4Health Magazine # 204 issue by MOO Publishing

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SIGNS

YOU MAY HAVE A BLOOD CLOT IN THE BRAIN

HOW TO TELL IF ITâ&#x20AC;&#x2122;S DRY EYE OR ALLERGIES

HOW TO DECIDE

WHETHER YOUR CHILD NEEDS EAR TUBES

7 COMMON FOOT PROBLEMS AND HOW TO TREAT THEM

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5 REASONS TO AVOID SMOKING MARIJUANA

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WEIGHT LOSS IMPROVES SLEEP AND MOOD

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(ISSN 1942-6801) is published monthly by MOO Publishing Corp.Copyright © 2007-2017 by MOO Publishing Corp. All rights reserved. Printed in Canada. All requests for permissions and reprints must be made in writing. Reproduction in whole or in part without written permission is prohibited. Printed in November 2017.

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“4Health” is an editorial-based medical magazine (the "Magazine") provided by Moo Publishing Corp. and by other sources. DISCLAIMER This Magazine is for consumer educational use only. Nothing contained in this Magazine is or should be considered, or used, as a substitute for medical advice, diagnosis or treatment. The opinions in this Magazine are here to educate consumers on health care and medical issues that may affect consummers’ daily lives. This Magazine does not constitute the practice of any medical, nursing or other professional health care advice, diagnosis or treatment. The Magazine advises readers to always seek the advice of a physician or other qualified health care provider with any questions regarding personal health or medical conditions. Never disregard, avoid or delay obtaining medical advice from your doctor or other qualified health care provider because of something you have read in this Magazine. If you have, or

suspect that you may have, a medical problem or condition, please contact a qualified health care professional immediately. If you are in the United States and are experiencing a medical emergency, please dial 911 or call for emergency medical help on the nearest telephone. WARRANTIES AND LIMITATION OF LIABILITY We do not make any expressed or implied warranties, representations or endorsements of any kind whatsoever with regard to the magazine, or with respect to any information, product, service, merchandise or other material provided in or through the magazine. We do not warrant or guarantee the accuracy, completeness, correctness, timeliness or usefulness of any information, products, services, merchandise or other material provided throughout the magazine. We are not liable to any reader or anyone else for any decision made or action taken based on their reliance upon the information contained in this magazine. 4HEALTH | 877.807.0989

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Is It Normal to Experience Bleeding After Menopause? Causes of Postmenopausal Bleeding

11 17 Signs You May Have a Blood Clot in the Brain When to Get to Your Doctor Right Away

SHOULD I SEE A DOCTOR ABOUT MY ALLERGIES?

WHEN YOU SHOULD CONSIDER SURGERY FOR SINUSITIS

10 12 14 16 18

Can Anyone Help Me With These Dry Eyes?

How to Tell If It’s Dry Eye or Allergies

26 How to Decide Whether Your Child Needs Ear Tubes Guidelines Suggest Watchful Waiting in Some Cases

28 7 Common Foot Problems and How to Treat Them

Find Relief for Bunions, Hammertoes, and More

When Over-the-Counter Treatments Aren’t Enough

Study Indicates that Sometimes, Medical Therapy Works Just as Well

5 THINGS TO REMEMBER IF YOU WANT TO ENJOY YOUR DENTAL VISIT Avoid the Hygienist Lecture!

10 HELPFUL FOODS FOR YOUR SKIN How to Bring Back a Healthy Glow After the Holidays

ARE FIBROIDS KEEPING YOU FROM WORK? How to Tell if it’s Time to See the Doctor about that Heavy Bleeding

TO INDUCE OR NOT TO INDUCE? Consider All the Risks Before Making a Decision

WANT TO PROTECT YOUR BRAIN? PROTECT YOUR BLOOD VESSELS! Study Reveals Unhealthy Blood Vessels Increase Risk of Alzheimer’s

WHAT’S CAUSING YOUR BELLY FAT?

STUBBORN BELLY FAT—TIPS TO GET RID OF IT

By Dr. Prab R. Tumpati

There’s More Than Your Appearance At Stake

WHAT TO ASK YOUR COSMETIC SURGEON BEFORE SURGERY How to Be Sure You’re Prepared

NON-SURGICAL LUNCHTIME FACE AND NECK LIFTING

HOW CAN I RELIEVE THIS PAIN IN MY HEELS?

IF YOU HAVE SORENESS OR SWELLING IN YOUR LEFT LEG, READ THIS!

STUDY: NEWER DRUGS LESS EFFECTIVE THAN OLDER ONES?

39 40

By Dr. Roman Rayham MD

Podiatrist Dr. Stepensky Has Answers

What You Need to Know about May-Thurner Syndrome

You May Be Better Off Ignoring the Latest Development

ANTIBIOTICS DON’T HELP THE COMMON COLD OR BRONCHITIS…BUT THIS WILL Have You Tried Acupuncture to Reduce Troublesome Symptoms?

PROSTATE CANCER: SLOW-GROWING VS. ADVANCED What is the Outlook for the Most Severe Stages?

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SHOULD I SEE A DOCTOR ABOUT MY ALLERGIES? WHEN OVER-THE-COUNTER TREATMENTS AREN’T ENOUGH

nnn By Morgan Rice Estimates are that about 50 million Americans suffer from nasal allergies, and that number is increasing. The American College of Allergy, Asthma, & Immunology (ACAAI) states that the prevalence of allergies is “surging upward,” with as many as 30 percent of adults and 40 percent of children having at least one allergy. Normally, you might take a pill, use a nasal spray, or simply suffer through symptoms like sneezing, itchy eyes, and headaches, but sometimes those symptoms become bothersome enough that you start to wonder: “Should I go see an allergy doctor?”

WHEN TO SEE YOUR ALLERGY DOCTOR Though it’s common to suffer a little hay fever during the spring season, or to have a runny nose now and then, allergies can become much more problematic. Even if you haven’t had allergies before, you may find that you start to have more difficulty as you age. Often over-the-counter remedies will help you manage the symptoms, but if any of the following apply to you, it may be time to see your allergy doctor: n Your symptoms last for three months or

longer n Your symptoms make it hard for you to

get a good night’s sleep n Your symptoms interfere with work or

with your daily activities n Over-the-counter remedies aren’t help-

ing much

n Your allergies are causing other problems

like headaches, ear infections, and sinus infections n Over-the-counter medications may interfere with your treatment for heart disease, high blood pressure, glaucoma, diabetes, and kidney disease If any of these sound familiar, you owe it to yourself to make an appointment with an allergist.

HOW AN ALLERGY DOCTOR DIAGNOSES ALLERGIES An allergist is a doctor who specializes in the treatment of allergies, asthma, eczema, and other allergic diseases. She completes the same schooling as a medical doctor, and then completes additional training and study in the field of allergy and immunology. When you visit an allergist, she may recommend allergy testing to determine exactly what you may be allergic to. Normally she’ll start by evaluating your medical history and asking you about your symptoms. Be prepared to tell her what your symptoms are, when they are more likely to occur, and how much they interfere with your life. You’ll also want to let her know what over-the-counter treatments you have tried, and whether they have worked for you. The allergist may then recommend skin testing. This is a procedure in which the doctor or nurse makes small pricks in the skin and then drops various allergen extracts near each mark to see whether or not the skin reacts. This test can tell you whether you’re allergic to pollen, mold, pet dander, dust, and more.

Once your doctor has the results of the test, she can work with you to establish the best treatment.

HOW YOUR DOCTOR WILL TREAT YOUR ALLERGIES Treatment usually involves three steps: n Trigger avoidance: You and your doctor will go over your test to see what you’re allergic to, and formulate a plan to help you reduce your exposure to these elements. If you’re allergic to pollen, for example, you may reduce your time outside during high-pollen periods of the year. n Medications: There are a number of medications available to help reduce your symptoms so you can go about your day more comfortably. Your doctor may recommend one or more of these medications to you. n Immunotherapy: Many patients benefit from this therapy, which is administered either in regular allergy shots or drops. The idea is that your doctor will expose you to a small amount of the substance you’re allergic to via a weekly shot or drops placed under the tongue. Gradually, the body grows used to the allergen and no longer reacts to it. This sort of treatment can take time, but can provide long-term results. There are some herbal treatments that can also help to reduce allergy symptoms — you may want to ask your doctor about those as well. The important thing is that you do not have to suffer from symptoms. If over-thecounter remedies aren’t helping, don’t hesitate to see your doctor for other options. 4HEALTH | 877.807.0989

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WHEN YOU SHOULD CONSIDER SURGERY FOR SINUSITIS STUDY INDICATES THAT SOMETIMES, MEDICAL THERAPY WORKS JUST AS WELL nnn

By Morgan Rice

Maria had been struggling with sinus infections for years. It seemed like when she got over one, another one would develop. She was tired of the headaches, stuffy nose, and missed days of work, so she went to see her ear, nose, and throat doctor. After her first visit, she came down with another infection, so she went in again. That’s when her doctor started talking about surgery. He explained that it could help open up the sinus passages and help her feel better. But Maria wasn’t sure she was ready for that. On the other hand, she sure didn’t want to continue battling sinus infection after sinus infection. You may be in a similar position. Recurrent sinus infections can make life really difficult, and your doctor may have suggested surgery. Should you go for it or not?

WHAT IS SINUSITIS? Sinusitis is a condition in which the sinuses — the air-filled cavities behind your cheekbones and forehead — become inflamed. The inflammation is usually caused by an infection, and creates symptoms like a blocked or runny nose, pain and tenderness in the cheeks and behind the eyes, headaches, fever, green or yellow mucus, and sometimes, a toothache. Once the body fights off that infection, the inflammation and the symptoms go away. In some cases, however, sinusitis becomes chronic. That means that the symptoms persist even after 12 weeks, or may go away and come back continually. This kind of sinusitis may also be caused by an infection, but allergies, nasal polyps, pollutants, structural problems in the nose (like a deviated septum), or other issues can also result in chronic sinusitis.

HOW IS CHRONIC SINUSITIS TREATED? Doctors usually try a number of other treatments before suggesting surgery. These may include antibiotics or antifungal medications 4HEALTH | 877.807.0989

if the sinus problems are caused by bacteria or fungi. Corticosteroids can help reduce the inflammation and may lead to recovery. In cases where the sinusitis is caused by allergies, allergy shots may do the trick. If these and/or other treatments don’t work, however, doctors may recommend surgery, particularly if you have a deviated septum or other structural problem in the sinuses. Keep in mind, though, that other treatments may still be necessary even after surgery, so it’s important to understand all the risks and potential benefits.

SURGERY OR MEDICAL THERAPY? IT DEPENDS ON THE PATIENT A recent study by Canadian researchers found that in many cases, standard treatments may be just as effective as surgery in helping patients achieve a higher quality of life. Scientists followed patients with chronic sinus infections who received either continued medical therapy or surgery for a period of 13 months. Those who chose to continue medical therapy — using nasal sprays, antibiotics, antihistamines, and regular nasal passage irrigation (such as with a neti pot)—improved just as much as those electing to go through surgery. The researchers did note, though, that the patients who did best with continued medical therapy were those with less severe forms of sinusitis. For those with more severe problems reducing their productivity and quality of life, surgery created significant improvements. The researchers concluded that patients need to talk to their doctors to make the best decision. “The decisions for each treatment should involve a shared decision-making process between physician and patient after informing the patient of their expected outcomes and potential risks,” said lead author Dr. Luke Rudmik. Chronic sinusitis can lead to frequent fatigue, sleep apnea, and other health problems. Patients may miss work and experience other complications that make life more difficult. Maria discussed the matter further with her doctor, and decided to try some different medications to see if they would work better for her. Surgery remains an option if she continues to experience problems down the road, but for now, she is investing in daily care that she hopes will make life a little easier.

