Seattle Met Women's Health Annual 2012

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Cutting Edge: Advances in Medicine p7

Frank Truths About Sexual Health p12

Reconstructing the Mastectomy p18

How to Get a Strong Heart p27

Women’s Health Annual 2012 presented by Seattle Met and Virginia Mason Medical Center

There are more than 80 autoimmune diseases. They share a common cause.

Our scientists and physicians have a common cause, too:

Eliminating Autoimmune Diseases Autoimmune diseases affect four of every 100 Americans and include Type 1 diabetes, arthritis, multiple sclerosis, lupus and many others. They occur when the body’s immune system, designed to protect the body, attacks it instead. Benaroya Research Institute at Virginia Mason (BRI) is leading the way in finding causes and cures for autoimmune diseases. At BRI, you have many opportunities to participate in some of the most exciting medical research of our time: • Join a BRI Registry to advance our research. • Learn about our many important clinical trials. • Make a tax-deductible financial contribution. Visit BenaroyaResearch.org to sign up for our newsletter and learn about the latest BRI research or call (206) 342-6500.

Contents

Departments

Cutting Edge: Advances in Medicine 7  What Lies Beneath 8  Royal Treatments 10 Minimally Invasive

Features

21 From MS to Motherhood 22 Beating Obesity to the Punch 24 Cognitive Care

Heart Health

Active Living

27 Cardio Matters 28 7 Days of Fun for the Heart

31 No Pain, All Gain 32 To the Exam Room, Jeeves

12 Pumping Up Your Sex Life Nearly 1 in 2 women experience problems with sex

15 The Ages and Stages of Menopause

16 Better Health for All Ages

18 Rescontructing the Mastectomy

Good health is made better when an active lifestyle is paired with annual screenings. Here’s when those annual exams should begin

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Family Matters

Return of mood swings

New surgical techniques get aggressive against cancer and help women keep breast tissue

Wo m e n ’ s H e a lt h A n n u a l 2 0 1 2

Breakthrough 3-D technology brings comfort. Mammograms are critical to breast health and recommended for women beginning at age 40. But too often, getting a mammogram can be an uncomfortable, uncertain experience. At Evergreen, we are the first and only hospital in the Puget Sound to use a revolutionary, 3-D mammography technology to obtain more precise

images than standard, two-dimensional imaging. Tomosynthesis reduces the need for follow-up visits by 40%. What’s more, the procedure is more comfortable for you through the use of the MammoPad®. To schedule a mammogram call 425.899.2831. Learn about our innovative care at EvergreenHealthcare.org

And nothing feels better than feeling better.

Call our 24-Hour Nurse Line and Physician Referral, 425.899.3000 Evergreen Healthcare, including Evergreen Hospital, Home Health and Hospice • 24-hour Emergency Care in Kirkland and Redmond • Urgent Care in Redmond and Woodinville • Primary Care in Redmond, Woodinville, Canyon Park, Duvall, Kenmore and Sammamish.

Welcome Virginia Mason Medical Center 1100 Ninth Ave., Seattle, WA 98101 206-223-6600; 866-team-med VirginiaMason.org

Raising the Bar

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Welcome to the 2012 Women’s Health Annual—the first-ever such publication for the women of our region. Since our founding in 1920, Virginia Mason Medical Center has had a long history of firsts in this community, and we are proud to join SagaCity Media and Seattle Met magazine in publishing this resource for you. As science and our health care system evolve, and as more women take critical roles in medicine and leadership, the health care field is progressing in ways our mothers could not have imagined. We highlight many of these advances here to help you be well informed of the breadth and depth of care that’s available to you, close to home. Whether you are looking for a primary care provider or seeking the most advanced treatment for breast cancer, we invite you to take a fresh look at what is available from your health care team. You may be surprised by what you find. Medicine today offers more choices and better care for women than ever before. I hope that by reading these pages, you will not only feel better informed, but also more empowered to make the best choices for yourself and those you love.

Sarah Patterson, mha Executive Vice President and Chief Operating O fficer Virginia Mason Medical Center

Bellevue · Federal Way · Issaquah Kirkland · Lynnwood · Sand Point Seattle · Winslow/Bainbridge Island Chairman and ceo Gary S. Kaplan, md Executive Vice President and Chief Operating Officer Sarah Patterson, mha

SagaCity Media President Nicole Vogel Publisher Rob Scott Editorial Director Bill Hutfilz Editor Julie H. Case Design Director Andre Mora Associate Art Director Chris Skiles

Contributing Writers and Editors Sarah DeWeerdt, Marc Fredson, Lucy LaBerge, Diane Mapes, Margaret Seiler, Bill Stein, M. Susan Wilson Contributing Illustrator Daniel Fishel Images Shutterstock Production Manager Mary Bradford Production Assistant Dan McDougall

Advertising Sales Manager Alysse Bryson Account Executives Dixie Duncan, Nina Feldman, Ryan Fitzgerald, Lysa Hansen, Grace Oppenheimer, Liz Utley

Women’s Health Annual Volume 1, Issue 1 The Women’s Health Annual is a publication of SagaCity Media in conjunction with Virginia Mason Medical Center. It is produced as a supplement to Seattle Met magazine and for distribution within the Virginia Mason system. For advertising inquiries contact Alysse Bryson at 206957-2234 x125. For editorial inquiries contact Bill Hutfilz at 503-222-5144 x144. All rights reserved.

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Skin Cancer Treatment The Latest Innovation Plastic Micrographic Surgery. This latest advance in skin cancer treatment combines the highest possible cure rate of Mohs micrographic surgery with cosmetic reconstructive surgery on the same day. The result is the most convenient, cost effective treatment with the highest cure rate and best cosmetic result. This treatment is covered by insurance and is often less expensive than other treatment methods.

Comprehensive Center of Excellence. The Skin Cancer Center, directed by Dr. Piasecki, specializes in treating all types of skin cancer. The Center offers all aspects of skin cancer care, including: • Routine skin cancer screening • All treatment options • Lymph node procedures The Skin Cancer Center is conveniently located in the quaint Tacoma suburb of Gig Harbor, an hour from Seattle and 45 minutes from Sea-Tac International Airport. Housed within Harbor Plastic Surgery Center adjacent to St. Anthony Hospital, The Skin Cancer Center has a Medicare-certified ambulatory surgery center which allows patients to have reconstructive surgery immediately following their Mohs surgery (cancer excision) in the same outpatient setting. The Harbor Plastic Surgery Center ASC is accredited by AAAHC, the most stringent deeming agency for surgery centers. This accreditation underscores the Center’s commitment to patient safety and continuous quality improvement.

