September 2008

What You Need to Know: Updates on Virtual Colonoscopy, and the Number of HIV Cases in the USA

Dr. J: In two recent studies in The New England Journal of Medicine, results were reported about the use of CT scans in screening for colon cancer, and about how long we should wait between colonoscopies to screen again. Is this new info?

Dr. R: Not really, virtual colonoscopy or CT colonoscopy can be a very good study. If someone is averse to having a regular colonoscopy or can’t afford a regular colonoscopy (virtual is cheaper), it can be a valuable screening tool. There are a couple of things to keep in mind. First, the test is only as good as the radiologist who reads it. It takes experience to read them correctly and there is a learning curve. Secondly, if something is found, the patient will need a colonoscopy for biopsy and treatment and the whole prep has to be done all over again. Finally, virtual colonoscopy is good for picking up large lesions that stick out but may not be as good for lesions that are flat. I think that having the CT colonoscopy every 5 years is a reasonable interval for that reason and until we have a large group of radiologists experienced in reading the studies. Colonoscopy is still the gold standard evaluation for now. But, virtual colonoscopy is a good option for some.

Now one for you. What’s this I read about the fact that more people have HIV in the US than anyone thought. Were the numbers wrong before? Can’t they count??!! Do we need to be worried?

Dr. J: Not to worry. First of all, the figures released by the Centers for Disease Control and Prevention have never been based on actually counting the number of people who have HIV. Why is this? Quite simply, we don’t know how many people in this country actually have the infection because it is not mandatory in many states for patients or their doctors to report that they have the infection. So, the numbers have always been estimated by very complex methods. This time was no different, though the method of calculation was newer. Even the Director of the CDC admitted that she found the method used to calculated the estimated number of people with HIV extremely complicated. So, despite what the lay press reported, the number of people with HIV is not on the rise.

However, these numbers do indicate that the transmission of HIV has not decreased much in the past ten years, which also means that prevention efforts in some communities have not been successful.

So, yes, we need to be still be concerned about this sexually transmitted infection – even at our age – but not panicked. We address this issue at length in Chapter 6 of our book.

Dr. R: Whew! Can we take a break now?

Dr. J: Absolutely. To our readers: enjoy your week and don’t forget to make taking care of yourself a priority!

What You Need to Know: Updates on Safety of Plastic Containers, and on Pelvic Floor Disorders

Dr. J: Enough gabbing in this month’s blogs about our philosophies. We promised to keep our readers up to date with the huge amount of new medical research findings that appears daily, sometimes hourly. So, I’ll ask you the first question. I read in a recent issue of the Journal of the American Medical Association (JAMA) that, in a large national study of over 1500 adults, Bisphenol A (BPA), a material commonly used in hard plastic beverage and food containers and in metal can linings, was associated with increased rates of diabetes, heart disease, and elevated liver tests. Soon after the results were released, the FDA defended the safety of BPA to an expert panel. Who are we supposed to believe? Do we now have to stop eating or drinking anything that comes in plastic containers or metal cans? Was this even a good study?

Dr. R: This study, looking at the association of BPA in the urine and the incidence of heart disease, diabetes and other illnesses, suggests an association. In other words, there may be a connection between exposure to BPA (usually from plastic bottles) and some diseases, but this study doesn’t prove it. The study looked at a set group of people who were part of a large health and nutrition survey done nationally, which studied many other behaviors and outcomes as well. Is it possible that people with diabetes and heart disease drink more water out of bottles and metal cans? And that that is the reason there is more BPA in their urine? Or, is BPA the cause of their illnesses? The only way to know is to follow two healthy groups of people who are similar, have one group drink out of bottles and cans that have BPA and have the other group avoid it and see which group gets more disease. That probably isn’t going to happen. Therefore, we may never know the answer. So, my advice is to find BPA–free water bottles and cans and not take any chances in the future.

Now here’s one for you. I saw a recent report, in the same issue of JAMA, that nearly ¼ of all women in the US have at least one “pelvic floor disorder”, especially as they get older. Good grief – another floor to take care of? I know you like to mop, but what aboutthose of us who don’t? Seriously, what does this mean and do we need to be concerned?

Dr. J: Not to worry at all. Pelvic floor disorder is a medical term which includes the symptoms of urinary incontinence, fecal incontinence, and prolapse of the pelvic organs, which we know(some of us personally!) is common in women as they get older, and which we discuss in detail in Chapter 7 in our book. What happens literally is that the muscles that are located on the “floor,” or at the bottom, of the pelvis, weaken and no longer support the bladder, the rectum, and/or the female reproductive organs. Here’s the thing about this study, though. We already knew these were common disorders associated with aging, this study simply quantitated the numbers of women in the US with these complaints. Very interesting to me about this study is that although the researchers confirmed the factors that we’ve always known put us at risk, including multiple childbirths, being overweight, and getting older, they found that getting older by itself – without having those other risk factors – can lead to at least one of the disorders in many women. In other words, even if you haven’t had several children or are not overweight, you are still at risk for getting urinary or fecal incontinence just by the passage of years. The good news is, as we discuss in Chapter 7, there are many things you can do to correct these problems, without having to resort to surgery. I think we’d better call it quits for now. All this talk about drinking fluids and the pelvic floor is making me…

-More discussion of recent medical research to follow!

