Index   --   WPGYN Newsletter  --  Volume 9, Issue 3,  July 2012

Drs. Sutherland and Litwin Up-to-Date in Personalized Medicine

Joint Pains in Women

USPSTF recommends treatment for obesity.  Women Physicians responds!

Chocolate is a Girl’s Best Friend

Drs. Sutherland and Litwin Up-to-Date in Personalized Medicine

 Drs. Sutherland and Litwin graduate the second week in July from an intensive 10 month course for physicians on genomic medicine.  Once a month for 2 hours each session, they have met with colleagues from El Camino Hospital and renowned genetics instructors to learn how to translate the new research and technology into improvements in your care.  They can now help you sort through your family history to look for red flags and recommend if genetic testing or a referral to a genetic counselor is appropriate.  They are now in a position to help you review your results from 23 & Me and comment on the meaning of the results.  

Sequencing of genes has become faster, more accurate, and less expensive.  Research is being published weekly about how new genetic discoveries may impact health.  As with all new technologies, the field has also opened up new dilemmas in terms of the ethics and risk vs. benefit ratios.  Drs. Litwin and Sutherland are on the cutting edge of these new developments. 

Currently, three areas of testing appear to hold the most promise for improved health.  One is expanded testing for recessive genes, especially in couples prior to having a pregnancy.  If both the mother and the father carry the same recessive gene, they will be fine but there is a 25% chance they will have a child with the disease caused by that recessive trait.  By undergoing IVF with preimplantation genetic diagnosis (PGD), that adverse outcome can be avoided.  A second important area is risk stratification for cancers and other diseases.  If almost everyone in your family dies of cancer, especially if it is at early ages, you may be a candidate for testing for certain high risk genes.  If you carry such genes, preventative strategies like more intensive screening, preventative medications, or preemptive surgeries may improve your health care.  Finally, pharmacogenomics allows testing of how you metabolize certain medicines.  Your genes may put you at risk of excess side effects or inadequate efficacy. 

If you would like to delve further into your own genetic risks, please make an appointment to consult with one of the doctors at 650-988-7550.  Your consultation will be most productive if you bring your family health history including 3 generations and the ages at which diseases developed.  This often requires some research and discussion with other family members.  You can record your results using the family health history tool on the El Camino Hospital Genomics website.    This website also provides a wealth of information on specific genetic diseases and how they can be diagnosed. 

 Joint Pains in Women

Noticing some increased aches and pains lately?  Is it age-related, hormone-related, or something more ominous?  When it comes to joint pains, as so many other areas of healthcare for women, men and women are not the same.  The CDC estimates that arthritis or chronic joint symptoms affect more than 70 million Americans, 41 million of whom are women.  For many arthritis conditions, women are more frequently and more severely affected than men. 

What is arthritis?

Arthritis, or joint inflammation, is defined as pain, stiffness, or swelling in or around a joint. Arthralgia refers to joint pain.  "We now recognize over 100 different forms of arthritis," says Robert Hoffman, MD, chief of rheumatology at the University of Miami Miller School of Medicine. "That's why getting the correct diagnosis is important. You need the right treatment."

There are 360 joints in the human body.   Joint pain often occurs in joints of high impact, such as the knees, hips, and back, but many women notice the joints in their hands become stiffer and more painful with age.  Women are 10 times more likely than men to suffer from joint pain in their hands.

What conditions result in joint pain in women?

·  Osteoarthritis - Of the nearly 27 million Americans with osteoarthritis (AO), 60 percent are women.  This is often called degenerative joint disease and is the most common type of arthritis in the over-50 crowd. As we get older, the rubbery cartilage that serves as a shock absorber to our joints becomes stiff, loses its elasticity, and becomes more susceptible to damage. As the cartilage wears away, tendons and ligaments stretch, causing pain. It can occur in almost any joint in the body – most commonly in the fingers, hips, knees, and spine.  Women are more prone to osteoarthritis of the knee than men which may be because they are more limber and loose-jointed, so there's more movement allowing the kneecap to rub on the bones below it.

