Healthy Living

Exercise 60 minutes a day

You get the most benefit from exercise if you do it for at least 60 minutes a day for 5 - 6 days a week. But you do not have to do 60 minutes in a row. Studies suggest that you get the same benefits if you work out for 20 minutes 3 times a day as you do during a longer session.

Exercise with friends

Exercising with a friend or a group of people can help make it more fun, interesting, and keep you motivated to continue with a regular exercise routine.

Exercise - a powerful tool

Physical fitness is essential to good health and is one of the best things you can do for your body, mind, and spirit. Exercise improves the way your body works, and it can make you look better, feel better, and even live longer.

Information

While maintaining good health habits cannot guarantee a longer life, it can certainly improve the quality of your life. A few simple things, if practiced regularly, can help reduce your risk of illness and enrich your life:

• Get regular exercise and control your weight.
• Don't smoke or abuse drugs.
• Do not drink a lot of alcohol. Avoid alcohol completely if you have a history of alcoholism.
• Eat a balanced and healthy diet.
• Take care of your teeth.
• Manage high blood pressure.
• Follow good safety practices.

EXERCISE

Exercise is a key factor in staying healthy. Exercise strengthens the bones, heart, and lungs, tones muscles, improves vitality, relieves depression, and helps you sleep better.

If you are just starting an exercise program and have any pre-existing conditions, such as obesity, hypertension, or diabetes, ask your doctor about an exercise stress test. This test will help you establish safe limits for your exercise program.

Tips for healthy exercise:

• Begin exercising gradually, perhaps with brisk walking. Don't expect to "get into shape" overnight. Your fitness should start to improve within 3 months, provided you maintain a consistent regimen.
• You should work hard enough to sweat during each exercise period, but not so hard that you cannot carry on a conversation.
• Plan an exercise routine that lasts 20 - 30 minutes, and perform the workout at least 3 - 5 days a week. Include stretching before and after your exercise. This will help avoid injury. Remember to start slowly and listen to your body. If it hurts badly, then you are probably overdoing it.
• Aerobic exercises strengthen the heart and lungs and should be part of the fitness routine. Examples of good aerobic exercises include walking, running, jogging, swimming, cross-country skiing, rowing, rope skipping, dancing, racket sports, and cycling. For the biggest benefit, aerobic exercise must be sustained for at least a 10- to 12-minute period.
• Strength and flexibility exercises are important and help you maintain your ability to do daily activites and maintain balance as you grow older.

Adjustments in exercise programs need to be made for children, pregnant women, the elderly, patients who are obese or disabled, and heart-attack survivors. Programs should also be modified for high altitudes and extreme hot or cold conditions.

SMOKING

Cigarette smoking is the single most preventable cause of premature death in the United States, and more than 400,000 Americans die each year from cigarette smoking. One out of every five deaths annually is either directly or indirectly caused by smoking.

Secondhand cigarette smoke exposure causes approximately 3,000 lung cancer deaths in adult nonsmokers in the United States each year. Studies have also linked secondhand smoke with heart disease.

The serious diseases most frequently caused by smoking are:

• Angina
• Chronic bronchitis
• Emphysema
• Heart attack
• Leg pain as a result of blockages in lower extremity arteries (claudication)
• Lung cancer (the risk for smokers is 10 times greater than for nonsmokers)
• Stroke (the risk for smokers is almost 3 times greater than for nonsmokers)

It is never too late to quit smoking. Two years after stopping, your risk of heart attack returns to average and there your lung cancer risk drops by about a third. After 10 years of not smoking, your risk for lung cancer returns to near normal.

ALCOHOL USE

Consumption of alcohol gradually depresses brain function. Emotions, thought processes, and judgment are first to be affected by alcohol consumption. With continued drinking, motor control becomes impaired, causing slurred speech, slower reactions, and poor balance. Both increased body fat and drinking on an empty stomach speed the rate of alcohol intoxication.

