Issue Date: September 30, 2001
It's time to take care of you
This feature on women's well-being concludes a year-long series on family health written by Contributing Editor Tedd Mitchell, M.D. A respected internist and USA WEEKEND's medical expert, he directs the Wellness Program at Dallas' renowned Cooper Clinic.
My sister-in-law just had a baby. We took the kids to the hospital, where my job was to keep them corralled in the waiting room while my wife went into the delivery room to give support to the expecting parents. After a relatively short labor (and a helpful epidural), my sister-in-law gave birth to a healthy 6-pound, 9-ounce baby girl. My 10-year-old daughter, Katherine, was too young to go into the delivery room, but she's plenty old enough to understand the excitement.
Here were five women -- baby, mother, grandmother, cousin and aunt -- all sharing in a very special moment. Each is at a unique stage in life. And each is subject to the ups and downs facing modern women.
For many women, roles and responsibilities have increased dramatically in the past few decades. While they remain the anchor at home, many also have tackled an outside job, increasing the demands placed on their time. Sadly, for many that means less time to take care of themselves. Fortunately, with help from family and friends, time management, fortitude and good health, women can successfully navigate this footrace we call life, enjoying every step of the way.
Today, pause a moment in your hectic trip and absorb information that will help you a little farther down the road. Here are pointers on the most important health topics -- hearts, cancers, hormones and habits -- for today's women.
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KNOW YOUR HEART RISKS
The No. 1 killer of American women is cardiovascular disease. In fact, it kills twice as many women as all forms of cancer combined. Of these deaths, half will be from heart attack, and the remainder will be from stroke, heart failure, high blood pressure and other forms of cardiovascular disease.
It never has been more important for women to be aware of the risks for heart disease so they can reduce them. The risks include high blood pressure, high cholesterol, diabetes, cigarette smoking, a family history of heart disease, obesity, physical inactivity and menopause.
These risk factors are more common than you may think. High blood pressure strikes 20% of white and Hispanic women and 33% of African-American women. A quarter of all women still smoke cigarettes; half have high cholesterol levels; one-third don't engage in regular physical activity. Furthermore, 5 million women have been diagnosed with diabetes, and 2.5 million others have diabetes but don't know it yet.
Obviously, lowering your risk is important. You know what to do: See your doctor, take your medicines and stop smoking. Also, check out the doable advice on diet at the end of this article, and exercise advice on pages 12 and 14.
Knowing the common signs of a heart attack is vital, too. Watch for chest pain or pressure that moves toward the jaw or the arm, shortness of breath, nausea and sweating. Remember, the main sign may not be chest pain. In fact, you may mistake symptoms of heart attack for muscle strain, indigestion, anxiety or the flu. Don't take a chance by misdiagnosing your own condition, and don't be embarrassed if your doctor tells you it is not your heart. After all, when was the last time you were embarrassed because your mammogram didn't show cancer? Be safe, not sorry.
If you do have cardiovascular risk factors or symptoms, your doctor may suggest a stress test to determine whether problems really exist and how severe they are. For women, the most common stress test combines an exercise treadmill, an electrocardiogram, blood pressure monitoring and an echocardiogram. Women's stress test results are sharper if an additional test -- a nuclear imaging procedure -- also is performed. If the test results are abnormal, a cardiac catheterization might be performed. When this happens, a dye is injected into arteries to define a specific location or severity of a blockage. The next steps may include surgery.
Now is the time to change and learn: More than 60% of women who have a heart attack die suddenly and without suffering previous symptoms (none that they told anyone about, anyway). Of the women who survive that first heart attack, 38% will die within a year. Partner with your health care professional to maximize your wellness. Let's encourage our grandmothers, mothers, sisters and daughters to turn these deadly statistics around.
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GET TESTED FOR CANCER
Young women today seem much more aware of cancer than our mothers and grandmothers were. When that greater awareness translates into more cancer screenings, lives are saved.
A study published in July revealed that the breast cancer death rate plummeted 63% for thousands of Swedish women ages 40-69 who were screened regularly with mammography, compared with a control group who did not undergo screening. That drop is double what previously had been reported by researchers, and it underscores the power of screening.
About 60% of American women get mammograms annually. Just think what we could do if all women were screened.
Don't let cost hold you back: Nearly every state requires insurers and HMOs to cover the cost of a mammogram, according to the American Cancer Society. The government also pays via Medicare and Medicaid.
Although mammography is extremely important, it's only one piece of the puzzle. Having an annual breast examination performed by a health professional and performing monthly breast self-exams also are essential tools in finding breast cancers early.
The key to beating any cancer is early detection. An annual pelvic examination and Pap test to detect cervical cancer may not be the high point of your year, but they are simple and save lives. Cervical cancer researchers say an impressive 90% of women with small tumors survive five years; a dismal 14% with advanced disease survive. Detection recently has become more sensitive through the use of a 'thin prep" test.
Lung cancer is easier to detect today, too, thanks to spiral CT scans and electron beam tomograms. But the best tactic with lung cancer is low-tech: Tobacco is associated with nearly 90% of lung cancers, and any smoker interested in her health needs to become a non-smoker.