Unique Skill Set. Justin Piasecki, M.D., the founder of Plastic Micrographic Surgery, is the only physician in the world who is Double Board Certified by the American Board of Plastic Surgery and the American Board of Facial Plastic and Reconstructive Surgery and is ACMS fellowship trained in Mohs Surgery. Lemons into Lemonade. Dr. Piasecki can combine cosmetic procedures such as eyelift, necklift, browlift, rhinoplasty (nose surgery), otoplasty (ear surgery), or mini-facelift with skin cancer surgery. Fees are reduced by 30% when combined with Plastic Micrographic Surgery. Come in with cancer, leave rejuvenated. Widespread Interest. Patients travel from Canada, Europe and across the United States to be treated by Dr. Piasecki. Our office staff is prepared to help with travel arrangements. Finest Service. Our patients have 24/7 access to Dr. Piasecki and report a 99.7% satisfaction with their care.

Trust your face to the expert. Best care. Best service. Less cost. Referrals are not required and all major insurances, including Medicare, are accepted.

theskincancercenter.org The Skin Cancer Center at Harbor Plastic Surgery Center 11511 Canterwood Blvd NW, Suite 310 Gig Harbor, WA 98332 253.858.5040

Chad D. Aschtgen, ND, FABNO Seattle Integrative Oncology at the Institute of Complementary Medicine Board certified in naturopathic oncology (FABNO), Dr. Chad Aschtgen received his Doctorate of Naturopathic Medicine (ND) from Bastyr University in Seattle. Subsequently he completed a two-year, hospital-based naturopathic medical residency at Midwestern Regional Medical Center, a Cancer Treatment Centers of America (CTCA) hospital in Chicago, IL.

Being diagnosed with cancer can be devastating. For many, going through treatment for cancer is a near-impossible task. Life after cancer is full of questions and too many unknowns.

We’re here to help… Every step of the way! Through a personalized naturopathic care plan, we will help you: • • • •

improve your general health and optimize wellness strengthen and support your immune system and manage side effects incorporate a targeted nutrition, exercise and dietary supplement plan assess your underlying health through lab testing and address those factors that may contribute to disease

1600 E. Jefferson Street, Suite 603 Seattle, WA 98122

206.726.0034 • www.seattlend.com

Dr. Aschtgen is a preferred provider for most major medical insurance plans

Cutting Edge

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W hat Li es B eneat h

The secret lives of autoimmune disease By Sarah DeWeerdt

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What do Type I (juvenile) diabetes, lupus, multiple sclerosis, and rheumatoid arthritis have in common? A cause. All of these conditions—along with more than 80 others—are autoimmune diseases. They develop when the immune system, which normally protects the body by fighting off disease-causing germs, instead attacks the body’s own tissues. About 1 in 20 Americans suffer from an autoimmune disease, and women are at greater risk. For example, three times as many women as men have rheumatoid arthritis, which can cause debilitating joint pain and stiffness. In fact, autoimmune disease is among the top 10 causes of death for girls and women under age 64. But these facts don’t always mean people have to 7

Cutting Edge suffer. “We have a lot we can do for people with autoimmune diseases,” says Jane Buckner, MD, a rheumatologist and head of translational research at Virginia Mason’s Benaroya Research Institute. Treatments are much more effective than they were even five or 10 years ago. In the coming years, new research findings will make their way to the clinic to further improve treatments, and even open up the possibility of preventing some autoimmune diseases altogether. Each autoimmune disease manifests differently, depending on which part of the body comes under attack: rheumatoid arthritis affects the synovium, or lining of the joints; Type I diabetes involves the loss of insulinproducing cells in the pancreas; multiple sclerosis is caused by damage to the fatty material called myelin that surrounds nerve fibers. Yet underlying these differences are important connections. “We have to think of autoimmune diseases as having common genes, common mechanisms, and that will lead us to better therapies,” says Carla Greenbaum, MD, director of the Diabetes Program at Benaroya Research Institute. This basic insight has led, in recent years, to an ebb and flow of research questions and treatment strategies moving back and forth between the different diseases. For example, medications for rheumatoid arthritis that target an inflammatory molecule called TNF-alpha are now being used to treat inflammatory bowel disease and psoriasis. “It’s clear that they work in multiple diseases, and they work very well in some individuals,” says Dr. Buckner. Dr. Greenbaum’s research team has found that several different drugs (including one currently used for rheumatoid arthritis) can help control the immune system and preserve insulin-producing cells in patients recently diagnosed with Type I diabetes. Eventually, this type of treatment could make Type I diabetes easier to manage and even—when started in people who are at high risk but 8

have not yet developed the disease—prevent it. “This is really a way to change the whole therapy and how we approach this disease,” she says. But perhaps the best part is that the same principles could be applied to other autoimmune diseases as well. To find out about clinical trials, visit BenaroyaResearch.org/Clinical-Trials. ■

due to the irritating effects of GERD,” says Andrew Ross, MD, a gastroenterologist at Virginia Mason Medical Center. The hospital’s Digestive Disease Institute, which is ranked in the top 50 in the country by U.S.News & World Report, offers minimally invasive endoscopic procedures used to treat Barrett’s esophagus. Meanwhile, doctors urge those with GERD to make the lifestyle changes necessary to improve symptoms, including losing weight, quitting smoking, restricting caffeine and alcohol use, eating smaller portions, and not lying down after eating. ■

Royal Treatments Medical spas offer much more than just another pretty face

In Flux Taking the burn out of reflux disease More than 17 million adults and children in the U.S. live with gastroesophageal reflux disease (GERD), a common digestive disorder, and it’s something that affects pregnant women and women under stress especially. While prevention is possible (including not eating foods that trigger heartburn such as chocolate, peppermint, garlic, tomatoes, and citrus fruits, and not being overweight) and mild symptoms can be treated effectively with overthe-counter medications, when these methods no longer work it’s time to visit a doctor. “It’s important for people who have had long standing reflux to speak with their health care provider about their risk of developing Barrett’s esophagus, a precancerous condition in which the esophagus lining has changed

In an ever-busier world that seems to sap our last ounce of energy, it’s more important than ever to take time out for yourself. One way to restore and rejuvenate your overall health and well-being is to spend quality time at a medi-spa. A medi-spa is part medical clinic and part day spa. Operating under the supervision of a medical doctor adds to its high standard for quality care. Unlike day spas, medical spas are staffed by aestheticians with medical backgrounds, something that’s particularly helpful if potential medical concerns— such as a mole with irregular boundaries—are identified during the course of skin treatment. Skin care is especially important for women as they get older. “As women age, we see more skin conditions that require our attention and treatment,” says Christina Wahlgren, MD, a dermatologist at Virginia Mason’s downtown Seattle Medi Spa and Bellevue clinic. “Some women develop acne later in life despite having flawless skin in their teenage years.” Wo m e n ’ s H e a lt h A n n u a l 2 0 1 2

