The Hot Years Magazine Issue 47

Feel Better, Look Better NOW!

Cardiac Disease in Menopause

Hot Flash Treatment Alternatives

Dr. Marla Shapiro Covid-19 and Menopause

N 47 o

Heart Facts Every Woman Should Know

Is Irritable Bowel Making You Irritable?

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Recipe Chili Con Carne Hot Years Exercises Where Do You Carry Your Weight?

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The Hot Years

No 47

TM

Feel Better, Look Better NOW!

In this Issue: Dr. Marla Shapiro Covid-19 and Menopause

Hot Flash Treatment Alternatives

Is Irritable Bowel Making You Irritable?

Cardiac Disease in Menopause

Heart Facts Every Woman Should Know

Chile Con Carne

Where Do You Carry Your Weight?

Editorial

The Hot Years

Covid, Your Health and You

C

ovid-19 is not only infecting people across the globe, it’s stressing them out, and there’s a good chance that you are affected too. You may hold an essential job, and even if you don’t, you hold an essential role. As the sandwich generation, you have already assumed a central position as a nurturer of your children, partners and parents.

Now faced with the Covid-19 pandemic, your role has been expanded to health protector. You try to be informed about Covid-19 and best practices so that you can impact and influence your family and beyond.

Whether you have an elderly parent living in a nursing home or assisted living community, a daughter who is pregnant, a spouse, child or friend who becomes sick, or you are just trying to help all those people stay well, you are constantly being called upon for advice and support. It’s overwhelming.

Covid-19 is dominating the news, but other health concerns have not dis-

appeared, and it’s important to address medical and emotional symptoms that you are experiencing. With this in mind, we’ve included articles that focus on common conditions you may be facing, such as hot flashes, sleep problems, cardiac disease and irritable bowel. All of these can be affected by the stress either due to Covid-19 or other causes. We’ve also included an easy and delicious chili con carne recipe, exercises you can do at home, and a soothing song to help you relax.

Like all of our issues, this issue of The Hot Years is focused on taking care of the SUM of you, not just SOME of you.

Editor

Associate Editor

Dr. Mache Seibel

Dr. Sharon Seibel

Hot Years Featured Article

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Covid-19 and Menopause We’re in a very challenging time with the Covid-19 pandemic.

This interview is about how Covid-19 is impacting women in midlife and in menopause.

Dr. Marla Shapiro is a past president of the North American Menopause Society (NAMS). She’s a practicing physician in the Department of Family and Community Medicine at the University of Toronto, but a lot of Canadians know her as Dr. Marla. She’s been on the air for many decades and currently the medical professional for CTV News, commenting on stories of today. This article is an excerpt of an interview with Dr. Shapiro.

Does Covid-19 affect men and women differently? When we follow the epidemiology of this pandemic, what we’ve seen is a preponderance of morbidity and mortality in the older decades. There does seem to be a little bit of a male prevalence. About 1.3

Hot Years Featured Article men to 1 women, and whether or not it’s because of gendered lifestyle behaviours such as men are more likely to be smokers or have other comorbidities is not clear. But, what we’ve learned is that decade for decade, the higher mortality stats are higher by the 80th then 70th, and then 60th decade, and we are seeing a little bit of a male prevalence over women in each of those decades. We’re not really sure what the mechanism is, but we do see a little bit more in men. [Since this interview with Dr. Shapiro, a study has shown that estrogen may be the reason why women appear slightly less at risk.]

Does specifically being in menopause make a difference in risk?

Firstly, let’s talk about age. No matter how young at heart we feel, the fact is that with age, comes an aging immune system. And what we’re finding in older individuals and people over the age of 60, we do see increasing mortality by each of those decades. The role of menopause in Corona is really not established. We don’t really know whether or not menopause makes a difference or if it’s age alone. We of-

The Hot Years ten ask ourselves that question when it comes to lots of issues, for example cardiovascular disease. But if it’s age or menopause, we know it’s a combination of both because we know that estrogen is cardio-protective.

