How To Exercise In The Heat

Summer is finally here, for real!  We’ve had some really hot days over the last few weeks and workouts have been a challenge for me.  The heat just really seems to sap all your energy and leave you a soggy, sweaty mess with half your workout left to complete.

Credit: physiqueft.co.uk

You can get amazing workouts in the summer but, like when it’s super-cold, it takes more planning.  Here are 3 tips to help you safely exercise in the heat.

Work Out Indoors

I know, I know, it’s beautiful and you want me to stay INSIDE?  No, not necessarily, but if you find yourself skimping on your runs or hikes or whatever your exercise of choice is, moving the workout indoors can help you stay a little more comfortable so you can push yourself a little more.

If you’re a runner, give the treadmill a try, or do some cross-training in the weight room.  It’s only for a few weeks until the weather cools off.

Work Out Early Or Late

If you absolutely MUST work out outdoors (for instance if you’re like me and take your life in your hands trying to run on a treadmill, LOL!) shift your workouts to early mornings or late in the evenings when it’s cooler and the humidity is lower.

I personally LOVE running early in the morning.  It’s quiet, you have the trail to yourself and you can enjoy the rest of your day knowing you’ve done good for your body.

Stay Hydrated

If you play a sport like baseball or soccer where you don’t get to pick your workout times or where you practice, the key is staying hydrated.  Drink copious amounts of water to replace what you lose by sweating.  Watch for symptoms of dehydration like dizziness, muscle cramps and nausea.

If you play a sport where you sweat a lot in the heat, consider using an electrolyte replacement drink.  Electrolyte replacement drinks maintain better blood glucose levels than water alone, and also replace salts and minerals lost in sweat.

Be careful which electrolyte replacement drink you choose.  Many of them have artificial flavors, colors and sweeteners (yuck) that definitely don’t contribute to health or optimal sports performance.

I recommend Shaklee’s Performance which has been proven to hydrate better than water alone, is completely free of artificial ingredients, and was developed for NASA to keep the astronauts well-hydrated in space.

Through the end of July, Shaklee is running a summer athlete special on Performance.  When you buy 3 canisters of Performance (or Physique, Shaklee’s muscle recovery shake) you get 3 canisters at 50% off.  If you’re interested in this promotion please let me know – it’s only open to members but I can make some magic happen if you’d like to take advantage of it 🙂

If you’re struggling to get your workouts in because of hot weather, there are a few ways to make them safer and more comfortable.  Change up the time and/or place you work out.  Stay well hydrated, and consider adding a good electrolyte replacement to keep your stamina up.

We’ve got quite a bit of summer left!  Get out there and have fun 🙂

QUESTION: Are you having trouble getting your exercise in the hot weather?

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Shingles

You’re a woman in your mid-forties, generally healthy but under some stress with work and your family.  Going about your business every day as usual, you wake up one morning with the right side of your neck feeling stiff and sore.  No worries, probably just slept wrong, right?

Nope.  As the day goes on the pain gets worse.  Then the outer side of your shoulder starts to hurt, and the pain spreads into your upper back and then into the upper chest, which makes you a little nervous.  That evening you find what looks like an insect bite on your back.

After a restless, uncomfortable night in which Tylenol and Motrin are of NO help at all, you get up the next morning and find this:

Credit: www.zostavax.ca

You’ve got shingles.  And you’re miserable.

So what is shingles anyway?  Shingles, known as herpes zoster, is an illness caused by latent chickenpox virus.  Chickenpox is a herpesvirus, like the viruses that cause genital herpes, cold sores and infectious mono.  When a chickenpox infection clears up, the virus doesn’t go away completely but lies dormant in the cells of a particular part of the spinal cord.

When you’re under stress, sleep deprived or nutritionally depleted, or your immune system is depressed for any other reason (like old age or chemotherapy), the virus can reactivate.

