The American Cancer Society has come out with new recommendations regarding screening mammography for breast cancer. They recommend starting regular screening at age 45, yearly screening from 45 to 54, and screening every 2 years after that. They also discourage self and in-office breast exams. I have to strongly disagree. I understand their concerns about the stress and distress of false positives. However, as a clinician who has cared form women for the last 30 years, I don’t get it. I also don’t understand their recommendations when it comes to eliminating the in-office breast exam.

Starting mammography at the age of 45 years means that we will be missing the aggressive cancers found in younger women. I have diagnosed many in this group. They were not the kind that would lay dormant either. These were inflammatory cancers that had a high likelihood of metastasizing. I am happy with screening yearly between the ages of 45 and 54. But, why would we screen every two years in older women. The chance of breast cancer goes up, not down as we age. As far as the exam, I have picked up many cancers that were quite large that patients did not notice.

Unfortunately, insurance companies will seize on the recommendations and stop paying for mammograms that are recommended for good reason by conscientious primary care providers everywhere. Patients will not want to go to any extra trouble to have an exam that they are afraid of having in the first place, even if they have symptoms or feel a lump.

We have done such a great job with screening. The survival of those with breast cancer continues to improve, in part from early detection. Mammography also continues to improve. We now have the 3D mammogram machine, which promises to improve detection rates of invasive cancer by 40% and decrease false positives by at least 15%.

The American College of Obstetrics and Gynecology (ACOG) have a similar opinion to mine. I believe they feel the same way as I do, because those who belong to the organization have most likely saved many lives as a result of examination and screening.

“ACOG maintains its current advice that women starting at age 40 continue mammography screening every year and recommends a clinical breast exam. ACOG recommendations differ from the American Cancer Society’s because of different interpretation of data and the weight assigned to the harms versus the benefits.”

I am hoping that medical providers can prevail when it comes to common sense and concern for the women we care for and about. I am going to continue doing what I have always done, because I have seen the positive results of prevention and screening. I treat my patients as individuals.

Current global recommendations are just that. They do not take into account each person. They look at averages and base them on the whole not the parts. The recommendations will work for you if you are in the middle of the pack. If you are on the outskirts you will suffer. How do you know if you are on the outskirts? You don’t until it is too late.

November is diabetes awareness month. Why is this important? Because, diabetes (specifically type 2 diabetes) is a HUGE problem.

Here are some quick facts:

• Of those Americans over 65 years of age, close to a third (26.9%) had diabetes in
2010.

• Almost 30 million children and adults in the United States have diabetes.

• 86 million Americans have prediabetes.

• 1.7 million Americans are diagnosed with diabetes every year.

Why is it such a problem? Diabetes is a major cause of kidney failure, limb amputation and blindness. It is also a risk factor for stroke and heart attack.

Overweight and obese individuals are most prone to developing type 2 diabetes. Weight gain decreases the body’s sensitivity to its own insulin. This causes the body to kick out more insulin, but eventually insulin stores run down. This whole process results in inflammation, and that is how diabetes causes serious damage to the body.

Type 2 diabetes, also known as adult onset diabetes in the past, is no longer a disease of adults. As a result of our obesity epidemic it is becoming a disease of children. Unfortunately all the complications that follow as a result are being seen in children including stroke.

The symptoms of diabetes can be subtle. When it becomes more pronounced with increasing blood sugars the symptoms that occur include excessive thirst, urination and an increased appetite. Some people may lose weight. Others may also note fatigue and tingling of the hands and feet.

Fortunately, type 2 diabetes is preventable. A recent study found that small amounts of weight loss (5-10%) could delay or prevent diabetes in those who are at risk. In fact, it was pretty dramatic. Diabetes was reduced by 40 to 60% over the 3 to 6 years that the study was conducted. The solution to this growing problem sounds easy. But, it is not, because achieving significant weight loss is tough.

Obesity continues to grow as an epidemic that threatens to kill our children, crush our medical system and ultimately our economy. We worry about terrorism and weapons of mass destruction or WMD, but perhaps what we should fear most are the ultimate WMD, the knife and the fork.

Or……..”Everyone has plans, until they get punched in the face.” Mike Tyson

I have spent a good part of my life thinking about and striving to balance work and my life. Last year I was asked to give a talk at a professional women’s conference about how I was able to do that. Much to the chagrin of those in the audience, I told them that I had not found the magic bullet point to tell them all how they could achieve balance.

