Each year in the US over 700,000 people suffer a stroke and over 143,000 people die as a result.Three-quarters of those who suffer a stroke are over 65 years old.It is important to know who is at risk and how to recognize the symptoms.A stroke occurs when there is lack of blood flow to the brain.

The risk factors for a stroke are similar to those for a heart attack.These include: smoking, high blood pressure, high cholesterol, diabetes, and a sedentary lifestyle. A family history of stroke, a history of a previous stroke or transient ischemic attack (TIA), increasing age and alcohol abuse can also increase the risk of stroke.

The long term consequences of a stroke can be devastating.That is why it is important to prevent them.You can do this by reducing your risk and modifying your risk factors.Quit smoking, keep your blood pressure and cholesterol down. Eat healthy and exercise.Take folic acid as part of your vitamin regimen.

What are the symptoms and warning signs of a stroke,they include:

* Sudden numbness or weakness of face, arm or leg, especially on one side of the body
* Sudden confusion, trouble speaking or understanding
* Sudden trouble seeing in one or both eyes
* Sudden trouble walking, dizziness, loss of balance or coordination
* Sudden severe headache with no known cause

Other danger signs that may occur include double vision, drowsiness, and nausea or vomiting. Sometimes the warning signs may last only a few moments and then disappear. These brief episodes, known as transient ischemic attacks or TIAs, are sometimes called “mini-strokes.” Since they may clear quickly, many people ignore them but that is a mistake. Many people with a TIA have a stoke within 48 hours.

If you think you are having a stroke call 911. Time is of the essence. It is possible in some cases to reverse the damage of a stroke if you are treated within hours of having symptoms.

Find out more about stroke in our book, “The Smart Woman’s Guide to Midlife and Beyond”.

We know that laughing is healthy, but what about crying? It turns out that it can indeed be therapeutic as long as it is now and then and not all the time. After looking into it, I have discovered why a nice, old-fashioned cry can feel so good.

Crying is a natural response to sorrow, frustration and grief and helps relieve emotional stress. It lowers the risk for heart disease by lowering blood pressure and pulse rate and removes toxins from the body. William Frey II, a biochemist at the St Paul Ramsey Medical Center in Minnesota, has been studying tears for over 15 years.

He found that tears from stress or sadness contain different chemicals than tears that are produced by an irritant. He has done experiments analyzing tears after subjects watched a sad movie vs. when they cut onions. The sad tears contained 24% more albumin than the onion-induced tears.

They contained an endorphin called leucine-enkaphalin (which helps control pain) and prolactin a hormone, which regulates milk production. Sad tears also contain 30 times more manganese as compared to serum levels. Excess manganese is associated with anxiety, stress and serious mood problems.

Not surprisingly, women cry more than men. On average women cry 47 times a year and men cry 7 times a year. The average cry lasts 6 minutes. Eighty-five percent of women and 73% of men felt better after a good cry.

Removing stress hormones through tears is healthy. Suppressing them is not and can lead to stress related disease. Tears have a cultural purpose as well. They evoke a quick empathetic response from others.

I know in the past I have recommended a funny movie to make you feel better. Maybe once in awhile it would be good to throw in a sad one so that you can have a good therapeutic cry. Of course, if you are Kurt Vonnegut you might want to stick with the funny ones!

“Laughter and tears are both responses to frustration and exhaustion. I myself prefer to laugh, since there is less cleaning up to do afterward.” ~Kurt Vonnegut

Last spring I was at a medical conference where I heard a talk about nutrition for surgery patients presented by a prominent surgery professor. Although the information was good, I have to confess that I only remember a small amount of what I heard. What I do remember was that at the end of his very serious lecture, the professor spoke about the importance of laughter for health.

