WEILL MEDICAL COLLEGE OF CORNELL UNIVERSITY

HELPING WOMEN OVER 50 MAKE INFORMED HEALTH DECISIONSTM

January 2006 Volume 10 / Number 1 When Alcohol Becomes Troublesome Alcohol abuse in later life is an unrecognized problem—some women may not even realize they are drinking at unhealthy levels IN THIS ISSUE For some women, older age is a happy, fulfill- them at risk for illnesses and accidents, espe- 2 Frontline ing period—for others, it’s a lonely experi- cially falls,” says Dr. Millman. “For older peo- ence. The loss of a spouse or friends may ple who are at home and lonely, drinking • Aspirin may cut deaths in women with heart disease leave women feeling isolated and depressed. allays those feelings of loneliness; it passes • Exercise can add years to These feelings can intensify if there are phys- the time.” life expectancy ical limitations and family members are scat- “Women may be separated, divorced, or • Omega-3 fats in fish can tered across the country. Some women may widowed. Women who are alone at home reduce the risk of dry eye try to medicate depression or isolation with may have a tendency to drink too much due syndrome • Glucosamine and an accessible and inexpensive drug: alcohol. to lack of social constraints. Or, they have a chrondroitin help knee The National Institute on Alcohol Abuse partner who drinks, and it becomes a shared osteoarthritis pain and Alcoholism (NIAAA) reports that around unhealthy behavior, which may lead to vio- one-third of American women consume lence,” notes Denise Russo, PhD, program 3 Health News alcohol regularly. Around 2.3 percent director in the NIAAA’s Division of How big a threat is avian (upwards of 2.5 million women) meet the Metabolism and Health Effects. “Sleep prob- influenza? criteria for alcohol abuse, according to the lems become more common in older age, and NIAAA. Figures are hard to come by for some women may use alcohol as a sleep aid. 4 Solutions women aged 65 and older. Because alcohol Depression can also lead to unhealthy behav- What you need to know problems are often iors, and one of them is before going into the unrecognized LIGHT DRINKING IS <1 “DRINK” PER DAY: drinking. And we know hospital for surgery among older that alcohol impacts women, they go women harder than men 6 Mind and Body untreated. at lower levels of con- Ways to stay younger as you More women are sumption,” says Russo. get older staying healthy and For women, light living longer than drinking is defined as 8 FYI 12 oz beer = 5 oz wine = 1.5 oz distilled spirits ever before (see One drink = 12 grams of ethanol having one drink or News from the Society for page 6). For those less per day. Women’s Health Research: (Source: National Institute on Alcohol Abuse and Alcoholism) Women react to pain who choose to differently than men drink alcohol, the NIAAA says the pattern of Bigger impact consumption and amount consumed influence Alcohol becomes more concentrated in a 8 Ask Dr. Etingin whether alcohol has a helpful or harmful woman’s body due to smaller body size, • Comparing aspirin and effect on conditions that increase with age, lower weight, and higher percentage of warfarin for atrial fibrillation including heart disease, breast cancer, osteo- body fat; women also produce less of a • Why your bone scan may porosis, and dementia. stomach enzyme called alcohol dehydrogenase produce puzzling results (ADH) that breaks down alcohol, so more Drinking alone gets into the bloodstream. “Evidence is now Because of the stigma for women associated accumulating that women develop problems with heavy alcohol use, women often drink at such as fatty liver, hypertension, gastric home and drink alone, observes Robert bleeding, and peptic ulcers, and cirrhosis at a Millman, MD, director of the alcohol and faster rate than men at lower levels of con- drug abuse service at the Weill Cornell sumption,” notes Dr. Millman. Medical Center. “Most older women drink Alcohol is processed and eliminated more privately. Even though they may start later, slowly in older age, elderly people are often they may escalate their alcohol use, putting Continued on page 7 FRONTLINE Women’s Health Aspirin may cut deaths in women with heart disease ® A long-term study shows that aspirin may significantly reduce death rates in post- Advisor ASPIRIN menopausal women with heart disease. The study, presented at the American Heart Editor-in-Chief Association scientific sessions in November 2005 in Dallas, was conducted among Orli R. Etingin, M.D. Director, Iris Cantor Women’s Health 8,928 women with heart disease aged 50-79; 46 percent of the women were taking daily doses of Center; Vice Chairman, Dept. of either 81 mg or 325 mg of aspirin. During six and a half years of follow-up observation, all Medicine; Professor of Clinical Medicine, Weill Medical College of women taking aspirin had a 25 percent lower death rate from heart disease and a 17 percent reduc- Cornell University tion in death from all causes. However, the study was not a randomized trial, so the results do not Editor Rita Baron-Faust definitively prove aspirin was responsible for the cuts in death rates, and because the reduction in Copy Editor deaths was the same for both doses of aspirin, there’s no way to determine what the optimal dose Barbara