Other common skin conditions that may occur with aging include rosacea, a flushing of the cheeks often accompanied by red bumps, and skin damage occurring from too much time spent in the sun without proper protection. Medical spas typically develop a personalized skin plan—based on a doctor’s assessment and individualized testing—for each client, ensuring that nothing is overlooked in the overall care regimen. Services range from facial treatments that promote circulation and hydration while improving skin clarity and firmness to strictly cosmetic services such as waxing and tinting. “We use the latest techniques and cosmeceutical applications to ensure the best results,” says Dr. Wahlgren. “Spending time to receive professional skin treatment is a great way for women to take care of themselves—from both a medical perspective as well as an overall holistic perspective. They leave our spa with a renewed sense of well-being.” So go ahead, pamper yourself. It’s what the doctor ordered. ■

Controlling the Urge The only real secret about incontinence may be how many women suffer from it All it took was a few jumping jacks in fitness boot camp for Rachel to lose urine, no matter that she’d emptied her bladder before class. “I hated jumping jacks and

I hated jumping rope,” said the 47-year-old mother of three. “You go out and you’re clean, and you come home and you feel dirty. To be a grown-up and have this problem feels awful.” This is urinary incontinence, an often-embarrassing medical condition no one likes to talk about, yet one that’s surprisingly prevalent. According to Kathleen Kobashi, MD, a urologist at Virginia Mason Medical Center, 30 to 40 percent of all women have the disorder—closer to 50 percent for those who are postmenopausal. Urinary incontinence takes two primary forms: stress incontinence, where movements such as coughing, sneezing, or laughing cause the loss of urine, and urgency incontinence, sometimes known as “overactive bladder.” Stress incontinence occurs when the pelvic-floor muscles that support the bladder are weakened, perhaps by pregnancy or childbirth—which is what happened to Rachel—or a genetic predisposition to weak tissues. Other risk factors include being overweight or obese, smoking, or having a chronic cough. If the urge to go comes on suddenly, is seemingly uncontrollable, and results in urine loss, it is urgency incontinence. Triggers can be as innocuous as hearing running water or grasping a cold doorknob. Urine loss can occur even when there is very little urine in the bladder. Gone, however, are the days when women had to resign themselves to wearing what felt like adult diapers. “Today we have a variety of treatments that are relatively noninvasive and very successful,” says Dr. Kobashi. Nonsurgical options for stress incontinence include physical therapy, in which the patient is taught to strengthen the pelvic floor muscles, and injection therapy, in which the valve muscle of the urethra is “bulked up.” This minimally invasive treatment brings success to approximately

two-thirds of patients. If surgery is necessary, a “sling” is placed beneath the urethra to help prevent leakage. Slings, which can be placed on an outpatient basis, are successful in 80 to 85 percent of women. Nonsurgical options to improve urgency incontinence include bladder training, which helps people learn to delay urination and suppress urges; reduction in fluid intake, when appropriate; and dietary changes, such as decreasing consumption of acidic and spicy foods, caffeine, and alcohol. Medication, either in the form of muscle relaxants or hormone replacement (for menopausal women) can also improve urgency incontinence. Women who have concerns about urinary incontinence should consult a physician. In exceedingly rare cases, urinary incontinence can be caused by a bladder tumor, a wayward stone in the bladder, or a urinary tract infection. For Rachel, the decision to do something about her problem was easy. “I thought ‘I don’t want to live like this. If I’m in my 40s now, what’s going to happen when I’m an old lady and it’s much more common? This is really going to impact my life.’” She had a sling inserted. Now, a few years after surgery, it’s a decision she doesn’t regret. She can run, she can swim, and she can do all the jumping jacks her drill sergeant of a boot camp instructor demands. ■

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Cutting Edge

PICK OF THE CLINIC CHOOSING THE RIGHT PRIMARY CARE PROVIDER HELPS KEEP YOUR HEALTH IN HARMONY We pore over vehicle reports when buying a new car and spend hours planning our next vacation, but when it comes to choosing a primary care physician, many of us leave that to recommendations and luck. And yet this is a person integral to managing your health. “Think of your primary care physician like a symphony conductor,” says Catherine Potts, MD, chief of primary care at Virginia Mason Medical Center. “Not only do they address specific issues, they coordinate all your care. They help keep your health in harmony.” When it comes to choosing a primary care physician, it’s important to know that different doctors and health care systems embrace distinctive philosophies of care, which they deliver in different ways. One of the most important factors to consider is the hospital your doctor uses. It’s critical to know as much as possible about the hospital, and be sure you’re comfortable with it, should you ever have to become a patient. Some valuable sources of objective information and data comparing the quality of health care are available from the Puget Sound Health Alliance, the Leapfrog Group, HealthGrades, the Washington State Hospital Association (wsha.org), which lists outcomes data and procedure costs, and Hospital Compare, which compiles data from the Centers for Medicare and Medicaid Services. Other things to consider are whether you’re looking for a family care doctor, who can treat everyone from newborns to the elderly, or an internist, who is intricately familiar with adults and their concerns. Because medical care can get complicated quickly, it is important to know how your doctor chooses and coordinates care with specialists. Also consider the 10

general responsiveness of a health care system, for instance, how long it takes to get an appointment and whether your doctor is generally on time with appointments. Does the clinic truly live a “patient first” philosophy? And, because electronic records can mean improved efficacy, you may want to ask whether your records will be available electronically to all of your health care providers. Ultimately, the bond with your primary care doctor is likely to be a long-term relationship, spanning decades of sickness and health. Taking the time to familiarize yourself with your physicians and health care systems is an investment you’ll never regret. ■

MINIMALLY INVASIVE ROBOTICS HELP BIG SURGERIES GO SMALL The advent of minimally invasive surgery, wherein medical procedures are performed through tiny incisions instead of large openings, is revolutionizing health care. For patients, the benefits are everything from less pain and scarring to shorter hospital stays and faster recovery times. Such minimally invasive surgery is possible thanks to new, robot-assisted surgical tools and techniques such as the da Vinci Surgical System, which allows the surgeon to make traditional, grand surgical movements outside the body, while a robotic arm makes the correlating minute incisions and sutures within the body. Women are among the biggest beneficiaries of the new procedures. Robotic-assisted surgery for pelvic-floor prolapse and the

minimally invasive insertion of urinary slings have revolutionized the care of female urinary incontinence, for example. And then there are hysterectomies. “Not long ago, a hysterectomy meant a hospital stay of several days and an absence from work of about six weeks,” says Fred Govier, MD, chief of surgery at Virginia Mason Medical Center. “With advances made by laparoscopic surgery, recovery time has been vastly accelerated. Often, patients can return home the day after surgery and return to everyday activities in just days.” Despite the benefits, a November 2009 article in Obstetrics & Gynecology reported that as many as two out of three hysterectomies are still performed in the traditional fashion, which involves large abdominal incisions. In contrast, 94 percent of hysterectomies—and 95 percent of all surgeries—performed by Virginia Mason gynecologists are done using minimally invasive techniques. Because studies show that complication rates decrease considerably after a surgeon has performed more procedures, experience with minimally invasive surgery is critical. “It’s important for women to research their surgical options and look for surgeons who are experienced in minimally invasive techniques, including both laparoscopic and robotic-assisted procedures,” says Dr. Govier. ■ WO M E N ’ S H E A LT H A N N U A L 2 0 1 2