Shingles is found on one side of the body, in a stripe of skin that is served by one or two spinal cord levels.  This is what’s known as a “dermatomal distribution.”  In the picture above, the affected skin is all served by one spinal nerve.  This is the nerve that is sick and being attacked by the reactivated chickenpox/shingles virus.

Shingles hurts.  It is a burning, electric pain.  The combination of pain and a blistering rash should make any medical person think of herpes and specifically shingles.  There’s no test needed to make the diagnosis of shingles, it is based on symptoms and the presence of a typical rash.  Sometimes if the rash is located in the area of the body covered by a pair of shorts, a culture needs to be done to distinguish shingles from genital herpes, because the treatment is different.

Treatment for shingles consists of a week of antiviral medicine to stop the virus from replicating.  Unfortunately, stopping the virus doesn’t make the rash or pain go away – they will slowly subside over several weeks.  We don’t have good treatment to relieve the pain of shingles.  Narcotics don’t work, and medication that relieves nerve pain can be very sedating in the doses needed to relieve the pain of a shingles outbreak.

Is shingles contagious?  In general the answer is no.  If someone who has never had chickenpox or been vaccinated against it touches the shingles rash, they can catch chickenpox.  Keeping the rash covered is all that is needed to protect loved ones if they are not immune to chickenpox.

We have a vaccine to decrease the risk of shingles, called Zostavax.  It is given at age 60 or thereabouts to adults who have had chickenpox.  If you have had shingles, you still benefit from the vaccine to boost your immunity.  If you are in your 60s and haven’t had the vaccine, talk to your doctor about whether this vaccine is right for you.

One of the biggest benefits of the shingles vaccine is that it really decreases the risk of permanent nerve pain after a shingles outbreak.  Yes, that’s right, this severe electric burning pain can be permanent.  This is called postherpetic neuralgia and it is a horrible problem that is so difficult to treat.  Much better to prevent it.

It is estimated that at least 25% of adults will have had shingles by the time they reach age 85.  YOU can decrease your risk of this terrible disease that can leave you in permanent pain.  Ask your doctor about the vaccine.

If you get shingles, what can you do to help it heal as quickly as possible?  The first thing to do is see your doctor as quickly as you can.  If you can’t see your doctor within 48 hours, go to the urgent care, because the antiviral medicine needs to be started within 48 hours of the rash starting.

As with other illnesses, you want to do everything possible to support your immune system.  This means getting plenty of sleep, eating healthy food and drinking plenty of fluids.  In addition, there is evidence that micronutrient deficiencies play a role in not only shingles outbreaks but in increasing the risk of postherpetic neuralgia, particularly zinc, calcium and vitamin C.  So taking a high-quality multivitamin is a good idea.

Shingles is common, it is serious and can have severe long-term consequences.  Recognizing it, getting it treated quickly, and taking steps to prevent it are important ways to protect your health from this major medical problem.

QUESTION: Have you or a family member had shingles?  What was your experience?

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The Importance Of Healthy Teeth

This week I saw a patient, Caroline, for a general physical.  She has some chronic health problems and only rates her health as “fair.”  As part of a routine physical I always ask about dental care.  Because she is on a limited income, she does not see the dentist regularly.

Is that important?  If you don’t have dental insurance, is it OK to skip your cleanings?  What is the importance of healthy teeth and gums?

Because I’m writing about this, I think you can guess my opinion!  It’s very important to keep your teeth and gums healthy.  I’d like to review what happens when you don’t take good care of your teeth.  What are the risks to your health?

When you don’t brush and floss regularly, plaque builds up on the teeth.  What’s plaque?  It is actually a biofilm of sticky bacteria on the surface of the teeth which extends under the edge of the gum.  It is removed when you brush with toothpaste, but builds up again over 12-24 hours.

If you look at the cuticle of your fingernail and push on it a little, you can see that there is a little space under the cuticle above the nail.  There is a similar space between your tooth and the gum.  Normally the space is very small and your toothbrush gets in there and cleans it out when you brush.

