YHC MAGAZINE MAY 2012 - WOMEN'S HEALTH

VENTURA COUNTY

CONEJO VALLEY

WEST SAN FERNANDO VALLEY

WOMEN & HEART DISEASE:

KNOW THE FACTS

WOMEN’S

HEALTH SCREENINGS

IS YOUR MAN

THE BEST HE CAN BE?

WOMEN’S ISSUE HEALTH MAY 2012

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UNDERSTANDING

HRT

& VENOUS REFLUX

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WOMEN’S HEALTH ISSUE / MAY2012

D E PA RT M E N TS

PUBLISHER’S LETTER Sisterhood

pg 6 FYI

Health Tips & Tidbits

pg 9

9

14

10

20

24

28

NATURAL APPROACH

Hormonal Replacement Therapy— Health or Harm?

pg 16

F EAT U R ES

SPECIAL HEALTH BULLETIN

Be Aware—Every Year More Women Die from Heart Disease than Men

pg 10

HEALTH VIEW 1 When Does Leg Discomfort Point to Venous Reflux?

pg 20

HEALTH VIEW 2

Team Effort Leads to Successful Interventions

pg 24

HEALTH VIEW 3 Better Man The Most Important Question a Man Can Ask Himself?

pg 28

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MAY 2012

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Finding answers together - since 1986 MAY 2012

yhcMAGAZINE.COM | 5

PUBLISHER’SLETTER | ANN K. CASTLE

S I S T E R H O O D I CONSIDER MYSELF A VERY BLESSED WOMAN FOR MANY REASONS, BUT ONE REASON IN PARTICULAR IS FOR THE WONDERFUL FRIENDS IN MY LIFE. WHETHER WE ARE LOCAL AND GETTING TOGETHER FOR AN EVENING OF SHARING LIFE’S EXPERIENCES BY THE FIREPLACE OR IT’S COFFEE TALK WITH MY DEAR FRIENDS OUT OF STATE, THEY ARE ALL EQUALLY PRECIOUS TO ME.

No matter what happens in our lives, many of the conversations are based around the various health issues in the news or in our respective homes. Taking into ANN K. CASTLE consideration most of FOUNDER & PUBLISHER my friends are in their middle years, we cover everything from the growing aches and pains of life to hormonal challenges.

There are several issues facing women today that are of a deep concern, especially this year.

While the nation watches, women are faced with very sensitive issues that could impact not only their lives but the lives of their mothers, daughters, sisters, and of course their friends.

Whatever the subject or the outcome, it is paramount to band together in the spirit of sisterhood and discuss these life-changing matters.

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MAY 2012

We must be proactive and educate ourselves to better understand the long- and short-term effects of the many health-related issues unfolding. There is no better way than to hear each other with respect and with an open mind.

In this issue, we explore the complexities of our hormones, the tell-tale signs of venous disease, the statistics of heart disease in women and much more.

Through the years, YHC Magazine has covered a plethora of health issues, from pets to seniors, addressing the various modalities to help you, dear reader, to be informed and empowered. I hope you will find YHC Magazine a constant source of vital information in order to make the right decisions for each of you.

With Peace, Love, Blessings and Gratitude,

MAY 2012

yhcMAGAZINE.COM | 7

CATCHING UP ON ZZZZZ’S

BY DR. HEVER

FOUNDER & PUBLISHER ANN K. CASTLE COPY EDITOR JAN TUCKER, MBA ACCOUNTING DONNA BRYANT ADVERTISING MARIAN GREEN MARIAN@YHCMAGAZINE.COM 818.943.0751 LAURA MUSTACCHIO LAURA@YHCMAGAZINE.COM 805.558.9817

What causes snoring?

CONTRIBUTING WRITERS GREGORY K. ALBAUGH, DO, FAPWCA; ALICIA DOYLE; WAYNE M. LEVINE, MA; SHARON NORLING, MD, MBA; ALON STEINBERG, MD, FACC

When you lie down and go to sleep, the muscles of your mouth relax and gravity pulls the tongue and lower jaw back.

This can lead to partial or full airway obstruction. Your uvula—that teardrop-shaped thing in the back of your throat—can cause minor snoring when it vibrates.

COVERAGE AREA INCLUDES MONTHLY TO VENTURA COUNTY, WEST SAN FERNANDO VALLEY, AND THE CONEJO VALLEY; AGOURA HILLS, CALABASAS, CAMARILLO, ENCINO, MOORPARK, NEWBURY PARK, NORTHRIDGE, OAK PARK, OXNARD, SIMI VALLEY, TARZANA, THOUSAND OAKS, VENTURA, WESTLAKE VILLAGE, WEST HILLS, WOODLAND HILLS

Some people have sleep apnea, a more serious condition that deprives the brain of oxygen throughout the night. If you have sleep apnea, it can wake you up and leave you tired throughout the day. More serious conditions like this require a C-PAP device.

WWW.YHCMAGAZINE.COM

If you snore, try lying on your side. This works for a small percentage of people.