Then, he started stomping around the room laughing. It was hilarious and inspiring to see this senior surgeon in a three-piece suit convulsing in laughter. The audience spontaneously got up and started following suit (pardon the pun). Before I knew it I was laughing uncontrollably. I felt fantastic. During his talk I was having post-lunch fatigue and was fighting to stay awake. After his talk I felt alive, happy and refreshed.

I have always loved to laugh. Recently, I have realized that not only does it feel good, but also there may be health benefits. In 2000, Dr Michael Miller (not a relative) at the University of Maryland did a study, which found that patients with heart disease were less likely to find amusing daily life situations funny when compared to those without heart disease. The question raised was which came first, the lack of humor or the heart disease.

Five years later he conducted a study that may give a hint at the answer. Using healthy volunteers to see the effect of hearty laughter on blood vessels, he found that it dilated and opened blood vessels improving blood flow to the body. Sad or stressful movies had the opposite effect causing constriction and narrowing of blood vessels. The body reacts to laughter in a way that is similar to aerobic exercise.

The take home lesson from this is that in addition to aerobic exercise for wellness you can add a healthy dose of laughter. This is especially useful if you are in a place where you cannot exercise. When you are on an airplane watch a funny movie. If you are stuck at a desk at work, entertain your colleagues with some good jokes, because laughter is good medicine for all. The main side effect is that you may annoy others around you. Engaging them in whatever “funny” business is going on can solve that problem and help them at the same time.

“If taking vitamins doesn’t keep you healthy enough, try more laughter: The most wasted of all days is that on which one has not laughed. “ - Nicolas-Sebastien Chamfort

If I told you there is something that could improve your mood, decrease blood pressure, keep your blood flowing, lower your heart rate, calm you down, boost your immunity, and enhance your ability to learn, would you be interested?

What if I told you that it is free and does not involve medication? Now I have your interest! There is something that will do all of the above and is also quite enjoyable.

It is music!

Studies in England have found that patients who were taught to play music as part of a study for the treatment of depression experienced a reduction in their symptoms by 25%. Research in Italy revealed that listening to Celtic, classical, or Indian (raga) music for 30 minutes a day can significantly lower blood pressure. Researchers in the US found that relaxing music can dilate blood vessels in the body and improve general blood flow. Music that was perceived as stressful (heavy metal as an example) caused the blood vessels to contract and decrease blood flow to the body.

When students were studied by having them listen to six types of music, researchers found their heart rate synced up to the speed of the music regardless of the style and their interest. If the music was lively, their hearts sped up. If the music slowed down, so did their heart rates. It produces an additional calming, immune, and mood boosting effect by lowering cortisol levels, increasing hormones that improve the immune response and raise endorphin levels.

Finally, you have probably heard about the Mozart effect, where listening to Mozart’s music enhances learning. Baroque music, with a 60 beat per minute pattern, particularly activates both the right and left side of the brain. This enables the brain to process information more easily. It also improves recall of information when a particular tune is used during studying and then replayed.

Music is the universal language appealing to all of us while enhancing learning and healing. As medical costs continue to skyrocket, it is nice to know that there is something enjoyable and therapeutic we can do (in addition to your regular preventive evaluation and treatments) to improve our health!

“I think music in itself is healing. It’s an explosive expression of humanity. It’s something we are all touched by. No matter what culture we’re from, everyone loves music.” ~ Billy Joel

What music helps you to feel better and heal?

At my house next to our front door there is a beautiful bush filled with Daphne flowers. It smells wonderful and makes me smile on my way in and out of the house. That got me thinking. Can flowers make us happy? I did a little research and found several studies that do indeed show that flowers can affect our mood in a positive way.

At Rutgers University a behavioral research study has found that flowers elicit a universal reaction that can help people feel happiness. Those who received flowers felt less depressed and anxious after receiving them, and the flowers led to more frequent contact with friends and family.

A study done at Harvard found that when people had freshly cut flowers around the house, they were less anxious. They were happier at work and also expressed more compassion and kindness towards others.