If you don’t brush regularly and the plaque builds up, your body mounts a local inflammatory reaction to protect your gum tissues from the bacteria in the biofilm.  The inflammation, over time, weakens the connection between the tooth and the gum.  The attachment point gets weaker and the gum gradually separates away from the tooth surface, causing formation of a pocket.  Food particles can get trapped and it is difficult for toothbrush bristles to get down in there and clear everything out.

Regular dental cleanings and exams to look for gum redness, swelling, easy bleeding and pocket formation are needed to identify problems early and get your gums back in good shape.  If left untreated, gingivitis can progress to periodontitis.  Severe cases can require surgery, tissue grafts and sometimes lead to tooth loss, bone loss, and abscesses.

Okay, Dr. Jen, but so what?  So I don’t have healthy teeth.  Why is that so important for the rest of me?

It turns out that the inflammation of chronic gum disease has a big impact on the health of the rest of your body.  I did a quick PubMed search and there have been an absolute wealth of studies published exploring the link between periodontal disease and various medical illnesses including diabetes, heart disease, autoimmune diseases like rheumatoid arthritis and systemic lupus erythematosus, and Alzheimer’s disease.

Without fail, it has been shown that better dental and gum/periodontal health results in better overall health.  Period.

So if you are one of those people who hates the dental chair, please explore the options to get more comfortable with regular cleanings.  Shop around and find a dentist and hygienist that you really like.  Some dentists will provide mild sedation for those who are really super anxious.

My hygienist, Barb, knows I don’t like getting scraped.  She cheerfully carries on a one-sided conversation while I’ve got a handful of instruments stuffed in my mouth and can only grunt in response, LOL!  While I don’t necessarily love the process, I do love having healthy teeth and gums and I know it’s a necessary thing.  Sort of like getting Pap tests, mammograms and colonoscopies to check for problems.  Uncomfortable but necessary for routine maintenance of your body.

It is very important for you to brush and floss regularly and see the dentist every 6 months for cleanings and checkups.  The health of your whole body depends on you having healthy teeth and gums!

PS – If you don’t have dental insurance I would recommend you check out the CWRU School of Dental Medicine’s student clinic.  They see both adults and children and provide extremely thorough care at reasonable rates.  When I was a student I used that clinic as I didn’t have dental insurance, and I can personally vouch for their excellent care!

QUESTION: Do you see the dentist twice a year?  If not, why not?

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What Is Lyme Disease?

It’s summertime!  Everyone is outside walking, hiking, camping and doing yardwork.  Every year at this time we start getting calls and appointments because people find ticks on themselves, their children, their family/friends/acquaintances/perfect strangers and their pets.  Finding a tick immediately makes people think of Lyme disease.  What is Lyme disease?

Lyme disease is an infection that causes pretty significant symptoms.  There has been a lot of buzz lately about so-called Chronic Lyme Disease and many people with chronic joint pain and fatigue (VERY common symptoms) are concerned they may have Chronic Lyme Disease.

Transmission

Lyme disease is caused by infection with a bacteria called Borrelia burgdorferi.  The deer tick, Ixodes scapularis, transmits the infection when it bites a human and takes a blood meal.  Most of the time the tick must be attached to the host for 36-48 hours in order to spread the infection.

Credit: www.co.ontario.ny.us

Lyme disease can also be transmitted by the bites of immature ticks called nymphs.  Nymphs are less than 2 mm in size, much smaller than the adult tick pictured above, and difficult to see.  Just because you haven’t found a tick attached to your body doesn’t mean you can’t have Lyme disease!

Symptoms

Lyme disease causes flulike symptoms and a rash.  Symptoms include fever, chills, headache, muscle and joint pain, and swollen lymph nodes.  70-80% of patients will have the typical bulls-eye rash.  A small percentage of patients may have brain or nerve symptoms, like weakness of the face, burning nerve pain, severe headaches, stiff neck and problems with short-term memory.  Lyme disease can also affect the heart and cause irregular heartbeat, palpitations, shortness of breath and dizziness.