But those who snore even when on their side should consider a small jawrepositioning appliance. This custom made appliance can be quite affordable at your dentist and can deliver a good night of sleep for you and your loved ones. Ask your dentist about this snore stopper. Sweet dreams ;) Questions can be addressed to Dr Hever by emailing info@westlakevillagecadentist.com

FOR ALL INQUIRIES, CONTACT ANN K. CASTLE AT ANN@YHCMAGAZINE.COM OR 805.341.2972

MEDICAL ADVISORY BOARD KATIE GREELEY, DC UNTIED FAMILY CHIROPRACTIC SPECIALIZING IN PEDIATRIC CHIROPRACTIC CARE STEVEN GREENMAN, DDS SPECIALIZING IN ADVANCED COSMETIC, IMPLANT & SEDATION DENTISTRY, SNORING & SLEEP APNEA HILDA MALDONADO, MD SPECIALIZING IN FUNCTIONAL MEDICINE, ANTI-AGING MEDICINE & HORMONE THERAPY SHARON NORLING, MD BOARD CERTIFIED OB/GYN, HOLISTIC/INTEGRATIVE MEDICINE, MEDICAL ACUPUNCTURE, NUTRITION & FUNCTIONAL MEDICINE DENISE NOYER-EREZ, LAC, FABORM LICENSED ACUPUNCTURIST, SPECIALIZING IN WOMEN’S HEALTH DANIEL SLATON, DVM WESTLAKE VILLAGE ANIMAL HOSPITAL ALON STEINBERG, MD, FACC BOARD CERTIFIED CARDIOLOGIST

STEVEN HEVER, DDS www.westlakevillagecadentist.com 860 Hampshire Road, Suite E Westlake Village, CA 91361 805.777.7447

The opinions expressed here are those of the individual writer and not necessarily those of the publishers or management of YHC Magazine. All rights reserved. Reproduction in whole or in part without written permission is prohibited. Publication of the name or photo of any person or organization in YHC Magazine should not be construed as an indication of that person’s expressed opinion. Advertisers and their agencies assume responsibility and liability for the content of their advertisement in YHC Magazine. Photographers whose work is published in any advertising or editorial content within YHC Magazine agree to indemnify and save harmless the publishers from all liability, loss and expense due to a photographer’s failure to gain a model release. YHC Magazine is not responsible for loss of or damage to unsolicited manuscripts, unsolicited artwork, or any other unsolicited material.

Unsolicited material will not be returned. YHC Magazine’s liability in the event of an error is limited to a printed correction. YHC Magazine does not assume liability for products or services advertised herein.

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HEALTH TIPS & TIDBITS

REGULAR HEALTH SCREENINGS ARE THE MOST IMPORTANT TOOLS YOU CAN USE TO BE PROACTIVE ABOUT YOUR HEALTH. AS WOMEN, WE TEND TO TAKE CARE OF EVERYONE ELSE FIRST. REMEMBER, YOU CANNOT BE PRESENT AND AT YOUR BEST FOR YOUR FAMILY IF YOU DON’T TAKE CARE OF YOURSELF. Following is a list of health screenings to keep in mind:

Vision: Eye exam including dilation is recommended annually by your optometrist or ophthalmologist, unless otherwise prescribed.

Blood pressure: Have your blood pressure checked at least annually. If it is higher than 130/85, most doctors recommend having it checked more often. Also, people with diabetes, heart disease, kidney problems and other serious medical conditions may need to be monitored more closely.

Dental: Dental check ups with oral exams are normally done every six months unless prescribed more frequently by your dentist.

Bone density: This test, also called a bone mineral densitometry (BMD) or DEXA scan, evaluates bone mass and helps find areas of low bone density. This test is usually done at the age of menopause and every two years thereafter to screen for osteoporosis and osteopenia, the first step of calcium loss.

Blood test: At every yearly checkup, a blood test should be done to detect diabetes, cholesterol levels, complete metabolic panel, thyroid function (TSH, free T3 and free T4), complete blood count and vitamin D3.

General checkup: No matter what age you are, make sure to get a full annual checkup, including weight and height. If you haven’t already, call your doctor soon to schedule an appointment.

Urinalysis: This test is done to determine glucose levels and any blood or protein that might suggest hepatitis or problems with the bladder or kidney.

Mammogram: Beginning at age 40, have a mammogram once every one to two years. A mammogram produces images of each breast’s inner breast tissue on film, using a very low dose of radiation produced by a machine specifically designed for mammograms. Mammograms can help identify malignant tumors within the breast and help detect the development of cancers.

Thermography is another diagnostic test for the detection of breast cancer.

Pelvic exam and pap smear: The pelvic exam is a complete physical exam of the pelvic organs. In addition to your general health, this exam is used to detect vaginal infections and sexually-transmitted diseases (STDs) such as chlamydia, herpes, gonorrhea, trichomoniasis and human papillomavirus (HPV), some of which are undetectable without an exam.

Abdominal aortic aneurysm screening: For people older than 65, this ultrasound test looks for stenosis tightening, clogging and may help predict strokes.

Colorectal cancer screening: Begin this screening at age 50. This may involve a stool test, a rectal exam, a colonoscopy, flexible sigmoidoscopy or double-contrast barium enema. If the results are negative, one can wait another five to seven years for the next screening. This screening may be done more frequently if the test results are positive or if polyps have been detected. development of cancers. Thermography is another diagnostic test for the detection of breast cancer.

MAY 2012

yhcMAGAZINE.COM | 9

SPECIALHEALTHBULLETIN WOMEN’S HEART HEALTH

BE AWARE—

EVERY YEAR MORE WOMEN DIE FROM HEART DISEASE THAN MEN

BY ALON STEINBERG, MD

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Do you know the greatest health problem facing women toDay? Many women answer cancer—specifically breast cancer. But more than one in three women die from heart disease while one in 30 die from breast cancer.1

...63 “

PERCENT

OF WOMEN DIE SUDDENLY FROM HEART DISEASE WITHOUT A WARNING SYMPTOM VERSUS 48 PERCENT OF MEN.