Pump Up Sex Life Nearly 1 in 2 women experience problems with sex

by s usa n w i l s o n

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ere’s a quick survey to pose the next time you’re out with the gals: Raise your hand if you’ve ever heard of pelvic organ prolapse, or POP. How about erectile dysfunction, or ED? Chances are the first question will elicit curious stares; the second, hands shooting in the air. After all, if you’ve turned on a TV lately, you know all about ED and drugs such as Viagra, which are used to treat it. Not so with POP—just one of many sexual health issues that occurs among the double-X-chromosome crowd. According to one study, 43 percent of women and 33 percent of men experience some form of sexual problem. And yet it seems that, in comparison to men’s, women’s sexual health issues—such as POP, low libido (a common concern among women), or even painful sex—are not widely discussed. The reasons for the silence vary, and cultural taboos may play a role. It could also be because women’s sexual desire and response are more complex than men’s. And because no FDA-approved treatment for low female sexual desire is currently available, this issue rarely gets prime-time placement. »

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Your

13

This is not to say that treatments for women’s sexual health concerns are scarce—or that sexual health issues in women are, or should be, ignored. To understand female sexual issues, it’s easiest to think of them in two categories: physical and functional. Physical issues include, among others, POP, which occurs when the pelvic-floor muscles weaken, ultimately allowing pelvic organs such as the bladder to bulge into the vagina; vulvovaginal atrophy, a thinning and loss of elasticity of the vulva, vagina, and urethra; vaginismus, involuntary spasms of the muscles around the vagina; and vulvodynia,

In other words, a patient may cognitively want to have sex because she feels it’s important to her relationship (i.e., she has the motivation), but simply doesn’t have the sense of biological desire or drive. Or, she may have the drive—for example, she may successfully self-stimulate every day—but lack the motivation to have sex with a particular partner because of a specific issue in that relationship or other issues or stresses in her life at that time. In women, “there are many components of sexual desire,” Dr. Stefanovic reiterates. Additionally, she says, women tend to present with more than one issue. For example,

To understand female sexual issues, it’s easiest to think of them in two categories: physical and functional. burning, stinging, or pain of the vulva. POP and vulvovaginal atrophy are related to a decline in estrogen and, in the case of POP, to vaginal childbirths. Vaginismus can be a psychological response or learned response of the body after episodes of painful intercourse. Vulvodynia, thought to be a type of neuropathy, is still being studied. For each of these and other issues treatments are available, including surgery, a vaginal pessary (a support device inserted into the vagina—just one treatment for POP), drugs, lubricants, hormones, biofeedback, and psychological and physical therapy. While physical sexual issues are certainly numerous and can make intercourse difficult or painful, Ksenija B. Stefanovic, MD, Ph.D., a urologist at Virginia Mason Medical Center’s Sexual Health Clinic, says the most common reason women come to see her is low libido, which, along with difficulty with arousal and orgasm, is a functional issue. (The underlying cause may be at least in part physical; for example, a patient may have pain with sex, which then results in a low desire for sex.) Again, female sexual desire and response can be complex, with factors such as stress, big life changes, relationship issues, and so on impacting a woman’s experience. When working with a female patient with low sexual desire, you really have to know what is going on, says Dr. Stefanovic: “Is it a problem of sexual drive? Or of sexual motivation? Or when to be sexually active with a certain partner?” 14

one woman might have low desire, difficulty with arousal, and a weak orgasmic response. In every case Dr. Stefanovic’s first goal is to assess whether there are any underlying reasons for the expression of sexual problems. That is, to look for physical, medical, or psychological issues at work. Conditions such as depression, hormonal changes in the body, diabetes (which can affect bladder function and sensation in the genitals), and certain medications, including some antidepressants, can interfere with sexual function. Finding the underlying cause or causes may take time, as well as connected care. Dr. Stefanovic may work with a sex therapist, an endocrinologist, a physical therapist, a pain specialist, a gynecologist, and so on. Some may be surprised to learn that most of the women Dr. Stefanovic sees in the Sexual Health Clinic have yet to reach menopause—an event many may assume is accompanied by a decline in sexual desire and activity. But a six-year study of women ages 50 to 79, recently published in the North American Menopause Society’s journal Menopause, showed that among women who reported dissatisfaction with their sex life, most indicated that they would prefer more sex, not less. Regardless of age or issue, any woman who experiences pain or other unusual symptoms, or who is concerned about sexual drive and response, should talk to her doctor. After all, while you may not be able to wish it away, with a doctor’s help you may be able to talk it away. ■ Wo m e n ’ s H e a lt h A n n u a l 2 0 1 2

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eriods, you could say, go out not with a bang, but a whimper. First, your body enters perimenopause, which typically lasts four years but can linger on for 10, and can wreak havoc with moods, sleep cycles, and more due to the erratic fluctuations in ovarian hormones like estrogen. According to Susan Sandblom, ARNP, a nurse practitioner in Virginia Mason Medical Center’s gynecology clinic, erratic cycles; prolonged, skipped, or multiple periods in one month; changes in skin; and mood swings are hallmark signs of early perimenopause. Other symptoms can include hormonal headaches and a lowered sex drive; however, if a low libido isn’t your issue, you may want to keep in mind it’s still possible to conceive during perimenopause. Women without trademark symptoms can still be perimenopausal, says Sandblom. A basic endocrine hormone test called FSH—follicle stimulating hormone—can help determine whether you’re menopausal. When the ovary begins to have fewer eggs, estrogen levels decrease and FSH rises. “As you get later into perimenopause, and truly into menopause, you start to see more of the classic symptoms such as hot flashes and night sweats,” says Steven R. Goldstein, MD, immediate past president of the North American Menopause Society. “Much later, you’ll get vaginal dryness.” While the average age for menopause is 51, you’ll know it when you truly get there. Once you’ve missed your period for a full year (without some underlying reason, for instance, pregnancy), you’re officially in menopause and have reached the end of fertility. ■

