By Dinah Wisenberg Brin | April 20, 2015 | Lifestyle
Small lifestyle changes can mean the world for overall health. Thanks to Philly’s finest doctors and medical centers, it’s never been easier for women to be proactive toward everything from heart disease to breast cancer.
Penn Medicine’s Perelman Center for Advanced Medicine is championing 3-D mammography to the benefit of women around the country.
Industry in Philadelphia is synonymous with healthcare. It extends beyond the region’s scores of hospitals and medical schools to global pharmaceutical companies, health insurers, and medical startups. Greater Philly invests some $10.5 billion a year in life sciences R&D, and the Jefferson and Penn health systems are the region’s first and third leading employers, respectively. Seven other hospitals or outpatient facilities rank among the top 25.
Given this history, it’s no surprise we’re the nation’s capital for state-of-the-art medical care, and the city’s latest focus mirrors the country’s: preventative care—though the City of Brotherly Love is paying especially close attention to its sisters. In our inaugural Health & Wellness report, we take a look at the top six programs emphasizing prevention over treatment for women in Philly and beyond.
In a study involving nearly 500,000 women published last year in the Journal of the American Medical Association, Penn Medicine researchers found that 3-D mammograms discover significantly more invasive, potentially lethal cancers than traditional, 2-D mammograms. 3-D mammograms, which give radiologists a clearer view of breast tissue, also reduced the number of callbacks for more testing.
3-D, or tomosynthesis, imaging uses X-rays to produce multiple breast “slice” images that allow radiologists to see abnormalities they might not find in a standard 2-D mammogram. The technology may be especially beneficial for women with dense breast tissue.
“We think it’s an improvement over routine mammography,” says Dr. Emily F. Conant, radiology professor and chief of breast imaging at UPenn’s Perelman School of Medicine. “We reduced the number of false positives and increased the number of cancers [found], [which] really addresses the major criticisms of mammography.”
In 2011, the FDA approved the use of 3-D mammography for breast cancer screening. That fall, the Hospital of the University of Pennsylvania started providing it to every patient coming in for a routine breast exam, and now provides it to all patients, at no additional charge, says Conant.
In the first three years at Penn Medicine, the 3-D mammogram was done simultaneously with the 2-D, says Conant, leading to concerns that the higher X-ray dosages involved, while within approved ranges, may not be sustainable over women’s lifetimes. But Penn has now brought the dosage down to where it was before by fabricating the 2-D images from the 3-D scans.
The mammography machinery looks the same, and the routine doesn’t differ much from a traditional mammogram, says Conant. The breast compression lasts only a few seconds longer. “The important message to get across to women is to simply ask for [a 3-D mammogram].” Hospital of the University of Pennsylvania, Department of Radiology, 3400 Spruce St., 215-662-4032
Wills Eye Hospital is out to educate people on keeping eyes healthy.
The eyes may be the windows to the soul, but they also provide insight into what’s happening elsewhere in the body. “Eyes are impacted by systemic health,” says Dr. Julia A. Haller, ophthalmologist-in-chief at Wills Eye Hospital, the first US eye hospital and one of the leading eye care institutions in the world. In fact, says Haller, most systemic diseases affect the eyes.
As with other health conditions, prevention can go a long way in heading off, delaying, or limiting eye disease. “Anything that’s heart healthy is also good for your eyes,” says Haller. Smoking, however, contributes to cataract development and exacerbates dry-eye problems, allergies, and diabetic eye disease. It is also a risk factor for age-related macular degeneration, a leading cause of central and general vision loss in older Americans. Genetics and cardiac risk factors, like high blood pressure, are also associated with macular degeneration. “It’s an area where prevention makes a big difference,” says Haller, who recommends that at age 50 people be checked for macular degeneration and begin yearly eye exams. A routine eye checkup can pick up on a number of serious conditions, she notes.