It is a myth that heart disease is a man’s disease. The following are shocking facts about women and heart disease.

1. More women die of heart disease than men every year.2 2. 23 percent of women die within the first year of a heart attack versus 18 percent of men.

3. Rates of heart disease in men have dropped significantly during the last two decades (22 percent) due to improved awareness and medical treatments, but rates of heart disease in women have fallen significantly less than those of men (9 percent).

cVD disease mortality trends for males and females, (united states: 1979-2006).

2

Notice the dramatic declines in death in men with heart disease, stroke, and all other forms of cardiovascular disease during the last two decades. There is only a recent decline in female deaths since 2000, likely due to improved education and treatment in women. Still, more women die of cardiovascular disease every year than men.

“

After the age of 60 the rate of death from heart disease (blue line) and stroke (yellow line) is multiple times higher per 100,000 women than that from four different types of cancer.

1

WHY ARE THESE FACTS TRUE? One reason females with heart disease do so poorly is a lack of awareness among women. In one survey only about 20 percent of women identified heart disease as their main health threat, even though heart disease is the number one killer of U.S. women today.

Women may not be taking their risk of heart disease seriously. Many women do not know that chest pain may be a warning sign of heart disease and a heart attack. Many women delay seeking help for symptoms because they feel their symptoms likely are not coming from their heart.

Women are less likely to call 911 or see their health care provider when they have chest pain. Also, women are more likely than men to have atypical chest pain that represents heart disease. They are more likely to have dull or sharp chest pain and less likely than men to have the typical substernal chest pressure (perceived pressure below the sternum or breastbone) when having a blocked heart artery.

When presenting with heart disease, women compared to men are also more likely to have no chest pain at all. They more often present with just shortness of breath, nausea or fatigue as their first symptom of heart disease. Also, women are more likely to have no symptoms at all when they have a blockage in the heart. This is called silent ischemia (a deficient supply of blood to the heart with no symptoms).

>>

MAY 2012

yhcMAGAZINE.COM | 11

SPECIALHEALTHBULLETIN WOMEN’S HEART HEALTH

In fact 63 percent of women die suddenly from heart disease without a warning symptom versus 48 percent of men. When women do have symptoms and finally come to seek help, the delay in care has led to progression of their disease. They are in worse condition when they reach their medical professionals and are therefore at a higher risk.

OUR HEALTHCARE SYSTEM IS ALSO AT FAULT Unfortunately doctors are at fault too.

Healthcare professionals don’t always take their female patient’s risks and symptoms seriously. Underdiagnosis and undertreatment likely contribute to excess female deaths.

In a recent survey, 90 percent of primary care physicians did not know heart disease each year kills more women than men. Women are less likely to receive certain diagnostic testing from doctors such as stress testing. They are less likely to receive necessary treatment such as cardiovascular medications, angioplasties and stents.

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• Nutritional supplementation • Lifestyle changes (individualized diet and exercise) • Stress management • Education • Judicious use of medications as required Dr. Hilda Maldonado is board certified in Internal Medicine and additionally she is a diplomate of the American Academy of Regenerative and Anti-Aging Medicine.

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MAY 2012

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UNDERREPRESENTATION OF WOMEN IN CARDIOVASCULAR CLINICAL TRIALS Another possible reason prognosis in women with heart disease is lower than in men is that women are significantly underrepresented in clinical trials. Even though around half of the population with heart disease is women, when new medications or new devices were tested (stents, pacemakers, defibrillators), only 27 percent of patients studied were women. Many clinical studies regarding stress testing were conducted with women representing only 10 percent of the subjects!

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3 Doctors are treating women with data and information derived from trials using mostly males. Our derived medical guidelines may not translate to optimal diagnosis and treatment in women.

WHAT IS BEING DONE? Medical societies and our government are trying to implement changes in this biased practice of clinical trials. Congress recently passed the HEART (heart disease education, analysis, research and treatment) for Women Act. One of this bill’s original sponsors is Lois Capps, a former nurse and local congresswoman representing Santa Barbara and Ventura Counties.

This law ensures gender-specific information about new medical treatments is available to clinicians and the public. The legislation requires clinical drug and medical device trials to study safety and efficacy in a proportionate number of women and men.

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The HEART for Women Act also requires the Secretary of Health and Human Services to report annually to Congress on the quality of and access to care for women with heart disease, stroke and other cardiovascular diseases.

>>

MAY 2012

yhcMAGAZINE.COM | 13

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PREVENTING HEART DISEASE IF YOU ARE A WOMAN You can do a lot to prevent heart disease.

It is crucial to educate yourself thoroughly about heart disease. You should understand your risk factors and start working to modify them. If you have heart disease already, you and your doctor must work harder to prevent recurrent heart problems.

When we speak about heart disease we are mostly concentrating on atherosclerosis of the heart arteries or coronary artery disease. The coronary arteries are the blood vessels on top of the heart that supply circulation to this muscle.

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Coronary artery disease is the accumulation of plaque in these heart blood vessels.

Atherosclerosis or plaque can grow and eventually obstruct blood flow to the heart muscle, causing chest pain or angina.

