By Dr. Nina Radcliff with Additional Reporting by Kristin Detterline | April 28, 2016 | Lifestyle
Diseases and disorders can vary greatly between the sexes. Here, Philly’s finest doctors and medical centers share how women can sleep better, look younger, and live longer.
Researchers are continuing to discover that men and women are more different psychologically and physiologically than realized. It turns out that major illnesses such as heart disease and lung cancer are indeed influenced by gender. Research shows that women are more likely to develop certain chronic illnesses and have different symptom presentation and response to treatment than men, and may need different treatment approaches. Today’s groundbreaking medical and scientific advancements along with technology are expanding our knowledge and improving care. Bolstering women’s health not only decreases illness and disease, but has far-reaching benefits on the individual as well as her entire household, community, and society in general.
Sleep is a treasure. It is vital to a healthy lifestyle and optimal function. Chronic sleep disorders have been shown to increase our risk for heart disease, obesity, memory impairment, and even premature death. Today, nearly 70 million American men and women suffer from insomnia—difficulty falling asleep, staying asleep, or waking up too early. “Women face a unique set of lifestyle and life-cycle changes, such as menopause, that can make getting adequate sleep even more challenging,” says Dr. Ritu Grewal, a pulmonologist and attending physician at Jefferson’s Sleep Disorders Center Women’s Program (211 S. Ninth St., Ste. 500, 215-955-6175). “More women are in the workforce and many work night shifts,” she says. “Women are oftentimes mothers—some are single mothers—and caregivers. This juggling of responsibilities can lead to chronic sleep deprivation. Our Women’s Program teaches strategies to improve sleep hygiene.”
Maintaining good sleep hygiene—the routines and rituals we undergo before bedtime—calms us and helps transition from being awake to falling asleep. Dr. Grewal remarks that “One-third of our day is meant to be spent sleeping. We need to power down the television, laptop, and smartphone, avoid alcohol, and learn effective strategies to put our worries to rest, so that we can get our rest.” Research shows that nearly half of all women experience sleep disturbances as they enter menopause. “Reproductive hormones or the lack of them can result in hot flashes, depression, sleep apnea, and restless leg syndrome,” Dr. Grewal says. She goes on to explain that after a comprehensive sleep evaluation, a sleep study may be ordered for evaluation of sleep apnea. Short-term hormone replacement therapy may be appropriate in some situations. Antidepressants and non-pharmacologic therapy like cognitive behavioral therapy for insomnia may help in some cases of insomnia in postmenopausal women. Dr. Grewal notes that “because women tend to experience fatigue instead of daytime sleepiness” when they do not get adequate sleep, they are less likely to realize they have a problem. “If you are fatigued and suspect a sleep issue, start by cleaning up your sleep hygiene. If you continue to have sleep issues, speak to your healthcare provider.”
Alzheimer’s disease (the most common type of dementia) has a far-reaching impact on our nation: More than 5 million Americans are affected, with that number expected to triple by 2050. It is the only leading killer that has no cure or medication to slow down progression or current facts reveal that two-thirds of Americans with Alzheimer’s are women.
Groundbreaking research discoveries at the Penn Memory Center, along with its excellence in diagnosis and treatment of memory loss including comprehensive Alzheimer’s patient programs, has earned the program designation as a National Institute on Aging Alzheimer’s Disease Center. “We are one of only 30 such sites in the nation and the only center in the Philadelphia area with this designation,” says Dr. John Trojanowski, director of the Penn Memory Center (3400 Civic Center Blvd., 215-662-7810). Dr. Trojanowski explains that, “In order to develop drugs, biomarkers, and other treatments, you first need to find the causative agents. Over the last 25 years, our center’s research laboratories have uncovered the structure of three lesions that lead to degenerative brain disease.” These lesions cause nerve cells in the brain to die or no longer function normally, which affect memory, behavior, and the ability to think clearly. A critical challenge for patients with Alzheimer’s is getting accurately diagnosed. Dr. Jason Karlawish, co-director of Penn Memory Center, asks, “If you are diagnosed or concerned with heart disease you go to a cardiologist. If you are concerned about Alzheimer’s, who do you go to?” The focus of the center is on treating individuals with Alzheimer’s disease, mild cognitive impairment (MCI), and other age-related progressive memory disorders. “Specialized memory centers are uniquely equipped to diagnose patients as well as provide highly specialized and dedicated health educators who can teach patients and their loved ones how to deal with the disease,” says Dr. Karlawish. “When a patient is told they have diabetes, a dietician teaches them about their diet and how to manage their disease, and Alzheimer’s patients and their families need the same skilled support,” Dr. Karlawish adds.