The diseases most frequently caused by alcoholism are:

• Acute and chronic pancreatitis
• Bleeding esophageal varices
• Cancer of larynx, esophagus, stomach and pancreas
• Cardiomyopathy
• Cirrhosis of the liver
• Hepatitis
• Impotence
• Mallory-Weiss tear
• Menstrual irregularity
• Sleep disorders
• Wernicke-Korsakoff syndrome

Do not drink alcohol when you are pregnant. Fetal alcohol syndrome is the most common known cause of mental retardation.

Parents should talk to their children about the dangerous effects of alcohol. Establish trusting communication with your children so that sensitive issues can be discussed. Don't allow your children to be guided completely by their peers. Children need firm and loving guidance.

DRUG USE AND ABUSE

Everybody reacts differently to medications. Always tell your doctor about the drugs you are taking, including over-the-counter medications and vitamins.

Drug interactions can have serious health consequences. Elderly people should be particularly careful about drug interactions with multiple medications, and should closely monitor this situation if it applies. Carry a list of your current medications, especially when going to different doctors for the treatment of different problems.

Avoid drinking alcohol while on medications -- this combination can be very dangerous, particularly with tranquilizers or painkillers.

Mothers-to-be should avoid taking any unprescribed drug during pregnancy -- especially during the first trimester, when the fetus is very sensitive to drugs in the mother's body. If you have been taking any drugs just before becoming pregnant, inform your doctor.

Always take medication as prescribed. Taking any drug in a manner other than as intended or in quantities other than directed is considered drug abuse. Abuse and addiction are not just associated with illegal "street" drugs. Legal drugs such as laxatives, painkillers, nasal sprays, diet pills, and cough medicines can also be misused, resulting in serious health problems.

Addiction is defined as compulsive use of a substance despite continued negative consequences. Simply needing a drug (like a painkiller or antidepressant) and taking it as prescribed is not addiction.

The signs and symptoms of addiction are different for each person but may include:

• Agitation
• Bloodshot eyes
• Dazed appearance
• Excessive sweating
• Flushed skin
• Insomnia
• Persistent running nose
• Personality changes
• Unexplained weight loss
• Unpredictable moods

Signs of drug abuse in teenagers may include: apathy, temper tantrums, missing school, sloppy dress, lack of interest in school, excessive demands for privacy, secrecy, and a change in type of friends. However, some teens in trouble may show none of these symptoms.

DEALING WITH STRESS

Stress is normal. It can be a great motivator, and in small amounts can even improve health. However, excessive stress can cause headaches, sleeping problems, stomach problems, mood problems, and more.

Learn to recognize the things most likely to cause stress in your life. You may not be able to avoid all of them, but knowing the source of your stress can help you feel more "in control." The more control you feel you have over your life, the less damaging the stress.

OBESITY

Obesity is serious health concern. It adds stress to the heart, bones, and muscles. and increases the risk for high blood pressure, stroke, varicose veins, breast cancer, and gallbladder disease.

Overeating, an unhealthy diet, and a lack of physical activity can lead to obesity. Your family history also plays a role.

DIET

As a general rule, you should choose foods that are low in saturated and trans fat, and low in cholesterol. Also limit your intake of sugar, salt (sodium), and alcohol. Eat more fiber , which can be found in fruits, vegetables, beans, whole grain products, and nuts.

TOOTH CARE

Good dental hygiene is essential in preserving your teeth for a lifetime. It is important for children to start young with good dental habits. Proper hygiene should include:

• Daily flossing and twice-daily brushing of the teeth
• Use of fluoride toothpaste
• Regular dental checkups
• Limiting sugar intake
• Using a toothbrush with soft bristles (replace the toothbrush with a new one as soon as the bristles become bent)
• Having the dentist instruct you on proper brushing and flossing techniques
• Being aware that "tartar-controlled" toothpastes have little or no effect on tartar below the gum line and, therefore, will not provide a safeguard against gum disease

Consumer Rights and Responsibilities

Types of health care providers

Health care providers range from generalists to providers who specialize in certain areas of the body or disease. Any category of medicine or care such as cancer or anesthesia can have a specialist. Nurses also can specialize in certain areas of medical care.