Merchant is. Experts say randomized clinical trials are needed. Higher doses of aspirin are associated with Contributing Writers gastric bleeding and other side effects. Peggy Eastman, Washington Correspondent; Sheila Sobell Editorial Support Exercise can add three years to life expectancy Weill Cornell Public Affairs If you engage in regular exercise, even just 30 minutes of brisk walking a day, you can Group Director add as much as three years to your life expectancy free of heart disease, according to David Eltz two studies in the November 14, 2005 Archives of Internal Medicine. One study, from ADVISORY BOARD Cardiology the Netherlands, analyzed more than 40 years worth of data from 4,121 people taking part in the Erica Jones, M.D. landmark Framingham Heart Study. Participants were grouped according to whether they had low, Dermatology medium, or high activity levels. Compared to those who engaged in low levels of activity, life Richard Granstein, M.D. Diane S. Berson, M.D. expectancy for the medium activity group was 1.5 years longer and 3.5 years longer for those with Endocrinology high activity levels—years spent mostly free from heart disease. A second, smaller study from the Carol Levy, M.D. University of Florida of 492 sedentary men and women examined the type of walking program Gastroenterology Ira Jacobson, M.D. that would produce the biggest improvements in heart health. The results: Walking moderately or Ellen Scherl, M.D. briskly for 30 minutes five or more days a week, or walking briskly 3-4 days a week, improved Gerontology cardiorespiratory fitness the most. Walking at a fast pace five or more days a week improved Veronica Lofaso, M.D. cholesterol levels. Gynecology Margaret Polaneczky, M.D. Internal Medicine Fish with omega-3 fats reduce dry eye risk Shari Midoneck, M.D. If you eat plenty of cold-water fish rich in omega-3 fats, you may be able to reduce Neurology Nancy Nealon, M.D. your risk of dry eye syndrome. Women with dry eye syndrome do not produce tears in Nutrition sufficient quantities to lubricate the eye. The most common remedy, artificial tears, pro- Barbara Heller, R.D. vides only temporary relief. Researchers from Brigham and Women’s Hospital in Boston note that Oncology inflammation is thought to play a role in dry eye, and omega-3 fats appear to have antiinflammatory Anne Moore, M.D. Psychiatry properties. The researchers looked at data from 32,470 women taking part in the Women’s Health Minna Fyer, M.D. Study, and found that those who had the greatest intake of omega-3 fats were at 17 percent lower Radiology risk of dry eye syndrome than women with the lowest intake. Tuna especially seemed to protect Ruth Rosenblatt, M.D. against dry eye, with women eating more than five 4-oz servings a week reducing their risk of dry Rheumatology Linda Russell, M.D. eye by 68 percent, compared to women who ate one or fewer servings of tuna per week. No other Sexuality types of fish or seafood were associated with lower dry eye risk in the study in the October 2005 Barbara Bartlik, M.D. American Journal of Clinical Nutrition. The study did not address the issue of mercury in tuna. Sports Medicine Lisa Callahan, M.D. Glucosamine, chondroitin ease knee osteoarthritis Weill Medical College of Results from two major clinical trials, one conducted in the U.S. and the other in Cornell University Europe, show the supplements glucosamine and chondroitin can reduce pain in people Women's Health Advisor® (ISSN: 1524- with knee osteoarthritis (OA). The U.S. study, the Glucosamine/Chondroitin Arthritis 881X) is published monthly for $39 per year by Belvoir Media Group, LLC, 800 Intervention Trial (GAIT), funded by the National Institutes of Health, involved almost 1,600 peo- Connecticut Avenue, Norwalk, CT ple over age 40 with moderate to severe knee OA pain. The GAIT trial found that patients with 06854-1631. Robert Englander, Chairman and CEO; Timothy H. Cole, severe knee pain randomized to take 1,500 mg glucosamine hydrochloride had a more than 65 per- Executive Vice President, Editorial cent reduction in pain, but those taking a combination of glucosamine and 800 mg of chondroitin Director; Philip L. Penny, Chief Operating Officer; Greg King, Executive Vice President, Marketing Director; Marvin Cweibel, sulfate had an almost 80 percent reduction in pain. Patients assigned to take 200 mg of celecoxib Senior Vice President, Marketing Operations; Ron Goldberg, Chief Financial Officer; Tom Canfield, Vice President, Circulation; (Celebrex) had an almost 70 percent reduction in knee pain, compared to a 54 percent response Michael N. Pollet, Senior Vice President, General Counsel. among those taking placebo. The European trial, involving 318 patients given 1,500 mg a day of © 2006 by Belvoir Media Group, LLC. Postmaster: Send address corrections to Women's Health Advisor, Box 420235, powdered glucosamine sulfate, found it may be more effective for knee OA pain than acetaminophen Palm Coast, FL 32142-0235 or placebo. Both trials were reported at the American College of Rheumatology annual meeting in

www.womens-health-advisor.com San Diego, California in November 2005. Researchers also reported that a combination of exercise and weight loss can improve knee function among elderly people with OA.