A study done at Texas A&M found that when both men and women were exposed to cut flowers at work, they both had an increase in ideas and solutions to office problems. Men generated more ideas than women, but women had more innovative and creative solutions to problems when flowers were nearby.

Flowers have certain meanings according to those who specialize in that sort of thing (Taken from The Language of Flowers by Vanessa Diffenbaugh). If you want to say something specific you might try these: Gerber daisies represent cheerfulness, baby’s breath reveal everlasting love, bird of paradise say magnificence, hyacinth communicate beauty, and jonquils represent desire.

It is spring and flowers are blooming everywhere. If you want to brighten your day or someone else’s bring in some flowers or visit your local flower shop. It will help you to be more productive, tell people how much you appreciate them and keep a smile on your face!

Today my mother sent me a great picture of herself in a gift shop in Cambodia. She looks fit and happy. It got me thinking about the fact that as we age we have many choices. The major one is to be or not to be fit. I saw what happens both ways in my family. Let me start with my father.

My dad was brilliant but stubborn. He smoked, ate a fat-filled, high sugar diet, and was totally opposed to exercise. He had to quit smoking when he developed bladder cancer and his urologist told him that if he continued to smoke he would not see him in his practice, because a cancer recurrence would be inevitable.

He started eating healthier when his brother developed type 2 diabetes and he realized that he might end up with the same thing. However, he refused to get regular check-ups until he was in his mid 60’s. He did not realize that for most of his adult life he had high blood pressure, because he did not feel it. But, it took its toll on his kidneys in a big way.

By the time he was being seen on a regular basis he was in renal failure. Despite treatment for his hypertension, his kidneys finally failed completely. He made it to 84. He was alert and with-it till the end. Had he been treated for his high blood pressure early on he would still be here. It was amazing that he made it into his 80’s, but his quality of life suffered, especially the last 10 years.

My mother on the other hand has always been a health nut. She was exercising and eating healthy before it was fashionable. She quit eating red meat when she was in her 40’s. She has been walking and going to exercise classes most of her adult life. She now does Pilates, yoga, and is an avid tennis player. She started playing doubles a couple of years ago because her knee was acting up and she couldn’t run as fast in her singles games. She plays bridge, goes to lectures at the local university, and is now traveling around the world.

I cannot say how old she is because she would kill me, but I am 58 and she was not a teen mom so you can kind of guess her age. To look at her you would think that she was in her 60’s. She is committed to keeping her brain and body healthy and has been for most of her life. Fortunately my siblings and I have followed her example.

We have no control over what goes on in the world, but we can control how we treat our bodies. Life can get crazy, but there are choices we can make. You can choose to ignore your health as my father did (and please say hello to him when you see him) or you can follow the path that my mother is on and be well!

“To resist the frigidity of old age, one must combine the body, the mind, and the heart. And to keep these in parallel vigor one must exercise, study, and love.”
Alan Bleasdale

In 2002, the Women’s Health Initiative study found that the risks of Premarin and Provera treatment for menopause outweighed the benefits. Since that time, women have been looking for alternative ways to treat their menopausal symptoms.

Bioidentical hormones have taken the place of Premarin and Provera. Bioidentical are so named because they are identical to our natural hormones. The big question is, are they safe? The answer is yes and no. There have been no long-term studies in the United States so we have to look to Europe for some answers.

A study of nearly 100,000 women in France found that those on estrogen alone had a 30% increased risk of developing breast cancer. When estrogen was combined with natural progesterone there was no increased risk for developing breast cancer. They also found that when estrogen was given in the form of a patch or gel there was no increased risk for blood clots. This may also decrease the risk for stroke or heart attack.

Most physicians would agree that treatment of symptomatic women in early menopause is relatively safe. Before starting hormones, it is important to make sure that your mammogram is negative and that they are done yearly. In addition, your risk factors should be reviewed. For instance, I am very reluctant to start women on hormones when they have a mother or sister with a history of breast cancer.