·  Rheumatoid Arthritis - Rheumatoid arthritis (RA), an autoimmune disease, strikes approximately three times more women than men. This form of arthritis is very different from degenerative joint disease. The inflammation occurs in joints in a symmetric distribution on both sides of the body.  In RA, the body’s own immune system attacks the joints.  The healthy immune system triggers an inflammatory response to deal with problems like injury or infection. But in some women, the inflammatory response occurs without a trigger.   This chronic, low-grade inflammation can break down healthy tissues — including those in your joints.    The damage to the joints can be progressive and severe so early diagnosis and treatment it important.  

·  Other autoimmune diseases - Other autoimmune conditions that cause joint pain, such as lupus, scleroderma, and multiple sclerosis (MS), also hit women harder than men: Women are nine times more likely to develop lupus, three times more likely to have scleroderma, and twice as likely to suffer from MS. Polymyalgia rheumatica (PMR),  temporal arteritis (TA), and psoriasis are other autoimmune diseases that can cause joint pains.  All of these autoimmune diseases affect many different organs of the body, so fatigue, rashes, weakness, or organ failures may also occur.  Nonetheless, the first early signs may be joint pains.  

·  Fibromyalgia - Fibromyalgia, a little understood condition that can cause joint pain, affects women eight times more frequently than men.  This chronic disorder creates pain and tenderness at numerous points throughout the body, resulting in serious sleep problems and fatigue. The cause of fibromyalgia is poorly understood, but is not related to any muscle, nerve, or joint injury. One theory is that the condition may be related to oversensitive nerve cells in the spinal cord and brain. Or it may be due to an imbalance in brain chemicals that control mood, lowers a person's tolerance for pain, possibly triggering a cycle of restless sleep, fatigue, inactivity, sensitivity, and pain.

How are hormones connected?

Estrogen affects joints by keeping inflammation down. Inflammation is a leading cause of joint pain.  Many women with OA, RA, lupus, and fibromyalgia report an increase in joint pain just before or during their periods. This is likely because estrogen levels plummet right before menstruation and rise again after a woman's period is over.  Some research shows that 80 percent of women with RA experience a remission of symptoms during pregnancy when estrogen levels are highest and a flare-up when estrogen dips during the postpartum period. Additionally, reproductive hormones are suspected as factors in the high incidence of autoimmune diseases in women since these diseases occur during the reproductive years. 

The perimenopause and menopausal time periods are also a time of increasing joint pains.  As estrogen levels begin to drop during perimenopause, the five-year time span leading up to menopause, joints get less and less estrogen and pain often is the result.  Sometimes this is the most troubling symptom of the menopausal transition.  Because joint pain is common in women approaching menopause, some call it "menopausal arthritis.”   It can be an extremely discomforting ailment and make simple tasks and movements almost unbearable.  It can often be improved by treatment with hormone replacement, though it usually gradually improves over time just as hot flashes generally improve with time.  Aromatase inhibitors, medications used to inhibit all production of estrogen in breast cancer patients, often result in significant joint pains as well.

What are other contributors to joint pain?

Damage to joints from injuries or wear and tear can increase the risk of osteoarthritis.  Weight is a critical issue, as every extra pound of weight is like 5 pounds of pressure on the knee joints.  Inadequate exercise and muscle loss results in loss of support of the joints.  Heredity is also an important  factor.  Bone loss, such as osteoporosis, makes joints more vulnerable.   

What can be done to treat joint pain?

1)  Lifestyle Changes

Lose weight— Losing as little as 11 pounds can cut the risk of osteoarthritis of the knee by 50%.  As weight increases, so does knee pain. 

Exercise—It may be wise to start working out with a physical therapist who can teach you how to strengthen the muscles that support the joints and how to avoid injuring them further.  Low impact exercises like swimming, or biking are often best for joints. 

Wear proper shoes—Shoes with soft soles or cushions will add another layer of protection.

