Health24.com | When the big ‘C’ hits close to home

The big “C” has never really been a major issue in my life. It never really hit close to home – until it did. Within the space of two years it reared its ugly head – twice.

First a very close friend was diagnosed with breast cancer in April 2014.

‘I nearly fell off my chair’

I hadn’t heard from Kass in a while. But we’re like that; we have been friends for more than 20 years; she was my first mentor way back when I was an eager, nervous and very young intern. Through the years, though, we have always shared our big milestones, so longish gaps are normal for us. When we do catch up it is always epic, and always real. 

So when she popped up on my timeline, I was happy – as always – to catch up. And then she very casually slipped into the conversation: “Oh, by the way, we may have a breast cancer diagnosis.” At which point I nearly fell off my chair. Kass is my one friend who really does it by the book in terms of health – she eats well, looks after herself, and she runs marathons, for God’s sake.

She also has the two most beautiful children. Her youngest was 16 months at the time of diagnosis, and the eldest son four. My first thought was, “What about the kids?”

To say I was shocked would be an understatement. But over the years, Kass and I have also not done drama. This time would be no different – we’d get on with it. Practically speaking, her treatment involved immediate chemo, followed by a lumpectomy, more chemo and eventually a bilateral mastectomy.

Bilateral mastectomy

I saw Kass for the first time after she had started chemo. She’d already cut her hair short and it had started falling out. But she looked okay; she looked, well… normal, except the glossy curly mane was gone. She still had her sense of humour. But beneath it all – I cannot imagine how terrified she must have been – her whole world had changed.

I also can’t imagine how she must have felt when, after the initial chemo and lumpectomy, she was told she would have to undergo a bilateral mastectomy. What if she weren’t around to see the children grow up?

Being the resilient and strong person she is, Kass approached the treatment head-on. She gave it horns as it were. A week after having both breasts removed, she was at a fundraiser to raise money for her treatment. Dressed to the hilt and looking amazing.  

Three years later, she has started running marathons again. The children are thriving. So is her career – she edits a health magazine. Things are back to normal, whatever that is. She is an inspiration, as is her devoted husband who was steady as a rock – and an equally strong network of family and friends. Even her sisters now run. I haven’t got there yet…

‘How long does she have?’

In July, 2015 my mom was diagnosed with terminal lung cancer after having a minor stroke. The cancer diagnosis was made kind of by the way, following various scans after the stroke. She refuses treatment, which is her right. As a former nurse, she had a fair idea of what would lie ahead should she opt for treatment.

Her diagnosis was a cold slap in the face for me and my two sisters – one of whom is based in the UK. And of course the resultant worry – how would we cope, how do we manage her pain, and how long does she have?

Mom also has serious renal issues, so doing actual dye tests etc to test for spread would kill off her existing renal function. So every few months, we visit her physician and have the necessary X-rays done to see what we can.

To date, nothing much has changed – the cancer lesion hasn’t shown much growth. And although she eats like a baby bird, she is in relatively good shape. We manage whatever raises its head symptomatically. She has a great physician who takes no prisoners, a straight-talking, feisty woman. And we prefer it that way.

There is a reason mom was (and still is) known in nursing circles as “Battle Axe”. The  moniker is a perfect fit for her – and us – right now.

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Health24.com | How menopause harms your body

Oestrogen is the hormone that protects you against osteoporosis, cardiovascular disease and the external signs of ageing. Without oestrogen, it’s just a matter of time before you’ll start experiencing conditions such as atherosclerosis and osteoporosis, both of which are potentially lethal.

Menopause is, therefore, a signal to have a thorough medical check-up. Your doctor will help you to detect potential health problems before they occur and/or treat existing conditions before they become more serious.

Menopause and your bones

Osteoporosis can be a serious, long-term health consequence of menopause. It’s a silent disease until your bones become so weak that a sudden strain, bump or fall causes a fracture or a vertebra to collapse. Oestrogen deficiency accelerates the bone depletion that occurs during the normal ageing process, and about 25% of women gradually experience bone fragility and fractures.

Collapsed vertebrae may initially be felt or seen in the form of severe back pain, loss of height, or spinal deformities such as stooped posture.  