Atherosclerotic plaques usually grow gradually but the plaques also can rupture suddenly, causing a blood clot which can completely cut off flow to the blood vessel.

When there is poor flow, the heart muscle can die, causing a heart attack or myocardial infarction. This damage to the heart can lead to death.

It is important to prevent atherosclerosis and its progression early in life. You can do this by modifying your risk factors.

Common major risks to be aware of are: • • • • • • • • • •

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High blood pressure.

Diabetes.

Smoking.

Inactivity.

Obesity.

High LDL (bad) cholesterol.

Low HDL (good) cholesterol.

High triglycerides.

Family history of heart disease.

Age.

The risk factors, high-sensitivity C-reactive protein (hs-CRP) and metabolic syndrome, are lesser known but strong predictors of the risk of developing heart disease. Inflammation is part of a complex response in the blood vessels to harmful stimuli.

Hs-CRP is a protein that increases with inflammation—especially inflammation of the heart vessels.

Elevation of hs-CRP (which is a simple blood test) has been shown to be a strong cardiac risk factor in women.

Metabolic syndrome is a combination of multiple disorders/criteria associated with abdominal obesity (enlarged waist circumference). Metabolic syndrome is a strong risk factor for diabetes and heart disease—a stronger risk factor for women than men. More details on hs-CRP and metabolic syndrome will be included in a future issue of YHC Magazine.

Unfortunately risk factors and risk scores (like the Framingham risk score) do not always predict who is most at risk. One should consider getting an arteriosclerosis screening test like a carotid Doppler with intimal thickness assessment (CIMT) or cardiac CT for calcium scoring for better risk stratification (see February, 2012 YHC issue).

Again a woman’s presentation of heart disease is not always the classic chest pressure or angina.

More often than men, a woman’s chest pain is atypical (dull or sharp pain that is not necessarily in the center of the chest). Women also more often experience fatigue, nausea and shortness of breath without chest pain as a sign of heart disease.

These differences cause women and their doctors to be misled, thinking the symptoms are not heart disease. You should speak with your doctor about diagnostic testing if you have any concerning symptoms.

It is important to understand what heart disease is and understand the risk factors and symptoms. The best prevention is to sit down with your health care provider to discuss your risks and what you can do to modify your lifestyle and decrease your risk of heart disease.

Alon Steinberg, MD, FACC is a board certified cardiologist practicing with Cardiology Associates Medical Group in Ventura and Oxnard. Dr. Steinberg was recently an expert witness for the prosecution during the trial of Dr. Conrad Murray and recently appeared on the Piers Morgan show commenting on the death of Whitney Houston. His office can be reached at 805.278.4020 or visit www.cardiacadvantage.com.

NATURALAPPROACH | HORMONES

BY DR. SHARON NORLING

HORMONAL REPLACEMENT —HEALTH OR HARM? ONE OF THE MOST COMPLICATED AND DIFFICULT HEALTH CARE DECISIONS MENOPAUSAL AND PRE-MENOPAUSAL WOMEN FACE TODAY IS WHETHER OR NOT THEY SHOULD USE HORMONE REPLACEMENT THERAPY (HRT).

SHOULD YOU BELIEVE A POPULAR CELEBRITY SPOkESWOMAN AND USE A MORE NATURAL APPROACH WITH BIO-IDENTICAL HORMONES (BHRT) OR FOLLOW THE RECOMMENDATION OF CONVENTIONAL MEDICINE? DO WOMEN NEED ANY HORMONES OR NATURAL REMEDIES FOR THIS BIOLOGICAL AGING PROCESS?

In the WHI women using estrogen only, those between the ages of 50 and 59 exhibited 50 percent less cardiac heart disease and less invasive breast cancer than the placebo group.

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THERAPY Each woman wants to know if HRT is right for her, how she may benefit, how long she will have to undergo therapy to receive benefits, and if there are side effects or potential long-term risks.

who’s right? where is the balance?

No other pharmacologic agent has been as thoroughly studied as estrogen. The literature is vast and the messages are confusing. Many health care practitioners have a limited understanding of all the therapeutic options and the global issues of menopause. So, how do you decide what is best for you during this transition?

USC published a review in Cancer Journal in 2009 noting that from 2002 to 2008, reports from the Women’s Health Initiative (WHI) claimed HRT significantly increased the risks of breast cancer development, cardiac events, Alzheimer’s disease and stroke.

These claims alarmed the public and health professionals alike, causing an almost immediate and sharp decline in the numbers of women receiving HRT. However, actual data in the published WHI articles reveal the findings reported in press releases and interviews of the principal investigators were often distorted, oversimplified or wrong.

Menopause and hormone imbalances are complicated matters. Physicians and the public must be cautious about using press release statements to determine whether to prescribe or take HRT. I participated in the WHI study as full-time faculty at the University of Minnesota Medical School Department of OB/GYN. On June 17, 2002, WHI stunned the nation and the medical community with the results that synthetic HRT posed more health risks than benefits.

what are the facts?

First, the study design was flawed. This is very unfortunate because women deserve to have the most accurate information to make the best personal choices. The subjects in the WHI study were: • • • • •

50 to 79 years old with a mean age of 63.

34.1 percent were overweight or obese.

49.9 percent were smokers.

3 percent had previous MI (myocardial infarction or heart attack).

Women with hot flashes were excluded.

The group studied was at a higher risk for cardiovascular disease (CVD) and cancer, and women 65 to 80 years of age generally are not taking HRT. So a higher risk group that did not take the hormones was included in the study.