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5 THINGS TO REMEMBER IF YOU WANT TO ENJOY YOUR DENTAL VISIT AVOID THE HYGIENIST LECTURE!

nnn

By Gordon Barclay

Most of us don’t think too much about our teeth — until we end up in the dentist’s chair. Then all of our bad habits come back to haunt us. I remember one visit of mine. The hygienist kept scraping and polishing and scraping and polishing and then she gave me the evil eye: “Do you floss daily?” she asked. “Um, well, not every day…” I stammered. Truth is, I got back into it after my last dentist appointment, but then you know, life got busy, and I got tired, and pretty soon that great flossing habit went out the window. “We have quite a bit of plaque here…” she said, peering into my mouth. I got away with just a little bit of gum irritation and no cavities, but I didn’t escape without a lecture from that hygienist. I have to admit I deserved it. To help you a) enjoy healthier teeth and gums, and b) experience a more enjoyable dentist’s visit than I did, here are five things you should be doing regularly to take care of your mouth!

1. REMEMBER YOUR MOUTH IS A HAVEN FOR BACTERIA. We grimace when we think about it, but it’s important to remember that your mouth, like any dark, moist place, is a great home for bacteria. The food you eat creates an all-you-can-

eat buffet for those little bugs. As they chow down on the food particles left between your teeth, they create a film that can eventually form into gum-damaging plaque. You need to constantly wage war against these bacteria. Brushing, flossing, and rinsing are your weapons of choice, and you need them all, twice a day.

2. YES, YOU NEED TO FLOSS. There has been some news suggesting that maybe you don’t need to floss, but dentists say you should ignore it. Food particles easily become lodged between teeth, and are rarely removed through brushing alone. Fortunately, you have many options today. If you don’t have time for traditional flossing, you can use toothpicks or those handy little on-the-go flossers that you can easily carry in a purse or wallet. A water flosser or irrigator also works really well to keep all those in-between places free of bacteria.

3. RETHINK HOW YOU DRINK. Coffee and soda contain acids that can wear away the enamel on your teeth. Once that protective enamel is gone, you can’t get it back, and your teeth become more vulnerable to sensitivity issues. Your best bet is to drink the beverage, and then rinse your mouth out with water. The worst thing you can do is sip on coffee, soda, or an energy drink while you’re

working. This bathes your teeth in these disruptive acids for long periods of time. Choose water when you need something to sip on, and otherwise drink and be done with it!

4. GET AFTER YOUR TONGUE. You may forget to brush or scrape your tongue when you’re brushing your teeth, but that can be a costly mistake. Bacteria live on your tongue as well as on your cheeks and gums, and if you don’t get rid of them, you may still suffer from bacteria-related problems even if you’re regularly brushing your teeth. To avoid that gaggy feeling, scrape from back to front only. Having a clean tongue also increases your odds of avoiding bad breath.

5. SEE YOUR DENTIST REGULARLY. It’s tempting to imagine that if you’re being careful with your daily hygiene, you can avoid the dentist, but this isn’t a good idea. Your hygienist can catch problems you may not have been aware of before they grow into serious issues. It’s also important for your dentist to get a good luck at the structure of your teeth and mouth as you age, to be sure that your teeth and jaw stay strong and healthy. Besides, if you’re following the other four steps here, your appointment is likely to be pleasant, so why avoid it? You know you love that clean, sparkly smile you get when you’re done! 4HEALTH | 877.807.0989

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10 HELPFUL FOODS FOR YOUR SKIN

HOW TO BRING BACK A HEALTHY GLOW AFTER THE HOLIDAYS

nnn By Colleen M. Story You’ve probably heard the expression, “You are what you eat.” Nowhere is that more true than when considering the condition of your skin. In fact, if you dieted over the holidays, or overindulged in sugary treats, pies, and cakes, you may now be paying the price with dry, dull, and acne-filled skin. What can you do?

HOW YOUR DIET AFFECTS YOUR SKIN Sometimes we forget that the skin is a living organ—the largest one in the body, actually. It’s constantly regenerating and renewing itself through the exchange of nutrients and waste products from the blood. Vitamins, minerals and proteins, as well as carbohydrates, fats, essential fatty acids, and other elements from the diet all play important functions in the cellular activities that support skin structure, tone, and vitality. Scientific studies confirm that diet definitely affects the appearance of skin. A 2007 study published in the American Journal of Clinical Nutrition, for example, evaluated the associations between nutrient intakes and skin-aging appearance. They found that higher vitamin C intakes were associated with a lower likelihood of a wrinkled appearance. High intakes of fatty acids lowered the appearance of dry and dull skin. Too much fat and carbohydrates in the skin, on the other hand, increased the likelihood of a wrinkled appearance and of skin sagging.

WHAT DIET IS BEST FOR SKIN? Overall, dietary recommendations for healthy, vibrant skin are similar to recommendations

for a healthy heart. Whole grains, fruits and vegetables, lean meats, and calcium-rich foods are all known to be supportive to skin’s natural structure and function. Some studies have been more specific, however. Research in 2001 showed that those with a higher intake of vegetables, olive oil, and monounsaturated fat and legumes, and a lower intake of milk/dairy products, butter, margarine, and sugar products had less wrinkling in their skin. Another study in 2007 found that patients with acne who followed a low-glycemic diet had a reduction in acne breakouts versus those who consumed a diet rich in carbohydrates.

SPECIFIC FOODS THAT MAY HELP While a healthy overall diet is key to getting your best skin, there are specific foods known to provide anti-aging and protective benefits. Here are a few: Water: Water hydrates the cells of the skin, while eliminating toxins and waste products. Flaxseeds: Rich in healthy omega-3 fatty acids, flaxseeds can help support skin hydration and elasticity. Other options include fatty fish like salmon, and walnuts. Apples: Research from Japan found that apple polyphenol extracts inhibited skin cancer, while protecting DNA from cancerous changes. Almond butter: This is a great source of vitamin E, which protects cell membranes and guards against UV radiation damage. In fact, vitamin E is a powerful anti-aging ingredient. Sunflower seeds, hazelnuts, spinach, and dandelion greens are also good sources.

Oranges: These are rich in vitamin C, which is involved in collagen production, and also protects from free radical damage. Strawberries, lemons, and bell peppers are other good sources. Mangoes: Full of carotenoids, mangoes can give dull skin a more rosy glow. Papaya and apricots are other good sources, along with sweet potatoes, spinach, butternut squash, and pumpkin. Blueberries: Rich in protective antioxidants, blueberries protect your skin from daily assaults from pollution and UV rays. Green tea is another great source. Dark chocolate: The flavonoids in dark chocolate reduce roughness in skin and protect against sun damage. Limit your intake to a couple ounces a day to avoid weight gain. Tuna: It contains selenium, which helps preserve elastin—the protein that keeps skin firm and tight. To avoid sagging, add a tuna sandwich to your weekly menu. Other good sources include oysters, Brazil nuts, tilapia, mushrooms, eggs, and cottage cheese. Turkey: It has a lot of zinc, which protects cell membranes and maintains the collagen that keeps skin firm. Other good sources include lobster, lean beef, crab, clams, mussels, yogurt, and starchy beans.

SOURCES Maeve C. Cosgrove, et al., “Dietary nutrient intakes and skin-aging appearance among middle-aged American women,” Am J Clin Nutr, October 2007, vol. 86, no. 4, pp. 1225-1231, http://ajcn.nutrition.org/ content/86/4/1225.long. American Academy of Dermatology (2007, November 15). What To Eat For Glowing Healthy Skin. ScienceDaily. Retrieved December 4, 2012, from http://www.sciencedaily.com /releases/2007/11/071109201438. htm.

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ARE FIBROIDS KEEPING YOU FROM WORK? HOW TO TELL IF IT’S TIME TO SEE THE DOCTOR ABOUT THAT HEAVY BLEEDING

Paula had to excuse herself from the meeting. Not again, she thought. She ran to the restroom, her purse clutched to her ribs. It hadn’t ever been this bad, but here she was again, in that time of the month, changing her pad several times a day. The bleeding was so heavy that she was lightheaded. After changing, she downed the package of peanuts she’d brought to help her re-energize. As she looked in the mirror, she could see the stress showing up in the lines around her eyes. This had to stop. She had to go see the doctor. Many women like Paula experience similar symptoms — heavy bleeding, fatigue, cramping. These symptoms seem like common menstrual symptoms, until they become uncommon. Paula knew her body, and this wasn’t normal. Though she was tempted to just suck it up and go on, something told her that she needed to get this checked, so she made an appointment with her gynecologist. Paula was later diagnosed with uterine fibroids. If you’re a woman experiencing similar symptoms that are interfering with your life, should you check with your doctor?

WHAT ARE UTERINE FIBROIDS? These are growths that develop on the inner walls of the uterus, ranging in size from little seedlings to bulky masses that can become large enough they actually distort the natural shape of the uterus. They can also grow outside of the uterus or at the opening of the cervix. Though they very rarely become cancerous, fibroids can cause a number of uncomfortable symptoms to the point they can affect a woman’s quality of life.

WHAT ARE THE SYMPTOMS OF FIBROIDS? Many women may have fibroids, but never experience any symptoms from them. A gynecologist may find them during a pelvic exam or prenatal ultrasound, but as long as they aren’t causing any problems, they are usually left alone. Sometimes, however, the fibroids can make life miserable, as they did for Paula. Typical symptoms include: 4HEALTH | 877.807.0989

n Heavy menstrual bleeding and/or spot-

ting between periods n Periods that last longer than usual (more than a week) n Frequent urination and/or pressure on the bladder n Constipation and/or pressure on the rectum n Cramping and pelvic pressure or pain n Backache or leg aches n Painful intercourse n Fatigue and lethargy (related to heavy bleeding) How do you know if you may have fibroids? You can take a quick quiz at USA Fibroid Centers that will help give you a better idea: http://usafibroidcenters.com/quiz-uterinefibroid/

WHAT CAUSES FIBROIDS? Scientists aren’t sure what causes fibroids to form, but they do know that premenopausal women, obese women, and African American women are more at risk for them, though they can occur in any woman. They also seem to run in families and show up more often in women who started their periods at a younger age. If you are experiencing some or all of the symptoms above, and they are interfering with your work or home life, it’s important to check with your doctor. A diagnosis is made through a routine pelvic exam, which can illuminate irregularities in the shape of the uterus. Ultrasounds, x-rays, and other imaging tests, as well as blood tests, can also give a doctor clues to the presence of fibroids, and help him or her to determine how large they are, and where exactly they are located.