Joints, for example. We know that we see a lot of increase in joint pain in and around the time of menopause. But for many other issues, it’s simply the act of aging alone, and we don’t know enough about the science here to be able to say whether or not this is an aging phenomenon or whether or not this is lifestyle and habits in men that are different than in women. We’ll have to see what we learn as time goes on.

[Since this interview with Dr. Shapiro, studies have shown that estrogen reduces both influenza and virus replication in the epithelial cells of women’s noses, and in mouse models, estrogen moderates the cytokine storm, which is a life-saving effect that is eliminated if the mouses ovaries are removed, and restored when estrogen is given to the female mice who had their ovaries removed.

We don’t really know whether or not menopause makes a difference or if it’s age alone

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A more recent study suggests that the estrogen Premarin may protect women from Covid-19 by preventing respiratory virus infections in susceptible people. More studies are needed to determine estrogen’s role with Covid-19.]

We all can think about pregnancy as a time where the immune system is influenced by the pregnancy itself. Certainly, with SARS and MERS, which were also a type of coronavirus, we saw increased morbidity and mortality in pregnant women.

COVID-19 AND PREGNANCY Women are command central for families. There’s a lot of women in midlife with children who are now pregnant. How much do they have to worry about their daughters who may be pregnant?

We did not, however, see vertical transmission of the virus from the mother to the fetus.

Now, as far as coronavirus is concerned, we have not seen that preponderance in pregnant women. Pregnant women so far appear to be of average risk. For the most part, we have not really seen evidence of vertical transmission.

We’ve had a few case reports out of Wuhan China. One case with a mother who had COVID, where the fetus had elevated levels of IgM, which we assume happened because of

Hot Years Featured Article some transmission as IgM is too large to pass from the mother to baby. Yet, the baby was negative for the COVID virus.

In one report there was a series of 33 women in China delivered by C-section. C-section rates are very high in China compared to North America.

Three of the babies tested COVID positive on day two, and the assumption was because of the fact the babies were delivered in a sterile operating room, we could not rule out vertical transmission. So, while we have not ruled out vertical transmission, most of the data supports that we do not believe that there is vertical transmission.

We’re telling moms to come into the office or hospital for the antenatal appointments that are most necessary.

Some visits we’re doing virtually, but the ultrasound and prenatal screening are things that should go on under guidance according to the American and the Canadian Societies of Obstetricians and Gynecologists. And we recognize that the virus has not been

If elderly family members are living on their own, we ask you not to visit them and not to spend time with them

The Hot Years around long enough for us to answer the essential question women are asking, “What happens if I have an exposure in the first trimester?” We do not know. Most of the data that we have, since it’s a novel coronavirus is on women who have delivered, so the exposures were somewhere between the 30th to the 40th week. So, we don’t know what early exposure might mean.

COVID-19 AND BREASTFEEDING We have not seen the virus in placenta; we have not seen the virus in breast milk either. So, we do encourage moms to breastfeed. That’s the best way of giving your baby immunity in general. If the mother is ill, then she should follow her hand washing technique, which she should also be doing even if not ill, and I would suggest she wear a mask when she’s feeding to avoid that form of transmission. But, again, it’s going to be on a case by case basis depending on if mom is ill and how severe her illness is. But, there remain a lot of unanswered questions in pregnancy, and we’re keeping a very close eye on data as it emerges.

COVID-19 AND ASSISTED LIVING AND NURSING HOMES Social isolation is what we’re recommending. If elderly family members are living on their own, we ask you

Hot Years Featured Article

not to visit them and not to spend time with them. Support them in any way that you can in terms of groceries, but leave it on their doorstep.

For now we would like you to keep the social isolation going. The elderly are the most vulnerable population, and we know that the major mode of transmission is droplet transmission.

Often there can be asymptomatic carriers - in some reports up to 35% are asymptomatic carriers. They may not know that they have an early form of the disease, and put these very vul-

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nerable people at risk. And that’s the reason why it’s so important that people continue to social isolate.

