October 2009

Yet Another Reason To Do It: Breast Cancer Risk Lowered in Postmenopausal Women by Frequent,Brisk Exercise

A study published online in BMC Cancer on October 1 of this year, conducted by the National Cancer Institute and the National Institutes of Health-AARP, found that postmenopausal women who did regular and frequent, moderate to vigorous exercise lowered their risk for breast cancer. This held true even for those women who had not exercised regularly in the past.

Many studies have shown that women who regularly had a high level of physical activity have a lower risk of getting postmenopausal breast cancer than do those women with a low level of physical activity, in some studies by as much as 20-40%.  In addition, prior studies have shown that women with breast cancer have a reduced risk of having it recur when they do regular exercise. This study, however, was the first to look at the specifics of the parameters of exercise (eg, how often and how vigorous) and of age at the time the exercise begins and their relationship to breast cancer risk.

The study was made up of 118,899 women, ages 50 to 71, who were followed for nearly 7 years.  Initially, these women were asked about their prior exercise regimens during four periods of their lives: ages 15-18; 19-29; 35-39; and the ten years just prior to the beginning of the study in 1995. They were also asked the number of hours exercised per week (from 1-7 hours), and how vigorous that exercise was (with specific examples of each level given) – from light to moderate to vigorous. During the 6.6 years that the women were followed, 4,287 breast cancers were diagnosed.

The study found that the risk of breast cancer was reduced by 16% in those women who did vigorous exercise (7 or more hours per week) in the ten years prior to the study when compared to those women who led sedentary lives. In women who did light exercise (less than 1 hour per week) in the decade before the study, there was no significant reduction in the risk for breast cancer.

Interestingly, the BMI (body mass index) of the study participants had little impact on the correlation between high levels of activity and breast cancer. This suggests that if you regularly do a moderate or vigorous level of exercise, you can lower your risk for breast cancer, no matter what your weight is.

Yet another reason we must get regular, frequent, and moderate-vigorous levels of physical activity in midlife and beyond. I’m convinced that I need to do it – are you?

President Obama Declares H1N1 Flu a National Emergency: Should You Worry?

Several patients have just asked what President Obama’s declaration of the H1N1 pandemic as a national emergency means for them; more specifically, they wanted to know if they should be worried?

The answer to that is NO… and YES.


This declaration was made, not because anything has changed from what we already know about the H1N1 flu, but in order to allow greater flexibility in treating patients. For instance, it allows hospitals to set up emergency treatment areas away from the hospital itself in order to accommodate the growing number of people with the infection, and  to avoid exposing infected patients to those not infected.

So, if you’ve been keeping with what’s been going on with the H1N1 flu since last spring, when it first reared its ugly head, or more recently, you can be reassured that nothing new has happened to warrant this declaration. It’s actually a good thing.


If you haven’t kept up with the news about the H1N1 flu, then you should start now. And yes – you should be worried enough to protect yourself and your loved ones from this virus if you can, and to know what to do if someone you know does get infected.  But, you should not be so worried that you don’t do anything.

One piece of information about this virus that IS in fact new is that we now know that there are major production delays in the making of the H1N1 vaccine. This will obviously slow down the government’s initial optimistic attempt to get large numbers of the most at-risk people vaccinated in October. Only 11 million doses of the vaccine have been released thus far, whereas it was projected that 120 million doses would be given by midOctober.  The government hopes to have 50 million doses out in November, and another 150 million in December.

In the meantime, the virus continues its march across the country, with 46 states thus far reporting widespread flu activity.  Almost 1000 people, including nearly 100 children have died from infection with the H1N1 virus.  These numbers are not a complete surprise to the authorities, as high numbers of infected people were predicted since the H1N1 flu began its course last spring.

So, what can you do? Learn the basics from two of our September blogs discussing the H1N1 flu virus.

http://www.smartwomanshealth.com/horn_miller_blog/?p=397   and


Take the following actions to help prevent infection by this virus.

      Everyday actions:

1)      Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.

