1. The Wisdom of Women’s Health Presented by: Earlexia Norwood, MD Date: May 19, 2011

2. Program Objectives: Understand the key health issues facing women today Understand why prevention is key to maintaining good health and minimizing the risk of disease. Become knowledgeable of recommended screenings and tests Learn how to communicate effectively with your doctor To understand the mind, body and soul connection as it relates to health

3. Key Health Issues Facing Women Heart Disease Breast Cancer Osteoporosis Depression

4. Heart Disease Fact Heart disease is the leading cause of death in American women. The latest data show that 1 in every 3 women die of cardiovascular disease. It is estimated that nearly 35% of the women in the United States presently have cardiovascular disease Fact Men and women both may experience chest pain as the most common warning sign for heart attacks. Women, however, may also report other symptoms, such as indigestion, heavy arms, or fatigue on exertion.

5. Heart Disease Fact: Some tests such as the standard treadmill exercise test are less reliable for diagnosing heart disease in women

6. Diagnosing Coronary Heart Disease (CHD) in Women Electrocardiogram Exercise treadmill test Stress echocardiogram Stress thallium

7. Atherosclerosis Normal vessel Atherosclerotic vessel

8. Breast Cancer Breast cancer is the most common cancer in women The earlier breast cancer is found, the better the chance of survival Survival rates for localized breast cancer exceed 95%

9. Primary Breast Cancer Risks Early menarche (before age 12) Late menopause (after age 55) Family or personal history Bearing children after 30, or not at all Age (women over 50) Consumption of high fat foods and excessive alcohol Overweight Use of postmenopausal hormone therapy

10. Breast Cancer: Reducing Risk and Early Detection Women age 35-40: need a baseline Women age 40-69: Have a mammogram every 1-2 years, and a clinical breast exam every year. Women at increased risk may need to be examined earlier or more often. Be sure to consult your doctor!

11. Osteoporosis It affects more than 1 out of 24 Americans Another 1 out of 13 Americans has enough bone loss to be at risk Women are 4 times more likely to develop it than men One out of 2 women versus 1 in 8 men over 50 will break a bone in their lifetime because of it Risk increases as we get older

12. Osteoporosis Risk Factors Menopause Absence of periods before menopause Certain medications (steroids, thyroid hormone, antacids and others) Genetics Poor diet – low calcium intake History of multiple fractures Increased parathyroid hormone Excessive alcohol use Physical inactivity Smoking

13. Osteoporosis: What Does It Look Like? Normal BoneOsteoporotic Bone

14. Consequences of Osteoporosis More than 1.5 million broken bones each year result, in part, from osteoporosis. –300,000 hip fractures –700,000 spine fractures –250,000 wrist fractures –300,000 fractures in other parts of the body Common Fracture Sites

15. Screening for Osteoporosis DEXA – The T score compares your bone density with that of the average healthy young adult woman

16. Osteoporosis Prevention Get enough calcium (1000 -1200mg) and vitamin D (800 – 1000IU) Limit protein and salt – may decrease calcium absorption. Avoid smoking – smokers have less bone density Limit alcohol – may reduce the intestinal absorption of calcium and interfere with vitamin D conversion Exercise regularly –Weight bearing – bone is living tissue and responds to exercise by becoming stronger –Resistance

17. Major Depression Depression is more common than diabetes and occurs more often in women than men Biological, psychosocial, and cultural factors contribute to depression risk

18. Symptoms of Major Depression Difficulty concentrating, remembering details, and making decisions Fatigue and decreased energy Feelings of guilt, worthlessness, and/or helplessness, hopelessness Irritability, restlessness Overeating or appetite loss Loss of interest in activities or hobbies, including sex Persistent sad, anxious, or “empty” feelings Insomnia, early-morning wakefulness or excessive sleeping

19. Major Depression Never be afraid to discuss depressive symptoms with your doctor Treatment consists of medications and/or talk therapy Allow time for therapies to work

20. So How Do We Measure Health? With Numbers !

21. What Should The Numbers Be? Blood Pressure – Less than 120/80 mmHG Blood Sugar – Fasting –Normal - lower than 100mg/dl –Pre-diabetic - 100 -126mg/dl –AIC - less than 7 Waist Circumference –Men – less than 40 inches, –Women - less than 35 inches Body Mass Index – - Based on height and weight