Information

In March 1998, the Advisory Commission on Consumer Protection and Quality in the Health Care Industry issued its final report, which included the Consumer Bill of Rights and Responsibilities. The Commission was appointed by President Bill Clinton, and co-chaired by Donna Shalala, Secretary of the Department of Health and Human Services.

The purpose of the Bill of Rights is:

• To build up consumer confidence in the health care system, by making it easy for consumers to participate actively in their own health care.
• To strongly support the importance of a good healthcare provider and that of a good provider-patient relationship.
• To emphasize and support the importance of the consumers' role in making sure they have rights and responsibilities with regard to health improvement.

The following section, Consumer Bill of Rights, was developed by the federal government. This has been used as a foundation for many health plans, including the federal-government-sponsored health plans.

Consumer Bill of Rights

I. Information Disclosure

You have the right to receive accurate and easily understood information about your health plan, health care professionals, and health care facilities. If you speak another language, have a physical or mental disability, or just don't understand something, assistance will be provided so you can make informed health care decisions.

II. Choice of Providers and Plans

You have the right to a choice of health care providers that is sufficient to provide you with access to appropriate high-quality health care.

III. Access to Emergency Services

If you have severe pain, an injury, or sudden illness that convinces you that your health is in serious jeopardy, you have the right to receive screening and stabilization emergency services whenever and wherever needed, without prior authorization or financial penalty.

IV. Participation in Treatment Decisions

You have the right to know all your treatment options and to participate in decisions about your care. Parents, guardians, family members, or other individuals that you designate can represent you if you cannot make your own decisions.

V. Respect and Nondiscrimination

You have the right to considerate, respectful and nondiscriminatory care from your doctors, health plan representatives, and other health care providers.

VI. Confidentiality of Health Information

You have the right to talk in confidence with health care providers and to have your health care information protected. You also have the right to review and copy your own medical record and request that your physician amend your record if it is not accurate, relevant, or complete.

VII. Complaints and Appeals

You have the right to a fair, fast and objective review of any complaint you have against your health plan, doctors, hospitals or other health care personnel. This includes complaints about waiting times, operating hours, the conduct of health care personnel, and the adequacy of health care facilities.

Consumer Responsibilities

In addition to outlining consumer rights for health care, the Advisory Commission on Consumer Protection and Quality in the Health Care Industry also outlined guidelines for the responsibilities that the consumer has with regard to their own healthcare. The responsibilities outlined are ways that the consumer can work together with the health care provider to achieve the best quality health outcome.

• Take responsibility for maximizing healthy habits, such as exercising, not smoking, and eating a healthy diet.
• Become involved in specific health care decisions.
• Work collaboratively with health care providers in developing and carrying out agreed-upon treatment plans.
• Disclose relevant information and clearly communicate wants and needs.
• Use the health plan's internal complaint and appeal process to address concerns that may arise.
• Avoid knowingly spreading disease.
• Recognize the reality of risks and limits of the science of medical care and the human fallibility of the health care professional.
• Be aware of a health care provider's obligation to be reasonably efficient and equitable in providing care to other patients and the community.
• Become knowledgeable about his or her health plan coverage and health plan options (when available) including all covered benefits, limitations and exclusions, rules regarding use of information, and the process to appeal coverage decisions.
• Show respect for other patients and health workers.
• Make a good-faith effort to meet financial obligations.
• Abide by administrative and operational procedures of the health plans and health care providers.
• Report wrongdoing and fraud to appropriate resources or legal authorities.

Wine and Heart Health

Wine and health

The U.S. Dietary Guidelines recommend that if you drink, do so in moderation and when consumption does not put you or others at risk.

Information

There is a fine line between healthy drinking and risky drinking. More studies are being done on the possible benefits wine (particularly red wine) may have on heart disease. However, it is a controversial topic.