2 The Center for Women’s Health Care PREVENTION WHAT YOU CAN DO To avoid catching or spreading flu How Big a Threat is Bird Flu? and other respiratory viruses: The prospect of a pandemic of avian influenza is If you haven’t already done so, get a frightening, but seasonal flu is a bigger danger right now flu shot. Cover your mouth when you cough You may have seen some scary head- from infected humans have been or sneeze. lines about the potential for a pandem- reported. However, there have been no ic of avian influenza. But experts say cases of H5N1 reported among birds Wash your hands frequently; soap the bird flu poses no immediate threat. or humans in the U.S. and water kill most viruses. It’s seasonal influenza that kills an esti- Discard used tissues immediately mated 36,000 Americans in a typical Potential for pandemic year, and sends more than 200,000 What has health experts worried is the When possible, avoid crowded indoor into the hospital. “People should still potential for H5N1 to mutate into a spaces. focus on the seasonal flu, and it’s not form that can easily be spread among If a bad cough or other respiratory too late to get a flu shot,” stresses Anne humans, increasing the potential for a symptoms linger, see your doctor. Moscona, MD, professor of pediatrics, pandemic, a worldwide outbreak of microbiology, and immunology, at the disease, explains Dr. Moscona. As Weill Medical College of Cornell infected birds continue to migrate, cells to healthy ones, not only reducing University. Still, the prospect of a public health officials worry that the flu severity but also protecting people worldwide flu epidemic has health virus could become more adept at exposed to the virus from getting sick. officials concerned. Here’s what you spreading between humans. A recent Worldwide efforts are being undertak- should know about the bird flu and study noted that the influenza virus en to produce enough medication to this year’s human flu bug. that killed millions of people around treat large numbers of people. “There the globe in 1918 originated in birds. have been some cases of resistance to For the birds “However, right now, there is no Tamiflu, but not yet to Relenza. Avian influenza viruses have actu- AVIAN FLU H5N1 Avian flu pandemic. And However, the bulk of the flu strains ally been around for centuries. TRANSMISSION H5N1 may not acquire the are still sensitive to these drugs,” Dr. Wild birds carry avian flu Wild mutations to allow it to Moscona comments. viruses in their intes- migratory spread from person to person,” tines and shed the birds says Dr. Moscona. “There are The human flu virus in their saliva, worldwide This year’s seasonal flu vaccine would Poultry nasal secretions, and efforts to not protect against bird flu; it is for-

EALTH ORGANIZATION flocks H droppings, according to monitor mulated to defend against three other

ORLD the Centers for Disease H5N1. If the strains of influenza A: H1N1, H3N2, :W Control and Prevention virus does mutate, and a strain of influenza B. These are OURCE

,S (CDC). Bird flu viruses can be very we have to spot out- variations of strains that originate contagious and infect domesti- breaks and contain them every year in pigs in China. cated birds (including chickens, Humans with quarantines and drug “The flu vaccine is 80-90 percent ducks, and turkeys) by contact with treatment to prevent any spread.” effective, somewhat less so in older MARINA TERLETSKY excretions or droppings from wild There are currently no commercial- people whose immune systems may be birds. These viruses do not usually ly available vaccines that could pro- weaker. If you do get the flu, it’s likely spread easily from poultry to humans. tect humans against H5N1. Vaccines are to be mild,” says Dr. Moscona. “Older The strain making headlines is the being tested by the National Institutes of people get a lot of secondary infec- avian influenza A (H5N1) virus, a sub- Health and other agencies, but produc- tions, including bacterial pneumonia. type of an influenza A virus that ing a vaccine in sufficient quantities for The flu can also damage the lungs, occurs mainly in birds. Outbreaks of Americans could take 3-5 years. causing difficulty breathing. This can H5N1 have occurred among poultry The H5N1 virus is resistant to the be deadly for people who are already in eight Asian countries and in antiviral medications amantadine and affected by a heart or lung problem.” Europe, affecting tens of millions of rimantadine. Two newer antivirals, She urges older people to be alert for birds since 2003. There have been oseltamivir (Tamiflu) and zanamivir symptoms. The flu comes on suddenly, more than 120 cases of H5N1 among (Relenza), would likely work against with high fever and muscle aches; a humans, presumably spread by close H5N1 virus, Dr. Moscona noted in a cold comes on more gradually with a contact with infected poultry or con- recent review in the New England runny nose and scratchy throat. taminated surfaces; the virus has killed Journal of Medicine. These drugs, called Anxiety about the spread of H5N1 more than 60 people in Asia. Two neuraminidase inhibitors, prevent the has led to hoarding of Tamiflu in this cases of suspected H5N1 transmission release of the flu virus from infected Continued on page 4