The truth is that the notion of balance assumes you have almost total control over your life. Control is an illusion. Things happen all the time, and we need to deal with them. A perfect example is one that most women can identify with.

You have your whole day planned out. You are gong to take your two young children to school, go to work, finish just in time to pick the kids up, and you do your shopping, errands, etc. during your lunch hour. Then after you pick up the kids you can get dinner ready while they do their homework. Perfect right? That morning your older child starts throwing up, develops a fever, and he needs to stay home from school. You have no childcare so you have to call in to work, and stay home. You can’t leave the house, you can’t do your shopping, and you can’t run your errands. You have to scramble to get your other child to school.

That is a small example. There is no way to find balance in this situation. However, you can be flexible. In my opinion, juggling work and life is not about balance at all. It is about learning to go with the flow.

In the above example, you can look at a day home with your child as a blessing to spend alone time with him or her, get your laundry done, and get the house picked up while he or she takes a nap. Watch a video, read a book or phone a friend. There are many things that you can do instead of stressing about what you are unable to do because you were thrown a curve ball.

That is what I have realized in the last many years. Going with the flow and becoming more flexible is far more workable than striving for perfection in balance. It is never going to happen for me. I feel so much better having realized that. Is the world going to end if my house isn’t as clean as I like it? How horrible will it be if the laundry isn’t folded? Are these things that I will look back on and regret? No.

My advice; keep your to do list. But, if you cannot get to everything or you get sidetracked, appreciate it, and enjoy the detour. Life without balance can be a life well lived depending on your attitude.

There are many ways that you can improve your immune system and ward off colds and viruses. It can be as simple as eating the right foods and exercising!

Foods that Boost your Immunity

Omega 3 fatty acids that are found in fish, flaxseed, and walnuts reduce inflammation and help strengthen the immune system. You might want to shoot for at least two servings a week.

Protein

Zinc is important for white blood cells to function properly. The white blood cells are the cells that fight infection. Zinc is found in protein such as lean meats, chicken, eggs, and tofu. It is also found in fortified foods. It is important to eat adequate amounts of these zinc containing proteins.

Fruits and Vegetables

Brightly colored fruits and vegetables are loaded with phytonutrients. Phytonutrients improve the immune system and can help to fight cancers as well. Not to mention, they are just plain good for you!

Citrus

Citrus fruits contain vitamin C. This vitamin can help ward off colds. Although you can find it in supplements, it is probably more effective if you can get it in food such as oranges and grapefruit.

Nuts

Nuts contain vitamin E. Vitamin E is an antioxidant vitamin that helps to fight colds and upper respiratory infections. The best nuts for vitamin E are sunflower seeds (1/4 cup), almonds (1/4 cup) and 2-3 brazil nuts (they also contain selenium).

Garlic

Garlic has immune boosting properties that fights bacteria and viruses. If you have a cold, the best way to use garlic is to chop it up and swallow it. You can use it as a paste on bread or mixed in applesauce. Don’t chew it if you don’t want your breath to smell!

Chicken Soup

The hot liquid of chicken soup clears the nasal passages. However, something about most chicken soup helps boost the immune system and helps to fight colds. Whether it is the soup or the love with which it is cooked, chicken soup works!

Mushrooms

Mitake, shitake, and reishi mushrooms are among the mushrooms that help boost the immune system. You can stir fry them or get them in capsules (fungi.com). Better yet, put them in your chicken soup!

Exercise

Regular, moderate exercise allows the cells that fight viruses and bacteria to circulate more quickly throughout the body. While they are getting an energy boost, they give your immunity a big boost. The more you exercise, the longer lasting the immune effect. That is another reason why exercise is so important.

In Summary

By eating well and exercising, you can increase your odds of having a healthy cold-free winter!

In honor of breast cancer awareness month, I would like to share this inspiring video.

Click the link and enjoy!

https://youtu.be/cqryZJ2aNeM

I have noticed that over the last several years, dinner has changed. As I look around in restaurants, and even at my own home at times, rather than talk, people are often sucked into their phones. My favorite thing to do with my children and husband is to get them off their phones by texting them to put it down.