Credit: www.webmd.com

Treatment

Lyme disease is treated with antibiotics like doxycycline, amoxicillin and cefuroxime.  If caught and treated early, most patients will have a prompt and complete recovery.  Those who have brain or heart involvement may need to be hospitalized for IV antibiotics.  A small percentage of patients do not respond and develop long-term symptoms.  Also, those who are not diagnosed early may go on to have persistent symptoms.

Chronic Lyme Disease

Some patients who are treated appropriately with antibiotics for Lyme disease have symptoms that persist for more than 6 months.  This is commonly called chronic Lyme disease but it is more properly called “Post-treatment Lyme Disease Syndrome” (PTLDS).

The cause of PTLDS is not known.  There is some evidence that it may be a post-infectious autoimmune reaction similar to Guillain-Barrre after a viral or gastrointestinal infection, Reiter’s syndrome after Chlamydia infection, or rheumatic heart disease after strep throat.

PTLDS may also be due to persistent infection with Borrelia bacteria.  The research is ongoing to determine the cause and the best treatment.  Studies have NOT shown that long-term treatment with antibiotics results in better results than placebo, and long-term antibiotic therapy can have very serious adverse effects.

Most patients with PTLDS have gradual improvement of their symptoms over time.  It can take a VERY long time for symptoms to resolve completely, and sometimes they don’t go away altogether.  If this is the case, patients often get relief with treatments designed for chronic fatigue syndrome and fibromyalgia.

If you see the rash shown above at ANY time of year, not just in the summer, see the doctor right away.  If you develop a flu-like illness with fever, headache, body aches and joint pain and swelling, ask your doctor to test you for Lyme disease.  If you had Lyme disease and were treated, but your symptoms seem to be hanging around for longer than they should, talk to your doctor about it.  He or she may be able to help, or to refer you to a rheumatologist or infectious disease specialist who can help you feel better.

QUESTION: Do you know anyone who has had Lyme disease?

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Managing Seasonal Allergies

Happy spring everybody!  The trees are green, lawnmowers are running, flowers are blooming.  People are sneezing.  Yep, allergy season is here!

Now there are plenty of medications available for seasonal allergies over-the-counter that used to require a prescription.  Antihistamines like Allegra, Zyrtec and Claritin, and nasal sprays like Flonase and Nasonex can be purchased at the pharmacy.  Fewer people need to come see me to handle mild symptoms.

I’m still seeing people who are really suffering though.  Either the over-the-counter medications aren’t helping or they’re not reducing the symptoms enough to keep people comfortable.  I’ve got big-gun treatments like cortisone shots and higher-priced prescriptions, but is there anything else you can do to get your symptoms under control before seeing the doctor?

Of course there is!  (I probably wouldn’t be writing this if there weren’t, LOL!)  There are 3 more measures you can take to reduce your symptoms on your own.

1.  Ditch the fumes

Spring means spring cleaning, so many people are moving furniture, vacuuming carpet that hasn’t seen daylight in months, washing baseboards and the insides of cabinets.  What chemicals are you releasing in your house when you clean?

Pull out your cleaning supplies and read the labels.  If it says “use in a well-ventilated area” or contains bleach or ammonia, please don’t use it in your house!  Indoor air pollution from fume-forming cleaning products is a BIG problem.  Houses nowadays are much more airtight to stop energy leaks around windows and doors.  Chronic exposure to chemical fumes and scents can lead to chronic nasal and sinus congestion from the irritation.

I know this works from personal experience.  In medical training I developed what I was told was indoor allergies.  All winter I suffered with sinus congestion and occasional sinus infections.  It was worse when I spent nights in the hospital on call, and I figured that call rooms were just dusty places.  It got better in the warmer weather and I thought since the windows were open I was just not being exposed to as many indoor allergens.

