Seasonal Health Tips
Brigham and Women's Hospital experts offer health tips relevant to the time of year. Please scroll down for additional tips from this fall, including the basics about diabetes, sleep tips, how to have a more nutritious Halloween, information about gynecological cancer, nutritious food ideas for families on the move, and moving tips.
Learn the Facts About COPD for Awareness Month
Chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis, is the fourth leading cause of death in the US, and is expected to be the third leading cause by 2020. There are 12 million Americans diagnosed with COPD, and estimates suggest an additional 12 million people unknowingly have the disease. For COPD Awareness Month, Craig Hersh, MD, MPH, of the Center for Chest Diseases at Brigham and Women’s Hospital (BWH), describes the common risk factors for COPD, signs and symptoms that should prompt a visit with a physician, and ways to manage COPD.
Individuals over the age of 40 with a history of smoking are typically at heightened risk of developing COPD, yet one in six people with COPD have never smoked. Dr. Hersh shares some common factors that increase the risk of developing COPD:
Dr. Hersh explains that symptoms of COPD can differ, but the most common symptoms to take note of are:
Shortness of breath, especially with activities
Persistent coughing, with or without phlegm
A wheezing or whistling sound in the chest
Individuals should promptly report these symptoms to their doctor who can use a lung function test to determine if COPD is the cause.
Numerous therapies are available for those diagnosed with COPD, ranging from nutrition counseling to surgery. In a discussion with a physician, a number of treatment options should be discussed:
BWH is one of the only hospitals In New England to offer surgery for COPD, including lung volume reduction surgery (LVRS) and lung transplantation. BWH also has several research studies underway for smokers with and without COPD, and participants are always needed. Volunteer for one of the BWH’s COPD research studies by visiting http://clinicaltrials.partners.org/, e-mailing copdstudy@partners.org or calling 866-328-9494.
Lessons and Tips for National Diabetes Awareness Month
November is Diabetes Awareness month and Florencia Halperin, MD, an endocrinologist at Brigham and Women’s Hospita
l (BWH) is sharing some of the risk factors and symptoms of diabetes, as well as some pointers for those living with diabetes.
There are two main types of diabetes: type 1 and type 2. More than 90 percent of those with diabetes have type 2. Type 1 diabetes is characterized by insufficient production of insulin- a hormone our bodies need in order to use sugar and starches as fuel for daily life. Type 2 diabetes is a disease in which not enough insulin is produced and the cells of the body cannot properly use the insulin that is available, In both cases the result is high blood sugar levels, which can lead to the complications associated with diabetes.
The cause of diabetes is not well known, but research has demonstrated that both genetics and environmental factors may increase the chance of developing diabetes. These risk factors include:
Increasing age
Family history of diabetes
Being overweight or obese
Lack of regular exercise
Certain racial and ethnic groups are at higher risk for diabetes, including Non-Hispanic Blacks, Hispanic/Latino Americans, Asian Americans and Pacific Islanders, American Indians and Alaska Natives
Pre-diabetes
Low HDL (“good”) cholesterol, high triglycerides, and high blood pressure
For women, a history of gestational diabetes, or of having a baby that weighed 9 pounds or more at birth
More than 20 million people in the US are living with diabetes. Approximately one fourth of those are unaware that they have the disease. Dr. Halperin outlines some signs and symptoms that could indicate diabetes and should prompt a visit to a health care provider:
Although diabetes is a lifelong disease for which there is no cure at this time, we do have many available treatments, and those with diabetes can take steps to manage the disease and prevent potentially serious medical problems. Individuals should speak with their primary care doctors to outline a personal care plan, says Dr. Halperin, which may include some of the following:
Maintaining a healthy weight
Eating a healthy balanced diet
Exercising regularly, as advised by your physician
Attending routine visits with your health care provider, which should include periodic measurement of blood sugar levels, a hemoglobin A1c test, as well as measurement of blood pressure and cholesterol
Medications for control of blood sugar, blood pressure and cholesterol as needed
Yearly visits to eye and foot specialists
Gain More than an Extra Hour of Sleep with Daylight Savings Time
An extra hour is gained on November 1, at 2 a.m. when clocks are pushed back for Daylight Saving Time (DST). Many will utilize this extra hour to get some additional shut-eye, but all should be weary of how this shift in time can affect the body and mind, says Atul Malhotra, MD, medical director of the Sleep Disorders Research Program in the Division of Sleep Medicine at Brigham and Women’s Hospital (BWH). While the shift in the spring can be more problematic, for some people any change in schedule can be disruptive to sleep. To cope with the time change, Dr. Malhotra suggests some ways to prepare and manage the time shift, in addition to some tips for a better overall night’s sleep.
To prepare for and cope with the time change, Dr. Malhotra offers these tips:
Avoid stimulants that can have an effect on wakefulness, like consuming caffeine after lunch, especially a few days before and after the change. Try not to nap during this time as well, since napping can decrease your ability to sleep at night.