Women’s Health Advisor January 2006 3 SOLUTIONS BIRD FLU Continued from page 3 Preparing for Hospitalization country; the drug’s manufacturer had halted shipments of the drug to Knowing what to expect and planning for surgery and insure adequate supplies for the cur- the postop period can make recovery easier rent flu season. But there are concerns that people may find it difficult to get Anticipating surgery? Not knowing gist.” Did it cause nausea, vomiting, Tamiflu. “Tamiflu and Relenza are what to expect may well be the tough- headache, or oversedation? Was the only effective if you take them right est part of the experience. But work- level of pain control adequate? To away, within 48 hours of your first ing with your anesthesiologist select the best pain medication, your symptoms. Taken as early as six hours, beforehand to manage pain afterwards anesthesiologist needs a good under- they significantly shorten the illness. and with your doctor to plan for reha- standing of any drug allergies you After two days, they’re not effective,” bilitation challenges will up the odds may have. Don’t forget to ask close explains Dr. Moscona. of a speedy recovery. relatives about their own experience The old practice of having your ini- with anesthesia, as some drug reac- What’s being done about H5N1? tial meeting with your anesthesiologist tions might run in families. Unfortunately, people can carry and right at the door to the operating the- spread any flu virus before symptoms atre is changing. Today’s anesthesiolo- Awake but pain-free appear, notes Dr. Moscona. While gists are on the front line of control- To preserve cognitive function, better human-to-human H5N1 transmission is ling preop anxiety and postop pain control pain, preserve blood loss, and not a threat yet, with jet travel the virus before the surgeon ever picks up a speed recovery, some anesthesiologists could literally fly from one country to scalpel. To calm surgical jitters, anes- favor a regional anesthetic block like another, increasing the chance for a pan- thesiologists will frequently prescribe a an epidural or a spinal instead of demic. The CDC has opened quaran- mild oral antianxiety drug or adminis- anesthetizing the entire body, especial- tine stations at major ports of entry to ter one intravenously, according to ly for orthopedic procedures like total the U.S. The CDC has not yet recom- Sudhir A. Diwan, MD, director, divi- hip or knee replacements, shoulder mended travel restrictions to countries sion of pain medication, Weill and hand surgery. “This is an extreme- affected by H5N1, but advises people Medical College of Cornell University. ly safe procedure that gives the patient who travel to those areas to avoid poul- To establish good preop pain con- the option to remain awake and feel try farms and live food markets. trol, they’ll also set up an analgesic no pain during surgery,” says Diwan. Last May, the U.S. created a base prior to surgery. “That way, you “But if being awake without having National Pandemic Influenza don’t have rip-roaring pain when you any feeling below the waist makes you Preparedness and Response Task wake up,” says John Dombrowski, apprehensive, your doctor can admin- Force, and the government is working MD, spokesperson for the American ister intravenous sedation. Another with the World Health Organization Society of Anesthesiologists. “So we bonus of the regional blocks is the and Asian countries to investigate and might ask you to take some medica- long lasting postoperative pain control control H5N1 outbreaks. President tion even if you’re not in pain. This it offers.” Cleveland Clinic orthopedic George W. Bush has asked Congress approach has become increasingly surgeon Jonathan Schaffer, MD is con- for $7.1 billion in emergency funds to common in cardiac, gynecology, and vinced that “regional blocks are the help prepare for a pandemic. Efforts orthopedic surgery.” way to go in orthopedic surgery. Some to produce and stockpile antiviral According to a large, six-month patients even find it fascinating to drugs in the U.S. are also underway. study presented at the 2004 annual watch their own surgery on a TV In the meantime, health experts are meeting of the American Society of monitor and ask questions as it pro- urging people to be vaccinated against Anesthesiologists, seeing an anesthesi- gresses. One patient said it was like this year’s flu bug; the season usually ologist well before a surgical proce- watching the Discovery channel with peaks in February and March. “More dure significantly improved patient surround sound!” than 180 million people should get satisfaction and safety, and kept hospi- the (flu) vaccine and we have never talization costs down. Better analgesics for less pain gotten anywhere near close to that,” Thanks to advances in formulation of CDC director Julie Gerberding, MD, Learn from experience analgesics, pain from even major sur- told a briefing in November. “The “The experience of past surgery is gery is likely to be less than you imag- specter of pandemic influenza is very educational to the patient and provides ined, according to Diwan. “Morphine frightening to people…and it does valuable information to the anesthesi- and morphine-like drugs (such as remind people of the importance of ologist,” says Dr. Diwan. If you’ve had Dilaudid) are the gold standard for influenza as an illness. In the long surgery before, make some notes about acute postoperative pain control but run, it may result in people being how the anesthesia affected you. And their side effects (sedation, slow motivated” to get vaccinated. discuss it with your new anesthesiolo- breathing, even hallucinations, and the