Beyond being rude, it has curtailed meaningful discussions. More disturbing is what it is doing to American family dinners, which are significant for the development of healthy children and families. A recent study found that when moms used their cellphones at dinner, there were twenty percent fewer verbal and thirty-nine percent fewer nonverbal interactions with their children.

Research has found that the family dinner is important for helping to develop healthy behaviors.  Lower rates of substance abuse, teen pregnancy, depression, and high grade-point averages and self-esteem can all be attributed to regular family meals. Studies have also found that dinner conversation is even more important for boosting vocabulary than reading. Researchers counted the number of rare words that families used during dinner conversation. Children learned 1000 rare words compared to 143 from parents reading storybooks aloud.  A large vocabulary enhances reading skills.

Unfortunately, the average American eats one in every 5 meals in the car. Twenty-five percent eat at least one fast food meal every day, and the majority of families eat a single meal together less than five days a week.  When we do eat together, many are missing out on incredible opportunities to connect with each other.

It is time to plan regular meals, and put down the phone. Look at your children and connect with them.  Listen to them, engage them, and the odds are you will have a healthier family, and a lot more fun. There is a term my son taught me about the feeling that Facebook often elicits.  The term is FOMO or fear of missing out.  When it comes to Facebook, smartphones, and the web, if you get sucked into them during family dinners, the main things you are legitimately missing out on are the most important people and interactions of your life.

l

When I was growing up, my grandmother had a huge, heavy handbag. The reason I know this is because I was the designated shlepper of that handbag. Since that time, handbags have become purses and have gone through many size changes. We have seen the tiny purses; the medium purses, the backpack purses and we are now all lugging around the huge, heavy purses or handbags (which are really shoulder bags!) again. The more things change, the more things stay the same.

Designers are combining purses with computer bags, which can weigh up to ten pounds. As a result, doctors have been diagnosing women with shoulder strain because they are schlepping these bags. This can cause permanent shoulder damage and chronic pain. If women can keep their posture aligned while carrying their heavy bags, they have fewer problems. Those that do have shoulder pain may find relief with the use of anti-inflammatory medication, massage and physical therapy.

Now that children are back to school, they will be carrying very heavy backpacks. In the interest of looking cool, many will be throwing them over their shoulder.  This can cause injury.  It is important that you instruct them to wear them properly. The backpacks are to be worn with two padded shoulder straps or pulled on rollers.

As for you, if you are a busy woman who keeps her closet, computer, and spare shoes in her purse, the best way to prevent this problem is to change things up. Keep your purse light and change the weight and size of the purse frequently. Be sensible and prevent “shlepper shoulder” today!

As in life, in medicine there are rarely black and white answers to questions and treatments for medical conditions. Many of us have experienced different doctors with different personalities who either fit with us or did not.  When situations arise and you need treatment or diagnostic evaluation, and you feel things are not going in the right direction; it might be time for a second opinion.

This is especially important for those diagnosed with cancer. There are now a variety of approaches for acute and maintenance therapies.  Some doctors may prefer radiation to chemotherapy and others may have other types of treatments in mind.  This is especially apparent for those with prostate cancer. Some doctors may recommend conventional surgery vs. robotic surgery vs. cryosurgery.  For therapy there may be ultrasound vs. radiation pellets vs. hormone therapy vs. a variety of experimental therapies.

As you can see, it is important to find the approach that fits with what you may want and what will work best for you.  It is your body and you need to make an informed decision. It may take a couple of opinions for you to figure it out.  Patients are often afraid they will offend their doctors. However, most doctors welcome a second opinion.  If you have one that does not, perhaps it is time to find another doctor.

Who should you see for that second opinion? I will usually encourage patients to go to a university medical center such as Oregon Health Sciences University or Stanford.  However, there are often specialists that are highly regarded in our own communities. Speaking to people with similar diagnoses and your own physician can help you to find them. As a physician, I welcome another pair of eyes looking at my patients and possibly seeing something I may have missed or finding a treatment I might not have thought of or realized that was available.

Providers are always talking about how important it is for patients to take responsibility for their own health as regards to diet and exercise. Part of being accountable for your own health includes being an informed patient.  Seeking a second opinion is very often essential in order to do just that.

Nutritionists and scientists have long tried to unlock the secrets of overeating. But some of the best information is coming from an unexpected source: marketing experts! It turns out that even the most self-aware individuals are subject to mindless eating.

