February 2011

Hot Flashes Are Good For Some Things

A recent analysis of a study involving 60,000 women has found that those with hot flashes early on in menopause are 11% less likely to have a heart attack and 17% less likely to have a stroke. In contrast, those who develop hot flashes later in life after menopause are at a 29% increased risk of heart attack.

No one is quite sure why hot flashes may be protective. However, hot flashes occur as a response to dropping estrogen levels. Those with early responsiveness in menopause may have healthier vascular systems. Those who develop them later in life may have unhealthy vessels.

These findings are interesting when one looks at the results of the Womens Health Initiative Study (WHI) that looked at the health consequences of taking hormone replacement therapy. The study found that women on Premarin (estrogen from pregnant mare urine) and Provera (progestin) were at higher risk of having a heart attack or a stroke. However, women for this study were chosen specifically because they did not have hot flashes. They were also on average 63 years old. This potentially puts them at risk of stroke and heart attack regardless of hormone therapy.

Knowing that lack of hot flashes may increase the risk of heart disease, I think it is important to take another view of the results of the WHI study. In addition, we are in need of clinical trials looking at the use of bio-identical hormones and evaluating the treatments for women with hot flashes. Whether women choose to use hormone replacement therapy or not, it is important that we learn as much as possible on the true risks and benefits to help women make an educated decision for themselves.

WHAT I LEARNED FROM YOGA, PT II: GETTING THE COLD SHOULDER

During the same yoga class that I discovered the arthritis in my hands (see Part I – last week’s blog), I also made another discovery. And not a very pleasant one either.  No, this blog is not going to be about the yoga instructor giving me the cold shoulder because I hadn’t been there for awhile. Quite the opposite, in fact; she couldn’t have been more helpful. So what was my problem/discovery?

One of the yoga positions calls for the arms to be stretched up by the ears, then to rotate from the waist in the same position – first to one side, then to the other. Try that for a moment. Actually feels good to stretch, doesn’t it? I had always thought so too…until this class. As I stretched my left arm and shoulder up and then rotated to the left, an involuntary yelp escaped from my mouth, surprising even me. What was that pain? I asked myself. There couldn’t be something else wrong with one of my joints at the same time I had just discovered my hand arthritis, could there?

Sadly, there was. I had gotten not just a cold shoulder, but a frozen one. You’ve probably heard that term bandied around a lot. It actually means that there is limited motion and pain of the shoulder joint due to inflammation. The medical term for a frozen shoulder is “adhesive capsulitis.” This refers to the fact that inflammation has taken place in the capsule of the shoulder, leading to adhesions, or scar tissue.   

Adhesive capsulitis can occur after trauma – for instance with a partial or full tear of the rotator cuff (those tendons that connect the shoulder to the bones and allow it to move in all directions).  However, many times it occurs for no known reason. That’s right, just out of the blue.  And who does it affect most often out of the blue? Us. Women over the age of 50. There have been some studies showing that women who have thyroid disease have a greater chance of getting a frozen shoulder, but the actual reasons for its occurring spontaneously are unknown. It generally runs a course of approximately 18 months to 2 years, and then the pain usually subsides.

Back to me. The truth was that I had been having symptoms in that shoulder for the prior 6 months, including difficulty fastening my bra in the back, difficulty putting on my seatbelt, and pain when I tried to put on my coat from the back. But, these symptoms were not enough to make me take notice until that day in my yoga class. Wanting to give that shoulder every chance to regain the motion it had lost and to relieve myself of pain, I saw my orthopedic doctor, who prescribed an 8 week regimen of physical therapy to keep the shoulder moving. In addition, I had an injection of cortisone into the shoulder so that I could better do the exercises without pain.

It’s been about 18 months now since those symptoms first began, and my shoulder is better, but not completely normal. Despite the upset of discovering two age-related problems in that same yoga class, I’m actually grateful that I did. Because those particular joint problems – in my hands and in a certain aspect of my shoulder joint – didn’t show up in my day-to-day activities, I wasn’t aware of them until I stretched myself (literally!) and did movements that I didn’t usually do.  Now I know what to expect with various movements, and can even premedicate with aspirin or ibuprofen before one of my exercise classes.

So, I guess the moral to this story is that one must continually do things – mentally and physically – outside of one’s usual activities or comfort range in order to best take care of oneself. Or, a simpler message is: don’t ignore changes in your body!