4 The Center for Women’s Health Care WHAT YOU CAN DO stigma of becoming addicted) limits “During the meeting to discuss your To make hospitalization easier, ask their use. Epidural and peripheral discharge plan, make sure you under- these questions beforehand: nerve blocks allow the anesthesiologist stand how to take your medications to use local anesthetics only or in and what side effects to look for,” says Can I meet my anesthesiologist in combination with a low-dose opioids, Diwan. “Some sedatives or alcohol advance of surgery to discuss preop thereby minimizing the side effects should not be taken along with pain pain control? and maximizing pain relief so you’re medications, and it’s vital you under- What is my anesthesiologist’s philos- comfortable when you wake up.” stand this.” ophy about regional anesthesia? When you do experience pain, you’ll Finally, don’t be reluctant to call be able to control it yourself. If you are your doctor if you’re experiencing Am I a good candidate for a regional an inpatient on an IV, you should be more pain than expected. “You’re hav- block? able to give yourself small amounts of ing pain for a reason, and the doctor What types of accommodations pain medication simply by pressing a needs to find out why,” says should I make for home care once button connected to a computer. Called Dombrowski. “Something may have I’m discharged? patient-controlled analgesia (PCA), it gone wrong with the surgery or with offers immediate relief without delay, your rehab. A simple phone call can says Dombrowski. “In the old days, a put your mind at rest.” patient who wanted something for pain higher level than before,” Schaffer first had to call the nurse, who in turn After orthopedic surgery says. That includes activities such as might need a doctor’s authorization.” If you’re scheduled for a total knee or doubles tennis and golf. However, get- With PCA, patients are less likely to hip replacement, the two most com- ting your golf swing back can be dif- develop pneumonia or an inactive mon orthopedic procedures for ficult because of the twisting involved. bowel as a result of being overly women over 50, having a Once patients no longer need a cane, sedated and unable to exercise good recovery is a factor of Schaffer has them putt from all dis- sufficiently in the hospital. good planning. That includes tances for three weeks, take short iron Soon self-medication may everything from building up shots for two weeks, longer shots for be easier with IONSYS™, a your aerobic health to modi- another 14 days, and then move onto needle-free stream-lined fying your home environment drivers for the last two weeks. device that adheres to your to accommodate the tempo- arm or chest and is no bigger rary use of a walker or Laparoscopy reduces recovery time than a credit card. Without a crutches. “Today, most abdominal operations are cumbersome IV to lug around, “When surgery is more done laparoscopically, reducing the size the new system will make it than a few months ahead, of the incision, pain, and the time to easier for patients to be embarking on an exercise recovery,” says Mark Malangoni, MD, mobile. In a 2004 study pub- program to boost your aero- surgeon-in-chief and chair of surgery lished in the Journal of the bic capacity will improve at MetroHealth Medical Center in American Medical Association (JAMA), your stamina, control your Cleveland, Ohio. “As a result, patients about 300 women who had gyneco- weight, and improve your mood so are able to move about sooner and get logic surgery were randomized to that you come into surgery with a run- back to normal quicker than patients receive either IONSYS, which delivers ning start,” advises Dr. Schaffer. “The who have a traditional incision.” 40 micrograms of fentanyl on demand more active you are before, the easier Driving comes sooner too, normally up to six times an hour, or one gram your recovery.” For very sedentary five to seven days if you’ve had of morphine on demand up to 10 patients, Schaffer recommends pool laparoscopic surgery, another week for times an hour via IV PCA. Eighty-five therapy and upper extremity exercises. open surgery. You’ll be back at the percent of the women receiving ION- Expect to spend about four to six gym quicker too, but steer clear of SYS said their pain management was weeks in physical therapy working on exercises that strain the abdominal excellent or good during the first range of motion, stretching, and wall for six weeks (for gallbladder sur- treatment day. Researchers concluded strengthening exercises, gait, bending, gery) and three months for a hysterec- both systems provided similar pain- and straightening. To speed healing, tomy. After abdominal surgery, Dr. control relief, and that a similar per- your physical therapist may massage Malangoni says many women feel centage needed supplemental pain tender points and scars. Don’t even they’ve lost muscle tone in the abdom- medication. Twice as many women think about driving again for at least inal wall. That’s normal, he says, and (12) in the IONSYS opted out of the three to four weeks if you’ve had your easily corrected with a walking pro- study citing inadequate pain relief left knee replaced, six for the right gram. Women who were more physi- compared to six patients in the IV knee or a hip replacement. cally active can slowly increase their PCA group. IONSYS is awaiting final “Because they no longer are in pain, exercise to pre-op levels with brisk FDA approval. most people find they can exercise at a walking at three weeks