There is some evidence from studies of large populations of people that those who drink moderately may be less likely to develop heart disease than those who do not drink at all. However, drinking alcohol has been linked to high blood pressure, cancer, stroke, suicide, motor vehicle accidents, physical abuse, obesity, heart failure, arrhythmias (irregular heart rhythms), pancreatitis (inflammation of the pancreas), and liver disease.

Specifically, alcohol abuse is associated with cancer of the mouth, larynx (voice box), pharynx (throat), colon, rectum, and female breast, among others. In addition, although some studies suggest that alcohol may raise HDL (the good kind of cholesterol), it also raises triglycerides (a type of fat in the blood).

The American Heart Association and other experts emphasize that there are much more effective ways to prevent heart disease including:

• Controlling your blood pressure and cholesterol
• Exercising and following a low-fat, healthy diet
• Not smoking
• Maintaining a normal weight

These tried and true methods have much more scientific proof supporting them than does drinking moderate amounts of alcohol. Furthermore, the benefits suggested by some of the studies on alcohol are likely due to other factors such as the antioxidants found in red wine called flavonoids (which are also found in other foods such as grapes and red grape juice), more physical activity in countries that drink wine regularly, and a diet high in fruits and vegetables.

There is also a substance in alcohol known as resveratrol, which may reduce blood clot formation. However, taking aspirin in accordance with your doctor's instructions is a more standard method for lowering your chances of developing a blood clot if you are at risk for heart disease or stroke. Note: you should NOT drink alcohol if you take aspirin regularly.

Women should limit alcohol consumption to no more than one drink per day, men to no more than two drinks per day. A drink is defined as 12 ounces of beer, 4 ounces of wine, or 1.5 oz. of liquor or 80-proof spirits.

It is important to know that even light drinking can lead to addiction. Pregnant women need to avoid alcohol consumption altogether because it can cause serious birth defects.

Humidifiers and Health

Humidifiers and health

Humidifiers help raise the level of humidity or moisture in the air. Increasing the humidity in the home helps eliminate the dry air that can irritate and inflame the respiratory passages in the nose and throat. Humidified air can relieve the discomfort of colds and the flu, and help people who suffer from asthma.

Information

Increasing the humidity in your home helps eliminate the dry air that can irritate and inflame the passages in the nose and throat. Humidified air can relieve the discomfort of cold and the flu and can be particularly helpful for people who suffer from asthma. Humidified air can also help maintain skin moisture and alleviate dry skin.

Humidifiers must be drained and cleaned frequently, because bacteria can multiply in dirty and stale water, including the bacteria that causes Legionnaire's disease. Children should use a cool-mist humidifier to avoid accidental steam burns.

Breast Cancer

Female Breast

The female breast is either of two mammary glands (organs of milk secretion) on the chest.

Needle biopsy of the breast

A needle biopsy is performed under local anesthesia. Simple aspirations are performed with a small gauge needle to attempt to draw fluid from lumps that are thought to be cysts. Fine needle biopsy uses a larger needle to make multiple passes through a lump, drawing out tissue and fluid. Withdrawn fluid and tissue is further evaluated to determine if there are cancerous cells present.

Open biopsy of the breast

An open biopsy can be performed under local or general anesthesia and will leave a small scar. Prior to surgery, a radiologist often first marks the lump with a wire, making it easier for the surgeon to find.

Breast self-exam

Monthly breast self-exams should always include: visual inspection (with and without a mirror) to note any changes in contour or texture; and manual inspection in standing and reclining positions to note any unusual lumps or thicknesses.

Breast self-exam

Monthly breast self-exams should always include: visual inspection (with and without a mirror) to note any changes in contour or texture; and manual inspection in standing and reclining positions to note any unusual lumps or thicknesses.

Breast self-exam

Monthly breast self-exams should always include: visual inspection (with and without a mirror) to note any changes in contour or texture; and manual inspection in standing and reclining positions to note any unusual lumps or thicknesses.