Managing Menopause You’re moody, headachy, and your periods are stopping by about as often as Santa Claus and the Easter Bunny. What’s an anxious, overheated, sleep-deprived woman to do? First, set aside those fears about the possible link between hormone therapy and breast cancer, heart attack, and stroke. “The initial risks publicized in 2002 were overstated,” says Dr. Steven Goldstein. “It’s much safer to take hormone therapy than we originally thought. But each woman should go through her risk and benefit profile with her health care provider. It’s a very individual decision, depending on your history, your family history and your symptoms or lack thereof.” If you decide to stanch your symptoms with hormone therapy (or HT), you’ll first need to determine whether you’re WO M E N ’ S H E A LT H A N N U A L 2 0 1 2

The Ages and Stages of Menopause Return of the mood swings BY D I A N E M A P E S

perimenopausal—and still making erratic amounts of estrogen— or menopausal. Then, you’ll want to suppress the erratic ovarian function and fix the symptoms. This is accomplished with a low-dose birth control pill—at least for nonsmokers and women with normal blood pressure. Women who have reached menopause receive a different type of HT, and what they get depends on whether they still have a uterus, says Virginia Mason’s Susan Sandblom. “Newly menopausal women with a uterus get the lowest, most effective dose of estrogen and progesterone,” she says. “If they don’t have a uterus we can give low-dose estrogen HT only.” As for relieving vaginal dryness symptoms, if it’s just related to low estrogen Sandblom recommends localized estrogen. A ring that lasts three months can be placed in the vagina and gives a very low dose; a tablet can be placed in the vagina three to four times a week; or an estrogen cream can be applied, typically three times a week or less. ■ 15

Better Health for All Ages Good health is made better when an active lifestyle is paired with annual screenings. Here’s when those annual exams should begin.

16–18

18–30

31–39

As they enter womanhood, girls age 16 to 18 should begin having annual chlamydia and hypertension screenings. Patients with Type I and Type II diabetes should begin receiving annual retinopathy and nephropathy screenings and cholesterol checks, and they should have their blood glucose levels checked twice yearly by a physician. Don’t forget the influenza vaccine!

While the HPV vaccine may be aimed at wiping out cervical cancer, early detection is critical to prevention. Along with the annual exams begun in the teens, Pap smears—which can detect precancerous conditions of the cervix—should occur every one to two years.

It’s never too early to be on the lookout for signs of heart disease. Now is a good time to make sure your blood pressure is in check and cholesterol levels are within optimum ranges. Pap exams and diabetes management screenings should continue as well.

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40–49

50–64

65+

This is when annual mammograms should begin. Performed to screen healthy women for signs of breast cancer, mammography is also used to evaluate a woman who has symptoms of a breast disease, such as a lump, nipple discharge, breast pain, dimpling of the skin on the breast, or retraction of the nipple. The fun doesn’t end there, though: 90 percent of colon cancer is preventable, and screening can detect polyps and early cancers. Discuss your risk level with your doctor to determine whether you should be getting a colonoscopy.

With the average age of menopause being 51, during these years most women will have reached it. Regular breast cancer screenings and Pap smears should continue, as well as colonoscopies and diabetes screenings for those at risk. Don’t forget to have blood pressure and cholesterol checked during each annual exam.

An estimated 10 million Americans have osteoporosis; another 18 million have osteopenia—low bone mass—which may lead to osteoporosis if left untreated. In addition to the annual checks already on the to-do list, it’s time to begin osteoporosis screening. Meanwhile, those who have never received the pneumovax should. The vaccine helps protect against severe infections due to the bacteria responsible for meningitis and pneumonia.

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or women diagnosed with breast cancer (and keep in mind there are many different types, each with its own nuances), there are a number of new surgical advances. “Traditionally, when a woman was diagnosed, everybody was interested in getting the cancer out and not as interested in what the breast looked like afterwards,” says Carly Searles, a breast health nurse practitioner at Virginia Mason Medical Center. “Today, that’s changed a lot. It’s not your mother’s breast cancer.” Janie Grumley, MD, a Virginia Mason surgical breast oncologist, is one of a handful of surgeons who use a new technique known as oncoplastic surgery with her patients. “It’s basically taking a page from the plastic surgeon’s book,” she says. “We remove the cancer, then reshape the breast so there isn’t a defect.”

Designed primarily for lumpectomy patients, oncoplastic surgery leaves a more naturally-looking breast—and often incorporates a breast lift. “With the traditional method of breast conservation therapy, you make an incision, take out the cancer, and close it up, but what can happen is that you have a significant defect in the breast,” says Dr. Grumley. “It’s like a pillow—if you take out a huge chunk of stuffing, it’s going to fall in.” Once a patient has radiation—and most lumpectomy patients do—Dr. Grumley says the chances of a breast deformity are even greater. “It’s really important to keep a woman whole,” says Dr. Grumley. “I admire all the great techniques for reconstruction, but most patients would rather have their own tissue than have it reconstructed.” According to Dr. Grumley, oncoplasty

Reconstructing the Mastectomy New surgical techniques get aggressive against cancer and help women keep breast tissue BY D I A N E M A P E S

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WO M E N ’ S H E A LT H A N N U A L 2 0 1 2

is “all over Europe” but less popular in the U.S., primarily because fewer surgeons are trained in the techniques. She’s hoping to change that. “I’m teaching all my residents to do it this way,” she says. “In my mind, this is how breast surgery is done.” Other innovations in breast cancer surgery include: Concurrent mastectomy/reconstruction Some women may be able to have their breast(s) reconstructed at the same time as their mastectomy. It’s a longer surgery (and there can be more complications), but you wake up without that “empty space” where your breast(s) used to be. Nipple/skin sparing mastectomy Nipple or skin-sparing mastectomies keep as much of the skin and nipple as possible in order to make reconstruction look more natural. It also allows the patient to retain something of themselves. IORT (intra operative radiation therapy) This technique applies radiation directly to the tumor area while the patient is still in surgery, often eliminating the need for traditional radiation treatment afterward in early stage breast cancer patients. “I think this is going to be huge for women who get breast cancer,” says Dr. Grumley of Virginia Mason’s cutting-edge IORT technique. “I think it will revolutionize breast cancer treatment. Imagine having a lumpectomy and then waking up and you’re done. Your radiation and your surgery—all done at once. But you have to be a good candidate for it. That’s always the thing.” ■