Women’s Health Advisor January 2006 5 MIND AND BODY WHAT YOU CAN DO It’s Not Your Grandmother’s Aging To stay “younger” as you get older: Staying active mentally, physically, and socially can help Stay active mentally and physically. Get regular exercise; try indoor your brain and body stay younger as the years go by mall walking in the cold weather. Experts are now saying that “60 is the Younger in body Keep up your social networks. new 40” and “80 is the new 60.” In To help avoid frailty, fractures, and other words, getting older isn’t what it fatigue, you need regular exercise Take a class, learn a new skill, vol- used to be. Women today are (along with calcium and vitamin D). unteer; helping others is a terrific “younger” in every way than the Your exercise capacity and aerobic fit- tonic for the spirit. women of the same age in the previ- ness will decline as you get older, but Keep your mind sharp with cross- ous generation. that does not mean you should avoid word puzzles, card games, and Chief among the steps to staying exercise, according to a study published reading. younger in older age is reducing risk in the July 25, 2005 issue of Circulation. factors or gaining control of chronic The study by the National Heart, Lung, If you find yourself feeling diseases that often accompany aging, and Blood Institute (NHLBI) measured depressed, seek help. such as coronary heart disease, type 2 the rates of aerobic decline among more diabetes, and high blood pressure. than 800 people, aged 21-87, and “These are things that are easily found that if you remain active you’ll are a number of studies now that addressed that can keep your mind have a higher level of fitness than some- appear to indicate that if you stay functioning longer and stronger,” says one who’s stayed sedentary. You’ll also mentally active it has an ‘exercising’ Norman R. Relkin, MD, PhD, director be “younger” in terms of your capacity effect on thinking and memory func- of the Cornell Memory Disorders to do everyday activities without becom- tions in the brain.” Program. “You also need to address ing winded or fatigued, and retain your Age-related mental decline affects things like stress, sleep problems, use independence, says lead author Jerome some people more (or less) than oth- or misuse of medications, depression, L. Fleg, MD, a medical officer at the ers, but most people actually have the and anxiety. Exercise your body and NHLBI. “By taking part in an exercise ability to reverse a decline, note mind, and keep a positive outlook,” training program, you can raise aerobic researchers from the University of Dr. Relkin told the 23rd annual fitness by 10-15 percent which, in our Alberta in Canada in the September Cornell Women’s Health Symposium study, would be equivalent to being 10- 2005 issue of in October 2005. 20 years younger.” Educational Of course, being born with good A recent study from Sweden found Gerontology. genes—having a long-lived family, that people who exercise 2-3 times a They and other with no heart disease or cancer— week have around a 50 percent less experts rec- helps. But genetics is only part of bio- chance of losing their memory as they ommend that logical aging. “Most researchers now get older, Dr. Relkin notes. Exercise you read, agree that genetics, even including has another benefit: It reduces the risk take classes, mutant genes, is only 30 percent of of obesity; researchers recently report- learn a new healthy aging and the rest depends on ed that obesity in midlife may double skill, take up a your environment,” says Lila the risk of dementia later on. Not to new hobby, play Nachtigall, MD, professor of Ob/Gyn mention that exercise could extend card games, do at the NYU School of Medicine. your life expectancy (see page 2). crossword puz- Environmental factors that affect how zles, even learn how to play a musical you age include “social support, expo- Younger in mind instrument. “With a little effort, even sure to stress, exercise, diet, and of For many people, the biggest fear of people in their 70s and 80s can see course smoking, to name a few.” aging is developing Alzheimer’s dis- dramatic improvements in their cogni- A 75-year-old woman can expect to ease. And it’s true that as we move tive skills,” study co-author Dennis live 13 additional years. “If you want past retirement age, we may lose a lit- Foth, PhD, said in a statement. to age well, you need to start making tle mental sharpness. But in many changes at least by menopause,” Dr. ways, the brain is a muscle that also A stay-young diet Nachtigall said in her keynote address needs exercise. You need to exercise You also need a healthy diet packed to the 2004 annual meeting of the the mind to keep it strong, says Dr. with plenty of antioxidant- and folate- North American Menopause Society in Relkin. “We tend to focus on the rela- rich fruits and vegetables, whole San Diego in October. Recent scientif- tively small percentage of people who grains, and fatty fish. In particular, ic evidence supports these stay-young suffer from Alzheimer’s and other recent research has shown that the strategies. memory-robbing diseases. But there omega-3 fatty acids in cold water fish