Our eyes can say a lot about us. They provide a unique window into our health and how we are feeling. “Rejuvenating the area in and around the eye can have a dramatic effect on helping us see better as well as making us look fresher and more alert,” says Dr. Jacqueline Carrasco, associate clinical professor of Ophthalmology and Oculoplastic Surgeon at Wills Eye Hospital (840 Walnut St., 877-289-4557). Oculoplastic surgeons are ophthalmologists who specialize in reconstructive and plastic surgery around the eyes—eyelids, eyebrows, bones of the orbits, and tear ducts. “In addition to providing a variety of cosmetic improvements, we also repair deficits that may result from the removal of cancerous growths and for medical conditions, such as ptosis,” Dr. Carrasco says. Ptosis, or droopy eyes, can affect vision and its prevalence increases as we age. “Blepharoplasty is surgery of the upper and/or lower eyelids; it helps people have a better view of the world and provides them with a more youthful appearance,” says Dr. Carrasco. Blepharoplasty is also done for cosmetic reasons such as dark circles, excess puffiness, and heaviness of the upper lids. More than 200,000 blepharoplasties are performed annually, with women comprising about 85 percent of patients. “Surgery is typically 90 to 120 minutes for all four eyelids, and patients go home approximately an hour after,” Dr. Carrasco explains. “Generally speaking, it is non-painful and requires one or sometimes two weeks off from work.” Wills Eye’s clinical expertise, state-of-the-art diagnostic center, and advanced surgical capabilities make it a world leader in the treatment of eye concerns. Dr. Kristin Hammersmith, attending corneal surgeon at Wills Eye, noted that with women, “Dry eye condition is more prevalent and related to their tear glands. The glands have hormone receptors that are affected by life changes such as pregnancy, menopause, or taking birth control pills or hormone replacement.” Dr. Hammersmith adds, “My recommendation is that if anyone has anything going on with their eyes—either in or around the eye—there’s usually a solution.”
Infertility is more common than many are aware, affecting nearly 15 percent of couples in some way. Even under ideal circumstances, getting pregnant is not easy. “At age 30, the odds of getting pregnant are 20 to 25 percent a month. At age 40, it drops to four to six percent,” says John J. Orris, DO, MBA, division head of Reproduction Endocrinology & Infertility for Main Line Health System (25 Old Lancaster Road, Ste. 170, Bryn Mawr, 610-527-0800) Today, more couples than ever are turning to Assisted Reproductive Technologies (ART), which includes in vitro fertilization, to help build families. In 2012, there were 61,000 babies (1.5 percent of the 3.9 million births) conceived with the help of ART. This increasing rate has been attributed to evaluations being performed earlier. Dr. Orris notes, “In the past, couples would often seek consultation with a fertility expert after a year of trying to get pregnant without success. However, time is of the essence as women age and problems take time to fix. You may want to consider consultation after six months if you have not been successful.”)Insurance companies often cover the initial reproductive physical in its entirety. “It consists of a physical exam, transvaginal ultrasound, and a blood test to measure reproductive hormones,” Dr. Orris explains. “We also perform a semen analysis on the male.” Treatment options depend on the underlying problem and range from oral or injectable medications called gonadotropins to artificial insemination. As treatment may not be covered by medical insurance, Main Line Fertility offers information on more affordable options. “Reproduction Endocrinology & Infertility at Main Line Health System also sees a number of professional women that seek to freeze their eggs because they want to hold off on childbearing but desire a family down the road when the time is right,” says Dr. Orris, adding, “the process consists of 10 days of injections—eggs are harvested 36 hours after the last set of injections. The whole process can be wrapped up in 12 days.”
Three years ago, Angelina Jolie penned an op-ed for The New York Times that explained her decision to have a preventive double mastectomy. She expressed her gratitude to the advancements made in genetic testing that allowed her to discover that she was a carrier of a mutated BRCA1 gene. The BRCA gene normally produces tumor suppressor proteins that help repair damaged DNA. But when there is a mutation, DNA damage may not be able to be repaired and can increase the likelihood of developing cancer. Studies have shown that women with this mutation have a 45–65 percent risk of developing breast cancer and an 11–39 percent risk of developing ovarian cancer over their lifetime. In comparison, the average woman has a 12 percent risk of developing breast cancer and a 1.4 percent risk of developing ovarian cancer over her lifetime. Jolie’s story moved women with a strong family history of breast or ovarian cancer or those who have developed breast cancer at an early age to follow her lead. “Referrals to testing centers increased by over 50 percent after that,” says Dr. Generosa Grana, medical oncologist at MD Anderson Cancer Center at Cooper (multiple locations, 855-632-2667). Genetic testing has been a substantial part of the work that MD Anderson has been doing since 1994. The program is twofold, according to Dr. Grana: screening for cancer predisposition in individuals and genetic profiling of cancer for treatment planning and research. “We test individuals for genetic abnormalities, and, if they are carriers, then you can broaden to family members to determine who has inherited that abnormality and help them make decisions about enhanced screenings, drug therapy, and prophylactic surgery.” Technological advancements, including drug development and vaccine therapy, have dramatically improved patients’ prognoses. “It’s no longer doom and gloom,” she says. While we cannot change our genes or slow down aging—a risk factor for breast cancer—we can modify a number of lifestyle choices. Dr. Grana says that being physically active, not smoking, and limiting alcohol intake are important choices women can make to decrease the risk of breast cancer.