Most of the research comes from a marketing professor, Dr Brian Wansink, from Stanford University. He wrote a book called Mindless Eating: Why We Eat More Than We Think.

Interesting things to know

* Package size counts
In one study, two groups of people were given free, but stale (five-days old) popcorn while watching a movie. Half of the group got a medium-sized tub; the other got a large tub. The people with the larger tubs ate 53 percent more than those with the medium tubs. They ate the popcorn regardless of taste (five-day-old movie popcorn? YUK!) because it was there and they were distracted by the movie.

* People use visual clues to stop eating
In another study, Dr. Wansink rigged a soup bowl to continuously fill with tomato soup essentially making it bottomless. The eaters with the rigged soup bowls ate on average six ounces more soup than those with a regular bowl. This means that most people ignore how full they feel and eat until they clean their plates.

• Our eating is influenced by color
People will eat more M&M’s when they are multicolored than when they are all one color. People also eat more in a yellow or red room (think about the colors at McDonald’s), and eat less in a blue room.

• We are influenced by those who eat around us
People are more likely to eat faster (and larger amounts) if those around them are shoveling food into their mouths.

• Sound and distraction matters
Playing fast music while eating will cause you to eat more. And every parent knows that kids (and adults) eat more when in front of a TV.

Some tips to help you avoid overeating:

* Eat slowly (or pick a slow eater to sit next to at the next dinner party). It takes ten to 20 minutes for your brain to register that your gut is full.

* Use smaller bowls and plates. Since we all have a tendency to clean our plates and bowls, start small and use smaller utensils as well.

* Never eat directly from the box or bag (think cookies and chips). You can’t see how much you’re eating, which means you won’t remember how many calories you’re consuming.

* Beware of buffets. Use a small plate and only put two items on the plate at a time.

* Be aware of your surroundings. Always sit down to eat and try not to eat in front of the TV. When you choose restaurants, gravitate toward the quiet ones that are painted blue!

Mindless eating contributes to the gradual weight gain that many of us experience as we age. By being aware of some of the cues that trigger overeating, you can turn gradual weight gain into weight loss!

As a practitioner of Integrative medicine, the majority of my patients prefer herbal remedies to modern medications. When my patients come to see me initially, I always ask them to bring their supplements. I do that so I can see which ones they are taking and which brands.   Most patients bring their supplements in huge shopping bags.  One of my colleagues had a patient who brought in a shoebox overflowing with bottles of vitamins and all kinds of things.  He told her that she was either going to have to eliminate some of the bottles or buy bigger shoes.

Needless to say, the majority of those who prefer herbal remedies are probably overdoing it on many levels.  It makes me very uncomfortable, because we do not have any way to tell if the supplements contain what they say they do and if they are free of contaminants.  This is especially true for those that come from China.

It is my experience that most patients take supplements to get more energy and to ease their aches and pains. The majority of those I see would prefer to take the supplements rather than get what they need from food.  I always try to emphasize that it is far better to get vitamins and herbs in their natural state such as food or tea, than it is from a pill. Pills do not often digest for starters, and they usually cost a lot. So, you might end up with expensive toilet water and sewage.

Finally, natural does not mean safe. It is possible to become toxic from supplementing too much of a vitamin such as those stored in the liver (Vitamins A, D, E and K).  Herbs can be dangerous as well and can interact with each other and modern medicines causing serious problems.  As an example, St. Johns Wort, commonly used to treat depression can decrease the effectiveness of birth control pills.

Fortunately for you, dear reader, I have an amazing resource on my website at www.triunemed.com. If you go to the homepage, you will find three icons that you can click on from Natural Standard-Therapeutic Research Center.  This is an excellent organization that reviews herbs and supplements and gives them grades as to how well they work for different ailments. It also discusses interactions and dosages. I highly recommend checking it out before you try anything.

Review everything you are taking with your doctor.  Know that there are certain brands that are better than others. The ones I prefer are Integrative Therapeutics and Standard Process.  Take a hard look at which supplements you are taking and why.  Usually, once I get people eating a healthy diet and exercising, the need for their supplements goes way down and their wellness quotient goes way up.

Remember the wise words of Hippocrates: “Let food be thy medicine and medicine be thy food”