Mammary gland

The anatomy of the breast includes the lactiferous, or milk ducts, and the mammary lobules.

Sentinel node biopsy

Sentinel node biopsy is a technique which helps determine if a cancer has spread (metastasized), or is contained locally. When a cancer has been detected, often the next step is to find the lymph node closest to the tumor site and retrieve it for analysis. The concept of the "sentinel" node, or the first node to drain the area of the cancer, allows a more accurate staging of the cancer, and leaves unaffected nodes behind to continue the important job of draining fluids. The procedure involves the injection of a dye (sometimes mildly radioactive) to pinpoint the lymph node which is closest to the cancer site. Sentinel node biopsy is used to stage many kinds of cancer, including lung and skin (melanoma).

Mastectomy - series: Normal anatomy

Breast cancer begins in the breast and spreads first to the lymph nodes of the armpit (axilla). When a breast lump is found to contain cancer, and if the cancer has not spread beyond the nodes of the axilla to distant sites, it is often removed surgically. Radiation therapy may be used in addition to surgery. In certain cases of malignant lumps, lumpectomy followed by radiation therapy is as effective as a radical mastectomy. Typically, lumpectomy does not require a breast replacement (prosthesis).

Breast lump removal - series: Normal anatomy

The female breast is composed mainly of fatty tissue interspersed with fibrous or connective tissue. The circular region around the nipple is often a different color or pigmented. This region is called the areola.

Definition

Breast cancer is a cancer that starts in the tissues of the breast.

There are two main types of breast cancer:

• Ductal carcinoma starts in the tubes (ducts) that move milk from the breast to the nipple. Most breast cancers are of this type.
• Lobular carcinoma starts in parts of the breast, called lobules, that produce milk.

In rare cases, breast cancer can start in other areas of the breast.

Many breast cancers are sensitive to the hormone estrogen. This means that estrogen causes the breast cancer tumor to grow. Such cancer is called estrogen receptor positive cancer or ER positive cancer.

Some women have what's called HER2-positive breast cancer. HER2 refers to a gene that helps cells grow, divide, and repair themselves. When cells have too many copies of this gene, cells -- including cancer cells -- grow faster. Experts think that women with HER2-positive breast cancer have a more aggressive disease and a higher risk of recurrence than those who do not have this type.

Causes, incidence, and risk factors

Over the course of a lifetime, one in eight women will be diagnosed with breast cancer.

Risk factors you cannot change include:

Age and gender -- Your risk of developing breast cancer increases as you get older. The majority of advanced breast cancer cases are found in women over age 50. Women are 100 times more likely to get breast cancer then men.

Family history of breast cancer -- You may also have a higher risk for breast cancer if you have a close relative has had breast, uterine, ovarian, or colon cancer. About 20-30% of women with breast cancer have a family history of the disease.

Genes -- Some people have genes that make them more prone to developing breast cancer. The most common gene defects are found in the BRCA1 and BRCA2 genes. These genes normally produce proteins that protect you from cancer. But if a parent passes you a defective gene, you have an increased risk for breast cancer. Women with one of these defects have up to an 80% chance of getting breast cancer sometime during their life.

Other genetic defects have been linked to breast cancer, including those found in the ATM gene, the CHEK-2 gene, and the p53 tumor suppressor gene, but these are very rare.

Menstrual cycle -- Women who get their periods early (before age 12) or went through menopause late (after age 55) have an increased risk for breast cancer.

Other risk factors include:

Alcohol use -- Drinking more than 1-2 glasses of alcohol a day may increase your risk for breast cancer.

Childbirth -- Women who have never had children or who had them only after age 30 have an increased risk for breast cancer. Being pregnant more than once or becoming pregnant at an early age reduces your risk of breast cancer.

DES -- Women who took diethylstilbestrol (DES) to prevent miscarriage may have an increased risk of breast cancer after age 40. This drug was given to the women in the 1940s-1960s.

