December 4th, 2007 by Dr. Val Jones in Expert Interviews
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I recently interviewed Dr. Cliff Bassett about asthma in women and he gave some interesting insights into gender differences associated with this disease. I’ve summarized our conversation below – or you can listen to it here.
The CDC reports that 9% of women have asthma compared to 5% of men. I think that’s a very important finding and I’m not sure if women know that they’re at higher risk than men. The good news is that asthma is completely treatable, although sadly we have as many as 4000 deaths per year in this country attributed to asthma. We’re doing a better job identifying those with severe asthma, and the death rates are decreasing.
Women need to understand that even a small amount of weight gain (as little as 5 pounds) can add up to a much higher risk of death for women with severe asthma. So weight management is very important for those with more challenging asthma symptoms.
Women are more likely to be hospitalized due to an asthma attack than men. And interestingly, up to 40% of women report that their asthma symptoms get worse just before and after menstruation. So for women it’s important to keep a symptom diary, so that if there’s a regular worsening of asthma during menstruation, they might need to be treated more aggressively (perhaps with steroids or other medications) during that time of the month.
The new asthma guidelines (from the NIH) emphasize understanding asthma triggers as the foundation of prevention. It’s much safer to avert an asthma attack than to have to treat a full blown one. So it’s really important for women with asthma to figure out what might trigger their symptoms, and avoid those triggers as much as possible.
Now that it’s winter time, most environmental triggers are of the indoor variety. Over 100 million US households have pets. The most common pet is the cat, and up to 10% of people with allergies develop specific allergies to cats. If an individual suspects that she has a pet allergy, she should see an allergist to get tested to confirm that. Avoidance measures are important, though there are medications and allergy immune therapy (allergy shots) that can help with pet allergies.
Cold dry air can be an asthma trigger in some individuals, especially if they’re engaging in outdoor physical activity. Warm ups and cool downs can help to head off an asthma attack in the cold, though it’s always a good idea to have a rescue inhaler handy.
**Listen To Podcast***This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
December 2nd, 2007 by Dr. Val Jones in Opinion
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I recently had the chance to observe a breast augmentation procedure performed by a surgeon friend of mine. The patient was a tall, attractive woman in her late thirties. Her husband was in the room, quietly listening to my friend’s explanation of the procedure and what should be expected. The patient was friendly and enthusiastic – the breast augmentation procedure was her birthday gift to herself. This was her second procedure, as she had already increased her cup size from an A to a C a few years prior. This time she wanted D or larger.
I felt mixed emotions as I observed the surgery. On the one hand the patient’s breasts looked fine the way they were (in my humble opinion) and it seemed wrong to further distort her natural body type. Yet on the other hand, I think that patients have the right to look the way they want to, and my personal beauty ideal shouldn’t be projected on to them. I asked my friend how she dealt with this sort of conflict.
“Well,” she said, looking at me with her surgical mask and blue hair net, “if a woman wants a green dress, it’s not the store clerk’s business to try to pressure her into buying a red one. I just try to give the patients what they want, and not impose my opinions on them.”
And so I watched as my friend carefully sutured the wounds around the new implants. She checked the movement of the saline-filled sacs inside the chest. She pushed the breasts together to check the cleavage.
“But the breasts don’t touch each other when you push them to the center,” I said, head tilted sideways.
“Her sternum is too wide for that. This is one of the limitations of implants of this size on her body. She just doesn’t have enough tissue to make that kind of cleavage.”
“Is that ok with her?” I asked, glancing down my own scrub top.
“It’s a give and take – she knows that going larger will not give her a natural look, but she’s ok with that. This is what she wants.”
And so the anesthesiologist woke the patient up, extubated her, and the nursing staff slid her over to the stretcher that would carry her to the recovery area. My friend escaped her sterile gown and gloves and prepared her post-op note at the nursing station desk. I smiled at the nurses who assisted in the surgery, and we shrugged at each other and went on our separate ways. I hope the patient is pleased with the outcome, though most of all I hope she feels content with how she looks, no matter what the bra cup size.
What do you think about breast augmentation?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
December 1st, 2007 by Dr. Val Jones in Expert Interviews
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I recently spent some time with Dr. Kevin Means, Chairman of the Department of Physical Medicine and Rehabilitation at the University of Arkansas in Little Rock. I asked Dr. Means about his life, how he chose his specialty, and how he came to Little Rock from New York City. This is his story:
Kevin Means grew up on Long Island and attended college in Binghamton, NY. The summer after his first year of college he began looking for work to help him pay his way through school. Jobs were few and far between, and only “undesireable” work remained for college students. Kevin heard about a position as a physical therapy assistant at a facility for the disabled. They were having a difficult time recruiting and retaining candidates due to the strenuous work requirements – heavy lifting, assisting patients with exercises, and moving imobile (and sometimes obese) individuals around was not feasible for many people. But Kevin was a tall, strong, African American man – undaunted by the challenges.
The first few days filled him with sadness – young men with spinal cord injuries, elderly people recovering from severe strokes, amputees with traumatic brain injuries – all doing what they could in the gymnasium. Kevin surveyed the patients and took to heart the individual tragedies that had brought each of them there. He observed the physical therapists as they encouraged movement in the imobile, taught people how to use shriveled limbs, and helped amputees use new prostheses to walk again. Over time, he began to see that each life was a beautiful story of triumph over adversity, and his initial sadness melted as he witnessed the daily victories of recovery.
Slowly, Kevin began taking on more responsibility at the facility. He would sometimes offer additional therapy sessions to patients and stayed late in the evening to make sure that everyone had a full day of exercise. Although he had no formal training as a physical therapist, he grew to understand and practice their techniques, and was dearly loved by the patients.