In Canada, our Prime Minister put in the Quarantine Act, which means that a person coming from abroad - that’s anybody returning from anywhere including the United States through the Canadian border - must quarantine at home 14 days. And that means not going to the grocery store, not going to the bank. That means you are staying home. And, if you’re out of the quaran-

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tine period, we’re still really encouraging social isolation, staying away, and only doing those things that are most essential. Your grocery shopping, go in, do it, come home, put away your groceries, and make sure you wash your hands. Avoid touching your face.

HOW TO FEEL MORE IN CONTROL IN AN OUT OF CONTROL SITUATION There is a sense of helplessness. But the fact is that there is a lot that you can control. You can control what you eat. You can control sleep. You can make sure you get a good dose of exercise. Go out, socially distance, get your walk in, come back home.

You can continue to wash your hands and disinfect your surfaces as required. You can really become much more mindful so that if you begin to feel panicked or anxious you really won’t allow yourself to become over-

Make sure you get a good dose of exercise. Go out, socially distance, get your walk in, come back home.

You can continue to wash your hands and disinfect your surfaces as required

whelmed. Practice meditation. Practice pleasurable activities. If you like to read, or if you like to dance, or whatever it might be. See your friends over a virtual visit. Talk to them, chat, don’t become socially isolated.

Because of that social distancing, social connectedness is very important.

So, while you may not be able to see your mother and sister or your pregnant daughter right now, ensure that you talk frequently on the phone, and if you’re comfortable with Zoom or Skype, see them virtually.

Eventually this will end. But it will only end if we all do the same thing together. The sense that people have that, “This doesn’t apply to me,” is wrong.

It applies to all of us. This isn’t an individual enemy, and we must do our best to work together as a nation to flatten the curve.

Menopause Quiz:

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Find out how much your menopause symptoms impact your health, your happiness and your life.

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It only takes a minute, then watch your email for your results and some suggestions on next steps to support you.

Your menopause mentor, Mache Seibel, MD

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Hot Flash

Treatment Alternatives Are you struggling with hot flashes? Do night sweats interrupt your sleep? If so, you are not alone. Hot flashes are the most common symptom of menopause, and they can make your life miserable. To discover some alternative approaches, read on...

D

r. Lisa Larkin is Founder and CEO of Ms. Medicine and a member of the Board of Trustees of the North American Menopause Society.

Hormone therapy (HT) is an extremely effective treatment, but if a woman either can’t or won’t take hormones, what else should she try? I asked Dr. Larkin that question at the National Meeting of the North American Menopause Society.

According to Dr. Larkin, Hormone Therapy (HT) is the most effective treatment for vasomotor symptoms or hot flashes. But for women who either don’t want to take or can’t take hormone therapy, there’s two other ‘option buckets’ to consider: 1) Non-hormonal prescription medications, and 2) Complementary and Alternative Medicine (CAM), and lifestyle modifications.

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NON-HORMONAL PRESCRIPTION MEDICATIONS “Several prescription medications are used to treat hot flashes, but the only non-estrogen that’s actually FDA-approved specifically for treating hot flashes is the brand Brisdelle which is a low dose of paroxetine”, Dr. Larkin explained. “It is in the class of antidepressant medications called SSRIs (selective serotonin reuptake inhibitors) and has studies that support that it is effective with a very low side effect profile for treating hot flashes.”

Several prescription medications are used to treat hot flashes, but the only non-estrogen that’s actually FDA-approved specifically for treating hot flashes is the brand Brisdelle which is a low dose of paroxetine The doses that are typically used for hot flashes are lower than doses used to treat depression, so Brisdelle should not be used as an anti-depression treatment.

The Hot Years Dr. Larkin went on to say that there are many other SSRIs used off label to treat hot flashes as well as a similar class of medications known as serotonin-norepinephrine reuptake inhibitors or SNRIs. An example in venlafaxine.

