June 2010

The “Best of” Our Blogs: Food Safety

In celebration of our two years of blogging and updating our book, we’ve chosen a few of our past blogs to “replay” this month. Our final blog from the past is about an issue we should be aware of all the time, but especially in the summer with much of our eating taking place outdoors which can lead to barbecuing (and undercooking) and no refrigeration.

Watch Out for Food-Borne Illnesses During the Holidays (and all the time)!

Now that Thanksgiving is right upon us, and the rest of the Holidays are around the corner – all of which have a feeding frenzy associated with them – a warning about food-borne illnesses is timely. My husband could quickly give you an example of a food-borne illness because he’s been upset with me ever since I told him to be careful about eating hamburger meat due to the recent outbreaks of E. Coli infection associated with that particular food.

So, why should you worry if you don’t eat hamburger? Because the Centers for Disease Control and Prevention (CDC) estimates that 76 million Americans get sick from food-borne illnesses each year. And that’s just the tip of the iceberg because not all food-borne illnesses are even reported to public authorities.

A recent study done by the Center for Science in the Public Interest (CSPI), reported on October 9, 2009, found that even some of the healthiest foods can carry food-borne infections. The CSPI group analyzed information on food-borne illnesses from the most recent all the way back to 1990; the information was based on the CDC’s data.  The authors found that the most common organisms causing the illnesses included norovirus, and E. Coli and Salmonella bacteria.

What specific foods were most likely to carry an organism that caused a food-borne infection and illness? The authors found that leafy green vegetables were the food type that was responsible for the highest number of outbreaks, causing approximately 13,600 illnesses during the time period studied.

Here is a listing of the rest of the top ten foods responsible for food-borne illnesses during this period.

  • Eggs, involved in 352 outbreaks and 11,163 reported cases of illness.
  • Tuna, involved in 268 outbreaks and 2,341 reported cases of illness.
  • Oysters, involved in 132 outbreaks and 3,409 reported cases of illness.
  • Potatoes, involved in 108 outbreaks and 3,659 reported cases of illness.
  • Cheese, involved in 83 outbreaks and 2,761 reported cases of illness.
  • Ice cream, involved in 74 outbreaks and 2,594 reported cases of illness.
  • Tomatoes, involved in 31 outbreaks and 3,292 reported cases of illness.
  • Sprouts, involved in 31 outbreaks and 2,022 reported cases of illness.
  • Berries, involved in 25 outbreaks and 3,397 reported cases of illness.

An important issue about the above listing of specific foods is that the CDC’s database cannot discriminate whether the specific food caused the illness, or whether it was other foods mixed with that food; for instance whether tomatoes alone caused an illness, or if tomatoes were in a salad, whether it was the other ingredients of the salad. The authors of the study also caution that since potatoes are almost always eaten cooked, it was probably a food eaten along with the potato that caused the illness.

Having said all that, the above list is pretty scary, right? Especially when you remember that this is an underestimate of the actual number of illnesses caused by food borne infections.

Is there anything you can do to prevent a food-borne infection from ruining your happy and healthy holidays? Absolutely. 

·        Always keep fresh (and frozen) food products cold.

·        Always be sure to thoroughly cook your food.

·        Always keep your food preparation area clean and sanitary.

·        Avoid eating raw eggs or using them in recipes, including ice cream.

·        Keep foods, like oysters, chilled. Avoid eating them raw.

·        If you do eat raw oysters or sushi, be aware that they can carry organisms that can cause illness.

·        Wash your hands frequently!  Janet Horn




The “Best of” Our Blogs:Fruits and Vegetables

In celebration of our two years of blogging and updating our book, we’ve chosen a few of our past blogs to “replay” this month. June is Fruits and Vegetables month. In the Robin’s blog below, she discusses what you need to know.

June is Fruits and Vegetables Month

In honor of this, let me tell you some things you may not know about two popular fruits. They taste great and may even help you to lose weight. Let’s start with my favorite, grapefruit. Then we will move on to raspberries.

Grapefruit has many of the vitamins of the other citrus fruits but is has a lower Glycemic Index. That means that sugar is released slowly in the body rather than in one quick rush.

The results of a 12-week study linking grapefruit to weight loss done at the Scripps Clinic in 2004 put 100 men and women on a diet that included half a grapefruit or grapefruit juice three times a day with a meal. The average weight loss was 3.6 pounds for those who ate their grapefruit, 3.3 pounds for those who drank it. However, many reportedly lost more than 10 pounds. Grapefruit has chemicals that may lower insulin levels and expedite weight loss. The only problem with it is that it can interact with certain medications. It is important to check with your doctor or pharmacist to find out if you are on any of these medications. If so, you need to avoid it. (Sorry about that)

Raspberries are rich in antioxidants. Eating three or more servings per week have been found to lower the risk for age related macular degeneration. The anthocyanins (important antioxidants) in raspberries have been found to delay the effect of aging. Although raspberries contain sugar it does not seem to affect blood sugar in a significant way. Red raspberry ketones are currently being used in Japan as a weight loss supplement. Red raspberry seed oil has attracted the interest of the cosmetic and pharmaceutical industries because it is rich in Vitamin E, omega-3 fatty acid and has a sun protection factor (SPF) of 24-50.