Your Health Is Up To You

It is fascinating in this day and age of tremendous technological advances that whether you have good overall health really depends on the choices that you make. Recent estimates by the American Institute for Cancer Research and the World Cancer Research Fund have found that the incidence of certain cancers such as breast, lung, colon, prostate and stomach could be significantly decreased by never smoking and make healthy lifestyle choices.

It is also estimated that decreased physical activity is responsible for as many as 25% of breast and colon cancers, 30% of heart disease and 27% of diabetes in the world. Unfortunately, knowing that healthy habits can have such an impact does not seem to be enough to inspire people to follow them.

I have wondered why this is the case and I think the answer is complicated. It is hard for many of us to follow healthy lifestyle choices because they require time and energy. We all tend to get caught up in our busy lives and neglect ourselves. In addition, many of us live in denial that anything bad will happen to us.

Hopefully, if we hear the message enough, the wisdom of making healthy choices will sink in. It is important for each of to take responsibility for our overall health and the health of our families.

WHAT I LEARNED FROM YOGA – PART I (REDUX)

The following is a past blog that I am reposting, not only because it’s a common malady in our age group, but also because my next (new) blog will be Part II. Since I am going to refer to Part I in the new one, I thought it might be useful to run it again first.

What I Learned From Yoga

I know you’re expecting me to talk about my spiritual awakening after reading the above title. But this blog is about the physical aspects of yoga. In fact, a very physical aspect – pain.

When my trainer at the gym left to pursue another career some months ago – after 4 successful years of getting me to come to the gym AND do strengthening, balance, and flexibility exercises there regularly – I was at a loss. Being motivated to do regular physical activity is a problem for me.

It was around this same time that a lovely yoga and Pilates studio opened in my neighborhood. I figured that if I got myself onto a schedule of going to classes there , then it was just one step more to keep up my cardio workout. So, I enrolled and went to my first class, an intermediate Ashtanga yoga session.

Now, I’ve practiced yoga positions before, though not in a long time. But I’m fairly flexible and had no trouble keeping up with the different postures during the class. Things were going swimmingly (I use that word because I was literally swimming in sweat) until we got to Downward Facing Dog and I surprised myself by squealing out in pain as my palms hit and pressed down into the floor. Especially the right palm just beneath the bottom of the thumb.

What in the world? I thought. I’ve never noticed pain in my hands before. My mind automatically switched into doctor mode, and I figured that I had stretched the ligaments or tendons between my thumb and forefinger when I had swooped down and picked up my own little 9 pound downward facing dog several days before . Having a quick satisfactory explanation, my immediate problem became what to do about this particular pose, and the ones after it that required pressure on the palms. Unfortunately, the pain was so severe that for the rest of the class I could only take part in those postures that did not require my hands to be in that position.

Fast forward two weeks. I was still having aching now in both palms,worse in the right hand. So, while I was accompanying my husband for his preoperative visit for carpal tunnel surgery, I mentioned the pain to the hand surgeon, thinking he’d confirm my diagnosis of a tendon or ligament or muscle strain and would tell me it would clear up in a few weeks.  He grabbed my hand, pressed down in the exact spot that hurt causing me to grimace, and said that he was sure I had arthritis of the CMC joint. Then he did an xray which proved it. And then he said it was one of the most common joints to get arthritic in older people.

The CMC?  (That’s “carpometacarpal” ). I’d never even thought about that joint since medical school. It’s the one connecting the base of the thumb to the bones in the wrist and plays a crucial role in the function of the thumb. In some studies, degenerative arthritis (inflammation caused by wear-and-tear) of the CMC joint is up to 20 times more common in older women than in any other group.  Like arthritis in other joints, it responds for a time to anti-inflammatory medications, but can become progressively severe in which case it can be debilitating resulting in severe pain, decreased range of motion of the thumb and decreased hand strength. It can even make simple tasks at home – like turning the doorknob or twisting open the lid of a jar painful and difficult. The good news is that in recent years a successful surgery has been developed to treat it in the most severe of cases.

So what about me and yoga? After getting over the shock of being called, yet again, an “older” woman, I did the usual things one does for arthritis, including a brief course of anti-inflammatory meds, heat to the area, and rest.  My pain is better for the moment, and I think I’ve accepted this diagnosis as one that will be with me for the longterm, as well as the fact that this is an age-related problem. That last realization may have been the hardest part of the entire experience.