Another prescription non-hormonal medication is gabapentin, which is an antiseizure medication. Occasionally, people will use the high blood pressure medication Clonidine for treating hot flashes.

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COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM), AND LIFESTYLE MODIFICATIONS Hypnosis has “been shown to be very, very effective for hot flashes,” Dr. Larkin explained. “There’s also relaxation techniques and other mind, body approaches that have some evidence such as paced respirations. But hypnosis and Cognitive Behavioral Therapy (CBT) really have the best data around it.”

There are several lifestyle modifications that are able to lower hot flashes.

Weight loss and exercise have some mixed results. But Dr. Larkin encourages patients to use all healthy lifestyle habits.

The other category that comes up a lot is supplements. There’s a wide variety of supplements that are promoted

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to women in varying settings either at the health food store or online, or on social media as being effective for hot flashes. Dr. Larkin replied, “Really, the data is not strong in support of any of these agents, or combinations of things that have what’s called proprietary blends. You don’t know exactly what’s in them. Again, we just don’t have a lot of data.”

“I certainly have women who try these things and feel that they are beneficial. That’s why we have to remember that in all of the treatment trials of hot flashes, there’s a very substantial pla-

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We know that about 30% of women will report at least some reduction in hot flashes to placebos cebo effect. We know that about 30% of women will report at least some reduction in hot flashes to placebos.

What we really need before I personally will recommend most supplements is a randomized controlled study that shows they are both safe and effective beyond placebo.”

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The Hot Years

Is Irritable Bowel Making You Irritable?

We are living in an extremely stressful time. And for many people, the stress shows up as a very painful and upset stomach. To help us understand this, Dr. Mache talked with Dr. Allison about irritable bowel syndrome, sometimes referred to as IBS. Read on to discover if you may be suffering from IBS. Dr. Harmony Allison is an Associate Professor and Director of the Outpatient GI Clinics at Tufts Medical Center in Boston.

What is Irritable Bowel Syndrome (IBS)?

Irritable bowel syndrome affects about 10% to 20% of people and falls into something called functional bowel disorders. Dr. Allison explained that these are all the symptoms that people associate with the abdomen. “They are vague, and part of a very large number of syndromes.”

In order to better understand these, a committee developed a system to try and nail down what it means when people have any type of disturbance in their GI tract. And this was done through the Rome Foundation.

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The Top Symptoms include: 1. Some sort of pain anywhere in the abdomen at least one day per week.

You can’t find an ulcer. You can’t find an inflammation of some sort. You can’t find anything to explain why somebody has that pain.

to do any further testing whatsoever.

So if you eat ice cream and have lots of gas and diarrhea, that is IBS diarrhea caused by lactose intolerance.”

We don’t understand what causes IBS for the vast majority of people

2. Nausea, vomiting, diarrhea, constipation, those are the typical symptoms of IBS and it doesn’t get better with a bowel movement.

How Does IBS Show Up? Dr. Allison gave as an example that “if you are a young person who is about to take a test in school, or you have to talk to your boss, or you have to do something that is stressful for you such as travel during a pandemic, and every time that happens you find that you have to run to the bathroom more frequently or you get constipated, that’s a diagnosis of irritable bowel syndrome.”

That is particularly so if you don’t have any rectal bleeding, you haven’t lost weight, and you’re not in an age bracket where we have to think about different things such as cancer.

“It’s not always stress that is causing the IBS,” Dr. Allison explained. “Lactose intolerance actually falls under IBS. If that’s the case, you don’t need

“Some people are more at risk for IBS,” Dr. Allison went on to say. “People with inflammatory bowel disease like Crohn’s Disease or ulcerative colitis can also have IBS. If you’ve had a bad gastroenteritis, and then you feel that your bowels have never been the same, that can be an IBS, and that can affect anyone. So I don’t really think that there’s any specific population that’s going to be affected more than another.”

What Causes IBS? “We don’t understand what causes IBS for the vast majority of people. It is either one or some sort of combination of motility disturbances, which is how things move through your GI tract.”

