Index   --   WPGYN Newsletter  --  Volume 11, Issue 4,  October 2014

Viruses, Viruses Everywhere!

The Number One Killer in Women -- Heart Disease!

Concerned about Memory?  Look at your Meds!

Viruses, Viruses Everywhere!

There’s been much in the news about the Ebola virus lately.  This virus, which is infecting and killing people in West Africa, is the worst recorded Ebola outbreak to date, according to the World Health Organization. Recently, the Centers for Disease Control and Prevention has confirmed the first case of a patient with the Ebola virus in a US hospital and he died of the disease.  There is no vaccine and there is no treatment—so what can one do?  This has created a lot of fear.  Firstly, know that it is spread by blood and body fluids of an infected and symptomatic person.  It is not airborne or on doorknobs (unless they are contaminated by blood and body fluids).   Just as you would avoid intimate contact with strangers who might have HIV, avoid close contact with anyone who might have Ebola.  Take reasonable precautions, but at this time, Ebola in the US is under control and unreasonable fear will only make you more prone to a heart attack (see the next article).

A virus that you can and should do something about is the influenza virus.  It has caused as many as 49,000 deaths in a season.   Each season is different, but in general, the widespread use of the flu vaccine can make a dramatic difference in the morbidity and mortality due to influenza.  The CDC strongly recommends universal vaccinations for everyone 6 months of age and older. 

This year there are some new options in terms of the types of flu vaccinations.  The CDC has not expressed a strong preference.  Here, at Women Physicians, we feel there are some advantages of the new quadrivalent vaccine over the traditional trivalent vaccine for people with normal immunity.  The quadrivalent flu vaccine protects against two influenza A viruses and two influenza B viruses whereas the trivalent only protects against 1 type of influenza B.  For patients over 65, we recommend the high-dose trivalent vaccine since the immune response of seniors may be decreased. 

You may have also heard of a virus called enterovirus D68 (EV-D68) that has been causing severe respiratory illness among some children, especially those with asthma. It has now spread coast to coast and has been associated with 4 deaths and several cases of paralysis.  Much like the influenza virus, EV-D68 can shed from an infected person's respiratory secretions, such as saliva, nasal mucus, or sputum. The virus likely spreads from person to person when an infected person coughs, sneezes, or touches surfaces.   There is no vaccine. 

What’s the best way to fight all viruses?

Handwashing! 

Wash hands often with soap and warm water for at least 20 seconds, multiple times a day (some evidence suggests that soap and water is more effective at killing enteroviruses than alcohol rubs).  For frequent handwashers  (like doctors and nurses :-)), alcohol rubs are quite effective.

The Number One Killer in Women — Heart Disease!

By Catherine Collings, MD

Statistically, every minute in the United States, someone’s wife, mother, daughter or sister dies from a form of heart disease.  And although heart disease rates among men have declined steadily over the last 25 years, rates among women have not.  Why? A difference in symptoms between men and women may have something to do with it.  Men and women alike can experience the well-known heart attack symptoms like gripping chest pains and breaking out in a cold sweat. But women can also have more subtle, less recognizable symptoms such as pain or discomfort in the stomach, jaw, neck or back, nausea or shortness of breath.  As a result, women are often unaware that what they are experiencing is a heart attack.  So what happens?  Women blow off the warning signs, assuming something else is the problem. 

To add to the problem, women’s healthcare providers may misdiagnose these symptoms, and the result is that women discover their heart disease when it’s too late.  Men, on the other hand, seem to benefit from having more frequently participated in clinical trials, and having received more aggressive testing and treatment.  So is it any wonder that heart disease is the No. 1 killer of women?

Research continues to be conducted to further explain the reason why heart disease affects men and women differently.  Research has found that women are more susceptible to damage of the very small coronary vessels – the vessels that are too small for stents or surgery.  Heart testing to evaluate, understand, and treat this type of coronary artery disease must be specialized for women. A study reported in the Journal of the American Heart Association also offers clues about women’s heart disease.  Researchers found the right ventricle to be larger in men than in women.  The right ventricle pumps blood to the lungs so that all types of lung disease, such as COPD and sleep apnea, may uniquely weaken women’s health more than men.

Does Menopause play a role? 

Additional studies are being conducted to learn about the role hormones play in women’s heart health, as well.  Your body goes through many changes as you age and menopause is one of those changes.  Studies have shown an increase in heart attacks among women about 10 years after experiencing menopause.  Estrogen levels drop during menopause and estrogen helps arteries be more flexible and strengthens their interior walls.  Since there is a decline in estrogen as you age, this may be a reason for an increase of heart disease in post-menopausal women.  In addition to a drop in estrogen, a woman’s body goes through other changes when in menopause.  For starters, blood pressure levels start to go up.  In addition, LDL cholesterol (bad cholesterol), levels may increase and HDL cholesterol (good cholesterol) may decline or stay the same.  Triglycerides (groups of fatty cells) contained within blood vessels, also go up during and after menopause.  Women who go through menopause at an earlier age seem to accelerate their heart risks.

Despite the increase in heart disease in post- menopausal women, estrogen replacement therapy is not now recommended  for heart disease prevention.  According to a study published in the Journal of the American Medical Association Internal Medicine, hormone replacement therapy may actually increase women’s heart disease risk.  Confusing?  The authors found that women taking estrogen and progestin had higher risks of heart disease and breast cancer as well as more strokes and blood clots than those taking the placebo.