USA Fibroid Centers, a nationwide network of physicians, nurses, and specialists, is the leading non-surgical, outpatient treatment center and offers personalized treatments for fibroids without invasive surgery and no hospital stay. The gold standard in fibroid treatment today is called uterine fibroid embolization (UFE) and involves only a small incision, through which the doctor inserts a tiny catheter. He or she then injects embolic agents through that catheter into the uterine arteries, which blocks blood flow to the fibroids. Without the nutrients in the blood, they shrink and die. The procedure takes only 60–90 minutes, and women can go home afterward. The treatment has a high rate of success — studies show it to be a well-established, safe, and effective therapy. If you are experiencing symptoms like Paula’s, talk to the doctors at USA Fibroid Centers about your options. They can help you decide which type of treatment is best for you. You can find them all over the nation, including in Florida, California, Illinois, and several in the New York area. Call today at 718–504–6525, or go to www.USAFibroidCenters.com to schedule a consultation. SOURCES James B. Spies, “Current Evidence on Uterine Embolization for Fibroids,” Semin Intervent Radiol., December 2013; 30(4):340–346, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3835459/.

HOW ARE UTERINE FIBROIDS TREATED? Treatment depends on a woman’s particular case. If you are experiencing only mild symptoms, it may be best to just watch and wait. If your symptoms are messing up your life, then treatment is usually required. It used to be that a hysterectomy was the only recommended option for removing fibroids, but that’s not the case anymore.

(718) 504-6525 www.USAFibroidCenters.com

4HEALTH

TO INDUCE OR NOT TO INDUCE? CONSIDER ALL THE RISKS BEFORE MAKING A DECISION

nnn

By Lynn Merrell

To induce or not to induce? That is the question for many parentsto-be, and it can be a confusing one. In some cases, inducing can help prevent complications, and is actually better for mom and baby, but in others, inducing can create issues of its own. How are you to know which is best in your situation?

WHAT IS INDUCING? Sometimes the baby just doesn’t come when he or she should. Nature usually handles these things, but in some cases, she needs a little help. If mom has gone past her due date and doctors feel like waiting could increase risk of problems, they may choose to give moms medication that will help to encourage contractions. These medications actually stimulate the uterus to contract and begin labor. The main medications used are called Syntocinon and Pitocin. They are both synthetic forms of the hormone “oxytocin,” which is a natural hormone involved in childbirth and breast-feeding.

WHEN DO DOCTORS RECOMMEND INDUCING? There are a number of reasons why doctors may elect to induce labor. The most important reason is a medical reason — the baby needs to come out for his or her own health. Maybe the baby is showing signs of distress, is not getting enough nutrients from the placenta, the amniotic sac has ruptured, or the pregnancy is prolonged beyond 42 weeks with a possible risk to the baby. If the mom suffers from preeclampsia or gestational diabetes, or if she’s bleeding, it may also be best to induce labor. Sometimes, inducing labor is the smart decision when considering the baby’s safety. But most pregnancy experts will tell you that the process should be reserved to only those times when its needed for health reasons.

IS IT OKAY TO INDUCE FOR CONVENIENCE SAKE? These days, many parents and their doctors are electing to induce labor to accommodate their schedules. Maybe they have something important planned, so they simply schedule induction on a date when

the doctor determines it will be safe. Other times, moms may elect to induce simply to escape the discomfort that can be present in the late stages of pregnancy, or because they live a long distance from the hospital. The American College of Obstetricians and Gynecologists (ACOG), however, states that this is not a good idea because it can create unnecessary risks. Instead, they say that labor should be induced only when it’s more risky for the baby to remain inside the mom than to be born. Even the manufacturers of labor-inducing medications warn that their drugs should not be used for elective inductions, because of the potential risks.

WHAT ARE THE RISKS OF INDUCING? Like any medical procedure, there are health risks to inducing labor. About 25 percent of moms, for example, may end up needing a Csection after they are induced. The medications can cause abnormal or excessive contractions, which can potentially harm the baby. Induction may also increase the risk of serious bleeding after delivery, as well as increase risk of infections in both mom and baby. In rare cases, it can lead to uterine rupture. Induction is not a good idea for moms who gave birth before via C-section, or if the baby is breeched or lying sideways. In fact, according to a 2006 article published in the Journal of Perinatal Education, induction alters the process of normal labor and birth, and increases risk of giving birth to a baby that is near-term (born between 35 and 37 weeks, when it should be 38–40 weeks or even 42 weeks). Near-term infants are often physiologically and developmentally less mature than full-term infants and are at increased risk for problems in the newborn period.

SHOULD WE INDUCE OR NOT? Every woman is different, and every pregnancy is different. Discuss your situation carefully with your doctor before making a decision. It may be that for you, inducing labor is the safest option. But on the other hand, think twice before scheduling induction simply for convenience. Don’t be afraid to take some time to think over the decision. If there’s a medical condition, then the baby’s safety should come first, but otherwise, it may be best to wait. 4HEALTH | 877.807.0989

4HEALTH

IS IT NORMAL TO EXPERIENCE BLEEDING AFTER MENOPAUSE? CAUSES OF POSTMENOPAUSAL BLEEDING

nnn By Lynn Merrell Eleanor hadn’t had a period in over a year. She’d suffered from hot flashes and insomnia, but things were starting to ease up a bit, and she was adjusting to life after menopause. Then one day she woke up to find blood. Her heart raced. Could this be something serious?

n Polyps and/or fibroids: These are small,

WHAT IS POSTMENOPAUSAL BLEEDING? Postmenopausal bleeding is any bleeding or spotting that occurs after menopause. Menopause means you haven’t had a period in at least one year, and marks the end of a woman’s reproductive period. Hormones change — estrogen decreases, which can cause some troublesome symptoms like hot flashes and mood swings, but things eventually even out again as a woman enters her senior years. Usually bleeding no longer occurs after menopause, and if it does, it’s important to see your doctor. You don’t have to be overly worried however, as there are a number of things that can cause it, and not all of them are serious.

WHAT CAUSES POSTMENOPAUSAL BLEEDING? The most common cause of postmenopausal bleeding is hormone replacement therapy. If you are taking hormone pills to manage your symptoms, you may experience bleeding. This is because the hormone estrogen, usually included in hormone therapy, stimulates the growth of the endometrium in the uterus, just as it does before menopause. In this case, there’s usually no cause for concern, but it’s always best to check with your doctor. Other potential reasons for postmenopausal bleeding include: 4HEALTH | 877.807.0989

usually non-cancerous growths that can develop inside the uterus or on the cervix. They can cause spotting, bleeding, or bleeding after intercourse. Endometrial atrophy: Just as the endometrial lining is sensitive to estrogen in hormone therapy, it’s also sensitive to the lack of estrogen. During menopause, the level of estrogen drops dramatically. The endometrial lining may become thin, dry, and inflamed, which can lead to bleeding after intercourse. Endometrial hyperplasia: Instead of getting thinner, the endometrial lining gets thicker because of hormonal changes. Women who have more estrogen after menopause and less progesterone are likely to develop this condition, which may cause bleeding, and in some cases, can also lead to endometrial cancer. Medications: In addition to hormone therapy, other medications like blood thinners and tamoxifen may cause bleeding. Endometrial cancer: This is a cancer of the endometrial lining. It’s rare, however. Only about 10 percent of women with postmenopausal bleeding have endometrial cancer. Vaginal infections: A yeast infection or bacterial infection of the vaginal area may cause bleeding. Sexually transmitted disease: Some diseases like Chlamydia, gonorrhea and trichomonas can cause bleeding. Other cancers: Vaginal and cervical cancer may also cause bleeding, but these are less common causes.

WHAT DO I DO ABOUT POSTMENOPAUSAL BLEEDING? First, take note of the bleeding. When does it occur? How much bleeding is there? Have this information available to share with your doctor. Then, make an appointment with your gynecologist, just to be safe. He or she will ask about your symptoms, and will likely conduct an examination of the vagina and cervix. If the examination doesn’t reveal a potential cause of the bleeding, the doctor may order other tests including an ultrasound or endometrial biopsy. Other more serious tests may include a hysteroscopy, in which the doctor looks inside the uterus with a lighted tube, or a D&C (dilation and curettage), in which he takes a sample of the uterus lining to check in the lab. Depending on the results of the tests, the doctor will suggest a treatment. For vaginal or endometrial thinning, there are creams and medications that can help. Some hormonal therapies can treat endometrial hyperplasia. If you have polyps, these can be removed with a hysteroscope. More serious treatments like a hysterectomy (removal of the uterus), or radiation and chemotherapy are reserved for those rare cases when the doctor finds evidence of cancer. Remember that if you are in perimenopause — that period where your hormones are starting to shift, but you are still getting periods — bleeding is perfectly normal. After you have gone without a period for at least a year, however, bleeding may signal another issue that is best detected early, so check with your doctor right away.

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WANT TO PROTECT YOUR BRAIN? PROTECT YOUR BLOOD VESSELS!

STUDY REVEALS UNHEALTHY BLOOD VESSELS INCREASE RISK OF ALZHEIMER’S nnn By Colleen M. Story You probably don’t think about them much, but did you know that you have about 60,000 miles of blood vessels in your body? They’re like little pipes that carry blood from the heart out to the rest of your body and back again. The smallest is smaller than a strand of human hair, and the largest — the aorta — is about an inch in diameter. How healthy are your blood vessels? It’s hard to tell. We can’t see inside ourselves, after all. But things like blood pressure, blood choles-

terol, and blood sugar levels give us clues. Healthy blood vessels mean a healthy cardiovascular system, and vice-versa. But it goes even further than that — according to a recent study, unhealthy blood vessels not only put you at risk for heart disease, but for Alzheimer’s disease, as well.

HOW BLOOD VESSELS AFFECT YOUR HEALTH Your blood vessels will carry about a million barrels of blood over the course of your lifetime. Every day, your heart pumps about 1,800 4HEALTH | 877.807.0989

4HEALTH gallons through these vessels, so it’s important that they remain clear and flexible. Imagine a garden hose. A new one is clear and open and water flows through easily. Over time, especially if you leave that hose outside, it’s likely to get stiff, and may even become clogged with dirt and grime. Eventually, water flow slows and may even stop altogether. Your blood vessels may be affected the same way, depending on your lifestyle. Over time, they can become clogged and stiff, too, particularly if you are overweight or obese, or have chronic inflammation or high blood cholesterol. The arteries may narrow and become less flexible, which is what increases blood pressure, as the heart has to work harder to get blood through. These changes can put you at an increased risk for heart attack and stroke, because as blood vessels deteriorate, it’s more likely a blood clot may develop that blocks blood flow to the heart or to the brain. Recent research also suggests that unhealthy blood vessels can lead to dementia.

BLOOD VESSEL HEALTH RELATED TO DEMENTIA Blood vessels not only carry blood to and from the brain, they also help protect the brain from harmful substances. They are part of the “blood-brain barrier,” which is a shield that allows water, oxygen, and other nutrients in the brain, but keeps things like bacteria out. Various things can damage the blood vessels in the brain. High blood pressure, cholesterol, and blood sugar can affect these blood vessels as well as the ones around the heart, causing “atherosclerosis” or blood vessel narrowing and stiffening. In a 2016 study, researchers

found that the worse shape the brain vessels were in, the higher the chance of having dementia. Poor blood vessel health was also associated with memory and thinking problems. “Both large and small vessel diseases have effects on dementia and thinking abilities,” said lead author Dr. Zoe Arvanitakis, “independently of the common causes of dementia such as Alzheimer’s pathology and strokes.” In other words, even if you don’t suffer a stroke or other brain-damaging disease, if your blood vessels become unhealthy, that alone can cause dementia and increase risk of Alzheimer’s.