When I joined Shaklee and switched my cleaning products, my indoor allergies went away!  Turns out I wasn’t allergic to dust and mold (I’m not any better at housekeeping now than I was as a medical student, LOL!) but I was reacting to the cleaning products I used.

If you’re suffering with allergy symptoms, I strongly suggest you change to nontoxic cleaning supplies.  Get rid of everything that has a scent or makes fumes.  Those of you who love scented candles and perfume and lotions, I recommend you pack them ALL up for 2 weeks and switch to unscented personal products to see if it makes a difference to your symptoms.

Shaklee has cleaning products that clean like crazy but won’t hurt you, your family, your pets, or the environment.  I encourage you to check out the Get Clean lineAll-purpose cleaning solution, disinfectant, laundry products, kitchen products, and personal care items are all available.  As always, if you don’t love them they have a money-back guarantee.

2.  Alfalfa

If switching cleaners doesn’t work, one supplement that really helps allergy symptoms is alfalfa.  Before you get really confused (thinking alfalfa is for horses and rabbits), yes, alfalfa is a very nutritious and perfectly edible salad green.  It also seems to tell the immune system that grasses and plants are safe for you!

Taking alfalfa by mouth seems to down-regulate the immune reaction to grasses and pollens (this is called oral immunotherapy).  Since 2/3 of the immune system lives in your intestines, and in THAT location it seems to be primed to ignore allergens, this response makes sense.

If you don’t want to eat a big alfalfa salad every day, Shaklee has alfalfa tablets which are produced organically.  I have customers with allergies who have been happily taking alfalfa tablets for years to control their symptoms.

3.  Food allergies

Yes, I see food allergies EVERYWHERE!  However, that’s because the symptoms that food allergies cause are everywhere too.  One of the many symptoms related to food allergies is chronic sinus congestion.

If you have switched your cleaning products and ditched scented, fume-forming products and added alfalfa and STILL have allergy congestion, you should consider a 3-week food allergen elimination diet.  The one I give my patients is found here.

Got allergies?  You’re not alone.  If nonprescription meds are not working or you’d prefer a non-pharmaceutical approach, there’s a lot you can do to reduce your symptoms before calling in the professionals 🙂

QUESTION:  Are you suffering with allergy symptoms this spring?  What are you doing about it?

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Nutrients For Fracture Healing

As many of you know, almost a week ago my husband broke both bones in his right ankle.  After a late-Sunday urgent surgery and a short overnight stay in the hospital he came home and has been keeping my couch from escaping pretty much ever since.

Since I am NOT loving the extra stress here at the start of summer, I am invested in getting his fracture healed as quickly and as well as possible.  What does the literature say about important nutrients for fracture healing?

Vitamin D

It’s no surprise that there’s been a lot of research about vitamin D and fracture.  It’s well known that calcium, magnesium and vitamin D are required for healthy bone matrix and vitamin D deficiency accelerates bone loss and osteoporosis.  It has been shown that vitamin D deficiency is more common in fracture patients, and there is preliminary evidence that vitamin D supplementation improved fracture healing.  Since in northern Ohio we can’t get any vitamin D from the sun in the winter, it makes sense to take supplemental vitamin D.

Pro-Angiogenesis Factors

In order to put down new bone matrix, the body must grow new blood vessels. This process is called angiogenesis.  There are nutrients that are known to promote the development of healthy new blood vessels and, in theory may help to speed the healing of bone fractures.  These nutrients include fish oil, antioxidants and polyphenols like resveratrol, and ginseng.

Other Nutrients

Good nutrition will support wound healing and help fractures heal properly.  From a high-quality multivitamin to trace minerals to probiotics.  Soy and zinc have also shown to be helpful in supporting healthy bone.

So what do I have my husband taking? He is taking Shaklee products, of course.  Vitalizer and Vivix, extra vitamin D and OmegaGuard and Chewable Cal Mag.  These are part of his normal supplement regimen so I don’t believe we need to make any changes at this point.