Diabetes, a global epidemic, can cause blindness via diabetic retinopathy and macular edema. Only half of diabetics recognize the eye is the organ most commonly impacted by their disease and visit an eye doctor annually, according to Haller. She notes while most diabetics eventually develop diabetic retinopathy, caused by bloodvessel changes in the retina, they can stave it off long-term by keeping their cholesterol, blood pressure, and blood sugar under control.
Wills Eye has active research investigating gene therapy and other treatments for blinding diseases. Last year, a Wills surgical team implanted a new, government-approved retinal prosthesis, described as a “bionic eye,” in a blind woman born with retinitis pigmentosa. Used with camera-equipped glasses, the implant allows the woman to now see low-resolution images. “We’re very interested in working at the translational end of this research continuum,” says Haller. “It’s an incredibly exciting time.” Wills Eye Hospital, 840 Walnut St., 877-289-4557
The Rothman Institute has urgent care sites and surgical centers in orthopedics throughout Greater Philadelphia.
At any age, women have an increased predisposition for ACL injury compared with men, says Dr. Sommer Hammoud, a physician with the Rothman Institute, a leading orthopedics center. Women are three to eight times more likely to sustain ACL injuries than men, a phenomenon that’s more pronounced under age 25, she says. “However, the risk really persists if you’re an active woman into your 30s, 40s, 50s, and 60s,” engaged in skiing or playing sports with your kids. “Just from being an active woman, you’re at risk.”
Hammoud recommends injury prevention techniques developed by the Santa Monica Sports Medicine Foundation. The PEP, or Prevent injury and Enhance Performance, system involves warmup, stretching, strengthening, plyometrics, and sport-specific exercises to protect the ACL, or anterior cruciate ligament, which helps stabilize the knee. These are simple exercises and drills that can be incorporated into any workout routine to keep the lower leg in good shape and help prevent injuries, says Hammoud. In total, they require about 20 minutes, three times a week.
Warming up “helps you greatly reduce the risk of injury” by making muscles more supple, she explains. It’s also important to focus on your form, she adds. When doing a box jump, for example, land with good balance, with the hips in good alignment directly over the knees. She recommends exercising in front of a mirror at the gym to watch your form, if possible, and having a partner or trainer who knows what to look for assess your technique. Soft landings are important. Agility drills—for example, not allowing the knee to cave inward while decelerating from a sprint—can help athletes develop good knee and hip flexion to head off injuries when accelerating or changing directions quickly. Says Hammoud, “These are very easy things to do.” Rothman Institute, multiple locations
According to the Cooper Heart Institute, escaping heart disease, especially for women, is all about prevention.
Heart disease is the leading killer of American men and women, but it differs significantly, and develops differently, between the genders. As part of Cooper University Health Care, the Cooper Heart Institute in Camden (and other locations in South Jersey) addresses heart concerns distinct to women in its Women’s Heart Program.
“Women are protected by estrogen until menopause, so we have very little heart disease until our 50s,” says Kathleen M. Heintz, assistant professor of medicine and director of the Women’s Heart Program. Between ages 50 and 60, she adds, “we very quickly catch up with men.”
More than a third of women have some form of cardiovascular disease, and since 1984, more women than men have died of it, according to the American Heart Association. Sixty-four percent of women who died suddenly of coronary heart disease had no previous symptoms, the AHA also says. While disease progression is different, both women and men share the same risk factors for heart disease: diabetes, poorly controlled cholesterol, smoking, high blood pressure, and a family history of early heart disease.
Obesity is also a risk factor, since it contributes to diabetes, high blood pressure, and high cholesterol, says Heintz. This can be an issue for women, who tend to gain weight after menopause, and often in the abdominal area where it’s more likely to contribute to diabetes and heart disease. “If you are overweight, it puts you at a much higher risk,” she says. (Those who don’t gain weight are unlikely to develop heart disease, she notes, even if it runs in their family). The same is true for diabetes: “Once you have diabetes, you are just as likely to have a heart attack as a person who’s already had a heart attack.”