Hormone replacement therapy (HRT) -- You have a higher risk for breast cancer if you have received hormone replacement therapy for several years or more. Many women take HRT to reduce the symptoms of menopause.

Obesity -- Obesity has been linked to breast cancer, although this link is controversial. The theory is that obese women produce more estrogen, which can fuel the development of breast cancer.

Radiation -- If you received radiation therapy as a child or young adult to treat cancer of the chest area, you have a significantly higher risk for developing breast cancer. The younger you started such radiation, the higher your risk -- especially if the radiation was given when a female was developing breasts.

Breast implants, using antiperspirants, and wearing underwire bras do not raise your risk for breast cancer. There is no evidence of a direct link between breast cancer and induced abortion or pesticides.

The National Cancer Institute provides an online tool to help you figure out your risk of breast cancer.

Symptoms

Early breast cancer usually does not cause symptoms. This is why regular breast exams are important. As the cancer grows, symptoms may include:

• Breast lump or lump in the armpit that is hard, has uneven edges, and usually does not hurt
• Change in the size, shape, or feel of the breast or nipple -- for example, you may have redness, dimpling, or puckering that looks like the skin of an orange
• Fluid coming from the nipple -- may be bloody, clear-to-yellow, or green, and look like pus

Men get breast cancer, too. Symptoms include breast lump and breast pain and tenderness.

Symptoms of advanced breast cancer may include:

• Bone pain
• Breast pain or discomfort
• Skin ulcers
• Swelling of one arm (next to breast with cancer)
• Weight loss

Signs and tests

The doctor will ask you about your symptoms and risk factors, and then perform a physical exam, which includes both breasts, armpits, and the neck and chest area. Additional tests may include:

• Mammography to help identify the breast lump
• Breast MRI to help better identify the breast lump
• Breast ultrasound to show whether the lump is solid or fluid-filled
• Breast biopsy, needle aspiration, or breast lump removal to remove all or part of the breast lump for closer examination by a laboratory specialist

If your doctor learns that you do have breast cancer, additional tests will be done to see if the cancer has spread. This is called staging. Staging helps guide future treatment and follow-up and gives you some idea of what to expect in the future.

Breast cancer stages range from 0 to IV. In general, breast cancer that stays where it has started is called in situ or noninvasive breast cancer. If it spreads, it is called invasive breast cancer. The higher the number, the more advanced the cancer.

Treatment

Treatment is based on many factors, including type and stage of the cancer, whether the cancer is sensitive to certain hormones, and whether or not the cancer overproduces (overexpresses) a gene called HER2/neu.

In general, cancer treatments may include:

• Chmotherapy medicines to kill cancer cells
• Radiation therapy to destroy cancerous tissue
• Surgery to remove cancerous tissue - a lumpectomy removes the breast lump; mastectomy removes all or part of the breast and possible nearby structures

Other treatments:

• Hormonal therapy to block certain hormones that fuel cancer growth
• Targeted therapy to interfere with cancer cell grow and function

An example of hormonal therapy is the drug tamoxifen. This drug blocks the effects of estrogen, which can help breast cancer cells survive and grow. Most women with estrogen sensitive breast cancer benefit from this drug. A newer class of medicines called aromatase inhibitors, such as exemestane (Aromasin), have been shown to work just as well or even better than tamoxifen in post-menopausal women with breast cancer.

Targeted therapy, also called biologic therapy, is a newer type of cancer treatment. This therapy uses special anti-cancer drugs that identify certain changes in a cell that can lead to cancer. One such drug is trastuzumab (Herceptin). For women with stage IV HER2-positive breast cancer, Herceptin plus chemotherapy has been shown to be work better than chemotherapy alone. Studies have also shown that in women with early stage HER2-positive breast cancer, this medicine plus chemotherapy cuts the risk of the cancer coming back by 50%.

Cancer treatment may be local or systemic.