2)     Wash your hands often with soap and water, especially after you cough or sneeze. If soap and water are not available, use an alcohol-based hand rub.*

3)     Avoid touching your eyes, nose or mouth. Germs spread that way.

4)     Stay home if you get sick. CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

5)     Stay healthy by continuing to regularly exercise, to eat nutritious foods, to drink plenty of fluids, and to get enough rest.


       Ask your healthcare provider if you should:


1)       Get the seasonal flu vaccine

2)      Get antiviral medication (Tamiflu) if you’ve been exposed to someone with H1N1 flu or are very ill



For continuous updates on the H1N1 flu and the seasonal flu, go to:


For H1N1 info:




For seasonal flu info: 




Probiotics – The Anti-antibiotic: Learn about the bacteria that’s GOOD for you

You’ve seen the TV commercials promoting special yogurt to rid abdominal cramps, bloating, and make up for years of poor eating habits. And you must be wondering: What makes yogurt so therapeutic? Wonder no longer, yogurt contains probiotics.

What are probiotics?

Probiotics are live bacteria that are good for us — improving the balance of good and bad bacteria in our bodies. Yes, bacteria has become a “dirty” word, but truth be told, we all have lots and lots of bacteria living in our gut, mucus membranes and on our skin. When these bacteria are in balance they assist in digestion, release gas in our colon (and are the origin of all farts), and improve your immune system by, among other things, stimulating our body’s own production of antibodies to help fight infection. Probiotics also help your body turn certain foods – through fermentation – into important vitamins for you to absorb.

Why do we need probiotics?

1. Antibiotics – They kill off the bacteria that make us sick, but in the process, they can kill strains of natural bacteria that help your body absorb nutrients. This can cause diarrhea and other digestive upsets, such as gas and cramping. In women, antibiotics can also cause yeast infections.

2. Enzyme deficiencies – Lactase, for instance, is an enzyme that helps us digest milk products. As we age, many of us become lactase deficient, causing gas and bowel trouble. Drinking milk with acidophilus can help.

3. Irritable bowel syndrome – A common problem as we age, irritable bowel syndrome causes gas, bloating, and abdominal cramping. Many factors can cause the discomfort, however, many of the symptoms may actually be caused by a bacteria imbalance in our gut.

4. A recent study done in China has found that children given probiotics had 72% fewer fevers in the winter and used 84% fewer antibiotics.

And, even if you do not have any of these problems, probiotics are still worth trying. They can help relieve constipation, prevent yeast infections, lower cholesterol, and increase protection from certain cancers including colon and bladder cancer.

Where can you get probiotics?

You can find probiotics in cultured dairy products like yogurt and kefir, as well as fermented foods like sauerkraut. You can also take supplements, which are made up of a mix of bacteria. The most common types are acidophilus, lactobacillus species, and bifidobacteria species. Most probiotics need to be refrigerated and kept tightly sealed in an opaque container.

If you’re experiencing cramping or bloating, you should start feeling better soon after you begin taking the probiotics. If you’re healthy, you won’t notice much change. Although you might have a happier glow because you are preventing illness.

Have you tried any probiotic products? Did you notice any improvement in your health?

This Month is the 25th Anniversary of National Breast Cancer Awareness Month

This month is the 25th Anniversary of National Breast Cancer Awareness Month.

What do we now know now about breast cancer? We know that it’s the most common cancer in women over the age of fifty, that statistics show that each of us has a 1 in 8 chance of developing it, and a 1 in 33 chance of dying from it over our lifetime.


We also know which of us has a greater chance of getting breast cancer because many factors that place us at risk have been defined. Although it seems that every Monday and Thursday a new study is coming out telling us about something else that can cause it, there actually are some definites in this regard. As with the risk factors for heart disease, we can change some of these risk factors, and can do nothing about others. Also, as with heart disease, the more risk factors that one has, the greater are one’s chances of developing the disease.