6 The Center for Women’s Health Care WHAT YOU CAN DO ALCOHOL Continued from page 1 like salmon and tuna seem to boost To avoid risky drinking: brain functioning, reduce the inflam- more dehydrated, says Russo. “Some Do not drink alcohol every day. mation associated with risk factors for people become more sensitive to the heart disease, stroke, and cognitive effects of alcohol and can’t drink as If you drink socially, limit yourself decline, and lower the risk of stroke. they age.” Older women are also more to one or two drinks and alternate A recent study (just one of several) sensitive to the effects of medications; with nonalcoholic beverages. found eating fish at least once a week there are more than 150 prescription Never consume more than three may actually slow the effects of aging and over-the-counter (OTC) drugs that alcoholic drinks on one occasion. on the brain. The six-year population interact negatively with alcohol, study of Chicago residents found that according to the NIAAA. “Older If you are worried about your alco- the rate of cognitive decline was women often take multiple medica- hol consumption, or have ever reduced by 10-13 percent among tions and may be seeing several doc- tried to cut back and can’t seem people who ate one or more fish tors, who may be unaware of these to, seek counseling. meals a week, even after taking into drugs and unaware of any alcohol use. account fruit and vegetable consump- Symptoms, such as dizziness, sleepi- Unhealthy drinking tion. “The rate reduction is the equiv- ness, withdrawal, cognitive problems, Three in 10 people are drinking at alent of being three to four years may all be signs of cross-reactivities what may be considered “risky” or younger in age,” said the report in the with drugs,” says Russo. “Alcohol can unhealthy levels, observes Richard October 2005 Archives of Neurology. also affect levels of hormones in the Saitz, MD, MPH, associate director of body that can impact on diseases such the Clinical Addiction Research and Young at heart as thyroid disease or breast cancer.” Education (CARE) Unit at Boston It’s a cliché but true: To stay young as University Medical Center. “We define you age, you have to remain young at Weighing risks…and benefits ‘risky drinking’ as more than seven heart. That means keeping a positive Alcohol seems to raise levels of estro- drinks per week, or three drinks per attitude, keeping up with activities you gen in the body; estrogen is known to occasion, for women and adults over find enjoyable, and maintaining social fuel the growth of breast cancer cells. 65. These are amounts that over time contacts, whether they’re at a church, A study of almost 52,000 post- place people at risk for health conse- synagogue, or through volunteering. menopausal Swedish women, reported quences,” says Dr. Saitz. More than “My best advice is to do the things in the November 2, 2005 Journal of half of the health consequences of you find most interesting and most the National Cancer Institute, found those alcohol occur at the level of risky or engaging. Socializing is an excellent with the highest alcohol intake (more problem use, notes Dr. Saitz. For mental stimulation, because it involves than 10 grams of alcohol per day), example, the risks of hypertension can the use of memory, logical thinking, had around a 35 percent increased risk increase at just three drinks a day, and and a variety of other mental process- for hormone receptor-positive tumors, breast cancer risk may rise at two es,” says Dr. Relkin. Also important: compared to nondrinkers. drinks per day. reducing stress and treating depres- A 2005 review of the Women’s In a 2004 review of the current sci- sion. “Keeping things under control as Health Initiative Memory Study entific knowledge of health risks and far as anxiety and stress are concerned (WHIMS), involving more than 4,400 potential benefits of moderate alcohol can go a long way to keep memory women aged 65-79 followed for four consumption, the NIAAA concluded strong,” he adds. years, found that moderate alcohol that except for women at specific risk Keep a positive outlook, stresses consumption may be associated with having one alcoholic drink per day is Dr. Nachtigall. She points to a study improved cognitive function and a unlikely to cause problems. done years ago among nuns who were reduced risk of cognitive decline and However, if you’ve been a teetotaler given tests to gauge mental outlook dementia. Researchers speculate the all your life don’t start drinking alco- when they entered the convent in antioxidant and anticlotting effects of hol in older age because you think it their 20s. “They were tested again in alcohol that protect the heart may keep will protect your heart or brain. Daily their 50s. The ones who had a very blood vessels in the brain healthier. On alcohol use can quickly become a positive outlook—the half full glass the other hand, studies show that habit, says Dr. Millman. rather than the half empty glass— heavy alcohol use harms the brain. A quick self-test: Have you occa- they had much fewer diseases and a As for bones, epidemiologic studies sionally had more than four drinks in much better survival rate,” remarks Dr. find that light-to-moderate drinking is one day? “A positive answer does not Nachtigall. “Let’s help women associated with increased bone mineral necessarily mean that you are abusing embrace the aging process. Let’s help density and a decreased fracture rate alcohol, but you may be at risk for them by helping them lift their arms, among postmenopausal women. problems and should seek some helping them lift their spirits, adding However, heavy alcohol use weakens advice,” says Dr. Saitz. life to their years.” bones, says the NIAAA.