Pooling the data from this group led to inaccurate results.

In addition, only the synthetic hormones Premarin (a xenoestrogen) and Provera (a progestin), were studied. The study did not include bioidentical hormones or crèmes. It also included only those taking one fixed dose and not individualized dosing.

The findings for 12,304 women who took HRT for 5.3 years during the study were: • • • • • •

No increase in breast cancer.

No deaths in the breast cancer group.

A 33 percent decrease in hip fractures.

A 37 percent decrease in colon cancer.

An increase in strokes and clotting but no increase in deaths.

No increase in mortality from any cause.

The real numbers indicate that out of 10,000 women, there were eight more breast cancers, seven more heart attacks and eight more strokes in the group using HRT as compared to those taking a placebo. Are you surprised? These are the facts.

the other fact is that it is all about age!

According to Steven Goldstein, MD, professor of medicine at NYU Medical Center, “What we discovered is that if a woman is between the ages of 50 and 55 when she starts taking hormones, or if she begins HRT less than 10 years after she started menopause, she has less heart disease and less death from any cause, compared to the placebo group.”

These results were published in April 2007 in the Journal of the American Medical Association—and then again reinforced by similar research published in The New England Journal of Medicine the following June.

The WISDOM (Women’s International Study of Long Duration Oestrogen after Menopause) study published in the British Medical Journal duplicated many of the same findings detailed by WHI, particularly concerning the increased risk of heart disease in older women who began or restarted hormone therapy long after menopause.

>>

MAY 2012

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NATURALAPPROACH | HORMONES

The Journal of Clinical Endocrinology Metabolism 2010 stated that data from various WHI studies, which involved women of average age 63, cannot be appropriately applied to calculate risks and benefits of HRT in women starting shortly after menopause.

In Lancet Oncology 2012, the use of estrogen only for a median of 5.9 years was associated with lower incidence of invasive breast cancer (151 cases compared with 199 cases among subjects taking the placebo).

In the WHI women using estrogen only, those between the ages of 50 and 59 exhibited 50 percent less cardiac heart disease and less invasive breast cancer than the placebo group.

The question now being raised by researchers and clinicians is, are the risks increased by the synthetic progestins? All studies using oral synthetic HRT have shown an increase in strokes and gallbladder disease. But there is lack of consistent data.

We know HRT decreases osteoporosis, colon cancer, menopausal symptoms, and supports mental function—but what about sex? Most participants (63.2 percent) were satisfied with their current level of sexual activity. Of those dissatisfied, 57 percent preferred more sexual activity. HRT was associated with a higher percentage of participants reporting sexual activity.

benefits

Recent studies have also shown a decrease in short-term memory loss and a reduction in diabetes risk by 12 to 21 percent.

A 2011 study published in the Journal of Alzheimer’s Disease showed HRT had favorable mental effects across multiple cognitive areas, including memory and visual memory, in postmenopausal women with Alzheimer’s.

bioiDentical hormonal replacement therapy (bhrt)

Synthetic HRT is associated with benefits and risks. What about BHRT? Estriol, most often the predominant estrogen in BHRT, has not been associated with an increased risk of breast cancer, according to the International Journal of Cancer. The transdermal

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MAY 2012

estriol was also not associated with an increase risk of uterine cancer (Lancet).

Estriol has been shown to increase bone mass, improve urinary incontinence and vaginal atrophy.

Natural progesterone crème has been correlated with a decreased risk of breast cancer and supports cardiovascular health. Progesterone is also calming, supports sleep, increases metabolic rates and is a natural diuretic.

When considering hormones, don’t forget testosterone. Testosterone is a female hormone which not only increases sexual interest, but increases the sense of well-being and muscle strength. It helps to maintain memory, keeps skin from sagging, helps maintain bone health, and decreases excess body fat.

how to DeciDe?

Regardless of your decision, I highly recommend women be tested for 2OHE1 and 16-OHE1 estrogen levels before and after taking estrogen. This test determines how you are metabolizing estrogen and may help you and your doctor identify if you are at a higher risk for developing breast or other cancers.

Estrogen is metabolized by two pathways; the 16-OHE1 may increase your risk of cancer and the 2-OHE1 is protective. The good news is that it is possible to change the pathway in favor of the protective 2-OHE1 by eating cruciferous vegetables (e.g., broccoli, brussels sprouts, cabbage and cauliflower), soy and omega-3.

Nutritional supplements containing Indole-3-carbinol (I-3-C) or diindolylmethane (DIM) also support the 2-OHE1 metabolism.

Balanced hormones are the key to health and every person is unique. As hormones decline, health declines and aging accelerates. Decisions about whether to start, stop or change your hormones should be made on an individual basis only after consulting your physician. Whatever choices you make when deciding your course of action should be taken seriously and should be based on accurate and balanced information.

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The primary purpose of HRT is to manage the transitions, prolong life and preserve a healthy, active lifestyle. The approach to achieving these important goals is to normalize as many hormones as possible.

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Feeling your best usually takes more than just the right prescription. Consider trying the most natural, least invasive steps first to create a foundation of health and hormonal balance, gradually adding remedies if and when they are needed.

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A healthy foundation usually includes good dietary habits: avoid processed foods and sugar and eat six, small, healthy meals per day with lots of fresh fruits and vegetables. Add to this regime, time for yourself, multivitamins and minerals, essential fatty acids, relaxation and an overall healthy lifestyle. keep these tips in mind: • •

•

•

•

Choose a knowledgeable physician who listens to your story.