Some people use the extra hour to try to get more chores done. Be careful about this approach, since many people may benefit from getting an extra hour of sleep.
Avoid driving if you are sleep deprived. If possible, take public transportation into work for a few days after the change, rather than driving. If you must drive, make sure to get a full night's sleep each night and remain vigilant when driving.
Even one hour of sleep deprivation has been associated with increases in the rate of heart attacks, recent research shows. Be sure to avoid stress, plan for a relaxing weekend, and be sure to take your regular medications.
For an ideal night’s rest, aim for eight straight quality hours of sleep, says Dr. Malhotra, also Medical Director at the Sleep HealthCenter in Brighton, Ma., and consider these suggestions, particularly if you have trouble sleeping:
Maintain a consistent sleep schedule to help regulate the body's sleep cycle. Go to sleep and wake up at the same time daily, even on weekends.
Foods and drinks with caffeine, like hot chocolate, tea, coffee, soda, and chocolate can interfere with sleep and should be avoided after lunch.
Start a bedtime routine that includes at least 15 to 30 minutes of calm, quiet, soothing activities such as reading.
Talk or write about any thoughts, stresses, or concerns. By discussing the issue with someone, or getting it down on paper, the mind is alleviated, making it easier to fall asleep.
A dark, quiet, cool room is typically the best sleeping environment. Extreme temperatures, noise, and lights- even nightlights- can make getting to sleep and staying asleep difficult. Use an eye mask and ear plugs if you need to.
Limit time spent in front of the TV or computer close to bedtime, and do not have a TV or computer in the bedroom.
Avoid any work right before bedtime. Studying or doing written work does not allow the mind to relax before falling asleep.
Avoid strenuous exercise right before bedtime. While exercise earlier in the day is good, exercising close to bedtime may make it more difficult to go to sleep.
If you think you may have a sleep disorder, talk to your doctor or consider seeing a specialist.
Avoid the Halloween Candy Overload
Each year children anxiously await Halloween and its spooky fun, creative costumes, and tricks and treats, leaving parents to anticipate loads of sugary candy and the calories and belly aches that can ensue. To prepare for a healthier Halloween this year, Kathy McManus, RD, Director of the Department of Nutrition at Brigham and Women’s Hospital, offers some health-con
scious suggestions.
McManus suggests some healthy treat options to hand out, that won’t get your house egged:
Try to choose lower calorie treat options or sugar-free options, like sugar-free gum.
Stick to small portions. Bite-sized treats will help children eat their candy in moderation.
Beware of the common misconception that non-chocolate treats are healthier since they don’t have fat. Instead, they most likely have loads of sugar, making them no more healthy.
Rather than letting the Trick-or-treaters grab all they want from your candy stash, decide on a reasonable amount of candy to give out and stick with it throughout.
Give out tricks instead of treats, like a small toy from a party store, stickers, crayons, or colorful pencils.
Packaged sunflower seeds, popcorn, or a small granola bar are also healthier alternatives.
The dreaded Halloween stomach aches are preventable, says McManus:
With your child involved in the planning, map out a limited number of houses to collect treats from.
Before Halloween, decide on a designated number of candies your child can have Halloween night and on the days that follow.
Serve a meal that you know your child will enjoy on the night of Halloween to ensure that they will be satisfied before going out to get candy.
Talk to your child about splitting their candy in half. Let them sort out their favorite candies, and taking the other half to work or throw it away.
Don’t let them eat candy while watching TV or using the computer – this only leads to mindless eating and often results in an excessive intake of candy.
Remind your kids that Halloween is not about gorging – it’s about enjoyment! Getting dressed up, going to parties with friends and enjoying some treats.
Sometimes adults need help to avoid dipping into the candy stash, says McManus, who offers some tips:
Do not deny yourself candy altogether, but indulge with a keen sense of mindfulness and moderation.
Buy candy that you dislike. This will help you control yourself from dipping into the stash.
Don’t buy Halloween Candy until October 31. This will prevent pre-holiday snacking.
Before Halloween arrives, make a decision about how many treat calories you allow yourself per day around the holiday. Whatever you decide try to keep this calorie amount below 200 calories.
On the days you do decide to indulge with the extra calories – try to do more physical activity on that day
And if you’re worried about eating your child’s candy, see about limiting their cache to begin with.
Answering Questions for Gynecological Cancer Awareness Month
The fourth most common cancer among women, gynecologic cancer, is diagnosed in more than 80,000 women each year. For gynecological cancer awareness month, this September, Colleen Feltmate, MD, a physician in the Department of Obstetrics and Gynecology at Brigham and Women’s Hospital, answers some important questions about the various types of gynecological cancers, and the symptoms, risk factors, preventive measures and treatments options.