Dr. Allison went on to say that, “feeling more pain than you would expect (visceral hypersensitivity), or having an altered mucosal or immune function, such as low IGA levels that can cause a person to get sick for longer periods of time than other people is also associated.” In addition, people who have an altered gut microbiota, or whose

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The Hot Years

microbiome has been altered in some way such as by taking antibiotics or eating lots of processed foods, and then your brain communicates with

your GI system moves quicker. And that seems to be a trigger for your central nervous system to say, “Okay, move this cantaloupe quicker because we’ve had too much of it.”

Blood in your stool tends to occur with inflammatory bowel disease, and it may not be IBS

The Rome IV process tries to hammer down on a huge hodgepodge of symptoms and really categorize them, and understand what medications work for what type of IBS.

your intestines in a different way that it normally would for that a particular food, is a possible candidates for IBS.” Why is it that you can eat one type of food but you can’t have too much of it? You can have a little bit of cantaloupe, but if you have too much of it,

How Do You Test for IBS? The testing for IBS comes in stages.

Dr. Allison explained that, “I like to get just a plain old blood count. That gives me an idea of overall health. If your blood cells are a little small or a little large, that may indicate that there are some vitamin deficiencies, which may point me into another direction.”

Hot Years “Because celiac disease is quite common,” Dr. Allison went on to say, “If it hasn’t been done before, I usually test for celiac disease. Other types of tests depend on what the symptoms are.”

The Hot Years companying symptoms, and if they’ve traveled,’’ said Dr. Allison. “IBS is usually a mystery, and I try to get the clues to point me in the right direction.”

Menopause and IBS “For people with diarrhea who are “Menopause adds a little additional having some blood in their stool, I confusion,” Dr. Allison went on to say. tend to get a C-reactive protein blood “With aging, your body slows down test, because on the outside; blood in your but it also slows stool tends to Low estrogen levels can down on the inside, so you may occur with inslow down intestinal flammatory bowel find that you’re motility and even disease, and it getting more concontribute to constipation; stipated. Also, may not be IBS, which is treated higher estrogen levels can you may be taking completely differspeed up intestinal motility new medications ently,” Dr. Allison that you’ve never said. had to take before. These can affect your GI system, To get to the correct diagnosis and so you can get more diarrhea, takes a little detective work. more nausea, more constipation.”

People who say they’re up all night, But nausea and vomiting are actually and they’ve got tons of energy, and more dyspepsia than IBS. So Dr. Allison they’re having trouble sleeping, Dr. Allison will test for an overactive thyroid. asks if the discomfort is above the belly If they find they’re cold all the time button, or below the belly button. “Beand they’re more constipated, she will low the belly button is the IBS; above check for an underactive thyroid. If the belly button is usually dyspepsia, people have traveled to areas where which is another vague word that could they are drinking well water, they may have a lot of things going on with it.” have an intestinal infection called GiarHormones can also affect your whole GI dia that can cause diarrhea and not system. Low estrogen levels can slow IBS. “So you have to take a really good down intestinal motility and even conhistory to understand when the symptribute to constipation; higher estrogen toms started, what are some other aclevels can speed up intestinal motility.

Hot Years Who Needs Endoscopy or Colonoscopy?

If we still don’t have a diagnosis, we may have to do an upper endoscopy or colonoscopy on someone that comes with symptoms, especially if you are over 40, to make sure that there’s nothing else going on. These are incredibly safe procedures, but they’re procedures. You have to take a day off from work. And if you’re doing a colonoscopy, you do have to do the prep to clear the stool out of the colon so the doctor can see the intestinal lining, and you have to have somebody that can escort you home.

Lifestyle Changes Can Help There are also lifestyle changes that can be helpful. Things like lowering stress, increasing sleep, improving nutrition, and exercise. All of those come into play. Exercise is definitely a key component. There are a number of diets, depending on what your symptoms are, and what triggers your symptoms. That’s why we work with a nutritionist here to help us understand what’s going on and pull out that information. Some people are fructose intolerant; some are lactose intolerant.