We didn’t plan on a serious fracture but it’s nice to know we are taking the right supplements to heal it if it happens.

QUESTION: Have you ever had a fracture?  Did you use supplements to help it heal?

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The Cost Of Poor Health

This topic comes up in the office all the time.  Patients tell me they can’t afford to eat healthy.  They don’t have time to exercise.  Their medications are too expensive.  There is always a reason why patients have a hard time doing the things they need to do to stay well.

Today I’m fed up.  I’m going to talk about how expensive BAD decisions are, when it comes to your health.  What exactly is the cost of poor health?

Which is more expensive?  Fresh fruits and vegetables, or a heart attack?  The time to exercise, or the time you miss with your grandkids because you died of a preventable stroke?  Your $150-for-90-days prescription for diabetes medication, or the $2,200/year pack-a-day cigarette habit?

Which costs more?  Health, or illness?  Where are you going to invest your time and money?

Now, I’m blessed that my parents taught me good eating habits and helped me learn to enjoy being active.  I’m even more blessed that my husband and best friend knows I’m happier and less stressed when I run regularly and eat right.

But I’m also an adult and in charge of my own health.  If I were not in good health, there are lots of resources I could use to learn what I need to know.  From my doctor to good books to reputable websites on the Internet (like this one, LOL!), there is plenty of good sensible information about how to improve your health.

If you or someone you love is unhappy with their health, suffering with the dreaded “I don’t feel good” disease, overweight or obese, PLEASE do three things.

LEARN

Talk to your doctor and ask for good resources to learn more about what’s going on with your health.  Ask for books, websites, referrals to specialists or nutritionists or physical therapists to skill up.

Invest TIME in learning about what’s going on with your body.  Learn how to eat, what foods are best for your particular health problems.  Ask if you’re able to exercise safely and what the best exercises would be.  Learn how to manage your stress.  Get enough hours of sleep.

LOOK

Check out your budget and track for a month where your money is going.  How much do you spend on junk food?  Do you eat out a lot?  Do you buy fast food lunches during the week?  Do you smoke?  Do you drink soda or energy drinks?  What discretionary money do you spend on things that are unhealthy, and how might you redirect that money to BUILD your health instead of tearing it down?

What money are you spending NOW because you are unhealthy?  Do you spend money on medications and treatments that you might not need if you changed your diet, improved your nutrition, exercised, got good sleep, managed your stress better?  How much is being unhealthy costing you NOW?

INVEST

Now I’m going to ask you to exercise some discipline.  I want you to make a mindful decision about where your money goes.  I want you to redirect some or all of the money you are spending on UNHEALTHY or frivolous purchases and spend it on your and your family’s health.

That may mean eating out once per week instead of three times.  That may mean packing a healthy lunch every day instead of hitting the fast-food drive-through.  That may mean getting up 15 minutes early and drinking your coffee at home instead of stopping at Starbucks on the way to work.

You might decide to decrease your pack-a-day cigarette habit to a half-pack and spend the other $100 per month on a gym membership and a high-quality supplement program.

After all, which is better?  Spending 2 hours a week in the gym, or spending 10 hours a week in the dialysis center?  (And no, that’s not a stretch.  The number one cause of renal failure requiring dialysis is diabetes which responds beautifully to regular exercise and a sensible diet.)

I have no idea what is going on in your life or in your budget.  However, I don’t know anyone (including myself) that doesn’t spend money on things that harm their health.  Think about how that money could be better spent.

What are you giving up in terms of money, time, and the ability to do the things you desperately want to do, because of your health?  What small changes (or really HUGE changes!) could you make that would pay big dividends in health and wellness?

You deserve it 🙂

QUESTION: Is your health costing you anything?  What are you investing to make it better?

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Healthy Heart Equals Healthy Sex Life?