HOW CAN WE PROTECT OUR BRAINS? How can we protect our blood vessels and thereby protect our brains as we age? Researchers say that whatever you do for your heart, you’re also doing for your brain. Eating a healthy diet, for example, exercising regularly, and controlling your blood sugar, pressure, and cholesterol can all help reduce risk of heart disease, stroke, and dementia. Realize that blood vessel damage can start early in life, particularly if you’re overweight or obese. Exposure to cigarette smoke makes it worse. So start today — eat more fruits and vegetables, exercise for at least 30 minutes every day, and do your best to maintain a healthy weight. You can also eat more dark leafy greens, garlic, green tea, walnuts, and fiber — they can all help encourage blood vessel health. SOURCES “

Cerebrovascular disease linked to Alzheimer’s,” MedicalNewsToday, July 5, 2016, https://www.medicalnewstoday.com/releases/311429.php.

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SIGNS YOU MAY HAVE A BLOOD CLOT IN THE BRAIN WHEN TO GET TO YOUR DOCTOR RIGHT AWAY

nnn By George Barclay It was in June 2013 that CNN reported Ted Dwane — the bassist for musical group Mumford & Sons — had suffered a blood clot on the surface of the brain. We often hear about blood clots in the legs, or in the heart, but what does it mean when a blood clot lodges in the brain? For Dwane, it didn’t cause him to pass out or suffer a seizure. Instead, he just went to the doctor because he wasn’t feeling well. Tests revealed the clot, Dwane underwent surgery, and fortunately, recovered quickly. Earlier that year, former Secretary of State Hillary Clinton suffered a similar blood clot on the brain, for which she received successful treatment. This type of story doesn’t always turn out so well, however. Sometimes people ignore the early warning signs, and suffer a stroke, or even death.

WHAT IS A BLOOD CLOT ON THE BRAIN? Blood usually flows smoothly through your body, until you’re injured. Then chemical reactions occur that allow blood to clot and stop the bleeding. Sometimes, however, things can go awry, and a clot forms when you don’t need it. If you have damaged blood vessels for example, the blood may clot together to reduce the bleeding, but that clot can go on to actually obstruct the blood vessel, causing a heart attack or stroke. A number of other factors can increase the risk of a blood clot, including arrhythmia,

obesity, deep vein thrombosis, peripheral artery disease, smoking, and even sitting too long or traveling extensively.

HOW DOES A BLOOD CLOT AFFECT THE BRAIN? The damage that occurs because of a blood clot depends on where it forms. A blood clot in an artery near the heart can cause a heart attack. A clot in the blood vessels that supply the lungs can cause a pulmonary embolism. A blood clot in the brain can cause a number of problems, from headaches to a fatal stroke. Again, it depends on exactly where in the brain the blood clot forms. One on the dominant side of the brain, for example, can cause more damage than one on the less dominant side, because there’s more blood flowing to that area. Sometimes, the person won’t even notice it, as the brain will direct the blood to flow through other, unobstructed blood vessels. But other times, the effects can be very serious.

POTENTIAL SYMPTOMS OF A BRAIN BLOOD CLOT Before you worry too much about suffering from a blood clot on the brain, consider your risk factors. People who have a family history of blood clotting are more at risk. So are those that are diagnosed with deep vein thrombosis, who have had other clots in the past, and who are already struggling with heart disease or other vascular problems.

Other factors to consider are how often you travel, or if you sit for long periods of time because of work or a long commute. Overweight and obesity, lack of exercise, smoking, and some medications can also increase risk. Though a blood clot can form very quickly and you may not have time to respond, in many cases the following symptoms will show up: Headaches: these are usually on one side of the head, get worse with time, and make it difficult to tolerate movement. Dizziness: especially if accompanied by temporary blindness, this may indicate the presence of a clot. Confusion: you may suffer from brain fog, or find that you can’t think straight. Loss of coordination: if you have trouble going up the stairs or walking in a straight line, a blood clot may be to blame. Speaking troubles: this is especially common if your clot is on the left side of the brain. Paralysis: this may indicate a stroke, particularly if you feel it in on one side of the body. Seizures: these can last up to two minutes.

TREATMENT FOR A BLOOD CLOT ON THE BRAIN Those who catch the blood clot in its early stages have the best chances of being treated successfully. Doctors find the clot with brain scans, and may prescribe blood-thinning medications, or recommend surgery, depending on the location of the clot and any potential dangers. 4HEALTH | 877.807.0989

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Obesity Medicine | 4HEALTH23

WHAT’S CAUSING YOUR BELLY FAT? YOU MAY HAVE INSULIN RESISTANCE!

During the past 20 years, there has been a dramatic increase in obesity in the United States. More than one-third of U.S. adults (35.7%) and approximately 17% (or 12.5 million) of children and adolescents aged 2–19 years are obese. Another 33% of all adults are in the overweight category. Though there are a lot of things that can cause weight gain, I find the following four factors often play a crucial role in expanding my patients’ waistlines.

THREE THINGS HAVE CHANGED ABOUT HOW WE EAT Hippocrates, father of medicine, is quoted as saying, “Let food be your medicine, medicine be your food.” Over the past several decades, however, we’ve moved away from this concept, and now see food merely as “calories in, calories out,” which has changed our relationship to what we eat. Three things happened to the modern diet that now contribute to the high levels of inflammation we currently see in the population at large, leading to increased health problems and disease. Understanding these three fundamental principles forms the foundation for a healthy and long life. Belly fat and insulin resistance: Insulin resistance, or metabolic syndrome, affects one in three Americans and leads to excess belly fat. Unlike the subcutaneous fat that is protective, studies have shown that belly fat produces cytokines and other inflammation-causing chemicals that lead to the increased risk of cardiovascular disease, diabetes and other conditions. In fact, waist circumference of over 40 inches in men and 36 inches in women (lower in Asian Populations), is one of the five criteria for metabolic syndrome. This leads to belly fat which increases the risk of diabetes, heart disease and even cancer risk! Lack of antioxidants: Before the modern food processing era, our diet used to have more than 50 percent unprocessed and uncooked food items such as colored fruits, vegetables, and other natural ingredients that are high in antioxidants such as polyphenols. Studies have shown that lack of polyphenols leads to increased inflammation in the body. 4HEALTH | 877.807.0989

Ratio of fats: The ratio of omega-3 to omega-6 fatty acids used to be 1:1, but is now at 1:16, which also increases inflammation.

THE FOURTH FACTOR More recent research has revealed a fourth factor in this list—lack of quality sleep. According to the National Institutes of Health, 50 to 70 million Americans are affected by chronic sleep disorders and intermittent sleep problems. The Centers for Disease Control and Prevention (CDC) adds that sleep insufficiency is linked to motor vehicle crashes, industrial disasters, and occupational errors. Lack of proper duration and quality of sleep also contributes to insulin resistance, which in turn leads to weight gain. A 2012 study, for example, found that sleep deprivation impaired the ability of fat cells to respond to insulin, the hormone that regulates blood sugar. Unfortunately, this can set in a vicious cycle where sleep problems lead to weight gain and weight gain in turn—particularly if it leads to sleep apnea—can make sleep problems worse!

PHYSICIAN ASSISTED WEIGHT LOSS CAN HELP Reversing the many factors leading to weight gain such as insulin resistance, sleep apnea, lack of proper sleep, stress, nutritional deficiencies, food sensitivities, eating disorders, hormonal imbalances etc., can be very difficult to do on your own. Diet fatigue, discouragement, and the constant ups and downs can deter even the most disciplined person from his or her goals. A physician familiar with weight loss, sleep disorders and wellness can be the helping hand you need to get back on track with your weight and your health. Realizing the bidirectional relationship between sleep disorders and weight gain, we are able to address these very inter-related fields together so you can lose weight, sleep better, and enjoy a healthier and perhaps even longer life. Our delicious and affordable W8MD weight loss meal replacement supplements start as low as $2.25 cents per meal replaced and can save up to 15% on grocery food cost. The biweekly program cost of $45.00 includes up to two appetite suppressant weight loss medications such as Phentermine, Topiramate etc. when appropriate.

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STUBBORN BELLY FAT—

TIPS

TO GET RID OF IT THERE’S MORE THAN YOUR APPEARANCE AT STAKE nnn Colleen M. Story Belly fat seems to be as big a concern today as cancer and heart disease, as least if you judge by the number of ads and products promising solutions. Unfortunately, belly fat not only looks unattractive, it’s also dangerous for your health. People who have wide girths are likely to have large amounts of deeply hidden fat around their internal organs, called “visceral fat,” which is linked with heart disease, diabetes, stroke, various forms of cancer, and other serious health issues. One study even linked belly fat to a higher risk of premature death. You may have already tried to get rid of your belly fat, and failed. If so, you know that belly fat is stubborn. How then, are you expected to get it down to size, and improve your health in the process?

Improper eating: If you eat late at night, just before you go to bed, it’s likely the extra calories will settle in around your middle. Eating too many refined carbs: Refined carbohydrates, such as those that are in white flour, white rice, cookies, cakes, and other sweetened foods, can cause a rise of insulin levels in the body. Insulin instructs the fat in your belly to store more fat. Not getting enough sleep: When you don’t get a full 7-9 hours of sleep at night, it throws off your body hormones, which can encourage you to eat more and store more fat. Age: As you get older, your metabolism slows down, which can lead to more weight gain and more belly fat. Belly fat: Unfortunately, belly fat leads to more belly fat. A 2008 study found that a hormone found in belly fat may act as an appetite stimulant.

WHAT CAUSES BELLY FAT? Eating too many calories per day while getting little exercise can cause your waist to swell. But what if you have always been slim, and then suddenly, after 40, you find your belly plumping? There’s probably a reason for that. Stress: When you get stressed out, your body releases cortisol, which translates into more sugar in the blood, and more weight gain. Genetics: If your parents had excess belly fat, your odds of having it too go up. Alcoholism: Alcohol decreases the rate of metabolism and increases obesity—calories from excess alcohol consumption are often stored around the belly. Menopause: Hormonal changes during menopause affect estrogen levels, which can also affect fat distribution in the body, leading to more belly fat.

HOW CAN YOU TELL? Whereas any belly fat isn’t good for you, a general guideline is that women with a waistline of more than 35 inches and a man with a waistline more than 40 inches are at risk of additional health problems. You can also measure your waist-to hip ratio. Measure your waist at the smallest point and your hips at the widest point, and divide the waist measurement by the hip measurement. A waist-to-hip ratio higher than 0.9 for men and 0.8 for women is considered a high risk.

TIPS TO HELP What if you find your health is at risk? The best way is by adopting lifestyle habits you can keep for the rest of your life.