Exercising most days of the week can help prevent heart The Rothman Institute has urgent care sites and surgical centers in orthopedics throughout Greater Philadelphia. disease, even if you do it in small, separate doses. Also, says Heintz, women’s diets should include omega-3 fish oil, which may help control cholesterol. (The AHA lists salmon, mackerel, herring, and sardines as good sources of these fatty acids.) A daily low-dose aspirin is also indicated for post-menopausal women with two risk factors for stroke or heart attack, or women of any age with a history of stroke or heart attack, according to Heintz. Women’s Heart Program at the Cooper Heart Institute, multiple locations
Jefferson’s Mindfulness Institute is implementing awareness as a proactive measure.
Mindfulness—paying attention to the present rather than worrying about the past or the future—can affect more than your state of mind. A mindfulness-based stress reduction (MBSR) program can help relieve chronic pain, anxiety, and depression, according to Thomas Jefferson University Hospitals’ Mindfulness Institute, whose eight-week course is among the longest-standing MBSR programs in the country.
“Women come to our program for a myriad of reasons,” says Diane Reibel, the research institute’s director. “It can be just ‘stress [from] trying to juggle my family and profession.’ It can be that they [would like to better handle their] menopausal symptoms. We are a hospital-based program, so we also see people who are dealing with illness.”
While the institute is open to both men and women, the latter comprise about 70 percent of program users, says Reibel. “They are having stress and anxiety, and are aware that stress and anxiety, no matter what else is happening, can be detrimental to health and well-being.” MBSR is an evidence-based program built on significant research, says Reibel, and currently the top form of stress reduction in the field. She adds that research data shows stress reduction can increase cognitive function and, in diabetics, help regulate blood sugar.
“It’s really about being more aware in your life,” so you can live more fully and make healthier choices, she explains. “It helps deal with the clutter of the mind that takes us out of the moment.” The Mindfulness Institute, 1015 Chestnut St., Ste. 1212, 215-955-1376
Main Line Health is committed to supporting new mothers.
Main Line Health’s Women’s Emotional Wellness Center (WEWC) specializes in the period before, during, and after pregnancy and adoption, providing outpatient counseling and psychiatric services to women and their families. “We really [engage in] a team approach. Everything is done under one roof,” says program manager Elizabeth Bland.
Main Line Health’s two-year-old postpartum depression program grew out of a need. The hospital saw new mothers seeking help postpartum, says Bland. The program starts on the first day after delivery at Bryn Mawr, Paoli, and Riddle Hospitals and Lankenau Medical Center. All new mothers are screened before being discharged home, using the Edinburgh Postnatal Depression Scale. Those with high scores are seen by a social worker for a full assessment prior to discharge and are offered a supportive phone call from the WEWC about a week and a half later. Also noteworthy is the program’s support for male caregivers and family members.
“Most folks, after a baby arrives, have some sort of help the first week or so,” Bland notes. It’s only after the grandparents or other helpers have gone home that women sometimes realize they need more support. “There are so many varied societal pressures on women. We have to be everything to everybody,” says Bland. “We are fed what we see in movies and on TV,” that we should feel great after a baby arrives, that it’s easy. “That’s not how it works for a lot of us. Welcoming a new baby is a huge adjustment.” A CDC survey found that 8 to 19 percent of women reported having frequent postpartum depressive symptoms. Bland suggests that those numbers are underreported.
To help mothers who recently gave birth, WEWC has started After Baby Connections, a weekly therapy group focusing on coping with depression, anxiety, and adjustment; positive self-talk and selfcare techniques; and social support. Bland suggests that expectant mothers speak with family members about how they’re feeling and line up good support for the postpartum period, as not everyone lives close to family. Women with PPD often don’t feel well but don’t want to say anything, she says. “We don’t want [anyone] to suffer alone.” Main Line Health, 3855 West Chester Pike, Newtown Square, 484-337-6300
Photography by Feinknopf Photography (Perelman Center); Penn Medicine (Conant); Glenn Dipaola (Reibel); Robert Coldwell Photography (Main Line Health)