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When Should Women Consider Stopping Hormone Replacement Therapy?
Tweet Share on Facebook January 26, 2009 Comment (5)If a woman has been on hormone replacement therapy for two years and has had no problems, is there any danger in her continuing HRT?
The health risks of the combination of estrogen and progestin as menopausal hormone therapy—breast cancer, stroke, serious blood clots, and, in older women, dementia—have been proved to increase over time, relative to the benefits (reduced fractures), and it is highly recommended that women consider stopping after two or three years. Lowering the dose is an alternative to "cold turkey." The story for estrogen alone, which is prescribed to women who do not have a uterus, is somewhat different, in that the risks (stroke, in particular) and benefits (reduced fractures) are more balanced; however, it is still reasonable to encourage a woman to stop taking menopausal estrogen after two years to determine if she still needs them. The primary reason to take them is to prevent hot flashes, which may no longer be present two to three years after they begin. -
What Are the Most Important Supplements to Take Daily?
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What supplements are the most important depends on your gender and your age. If your diet is lacking, a basic multivitamin is a good idea, which simply assures that you are getting the recommended daily doses of a number of essential vitamins. Beyond this, if you are a woman, I recommend you consider both calcium (600 mg twice a day) and magnesium (200 mg twice a day). Calcium is needed for bone health, and while we need approximately 1,500 mg a day, the average American woman has approximately 500 mg a day in her diet. The good news is that if you do not like to take pills, you can get your calcium in the form of chocolate chews! Magnesium is needed for bone health, and it also counteracts the constipating effects of calcium. If you are premenopausal, you will be glad to know that calcium and magnesium have been shown to improve menstrual symptoms, including cramping, breast tenderness, mood swings, and even food cravings. (Chocolate is actually rich in magnesium, and it has been hypothesized that the need for magnesium may be why women crave chocolate around their periods.) Men do not need to supplement with calcium but should try to get 1,000 mg daily in their diet. -
Which Statin Is Right for Me?
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Well, there are several principles. First of all, for people who need only a modest amount of lowering of LDL, the bad cholesterol, whenever possible we would like to use a generic statin because it's less expensive. And the most commonly used statins that are generic are pravastatin (known as Pravachol), or simvastatin (brand name Zocor). Pravachol is a relatively weak statin, but for people who only need a small amount of cholesterol reduction, it's adequate. Simvastatin, or Zocor, is a medium-potency statin. We can get the majority of patients to their goal level of cholesterol with simvastatin.However, there are some people in whom the cholesterol levels are so high that we need a more powerful drug. And in those people we tend to use the higher potency statins, which are still branded—and that means they're more expensive. Those include atorvastatin, or Lipitor, and rosuvastatin, or Crestor. The most powerful of them is Crestor, which can lower LDL cholesterol by 50 percent or more.
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Is Sex Safe for Heart Patients?
Tweet Share on Facebook January 26, 2009 Comment (2)The Viagra ads always end with a warning to heart patients. When is it dangerous for a heart patient to have sex?
It is dangerous for heart disease patients to engage in sexual activity if they have frequent symptoms of angina. Men should not take Viagra or similar medications if they also need to take a special class of cardiac medications knows as nitrate. The most common types of nitrates include nitroglycerin or isosorbide mononitrate or dinitrate. The use of Viagra-like drugs in a person who has taken a nitrate within 36 hours can cause a very unsafe drop in blood pressure. It is always best to talk to your personal physician about what level of physical activity is safe to perform if you have a history of heart disease—whether it is sex or any other effort that might bring up a sweat. -
What's Important to Know About Malignant Melanoma and Skin Cancer Screening?
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It's important to follow a program of prevention, screening, and early detection.The term malignant melanoma and melanoma describe the most serious form of skin cancer, whose frequency is rising due to increasing sun exposures, especially when intermittent high-dose exposures (sunburns) come into play. Melanomas originate in melanocytes, which are specialized skin cells that make a protective brown pigment (melanin) to shield the skin against the harmful effects of the sun. Melanomas may arise in a mole (nevus). Individuals with a special skin condition called dysplastic nevi are at increased risk, as are people with a very large number (more than 50) of 'ordinary' moles.