Exercise: Get at least 30 minutes of moderate-intensity exercise a day. If you’re trying to lose, go for 60 minutes. Get a pedometer and shoot for 10,000 steps a day. It also helps to add in some intensity—check with your doctor first, then try sprinting as fast as you can for 30 seconds each couple of minutes of your walk. Cut back on sugar: Try swapping one sugary food for a piece of fresh fruit each day. Give up sugary sodas on most days. Eat more healthy fats: Omega-3 fatty acids are actually associated with less belly fat. Consume more nuts, olive oil, flaxseed, avocadoes, and sunflower seeds. Reduce portion size: Eating smaller meals is a great way to cut back on calories. You can eat more often, but use smaller plates and stop before you’re completely full. Sleep: Get 7-9 hours on most nights. Reduce stress: Cut back on the stress in your life, and adopt some stress-relieving techniques like yoga, meditation, and long walks. You may also try regular massage therapy. Watch what you eat: Refined carbs contribute to belly fat, while complex carbohydrates fight it. Try fresh veggies, whole grains, whole grain bread and whole grain rice. Eat more fiber: A recent study from Wake Forest Baptist Medical Center followed more than 1,000 participants and found that those who consumed more soluble fiber accumulated less visceral fat. Eat more apples, oranges, pears, peas, carrots, Brussels sprouts, oats, barley, beans, and lentils. Drink more water: Studies suggest that drinking water throughout the day can lead to a more active metabolism. 4HEALTH | 877.807.0989

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4HEALTH | 877.807.0989

CAN ANYONE HELP ME WITH THESE DRY EYES? HOW TO TELL IF IT’S DRY EYE OR ALLERGIES

nnn By Lynn Merrell You’ve seen the commercials. You know about the prescription eye drops. But surely you don’t have “dry eye syndrome?” I mean, it sounds so serious! We all suffer from dry, gritty eyes now and then. Most of the time, over-the-counter eye drops are all we need to feel better. But other times that itchy, uncomfortable feeling just goes on and on, day after day. Here’s how to tell if it’s time to see your doctor.

WHAT IS DRY EYE SYNDROME? According to the American Academy of Ophthalmology (AAO), an estimated 3.2 million women age 50 and over and 1.68 million men age 50 and over are affected by dry eye syndrome. Now keep in mind that this is an actual medical condition, and is different than the occasional dry or itchy eyes. People with dry eye syndrome have eyes that can no longer produce the lubricating tears that are needed to keep the surface of the eye comfortable and protected. In a healthy eye, the tears continuously bathe the outer surface of the eye, shielding it from the environment and keeping it hydrated. In dry eye syndrome, the eye either doesn’t produce enough tears, or the tears it does produce no longer contain the necessary lubricating liquids.

Tears are made up of other ingredients besides water. They include water, yes, but they also have lipids (a type of fat) and proteins. If there is an imbalance of the other ingredients in the tears, they may no longer be able to nourish the eye as they should. The lipids, in particular, work like “lotion” over the surface of the eye to keep it moist throughout the day.

WHAT DOES DRY EYE FEEL LIKE? You’ve likely experienced itchy, dry eyes somewhere along the way. So how can you tell whether it’s the weather, allergies, or dry eye syndrome? It’s not easy. There are similarities in all of these conditions. But one thing you can watch for is whether your dry eyes go away, or if they seem to bother you consistently day after day. Allergy eyes, for example, tend to be seasonal, and often back off after the pollen count goes down. Weather-related dry eyes will subside when the wind calms. Symptoms of dry eye can be slightly different, too. You may experience a burning or scratching feel, like something is in your eyes, along with a possible sensitivity to light. Your eyes may water more than usual — a sign that they are reacting to the dryness and are trying to fix it. Allergy eyes, on the other hand, are usually itchy first of all, and then teary. Still, it can be difficult to determine what’s causing your eye symptoms. Particularly if you’ve never experienced allergies before, you

may think that it’s dry eye when actually it’s a new allergy sensitivity.

HOW IS DRY EYE SYNDROME TREATED? The only way to know for sure what’s causing your dry, scratchy eyes is to see your eye doctor. During a complete examination, he or she can see any inflammation that may exist, and can look inside the eye to check for other issues. Do be sure that you write down all the symptoms you’re experiencing and when you experience them, to help ensure a correct diagnosis. If you are diagnosed with dry eye syndrome, your doctor will likely recommend eye drops as a first-line treatment. There are a wide variety available, and if the drops don’t work, there are ointments that are more moisturizing. These help most people to experience more comfortable vision, but if they don’t work for you, there are other options. In some cases, doctors will block the tear ducts to keep more tears available to the eye. You can also take steps at home to improve your eye comfort. Examine any medications you have to see if they may exacerbate dry eyes. Antihistamines, decongestants, blood pressure medications, and antidepressants can all reduce tear production — your doctor may have alternatives that would be less drying. Then consider taking a fish-oil supplement — the AOA some studies suggest they can help reduce symptoms. 4HEALTH | 877.807.0989

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HOW TO DECIDE WHETHER YOUR CHILD NEEDS EAR TUBES GUIDELINES SUGGEST WATCHFUL WAITING IN SOME CASES

nnn

By Morgan Rice

Kerrie’s daughter was suffering from earaches. She had hoped that the drops she got from the doctor would help, but the poor little girl was still having trouble four weeks later. It was then that Kerrie started wondering about surgery. “Don’t most little kids with ear problems get ear tubes,” she asked her friend? Indeed, surgery for recurrent ear infections is common. An estimated 700,000 children get ear tubes every year. But in 2013, the American Academy of Otolaryngology — Head and Neck Surgery (AAO-HNS) issued new guidelines stating that not every kid should get ear tubes. Here’s how to know if your child should wait.

WHY DO DOCTORS INSERT EAR TUBES? Ear tubes are tiny plastic tubes (also called ventilation tubes) that specialists insert into the eardrum to drain chronic fluid caused by recurrent ear infections. Children are most at risk for this fluid buildup because their small Eustachian tubes can’t provide needed ventilation in the ear, creating a vacuum that sucks in fluid and infection from the nose and keeps it there. Ear tubes, in addition to draining fluid, help promote optimal air exchange in the middle ear, which helps prevent a vacuum

and thereby, prevents future infections. The tubes reduce complications from ear infections, and help preserve hearing and speech development in children with chronic middle ear fluid. Most children undergo general anesthesia for the surgery. The surgeon makes a small incision in the eardrum and inserts the tiny, hollow plastic device. Ear tube insertion is the most common outpatient surgery performed on children in the U.S. Children who really need ear tubes usually benefit greatly from them. They experience more comfortable ears without the earaches, are able to sleep better and hear better, and typically act much more healthy and happy. Some ear tubes fall out on their own, and others will need to be removed by a doctor when the prescribed treatment period has ended.

RISKS ASSOCIATED WITH EAR TUBE SURGERY Though ear tube surgery is common and beneficial, like all surgeries, it comes with some risks. These include bleeding and infection, scarring or weakening of the eardrum, and failure of the eardrum to close after the tube falls out or is removed. The ear tubes may also fall out too soon, which could lead to additional surgeries to put them back in. If children have to go

through repeated insertion of ear tubes, there is a risk of scarring, though in most cases, this does not create hearing problems.

EAR TUBES MAY NOT BE NECESSARY The (AAO-HNS) states that ear tubes are not always necessary. Doctors may recommend them early on for children who suffer from recurrent ear infections, but studies have indicated that watchful waiting may work just as well. In many cases, children will get better on their own, particularly if the problem lasts for less than three months. Children without persistent fluid buildup in the ear are the most likely to recover without ear tubes. Children who do suffer from fluid buildup for at least three months are the best candidates for ear tubes, and should strongly consider surgery because the fluid buildup usually persists. Inserting the tubes most often improves hearing and quality of life, according to an analysis of 113 randomized trials. The academy also warns that waiting is not a good option for kids who are at risk for permanent hearing loss or other developmental delays, like Down syndrome and autismspectrum disorder. These children often don’t tolerate middle ear fluid well, and the fluid buildup is typically long-lasting. Studies show that ear tubes are particularly beneficial in these. 4HEALTH | 877.807.0989

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WHAT TO ASK YOUR COSMETIC SURGEON BEFORE SURGERY HOW TO BE SURE YOU’RE PREPARED

nnn By Morgan Rice You’ve made the decision. You’re going to go for it. Now you just have to be sure you understand the procedure, the risks, and what to expect. You want to be as informed as you can before undergoing any type of cosmetic surgery. Not only do you need to understand the procedure itself, but you need to know what to do afterwards, what activities to avoid, and how to take care of yourself. You need to know how much time you’ll need off work, and how quickly you can expect to recover. You also need to be sure that your surgeon is the best one for the job. All this can be a little daunting, so we’ve given you some sample questions you can take with you when you go to your next appointment.

1. ARE YOU BOARD CERTIFIED IN COSMETIC SURGERY? No matter how nice or knowledgeable your surgeon seems, you want to be sure you’re in the best hands. Most cosmetic surgeons are on the up-and-up, but remember that any licensed surgeon in the U.S. can legally perform these operations, even if they haven’t received cosmetic training, so you want to be sure you have one that’s been trained specifically for your procedure.

2. HOW OFTEN HAVE YOU PERFORMED THIS PROCEDURE? Even if your surgeon is properly certified and experienced, he or she may not be experienced in your particular procedure. Maybe he’s done a lot of eyelid lifts, but not so many belly tucks. It’s important to find out, as experience matters.

3. WHAT TYPE OF ANESTHESIA WILL I RECEIVE? Some procedures require only local anesthesia, but others require you to be totally out (general anesthesia). Local anesthesia allows for a faster recovery, but general anesthesia is generally required for more 4HEALTH | 877.807.0989

complex procedures, like a full facelift. It’s important that you understand which you will have, and who will be administering it. The person should be a board certified physician anesthesiologist.

4. WHAT WILL MY RECOVERY BE LIKE? You need to know what to expect. Will you be able to go back to work the next day, or do you need a week or two off? Will there be redness, swelling, pain? What complications should you watch for? Understanding all these things ahead of time will help you prepare, and will increase the likelihood that you’ll experience a positive recovery.

5. WHAT ARE THE RISKS? Risks can be scary, and sometimes we don’t even want to hear about them, but it’s best if you make an informed decision. Understanding the risks can also help you to catch any problems early when they are best treated.

6. WHAT WILL THE PROCEDURE COST ME? Insurance companies consider most cosmetic surgeries “elective,” which means that you will likely have to pay for the whole thing yourself. (Talk to your doctor about some cases where your insurance may help, such as in eyelid surgery, if the lids are interfering with vision.) Realize that your surgeon’s cost may be only part of the total cost. You must also pay the anesthesiologist, the operating room expenses, and for any materials used. If the costs become concerning, ask your surgeon about financing options.

7. ARE THERE ALTERNATIVES TO THIS PROCEDURE? You may have already decided on surgery, but there may be alternatives you weren’t aware of. Make sure you know if there are other ways to address the issue you’re concerned about before choosing surgery. There may be other cosmetic treatments that may create the results you want that would be less invasive and less expensive.