How many different types of gynecologic cancers are there?
There are six basic gynecologic cancers: ovarian, fallopian tube, uterine, cervical, vulvar and vaginal. Each different type has unique signs and symptoms, risk factors, and prevention strategies.
What are the risk factors for developing these cancers?
Risks for development vary among the different gynecological cancers. Common risk factors which may predispose an individual include a personal or family history of gynecologic or breast cancer, early onset of menstrual cycle, late onset of menopause, increasing age, obesity, human papilloma virus infection (HPV), tobacco use and an impaired immune system.
What are factors that reduce the risk of developing gynecological cancers?
Annual exams preformed by a gynecologist and HPV vaccination can help reduce the risk of developing cancer of the cervix, vulva or vagina. Birth control use can be effective in reducing the risk of developing ovarian, fallopian and uterine cancers, and having been pregnant also reduces the risk of uterine cancer. Also, keeping a healthy weight helps to lower the risk of ovarian, tubal and uterine cancer, and refraining from tobacco use lowers the risk of developing cervical, vulvar and vaginal cancer.
What are the symptoms of gynecological cancer?
Symptoms of ovarian or tubal cancers include bloating, feeling full after consuming even small meals, excessive burping and an increase in waist size, while less frequently, pain can also be a symptom.
Symptoms of cervical, uterine, and vaginal cancer include bleeding or discharge unrelated to the menstruation cycle and pain during urination or intercourse. Any postmenopausal bleeding or staining should be considered abnormal.
Most common symptoms for vulvar cancer are itching, burning, pain, tenderness or changes to the skin of and around the vulva, including ulcers around the vulva.
How is a diagnosis made?
For cervical, vulvar, and vaginal cancer, annual gynecological exams screen for cancer. A pap smear, which includes taking a sample of cells from a woman’s cervix, is used to screen for cervical cancer by detecting abnormal changes in these cells. An abnormal pap smear may also be present with vaginal or vulvar abnormalities. A pelvic exam is used to screen for vaginal and vulvar cancer and includes both a visual and physical examination of the pelvic organs.
Typically undetectable during a gynecological exam, uterine cancer can sometimes be detected using ultrasound, but is usually identified after a woman reports irregular or postmenopausal bleeding and a biopsy is performed to determine if the cells of the uterus are cancerous.
There is currently no screening technique for ovarian or tubal cancers, which is why it is important for women to observe and report any of the common symptoms (listed above), and report them to her physician. A yearly physical exam can sometimes detect a mass and may be helpful in earlier detection of these cancers.
What are the treatment options for these cancers?
Surgery: Treating gynecological cancers often begins with surgery, removing the cancerous area or organ, depending on the stage and location of the cancer.
Radiation therapy: After surgery, radiation therapy may be used to destroy microscopic cancer cells that may remain after surgery. In cases where a tumor cannot be safely removed because of the stage of cancer and condition of the patient, radiation may also be used instead of surgery.
Chemotherapy: Chemotherapy may be used to destroy cancer cells after surgery in ovarian, tubal and some uterine cancers. Chemotherapy may be used when surgery is considered an unsafe option because of the stage of cancer and/or the patient’s health.
Hormone therapy: Hormones, such as progestin, may also be used in some circumstances.
How curable are these cancers?
Most cancers are curable if found at an early stage, with 90 percent or more of these cancers cured if it is confined to the organ or is fairly small in size. Research has continually shown that the earlier the cancer is found the higher the chances of cure and long term survival.
“Getting your annual exams and being observant of the signs and symptoms of those cancers that are not detectable through screenings is the best way to protect against these cancers,” says Dr. Feltmate. She urges women to keep their annual appointments, and talk with their physicians about any concerning symptoms.
Nutrition for Families On The Go
The back-to-school season is upon us. The lazy days of summer will soon be replaced by endless activities and errands, and all-around busy schedules for the whole family. Stopping by the farmer’s market regularly for fresh fruits and vegetables, and preparing a healthy meal on the grill will quickly become more and more difficult.
In order to keep your family on the right track, or perhaps start fresh after a summer of burgers and hot dogs, Linda Antinoro, RD, of the Nutrition Department at Brigham and Women’s Hospital, offers some tips to take the brainwork out of eating healthy, no matter how little time you have.
Pack portable snacks. “The easiest way to avoid being tempted by candy bars and fast food is to make sure you are always armed with balanced, nutritious snacks,” says Antinoro, suggesting:
Nuts: walnuts, almonds, pecans, pistachios, etc. are all packed with vitamins and heart healthy fats.
Dried fruit: cranberries, raisins, apricots, apples, etc are great for a quick burst of energy before sports practice. For more of a balanced snack, combine them with a handful of nuts.
Peanut butter and crackers: pack up some whole wheat crackers and natural peanut butter.