22. What Should The Numbers Be? ●Total Cholesterol – less than 200mg/dl ●Low-density lipoprotein (LDL) – less than 100mg/dl ●High-density lipoprotein (HDL) ●Women greater than 50mg/dl ●Men greater than 40mg/dl ●Triglycerides – less than 150mg/dl

23. How Do We Find the Numbers? By partnering with your health care provider and scheduling your preventive screenings

24. BMI Chart 120140160180200 5’1”2326303438 5’3”2125283235 5'5"5'5"2023273033 5'7"5'7"1822252831 5'9"5'9"1720242730 5'11"1720222528 Weight in Pounds Height in Inches OverweightObese

25. Screening Guidelines 18 - 40 yrs40 – 50 yrs50 – 65 yrs 65 and over Annual Health Risk Assessment PAP/pelvic yearly until 3 normal results, then every 3 years or as directed Chlamydia screening for sexually active 25 yrs and younger and those over 26 yrs at high risk Annual breast exam. Mammogram beginning age 40 (every 1-2 yrs Cholesterol and Lipid screening every 5 years or as directed

26. Screening Guidelines 18 - 40 yrs40 – 50 yrs 50 – 65 yrs 65 and over FOBT annually and/or sigmoidoscopy every 5 yrs or colonoscopy every 10 yrs or as directed Blood pressure screening at least every 2 years or as directed Diabetes screening. Fasting plasma glucose (FPG) every 3 yrs at clinician’s discretion Human Papilloma Virus (HPV) all females 26 yrs and younger

27. Screening Guidelines 18 - 40 yrs40 – 50 yrs50 – 65 yrs 65 and over Influenza vaccine annually if high risk Pneumonia vaccine once at age 65; booster may be needed after 5 years Electrocardiogram (EKG) Baseline as directed Osteoporosis screening (Bone density test) as directed Vision exam – every 2 years Height and weight annually

28. The Mind/Body Relationship Physical health and mental health are interdependent Stress and psychological events that are potentially negative worsen health

29. The Mind/Body Relationship Physical illness can increase risk of developing depression and anxiety disorders Getting support has been shown to improve health

30. The Benefits of Relationships Relationships are vital sources of emotional support and good health. It is important to have: –Someone to talk to about things at work or at home –Someone who regularly helps with responsibilities and tasks –Someone who regularly helps with the children

31. You and Your Doctor Good communication is the key to a successful relationship! Go prepared to the office visit by making a list of your concerns and be as specific as possible.

32. You and Your Doctor Your doctor is your health care partner. It is important to choose doctors who will give you good care and who you can work well with. How to Choose a Doctor Look for a doctor who accepts your insurance and who is in your network (if you have an HMO or PPO) Internists and family practice doctors are good choices for a primary care doctor Ask relatives and friends for recommendations

33. In Summary: To Stay Healthy, Practice Prevention Eat healthy Exercise regularly Avoid tobacco use and limit alcohol Manage stress Get regular check-ups and recommended health screenings Know your numbers and your family history

34. Thank-you!!!

35. Thank you for participating in today’s workshop ! HAP encourages you to take an active role in managing your health. We offer iStrive SM for better health, a digital health coaching program to HAP HMO and Alliance members. The iStrive SM programs make it easy for you to achieve better health. HAP’s Vision: Enhancing the Health and Well-Being of the Lives We Touch

36. Resources/References Women and Cardiovascular Disease in Michigan Fact Sheet – MDCH Feb.2009 What Your Cholesterol Levels Mean – www.americanheart.orgwww.americanheart.org Heart Disease Health Center – Her Guide to a Heart Attack: Recognizing Female Heart Attack Symptoms – www.webmd.com www.webmd.com Depression Guide www.webmd.com/depressionwww.webmd.com/depression National Institute of Mental Health www.nimh.nih.govwww.nimh.nih.gov Osteoporosis – National Osteoporosis Foundation www.nof.orgwww.nof.org