Choose a reputable compounding pharmacy that specializes in compounding products rather than using a general pharmacy.

Thyroid, adrenal and neurotransmitters must also be balanced.

Be your own advocate and participate in the decisionmaking process.

Use the lowest dose of hormones and only what you need from high-quality supplements.

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Dr. Norling participated in the hormone research including the Women’s Health Initiative and the HERS study. Her advanced training in bioidentical hormones for both women and men give her patients the best options. Visit her office at 5655 Lindero Canyon Rd, suite 401, Westlake Village, CA. 818.707.WELL.

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MAY 2012

yhcMAGAZINE.COM | 19

HEALTHVIEW 1 VENOUS DISEASE

WHEN DOES LEG DISCOMFORT POINT TO

VENOUS REF THE MOST APPARENT FEATURE OF THE BEAUTIFUL PINUP GIRLS OF THE 1940S AND THE SEXUALITY OF THE PRE-1960S IS THE LEGS. MEN HAPPILY WHISTLED AT THE SIGHT OF MARILYN MONROE’S LEGS AS THE AIR RAISED HER SKIRT ABOVE HER KNEES. IT SEEMS LEGS HAVE TAKEN A SECONDARY ROLE TO OTHER PARTS OF THE ANATOMY, BUT THEY ARE STILL AN IMPORTANT FEATURE. KEEPING YOUR LEGS HEALTHY HELPS THEM REMAIN BEAUTIFUL.

BY GREGORY K. ALBAUGH, DO, FAPWCA

Until the 1990s it was very common for women to wear nylon stockings. My grandmother wore hose attached to a girdle with specially-designed straps. This style gave way to pantyhose and the inconvenience of pantyhose evolved to a popular knee high version to wear with slacks.

Ultimately nylon stockings became a victim of fashion and are now all but extinct.

As far as the health of the legs is concerned, support pantyhose provided a benefit. When worn by waitresses, flight attendants and nurses or anyone spending extended periods of time on their feet, they helped reduce the amount of accumulated fluid in the legs.

NORMAL LEG DISCOMFORT OR A PROBLEM? Heaviness in your legs at the end of the day may or may not suggest a clinical problem. As the blood flows to the legs, it returns via the venous system to the heart. Some fluid remains in the lower legs as a result of gravity. This is normal in people who work while standing or sitting for long periods. Long airplane flights are notorious for making passengers’ legs swell.

20 | yhcMAGAZINE.COM

MAY 2012

But when we rest or sleep, lying down, the effect of gravity is no longer an issue and the lymphatic system can move the fluid out of our legs. By morning, our legs are the smallest they will be throughout the day.

As leg discomfort heightens, it can signify a condition called venous reflux. This is a condition where the tiny valves in the veins of the legs are unable to close properly.

FLUX?

Leg veins carry blood from the feet to the heart and rely on properly working valves which stop blood from going in the opposite direction. When the valves become incompetent, the blood returns back down toward the feet.

As this situation progresses, pressure builds up in the vein, causing two things—dilation and elongation. Through years of excess pressure, the very small veins in your leg can become very large and begin to exhibit symptoms of venous reflux.

CLINICAL SYMPTOMS OF REFLUX The first clinical symptom of venous reflux is leg heaviness at the end of the day. As mentioned, this can occur without venous reflux. I assume patients who seek treatment for leg heaviness have had a worsening of the symptom somewhere along the way.

The majority of patients in my practice with leg heaviness do have some venous reflux.

Swelling is probably the second most common complaint regarding venous reflux, and is the natural progression from leg heaviness.

Swelling can confuse the issue when seeking advice from your family doctor. Early in medical school, students are taught that leg swelling is associated with congestive heart failure which is best treated with a diuretic or water pill to make you pass the excess fluid through urination.

If your heart is healthy and you report a swollen right leg at the end of the day to your doctor, chances are a diuretic is not what you need. A better option would be to have your veins examined.

Other symptoms of venous disease include leg fatigue, itching, throbbing and pain. These symptoms are the result of increased pressure building up in the superficial veins during the course of the day. Once you elevate your legs all of these symptoms subside.

The visual changes to the legs can be varied with venous reflux. Early stages can start with fine purple spider veins and can progress to larger, bumpy veins on the inside of the calves.

Another symptom seems to most patients to be unrelated to the veins. They come in to get rid of some unsightly veins in their legs and when I begin to ask them questions, some folks with horrible looking veins deny all symptoms. They are quite content that they are asymptomatic—no swelling, no heaviness, no throbbing or pain. But when I ask them if they have legs cramps at night, most of them do but never connected it to their veins. The cramps appear to be from a spasm of the veins as they decompress.

>>

MAY 2012

yhcMAGAZINE.COM | 21

HEALTHVIEW 1 VENOUS DISEASE

Other conditions can cause nightly leg cramps, but if patients with leg cramps have varicose veins and good pulses, there is a good chance the symptoms are related to venous reflux.

Many of my patients who have read the newspaper column written by Dr. Gott have tried his recommendation of placing a bar of soap between their bed sheets.

Although I do not understand the mechanism of action of a bar of soap in the bed, I cannot dispute the fact that a good number of these folks get relief from the cramps.

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The visual changes to the legs can be varied with venous reflux. Early stages can start with fine purple spider veins and can progress to larger, bumpy veins on the inside of the calves. The number of large varicosities does not correlate with the severity of venous reflux or the number of symptoms.

