoughts and outside stimuli “flow by.” Capsaicin-containing over-the-counter creams, ointments and patches are recommended by the American College of Rheumatology for soothing knee osteoarthritis pain. Use with caution: Capsaicin is found in hot peppers and may cause skin irritation. Depending on your needs, your physician may also suggest physical therapy, water therapy, cognitivebehavioral therapy and biofeedback to help control your pain. WHT

Foiling the flu S i m p l e s t e p s to stop the spread

ne person with the flu can quickly turn into a family with the flu unless you take the right precautions. Influenza is a highly contagious viral infection that affects the respiratory system. For most healthy people, catching this bug means a few miserable days in bed, but for children, the elderly, people with chronic illnesses and those with a weakened immune system, the flu can be deadly.

Avoid the achoos When an infected person sneezes, coughs or talks, he or she sends droplets into the air—and onto the phone, remote control, computer keyboard and countless other surfaces. You can get sick when you inhale the droplets or simply touch the contaminated object before bringing your hand to your nose, eyes or mouth. The best way to prevent the flu is to get vaccinated every year. The vaccine can’t protect you completely, but it can lessen the flu’s severity if you do get sick. Other ways to prevent the virus from spreading: n Ask your physician about antiviral drugs. These can be up to 90 percent effective in preventing infections if you’re exposed to the flu virus; they can also help treat the flu. n Wash your hands with soap and water for 15 to 20 seconds. Teach your children to do the same. Use a paper towel to dry your hands. No water around? Use an alcohol-based hand sanitizer.

n Sneeze and cough the right way. Instead of sneezing into your hands (a surefire way to spread germs), cover your nose and mouth with a tissue or with the crook of your arm. Throw out used tissues immediately, and then wash your hands. n Avoid touching your eyes, nose or mouth. n Don’t share household items like towels and utensils. n Boost your immune system. Make sure you’re getting enough sleep, exercising regularly and eating plenty of fresh fruits, vegetables, whole grains and lean protein. n Clean up. Regularly spray commonly used surfaces (the phone, refrigerator door handle, computer mouse) with a household disinfectant. n Skip school or work if you’re sick. Persuade your spouse and children to do the same, sparing classmates and coworkers from the flu’s wrath. If you do get sick, drink plenty of fluids and get some rest. And see your healthcare provider: He or she may be able to give you an antiviral drug to speed your recovery. WHT

Stop the sniffles! If you don’t have a primary care physician available to monitor your family’s flu symptoms, call 513-585-1000 to find a physician with The Christ Hospital Medical Associates.

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Healthy moves

Want fab abs?

Use these moves for a tauter tummy

ave you discovered lately that your favorite pair of jeans still fit—as long as you hold your breath? If your middle has been expanding, you’re not alone. Many people tend to gain extra abdominal inches as they get older. Unfortunately, that can set the stage for several serious conditions, including coronary heart disease, diabetes and hypertension. Now the good news: Whittling your waist to a healthy size may help ward off these conditions and can ease or even prevent low-back pain. Plus, you’ll be able to zip up those Levi’s without sacrificing your breath! Are you ready to flex your muscles? To begin, aim for eight repetitions of each exercise.

Before you begin, remember … ∆ Go gradually. You want results—fast. But the most common injury trigger is exercising too aggressively. Instead, start off at a low intensity and work your way up to a more demanding level. ∆ Move smoothly. Focus on slow, smooth movements. Sudden or jerky movements can cause strain. ∆ Breathe easily. Exhale as you tighten your muscles or lift your body. Inhale as you return to the starting position. Never hold your breath; this can trigger lightheadedness or even fainting. ∆ Get with a program. Your body will benefit best if you also do hearthealthy aerobic exercises, such as jumping rope, brisk walking or swimming, several times a week.

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The crunch The crunch is a safe and effective way to tighten your belly. ∆ To do the basic crunch, lie with your back flat against the floor with your knees drawn up to about a 90-degree angle. (Tip: Don’t anchor your feet; this takes the emphasis off the abdominal muscles.) • Support the back of your neck with your hands placed just below your skull. • Slowly lift your upper body with your abdominal muscles, raising just the bottom of your shoulder blades off the floor. • Let the weight of your head hang in your hands. • For less exertion, keep your arms straight at your sides and reach forward. • To crank up the intensity, fold your arms across your chest.