Celebrate this month by eating your favorite fruit or vegetable and enjoy!   Robin Miller

The “Best of” Our Blogs:Driving and Texting and Goats

In celebration of our two years of blogging and updating our book, we’ve chosen a few of our past blogs to “replay” this month. June is National Safety Month. The past blog below is as relevant today as it was a year ago – even moreso given the increase in texting while driving. And for a bit of humor, you can learn about safety and goats.

June is National Safety Month (and National Goat Trauma Awareness Month)

The National Safety Council (NSC) has designated this month as National Safety Month, and this week as “Distracted Driving Week.”  Were you aware that 80% of all motor vehicle crashes are the result of driver inattention? Many studies have shown that use by the driver of wireless communication devices (talking on a cell phone, texting messages, or reading your email, for instance) is one of the main distractions affecting drivers, and also one of the most common. This is so often the case that the NSC has just launched a new advertising campaign on billboards across the country called “Death by Cell Phone.”

Bottom line: If you’re truly focused on your driving, and more importantly, on the other guy’s driving, you should never get bored and need to talk, text, or read. Or eat and drink. When you or a member of your family or one of your friends is driving the car, just drive the car.

Of course, being safe in the car also requires that you wear seatbelts.

In addition to motor vehicle safety, you should take this opportunity to think about safety in all areas of your life. Walk through your house and look for potential dangers – that electrical cord in the middle of the floor that could be tripped over; the rug that slides when you step on it; that bedside table on which the books are stacked way too high. Regularly check all your medications – over the counter and prescription, and your foods for expiration dates. (And your eye makeup as well.) Look around your yard and your neighborhood for hidden safety hazards. Start doing this now and do it on a regular basis throughout the year. Go to the NSC’s website for other good ideas about keeping you and your family safe: http://www.nsc.org/

I’ll end this reminder about safety by telling you that it is also “National Goat Trauma Awareness Month.”  This is important for you to know even if you don’t have a goat, or do not know a good goat therapist. (Sorry about that but you can see what I initially thought “goat trauma” meant.) The Childhood Goat Trauma Foundation says that most trauma occurs at petting zoos, and therefore to be careful there, or better yet, avoid them. They also say that, because loose goat attacks mostly occur in less populated areas, you may not be safe even in civilized areas as there have been reports of “roaming urban goats.” Be forewarned.

If you’d like more information on this, go to: http://www.goat-trauma.org/news.shtml      Janet Horn

The “Best of” Our Blogs:More on Summer Safety

In celebration of our two years of blogging and updating our book, we’ve chosen a few of our past blogs to “replay” this month.The past blog below discusses one of the most important safety measures you can take, especially in the summer months.

The Talk

This is the time of year that many of my patients dread because they know I will soon be giving them “the Talk.” And not just once, but probably every time I see them over the next 5 or so months. What is it about this particular discussion that makes them hate having to listen to it? Well, just listen to some of their comments after I’ve given them the Talk:

“Ooh, I hate getting that sticky stuff all over me.” 

“Ugh – way too greasy for me.” 

“I hate the way it smells.”

“Doing it is not worth the benefits.”

“It makes me look like I’m having a permanent hot flash.”

My own opinion is that they are all overreacting to using sunblock. Especially given its benefits. Not only is using it religiously every day and anytime you are outside (rain OR shine) lifesaving in many cases, but it can actually prevent wrinkles. If you’re one of those women who like your wrinkles (I like some of mine), then look again at what else it does – it can prevent skin cancer which can be deforming and, in the case of melanoma, lifethreatening.

I think that there are two reasons that make people not want to use sunblock regularly. One is that they don’t know about all the newer products that are formulated so that it’s easy to wear: ie, not greasy or sticky or smelly, and doesn’t interfere with your makeup or make you look sweaty. The other reason is the whole topic of sunblock just seems to be too complicated. And, in a way, it is complicated.

So, I’m going to make it easy for you and give you a quick lesson on SUNBLOCK because I believe it is that important.We discuss it in much greater detail in our book if you want to learn more. Here goes – quick and easy:

1) Especially during the months of April – October (in this country), you need to wear sunblock on all  exposed skin when you are outside –     even for a short walk. That includes your face and lips, ears, neck, exposed chest, arms and hands, and legs/feet (something I always forget).