Stop smoking—Smoking interferes with bone health and with treatment strategies. 

2)  Medications

For mild pain, OTC meds like Tylenol, aspirin, or ibuprofen may help.  Be aware that even OTC meds in high quantities or in susceptible people can have risks like liver, stomach or heart damage.  Check with your doctor before using.  Stronger pain may require prescription anti-inflammatories, immune modulating meds, or even narcotics. 

Several studies have shown glucosamine and chondroitin supplements can help with the pain of osteoarthritis, and possibly prevent progression as well.  It does take 2 to 3 months to see any effects.  A joint specialist may also recommend a steroid injection or a hyaluronic acid injection into the joint.

3)  Surgery—If all else fails, some joint pains can be improved by repairing damage to the joint with an arthroscopy, or in the worst case scenarios, having a complete joint replacement. 

USPSTF recommends treatment for obesity.

Women Physicians responds!

 In June 2012, the US Preventative Services Task Force updated their recommendations on obesity.  The USPSTF recommends

screening all adults for obesity based on their BMI.  A BMI of 20 to 25 is normal weight, 25 to 30 is overweight, 30 to 40 is obese, and over 40 is morbidly obese.  The BMI is calculated based on your height and weight.  Do you know your BMI?  At Women Physicians, we calculate your BMI at each annual exam.  You can calculate it yourself at this website.  Presently over 30% of women are obese.  Obesity has definite health consequences including increased risks of diabetes, heart disease, cancer, arthritis and sleep apnea. 

The USPSTF went on to say that obese patients can benefit from intensive, multicomponent behavioral interventions. We have spoken to many of you about weight management in the past, but have not previously provided the kind of intensive program that is most effective for getting results.   Nurse Barb is now working on just such a program which will be medically sound and supervised.  She will be able to provide the help you need in the trusted and private environment of Women Physicians.  More information will be forthcoming in the next newsletter or you can call to make an appointment with Nurse Barb at 650-988-7550. 

Chocolate is a Girl’s Best Friend

If you are health conscious but suffer from a sweet tooth, a daily dose of chocolate may be the answer to your prayers.  A group of Australian researchers recently concluded that dark chocolate could be a cost-effective treatment for preventing heart disease – and with excellent compliance.  Watch out statins – here comes competition.

Chocolate has health benefits due to the antioxidant flavonoids.    The cacao bean is extraordinarily rich in flavanols, a type of flavonoid phytochemical.  The USDA published a chart of antioxidant foods measured in ORACs (Oxygen Radical Absorbance Capacity Units). For every 100 grams, dark chocolate has 13,120 ORACs, and blueberries have only 2,400.

What kind of health benefits does dark chocolate have?  A few squares of dark chocolate a day can reduce the risk of death from heart attack by almost 50% in some cases, says Diane Becker, MPH, ScD, a researcher with the John Hopkins University School of Medicine.  Researchers from Harvard University School of Public Health concluded that cocoa and chocolate may reduce the risk of cardiovascular disease by lowering blood pressure, decreasing LDL oxidation, and anti-inflammation action.  An Italian group showed chocolate could decrease blood pressure and increase insulin sensitivity.  Other effects include improving arterial blood flow and reducing blood clotting.  Some studies suggest help with chronic fatigue and mood disorders. 

Unfortunately, one has to watch out for fat, sugar, and caffeine.  The darker the chocolate, the better.  But you still have to check the labels carefully to avoid saturated fats, trans-fatty acids, and excess sugar.  New commercial products are being developed to taste yummy while using the healthiest fats and sugars.  Examples include CocoaVia and Hershey's Cacao Reserve. 

To learn more about the benefits of chocolate and experiment with some low calorie healthy recipes on your own, go to http://www.webmd.com/diet/features/health-by-chocolate.  If you would like to find a gift for your favorite health-conscious chocoholic, try http://www.thechocolatetherapist.com/ 

Information on this website is for educational and reference purposes only and should not be interpreted as specific medical advice.

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Women Physicians Gyn Medical Group

650.988.7550