Save Second Base!

This is the funniest T-shirt I’ve seen this month for Breast Cancer Awareness!¬† I’m kind of glad my ten-year-old son is oblivious though, not sure I’m ready to explain this one ūüôā

Many of you know I was¬†in Pittsburgh yesterday for a primary-care breast cancer conference¬†at¬†UPMC.¬† It was a great conference!¬† The most important things I learned were NOT what to do about a large-core breast biopsy showing atypical ductal hyperplasia (in case you’re interested, the right answer is refer for¬†excisional biopsy).¬† I learned there are simple lifestyle measures every woman can implement to reduce her personal risk of breast cancer.

First of all, exercise!¬† 30¬†minutes of brisk walking 4 times a week reduced breast cancer risk by 30-50%.¬† Walking, just walking.¬† Get out your sneakers and get moving!¬† As you’ll see in #2, weight management is important but even without looking at the correlation with weight, exercise still reduced the breast cancer risk.

Second, get to a healthy weight and STAY there, especially after menopause!  Fat cells have an enzyme called aromatase that change male hormones made by the adrenal glands into estrogens.  After menopause, estrogens raise the risk of breast cancer substantially.  Women who carry their body fat in their abdomens (apples)  have a much higher risk of breast cancer than those who have more around their hips and thighs (pears).  Obesity in women also raises the risk of uterine and colorectal cancer, BTW.

Third, don’t drink alcohol.¬† Even half a glass of wine daily raises the risk of breast cancer.¬† There doesn’t seem to be a level of alcohol intake that is “baseline” or safe, so it’s really safest to not drink at all.

Breast cancer is the most common cancer in women.¬† It is the second greatest cancer killer of women (after lung cancer).¬† Many women believe that their risk of breast cancer is something they can’t control, that it’s based in the genes alone.¬† That’s not true!¬†¬†Adopting these three simple measures (which are good for you anyway, not just in their ability to reduce your breast cancer risk) can help women avoid this awful disease.

Notice I said “simple,” not “easy.”¬† No one will ever tell you that maintaining a normal weight is easy.¬† But it is certainly not as tough as changing your age, gender, race or family history!¬†¬† These things ARE under your control.¬† You CAN choose to get moving, eat right, lose weight, and avoid drinking alcohol.

Which will you choose?

PS – if you want some help with weight loss, please let me know.


Rated “M” For Mature

Looking back, it’s hard to believe I’ve been writing this blog for 3 months.¬† It’s even harder to believe I’ve gone this long without talking about sex.¬† Seems like I talk about it all day long in the office!

I had a lady in the office recently, a good friend and long-term patient.  She was there for her annual physical and GYN exam.  I always ask about sexual activity, and she mentioned that things were getting uncomfortable in that area.  In fact, she was a little aggravated, because her kids were now grown and out of the house.  It seemed unfair that, although she and her husband were now more able to be spontaneous and frisky when the mood struck, menopause had made it so that she was LESS interested than in the past.

Let’s face it guys, if sex was painful for you, would you want to do it?¬† No matter how much you loved your wife/girlfriend/lover/etc, if¬†sex hurt you would think twice.¬† I’d like to review for my readers of BOTH genders the physical reasons why ladies of a certain age might¬†get rapidly less interested in sex.

At menopause, the ovaries stop making estrogen.¬† It’s usually not like flipping a switch, but rather¬†they¬†will sputter to a stop.¬† Menstrual periods get less frequent and eventually stop altogether.¬† She may get hot flashes and¬†night sweats, have trouble sleeping, and be more cranky than usual or get downright depressed.

It’s interesting that although the ovaries go on permanent vacation at menopause, the adrenal glands continue to make weak male hormones throughout life.¬† This seems to be why women struggle with acne and male-pattern hair growth around menopause.¬† The body’s fat tissues have enzymes that change those weak male hormones into weak estrogens.¬† This may¬†give women who¬†carry more body fat¬†gentler menopause symptoms.¬† Here’s one of the few areas where women who are slender are at a disadvantage!

The one area of the body that is most sensitive to blood estrogen levels is the perineum, the area around the opening of the vagina and urethra.¬† Estrogen keeps those tissues strong, stretchy, and able to lubricate themselves.¬† The most incredible example of this elasticity is the perineum’s ability to stretch without tearing to let a baby’s head out at childbirth.¬†¬†Estrogen also makes the vaginal secretions acidic which helps to protect against infection.

After menopause estrogen levels fall rapidly and the skin and tissues of the perineum lose the ability to stretch.  The skin gets fragile and thinner, and the secretions decrease significantly and become more alkaline.  Urinary infections become more common due to these changes, but by far the most obvious consequence of these changes is painful intercourse.

The good news is that there is an easy¬†treatment for this problem.¬† A little bit of estrogen cream is the treatment of choice for menopausal women whose main (or only) symptom is pain with sex.¬† It’s only used twice a week and very little is absorbed into the bloodstream, so it is¬†generally considered¬†safe even for those concerned about the risks of hormone replacement.

I hope any of my female readers who are troubled by painful intercourse after menopause will make an appointment with their doctor to discuss the options.¬† My gentleman readers of a certain age who are experiencing resistance to sex should have a frank discussion with their¬†partner about whether pain is playing a role.¬† I might gently caution you not to take the “Honey you’ve got to get this fixed” approach.¬† A supportive and sincere¬†concern for HER pleasure¬†in your¬†intimacy will go much farther.