In the office, I often feel like I’m beating my head against a brick wall with some guys.  They are in their 40s or 50s and they smoke, they’re overweight, they eat crap and don’t exercise.  They don’t care that they are increased risk for a heart attack, diabetes and stroke.

Maybe I should start telling them they won’t be able to get an erection…

Don’t laugh.  There was a study published last month that suggested that erectile dysfunction is more likely to develop in men with lower cardiovascular health.  Keeping your heart healthy means you’re more likely to have a healthy sex life.

This study, published in the American Journal of Hypertension, followed over 1000 men for 10 years, starting in their early 60s.  They were assessed for cardiovascular health using 7 metrics:

  • Smoking
  • High blood pressure
  • High cholesterol
  • Diabetes / high blood sugar
  • Overweight or obesity
  • Unhealthy diet
  • Sedentary lifestyle

The researchers followed these men for 10 years to see how having these risk factors affected their chances of developing erectile dysfunction.

Now, we already know that erectile dysfunction is considered a marker of cardiovascular disease.  In order for the penis to become properly erect for intercourse, there has to be good blood flow to the tissues.  Atherosclerosis, the development of blockages to blood flow, interferes with the function of the tissues of the penis.

The researchers found that the higher (or more unhealthy) each man’s cardiovascular health score was at the beginning of the study, the more likely he was to develop erectile dysfunction by the end of the study.  In fact, the risk of erectile dysfunction ranged from 15% in the healthiest men to 100% in the unhealthiest.

So if the risk of a heart attack or stroke isn’t enough to make you (or your mate) get serious about quitting smoking, eating healthy, exercising, maintaining a healthy weight and controlling blood pressure, blood sugar and cholesterol, here’s one more reason.

Poor cardiovascular health can make you unable to have sex.

Now THAT’S a motivator!

QUESTION: Are you surprised about these findings?

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Pelvic Exams

Women over the age of 21 know what THIS is all about.  You go to the gynecologist or your primary care doctor for birth control or for your annual checkup.  After a zillion questions and the typical heart-lungs-belly exam the doc pulls out those lovely things for you to put your feet into and invites you to “Come on down!”

After scooting your bottom down (your NAKED bottom) until you feel like you’re going to fall right off into your doctor’s lap, the doctor proceeds with the annual two-part indignity of Pap test and pelvic exam.

The Pap test involves inserting a speculum (used to let him or her see your cervix) and taking a sample of cells from the surface of the cervix.  The bimanual exam has the doctor putting one or two fingers inside the vagina and the other hand on the abdomen to assess the size and position of the uterus and ovaries.

What if I told you half of that exam wasn’t necessary?

In March of this year, the United States Preventive Services Task Force issued a summary recommendation stating there is not enough information to recommend for or against the bimanual pelvic exam as a screening test.

I admit I had to stop and think about that one.  I was taught in school to do a pelvic exam every time I do a Pap test, but when I stopped to think I realized that I have never found a true problem in a woman who has no symptoms.

What symptoms might a woman have that indicate a potential problem in their pelvic organs?  Pain, of course.  Heavy or irregular menstrual periods.  Bothersome vaginal discharge.  In those cases, the pelvic exam is a useful part of the diagnostic process.

However, how often do we find problems in patients who have no symptoms at all?  Studies have shown that doctors actually are pretty lousy at telling the difference between a normal exam and an abnormal one.  We tend to find problems that aren’t actually there.

One analysis of three different studies looking at pelvic exams’ accuracy in finding ovarian cancer showed that 96-100% of abnormal pelvic exams actually had no abnormality identified.  The doctor felt something and ordered a test (usually an ultrasound or CT scan).  The test showed no evidence of ovarian cancer.

So if pelvic exams are not terribly accurate in identifying ovarian cancer, are they harmful?  Yeah, actually, they can be.  In studies, up to 60% of women reported physical pain and discomfort with the exam.  Up to 80% of women reported fear, embarrassment and anxiety.  Also, women who have a negative experience (because of pain or fear) are much less likely to return to the doctor for a repeat exam.  Obese women are more likely to report a negative experience and are much less likely to have an accurate exam, because of the difficulty of performing the exam.