Heart disease is the number one killer of women and takes more women’s lives than all cancers combined, according to Dr. Vincent M. Figueredo, chief of Clinical Cardiology at Einstein Medical Center Philadelphia (5501 Old York Road, Philadelphia, 800-346-7834) Despite these devastating statistics, awareness remains alarmingly low, he says, in part because so much mainstream focus is on cancer. “Many of the cancers—breast or uterine—directly affect women. It’s devastating for them, and the course of the disease is longer.” Yet statistics show that while 1 in 31 American women dies from breast cancer each year, 1 in 3 dies from heart disease. Dr. Figueredo adds that heart disease studies now include women and men equally; historically, studies were largely performed with male subjects. He explains that while men typically have a blockage of a major artery, women can have heart attacks related to milder blockages or spasms of the artery and have a higher incidence of heart attacks due to severe physical or emotional stress. “Women can have different types of heart attacks while men classically have a blockage of an artery feeding the heart muscle,” he says. Women also present different symptoms than men: Fifty percent of women will have the sudden chest pain that most men experience, but they can also have sudden fatigue, shortness of breath, indigestion, and pain in the neck, jaw, shoulder, arm, or back. Because of the mixed bag of symptoms and their intensity, women typically delay treatment and therefore have a higher mortality rate than men, according to Dr. Figueredo. Knowing the symptoms is as important as making lifestyle choices that prevent heart disease, he says: “In my practice, I tell patients to eat healthy and to exercise at least four days a week—ideally for an hour of sustained aerobic activity. And don’t smoke. Period.”
The world’s on-demand lifestyle means that programs like Penn Medicine’s Penn Passport are very much in demand: For an annual fee, members have access to a wealth of health care services outside the realm of insurance. these include access to doctors and hospitals worldwide, personal health assessments, inpatient care at the amenity-filled the pavilion, and even pet care. Dr. Jack Ende, MD, MACP, says the program was launched to provide the convenience of a high-end health care program. “it is an innovative approach in medicine because it is completely personalized and exceeds the needs of busy professionals and families, anytime and anywhere,” he says. “the immediate access, individual attention, and quality of care provided to a Penn Passport member is unmatched by any other health care program in the region. Philadelphia is a major city that has a reputation of hospitals that are cutting-edge, and in order to stay competitive, we need distinctive medical programs.” (800-789-7366)
Rothman Institute weighs in on easy ways to prevent osteoporosis. osteoporosis is a disease in which the bones become weak because of decreased bone mineral density. according to the National osteoporosis Foundation, 10.2 million adults in the Us have osteoporosis. and while the disease can occur in both men and women at any age, it is most common in post-menopausal women. according to Dr. Natacha Falcon (above), a physical medicine and Rehabilitation physician at Rothman institute, “it is considered a silent disease. often women are unaware that they have it until a painful, disabling fracture occurs, typically in their spine, hip, or wrist.” treatment is available, but lifestyle changes can make all the difference. Notes Falcon, “osteoporosis is preventable with early care, adequate nutrition of calcium and vitamin D, and [regular practice of] weight-bearing exercises such as walking, jogging, and weightlifting.” (925 Chestnut St., 800-321-9999)
Dr. Louis P. Bucky reveals a new secret weapon for your skincare arsenal. Fine lines, wrinkles, brown spots: Dr. Louis P. Bucky (above) has heard every skincare complaint imaginable. And no matter what your preferred treatment—surgery, injectables, or noninvasive procedures—he urges patients to give their skincare regimens just as much consideration. “We have to separate what surgery can do from what skincare can do,” says Dr. Bucky. “Surgery doesn’t treat the skin, and topicals aren’t rejuvenative. So you blend them together and find out what works best.” Dr. Bucky cites hyaluronic acid, the body’s naturally occuring lubricant for joints, as a key ingredient in “smart” skincare. Hyaluronic acid and novosomes, once used exclusively in pharmaceuticals to allow medicines to penetrate the skin, are the two key components in the new Alphaeon Dermal Solutions system that Dr. Bucky has recently been recommending to patients. “Alphaeon uses novosome technology to penetrate the skin and release nutrients so it gets into the skin like an injection,” he says, adding that patients typically see a difference within 30 days. “It really helps with the health of your skin.” (Multiple locations, 215-323-5000)
PhotograPhy by ShutterStock (SleePing woman)