2) This goes for everyone – light-skinned and dark-skinned ladies (and guys).

2) Be absolutely certain that your sunblock is protective against ultraviolet rays of both types – A and B. The box and tube should be   labelled as active against “UV A and UVB”. In fact, the FDA is requiring labels in the very near future.

3) Don’t be stingy with the amount you use. Slather it on! The official recommendation for the amount necessary to be protected is at least 2 tablespoons on each area of the body that will be exposed to the sun.

4) Don’t wait until you’re outside to use it. Put it on at least 1/2 hour before you are exposed to the sun, and reapply at least every 2 hours, or sooner if you are swimming or sweating excessively.

5) Use a product with a sun protection factor (SPF) of at least 15. I generally recommend and use products with a much higher SPF – usually 40 or 50.

6) Know that there are two types of sunblock ingredients – chemical and physical. The chemical sunscreens actually interact with your skin to protect it from the sun; some examples are PABA, Parsol, and oxybenzone. The physical sunscreens simply form a barrier on top of your skin to prevent the UV A and B rays from getting to the skin iself; these are descendants of the old zinc oxide – remember the heavy white paste that the cute lifeguard at your pool wore when you were a teen?- and today are called titanium dioxide and other similar names. Both types protect well; the main difference is that the chemical sunscreens are more prone to cause allergic reactions of the skin, and the physical ones do not. I personally cannot wear chemical sunscreens because I swell and turn red anywhere I use it, not to mention the dreadful itching.

That’s it! The basics of what you should know about sunblock. Not so bad, was it? OK, now, use it!  

P.S. You should actually wear sunblock all year round, but I will save that Talk for next October. Janet Horn

The “Best of” Our Blogs:On Going Barefoot

In celebration of our two years of blogging and updating our book, we’ve chosen a few of our past blogs to “replay” this month. The blog below discusses one of the dangers of going barefoot.

Remembrances of Summer Pleasures Past


Things that I miss from summers past: Basking in the sunlight in unsunblocked skin; The smell of the pool; Diving into the cold wetness and feeling the water in my eyes, ears, nose, and mouth; Not wearing a hat in the sunshine; Walking barefoot in the grass.

Since we are usually referring to the bodily effects of aging in this blog, I have to say here that, in my case, the loss of the above summer pleasures does NOT have to do with growing older. The restrictions on enjoying sunshine have to do with the negative effects of sunlight on the skin at all ages. My problems with swimming have to do with a chlorine allergy, and with adult-onset sinus problems; in the case of the latter, I have to wear goggles, and nose and ear plugs in order to swim without getting sick afterward.

And what about walking barefoot in the grass? What happened to me last summer will explain that one. I missed the freedom and feel of grass on my bare feet so much then, that I said the heck with covering up every inch of my body – including shoes – and sat, lolled, ate, and walked in the grass in crop pants and naked feet all summer. Loved every minute of it.

Then one morning last September I noticed a distinctive red rash on my arm, followed by several more identical rashes on other body parts. Target-shaped, or looking like a bullet. You know what I’m going to say next. Yes – I had gotten Lyme disease. Since the places that I like to go are also well-liked by deer, this did not come as a surprise. And then I remembered why I had always been so careful about insect repellant on my legs especially and about wearing shoes, socks and longer pants in wooded and grassy areas.

I was lucky because I caught the infection in its earliest stages; I took the recommended antibiotic and am fine now. But it could’ve been otherwise since Lyme disease is notoriously so sneaky – sometimes not even causing a rash but just infecting, and then laying dormant in, the body, only to cause serious problems months and years later. And  there are many other tick and insect-borne diseases that you can get besides Lyme. That is, if you don’t wear insect repellant, shoes, socks and long pants when you are outside in tall grass or in the woods this time of year, especially in locations where these diseases are common. Shoes, socks, insect repellant and sunblock – the new “must-haves” of summer.

So, the moral to the story? These days, some of those past summer pleasures are just that – past. And not because we’re older but because we know how better to protect our good health. Or, in my case, SHOULD know better. Janet Horn

The “Best of” Our Blogs:Summer Pleasures AND Safety

In celebration of our two years of blogging and updating our book, we’ve chosen a few of our past blogs to “replay” this month. Since we’re now in the thick of summertime, we thought that, for the rest of this week, we’d replay some of our past blogs about a few of the dangers present this time of year. To start, we’ll talk about 2 things that give most ladies a huge kick in the summer: sandals and barefeet! Below is a past blog on the dangers of my favorite style of shoe – the wedge sandal.