I learned something else important in that same class. But that’s another story for another day and another blog. Janet Horn

NEXT WEEK: PART II

Confessions of a Chocoholic

I have been doing the “Move it and Lose it Challenge” with Dr Oz on Sharecare.com since the first week it started. It is a great program where I have been diligently writing down my food consumption and exercise. I thought I was doing pretty well with my calories and should be burning quite a bit every day. However, I haven’t been losing as much weight as I would expect. It caused me to ponder what I might be doing wrong. I must confess, as I noted my calorie consumption going down, my chocolate consumption started going up!

I felt so good about doing well with my dietary changes that I was rewarding myself with chocolate. I know that dark chocolate is the healthier form, but I really like milk chocolate. I realized that any type of chocolate is my problem and I am hooked.

A week ago I stopped eating it and I am going through withdrawal. I think about it several times a day and last night I even dreamed about it. Today was better. They say it takes 21 days to break a habit. I am going to stick with it and see what happens. I bought some wonderful vanilla flavored tea and I have been drinking that when I feel the urge to splurge. I have also been taking a lot of walks.

From now on I will be rewarding myself with things other than food. I am thinking that a facial or a shopping spree may work really well. Without the chocolate I am hoping I make my goal weight ahead of time!

A WHOLE LOT OF SHAKIN’ GOING ON

If you’re old enough to remember Jerry Lee Lewis singing his hit song, or even to recall your older brother or sister dancing to it, then you’re old enough to be concerned about your balance and your bones. Even if neither is a problem now.

Why am I mentioning these two health issues together? Because there is one therapy that can help to prevent both of them, and in some cases, even help to reverse both diseases.  And that therapy is a form of exercise, or rather, a combination of two types of exercise: weight-bearing (also known as strengthening) – such as lifting weights – and those movements that work on the ability to balance – such as yoga, pilates, and Tai Chi. You can combine these by doing weight-bearing movements like squats or by lifting weights while you are challenging your balance – by standing on the unstable surface of a BOSU ball or on one leg. This combo of challenges to your body really works to improve your balance while putting pressure on your bones, and muscles for that matter. (See the chapter in our book on physical activity which discusses this combination of exercises.)

Now comes a new type of training that purports to challenge your balance  and strengthen your bones and muscles at the same time.  It’s called “whole body vibration” (WBV). This training works just as you would expect: you stand on an level platform which, when turned on, vibrates rapidly. You can either just stand there, and supposedly benefit your bone density, or you can add your other exercise while you are vibrating, which will help your balance and strength in addition. The vibrating machine upon which you stand is called a WBV platform.

There are a great many studies on this training, particularly in the physical and sports medicine literature since it was initially used for athletes and as therapy after injuries. Many positive effect have been seen with WBV, including enhancement of muscle strength and conditioning, improvement of blood flow, and especially rehabilitation of all types of injuries. Different frequencies and amplitudes of the vibration, and varying durations, are used for different purposes.* Therefore, one platform with its own specific vibratory frequencies and amplitudes is not good for all purposes or all people. In addition, many studies support the idea that to get the best results, training on the WBV platform should be done in a progressive manner.

Initially, the WBV platforms were huge, exorbitantly expensive, and available only in a professional setting. Recently – as happens with all types of exercise equipment that appears to have positive effects – the WBV platforms have become available in smaller, portable, and less expensive forms, especially for professional gyms and physical therapy offices. (And I’ve read that Madonna has her own, of course.)

Should you run out and buy one? I would do that only after asking a certified physical trainer their opinion about it, and then actually training on one at a gym or at a physical fitness store under a qualified person’s direction.  The portable  WBV platforms are not all alike, especially with regard to the speed of the vibrations. While some of the studies showing improvement in bodily functions, particularly in rehabbing injuries, are impressive, there should be further studies on the possibility of negative effects of vibration at that level. In addition, the WBV platforms for home use probably need to have some kinks worked out before you spend a lot of money on one.

On the other hand, do I think WBV is going to go the way of the hula hoop (which is actually good exercise!)? No. The idea and science of it makes sense. Just look at Pilates and the Reformer: previously thought by many to be a fad, both have withstood the test of time and are now a respected part of many exercise regimens.  

So, as with any new thing you are considering trying that may affect your health, research it and try it under supervision before doing it on your own.

 

*Albasini, A, Krause, M, and Rembitzki,I. Using Whole Body Vibration in Physical Therapyt and Sport. Elsevier, 2010.

 

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