Those risk factors we cannot change are age (the older we become, the greater the risk), race (see below), family history (see below), the density of our breasts (the denser, or the more glandular tissue rather than fatty tissue, the greater the risk), a past history of having breast cancer, our menstrual and reproductive history (this includes our history of taking hormones), our past exposures to environmental toxins and radiation and DES, and of course, our genetic makeup.

One thing to remember: even though we cannot change the above factors, simply our knowing about them and thus, knowing that we are risk, allows us to practice the measures that can lead to early detection of a cancer and the possibility of a cure, or at least, a much better outcome. So if you have one or more of the above risk factors, don’t despair – be proactive for your own good health. How to do that follows in a moment.

A further word about a couple of the above risk factors. Although Caucasian women have the highest risk of getting breast cancer, African American women have a higher risk of death from the disease. This is thought to be partially due to the fact that the disease is caught later in these women. Hispanic, Asian American, and Native American women have a lower risk than either of the above two groups. As for family history, if you have one or two first degree relatives (mother, daughter, sister) with breast cancer, your risk goes up dramatically, so you may want to be examined more frequently than is normally recommended if this is the case.

Those factors that put us at risk for breast cancer that we can change are being overweight or obese, having a sedentary lifestyle, and drinking too much alcohol. Currently being intensively studied, among other factors, is the role certain foods and nutrients play in the development of breast cancer.

What can you do to prevent this disease, or at the very least, to have the best outcome if you do get it? You can be proactive in the following two broad categories: establishing a routine for screening your breasts (and a team approach with your care providers) and establishing a healthy lifestyle. If you are fifty or over, you should be getting an annual mammogram; if you are still in your 40’s, it’s recommended that you get one every two years unless you have one or more of risk factors, or your clinician recommends them more frequently. Remember that mammograms are not always 100% accurate; they can miss tumors. If your breasts are dense you should ask your clinician whether you should have a digital mammogram or a MRI of your breasts. In addition, you should be having at least one annual breast exam by a professional, such as your gynecologist or internist; it makes the most sense to schedule your Gyn exam or your regular internal medicine check up six months away from your mammogram, so that you will have a professional breast check at least twice a year.

You should also be doing a self examination on your own breasts monthly. Don’t forget to examine your nipples and under your arms. If you’re uncomfortable in general with what you’re feeling when you examine yourself, here’s an idea: right after your Gyn or your internist has done a breast exam, go home and do one yourself that very day. That way, you’ll know what’s normal for you. Also, many clinicians have a realistic model of a breast – with and without lumps – on which you can practice the exam; ask about this. But, regardless, if you find something in your breast, even if you think you’re not good at examining yourself, see your clinician – it could save your life.

What about a healthy lifestyle? Being at a reasonable body weight is very important in prevention, as is regular exercise (30 minutes per day of walking for 5-7 days/week at least). You should limit your intake of alcohol to less than three drinks/day. A nutritious diet of many colorful fruits and vegetables, healthy proteins (fish and chicken) and “good fats and carbs” is essential, as are calcium and Vitamin D supplements. And add onto all of the above a positive outlook!

There is so much information out there about breast cancer that it’s easy to get bored with it.  DON’T.  Despite the explosion in our knowledge about this deadly cancer, many women (and men) still don’t know they are at risk, don’t get annual mammograms, don’t do regular breast self-exams, don’t know some of the steps they can take to prevent it – especially through lifestyle changes, and don’t know the warning signs. If you feel that you’re up to date on the facts about breast cancer, and are taking the necessary steps to prevent or have it diagnosed it early, then be the one in your [choose one: yoga class, carpool, lunch group, office, neighborhood] that makes sure the others are as up to date as you are.  Don’t get complacent; complacency is as deadly as the disease is.

To learn more about National Breast Cancer Awareness Month, see my blog from last October as well as go to the NBCAM and American Cancer Society’s websites:





To learn more about the disease itself, go to the National Cancer Institute’s site:










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.


*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.


The More Things Change, The More They Stay The Same-Part III: Schlepper Shoulder

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.

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!


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