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Is it Normal for Girls to Have Periods at Age 9?
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Most girls begin their menstrual cycles just before reaching their teens, when their bodies are growing into early womanhood. The average age of menarche (or the beginning of menstruation) in the United States is 12.5 years. Physical and sexual maturation is happening at earlier ages now than 15 or 20 years ago, and if a girl is on the large size for her age and has been developing other signs of puberty over the past year or so, she is probably on an appropriate though early end of the normal time line.With every milestone or biologic happening, there is a range of normal. Think about height. Plenty of people are 5'6" and are normal, but so are the folks who are 6'2'' and those who are 5'3". Same with weight. Weighing 105 lbs is normal, so is weighing 140 lbs. It does matter, though, how old you are, what racial or ethnic group you come from, and what your parents' height and weight were. It also matters if—all of a sudden—your weight or height changed or if you attained it at an appropriate pace.
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Does a Low-Fat Diet Reduce a Woman's Chance of Developing Breast or Colon Cancer?
Tweet Share on Facebook January 26, 2009 CommentThe data on diet for preventing breast or colon cancer suggest that just reducing total fat is not enough. Although we do not have definitive data on the role of vegetables (and fruits), increasing dark, leafy green vegetables and a wide range of other vegetables, reducing fat (especially animal fats), and restricting calories is highly recommended not only for cancer prevention but also for preventing cardiovascular disease, particularly in combination with regular physical activity, with an emphasis on maintaining a healthy body weight. -
When Is an Annual Stress Test Necessary?
Tweet Share on Facebook January 26, 2009 Comment (1)For a healthy, active person in his 60s, is it necessary to have an annual stress test and echocardiogram?
It is not necessary to get a yearly stress test and echocardiogram unless specifically indicated. If you are able to perform moderate to strenuous exercise without any symptoms such as chest pain or shortness of breath on exertion (e.g. swim a mile most days a week or any other form of substantial exercise) it tells us that even if you have atherosclerosis or blockage in your blood vessels to the heart, they are not significant to cause symptoms. However, the greater focus should be to continue living a healthful lifestyle including daily exercise, healthful eating habits (low saturated fat and diet richer in complex carbohydrates, whole grains, fruits, and vegetables) and modification of any cardiac risk factors such as hypertension and smoking. If you have elevated cholesterol and blood pressure based on your risk factors, then you should discuss with your physicians the role of starting any medications to control them. -
How Do Doctors Determine a Woman's Chances of Breast Cancer Recovery?
Tweet Share on Facebook January 26, 2009 Comment (1)So many women have had breast cancer and seem to be fine. If an individual woman turns up with breast cancer, can doctors figure out what her own chances are? And, does that information affect how she is treated?
Oncologists routinely use clinical risk-profiles, including tumor size, hormone receptor content, extent of involvement of the axillary nodes, and other factors discerned only when a pathologist examines the tumor cells under the microscope (sometimes referred to as the grade of the cancer cells). These factors can be used to provide a general clinical profile that estimates the risk of a future relapse, and thereby helps doctors and patients weigh the pros and cons of adjuvant ("helping") chemotherapy as an additional option. Such adjuvant therapy itself has recognized risks and quality-of-life issues, and the physician and patient must discuss these topics in order to personalize breast cancer management. However, some risk factors are open to subjective interpretation and may vary from one observer to another. -
Are We Overprotecting Our Kids From Infection?
Tweet Share on Facebook January 26, 2009 Comment (1)Some physicians think that we are overprotecting our kids from infection and that, as a result, they grow up with allergies and with poor immunity. Is it a good idea to let a young child play in the dirt and get all the routine diseases?
Over the past 20 or 30 years, many things have changed in the lives of families and children. Probably the best change has been that our children are protected from most bad infections like polio, measles, and bacterial blood infections. This is a direct result of the great advances in medicine and public health, especially antibiotics and vaccines. Other things have changed, too, like earlier enrollment in day care and, somewhat surprisingly, the increase in allergies.
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