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(877) 582-0400 www.NYPlasticSurgeryCenter.com

LANGUAGES: ENGLISH • RUSSIAN

One of the most frustrating signs of skin aging is the telltale sagging that occurs around the cheeks, brows, and neck. Individuals in their 40s and 50s are most often frustrated by this type of sagging because it can be so difficult to counteract. Creams and topical treatments hardly make a difference, yet for many, going under the knife for an all-out surgical face lift seems too drastic a step. Fortunately, Dr. Rayham of the RR Plastix/ New York Plastic Surgery Center has a new solution that can make you look younger in a matter of weeks, but can be done in about an hour. «This is a non-invasive alternative to a traditional face lift,» he says. «It’s as close as you can get to surgical results without actually performing cuts or incisions on the face.» What is this new treatment? Called «ultherapy,» it uses the technology of ultrasound to reach the deepest layers of skin and encourage the skin to tighten itself.

WHAT HAPPENS TO SKIN’S NATURAL SUPPORT? Over time, natural aging, exposure to pollutants, sun damage, and more all contribute to the gradual breakdown of the skin’s internal structure. One of the main problems is that the production of collagen slows down. Collagen is a kind of protein that works with elastin to give skin its strength and firmness. As levels decrease, the skin starts to sag, wrinkle, and look older. According to Dr. Rayham, ultherapy helps stimulate the production of collagen, which then helps to firm up, tighten, and improve the appearance of skin.

HOW ULTHERAPY WORKS Just as an ultrasound allows a doctor to see through the belly to the fetus, ultherapy allows a plastic surgeon to see past the superficial layers of the skin to the deeper layers. This is where we find the musculature of the face—called the Superficial Muscular Aponeurotic System (SMAS). During surgery, doctors typically manipulated the SMAS to create a lasting lift. With ultherapy, however, the doctor can stimulate this deeper layer without having to make incisions. «When the ultrasound device hits the SMAS area,» Dr. Rayham says, «it burns small holes

through it without actually burning the skin. The outer layer of the skin remains unaffected. As a result, the SMAS area contracts and creates new collagen during the healing process to generate tightness. We can create all this in one pass.» The doctor goes on to explain that with a second pass of the ultrasound device over the face, the surgeon can adjust the system to affect the more superficial level of the skin, where most of the collagen already is, and again stimulate new collagen production. «The procedure can be done in our office, and takes about 40 minutes to an hour depending on how many zones need to be treated. A patient will see some immediate improvement, then after about three to four months, will see significant improvement.» The best part? There’s no downtime, no weeks of recovery, and no hiding your face from the world. «There may be the occasional bruise,» the doctor says, «but for the most part people come in, get it done, and get back to their lives.»

CHOOSING THE BEST TECHNOLOGY There are several products available that deliver ultherapy, but after over a year of research, Dr. Rayham decided to purchase the Ulthera system for his office. Combining ultrasound imaging with ultrasound therapy in a single «see and treat» device, Ulthera is considered not only effective, but extremely safe. «It’s been FDA approved for about a year now,» he said. «I followed it to make sure it actually delivered the results the company promised, and I have seen significant improvement. It can lift sagging skin on the brows, neck, and cheeks, and helps make wrinkles less noticeable.» He adds that complementing ultherapy with filler injections like Sculptra, Juvederm, and Radiesse—around the mouth, for instance—creates cumulative results and an overall «lift» appearance. If you’d like to look younger over lunch, call the RR Plastix/New York Plastic Surgery Center. Double Board Certified by the American Board of Plastic Surgery and the American Board of Surgery, Dr. Rayham can answer any questions you may have. Call 1-877-582-0400, or visit the website at www.rrplastix.com. 4HEALTH | 877.807.0989

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Podiatry | 4HEALTH33

HOW CAN I RELIEVE THIS PAIN IN MY HEELS? PODIATRIST DR. STEPENSKY HAS ANSWERS

During a typical lifetime, a person travels by foot an average of 170,000 kilometers (about 105,600 miles), which is the same as walking around the globe more than four times. The complex anatomy of the foot allows us to move the body—often while carrying heavy loads— for enormous distances. Sometimes, however, our feet require care and attention, or we end up having trouble doing all that walking. Heel pain is one of the most common conditions that can arise as we age. If you’re experiencing heel pain, that is your first signal that your feet need help. We asked Dr. Leon Stepensky, a foot treatment specialist, to tell us what causes heel pain and how we can treat and prevent it.

DOCTOR, WHAT CAUSES HEEL PAIN? The main cause is an extremely common condition—flat feet. The arch of the foot begins to sag, and as a result, the muscles and ligaments in the foot must take on a greater burden when standing and walking. Over time, these overstressed ligaments become damaged and inflamed, and the heel, the most vulnerable area of the foot, may develop bone spurs, which are areas of bony overgrowth. In most cases, the pain comes not from the spur itself, but from the inflammation around it. Many patients experience severe pain in the heels first in the morning when they get out of bed. They take their first steps and, “Ouch!” The problem is that during sleep, small damaged areas in the ligaments heal, and they become shorter. When you step on the floor in the morning, you stretch and injure them again.

WHAT ELSE BESIDES FLAT FEET CAUSES HEEL PAIN? Other factors causing heel pain include toe deformities, nervous tissue swelling, and pinched nerves.

WHO IS MORE LIKELY TO SUFFER FROM HEEL PAIN? With age, most people gradually develop flat feet. The body tries to adapt to it, but in some cases, it happens too quickly and the body has no time to adjust and redistribute the load on the foot. The ligaments become inflamed, and the person experiences discomfort and pain. Women suffer pain in their heels more often than men. This is because many of them wear 4HEALTH | 877.807.0989

high-heeled shoes for long periods of time, and then abruptly switch to a flat sole. When the foot loses the support of the heel, the complete weight of the body drops upon the ligament, and a sharp, very severe pain develops.

WHAT WE NEED TO DO TO PREVENT HEEL PAIN? The best solution is to perform special exercises designed to stretch the muscles in the feet after sleeping. I also recommend wearing shoes that provide a small heel raise for the optimal load distribution in the foot.

IF HEEL PAIN DEVELOPS, HOW DO YOU FIND OUT WHAT’S CAUSING IT? Unlike other medical offices, at the Fit Feet Podiatry, we perform digital radiography, which allows us to immediately identify the presence of heel spurs or inflammation. We also use digital ultrasound, which helps us to see the condition of the soft tissues and ligaments of the foot without the use of magnetic resonance imaging (MRI). Most medical offices have to send patients to other hospitals to undergo these diagnostic procedures. We have the capacity to do them directly in our office, which significantly reduces time and stress levels for patients.

HOW DO YOU TREAT HEEL PAIN? Treatments include physical therapy, injections, orthopedic devices, wearing appropriate footwear and, in rare cases, surgery. When the patient turns to us for help at an early stage, usually three therapeutic procedures are sufficient, and the entire course of treatment takes from three to four weeks. If you follow the recommended regimen, it is possible, in most cases, to completely eliminate pain and other symptoms. During treatment, patients are not required to take sick leave from work, and they can continue to wear regular shoes. Our office is open late in the evenings and on weekends to allow patients to combine their work schedule with treatment. If you experience even slight pain in the legs, seek medical help immediately. The sooner you begin to treat the disease, the less aggressive treatments we have to use, and the more chances for a full recovery. Dr. Leon Stepensky performs all procedures necessary for the treatment of foot pain, including surgery.

NAME:

Leon Stepensky, DPM CERTIFICATION: Trained surgeon in minimally invasive surgery, endoscopic and arthoscopic procedures with a specialty in Diabetic Neuropathy

SPECIALTY: Board Certified Podiatrist

INSURANCE: We accept all major insurance plans & Medicaid

CONTACT: 3111 Brighton 2nd St., Brooklyn, NY 11235 235 Wyckoff Ave, Brooklyn, NY 11206 99 Moore St., Brooklyn, NY 11206

(718) 874-0224

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7 COMMON FOOT PROBLEMS

AND HOW TO TREAT THEM FIND RELIEF FOR BUNIONS, HAMMERTOES, AND MORE

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By Gordon Barclay

How many people suffer from foot pain? Researchers looked into it, and reported in 2008 that out of over 4,000 people, 17.4

percent indicated they had foot pain, aching, or stiffness in their feet. Those who were over the age of 50, and who also had knee, hip, and back pain, were more likely to report experiencing foot pain, too. The researchers concluded that foot pain affects nearly one in five people. 4HEALTH | 877.807.0989

4HEALTH Are you one of them? If so, you can find relief. Below are seven of the most common foot ailments, and what you can do to improve each one. 1. Bunion: This is a bony outgrowth at the end of the metatarsal bone that causes the big toe to angle toward the second toe. The deformity creates pressure on the joint and pain when walking. Bunions tend to run in families, and are more common in women than in men. Find relief with rest, ice, and pain relievers, and look for wide shoes that help you walk more comfortably. Bunion pads can help reduce friction and blisters, and your podiatrist may be able to fit you with customized orthotics that take pressure off the painful area. Surgery is reserved as a last resort. 2. Hammertoe: These occur when the toe bends abnormally at the middle joint. They most commonly affect the three middle toes — they curve into a hammer-shaped position. Doctors believe they are caused by a muscle imbalance in the foot, brought on by wearing high heels for too long. Other structural issues, like flat feet, high arches, and arthritis can also increase risk of hammertoes. To find relief, toss the high heels, and choose shoes with sufficient room in the toe area. Talk to your podiatrist — he or she may recommend a physical therapist that may be able to help retrain the toes to flatten out again. 3. Turf toe: This is a sprain that occurs when the big toe (or one of the other toes) is bent up too far — a hyperextension injury common in sports like football. It may also occur in athletes that wear shoes that don’t provide the proper support. To find relief, ice and rest immediately after the injury, and once the pain and swelling subsides, try gradual, gently stretches to increase range of motion. 4. Morton’s entrapment: This is a condition in the foot that’s similar to carpal tunnel in the hands and wrists. It’s caused by nerve

compression at the base of the toes, and creates burning pain in the ball of the foot. Doctors believe that wearing high heels increases risk, as do sports like ballet and tennis. To find relief, apply ice and massage, and ask your podiatrist about orthotics that may help relieve the pressure. Pads placed under the ball of the foot can help ease pain. 5. Stress fractures: These are tiny, hairline breaks in the bones of the feet, and can occur in the heel bone, the top of the foot, or in the metatarsal bones. They are common in runners, and in athletes who use shoes that provide poor cushioning and support. To find relief, use rest and ice, and talk to your podiatrist. It’s important that he check the foot, as in some cases a cast may be needed. Stay vigilant — X-rays often don’t reveal stress fractures, so if you still have pain a month later, ask your doctor for an MRI. 6. Black toenail (subungual hematoma): This is a bruise that shows up under the nail, and usually occurs because the toe is hitting against the inside of your shoe repeatedly. Soccer players are also at risk. The area is usually sensitive and can become painful with walking or jogging. If you experience severe pain or nail separation, see your podiatrist for help. Otherwise get to the shoe store and find better-fitting shoes. 7. Corns: These are thick, hard growths of dead skin that develop because of repeated pressure, usually from ill-fitting shoes or a problem in foot structure. Depending on where they form, they can put pressure on the nerves, causing pain. Your podiatrist can remove the corn if necessary, but if the pain is mild, you can try over-the-counter corn remedies. Then make sure you’re wearing shoes that fit well and avoid narrow-toed options that hurt.