One day Kevin was offered an office job that paid substantially more than the PTA position. He accepted it gladly, but in the afternoons found himself thinking about his friends at the rehab facility. He wondered if the patients were being cared for correctly, if they were recovering well, and if the nurses were strong enough to help the therapists transfer the patients safely. These nagging questions burned in his mind as he filed paperwork and made phone calls. He just couldn’t stop worrying about them.
A few days later, Kevin returned to his position as a PTA in the rehab facility. He had learned that working with disabled men and women was more fulfilling to him than an office job. He spent the next 3 years working there part-time, and developed long lasting friendships with the patients and staff.
When it came time to go to medical school, Kevin promised his friends that he would do all he could to sharpen his therapy skills and research new ways to help them become independent in their daily lives. For this reason, he chose PM&R as his specialty and attended residency at the top-ranked Rehabilitation Institute of Chicago (RIC). When I asked Kevin why he didn’t stay on at RIC after his residency, he simply said that they didn’t need him. They had plenty of bright, talented physicians who could help to advance the field. Kevin wanted to go where needs were greater, and where his work might bring new hope to those who had very little.
And so Kevin went to Little Rock, Arkansas in the mid ’80’s – to help to build a PM&R program there. He was single – a fact that his friends in Chicago and New York must have called to his attention. But he forged ahead on faith, assuming that he would meet his wife in good time.
Over the past two decades, Kevin has worked tirelessly to grow and establish the PM&R department at UAMS as a center of excellence in rehabilitation medicine. He met his (now) wife while she was working a second job as a clerk at a department store in Little Rock (she is a teacher), and they have 2 lovely children. Kevin took me on a tour of the UAMS facilities which span 3 modern buildings equiped with 2 large swimming pools, beautiful gardens and multiple gymnasiums.
I watched his face as he looked out onto a team of 30+ therapists assisting disabled adults with their goals in a gym. He smiled at the physical therapists and PTAs and I had to wonder if the scene reminded him of his days in Binghamton, and the friendships that gave him the first glimpse of his calling as a physician.
Kevin never did lose sight of his first love: advocating for the needs of the disabled. His career path has taken him from Binghamton to Little Rock – as he steadfastly fulfills his calling as a nurturing healer, working in places where needs are great, and workers are few.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
November 27th, 2007 by Dr. Val Jones in Expert Interviews
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I was speaking with Revolution Health expert Dr. Zach Bloomgarden about advances in diabetes care, and I suddenly realized that enhancing compliance with lifestyle measures is more important than researching treatments. In other words, we have the power to cure many cases of type 2 diabetes already – without any new research/treatments. The challenge is sticking with diet and exercise programs. Perhaps the same could be said of many diseases.
I thought I’d share this audio clip of Zach explaining that we already have the tools to radically improve diabetes outcomes and virtually eliminate this disease.
Listen Here
I hope that the new community groups at Revolution Health will help us all work together to get to a healthier place. I’m still struggling along with my diet team. I’m proud of those who have had great success already!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
November 26th, 2007 by Dr. Val Jones in Expert Interviews
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Dr. Cliff Bassett is an allergy specialist in New York City. We recently discussed the differences between men and women when it comes to allergies. You can listen to our conversation or read on for a synopsis of the discussion.
**Listen To The Podcast**
Seasonal Allergies & Women
Women don’t always realize that nasal stuffiness may be a sign of an underlying medical condition or a side effect of medications. Low thyroid (hypothyroidism), taking oral contraceptive pills, or frequent use of aspirin or NSAIDs (such as Motrin), can actually increase the risk for nasal stuffiness. Some studies also suggest that hormone fluctuations can increase nasal congestion and allergy sensitivity. So women in particular need to be aware of their unique allergy triggers and get treatment from an allergy specialist when necessary.
Food Allergies & Women
A recent study suggested that women are twice as likely to have seafood allergies than men (4% versus 2%). The reason for this difference is unclear, and it may be related to increased vigilance on the part of women to get tested and diagnosed. However, food allergies are certainly on the rise in this country. I suspect it might have to do with the increasing use of stomach acid blockers. The medicines change the pH (or acidity) of the stomach environment and may influence the way that proteins are being broken down and absorbed by the body. Another theory is that dieting can lead to increasing food allergies – as women eat more protein and fewer carbohydrates, they become exposed to more protein allergens and develop intolerances to them. Ultimately we don’t know for sure what’s contributing to the increase of food allergies in this country, but the good news is that you can easily get tested and treated for them.
Drug Allergies & Women
Some studies suggest that penicillin allergies are more common in women than men. Anyone who has an allergic parent is at higher risk for having an allergic condition. If both parents are affected, your chances are 50-75% that you’ll have a similar allergic profile.
Moms: Be a Label DetectiveA law was passed in 2006 that requires all food products to be carefully labeled regarding whether or not they contain any of the 8 most common food allergens. Moms need to become familiar with all the possible names of ingredients that are related to their (or their child’s) food allergen. So for example “casein” is a form of milk protein, and should be avoided if the allergic individual has milk sensitivities. Also, be very wary of hidden sources of allergens – the glaze on pastries may contain egg proteins and traces of nuts may be hidden in cakes and breads. When dining out it’s always good to carry an allergy card for the chef so he/she can make sure that the food you order doesn’t contain any offending ingredients. The website foodallergy.org has a great list of tips for avoiding exposure to food allergens. I highly recommend it as a resource for women taking care of food allergic children.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