The elevated crunch

If you’re a beginner, have back trouble or have weak abdominal muscles, start with this exercise. ∆ To work your obliques (the muscles that keep your body erect as well as let you do the twist), lie on your back with your bent legs resting on a stable support, such as a chair. • Extend your arms to form a wide “V” over your head. • Slowly lift your left arm and reach across your torso just to the right of both knees. • Do all the sets on that side before switching to your right arm. To work your rectus abdominis (the muscle that stabilizes your chest and abdomen), clasp your hands behind your head and lift your upper body straight up while keeping your legs on the chair.

The bicycle This version of riding an imaginary bike targets both the upper and lower abdominal muscles. ∆ It also strengthens the rectus and the obliques. • With your hands behind your head, legs bent and toes pointed, touch one elbow, then the other, to the opposite knee.

The plank

The V-up

Start in a modified push-up position: on your forearms and knees, with your elbows directly under your shoulders. ∆ Push your knees up, supporting your weight on your forearms and toes so that your entire body is off of the floor. • Draw your navel in toward your spine, contract your abs and keep your body in a straight line without letting your hips sink down. • Hold for 30 seconds or as long as you can. • Keep your body in a straight line from ears to ankles.

To give your lower abdominal muscles some undivided attention, try this exercise. ∆ (One caveat: If you have a weak back or feel back strain, choose an easier exercise, such as the bicycle, described above.) • First, lie on your back with your hands stretched behind your head and your bent legs held at an angle of about 90 degrees. • Now bring your arms over your head, raise your upper body and reach your hands beyond your knees, parallel with your lower legs.

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Health smarts

Alcohol pop quiz ow much do you know about the effects of drinking alcohol? Did you know that heavy drinking for women is typically defined as an average of more than one alcoholic drink a day? (For men, it’s an average of more than two drinks a day.) Test your knowledge by answering true or false to these statements. Then check the answers to see how you did. If you or a loved one needs help with alcohol dependency, call the National Drug and Alcohol Treatment Referral Routing Service at 1-800-662-HELP (4357) to speak with a representative or request helpful materials.

True or false? {1} Alcohol only affects the liver. {2} Wine is safer to drink than hard liquor. {3} Having a blood alcohol level below the legal limit doesn’t mean you can drive safely. {4} The effects of getting drunk only last for one night, and maybe the next morning. {5} No amount of alcohol use is safe during pregnancy.

Test your health knowledge online Take more health quizzes and assessments online at www.womenshealthexperience.com. Plus, find out what other women are saying by participating in our online polls!

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Answers {1} False. Alcohol, a central nervous system depressant, affects every organ in the body. It’s absorbed rapidly into the bloodstream and is processed by the liver. Only a small amount of alcohol can be processed; the excess circulates throughout the body. {2} False. The standard serving of wine, a 5-ounce glass, contains the same amount of alcohol as a 1.5-ounce shot of liquor (the usual amount in a mixed drink) and the same as a 12-ounce beer. What matters is the total amount of alcohol consumed, not the type of drink. {3} True. Alcohol impairment (slowed reaction time, impaired judgment and suboptimal coordination) occurs at levels far below the legal limit for driving. Drinking and driving is dangerous no matter your blood alcohol level. {4} False. Repeated alcohol intoxication over periods of time can increase your risk of liver disease and various cancers, including those of the liver, mouth and throat. Heavy drinking can also lead to high blood pressure and psychological disorders, as well as alcohol abuse and dependence. {5} True. Women who are pregnant or are planning to become pregnant should avoid all alcohol, says the Centers for Disease Control and Prevention. Several conditions—many dangerous to the fetus— have been linked to alcohol use during pregnancy, including fetal alcohol syndrome, a condition that causes mental retardation and birth defects.

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hoose…The Christ Hospital Medical Associates Lizzie's family from Price Hill did.

FAMILY MEDICINE Dr. Jennifer Spata was awarded for her work in family medicine while in Washington. Now that she’s back in Cincinnati, she intends to continue her award-winning primary care for people in her hometown. With a specific focus on women and children, Dr. Spata knows what it means to provide the best care for your family in a familiar place.

To find a location or doctor that’s right for you, call

513-585-1000 or visit www.TheChristHospital.com.

“I like Dr. Spata because she can see my mom, dad, brothers and sisters all in one place. It's cool having the same doctor.”