1. Women’s Health and Wellness MPH 342 HEALTH & WELLNESS Dr Shai’ Department of Health PNU Week of Oct 26, 2013 Lecture 4

2. objectives  Identify and understand primary health issues affecting women  Risks and prevention strategies Recommendations and homework

3. Overview of Women’s Issues  Leading health concerns  Heart Disease-#1 Killer of women  Cancer- 2 nd leading cause of death  Stroke- 3 rd leading cause of death  Osteoporosis- Common to almost all older women  Dementia- Leading cause of nursing home placement  Menopause-A quality of life issue for 1/3 of women  Concerns of younger women: Menstrual issues, nutrition, fertility, overweight, exercise

4. Heart Health in Women  Heart disease: Leading cause of death  What’s special about women?  Women are twice as likely to die if they have a heart attack, than a man  Women’s heart attacks are often missed/mis-diagnosed  Disproportionate % of heart attacks happen at 9 am Monday morning  Many women don’t recognize or believe they are having a heart attack  Heart attacks present differently in women-  Neck, jaw or arm pain (or no pain)  Panicky or uneasy feeling  Shortness of breath  General discomfort or tightness in chest  Sweating  Any of the above, exacerbated by exertion or stress

5. Why are heart attacks more deadly in women?  Women have smaller blood vessels with thinner walls (fragile)  Emergency room staff and medical professionals often miss the diagnosis due to unusual/mild symptoms  Women, often too busy to go to the doctor, may endure pain/discomfort in silence.

6. Heart Disease Prevention: ♀  Advise patients to quit smoking  Keep patient adjusted  Recommend regular physical activity  Monitor/control blood pressure & cholesterol  Manage stress effectively-yoga, relaxation techniques, biofeedback, exercise

7. Preventing heart disease

8. Heart Disease and Nutrition  Mediterranean Diet-Shown to lower risk of heart attack (More fruit, veggies, grains, less animal fat/red meat, more fish, etc.)  Whole bran foods-Oats, Wheat bran etc. (increase fiber intake)  Lower sodium intake  Vitamin E, other antioxidants, selenium

9. Cancers and Women

10. Lung Cancer  Leading cause of cancer death in women  Very preventable!  Most cases are related to smoking or radon  Have home checked for radon gases  Advise pts to quit smoking  Provide good smoking cessation materials  http://www.surgeongeneral.gov/tobacco/quits.ht m

11. Breast Cancer  Breast Cancer-  200,000 cases/year & 40,000 deaths/year  Risks:  Obesity, sedentary lifestyle  Alcohol use  High fat diet  Family history (only 10% of cases)  Genetics (BrCA1 and BrCA2 genes )

12. Red flags in breast health

13. Colo-Rectal Cancer  Third leading cause of cancer death  Prevention recommendations:  Diet high in fiber  Diet low in animal fat  High calcium intake  Resources: www.cancer.org

14. Stroke: The 3 rd Leading Cause of death in women  Risks:  Smoking  Overweight  Sedentary lifestyle  Use of oral contraceptives/hormone replacement.  High blood pressure or cholesterol

15. Stroke: Patient Presentation  Headache or neck pain-Severe  Dizziness  Speech disturbance (may be mild or none)  Vision disturbance (may be mild or none)  Unusual weakness, numbness, etc (not injury related)

16. Strategies for Stroke Prevention in Chiropractic Practice  Adjusting Strategies:  In patients with risk factors:  Avoid extension and rotational vectors  Employ a least invasive to most invasive strategy  Do not adjust if stroke symptoms are present  Recommend Stroke Prevention For Your Patients  Exercise!!  Quit Smoking  Increase fruits, vegetables, and whole grains  Decrease animal fat and red meat  Consume more fish

17. Osteoporosis: The “silent thief”  Osteoporosis is silent:  Often patient knows nothing about their bone loss until a fracture occurs  1/3 of women over 70 have osteoporosis  84% of women over 70 have low bone mass (osteopenia)  Osteoporosis is PREVENTABLE

18. Bone health

19. Identify who is at risk… Controllable risksUncontrollable risks  Low calcium intake  Sedentary lifestyle  Hi caffeine intake  Alcohol use  Smoking  Soda pop drinks  European or Asian descent  Fair skinned  Small framed/low weight  Family history of OP  Early hysterectomy

20. Recommendations for Bone Health  Exercise: Walking or other axial loading exercises, weight lifting  Calcium Supplementation: 1,200-1,500 mg/day  Avoid smoking, caffeine, alcohol, soda pop, etc

21. Menopause  1/3 of women in the US are menopausal  Process starts in mid forties w/ pre-menopause  Night sweats, mood swings, depression, sexual changes.  Patients seek help!

22. menopause

23. Menopause and Health  Post menopausal increase in risks  Breast, uterine, cervical, ovarian cancer  Osteoporosis  Heart Disease/Stroke  Dementia/memory problems

24. Help: Natural remedies  Isoflavones  Black Cohosh  Red Clover  DongQuai  Alfalfa  Passion Flower  Wild Yam

25. Especially….  Black Cohosh : Used for relief of general menopausal symptoms, nervousness, anxiety, hot flashes, vaginal dryness  Resources : Whiting, Clouston, Kerlin. M J Australia 2002;177(8):440-443.  Leiberman: J Women’s Health 1998;7(5):525-529.

26. What herbs for what?  Herbs For Bone Loss:  Wild Yam : natural progesterone source  Chaste Berry -LH/Progesterone stimulant  Red Clover : All 4 isoflavones  Daidzen, Genistein, Formononetin, Biochanin  Source: Nestel et al. J Clin Endocrinol Metab. 1999; 84(3):895- 8.

27. On your own…  What is the incidence and prevalence of breast cancer in the Kingdom?  What are the commonest types of breast cancer?  Who is most at risk for breast cancer?  Why is mammography so important?  What can a woman do to protect herself against breast cancer?