Sometimes it’s not that you can’t have something, it’s that you have to have it in moderation, and that moderation depends on yourself. Some people with lactose intolerance can have a

The Hot Years little bit of ice cream, and then other people with lactose intolerance can’t even have cream in their coffee. So it’s very person to person dependent.

Celiac disease is a little bit different. People with Celiac disease obviously have to be on a gluten-free diet. All of those things definitely come into play. Taking care of yourself helps everything, so getting enough sleep, getting enough exercise, and having a well balanced diet helps everybody.

Who Should See a Doctor for IBS? According to Dr. Allison, when GI symptoms start affecting the quality of your life you really should seek out some help, and there is a lot of help available.

There are medications that can help with symptoms. There are also a lot of diets that can help with symptoms.

A lot of people suffer for years with these symptoms. They avoid social activities, traveling, and visiting family because they’re so worried that they’re going to have to run to the bathroom, or that they’re not going to be able to participate in these activities.

At that level, you really need to come to a GI doctor, or go to your primary care physician, to discuss these things, because you don’t have to live that way.

There are a lot of good treatments to help people with these GI disturbances.

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Cardiac Disease in Menopause

To get to “the heart of the matter,” Dr. Mache Seibel spoke with Dr. Shufelt at the National Meeting of the North American Menopause Society about menopause and heart health.

Dr. Chrisandra Shufelt is Director of the Women’s Hormone and Menopause Program at Cedars-Sinai Medical Center, which is within the Barbra Streisand Women’s Heart Center.

HOW COMMON IS HEART DISEASE IN MENOPAUSE? The average age of menopause is 51 years in the United States. Before menopause, about one in eight women will die of heart disease. But after menopause, the number of deaths from heart disease jumps up to one in three. That makes heart disease the leading killer of women in the United States. Every year, heart disease kills more women than all cancers combined.

Menopause is an opportunity to get a really good heart checkup so you can know your numbers. Women are really good at going every year for their mammogram, but they need to know

and understand that there’s multiple things that you need to keep in line for your heart health.

KNOW YOUR NUMBERS • Blood Pressure • Cholesterol • Weight • Minutes you exercise each week • Number of family members with early onset heart disease or heart attack If your family member had heart disease or a heart attack under the age of 55 for a man, and under the age of 65 for a woman, that’s considered early heart disease.

HEART DISEASE AND THE DECISION TO TAKE HORMONE THERAPY If you’re suffering with hot flashes and night sweats, it’s important to get a

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good heart assessment. To do that, go into your provider and ask them to calculate your risk with a 10 Year Risk of Heart Disease calculator created by the American Heart Association and American College of Cardiology.

Based on your age, your gender, your ethnicity, your cholesterol numbers, your blood pressure numbers, whether or not you’re already taking a statin (a blood cholesterol lowering medication) or an aspirin every day, it will give you a percent risk of having heart disease or a heart attack in the next 10 years.

If that risk is high, we want to consider avoiding hormone therapy. But if your risk is considered low, you’re otherwise healthy, and you’re free of

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After menopause, the number of deaths from heart disease jumps up to one in three. That makes heart disease the leading killer of women in the United States other risk factors like breast cancer, then hormone therapy is the most appropriate treatment for hot flashes. It’s almost like that’s the green light.

If you fall into a moderate or intermediate risk or kind of an intermediate marker, then talk to your doctor about your family history. If there’s additional

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Go into your provider and ask them to calculate your risk with a 10 Year Risk of Heart Disease calculator risks, then you could consider getting additional testing. For those women who then decide on hormone therapy, we really want to prescribe them a transdermal patch of estrogen or a gel or a spray that goes through their skin because it’s lower risk for blood clots and heart attack.