Women’s Health Advisor January 2006 7 ASK DR. ETINGIN FYI: NEWS FROM THE SOCIETY I have had atrial fibrillation without any associated heart FOR WOMEN’S HEALTH RESEARCH disease for 40 years. I am unable to take Coumadin, so for Pain seems to affect women and many years I have relied on one (325 mg) aspirin daily for its men differently. Studies have anticoagulation effect. Are there any statistics as to aspirin's shown that women report pain benefit compared with those for Coumadin? more often than men. Certain studies even suggest that women Drugs to prevent clotting are needed to prevent strokes in peo- can handle and cope with pain ple with atrial fibrillation (AF), a condition where the upper better than their male counter- parts. Differences start early; chambers of the heart quiver instead of beating effectively. This males and females exhibit differ- allows blood to stagnate and form clots that could break away ent responses to pain only hours and block blood flow to (or in) the brain. The usual treatment to after birth. Past studies even sug- prevent strokes is the blood-thinner warfarin (Coumadin). Most studies comparing gest that men and women use aspirin (which prevents platelets from forming clots) and warfarin have found war- different pathways in the brain farin more effective. Warfarin reduces the risk of stroke by more than 60 percent, when it comes to pain. “Men and although it does pose a slightly higher risk of bleeding. A comparison of warfarin women both have pain and both and a newer blood-thinner, clopidogrel (Plavix), reported at the 2005 Scientific can inhibit pain, but may do so Sessions of the American Heart Association (AHA) in November in Dallas found the by the activation of neural newer drug was also less effective than warfarin. In addition, the study was halted mechanisms that are different in early after a high incidence of stroke and other heart risks was seen among the each sex,” Jeffrey Mogil, PhD, professor of pain studies at Plavix group. How well does aspirin work? A 2005 review by the Cochrane Database McGill University in Montreal of Systematic Reviews found that daily aspirin, in doses ranging from 75-325 mg, told the Society for Women’s helped reduce strokes and other major vascular events by around 25 percent in Health Research. It has also been patients with nonvalvular AF. In general, the AHA recommends that people with AF shown that a woman’s pain at high risk for stroke should be given warfarin. However, the AHA says people at threshold varies during the men- low risk for stroke, or who are under age 75, can safely be given aspirin. strual cycle, suggesting a role for estrogen and progesterone. I was prescribed alendronate (Fosamax) for bone loss a year ago at age 55, and Chronic pain conditions, includ- I just got the results of my bone density scan. Why would it show a good ing osteoarthritis, fibromyalgia improvement in the spine but not so much in my hip? How long would I have to and migraines affect women wait to see results on my bone density? more frequently than men. Research by Mogil and others have found that certain pain On average, bisphosphonate therapy increases bone mineral density (BMD) by 3-4 medications actually work better percent in the first year. In your case, there was a discernible effect in the spine after a in women than in men. year of antiresorptive treatment with Fosamax. As to why your spine would improve Researchers at the University of more than your hip, this can be due to a number of factors. It may have to do with California in San Francisco dis- how much bone loss was detected in each area, and differences in the nature of bone covered that female patients in the spinal vertebrae (axial bone) and in the hip area. The bone at the top of the achieved better pain control than thigh (femur), is different in structure than in the long part of the femur. The cortical male patients from a class of bone in the middle of the femur (and other long bones) is made of stronger, channel- pain relievers called kappa opioids like structures, but at the top and bottom it is more like after surgery to remove wisdom a honeycomb and is more vulnerable to fractures. There teeth. On the other hand, COMING SOON Australian researchers at the is also more turnover in this type of bone (called meta- University of New South Wales How strong are your physis). You may have isolated areas of higher BMD or showed in a randomized con- bones? may have started out with more BMD in your hip. So trolled trial in 2000 that ibupro- it’s hard to determine how long you’d need to have fen works better in men. Mogil Heading off strokes drug therapy in order to see any improvement in your says more research is needed to New chemotherapies hip. A repeat bone density scan in early post- further understand the role gen- for breast cancer menopausal women is generally done every 2-3 years. der plays in pain.

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