Bone loss in the femur bones occurs at a slower rate, and women who take menopausal hormone therapy (MHT) may not experience femur fractures until 70-75 years.

Hip fractures, in turn, are a common injury in women with osteoporosis at an advanced age. About 20% of Caucasian women at the age of 80 who don’t take MHT may develop hip fractures and usually require a long recovery period. Up to a quarter of those who do recover need to enter a long-term care facility, while 15% of women with hip fractures in this age group will die within six months – either from the fracture itself or from complications.

It’s been proven that oestrogen replacement therapy can slow and treat the development of osteoporosis.

Menopause and your heart

After menopause, the risk of a heart attack rises steadily. Generally, the incidence of heart attacks rises in both sexes with advancing age but the rate of increase is greater in women older than 50 than in men. As a result, the ratio of heart attacks in women to men after 50 decreases to 2:1 by age 65 and 1:1 by age 80. In addition, the first heart attack is more likely to be fatal for women than for men.

Oestrogen decrease is thought to cause unfavourable changes in cholesterol levels and other blood fats, as well as in fibrinogen, a substance that affects blood clotting. These changes may increase the risk of heart disease and stroke.

 

Heart disease is a leading cause of death among women. Part of the reason could be that women are taken less seriously when they arrive at the emergency unit with chest pain. Fortunately, however, most doctors now know that women may present with different patterns of chest pain than men, and that they should be assessed for a heart attack.

Menopause, fat distribution, muscle mass and skin

With increasing age and a decline in oestrogen levels, muscle mass decreases, body fat increases and skin collagen gradually becomes thinner and less elastic.

The increase in body weight and total body fat that many women experience is associated with a shift of fat: from the peripheral sites of the body to the abdomen. In some women this causes a change in shape from the more gynaecoid (female-like) to the android (male-like) fat distribution, which is thought to carry an increased risk for cardiovascular disease.

  Other changes include:

  • Changes to the breast tissue. The glandular tissue becomes less and is replaced by fat.
  • Skin changes. As oestrogen levels decline, skin collagen gradually becomes thinner and less elastic. This causes sags and wrinkles. The skin also becomes drier.
  • Hair loss. Oestrogen stimulates hair growth. When oestrogen levels fall, hair growth slows down and the hair becomes thinner and less manageable.
  • Dental problems. Decreased levels of oestrogen can lead to tooth loss, gingival bleeding and inflammation, and loosening of the teeth. Tooth loss could also be due to an underlying bone disease such as osteoporosis.

Menopause and your brain

Oestrogen has definite effects on the functioning of the brain. It affects the blood flow to the brain, growth and survival of nerve cells, and the way in which impulses are transmitted along nerve cells.  

Low levels of oestrogen have been linked to a decrease in mental abilities and alertness. This includes worsening short-term memory, disturbances of cognitive function, and going blank during sentences.

Menopause and fertility As the number of eggs in the ovaries is reduced and ovulation becomes irregular, the ability of perimenopausal women to conceive decreases. However, pregnancy is still possible. Use contraception until you’ve had 12 period-free months if you don’t plan to conceive.

When to see a doctor
Consult your family doctor or gynaecologist for routine check-ups and advice about the above-mentioned conditions. This is especially important if you have a personal or family history of heart disease and/or osteoporosis. Call a health professional without delay if:

  • You have prolonged, irregular bleeding. This may be particularly important if you’re overweight.
  • You experience bleeding after not having had a period for six months or more. Among other possibilities, it may be a sign of uterine cancer. 
  • Mood changes are causing problems. If depression is severe or persists for more than two weeks, consult your doctor. 

Reviewed and updated by Dr Carol Thomas MBChB (UCT) FCOG (SA) MMed (O&G) (UCT), specialist gynaecologist in private practice, Cape Town, President of the South African Menopause Society and Director of the WomanSpace and iMobiMaMa. (March 2017)

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Health24.com | How to deal with hot flushes

About 75-80% of women are affected by hot flushes – one of the most common symptoms of menopause.

Hot flushes (or flashes) generally start during the menopause transition, the period before the actual menopause (when you’ve completely stopped menstruating). Once you’ve reached menopause, you may continue to have hot flushes.