On Becoming Unbalanced in Midlife

I’ve become unbalanced. This didn’t develop slowly; rather, it seemed to happen overnight. Two things occurred right around the time I realized this problem. Perhaps they even caused me to realize it.

The first thing occurred with Teddy, my dog. Teddy is a standard poodle of sixty pounds and 9 years, with a prancing gait and a beautiful red coat.  One of the first things you would notice about him is his posture, at both rest and in motion. At rest, he looks like a sculpture – head erect, front legs placed directly in front of him, sometimes crossed, sometimes not – holding this position completely still for long periods of time. In fact, when our vet saw him in this position, he said Teddy looked so cool that all he needed was a smoking jacket! When walking or running, Teddy is wonderfully coordinated, no one body part moving more or less than any other part.

It was with some upset, then, when one day I noticed him falling as he walked. Not just a simple fall – more like crumpling. His entire body simply folded and collapsed. At first I thought he must’ve tripped on something and that this was an isolated incident. But, then it continued to happen in various ways: one time he wouldn’t be able to get up from the floor; another time he’d whine when he reached stairs he’d climbed before countless times. Then our vet found that his neurological exam was abnormal, which led to his possible diagnosis of  ”Wobbler’s Syndrome.”

 Wobbler’s Syndrome* does not usually occur in standard poodles, more often happening to Great Danes, Dobermans, and  horses. But that fact didn’t exclude the possibility that Teddy had it. Whatever Teddy had, it was causing a definite change in his ability to stay balanced.

The second thing that happened around the same time had to do with shoes. (Mine. Teddy doesn’t wear shoes – yet, anyway.) One of the constants in my life since my teen years has been an admiration for shoes with a wedge heel. It never even mattered to me if they were in style or not, I just liked them, and found them a comfortable way to gain some height without the horror of stilettos. So, it wasn’t much of a surprise, when – due to their being in style again and thus, easily available for the first time in a few years – I ordered a pair of wedges that I recently saw in a magazine, with no thought given to age-appropriateness. (Not that I was trying to look young; I just haven’t quite realized that I’m not anymore.)  

Despite having worn similar styles for years, I was, however, in for a surprise when they arrived.  I wobbled.  Although I didn’t crumple like Teddy, still I wobbled.  And these wedges weren’t even that high.  I wobbled when I walked, and I wobbled when I stood still.  Forget about going down stairs, definitely not safe. There was no fainting or dizziness associated with these findings, so it seemed to be a problem with balance, rather than another organ system.  Could I have my own version of a Wobbler’s syndrome?

The truth was, despite what I said about being surprised by my wobbling, I had noticed problems with my balance long before these wedges arrived at my house.  I would notice myself clutching and grasping for the rail as I went down stairs (of which there are a lot in my house).  I would trip easily and often, even on solid ground, over and above my normal klutziness.  And, at the gym, I couldn’t do, at least for very long, many of the exercises requiring standing on one foot or others requiring an intact ability to balance.  But it wasn’t until I noticed Teddy’s and my -on the newly-arrived wedges – wobbling, that I finally admitted to myself that there was a problem.

Following the advice that I give to my patients, I made sure that serious causes for my new imbalance were ruled out. After this, I guess this new physical reality shouldn’t have come as a surprise, since I know that the vestibular system, which controls balance and is located in the inner ear, deteriorates with age. But my disbelief in my own vestibular malfunction, and by extension, my age, is probably very similar to the time in recent years when I glanced my legs in a mirror and wondered whose they were. Knowing a fact, and accepting that it’s happening to you, are two different things.  Especially when it comes to your age. At least I’ve found this to be true.

This story has a somewhat happy ending. On realizing that I was wobbling, I asked my trainer at the gym to give me exercises that would improve my balance. Happily, I have actually been religious about doing them (totally unlike me since I don’t particularly like exercise) and have noticed a marked improvement.  

What about Teddy? On further investigation, he was given the diagnosis of several cervical disc herniations – “slipped” discs in the neck – with some spinal cord swelling. This occurred due to degeneration of the discs, or the wear-and-tear that accompanies aging.  Teddy was placed on steroids.  He’s much better, though his activity has to be limited – not bad for a nearly 63 year old dog (I had trouble admitting his age as well.) As for those wedges – with great sadness and the realization that my days of wearing wedges – of even moderate height – were probably over – I sent them back. Janet Horn

 *Wobbler’s Syndrome in dogs and horses refers to a most-likely inherited abnormality of the cervical vertebrae (spinal column in the neck) in which they are either malformed or misaligned. This causes instability in that area which leads to wobbling.

TOMORROW: The danger of bare feet

The “Best of” Our Blogs:Complementary & Alternative Medicine (CAM)

In celebration of our two years of blogging and updating our book, we’ve chosen a few of our past blogs to “replay.”  CAM is a huge topic of interest these days. In the past blog below, Robin – well-trained in, and actively practicing CAM along with traditional medicine – weighs in on her view about the state of CAM.