There are more serious harms too.  There was a study that showed 1.5% of patients who had a pelvic exam wound up with unnecessary surgery for a concern about ovarian cancer.

The USPSTF states that there is not enough evidence to recommend for or against pelvic exams.  However, the American College of Physicians and the American Academy of Family Physicians have made recommendations that pelvic examinations NOT be performed in women who have no symptoms and have no increased genetic risk of ovarian cancer.

What does that mean for female patients?  You need to see your doctor regularly for screening exams based on your age, which may include a mammogram, Pap test, colonoscopy and blood tests.  However, the doctor performing a pelvic exam shouldn’t be part of the visit unless you’re having symptoms.

QUESTION:  Will you be more likely to get regular physicals if you know you won’t have to have a pelvic exam?

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Lung Cancer Screening

It’s the number-one cancer killer of both men and women.  Almost 160,000 Americans died in 2016 from this cancer, and it accounts for over 25% of all cancer deaths in the USA.

We have no effective chemotherapy treatment for most cases of this cancer.  Once it spreads, it cannot be cured.

The most effective treatment for this cancer is surgery, but the vast majority of cases have no symptoms until the tumor is advanced.

Until recently we had NO way to screen for this cancer.

This is, of course, lung cancer.  One of the most feared and most difficult to treat tumors in humans, it usually spreads to the bone, the liver, the adrenal glands and the brain.  It is strongly associated with smoking and with second-hand smoke exposure, as well as with some occupational exposures like to radiation, asbestos and radon gas.

After years of research and the development of new less-costly and less-harmful technology, we finally have an effective tool for lung cancer screening.

In 2015 Medicare approved the use of low-dose CT scanning for screening for lung cancer in certain patients.  Most private insurers and Medicaid also cover this screening test although you should check whether your carrier offers this test.

Who is at risk for lung cancer and eligible to be screened?

  • Age 55-77, both men and women
  • NO signs or symptoms of lung cancer like a chronic cough, fevers, night sweats, coughing up bloody phlegm, or unexplained weight loss
  • Current smoker or quit smoking within the last 15 years
  • At least 30 pack-years of smoking history (an average of 1 pack per day for 30 years, 1 ½ pack per day for 20 years, or 2 packs per day for 15 years, for example)

It’s not a one-and-done screen though.  Like mammography, low-dose CT for lung cancer screening needs to be performed every year.  Often there are tiny nodules found on screening that may be scars, may be evidence of old infections, or may be very early lung cancers.  These need to be followed over time to make sure they are not changing and that no new spots develop.

One other important thing to realize is that although the screening CT is covered by Medicare at no cost sharing (like mammograms, Pap tests and bone density tests), any follow up done because of an abnormality WILL have an associated cost based on deductibles and copays.

It is also important to know that an abnormal screening scan produces a LOT of anxiety.  It’s very hard to hear that you have a 1/8-inch spot in your upper left lung, which is too small to biopsy or to scan in any other way, so we’re going to leave it alone and repeat the scan in 6 months.  Wait, what?!  What am I going to do for the next 180 days and nights until it’s time to scan again?  Wait, and worry, unfortunately.

If you meet the criteria above and are interested in being screened for lung cancer, make an appointment to talk to your doctor about it.  This should happen at a well visit so if you haven’t had your physical in over a year you should definitely call and schedule it.

Lung cancer kills more Americans than any other cancer.  It is difficult to diagnose early enough to be able to treat it effectively.  Low-dose CT scanning is the best tool for lung cancer screening we’ve ever had.

PS – If you meet the criteria to be screened for lung cancer and you are still smoking, you need to cut down and quit.  Today.  I know that goes without saying, but I just needed to say it anyway.

QUESTION: Do you meet criteria for lung cancer screening?  Have you had a low dose CT scan?

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