If you are already taking hormones for menopause, you don’t need to stop suddenly.  Work with your gynecologist, cardiologist, or internist to determine your individual risk and benefit and how to best wean off.

We want you to become fierce advocates of your own health. So what should you do right now and for years to come?

    Do:  Schedule regular heart screenings – Research shows that women have low risk factor awareness.  Do not be one of those women! The American Heart Association recommends getting your cholesterol checked every five years, your blood pressure checked at least every two years, your blood glucose levels checked every three years, waist circumference checked as needed and body mass index during every regular healthcare visit.

    Do:  See a Cardiologist – When in doubt refer yourself or get referred to a cardiologist for heart testing.

Advise the moms in your life to do so, too!

    Do:  Exercise regularly – Women should try to shoot for at least 150 minutes of physical activity per week to help lower their risk of heart disease. Expensive gym memberships and fashionable sports attire is not needed.  Take a brisk walk in your neighborhood and count yourself amongst the fitness buffs.  It is never too late to start!

    Do:  Eat a healthy diet – Healthier eating translates into efficient heart function and overall well-being.  Focus on adding healthy foods rather than subtracting unhealthy foods.  Strive to eat 6 types of vegetables every day and at least 2 whole grain items.

    Do:  Stay positive – Sometimes after menopause, women can suffer from depression.  According to research from the American Heart Association, depression doubles the risk of stroke in middle-aged women.  This is why staying positive after menopause is so important for women.  Going through menopause can feel like a huge life change for some women.  But instead of getting depressed, try to embrace this time in your life by eating right, exercising, and socializing with friends.  This is a time to celebrate your life, so get out there with people you enjoy!

You may look and feel healthy, but you should know what your risks are for developing heart disease in the next 10 years.  Many women spend their time as a caregiver for their family members instead of prioritizing themselves. Many of you reading this will probably be able to relate to this sentiment, as a mom, wife, sister, daughter, career woman, etc.  You are busy and time is precious, so you end up spending the free time you do have focusing on those you love.  The result is that you neglect yourself.  So, it’s time to shout louder, ladies, and take care of your own health!

Dr. Collings practices general & preventive cardiology, with special interests in cardiology imaging & women’s heart disease. 

She has board certifications in Internal Medicine, Cardiovascular Medicine, and Nuclear Cardiology. Her educational background includes undergraduate & master degrees in Exercise Physiology from UC Davis and University of Wis           consin, MD degree from the University of Wisconsin, & Residency & Fellowship training at Stanford.  She serves as a Medical Director of Cardiac Rehabilitation & Women’s Heart Services for the Heart and Vascular Institute of El Camino Hospital. 

In her spare time, she enjoys family time, travel, and everything outdoors including horseback riding, cycling, tennis, & skiing.

Collings MD FACC

Advanced Cardiovascular Specialists
2490 Hospital Drive, Ste 311, Mountain View, CA  94040  (650) 962-4690

Concerned about Memory?  Look at your meds!

Prescription drugs cause over 100,000 deaths per year and cause another 1.5 million people to experience side effects so severe they must be hospitalized.  Adverse drug reactions are now the fourth leading cause of death in the US.  Every medication carries some risks and memory loss is a very common side effect.

Medications known to be associated with memory loss

Sleeping Pills

Sleeping pills head the list.  The popular drug Ambien (generic name zolpidem) has been coined by some as “the amnesia drug.” Some users experience night terrors, sleep walking, sleep driving, and hallucinations.  Please don’t think I’m being mean when I recommend you stop taking a nightly sleeping pill or significantly cut back on the dose.  Large scale studies consistently show that the risk of motor vehicle accidents, falls, and hip fractures leading to hospitalization and death can more than double in older adults taking benzodiazepines and other sedative-hypnotics.

Lack of sleep can also cause memory problems and poor functioning, so what’s the best thing to do?  First, make sure you have optimized your sleep hygiene habits.   Secondly, you may find a natural product, like melatonin or chamomile tea, will work just as well as a sleeping pill.  Finally, if you give up after a couple of nights of tossing and turning and simply must take a sleeping pill, use 1/2 of your usual dose, and place the other half by the bedside with a glass of water to take only if you waken in the middle of the night. 

Anticholinergic medications

These include a large number of medications that can cause your acetylcholine levels to be decreased.  These medications can be critical for a number of illnesses, so don’t stop them without discussing with your doctor.  Because acetylcholine is involved with memory and learning, a decrease in its levels can lead to memory loss, as well as other symptoms.  These side effects don’t happen to everyone, but they are more likely to happen as you get older. 

Statin Drugs

One quarter of your brain is made up of cholesterol. Cholesterol is necessary for memory, learning, and fast thinking. So it is not a total surprise that cholesterol-lowering drugs can negatively affect the brain in some people, especially the elderly.  Statins can also be life-saving, so do not make any changes without discussing with your doctor. 

Anticonvulsant/Weight Loss Drug

A commonly used medication called Topomax (topirimate) can affect memory and cognition, especially when starting it.  Topirimate is now included in the weight loss drug, Qsymia.

Other Causes of Memory Loss

Medications are not the only things that can cause memory loss.  Other contributors include things like alcohol, smoking, lack of sleep, depression, stress, head injury, stroke, dementia, vitamin deficiencies, and hypothyroidism.  If you are concerned about your memory, discuss it with your doctor.