Protein bars like Pria or Balance Bars.
Fast food promises speed and convenience, making it nearly unavoidable at times. Grabbing a meal from the drive-through can be healthy too though, if you stick to grilled items instead of fried. Try checking out the nutrition chart for your favorite fast food restaurant ahead of time, looking for options low in saturated fat. Antinoro suggests some generally healthy choices:
Salad with grilled chicken and vinaigrette dressing.
Vegetable pizza.
Grilled chicken sandwich, light on the condiments.
Hamburger with baked potato or a side salad instead of French fries
Soup and whole grain bread.
A bagged lunch may take some preparation the night before, but it can be an even quicker- and healthier- lunch option. Consider packing a small cooler with:
Turkey and low fat cheese on wheat bread.
Peanut butter and jelly sandwich.
Tuna salad sandwich.
Fruit – sliced or whole.
Vegetables and hummus.
Greek yogurt and low fat granola.
With even a small amount of time, you can whip up a well-balanced meal. Antinoro provides these tips to make dinner preparation a little quicker and bit easier:
While cooking whole grain pasta, toss in some frozen vegetables to the same cooking pot.
Purchase frozen chicken breasts that can easily be thawed and used in a variety of simple meals.
Use a crock pot. Fill it with ingredients for a balanced dinner and leave it to cook while you work around the house.
Stock your freezer with frozen vegetables- a great option to have on-hand at all times to add balance to any meal.
Prepare double or triple portions of one meal and freeze the remaining portions for a quick meal on another night.
Grab a rotisserie chicken and a bagged salad on the way home.
“A healthy diet can improve energy levels, fuel the immune system to protect against illness, and help to reduce the risk of chronic disease, like diabetes, the fastest growing disease in the US,” says Antinoro, reminding families that it’s possible to make healthy food choices in a variety of situations, even in the drive-through.
Safety Tips for Moving Day
Each year on September 1, the streets of the Boston area are littered with moving trucks, vans, packed cars, clumsy amateur movers and any friends and family members they could persuade to participate in the big move. The biggest moving day of the year surely comes with its hazards, as a variety of these movers maneuver their way into new digs, one heavy box at a time. To prevent this event from being a “back-breaking” one, Marie-Josee McKenzie, physical therapist in Rehabilitation Services at Brigham and Women’s Hospital, has some tips for movers.
Preparation is key; McKenzie offers general tips to keep in mind before the move:
Pack boxes over time to avoid sore muscles on moving day.
Disperse heavy items in the bottom of a box with lighter items on top to maintain even weight distribution. The heavier the items, the smaller the box should be.
Place boxes on an elevated surface while packing to avoid repeatedly bending over.
Secure boxes with tape to prevent contents from spilling when lifted.
Dress for the task: wear lightweight, comfortable clothes and supportive and sturdy shoes (avoid sandals).
Stretch your muscles and warm up with a light activity as you would before any exercise.
Improper lifting techniques can cause a variety of injuries: neck and back muscle strain, ligament sprains, herniated discs and even compression fractures of the spine. To prevent potentially serious and lasting injuries, McKenzie provides smart techniques for movers.
Know your limits: lift a corner to test items first. Ask for help with heavy or bulky loads.
Establish a firm grip and a wide stance before fully lifting. Hold the heaviest portion of the load closest to the naval, your center of gravity.
When lifting objects, always bend at the knees, keeping your back straight and your abdominal muscles firm. Reverse the motion, avoiding an arched back, to lower objects.
When lifting items from inside a vehicle, place one foot in the vehicle to increase your mechanical advantage.
Never hold your breath when lifting a load, as this may cause elevated blood pressure levels.
Know where you plan to place an object before lifting and carrying it. Keep paths clear and move slowly while maintaining a clear line of vision.
If another person is sharing the load, communicate to lift and lower in unison.
Avoid twisting, which compounds stress in your back and affects balance. If you must turn, move your feet to change direction and pivot with your whole body.
Push, rather than pull, to maximize use of your full body weight.
Rest heavy or awkward items on waist-level surfaces midway through carrying.
Avoid reaching overhead with objects. Keep elbows close to sides when lifting.
Consider using devices such as handcarts, back supports and stepladders to ease strain.
Take frequent breaks and drink plenty of water to prevent dehydration.
Some are at higher risk for injury while moving. McKenzie cautions individuals to think twice before lifting heavy objects if they:
Have a history of neck or back injuries
Currently experience neck or back pain
Have poor cardiovascular endurance and do not exercise regularly
Have respiratory and cardiac conditions
Are at risk for obesity, high blood pressure, diabetes or bone density disorders
Are pregnant or think they may be pregnant
Brigham and Women's Hospital (BWH) is a 777-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. In July of 2008, the hospital opened the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery. The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 860 physician-investigators and renowned biomedical scientists and faculty supported by more than $416 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.
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