Ten Years is Not Long Enough!

A recent article in the news claims, “$2.5 billion spent, no alternative cures found” in reference to the National Center for Complementary and Alternative Medicine (NCCAM). For the last ten years the NCCAM has been conducting research on a variety of treatments including acupuncture, energy and herbal medicine.The article states that the only positive findings were that acupuncture helps osteoarthritis of the knee and supports the use of ginger capsules for nausea related to chemotherapy.

It does not mention the studies showing that acupuncture can help nausea related to chemotherapy or that there are promising results in lab animals for prevention of pain in those with cancer. Although it points out the fact that Gingko biloba and Echinacea are no more effective than placebo for memory and treating the common cold, the article does not discuss the value of fish oil for treating elevated triglycerides and for the use in prevention of heart disease. Nor does it mention the possibility that grape seed extract may help in the treatment of some neurodegenerative diseases. It fails to mention that massage is an effective treatment for chronic neck pain, a very common condition.

Although many of the studies have not produced positive results, when studying complementary medicine, maybe it is time to look at the study models. Does it really make sense to use a placebo-controlled trial when looking at acupuncture and massage? I know from my own experience that acupuncture is different depending on who is administering it. Massage and chiropractics are similarly provider dependent when it comes to quality. As far as the study of herbal supplements, they might have consulted with a panel of botanical experts to find out what part of the botanicals to use for the studies. For Echinacea, they apparently did not use the correct part of the plant. For many of these products it is not just the part of the plant that is important but also how it is prepared. For some the best form to use is a tincture or a tea. For others a tab will do.

I don’t believe it is fair to call for the end of the NCCAM and their studies.What they are doing is finding ways to determine the benefits and (most importantly) the risks to complementary and alternative therapies that are widely used in our country and the world. I think that they may need to find better ways to study these therapies by using more creative study designs. To write off therapies that have been found effective for the world (some for over 3000 years!) is arrogant and ignorant in my opinion. In the scheme of things, ten years of study is a really small amount of time.The NCCAM is just getting started.Robin Miller

The “Best of” Our Blogs: Sexually Transmitted Infections – You’re Never Too Old

People our age are always surprised to learn that we can still get a sexually transmitted infection in midlife and older. And I’m always amazed that there’s not more publicity on this issue for our age group. Not only can we still acquire these infections (even those of us who have had a hysterectomy), but there has been an increase in the incidence of some of them, such as gonorrhea and syphilis. Below are several of our past blogs on this issue.

The 40th Anniversary of Woodstock: Remember “Free Love”?

All the talk about this August being the 40th anniversary of the famous Woodstock Music Festival got me thinking.


Do you remember those years? The invention and availability of “The Pill,” and the then-new practice of “free love” (remember, “Make Love, Not War?”) led directly to the sexual revolution for which our generation became famous.

What you maybe did not hear so much about was the increase in sexually transmitted infections (STIs) as a result of that revolution. Take genital herpes (HSV) infection for example. The levels of the total number of cases in the North American population increased by over 30% in the late 70’s, 80’s and 90’s. Similarly, data on first-time treatment-seekers for genital warts (caused by Human papillomavirus – HPV) show an increase (in their presenting for medical care) of about 500% over the past three decades.

What does that mean for us now? We came of age sexually at the same time that many of the STIs were increasing; therefore, there’s a good chance that we may have been exposed to one of these infections in the past thirty or so years that we’ve been sexually active. And since several of these infections can stay in the body indefinitely but cause no symptoms, there’s also a chance we might not even know that we’ve been infected.

Which of the STIs am I specifically referring to in the above paragraph? The so-called “persistent viruses,” which include herpes virus, Human papillomavirus (HPV), the viruses which cause hepatitis B and hepatitis C, and the Human immunodeficiency virus that causes AIDS. Exactly how long can these viruses remain in the body after you become infected with them? Forever. And how long can they remain “hidden” and cause no symptoms? The first four of the viruses listed above may never cause symptoms, or alternatively, can cause symptoms at any time after you’ve been infected. The HIV virus can remain silent and cause no symptoms for up to 10-15 years. In addition, you can become infected with syphilis and have no symptoms for several years as well.

Think about the import of that. It means that if you don’t know your current, or past, sexual partner’s (or partners’) sexual history, you could be at risk for having one of these infections and not knowing it. Even if you haven’t seen the person who gave it to you in 15 years! This is especially worrisome to those of us who are just beginning new relationships now, after a divorce or break-up.

If you don’t think any of this applies to you, please read a list of the known factors which put people at risk for acquiring an STI. These have been extensively studied and are well known.