Estrogen taken through the skin avoids the “first pass metabolism.” Oral estrogen gets metabolized and broken down in the liver first. When you go through the skin, it doesn’t have to go to the liver first. By avoiding that first pass, you decrease a lot of the inflammatory markers that we see that can increase blood clotting risk as well as heart disease risk itself.

The further you are away from your last menstrual period, the higher the risk of restarting or starting hormone

therapy. The risk for heart disease and stroke is greatest if you begin hormone therapy more than 10 years after your last menstrual period. “Honestly, if you start to get hot flashes 10 to 15 years after menopause begins and never had them at the time of menopause,” Dr. Shufelt commented, “then have your doctor really look for other causes of hot flashes and night sweats because they can be many other things.”

DOES HEART DISEASE RISK CHANGE IF YOU HAVE HAD A HYSTERECTOMY? Which hormones you need depends on whether or not you have had your uterus removed.

If you have a uterus and you take estrogen, you have to also take pro-

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The risk for heart disease and stroke is greatest if you begin hormone therapy more than 10 years after your last menstrual period gesterone or a progestin (a synthetic progesterone) to prevent the lining of the uterine wall from thickening, which carries a small risk of becoming uterine cancer over a period of years. Progesterone prevents that risk. An exception to this rule is a relatively new medicine called Duavee. It’s a combination of an estrogen and a selective estrogen receptor modulator or SERM called bazedoxifene.

The common SERMs that many women know are Tamoxifen and Raloxifene which are often prescribed to prevent

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breast cancer. They block estrogen from binding to the breast itself. Bazedoxifene blocks estrogen from binding to the lining of the uterus, so you don’t have to use a progestin or progesterone if you have a uterus.

If you don’t have a uterus and you take estrogen, you don’t need progesterone or other medications because there is no uterus to protect. Taking estrogen alone has been shown to lower the risk of breast cancer if it is begun in the Estrogen Window, within ten years of entering menopause.

On estrogen and heart health, Dr. Shufelt’s group has published a study looking at 93,000 women comparing the oral versus transdermal (through the skin) estrogen, as well as high dose versus low dose, and synthetic versus bioidentical estrogen, and she explained that “we haven’t really seen a difference in cardiac health with one exception: we showed transdermals trended towards lower risk of blood clots and even strokes.”

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Heart Facts Every Woman Should Know Clues From Pregnancy About Future Risk of Heart Disease These five medical conditions associated with pregnancy put you at greater risk for heart disease in the following five years: • Preeclampsia • High Blood Pressure (alone or as part of preeclampsia) • A Preterm Delivery (spontaneous) • Gestational Diabetes (diabetes that occurs during pregnancy) • Autoimmune Disorders (inflammation is a risk factor for heart disease)

You’ll know you have preeclampsia if you have these six things • Blood pressure of ≥140/90, measured on two separate occasions at least four hours apart • Protein in your urine • Swelling • Nausea or Vomiting • Stomach or Shoulder Pain • Headaches

Cancer Treatments and Heart Disease Breast cancer treatments can actually impact heart health in the future. According to Dr. Chrisandra Shufelt, Director of the Women’s Hormone and Menopause Program at Cedars-Sinai Medical Center, “Radiation has gotten to become very minimal, and especially radiation to the left breast because your heart is located behind the left breast.

I think oncologists and cardio-oncologists specifically now know that, and

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Women might have milder chest pain. Women often have other symptoms like more fatigue, nausea, vomiting, a hot flash or getting sweaty they do more breast sparing or heart sparing radiation at lower doses.

But there are a lot of chemotherapies that are still being used that can cause inflammation, specifically to the small arteries, and that can set you up for heart disease or heart failure in the future.” If you need radiation or chemotherapy, discuss this possible risk with your oncologist.

Symptoms of Heart Attack in Women Differ From Men Men and women experience different symptoms of a heart attack. The most common symptom is chest pain in both men and women, but women might have milder chest pain. Women often have other symptoms like more fatigue, nausea, vomiting, a hot flash or getting sweaty. Some women complain of back pain like being stabbed or like something’s going through your back. All of those are signals that could be letting you know you are having a heart attack.