• Local treatments involve only the area of disease. Radiation and surgery are forms of local treatment.
• Systemic treatments affect the entire body. Chemotherapy is a type of systemic treatment.

Most women receive a combination of treatments. For women with stage I, II, or III breast cancer, the main goal is to treat the cancer and prevent it from returning. For women with stage IV cancer, the goal is to improve symptoms and help them live longer. In most cases, stage IV breast cancer cannot be cured.

Stage 0 -- Lumpectomy plus radiation or mastectomy is the standard treatment. There is some controversy on how best to treat DCIS.

Stage I and II -- Lumpectomy plus radiation or mastectomy with some sort of lymph node removal is standard treatment. Hormone therapy, chemotherapy, and biologic therapy may also be recommended following surgery.

Stage III -- Treatment involves surgery possibly followed by chemotherapy, hormone therapy, and biologic therapy.

Stage IV -- Treatment may involve surgery, radiation, chemotherapy, hormonal therapy, or a combination of such treatments.

Support Groups

Talking about your disease and treatment with others who share common experiences and problems can be helpful.

Expectations (prognosis)

How well you do after being treated for breast cancer depends on many things. The more advanced your cancer, the poorer the outcome.

The 5-year survival rate refers to the number of patients who live at least 5 years after their cancer is found. According to the American Cancer Society (ACS), the 5-year survival rates for persons with breast cancer that is appropriately treated are as follows:

• 100% for stage 0
• 100% for stage I
• 92% for stage IIA
• 81% for stage IIB
• 67% for stage IIIA
• 54% for stage IIIB
• 20% for stage IV

Complications

New, improved treatments are helping persons with breast cancer live longer than ever before. However, even with treatment, breast cancer can spread to other parts of the body. Sometimes, cancer returns even after the entire tumor is removed and nearby lymph nodes are found to be cancer-free.

You may experience side effects or complications from cancer treatment. For example, radiation therapy may cause temporary swelling of the breast, and aches and pains around the area. Ask your doctor about the side effects you may have during treatment.

Calling your health care provider

Contact your health care provider for an appointment if:

• You have a breast or armpit lump
• You are a woman age 40 or older and have not had a mammogram in the last year
• You are a woman age 35 or older and have a mother or sister with breast cancer, or have already had cancer of the breast, uterus, ovary, or colon.
• You do not know how or need help learning how to perform a breast self-examination

Prevention

Many risk factors -- such as your genes and family history -- cannot be controlled. However, a healthy diet and a few lifestyle changes may reduce your overall chance of cancer in general.

Breast cancer is more easily treated and often curable if it is found early.

Early detection involves:

• Breast self-exams (BSE)
• Clinical breast exams by a medical professional
• Screening mammography

Most experts recommend that women age 20 and older examine their breasts once a month during the week following the menstrual period.

Women between the ages 20 and 39 should have a doctor examine their breasts at least once every 3 years. After age 40, women should a clinical breast exam every year.

Mammography is the most effective way of detecting breast cancer early.

Screening recommendations:

• The American Cancer Society recommends mammogram screening every year for all women age 40 and older. The National Cancer Institute (NCI) recommends mammogram screening every 1-2 years for women age 40 and older.
• If you are high risk, experts say you should start getting a mammogram at age 30. Certain women at high risk of breast cancer should also have a breast MRI along with their yearly mammogram. Ask your doctor if you need an MRI.
• For those at high risk, including those who have or had a close family member with the disease, annual mammograms should begin 10 years earlier than the age at which the relative was diagnosed.

Questions have been raised about the benefit of screening mammography in women under age 50 and over the age of 69. Annual mammograms in women between 50 and 69 have been show to save lives. But while screening can also detect early breast cancer in younger and older women, it has not been shown to save lives.

This is a topic filled with controversy. A woman needs to have an informed and balanced discussion with her doctor, along with doing additional reading and researching on her own, to determine if mammography is right for her.