They include:

1) young age (teens and twenties),
2) a history of being sexually active with multiple partners, and
3) a history of having had even one STI in the past.

Even though the first risk factor doesn’t apply to us now, the other two definitely do. Even if you have not had multiple partners, do you know the answers to the 2nd and 3rd risk factors about your current partner?

Or do you know if your partner(s) knows of past exposure to an STI but doesn’t know if he/she acquired it?

Scary thoughts – but very important to think about. In the next blog, I’ll give you specific recommendations about how to approach these issues. Janet Horn

Sexually Transmitted Infections – at our age?! 40th Anniversary of Woodstock – Part II

 In a recent article of the Journal of the American Geriatrics Society, researchers report that adults aged 50 and older account for increasing proportions of HIV/AIDS cases. Specifically, when the trends of people infected with HIV were studied in the state of New Jersey, it was found that in 1992, people aged 50 and older accounted for only 6% of the HIV/AIDS cases; in 2004, this had increased to 26%! The conclusion of the authors of this article states that health care providers need to routinely discuss HIV and other STI’s with this “older population” (that’s us) in order to be able to offer prevention or care earlier. And we all know that getting care early in any disease means a better long term prognosis, or a better chance for a cure.

In addition to the above infections, you could be at risk from a more recent sexual encounter of acquiring other of the STIs, such as Chlamydia or gonorrhea. Although infection with gonorrhea usually presents itself with a discharge from the vagina or urinary symptoms – as can Chlamydia – infection with Chlamydia can also remain silent. Also important to know is that you can become infected with gonorrhea even if you’ve had a hysterectomy; in this case, the major symptoms would be urinary and would include burning or frequency. Although these latter symptoms are usually due to a plain old run-of-the-mill urinary tract infection, if your urine cultures are negative and your clinician cannot find a reason for your symptoms, think back on any recent sexual activity.

So what can you do to protect yourself if you are newly dating after a divorce, or if you just realized that you don’t know your partner(s)’ sexual history?

1) Ask your gynecologist to test you for STI’s when you get your routine pelvic exam or sooner as the need dictates (ie you are having symptoms; or you have a new partner; or are thinking about a new partner). Diagnosis of STIs is easy: it simply involves extra samples taken from your cervix at the time of your Pap smear and blood tests.

2) Be open and honest with your partner(s) about this issue, and ask directly about their sexual history; if they have not been tested recently (or ever), ask them to get tested for STIs;

3) Use protection during sexual activity; although in recent years it has been found that unfortunately condoms do not protect 100% against getting infected, they do lessen the risk, as do vaginal/dental dams. Only latex and polyurethane condoms should be used.


For further information, go to the CDC’s website on STIs:


Janet Horn

The “Best of” Our Blogs: Your Cervix and Ovaries

In celebration of our two years of blogging and updating our book, we’ve chosen a few of our past blogs to “replay.”  Since we’ve just been on the topic of our pelvic organs, we’ll finish the discussion with some good advice on how to take care of your cervix and your  ovaries. These recommendations still hold true.

Do Not Ignore Your Cervix (even though you no longer need it)!!

This month is Cervical Health Awareness Month. I’m referring here to the opening of your uterus (womb), not to be confused with the part of your spine that is located in your neck.

You may wonder exactly what you need to be “aware” of regarding your cervix, especially at this age if you’re either approaching, are in the midst of, or have completed menopause. It turns out that there’s a lot you still need to know, particularly about the disease, cancer of the cervix. In fact, the US Congress thought this was such an important topic that they’re the ones who actually designated this January as cervical awareness month.

One of the most important things about cervical cancer , and perhaps surprising to many of you, is that it is, in most cases, a preventable disease. Yes – that’s right – it can be prevented. Now, you might say that that is no big deal because we can prevent lung cancer by not smoking cigarettes, and breast cancer by not taking estrogen, but you’d be wrong on both counts. Yes – smoking can cause some lung cancers, but may not be the only thing to do that since not everyone who smokes gets it; neither does smoking cause all lung cancers as there are certain types of lung cancer which occur in people who have never smoked. And yes – taking estrogen may be related to breast cancer, but there are other factors that also may cause it.

We can prevent cervical cancer because we absolutely know what the main cause is – certain types (the “high-risk” types) of the viral infection, Human papillomavirus (HPV). That’s why the vaccine against cervical cancer that you’ve been hearing so much about, Gardasil, works – because it actually prevents infection with several of the high-risk types of HPV that can lead to cervical cancer. So, does every woman who has an HPV infection of her cervix get the cancer? No, because not all types of HPV cause the cells of the cervix to become abnormal and develop into cancer. Even women who are diagnosed with one of the high-risk types of HPV do not necessarily go on to develop cervical cancer.