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IF YOU HAVE SORENESS OR SWELLING IN YOUR LEFT LEG, READ THIS! WHAT YOU NEED TO KNOW ABOUT MAY-THURNER SYNDROME

Carrie was working as an elementary teacher and raising her two children. Everything was going great until one morning when she woke up with pain in her left leg. She had played catch with her son the day before, so she figured she had just pulled a muscle. She limped through her day, but the next morning her leg was worse, not better. After three days had passed, the swelling and pain were so intense that she went to see her doctor. Carrie ended up in the hospital, diagnosed with a blood clot in her leg. After a couple of days, she was discharged and sent home with a prescription for blood thinners. She hoped that would be the end, but it wasn’t. The swelling went down some, but her leg still hurt. She tried exercising more and stretching it, but it never went back to normal. After a few months, she saw her doctor again, and he put her through more tests. The results

showed another clot in Carrie’s groin, and she ended up back in the hospital. What was going on? Carrie was a healthy woman in her 30s. She had no other risk factors for blood clots. It made no sense that she was having so much trouble with them. After several more months of tests, procedures, and pain, she finally got her answer from the second hospital she went to: She had May-Thurner Syndrome (MTS). Carrie frowned. What was that?

WHAT IS MAY-THURNER SYNDROME? Also called Cockett’s syndrome and iliac vein compression syndrome, MTS is a rare condition that occurs when the left iliac vein — the main blood vessel in the left leg that carries blood back to the inferior vena cava and on to the heart — is compressed or narrowed by 4HEALTH | 877.807.0989

4HEALTH the overlying right iliac artery. The iliac artery is the main artery that carries blood from the heart down the right leg. The compression occurs in the pelvic area and can increase risk of blood clots. You can imagine your blood vessels as hoses, and then imagine one hose on top of the other, pressing down on it. That’s the artery pressing on the vein underneath. Over time, it can restrict blood flow from that vein and can cause pain, discomfort, and swelling in the left leg. In some cases, it can increase risk of deep vein thrombosis (DVT), which is just the medical term for a blood clot in the leg. The concern is that DVT can lead to pulmonary embolism (PE)—a blood clot in the lung. If a clot forms in the veins in the legs, there is a chance it could break free and travel back to the heart and lungs. A blood clot in the lungs can be a life-threatening event.

MTS CAN BE DIFFICULT TO DIAGNOSE MTS can be difficult for doctors to diagnose, because the symptoms show only a blood clot, not the cause of it. Like Carrie, most people experience pain and swelling in the left leg, so they don’t realize they may have MTS. Other symptoms may include varicose veins, chronic leg swelling, ulcers or sores on the left leg, pelvic pain, redness or discoloration in the skin, and swollen leg veins. However, these symptoms can be caused by other vascular issues, too, so it’s not a clear-cut situation. Some people can even have MTS, but experience no symptoms at all! Currently, we don’t know what causes MTS, or how many people may have it, but estimates are that it can range from 18 to 49 percent of patients who have left leg DVT. It usually shows up first as an acute blood clot in the leg and seems to occur in women more than men, usually between the ages of 20 and 40. Patients who have MTS may be treated initially just for DVT, but then experience recurring blood clots with chronic leg swelling, discomfort, and pain. They often return to their doctors with repetitive problems that don’t respond to common blood thinning drugs or other blood clot treatments.

USA VEIN CLINICS PROVIDES EFFECTIVE MTS DIAGNOSIS There are tests, however, that can reveal the presence of MTS. These include ultrasounds, computed tomography (CT scan), special x-rays, and magnetic resonance venography, which is another imaging technique that allows doctors to see the veins. Fortunately, USA Vein Clinics, a nationwide network of physicians, nurses, and specialists, offers evaluation and individualized treatment for MTS. They have the latest diagnostic technology to help zero in on what’s causing a blood clot and can help you finally figure out what’s going on. Treatments are customized to the individual to reduce the risk of future blood clots and PE. These may include blood-thinning medications or other blood clot dissolving techniques. If you are experiencing symptoms like Carrie’s, talk to the doctors at USA Vein Clinics about your options. They can help you decide which type of treatment is best for you. You can find USA Vein Clinics all over the nation, including in Florida, California, Illinois, and several in the New York area. Call today at 718–509–0906, or go to www.USAVeinClinics.com to schedule a consultation. SOURCES Manu Rajachandran, Robert M. Schainfeld, “Diagnosis and Treatment of May-Thurner Syndrome,” Vascular Disease Management, November 2014, 11(11): E265-E273, http://www.vasculardiseasemanagement.com/ content/diagnosis-and-treatment-may-thurner-syndrome.

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STUDY: NEWER DRUGS LESS EFFECTIVE THAN OLDER ONES? YOU MAY BE BETTER OFF IGNORING THE LATEST DEVELOPMENT nnn Colleen M. Story Diana heard about a new medication for depression in a television ad. It piqued her curiosity. Her current medication seemed to be working “okay,” but she wondered — maybe the new drug, developed with everything we now know about the disorder, would likely work better. According to a recent study, not necessarily. In fact, researchers found that new drugs seem to be even less effective than the older standbys that were developed decades ago.

WHAT THE STUDY FOUND For the new study, which was published in the journal Health Affairs, researchers examined data from 315 clinical trials that compared a drug to a placebo and were published in top medical journals like the British Medical Journal, Journal of the American Medical Association, Lancet and the New England Journal of Medicine. The studies were all published between 1966 and 2010. The drugs tested in the studies ranged from those used to treat cardiovascular disease and infections to those used against cancer, mental disorders, and respiratory illnesses. Scientists found that in the early years, the drugs easily beat the placebo (so-called “sugar pill”). On average, they were 4.5 times as effective as the placebo, helping to lower blood pressure, kill off tumors, ease depression, etc. By the 1980s, however, the scientists discovered a change. During that decade, drugs were less than four times better than placebo. By

the 1990s, they were only twice as good, and by the 2000s, newer drugs were just 36 percent better than placebo. Researchers concluded that older drugs were much superior to placebo, while newer ones were only slightly so — making older drugs generally more effective than newer ones.

WHY WOULD OLDER DRUGS WORK BETTER? As to why newer drugs may not be effective, researchers had some theories. Dr. Mark Olfson, one of the lead authors of the study, suggested that newer drugs target less-central causes of disease, which may be more difficult to affect. He also noted that patients who volunteer for clinical trials may be harder to treat today than they were in decades past, because existing medications did not help them. He suggested they may have forms of the disease that are harder to treat. Other experts commenting on the study suggest that it could be that science is looking more closely at drugs today than they did years ago, but Olfson cautioned against assuming the study results were only caused by improvements in science. “Something real is going on here,” he said.

NEW DRUGS CAN BE DANGEROUS Olfson went on to note that doctors often prescribe older drugs rather than newer ones for conditions like depression and high blood pressure. “Physicians keep saying that many of the new things just aren’t working as well,” he said.

Some newer drugs have also been associated with serious and often severe side effects. Some examples include: Pradaxa: A blood-thinning medication used to treat non-valvular atrial fibrillation. Has been linked with life-threatening bleeding, and unlike warfarin (Coumadin), has no readily available antidote. Yaz/Yasmin: Birth control pills that have been found to increase risk of blood clots and related complications like stroke and pulmonary embolism more than older birth control pills. Propecia: A male pattern hair loss treatment liked to sexual dysfunction and persistent erectile dysfunction. SSRI antidepressants (including Zoloft and Paxil): When taken by pregnant women, linked to birth defects, including heart, cranial, and abdominal defects. Actos: A treatment for type 2 diabetes linked with increasing the risk of bladder cancer.

BEST APPROACH FOR PATIENTS The best thing patients can do to protect themselves is to talk to their doctor carefully about any prescription medications. Don’t be eager to use a new drug if an older, less expensive and more proven one will work just as well. If you’re finding no relief on older medications and your doctor recommends a newer one, make sure you understand all possible side effects and interactions with other medications, and report any unusual or disturbing symptoms right away. 4HEALTH | 877.807.0989

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PROSTATE CANCER: SLOW-GROWING VS. ADVANCED WHAT IS THE OUTLOOK FOR THE MOST SEVERE STAGES?

nnn By Gordon Barclay Most types of prostate cancer are slowgrowing, and unlikely to cause problems requiring treatment. Harvard researchers reported in 2013 that the aggressiveness of prostate cancer “at diagnosis” appears to remain stable over time for most men. In other words, if your doctor told you that your cancer was slow-growing and advised watchful waiting rather than treatment, you can feel good about that recommendation. But what if you have the aggressive form of prostate cancer? Then how do things look for your future?

SLOW-GROWING PROSTATE CANCER DOESN’T REQUIRE TREATMENT Prostate cancer occurs when cells in the prostate start to grow uncontrollably. The prostate is a walnut-sized gland that is located below the bladder and produces some of the fluid in semen. It also helps control urine flow. Prostate cancer is the most common cancer in men, and affects about 160,000 men each year. Prostate cancer may not cause any symptoms, but if it does, they may include frequent urges to urinate, blood in the urine, painful urination, or difficulty maintaining an erection. These symptoms can also indicate prostate enlargement, however, without cancer, so it’s important to check with your urologist to find out.

As mentioned above, most prostate cancers are slow growing, and doctors are likely to recommend watchful waiting. They used to advise treatment no matter what, but recent studies have indicated that treatment can create difficult side effects like incontinence and sexual dysfunction. Meanwhile, slow-growing cancers are unlikely to cause problems in older men.

WHAT IS ADVANCED PROSTATE CANCER? Aggressive prostate cancer, however, requires immediate treatment. In this type of cancer, the cells and tumors may have spread to other parts of the body. If this happens, it’s considered an advanced form of cancer. This type of prostate cancer is rare, because most men are diagnosed in the early stages, which is best for long-term health. Stage IV prostate cancer is the most serious type, and usually means that the cancer has moved to pelvic lymph nodes or is interfering with the ureter tubes that connect the kidneys to the bladder. Sometimes, the cancer has spread to more distant locations like the spine or pelvis. The good news is that even this stage of cancer is treatable in most cases. Doctors focus on stopping the spread of cancer, and will use radiation and chemotherapy treatments to do that. The prostate will also be removed in surgery. Additional therapies are also available to help.

OUTLOOK FOR ADVANCED PROSTATE CANCER Other treatment methods for advanced prostate cancer include: n Hormone therapies: These treatments help inhibit hormones that can contribute to cancer growth, and can also reduce pain and improve quality of life. n Immunotherapies: These are immuneboosting treatments that strengthen the body’s own immune fighter cells so they can more effectively battle the cancer cells. n Medications to treat bone metastasis: These medications are used when the cancer has spread to nearby bones. They can reduce the breakdown of bone material and reduce pain. According to the American Cancer Society, the survival rate for all prostate types is very encouraging. It’s 100 percent at five years, 98 percent at 10 years, and 95 percent at 15 years. Even when the cancer has spread to nearby areas, the survival rates are still high. It’s only when the cancer has spread to distant lymph nodes, organs, or bones that treatment is more difficult. Then the survival rate is about 28 percent. No matter what the odds say, each person is different. Men should talk to their doctors about their unique types of cancer, and seek the opinions of other professionals as well, like dieticians and physical therapists, to help improve quality of life. 4HEALTH | 877.807.0989

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Medical Office is looking for a FT Front Desk Receptionist and a FT Medical Assistant (experience is a MUST). 718-854-5100

Call us if you need Mobile Ultrasound Services: Echo, Vascular and General Ultrasound. (917) 750-2275

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Medical office seeks a Russian-Speaking Registered Nurse Practitioner. Please submit your resume to medicaloffice41@gmail.com

Per Diem Covering CHIROPRACTIC PHYSICIAN (NY/NJ Lic.) available for PT. Own Malpractice Ins. Call Dr. Joseph Juliano 973-752-9559

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An opportunity exists for a Nurse Practitioner (NP) to care for Dermatology and Aesthetic patients in our outpatient clinic. The NP will be covering a full range of medical, aesthetic and minor office procedures. Full-time job. Experience: NP - 1 year. NP License, Active DEA License, Russian Speaking a must. Contact: info@allureclinic.com 347-683-3589 Richard

Medical space for subleasing at 500 Brightwatercourt in Brooklyn (b/n Brighton 4th street and Brighton 5th Street) for any medical specialist (not for internal medicine doctor and podiatrist). The office is located in the building for senior citizens. There is a big potential for new patients referrals. For details call (646)251-6646.