Achieving menopause¬†doesn’t mean that your sex life shouldn’t be as active and fulfilling as it was when you were younger.¬† Giving up the¬†fun of menstrual periods should be a joyful occasion, not shadowed with the loss of physical intimacy due to pain.¬† Be open and honest with your lover, keep your sense of humor, be adventurous!¬† Getting older isn’t for sissies!

PS – I am making the VERY large assumption in this post that¬†both members of¬†a¬†perimenopausal couple WANT to continue to be sexually active and that the only thing standing in the way of their mutual satisfaction is pain due to vaginal dryness and tissue fragility.¬† A complete discussion of all the psychological reasons that a couple’s sex life can go awry is WAY beyond the scope of this post.


I’ll Miss You, Part Two

For everyone who’s been praying for Josie’s husband and family (check here for the story) I wanted to let you know that¬†he found her¬†in the Light early this morning and they’re dancing together in Heaven.¬† Not even three weeks apart, and I’m sure for Josie that was much too long.

Thank you for your prayers, his passing was peaceful and my heart is full of joy for them both.


Who Needs A Pick-Me-Up?

This week I had a question from a subscriber:¬† Would an energy shot or drink¬†be good for me?¬† My initial reaction was “Heck no!”¬† Then I thought better of it and decided to do some research.

My initial “Heck, no!” response was from concern about caffeine intake.¬† The one who asked the question is a teenager and I’m concerned about use/overuse of energy drinks in teens.¬† This age group is prone to risky behaviors and generally feels a little immortal so I always want to wrap them up in bubble wrap ūüôā¬† Overuse of caffeine can cause sleep problems, palpitations, anxiety and raise blood pressure.¬† Energy drinks tend to be sugary and high-calorie too.

I looked up the caffeine dose in a typical energy shot or drink and found that they are fairly comparable (per serving) to high-test coffee.¬† In addition, most of the energy shot/drink products have B vitamins and amino acids in varying amounts.¬† Some are sugary, some are sugar-free (and hence artificially sweetened).¬† I haven’t found any REALLY objectionable ingredients in mainstream energy drinks and shots.¬† Some have very high doses of B vitamins which have questionable benefit and potentional for side effects (for example, high doses of vitamin B6 can cause neuropathy).

After analyzing the information I think I can safely say that occasional use of energy drinks and shots is not likely to cause health risks.¬† However, many people don’t use them only occasionally.¬† Many people use them daily, sometimes multiple times daily.¬† When coffee drinkers use energy drinks and shots it compounds the toxicity of caffeine.¬† In addition, suddenly decreasing or stopping the intake of caffeine can trigger migraine headaches.

I would recommend some restraint on the use of ALL caffeine products.  Those with heart problems should not use much caffeine at all.  Children should not use caffeine products and teens should be careful.  If you find yourself tired and needing a pick-me-up, rather than reaching for coffee or an energy shot, take a look at your habits instead.  Are you skimping on sleep?  Are you skipping breakfast every morning?  Are you eating a lot of processed foods and junk food?  These habits can contribute to fatigue and make you feel stressed as well.

Before you make a regular habit of energy drinks, I have a few suggestions.  Get plenty of rest and drink plenty of water.  Shift your diet away from processed foods towards more whole foods.  Use fruit to satisfy your sweet tooth.  Eat several small meals (including breakfast!) throughout the day rather than two or three large ones.  Take a look at your stress and see if it might be contributing to low energy.

All things in moderation, folks.¬† Occasional use of energy drinks and modest coffee consumption by adults aren’t likely to cause problems.¬† Parents need to keep an eye on their kids’ and teens’ intake.¬† Be careful out there!

PS РShaklee makes a great natural product that I took to China with me in June to combat jetlag.  It has caffeine from green tea but not as much as coffee or an energy drink, and it worked great!  For more info check here.


I’ll Miss You, My Friend

This week I’d like to talk about purpose in life.¬† Everyone needs one.¬† Everyone needs to feel they make a difference to at least one other person.¬† Everyone needs to touch another and be touched in return.¬† When someone loses their purpose I believe they can die just from having no reason to keep living.

My friend Josie died this week.¬† She had a great and meaningful purpose in life, which took all her effort and filled her days:¬† caring for her beloved husband.¬† She was frequently overwhelmed and we all worried about her, but she seemed to thrive on making his days calm and peaceful.¬† Her husband had fairly advanced Alzheimer’s disease and they had no children.¬† Much of her family lived out of town.¬† So he had Josie, and she had him.

Recently Josie’s health took a turn for the worse and she wasn’t able to care for him anymore.¬† He was settled in one of our nursing homes with special accommodations for Alzheimer’s¬†patients and actually transitioned very well.

Josie didn’t transition well at all.¬† Her health continued to deteriorate and after several weeks she died.¬† I believe she gave up, because she couldn’t do anymore what had given her such purpose in her life.¬† Now she is with God, and I pray she can see into the hearts of those who knew and loved her, and see how much we all admired her dedication and loving stubbornness.¬† She was an absolute bulldog who never gave up on her husband, and did everything in her power to see that he had what he needed.

I know one fellow in an Alzheimer’s program at a local nursing home who has a fierce guardian angel standing behind him.¬† We all will miss you Josie.¬† Rest well.¬† Any prayers for Josie’s peace would be much appreciated.