There’s another way cervical cancer can be prevented: screening. This means that by finding the early, pre-cancerous condition of the cervix, sometimes called cervical dysplasia, and treating it, those abnormal cells should no longer progress on to cancer. How is this done? Simple. By that test that you’ve known about and had done since you were young – the Pap smear. This test, taken at the time that you have your yearly visit with your gynecologist and your pelvic exam, has been a true medical success story; there has been a great decrease in the number of cervical cancer cases, and in the number of deaths from cervical cancer, since the Pap smear began to be routinely used in 1950. Today, death from cervical cancer is rare in women who get regular Pap smears.

And there’s more good news. There is another test that can help to prevent cervical cancer, which is as easily taken at the same time as the Pap smear, called the HPV test. This test takes cells from the cervix, as the Pap smear does, but looks for HPV infection itself within the cells. If the types of HPV that lead to cancer are found, further studies may be done to look for very early cancer of the cervix not seen on the Pap smear. Most gynecologists these days will obtain both a Pap smear and the HPV test in appropriate patients.

Now, here’s what is special about women our age and cervical cancer and the Pap smear. First of all, would it surprise you to know that many postmenopausal women no longer have annual pelvic exams because they think they don’t need them any longer? Studies have shown that the women least likely to get Pap smears and pelvic exams are over 50. And, within that group (our age group), women in their 70’s and 80’s are much less likely to have these exams than are women in their 50’s and 60’s.

If you happen to be one of the women who doesn’t think you need annual or routine pelvic exams, think again. The risk of getting cancers of the reproductive tract organs, like ovarian and uterine cancer, goes up with age; the risk of death from cervical cancer is highest for white women between the ages of 45 and 70 years of age, and for black women in their 70’s. Sometimes, particularly when the cancer has not progressed, these diseases don’t cause any symptoms, and are only found by your clinician. And we all know that the earlier any cancer is found, the better the chance is for a cure. So, if you’re not getting regular exams that screen for these cancers, you are missing the chance to save your own life.

The second thing that some women our age are surprised about is that we still can get sexually transmitted infection (STI). Yes – even after menopause and even if you’ve had a hysterectomy. If you’ve had a new sexual partner recently, you could’ve become infected with an STI, and not even know it. Further, several of the STI’s – HPV, HIV, and herpes virus included can remain silent in the body for years, only showing up and causing disease years later. This means that you might’ve been infected by a prior sexual partner – say, 10 years ago (even earlier for HPV and herpes) – and did not realize it at the time, only to have that infection become active in your body now, after all these years.

Bottom line, you still need to be aware of your cervix and its health. And you still need to get annual pelvic exams from your gynecologist or from your primary care provider. Even though cervical cancer most often shows up in younger women than our age group, it can show up at any age. As you’ve read above, not only can cervical cancer be prevented, but the chances of your dying from cervical cancer are much less if it is caught early. Make that appointment for a pelvic exam and the testing that goes with it today! And make sure all your girlfriends, as well as the younger women in your life, go too!

For more information, go to: http://www.nci.nih.gov/cancertopics/pdq/screening/cervical/Patient/page2 and to: http://www.nccc-online.org/index.html

Also, there is an entire chapter in our book devoted to cancers in women our age, including cervical cancer, and which goes into more detail than the above. There is another entire chapter devoted to the health, and the most common diseases, of the aging organs of the female reproductive tract, other than cancer. The latter chapter talks about the most common symptoms occurring in women of our age group, discusses the Pap smear and the need for us to continue to get annual pelvic exams, and the issue of sexually transmitted infections (remember – we can still get these at this age, but that’s topic for another blog…)  Janet Horn

Another Reason to Keep Your Ovaries

We’ve mentioned in our book, and here in several past blogs, how important we think it is that you keep at least one of your ovaries when you have a hysterectomy, if possible. That of course does not apply if there is a medical reason for removing both ovaries, such as cancer.

The thinking on this is that the ovaries continue to contribute some as yet undiscovered substances that protect our health well into our oldest years. It is already felt that such a substance promotes heart health. And a recent analysis from the Nurses’ Health Study, published in the journal Obstetrics and Gynecology in May, found that women who had had hysterectomies but kept their ovaries lived longer than women who had had the procedure but whose ovaries were removed. Other studies have shown that removing both ovaries at the time of a hysterectomy is associated with a substantially higher risk for lung cancer than when the ovaries were left in place. A recent study gives further evidence of this association.