Licensed Ultrasound Technologist (RDMS) is looking for part time or full time position. Resume available upon request. Tel. 718-608-7402; Email at violasvu@gmail.com.

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4HEALTH

DENTISTRY - GENERAL

Vladimir LEMPERT, DMD

3037 Ave U Brooklyn, NY 11229

(888) 607-9725

DENTISTRY - PEDIATRIC

Marina KREPKH, DDS

7708 4th Ave Brooklyn, NY 11209

(888) 502-6245

INTERNAL MEDICINE

Victoria ALEKSANDROVICH, MD

3080 W 1st St, Ste 102 Brooklyn, NY 11224

(718) 207-7071

DERMATOLOGY

NEUROSURGERY

Narayan SANDARESAN, MD

5 E 84th St New York, NY 10028

(212) 328-0135

2601 Ocean Pkwy, FL 7 Brooklyn, NY 11235 199 Mount Eden Pkwy, Fl 6 Bronx, NY 10457

(844) 957-7463

OBESITY MEDICINE

Prabhakara R. TUMPATI, MD

2003 Bath Ave Brooklyn, NY 11214 1718 Welsh Rd, Philadelphia, PA, 19115 987 Old Eagle School Rd, Ste 712, Wayne, PA, 19087

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ONCOLOGY

Anella BAYSHTOK, MD

2101 Ave X Brooklyn, NY 11235

(718) 512-2160

158-06 Northern Blvd Flushing, NY 11358

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OB/GYN - GENERAL

Yekaterina LEVIN, DDS

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Faina SHNAYDMAN, MD Leonard LEVITZ, MD

1749 E 16th St Brooklyn, NY 11229

312 Neptune Ave, Ste 1, Brooklyn, NY 11235 169-95 137th Ave, Jamaica, NY 11434

(718) 528-1503

(718) 375-4747

321 Edison St Staten Island, NY 10306

Tariq LAMKI, MD

5 E 84th St New York, NY 10028

(212) 328-0135

2601 Ocean Pkwy, FL 7 Brooklyn, NY 11235 199 Mount Eden Pkwy, Fl 6 Bronx, NY 10457

GASTROENTEROLOGY

(844) 957-7463

Hayama BRILL, MD

1725 E 12th St, Ste 301 Brooklyn, NY 11223

(718) 336-1909

2101 Ave X Brooklyn, NY 11235

(718) 512-2160 OPTOMETRY

629 Park Ave New York, NY 10065

(212) 744-0392 OB/GYN - FERTILITY SPECIALIST

Nataliya SAFONOVA, DDS

Lilia LEVITZ, MD

2211 Ocean Ave Brooklyn, NY 11229

1749 E 16th St Brooklyn, NY 11229

(718) 376-1090 (800) 801-0603

(718) 375-4747

321 Edison St Staten Island, NY 10306

Irina BERLIN, MD

Margarita BAUMAN, OD

NEUROLOGY

40 West Brighton Ave, Ste 104 Brooklyn, NY 11224

2601 Ocean Pkwy, FL 7 Brooklyn, NY 11235 199 Mount Eden Pkwy, Fl 6 Bronx, NY 10457

Salamon RAFAILOV, DDS

(844) 957-7463

Alexander BRODSKY, MD

8622 Bay Pkwy, Ste 1 Brooklyn, NY 11214

(718) 759-6979

5 E 84th St New York, NY 10028

(212) 328-0135

187-06 Union Tpke Fresh Meadows, NY 11336 3071 Ave U Brooklyn, NY 11229

1910 Ave U Brooklyn, NY 11229

Erico CARDOSO, MD

(718) 627-8300

(718) 736-0123

Paul GLIEDMAN, MD

Dmitriy GRINSHPUN, MD

Hanna JESIONOWSKA, MD

159 E 74th St, Ste C New York, NY 10021

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Aleksandra ZLOTNIK, OD

174 Brighton 11th St, Fl 1 Brooklyn, NY 11235

1910 Ave U Brooklyn, NY 11229

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(718) 759-6979

(718) 333-2121

PAIN MANAGEMENT

Amit SCHWARTZ, MD

948 48th St, Fl 2 Brooklyn, NY 11219

(718) 283-7219

Radmila SHUMINOV, DDS

187-06 Union Tpke Fresh Meadows, NY 11336 3071 Ave U Brooklyn, NY 11229

(718) 736-0123

Sam WEISSMAN, MD

202 Foster Ave Brooklyn, NY 11230

(718) 854-5100

Sergey ZHIVOTENKO, MD

2797 Ocean Pkwy, Fl 2 Brooklyn, NY 11235 20-04 Seagirt Blvd Far Rockaway, NY 11691

(718) 576-1212

Mila MOGILEVSKY, DO

1599 E 15th St, Fl 2 Brooklyn, NY 11230 369 Lexington Ave, STE 800 New York, NY 10017

(347) 252-6732

4HEALTH | 877.807.0989

4HEALTH PODIATRY

Julie PARITSKAYA, PA

1599 E 15 St, Fl 2 Brooklyn, NY 11230 369 Lexington Ave, STE 800 New York, NY 10017 th

(347) 252-6732

Leon STEPENSKY, DPM

3111 Brighton 2nd St., Brooklyn, NY 11235 235 Wyckoff Ave, Brooklyn, NY 11206 99 Moore St., Brooklyn, NY 11206

(718) 874-0224

ALTERNATIVE MEDICINE - GENERAL

RADIOLOGY

Sinai DIAGNOSTICS

2560 Ocean Ave Brooklyn, NY 11229

(888) 496-2688

2071 Clove Rd Staten Island, NY 10304

(888) 496-2688 UROLOGY

David SHUSTERMAN, MD

800 2 Ave, Fl 9 New York, NY 10017 69-15 Yellowstone Blvd Forest Hills, NY 11375 1013 Ave J Brooklyn, NY 11230

Universal Aesthetics 514 Ocean Pkwy, Brooklyn, NY 11218

(718) 360-9550 nyurology.com

VASCULAR SURGERY

(860) 671-1727

Ada KULAGINA, LAC

8635 21st Ave Brooklyn, NY 11214

(718) 934-8484

PHYSICAL THERAPY

NUTRITION AND DIETETICS

Essential Supply LLC (732) 881-6575 www.essentialdmbs.com

Alina VASILYEVA, DPM

2116 Ave P Brooklyn, NY 11229 1605 Voorhies Ave, Fl 5, Brooklyn, NY 11235

(718) 646-0131

PSYCHOLOGY

Yuly CHALIK, MD

USA VEIN CLINICS

(347) 508-3991

2511 Ocean Ave, Ste 102 Brooklyn, NY 11229

2632 E 14th St Brooklyn, NY 11235 107-15 Jamaica Ave Queens, NY 11418 www.nyui.org

1153 First Ave New York, NY 10065

2444 86Th St, Ste A Brooklyn, NY 11214

Albert GROSS, CNS, NYS, CDN

1942 E 8th St Brooklyn, NY 11223

(718) 376-8317 www.nylifex.com

MULTI SPECIALTY

USA VASCULAR CENTERS

116-02 Queens Blvd Forest Hills, NY 11375

260 W Sunrise Hwy, Ste 102 Valley Stream, NY 11581

(718) 393-5331

260 W Sunrise Hwy, Ste 102 Valley Stream, NY 11581

1901 82nd St Brooklyn, NY 11214

(718) 490-2416 PLASTIC SURGERY

2444 86th St, Ste A Brooklyn, NY 11214

1975 Hylan Blvd Staten Island, NY 10306

Vladislav RUDNER, PT

www.magichandspt.com

Chloe CARMICHAEL

230 Park Ave, Fl 10 New York, NY 10196

(212) 729-3922 PSYCHIATRY

Vitaly RAYKHMAN, MD

4159 Broadway Washington Heights, NY 10033

2632 E 14th St Brooklyn, NY 11235 107-15 Jamaica Ave Queens, NY 11418

59-20 Myrtle Ave Queens, NY 11385

www.nyui.org

122 Fulton St, 5th Fl. New York, NY 10038

(347) 508-3991

30-33 Steinway St Astoria, NY 11103

MEDICAL TRANSPORTATION

Multi SPECIALTY CLINIC 3023-3027 Ave V Brooklyn, NY 11229

(877) 807-0989 AESTHETIC CENTERS

5221 Broadway New York, NY 10463

RANNETA TRANSPORTATION

2965 Ocean Pkwy, 3rd fl, Brooklyn, NY 11235

Roman RAYHAM, MD, BOARD CERTIFIED IN PLASTIC SURGERY

62-69 99th St., Ste 2B, Rego Park, NY 11374

156 Route 59, Ste B1, Suffern, NY 10901

(347) 848-0049

(718) 509-0906 www.usaveinclinics.com

1616B Voorhies Ave Brooklyn, NY 11235 161 Madison Ave, Ste 11W New York, NY 10016

Interborough DEVELOPMENTAL & CONSULTATION CENTER

www.nyplasticsurgerycenter.com

(888) 987-5751

(877) 582-0400

MEDICAL SUPPLY

(888) 600-2262

Michael RISKEVICH, MD

3140 Coney Island Ave., 3rd Fl., Brooklyn, NY 11235

1623 Kings Hwy, Fl 4 Brooklyn, NY 11229

Ridwan SHABSIGH, MD

3121 Ocean Ave Brooklyn, NY 11235 944 Park Ave New York, NY 10028

(718) 283-7746

Michael PATIN, MD

6417 Bay Pkwy Brooklyn, NY 11204

(718) 234-6767

102-30 Queens Blvd Forest Hills, NY 11375

(718) 896-2333

LSA RECOVERY

1300 Ave P Brooklyn, NY 11229

(888) 983-4055

4HEALTH | 877.807.0989

4HEALTH Magazineâ&#x201E;¢ gathers data from a variety of different sources, public and private. While we strive to provide the most accurate, up-to-date information possible, we can't guarantee that our listings are completely free of errors. If you feel some data is missing or inaccurate, please feel free to contact us at any time. Thank you for your support!

4HEALTH

4HEALTH | 877.807.0989

4HEALTH

4HEALTH | 877.807.0989

4HEALTH

4HEALTH | 877.807.0989