Colon cancer, the second most common cancer in the United States, is preventable, too. Colonoscopy (a long scope inserted into the body to look for polyps and other growths) is the gold standard for diagnosing and treating precancerous growths. Many people will remember Today show host Katie Couric undergoing a colonoscopy on national television. After her husband died from colon cancer, Couric was surprised to learn how common and preventable that illness is. Risk factors include family history, and a personal history of uterine, ovarian or breast cancer; also, high-fat, low-fiber diets may increase the risk. All women over 40: Discuss with your doctor when you should begin colon cancer screening.
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MANAGE THE HORMONE MAZE
Although premenstrual syndrome, or PMS, normally is not mentioned in the same category as some of these other illnesses, it is a major factor in quality of life.
Most women will experience PMS, especially in their late 30s and 40s. Symptoms include irritability, anxiety, poor sleep, fatigue, depression, binge eating, headache, bloating and breast tenderness. The symptoms start about a week before the menstrual period and last from one day to two weeks a month. Up to 20% of those women have severe symptoms (called premenstrual dysphoric disorder, or PMDD). Researchers are still trying to understand exactly how hormones trigger that disorder.
Meanwhile, to minimize symptoms, get plenty of sleep, go easy on the alcohol, limit or avoid caffeine, watch salt intake, eat more fiber and less fat, relax sometimes, exercise regularly, and take B vitamins, calcium and magnesium supplements.
Note: If you have significant PMS symptoms, or if those symptoms don't seem limited to before your menstrual cycle, you may have depression or another disorder, such as a thyroid abnormality, that can be helped by a doctor. If you are significantly depressed, you have angry outbursts, your PMS symptoms interfere with getting your work done or your symptoms do not seem manageable, talk to your doctor. For some women, antidepressants are helpful and necessary.
With the approach of menopause, women face the complicated decision of whether to take hormone replacement therapy, or HRT. Discuss this option in detail with your doctor; a complete understanding of your health history is necessary to make a medical decision.
HRT usually relieves menopausal symptoms (hot flashes, night sweats and mood swings), and it offsets rapid bone loss that leads to osteoporosis. Estrogen also helps maintain skin, hair, and vaginal and urinary structures. Some researchers believe the hormone might keep thinking sharp and decrease risk of colon cancer.
The impact on hearts is another matter. Women at low risk for heart disease don't appear to receive any benefit to their heart from taking estrogen after menopause. Women with heart disease or at high risk for it may increase their risk of a heart attack in the first year of estrogen therapy but later decrease the risk.
Unfortunately, taking estrogen without progesterone increases the risk of uterine cancer and blood clots and may increase breast cancer risk. Some women will have bloating, breast tenderness, headaches and nausea. While on hormones, yearly mammograms are a must.
I can imagine a lot of women right now saying, 'HRT is certainly not for me!" But remember: The most important reason to use hormones is to reduce severe menopausal symptoms. Once the symptoms have passed, many women discontinue HRT to avoid long-term risks.
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Diet without dread
I know most women cringe when they think about dieting. It's psychologically deflating. So instead of looking at the glass as half empty, accentuate the positive. Strive for energy by combining foods that provide different types of fuel.
Proteins (fat-free milk, low-fat cheese, yogurt, poultry, fish, lean meat) provide energy for the next three to five hours.
Healthful carbohydrates (fruits, vegetables, whole grains) provide quick energy.
Fats provide energy for up to six hours, which is necessary to get you through between meals.
At the Cooper Clinic, we call this the P-C-F balance, blending sources of proteins, carbs and fats for continued energy and blood sugar control. This boosts energy and reduces hunger, and it's the kind of program you can follow and not feel guilty about.
Examples of P-C-F meals and snacks are yogurt and granola bars; milk and cereal; cheese and whole-grain, low-fat crackers; peanut butter on whole-grain bread; a sandwich made with turkey, grilled chicken or lean ham; and hummus with pita.
And while you're balancing the other foods, don't forget to have three milk/dairy/calcium servings every day. The reason is simple: The best way to treat a woman's decreasing bone mass is to try not to lose it in the first place.
If you develop good habits, even ones that require work, it makes the quality of your life much better in the long run. Unfortunately, many people choose easy daily routines that eventually make their lives more difficult. As the famously long-lived painter Grandma Moses said: 'Life is what we make it. Always has been, always will be."
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GET MOVING!
To add years to your life and life to your years, get regular exercise. See stories, on Cancer and exercise and Women & workouts.
If you haven't seen your doctor lately, call Monday for an appointment.
Waiting until you are sick limits the visit to specific problems, making it difficult to see the big picture.
A wellness checkup gives you a chance to ask questions while the doctor reviews your history, counsels you on habits and delivers important preventive services.
Remember: Your doctor is your advocate. Don't let your busy schedule hurt this valuable relationship.
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One way to achieve your daily dietary goals for all your food groups is to follow what I call the "Rule of Threes." Follow it and you'll meet your needs for calcium, fiber, protein, fats, carbohydrates, vitamins and minerals. Strive for:
-- Three milk/dairy/calcium foods
-- Three fruits
-- Three vegetables
-- Three whole grains
-- Three-ounce servings of meat (two per day)
-- Three starches
-- Three teaspoons of fat/oils daily
-- Eat beans three times weekly
-- Eat at least three colors per meal!
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