Are You Dense? The American Cancer Society readily admits that “not all breast cancer will be detected by a mammogram.” Dense breast tissue is one reason some cancers are missed. With less fat and more glandular and connective tissue, dense tissue appears white on a mammogram—as do cancerous tumors—making it difficult for radiologists to “see” the tumor. What can women do to ensure their best breast health? AreYouDense.org, a nonprofit dedicated to informing the public about dense breast tissue and its significance with regard to breast cancer, suggests you first find out if you have dense breast tissue by requesting a copy of your mammography report from your radiologist. If you do have dense breast tissue—and two-thirds of premenopausal women and one-quarter of postmenopausal women do—they then suggest you talk to your health care provider regarding ultrasound or breast MRI. The group also promotes selfexams and an annual breast exam by your physician. Virginia Mason’s Carly Searles says digital mammograms— which provide a clearer picture of the breast that can be analyzed both by computer and by a radiologist—are “optimum for people with dense breast tissue.” ■ Wo m e n ’ s H e a lt h A n n u a l 2 0 1 2

This is Not Your Mother’s Mammogram New research, new procedures, mean better outcomes

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ammograms have long been considered the gold standard with regard to breast cancer screening, but recent recommendations regarding the whens and how-oftens have left many women frustrated and confused. Should mammograms start at 40, or 50? Do we need them every year, or every other year? And are self-exams still necessary, or completely superfluous? Carly Searles, a breast health nurse practitioner at Virginia Mason’s Breast Clinic, has no confusion when it comes to the benefits of yearly mammograms. “I’m seeing more and more breast cancers caught earlier through mammogram,” she says. “I think they’re invaluable.” For one thing, yearly mammograms help women catch the cancer earlier, and the earlier it’s caught, the better the chances of avoiding some portion of the standard breast cancer treatment, such as surgery, chemotherapy, or radiation. Early mammos can also pick up high-risk indicators that can be treated with medications such as tamoxifen, which can then be used to decrease the chance of the disease gaining a toehold. Catching cancer early also means more surgical options for women: e.g., some may be able to get a lumpectomy as opposed to a full mastectomy. Searles says annual mammograms—and even additional screening techniques such as MRIs—are even more important for women with a family history of breast cancer. Currently, the American Cancer Society recommends that annual mammograms begin at age 40, although not all breast cancer will be detected by a mammogram. Because of this, Searles is a big advocate of self-exams, as well. “Some women feel that if they have a mammogram, they don’t have a problem,” she says. “But if you put your head in the sand, you’re not going to feel or see anything until it’s a good size. I’m for really good breast awareness. Look at your breasts once a month, check them in the shower, make sure they feel and look the same.” Things to look for include skin changes and/or rashes, dimpling, skin tethering (like there’s something on the inside pulling on the skin), changes in size, changes in contour, lumps, bumps, and bleeding or discharge from the nipple. Searles says it’s important to remember that not all breast changes result in a cancer diagnosis. But any of these changes are reason to call your health care provider and get your breasts checked out, she says. —dm 19

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Family Matters

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F r om MS to M ot herho o d Pregnancy brings some unusual joys for women with multiple sclerosis By Lucy LaBerge

Wo m e n ’ s H e a lt h A n n u a l 2 0 1 2

When her doctor asked Erin Musser when she and her husband planned on having a baby, she was dumbfounded. “I said, ‘What, are you crazy?’ ” recalls Musser, who had been diagnosed with multiple sclerosis a few years earlier. Multiple sclerosis is a disease that’s usually diagnosed between the ages of 20 and 40, right around the age many women are thinking about having children, says Mariko Kita, MD, director of the Virginia Mason Multiple Sclerosis Center. But while other conditions may prevent people from having children, several studies have highlighted the safety of pregnancy for women with MS and for their new babies. Dr. Kita and her team often talk with newly diagnosed women to let them know that children could be part of their futures. When it comes to pregnancy and motherhood, she says, “we don’t consider MS to be something that should get in the way of that superimportant life experience.” This wasn’t what women with MS used to hear in the doctor’s office. Musser has friends with MS, now in their 50s and 60s, who were encouraged to adopt because pregnancy was once thought to be too taxing. In fact, many women see a reduction in their MS 21

Family Matters symptoms during pregnancy. “While I was pregnant, my symptoms were gone—totally gone,” says Musser, who even stopped using her wheelchair and cane during her pregnancy. “It was amazing!” Typically, the immune system fights off foreign things it encounters in the body. In women with MS, the immune system goes on overdrive, attacking the insulation around nerves in the central nervous system. Pregnancy offers a reprieve. Because a woman’s body needs to provide safe harbor to a growing baby, Dr. Kita says, the immune system naturally has to turn off a little bit during pregnancy. In fact, some studies are being performed using hormones to mimic the levels experienced in pregnancy for MS patients, she says. In most cases, Dr. Kita recommends her patients go off medications that target MS once a couple starts trying to have a child. Then, throughout the course of the pregnancy, she and her team check in with the patient about her current health and her ideas about birth and life with a newborn. Women with multiple sclerosis can have natural births, epidurals and other anesthesia, or cesarean sections, depending on their individual pregnancy and labor. Women with MS do have the potential to relapse after giving birth, so before labor even begins, Dr. Kita talks with women about how long they would like to breastfeed. Injectable MS treatments are transferred through the breastmilk, so women wait until they are done nursing to resume treatment. Some studies even suggest that breastfeeding offers some protection from a return of MS symptoms. Along with tending to their patients’ physical symptoms during pregnancy, Virginia Mason Medical Center staff members work with women to set up the support they will need as new mothers. Virginia Mason has held support groups for parents with MS with a nurse on-site and connects women to MS-focused groups 22

Beating obesity to the punch for kids, it’s not just all in the genes

Today’s pediatricians are keeping a close watch on children’s diet and exercise habits—and it’s not just because they want socially happy kids. “If childhood obesity continues to rise, it could cut five years from the average child’s life span,” says Michael Dudas, MD, a pediatrician at Virginia Mason’s Sand Point clinic and chief of pediatrics for Virginia Mason Medical Center. “The current generation could become the first Americans in history to live shorter lives than their parents.” Over the past three decades the rate of childhood obesity has nearly tripled. Today, nearly 20 percent of children are obese. And while genetic and socioeconomic factors play a role in childhood obesity, nurture can play a huge part in preventing the disease. “If parents and health care teams can intervene at an early age, we will be giving children a lifetime of improved health,” says Dr. Dudas. With that in mind come pediatric health programs designed to respond to childhood obesity. Virginia Mason’s Nutrition and Fitness for Life program, for example, is responding to the epidemic by providing kids and parents with the tools they need for lifelong health and offering a proactive approach to establishing good dietary and fitness habits in young children.

through PEPS, Program for Early Parent Support. Fatigue had been one of Musser’s main symptoms before her pregnancy. So, in the months leading up to her son’s birth, Musser set up everything she needed on the ground floor of her three-story Beacon Hill home so she wouldn’t have to race upstairs to warm up a bottle. Both Musser, who started using a cane and a wheelchair again after her son was born, and Dr. Kita advise women

Tips for Fit Kids

Here’s how to develop healthy diet and exercise habits for children: • Eat Right: share family meals sitting down and away from the TV.