If left untreated and the condition is permitted to progress for many years, there can be a brownish discoloration of the skin on the shins which can lead to ulceration near the ankles. When the skin changes appearance and ulceration occurs, this is a permanent. Ulceration is caused by the local tissue pressure exceeding the body’s ability to provide oxygen to the tissues, and the skin dies.

PROPER TREATMENT FOR VENOUS DISEASE Management of these types of wounds is best provided by a vascular surgeon or a wound care center. Ignoring the wounds is never a good idea because they will never improve on their own and most likely will worsen.

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The standard of care for venous disease for many years has been compression stockings which compress the leg and stop the accumulation of pressure and fluid.

The stockings range from knee highs to pantyhose.

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Stockings work well but they do nothing to treat the underlying problem. In the past when stockings failed, which they typically did, the vein in the leg was removed with stripping.

Vein stripping helped many patients; however, most of these procedures were performed prior to the wide use of ultrasound. Today ultrasound is used to evaluate the superficial venous system of the legs, helping to pinpoint the cause of the reflux.

Vein stripping was a painful procedure with a relatively long recovery time and an unacceptable rate of recurrence. Thankfully we no longer perform many vein stripping surgeries. Vein surgery has come a long way. Ultrasound has increased the precision of the treatment, placing ultimate success within our grasp.

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The symptoms outlined in this article—leg heaviness, fatigue, swelling, pain and cramps at night may be related to the condition know as venous reflux.

Spider veins are not completely normal findings in healthy individuals and when they occur in conjunction with these symptoms, they can represent the tip of the iceberg.

Larger varicose veins obviously are not normal and usually indicate the presence of venous reflux. If your legs are heavy and tired at the end of the day, I recommend not passing this off as a normal result of aging. We have help for those who seek it and after the correct diagnosis has been made, you may be on the road to enjoying healthier new legs.

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Dr. Albaugh is board certified in both general and vascular surgeries. He has been with Coastal Vascular Center since 2004 with offices in both Camarillo and Oxnard.

He is currently the director of peripheral vascular lab at St. John’s Regional Medical Center and the director of hyperbaric oxygen treatment and wound care center at St. John’s Pleasant Valley Hospital. For more information, visit www.coastalvascularcenter.com.

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yhcMAGAZINE.COM | 23

HEALTHVIEW 2 DRUG INTERVENTION

BY ALICIA DOYLE

TEAM

EFFORT

LEADS TO

SUCCESSFUL INTERVENTIONS

MITCH STEIN GOT SOBER AT THE AGE OF 46 AFTER BATTLING ALCOHOL AND DRUG ADDICTION FOR MOST OF HIS ADULT LIFE. NOW 54, HE IS A REGISTERED SUBSTANCE ABUSE COUNSELOR AND COURT LIAISON WITH A FOCUS ON A TEAM APPROACH TO THE INTERVENTION PROCESS. His own recovery “really just came down to the point of complete surrender and complete reevaluation of everything I thought I knew about myself and my world. I had to re-invent myself as the person I wanted to be. I wanted to look in the mirror and feel good about what I do.”

Stein specializes in helping people with a range of challenges including eating disorders, anger issues and substance abuse problems. “Within that umbrella some people are diagnosed as bi-polar or manic and things of that nature. If there’s a dual diagnosis we refer them to a specific facility that is capable of handling a dual diagnosis.”

Ultimately “I can help you decide which intervention services best suit your specific needs. Together we will look at a variety of options and I will be glad to discuss your choices with you.”

Stein has been a Certified Anger Management Facilitator since 2009, and a Certified Batterers Intervention Facilitator since 2010. He is the past president and founding member of the Alcohol & Drug Studies Club of Glendale Community College, and a 2009 recipient of the Alcohol/Drug Studies Department Award. He also received an Outstanding Service and Achievement Award in 2010.

>>

>> 24 | yhcMAGAZINE.COM

MAY 2012

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yhcMAGAZINE.COM | 25

GRAND OPENING

HEALTHVIEW 2 DRUG INTERVENTION

“I ENCOURAGE A TEAM EFFORT WHERE THE FAMILY PARTICIPATES AS MUCH AS POSSIBLE.

SUCCESS REQUIRES

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Now working toward a master’s degree in family therapy, Stein’s focus is team and family intervention “meaning it takes a group effort. I see myself more as a coach in the initial intervention process.”

The majority of his clients come to him through word of mouth. “After they contact me there’s an initial consultation where first I determine if I can help and what they expect,” explained Stein, whose work is based in the San Fernando Valley. “Some people just want to get into rehab and are really motivated.”

Others are less than motivated “and might not even realize they have a problem. So the level of intervention by the team will have to be determined…and the logistics of what the

26 | yhcMAGAZINE.COM

MAY 2012

team is actually up against, or whether or not they’re really prepared to do it.”

When it comes to any addiction, people on the outside tend to think the person is being selfish “when in reality what they’re doing is self-abuse out of guilt and shame. So a lot of what I do is to educate people, as well as determine the level of care needed.”

For instance, if someone has an eating disorder that escalated into amphetamine use for weight loss, “you can address the psychological damage and twisted reward system that happens with the chemicals. You may get them clean per se, but that doesn’t deal with the core self-esteem issues. They look in the mirror and don’t see themselves the way others see them.”