It’s Your Health, But We Help

Last year around this same time, as Robin and I were madly writing away, we were also working with the talented staff at our publisher to come up with a title for our book. I was carrying around a little spiral notebook, and constantly jotting down words and phrases immediately as they came to me for possible use in a title. And there were endless emails of endless lists of ideas shooting back and forth. At one point, I even got out a thesaurus (an abbreviated one of course) and paged through lists and lists of adjectives.

One day, during this time, I was looking after my 8 year old neighbor while her mother was at work, and she naturally became curious about all the time I was spending at the computer and about all the books scattered all over the room. And asked what I was doing. So I told her that my friend and I were writing a book, which of course prompted many more questions – why were we doing it, what was it about, who was it for. After I answered these, she asked what the title was going to be and I told her we didn’t know yet.

So, she immediately said that she had one: “ It’s Your Health, But We Help.”

I laughed, told her it was a great idea, and promptly went back to my thesaurus and other books and computer.

Finally, after months of trying to come up with a title, we realized that what would help the most, as it always does, was to go back to the basics – why we were writing the book in the first place.

We were trying to accomplish several things at once with our book, all based on what we had learned from our own patients over the years. One thing we were trying to do was simplify the huge amount of complicated medical information flying around out there; to pull out the pieces relevant to women in midlife and older, and get down to the basic health issues that all of us need to know in order to best take care of ourselves in the twenty-first century.

We were also trying to prioritize those issues so that you, our readers, would learn which ones simply had to be taken care of regularly or immediately, and which did not. Especially given the state of the healthcare environment today, in which doctors and other clinicians are not able, even though we’d like, to spend the lengthy amounts of time with each patient that we used to. That time just isn’t available anymore. But, that’s another story/blog.

Back to our book. We had two focuses: to make you aware of the most common diseases that occur as we grow older, and of how to prevent them; and, because no matter how well we take care of ourselves we all get sick at some point, to let you know what symptoms indicate true health emergencies and what you should do about them.

But, even with all of the above in our book, we knew one thing for sure, the one thing that we’ve learned from our patients over and over again. That is, that no matter how much information we give or recommendations we make, each of us has to want, and to decide, to do the things that are necessary to stay healthy as we grow older. Our book can only be your roadmap; you’re driving the car.

You now know, of course, what title was chosen. And we’re very pleased with it. But when we need something that sums up our philosophy and that of our book, shorter than its title, we’ve got our “soundbite”:

It’s Your Health, But We Help.

Labor Day

I had a hard time deciding what to blog about this week because Robin’s blog from last week is so beautiful, and about such an important and personal issue, there is no other topic that could follow it. It truly stands on its own in the long list of issues that face us as we grow older.

But, to keep this blog rolling (no pun intended), I needed to find another topic on that list. So I came up with something that is near and dear to both Robin’s and my heart, is discussed nonstop throughout our book, and is relevant, to me at least, to this past holiday weekend.

Well, it’s certainly not what I would’ve said 20 or more years ago, or even 10 years ago for some of you readers, that is, labor – you know the kind that you do in the Delivery Room?! No, most of us are well past that kind of labor. I’m talking about another kind of labor; at least it’s labor to me, and I’m sure is to some of you out there, though it isn’t to Robin and those like her. Curious?

It’s exercise. Or working out or physical activity or whatever you want to call it. To me, exercise is labor. For those of you who have already read our book, you’ll know that the importance of it is discussed throughout the entire book. You may have even been surprised, as we were, that these days the necessity of regular exercise is not just a nice thing to do, it’s a “must-do.” We include many research studies that prove that people who do regular exercise as they get older stay healthier than those who don’t. And we also include our individual exercise regimens in the book. (Robin’s, at least, is truly a regimen.)

You also know if you’ve read our book, that there are different types of exercise that are important, each of which works in different ways, that we must do to stay healthy. These are: cardio (or aerobic), strength training, balance, and flexibility exercises. Of these, the one I truly hate, the one I consider to be hard labor, is the cardio type of exercise. Even though I say in the book that I’ve found some tricks to make me keep doing it regularly, I intermittently still have trouble.

I’m in one of those “having-trouble-sticking-to-it” phases right now. This Labor Day, cardio exercise for me is really a labor. Instead of just going outside and walking, or getting on my stationary bicycle and pedaling, or turning on some music and dancing around, I am currently spending all my time dreading those things.

Followed by talking myself out of doing them. “It’s going to rain in a few minutes, so why go outside now” OR “I just washed my hair, so why do I need to get all sweaty now” OR, best of all, “Oh dear, I’m so behind in my mopping/checking emails/brushing the dogs/exfoliating my skin that I just can’t spare the time now” Any, or all, of these sound familiar to you?

And, no, I don’t want a pep talk from those of you who are exercise machines (this means you, Robin). I would to love hear if any of you out with this same problem have come up with a permanent way to prevent this phase, this cycle of allowing the negative tape about exercise to play constantly in our brains. I haven’t. Not in all these years of trying to exercise regularly, probably since my 20’s, have I come up with a permanent solution. (I’m actually hoping that writing this now will pull me out of the phase this time – embarrass me out of it, in fact!)

So, until I hear from one of you out there with this issue who has found a way to beat it, I’ll continue cycling through these phases (and I don’t mean on the exercycle), spending more time making excuses to avoid it, and beating myself up about why I’m not doing it, than I would if I just did it. (Nike is right on.)

And, I’ll let you know if writing this blog about my problem actually helps to solve it.


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