• Make connections between food and health, not food and weight.

• Encourage children to eat when hungry and stop when satisfied.

• Substitute juices, soft drinks, and high-sugar sport drinks with water and nonfat milk.

• Make a variety of healthy foods available, such as cut-up fruits and vegetables.

• Make sure everyone eats breakfast.

• Replace high-fat and high-sugar foods with healthy fruits, vegetables, milk, whole grains, and fortified cereal.

• Take a Hike: Incorporate physical activity into daily life. • Model healthy behaviors and attitudes about nutrition and fitness.

with MS to line up plenty of support in advance for both mother and baby. While challenging, having MS also gives mothers the opportunity to raise a child who is compassionate and comfortable around people with a wide range of abilities. Musser laughs when she describes how her son, now 9, reacts when he sees someone else in a wheelchair. “He’ll say, ‘That guy’s chair is the coolest color. That’s way cooler than yours!’ ” ■ Wo m e n ’ s H e a lt h A n n u a l 2 0 1 2

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Family Matters If you’ve ever misplaced your keys or had a name hover on the tip of your tongue, you’ve probably experienced the normal memory lapses that come with age. But for some, memory loss is more serious. During the next two decades, an unprecedented number of people will be reaching their 60s and 70s—a wave known as the Silver Tsunami—and with age comes potential for memory disorders. As a result, 10,000 people per day— more than 4 million people per year—will face an increased risk of Alzheimer’s disease, a degenerative memory disorder that has no cure. Alzheimer’s is more likely to affect women, both as patients and as caregivers. “Women live longer, and the single greatest risk factor for Alzheimer’s is age,” says Nancy Isenberg, MD, a behavioral neurologist at Virginia Mason Medical Center’s Neuroscience Institute. For those suffering from memory disorders, early inter-

COGNITIVE CARE AS THE SILVER TSUNAMI APPROACHES, DEALING WITH MEMORY LOSS BECOMES INCREASINGLY IMPORTANT By Lucy LaBerge

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vention can help patients and their families better manage their symptoms, stay active for longer, and plan for the future. The goal is to bring people in early—even before symptoms like memory loss start to interfere with daily activities—to get them started on treatment quickly. This doesn’t mean just medication, but also connection to support networks, clinical trials, and ways to keep patients mentally and physically active, says Virginia Mason neuropsychologist Kristoffer Rhoads, Ph.D. When a person who is concerned about memory disorders—whether due to family history or symptoms—comes to the center for the first time, she will undergo a comprehensive cognitive and neurological workup. Dr. Isenberg and her colleagues look at everything from brain images to a person’s diet and overall physical health, since diabetes and vascular factors such

as hypertension and high cholesterol can be underlying causes of dementia. Later visits also combine testing and support services so patients don’t have to wait weeks or months between visits. Patients aren’t the only ones at risk: caregivers are a critical part of a patient’s support system and often need support themselves. The stress of caring for a person with dementia has serious effects on a caregiver’s health—those with a spouse hospitalized for dementia are more likely to die in the following year than those who have spouses hospitalized with other diseases, according to a 2011 report by the Alzheimer’s Association. To mitigate these issues, the institute’s staff encourages caregivers to take time—at least an hour a day—for themselves, and the center has started offering mindfulness groups for caregivers. They also offer strategies for dealing with some of the behaviors

“

that might accompany dementia, including paranoia and repetitive actions. Even simply acknowledging the difficulty of caregiving at the initial visit can be helpful. What excites Dr. Isenberg and others is the discovery that we can make new brain cells as we age. “When I was in medical school, we were taught that what you are born with is what you’ve got for life,” she says. “Now, not only do we know that we make new brain cells, but we know how to stimulate the growth of these neurons.” Exercise is one of the most powerful tools to keep your memory kicking. Forty minutes of cardiovascular exercise, three days a week, can reduce the risk of Alzheimer’s disease by 40 percent. Taking on new mental challenges, like learning a language, can also help forestall decline; complex activities like juggling can actually strengthen connections between different parts of the brain. ■

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Heart Health

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Cardio M at t ers What you don’t know about women’s heart health may shock you By Julie H. Case

Wo m e n ’ s H e a lt h A n n u a l 2 0 1 2

Krista Bates was unloading the dishwasher when she started feeling nauseous. She got clammy and sweaty. Then came the shortness of breath, the tightness in the chest, the pain in her back. Thinking she might be having a panic attack, she went outside and called a neighbor. In fact, the then 41-year-old mother of two—a junior high school principal who was training for her first half marathon and in the best shape of her life—was having a heart attack. “It was a total surprise,” says Bates. “It came totally out of the blue.” Fact: One-third of women will die of heart disease. Almost five times as many of us will die from heart disease as from breast cancer. The increased mortality rate for women may be in part due to the fact that symptoms for women are different than for men. “A lot of women expect to have the classic symptoms,” says Susie Woo, MD, a cardiologist at the Heart Institute at Virginia Mason Medical Center. “Even though they might worry about heart disease, they may not realize the shortness of breath might be their heart. They don’t have the threshold for worrying about atypical symptoms when they occur.” “We always worry about chest pain or shortness of 27

Heart Health breath, especially with exertion, but we’ve all seen cases of women who have presented late because they think other symptoms are not the heart,” says cardiologist Liz Chan, MD, “whether that be shoulder pain that’s not related to injury or heartburn they just treat thinking it’s heartburn or pain between the shoulder blades. Some women have atypical symptoms and don’t present until later, and that’s unfortunate because some of these patients have had a significant heart attack.” The later you’re seen, the more damage is done and the worse the outcome—which may be why women have a greater one-year mortality rate after a heart attack. Besides not recognizing a heart attack when it happens, why are women still dying of heart disease at such a high rate? It is due in large part to risk factors. According to the doctors, at least 90 percent of women have at least one—high blood pressure, high cholesterol, a sedentary or inactive lifestyle, poor diet, or diabetes. According to Virginia Mason cardiologist Sarah Weiss, MD, these risk factors don’t affect men and women equally. While diabetes increases a man’s risk of developing heart disease twofold, it increases a woman’s risk of heart disease fourfold. Hypertension, obesity, and a sedentary lifestyle also increase a woman’s risks of heart disease more than those same risk factors do in men. And a man who smokes a pack of cigarettes a day increases his risk of developing heart disease threefold; a woman, fivefold.