Stein’s level of personal service is unique because he works in person to motivate and coach the team involvement. “This is not a lucrative business, so what happens in many cases is, to make a profit, some interventionists will work more over the phone and less in person. This is at a time when the client is distraught beyond belief. The result is the client connects less with the interventionist’s passion and hope.

I encourage a team effort where the family participates as much as possible.

Success requires a system of support.”

After the initial consultation and multiple meetings “the success is determined by the support of their loved ones.”

“There is no charge to call and discuss your situation,” Stein said. “I can make recommendations, discussing low-cost or no-cost options as well as professional services. In addition to professionally-facilitated interventions, I can also offer consultation, case management, recovery mentoring and or my services as a court liaison.”

He also does pro bono work. “If I run into people who are distraught and

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Some cases are so complex that they require ongoing case management, especially for patients with a history of relapse. “I can assure continuity of service between various providers—inpatient, outpatient, psychiatric, etc.—and I can also continue to provide consultation and counsel to the family or workplace in the months following treatment.�

Often there is a need for professional help during the critical days after a loved one returns home from treatment. “Mentoring provides the missing link between inpatient treatment and continuing recovery at home,� Stein said. “Most people who relapse do so during the three-month period following treatment. They relapse because they haven’t truly bonded to their local recovering community. Recovery mentoring can make the difference.�

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yhcMAGAZINE.COM | 27

HEALTHVIEW 3 BETTER MAN

THE MOST IMPORTANT

QUESTION

A MAN CAN ASK HIMSELF?

BY WAYNE M. LEVINE DIRECTOR, BETTERMEN COACHING

+++

Most men, despite what you may believe, struggle with the same challenges as you.

But they’ll usually never let you know about it.

there is one question that can help you determine whether, in any given moment, you’re being the father, husband, son, brother, friend, co-worker, boss or mentor you want to be: Am I being the best man I can be?

When you’re in the middle of a senseless argument with your wife, ask yourself, “Am I being the best husband I can be right now?” When you’re inappropriately angry with your kids for doing just what kids do, ask yourself, “Am I being the best dad I can be right now?” When you see a friend in pain but you’re too uncomfortable to get involved, ask yourself, “Am I being the best friend I can be right now?”

If you have the courage, in those moments, to reflect on your feelings, actions or reactions, you have the courage to make significant changes in your life. Despite how you may feel about yourself at your worst moments, you’re probably a good man. And you know the same is true for your buddies, despite what they may tend to tell themselves at their worst moments.

>>

28 | yhcMAGAZINE.COM

MAY 2012

MAY 2012

yhcMAGAZINE.COM | 29

HEALTHVIEW 3 BETTER MAN

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We’re all doing our best, we all have obstacles in our way, and we all can benefit from a little help. Most men, despite what you may believe, struggle with the same challenges as you. But they’ll usually never let you know about it. Why should they? Why should they trust you, or any other man, for that matter? Unfortunately, that’s the hostile environment men find themselves in these days.

But if we allow trust to grow with other good men, we can change that hostile environment for ourselves and for everyone in our lives. You need men whom you can trust and who can trust you to be there and to be supportive.

The fathering we get from these men is something we can never get from women, even from the most loving and giving of women.

Think for a moment about the men in your life—friends, family, co-workers.

Have you watched as they’ve fallen deeper and deeper into trouble, debt, depression, fear, anxiety, addiction, or some other self-destructive behavior?

Have you reached out to them? Have you found yourself feeling helpless to help them, their wives or their children?

You’re not helpless. In fact, you have power far beyond your imagination.

Offer your support. Share your story and your honest concern with them.

Have the courage to risk your relationship with them if it means potentially saving their relationships or even their lives. Tell them that you care. Tell them there’s support available and they’re not alone.

Be brave and take a risk with the men in your life. It just might make all the difference in their world—and yours!

Wayne M. Levine is the director of BetterMen Coaching in Agoura Hills, CA. He teaches men to be the best men, fathers and husbands they can be through individual, couples, and group coaching, both in office and via phone.

Wayne is also author of the best-selling Hold On to Your N.U.T.s—The Relationship Manual for Men. Find out more and get a copy of Wayne’s book at www.bettermencoaching.com.

30 | yhcMAGAZINE.COM

MAY 2012

HEALTH

FAIR

2012

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5Įīħ ħĨīĭġ ĨħĭĨ .ĨĮħĭĜĥĞğ #ĨĮĥĞįĚīĝ ğīĨĦ 0ĥĬĞħ 3ĨĚĝ All screenings and services $25 per person as listed below Blood screening (12-hour fast required) * Complete blood count (determines overall health) * Lipid profile (cholesterol, LDL, HDL, triglyceride) * PSA (Men only—for prostate)

* Blood sugar (glucose) Asthma screening Foot screening Oral screening Skin screening Blood pressure Body mass index

Please note: The above list of screenings and services are planned at this time. Please accept our apologies should unforeseen events force the cancellation of any of them.

Nutritional information Oximetry (percentage of oxygen in red blood cells) H2U membership (1 year) or renewal Ask the Doctor sessions and more.

For additional information, call 805-370-4685.

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Pre-register by June 4. Walk-ins are welcome. Send payment and registration form to:

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Los Robles Health Fair 2012 Los Robles Hospital & Medical Center 215 W. Janss Road Thousand Oaks, CA 91360 ❑ Enclosed is my check for $25/person payable to H2U, along with this registration form.

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