Research shows that hot flushes are often linked to poor quality of life, including sleep disturbances, anxiety, depression and reduced cognitive function (e.g. forgetfulness, difficulty concentrating).

What is a hot flush?

A hot flush is a feeling of intense heat, not caused by external sources. These flushes can appear suddenly, or you may feel them coming on.

You may experience:

  • Tingling in your fingers
  • Your heart beating faster than usual (heart palpitations)
  • Your skin feeling suddenly warm
  • Your face and/or chest getting red or flushed
  • Sweating, especially in the upper body

A hot flush generally lasts less than five minutes, and the sweating that accompanies the flush usually starts a minute after experiencing heart palpitations. It may be followed by a chill, and some women feel anxious.

How often and when do hot flushes occur?

The frequency may range from one or two flushes per day to one every 15–30 minutes. Hot flushes tend to be more pronounced late in the day, during hot weather, after ingestion of hot foods or drinks, or during periods of stress and tension.

If thoughts about the general troubles of life don’t keep you awake at night, hot flushes might. In turn, this could lead to fatigue, anxiety and depression. Hot flushes accompanied by sweating during sleeping hours are called night sweats.

Hot flushes can begin during the menopause transition (the perimenopause), before menstruation stops. Most women have hot flushes for more than a year, while 25–50% will suffer for up to five years (or longer) if they’re not treated.

What causes hot flushes?

It’s not exactly clear what causes hot flushes, but they’re most likely due to hormonal changes in the body. Some women barely notice them or consider them a minor annoyance. For others, the intensity may have a pronounced effect on their quality of life.

Interestingly, new research is linking hot flushes to inflammation in the body, which is likely triggered by the decline of hormones such as oestrogen. This could explain the increased risk for cardiovascular disease and osteoporosis that coincides with this life event.

Previous studies also indicated that many women who experience hot flushes also have an impaired lipid profile (a risk factor for cardiovascular disease), endothelial dysfunction (i.e. the inner lining of the blood vessels don’t function as they should), increased atherosclerosis (a disease characterised by fatty deposits on the inner artery walls) and insulin resistance (which could lead to diabetes) during the menopause period. 

Home treatment of hot flushes

If you experience hot flushes, the following tips could be helpful:

  • Keep your home and workplace cool.
  • Wear loose clothing in layers that are easily removed. Choose natural fibres.
  • Drink plenty of fresh, cool water.
  • Avoid caffeine, alcohol, hot drinks and spicy foods if they bring on hot flushes.
  • Exercise daily to help stabilise hormones and insulin levels. Although hot flushes can occur during exercise, regular exercise can help beat flushes and relieve insomnia.
  • Avoid confined spaces and hot, humid weather.
  • Keep a journal about your symptoms. Write down what you were doing, eating, drinking, feeling, or wearing when each hot flush began. After several weeks, you may begin to see a pattern that can help you to avoid specific triggers.

Home treatment for night sweats

  • Wear light pyjamas.
  • Sleep under a sheet and/or a light blanket (not a thick duvet).
  • Have a brief shower if you wake up drenched.

Medication

About one in four women suffers from such severe hot flushes that they need menopause hormone therapy (MHT). MHT is the most effective treatment for menopausal symptoms.

The proposed mechanism of action of oestrogen therapy is that it ameliorates hot flashes by raising the core body temperature sweating threshold. Antidepressants are recommended as a first-line treatment for hot flushes in women who can’t take oestrogen. Talk to your doctor about your options.

Alternative therapies

Acupuncture may be helpful, and comes without the side effects of medication. A small study found that women who had acupuncture had significantly fewer menopausal symptoms, including hot flushes, than those who had sham treatments. Sham acupuncture is shallow needling that doesn’t stimulate a true acupuncture point.

Meditation can also be very successful in helping manage stress levels. Stress is a common hot-flush trigger for many women.

Reviewed and updated by Dr Carol Thomas MBChB (UCT) FCOG (SA) MMed (O&G) (UCT), specialist gynaecologist in private practice, Cape Town, President of the South African Menopause Society and Director of the WomanSpace and iMobiMaMa. (March 2017)  

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