So, how do women decrease their chances of dying of heart disease? First off, by making lifestyle changes. “If you smoke, I’d tell anyone immediately to quit,” says Bates, though she was never a smoker. Just as getting a Pap smear or a mammogram is critical to identifying risks for cancer, the doctors at Virginia Mason’s Heart Institute urge women to be screened for heart disease risk factors. It’s important for women to have their cholesterol, blood pressure, and blood sugar screened regularly. And they say fitness matters. Regular exercise and an active lifestyle are recommended for everyone, but in the case of primary prevention it can make a huge difference. The doctors urge women to follow the American Heart Association’s guidelines of 150 minutes of cardiovascular exercise every week, eat a diet low in fat and salt and high in fruits, vegetables, and lean meats, and keep blood pressure in check. Just two years after her heart attack, Bates is still on a cocktail of drugs, but she is also healthy. She completed her first half marathon a few weeks before the one-year anniversary of her heart attack—a major goal for her—and hasn’t stopped. Today she runs half marathons and 10Ks, albeit at a slower pace, and is careful with her time, making sure to leave work at the office and get a massage once a month. “This is something that’s killing women, and there’s a way to save yourself,” she says. ■

Know Your Numbers Total Cholesterol* <200 Desirable 200–239 Borderline high 240+ High LDL Cholesterol* <100 Optimal 100–129 Near/above optimal 130–159 Borderline high 160–189 High 190+ Very high

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HDL (good) Cholesterol* Protects against heart disease, so higher numbers are better. >60 Desirable <40 Major risk factor Triglycerides* <150 Desirable 150–199 Borderline high 200–499 High 500+ Very high

Body mass index Less than 25 Blood Pressure 120/80 Normal 140/90 High *Courtesy American Heart Association

7 Days of Fun for the Heart The American Heart Association recommends 150 minutes of moderate exercise or 75 minutes of vigorous exercise each week for optimal heart health. Can’t stand another 30 minutes on the elliptical? Here are fun ways to get some cardio. (Bonus: See how many calories the average 160-pound person burns.) Cha Cha Cha Salsa, swing, tango, tap ... whatever step you choose, a dance class is good for your heart in ohso-many ways. (327/hr) Hit the Slopes Snowboarding is excellent cardio, and skiing isn’t bad either. Best of all, the harder the terrain, the more your heart works. (250–630/hr) Drive the Fairways Between the swinging and the walking, golf—without a cart, please—can provide hours of cardio. (400/hr) ride a horse Trotting is good; cantering is better. Gallop, and both you and the horse will return to the barn

a sweaty mess. (290–581/hr) take a trip to the mall Walking is the best place to start a fitness journey, so make a brisk 30-minute lap before you hit the racks. (255/hr) Lace Up the Skates On the ice or at Green Lake, when skating keep a quick but comfortable pace for 30 minutes. Want a challenge? Interval train by speed skating for 2 of every 5 minutes. (508/hr) Climb the Walls At the gym or on a granite cliff, spend an hour a week rock climbing and you’ll build better muscles inside and out. (799/hr)

Wo m e n ’ s H e a lt h A n n u a l 2 0 1 2

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No Pain, All G ai n

In today’s fit lifestyle, there’s no room for old adages By Bill Stein

We all know it: exercise helps control weight, improve mood, boost energy, combat chronic disease, promote better sleep, and, well, put a little spark back in our sex life. But how do you keep going when nagging injuries and ailments cramp your style and keep you from the activities you enjoy most? “When it comes to enduring pain and injury, many women often assume they have to choose between

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Active Living stopping their activity or just pushing through the pain,” says Jordan Chun, MD, a sports medicine physician at Virginia Mason Medical Center and team physician for the WNBA’s Seattle Storm basketball team. “Unfortunately, that thinking just ends up in more injury and, ultimately, restriction from the activities they enjoy.” Fortunately, there are training strategies and treatments that can help women get back to the physical activities they love as well as open the door to new ones. When common activity-related injuries, such as tendinitis, stress fractures, sprains, shin splints, and various types of joint pain— typically caused by overuse—put you on the sidelines, the first part of effective treatment is to let the injury settle down so adequate recovery can take place. Working with a sports physician can help you safely and efficiently return to activity. Treatment often includes addressing biomechanical factors, such as problems with alignment, pelvic stability, or underlying conditions like arthritis, which may have contributed to the injury. “We take a comprehensive look at what’s causing the injuries so that women can resume the activities they enjoy at lower risk for injury recurrence,” says Dr. Chun. After recovery, more important still is adopting a proactive approach to taking care of your body. Regardless of your age, if you have pain, instability, or a general sense that something isn’t working right, you should consult a physician. “Anyone who identifies barriers to enjoyment of activity, exercise, and sports should know that we’ll do our best to work through the issues together with the goal of keeping them active for life,” says Dr. Chun. If you’re looking to begin a more physically active lifestyle, it’s important to find an activity that you’ll enjoy and that works for your lifestyle. “An activity that is engaging and fun is easier to maintain and can give you a mental boost outside of merely physical health,” says Dr. Chun. Be open-minded and consider 32

the wealth of exercise options that Seattle affords. If you’re not a fan of stand-up paddle boarding or not quite ready to join the Rat City Roller Girls, consider other possibilities such as a neighborhood walk, Pilates, yoga, tai chi, or gardening. The important thing is to get started and get active. ■

Quick Tips for Injury Prevention Here’s how to keep moving—and keep out of recovery mode. • Maintain a regular activity level. The goal: 30–60 minutes of moderateintensity activity five or more days a week. • Learn to do your sport right. Using proper form and training techniques can reduce your risk of injury. • Remember safety gear. Depending on the sport, this may mean knee or wrist pads or a helmet. • Listen to your body. Working with your body rather than against it will help keep you healthy and happy.

• Increase your exercise level gradually. As we age, our ability to tolerate overuse decreases, which can lead to injury. Smart training is a must. • Strive for a total body workout of cardiovascular, strength training, and flexibility exercises. Crosstraining reduces injury while promoting total fitness.

To the Exam Room, Jeeves Concierge concept takes medical services to a new level To all those struggling to find enough hours in the day, enough days in the week, and enough time to schedule their annual checkup or a follow-up visit, there comes a solution: concierge medical services, designed specifically for women with busy schedules who want more flexibility and personal service when it comes to their medical needs. Concierge medical services offer patients conveniences that can make coordinating health care just a bit easier. Such services include personal mobile phone and e-mail access to physicians, same-day appointments, and complimentary parking. Concierge medical doctors may also accompany patients to specialty appointments when appropriate. “Our patients appreciate that they typically don’t have to wait for appointments and can get right in to see their physician,” says Therese Shipley, manager of Virginia Mason’s Lewis and John Dare Center, a concierge medical practice with offices in Bellevue, in Seattle, and on Bainbridge Island. “Conveniences like 24/7 mobile phone access, help with arranging visits—these things make a difference for women with full, active lifestyles,” Shipley says. Concierge medical fees are paid at a flat rate separate from an insurance plan. ■

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