Montreal researchers recently conducted a study* in which they compared menstrual characteristics in 422 women diagnosed with lung cancer and 577 women who did not have lung cancer. In all participants, prior removal of BOTH ovaries was associated with a higher risk of lung cancer. Further, in those women who were postmenopausal, the risk for lung cancer was much higher in those who had had their ovaries surgically removed than in those who went through a normal menopause. These findings remained statistically significant even when smoking status was taken into consideration. Not surprisingly, 92% of the women with lung cancer (and 48% of the control subjects) were current or former smokers.

Although cigarette smoking is by far the most important risk factor for lung cancer that can be modified, this association between lung cancer risk and ovarian function cannot be ignored, and merits further study. At the very least, it is something to think about when you are discussing with your surgeon the type of surgery you will have when a hysterectomy is recommended.Janet Horn

*[Int J Cancer 2009 May 11; [e-pub ahead of print]. (http://dx.doi.org/10.1002/ijc.24560)]


The “Best of” Our Blogs: On Having a Hysterectomy Parts 3 & 4

In celebration of our two years of blogging and updating our book, we’ve chosen a few of our past blogs to “replay.”  Below, Robin concludes the story of her own hysterectomy.

Hysterectomy, The Saga – Part III: Physical and Emotional Preparation for Surgery

Have you ever had a procedure done or gone to the doctor and had them tell you that whatever they were going to do was going to hurt? Of course, when they tell you that, it almost always does hurt! This is what we call “Medical Hexing”. From the outset, I was told that I would be in a lot of pain after the hysterectomy; I was going to feel really tired and wiped out, and that I was not going to be healed for at least six weeks. In a way, I felt set up. I realized that there were things I could do that might help me avoid or cope with pain and improve my healing in ways that conventional medicine couldn’t or wouldn’t.

In my clinic where I work, we have a wonderful psychologist who is a guided imagery specialist. I knew that he could help me. Guided imagery is a method of treatment that uses your mind to take you to a calm, relaxing wonderful place. It induces a state of relaxation and helps your mind to direct pain control and expedite healing. I had a session with him at which time he had me relax and took me on a journey in my mind to a beautiful beach. While on the beach he had me see myself relaxed, healing quickly and experiencing very little pain. The tape was about 30 minutes long. I listened to it every day for a week before the surgery and I listened to it during the surgery. There are many medical studies that have shown this to be a very effective method to reduce surgical complications, reduce the need for pain medication, and improve the speed of healing.

In addition to the guided imagery, I went to our clinic acupuncturist. She treated me for a two-hour session the day before my surgery in which she worked on the acupuncture points to help prevent nausea, boost my immune system, charge up my adrenal glands and help with pain control. I walked out of her session feeling great. The session had the added benefit of stopping the bleeding that had been going on for almost two months! Between the two therapies, I felt really good and I wasn’t upset or scared anymore.

I was able to do one other thing that helped. I insisted upon being able to choose my anesthesiologist. Once I asserted myself, guess what happened? They let me choose! When you have surgery the anesthesiologist is just as important as the surgeon. I chose the anesthesiologist who was recommended by other doctors and one who understood my need to listen to the guided imagery tape during surgery. He was also trained in acupuncture just in case!

The day of the surgery I felt calm, and I told my doctor all the things I had done to prepare. I predicted to her that I would need very little pain medication, I would have very little bleeding and that I would be out of the hospital in two days. She looked at me as if I was nuts. That was the last thing I saw before the preoperative anesthetic went into my arm and I was in la la land.

Hysterectomy, The Saga – Part IV: The Process of Recovery

I was so happy to be home. However, although I knew that I had changed in a big way, it was hard for others to see that I wasn’t up to snuff and couldn’t do my usual activities. My dogs were totally confused. They angrily barked for me to take them out for a walk. My husband, who had the best of intentions and a touch of ADHD, would forget that I was up in my bed for hours at a time. My teenage sons were off with their friends. It was time to call for reinforcements. My mother came in to help me recover. She helped to keep me from overdoing it and to keep me company.We watched a lot of really horrible movies and laughed, reminisced and rested. No matter how old I get, my mom can always make me feel better. Now, two weeks post op, I am up and around, walking daily, and have about 80% of my energy back.

I was so distressed when I found out that I needed the hysterectomy. I was upset that I was going to miss work and that I couldn’t continue to do all my multi-tasking. I was upset that my body “failed” me. I felt powerless. The funny thing is that in losing my uterus, I found my power. I learned so much about “the patient” experience. I understood the frustration that my patients express with the way the whole medical system is set up. I learned how to work with the system to get what I needed. I experienced the therapies that I regularly recommend to patients first hand and realized their potency. I was able to reconnect with my mother in a way that we never could have done if I weren’t confined to my bed. Most importantly, I learned to ask for and accept help. How amazing that in losing an organ that has meant so much to me throughout my life that I would gain power, knowledge, wisdom and grace.  Robin Miller

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