There are some providers out there who will not give women hormones under any circumstance. They are either men who have never had to live through it with their female friends or partners or women who haven’t gotten there yet. If you are suffering and would like hormonal help, there are empathetic, understanding providers out there.
Find them. Have a full discussion so that you understand the benefits and the risks. We are all different. Some women may only need them for months and others may need them for years. There is no need to suffer, but make sure you are comfortable with your decision and that each year you re-evaluate your need for hormones.

Let’s talk menopause. Some people think of it as a disease. However, it is a natural consequence of aging. Many make the assumption that we know all there is to know when it comes to treatment. However, it is a relatively new phenomenon. Think about it. In 1900 the average life expectancy for women was 43 years. Menopause has only been something we have had to deal with for three generations. My grandmother was born in 1900 so she was amongst the first to make it beyond menopause, then there is my mother and myself following in suit.

In the past, those suffering from hot flashes, fatigue and mood swings were started on Premarin and Provera. Premarin is made from pregnant mare urine and Provera is a synthetic progestin not to be confused with natural progesterone. Most women were kept on these hormones and common medical opinion was that they prevented osteoporosis and heart disease.

All that changed in 2002 when the results of the Women’s Health Initiative study were released and the study was stopped because it was found that the risks of these particular hormones outweighed the benefits. Instead of putting almost every menopausal woman on hormone replacement, the majority of women were not started on them, were pulled off of them, or stopped them on their own.

Needless to say there were and are a lot of hot women running around who are a little testy because they are not sleeping and are sick of having to deal with their menopausal symptoms. Let’s talk about the study and what was found and who was studied. Then we can talk about alternative hormone therapy.

The study (started in 1997) involved over 16,000 women who were on average 63 years old, had a uterus and had never had a hot flash. They were either treated with Premarin (0.625 mgs) and Provera (2.5 mgs) or a placebo. Over 10,000 women who had a hysterectomy were either treated with Premarin alone or placebo. Many women in both groups had high blood pressure and high cholesterol that was being adequately treated.

The study was stopped early when it was found that those on combination hormones were more likely to have a stroke, heart attack and breast cancer than those on placebo. In those treated with Premarin alone there was no increased risk for breast cancer or heart attack but a slight increased risk of stroke.

Younger women (ages 50-59) who were treated within 10 years of going through menopause had a slightly decreased risk for developing heart disease. Women over 65 who were treated had an increased risk of developing dementia.

Here are some things to consider. When one looks at the group treated with Premarin alone, there were fewer associated risks. Provera seems to be the more dangerous medication when it comes to heart attack and breast cancer risk. In addition, most physicians would not start a 63-year-old woman with high cholesterol and high blood pressure on high dose hormones. The reason being that we know that hormones can increase the risk of clotting which would potentially precipitate a heart attack and stroke. Perhaps the increase in dementia was due to this as well.

I think it is important to know what the decision to stop hormones was all about. Knowing this, you can decide for yourself if hormone replacement is for you. To do that you need to know what else is out there. Premarin and Provera are rarely prescribed anymore. There are newer options called bioidentical hormones. These hormones are recognized as natural hormones by the body. Are they for you? Stay tuned!

More on these options in the next blog.

For those who are going through menopause and would like to avoid hormones there are many things that may help. Here are some suggestions for how to deal with the problems that I call the big three; hot flashes, insomnia and weight gain.

Hot Flashes

Two thirds of menopausal women suffer from hot flashes. Twenty percent find them insufferable. Hot flashes actually make you feel like you are igniting from the inside out. You can soak your shirt in the blink of an eye. This can be quite embarrassing and downright uncomfortable. What to do?

• Believe it or not there are certain foods that may help stop the hot flashes. A recent study found that eating a half-cup of soy nuts and dividing them up into three or four portions a day cut hot flashes in half. Another study found that keeping a steady blood sugar by eating frequent meals during the day decreased flashing.