You need to think about any symptoms from the waist up. If a woman is having those symptoms, they’re recurring, and they’re not consistent with what she’s eating (not indigestion or acid reflux), or they perhaps are associated with more fatigue lately, then that’s the time to get on in and get checked.

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The Hot Years

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The Hot Years

The Hot Years

The Hot Years

Chili Con Carne

(Beef, Turkey, Or Meat Substitute)

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hili Con Carne is one of my favorite comfort foods. And who doesn’t need comfort food! I like it because it’s easy to make and it’s even better the next day as leftovers. I’m always looking for healthy eats, so to keep down the saturated fats and salt I make it with ground turkey or Beyond Beef (meat substitute) and use unsalted tomatoes and beans. I recently made it for a niece who just had a baby and she loved it so much I decided to share it with you, too. Bon appetit!

Recipe Dr. Sharon Heat in a Skillet: 1-2 T olive oil or avocado oil Add and saute: ½ cup chopped sweet onion 4 cloves chopped garlic ¼ -½ cup red pepper Remove from heat when slightly tender and place in a separate dish

The Hot Years Add to skillet: 1 T olive oil or avocado oil 1-2 cloves chopped garlic 1 lb. ground beef, ground turkey, or beef substitute Stir and saute the meat or meat substitute until browned.

Drain fat then add: Onion, garlic and red pepper mix 1 15 oz. can of unsalted diced tomatoes 1 15 oz. can of unsalted tomato sauce 2 15 oz. cans of unsalted, drained and rinsed canned kidney beans 1 T chili powder (adjust to taste) ¼ teaspoon or more salt

The Hot Years ½ teaspoon sugar black pepper to taste ½ teaspoon basil (optional) Cover and simmer for 1 hour or more.

May be made the day before and reheated.

Serve with rice, tortillas, or cooked pasta garnish with: Shredded cheese Chopped onions or scallions

The Hot Years Musing

The Hot Years

Where your weight? do you carry

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or some people, their weight is almost all above the waist – in their chest and abdomen. People with their weight in their chest and belly have a body type described as an apple. Chest and belly fat carry a slightly higher risk for developing heart disease and diabetes.

Others have a body type described as a pear. They carry their weight in their hips and thighs. Not as dangerous a parking place for fat as the upper body. And of course, ideally, both body types could lose their extra weight with diet and exercise and perhaps medical intervention.

Recently, however, I spoke with a woman who carried her weight in a different location. It wasn’t on her belly or on her hips. In fact, she was thin, almost to the point of being too thin. Still she had a definite weight problem.

In talking with her, it was clear she continuously carried her weight on her shoulders – all the weight of the world.

After some discussion it was also clear that she would benefit from a different type of weight loss. In fact, it’s hard to know whose weight is heavier and more potentially harmful. Exercise and good nutrition would help – only in her case, emotional support would also be beneficial.

Where do you carry your weight? Sometimes it’s the weight on our shoulders and not our body that slows us down.

Click here to listen to Dr. Mache read this article over a background of his original music.

Hot Years Quote

The Hot Years

Gratitude builds a bridge to abundance Roy Bennett

CLICK HERE to hear The Planets, from From the Relax CD, written by Dr. Mache and piano performed by Ben Schwendener. You can find this song and other health songs at www.HealthRock.Bandcamp.com.

Every effort has been made to ensure that the information contained in this magazine is complete and accurate. However, neither the publisher nor the author(s) is engaged in rendering professional advice or services to the individual reader. The ideas, procedures, and suggestions contained in this magazine are educational and not intended as a substitute for consulting with your physician. All matters regarding health require medical supervision. Neither the authors nor the publisher shall be liable or responsible for any loss, injury, or damage allegedly arising from any information or suggestion in this magazine. The opinions expressed in this magazine represent personal views of the author(s) and are not a substitute for medical care.

All content in this magazine is Copyright © HealthRock, LLC

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