• Exercise can reduce body mass and that can decrease the number of hot flashes.

• If these measures fail, there are medications such as SSRI antidepressants that may reduce hot flashes. Herbs such as black cohosh are a popular remedy. Study results have been equivocal. It has helped some of my patients but not others. Certain alternative therapies such as acupuncture and meditation also can help you beat the heat.

Insomnia

Many women find that during and after menopause they have difficulty falling asleep and/or staying asleep.

• The key is to avoid caffeine and alcohol several hours before bedtime.

• I have found that hypnosis is very effective for helping people get to sleep and fall back to sleep if they wake up in the middle of the night.

• Supplements such as theanine and tryptophan may also be useful.

• It is important to discuss this problem with your doctor. Make sure that any supplement you take is safe with other medications you may have been prescribed.

Weight gain

At menopause, women start to lose muscle at a precipitous rate. This along with slowing metabolism can contribute to weight gain. However, this does not mean it is inevitable.

• Aerobic exercise, strength training and healthy eating can keep menopausal women from gaining weight.

• Hypothyroidism occurs in a large percentage of women at menopause. It is important to have your thyroid function checked if you are gaining weight. Many of the symptoms are similar to menopause so it can be missed.

Menopause can be very manageable without hormones. The key is to eat well, exercise and find a physician who can work with you in partnership to help relieve your symptoms. And remember,

“There is no more creative force in the world than the menopausal woman with zest.” Margaret Mead

It is time to go out there and get some zest!

I wrote this blog almost four years ago. I think it is appropriate to republish it as I see my friends going through similar experiences. Here goes.

As a baby boomer, I have joined the ranks of many of my brethren and can say I am part of the “sandwich” generation. I have children who are teenagers and I am helping them to leave the nest. I had a parent that needed my help to fly and leave his nest as well. How many of you have similar stories to the one I am about to tell?

On June 19, 2008 I lost my father. I would say that he died, but he wouldn’t let us use that term. He preferred that we say he “transitioned”. My father was an amazing man. He lived life with integrity and purpose. He was 84 years old and his mind was as sharp as ever. He had renal failure and had been on dialysis. His body was getting weaker and weaker and he finally decided to stop the dialysis. This allowed him to “transition” on his own terms. Once again his strength and dignity prevailed.

Having now gone through the experience of losing a parent and being there for the transition, it has caused me to look at how we see and experience death in our culture. I realize that each person needs to be allowed (whenever possible) to die on his or her own terms.

My father had expressed his wishes to my family and me well in advance and we were able to discuss them with him and understand what he wanted. He also put these wishes into a legal document known as a living will. In his, he put me in charge. At the time, I didn’t realize how important that was. But, when the time came, I had to act.

I felt like Shirley MacLaine in the movie “Terms of Endearment” when she was fighting for pain medications for her daughter who was dying. I had to scream for morphine for my father when his lungs started to fill up with fluid. Fortunately, after quite a bit of drama, he was able to get what he needed and I honored the promise that I made to him. His transition was peaceful and I am happy that he got what he wanted. In the wake of all this is a massive amount of grief, which is a natural part of life.

I share this story so that it will allow you to pause and think about whether you have a living will. Have you discussed the issues of death and dying with your loved ones? Although many of us live as if we will never die, that is one of those things that is inevitable for all of us.

Although death is never easy, knowing what my dad wanted and knowing that we were able to provide it both with the living will and details of his funeral that he planned ahead of time, made things better somehow.

Death is a natural part of the cycle of life. It is okay to talk about it and to address it when it is staring you in the face. But, it is also important to say all the wonderful things you want to say and understand the wants and needs of others before an emergency situation develops.

Hug your children, your parents, your brothers and sisters and your friends. Tell them you love them as often as you can. That is what my father taught me. I am glad I was able to tell him that many times before his grand transition!