Women at very high risk for breast cancer may consider preventive (prophylactic) mastectomy, which is the surgical removal of the breasts. Possible candidates for this procedure may include those who have already had one breast removed due to cancer, women with a strong family history of breast cancer, and persons with genes or genetic mutations that raise their risk of breast cancer.

Facelift

Sagging or wrinkled skin occurs naturally with increasing age. Folds and fat deposits appear around the neck, and deep flexion creases form between the nose and mouth. The jawline grows jowly and slack. Heredity, poor diet, smoking, or obesity may contribute to early or severe skin problems. A facelift can help repair some of the visible damage to skin, fat, and muscles and can restore a younger look. A facelift can be done alone or with nose reshaping, a forehead lift, or eyelid surgery.

Definition

A facelift is a surgical procedure to repair sagging, drooping, and wrinkled skin of the face and neck. It is performed to improve visible signs of aging, poor diet, or heredity; it is performed by removing excess fat, tightening underlying muscles, and redraping facial and neck skin.

Description

Sagging or wrinkled skin occurs naturally with increasing age. Folds and fat deposits appear around the neck, and deep flexion creases form between the nose and mouth. The jawline grows "jowly" and slack. Heredity, poor diet, smoking, or obesity may contribute to early or severe skin problems.

A facelift can help repair some of the visible damage to skin, fat, and muscles and can restore a "younger" look. A facelift can be done alone or with nose reshaping , a forehead lift, or eyelid surgery.

While the patient is sleepy (sedated) and pain-free (local anesthesia) or deep asleep and pain-free (general anesthesia), the plastic surgeon makes incisions above the hairline at the temples, behind the earlobe, to the lower scalp.

The surgeon removes some of the fat tissue and loose skin, then stitches (sutures) the incisions closed. The fat tissue is called the SMAS layer and is the primary lifting portion of the facelift.

Indications

Dissatisfaction with facial signs of aging and otherwise good health.

Risks

Risks for any anesthesia are:

• reactions to medications
• problems breathing

Risks for any surgery are:

• bleeding
• infection

Additional risks include:

• a pocket of blood under the skin (hematoma) that may require drainage
• injury to nerves that control facial muscles (usually temporary)

Expectations after surgery

Most patients are pleased with the results.

A small, thin drainage tube may be temporarily placed under the skin behind the ear to drain any blood that might collect there. The head is wrapped loosely in bandages to minimize bruising and swelling. Usually there is not much discomfort after surgery and pain medication can relieve it. Some numbness of the skin is normal and will disappear in a few weeks or months.

The head will be elevated on two pillows (or at a 30 degree angle) for a couple of days after surgery to keep the swelling down. The drainage tube will be removed 1 to 2 days after surgery if one was inserted. Bandages are usually removed after 1 to 5 days. The face will look pale, bruised, and puffy, but in 4 to 6 weeks it will be looking normal.

Most of the stitches will be removed in 5 days. The stitches or metal clips in the hairline could be left in a few days longer if the scalp takes longer to heal.

Convalescence

The patient should expect swelling, bruising, skin discoloration, tenderness, and numbness for 10 to 14 days. Most of the surgical scars are hidden in the hairline or the natural lines of the face and will fade over months. Sun exposure should be limited.

Heart Attack First Aid

Heart attack symptoms

Symptoms of a heart attack may be widely varied, from the classic "elephant on the chest" feeling of crushing pain, to the nausea and heartburn mistaken for indigestion. In some patients, the symptoms may only be sudden fatigue or an oppressive feeling of impending death.

Symptoms of heart attack

Symptoms of a heart attack can vary widely and can mimic other conditions such as indigestion or heartburn. The important fact to know is to take all heart attack related symptoms seriously and seek medical help as soon as possible.

A heart attack is a medical emergency.

The average person waits 3 hours before seeking help for symptoms of a heart attack. Many heart attack victims die before they reach a hospital. The sooner someone gets to the emergency room, the better the chance of survival. Prompt medical treatment also reduces the amount of damage done to the heart following an attack.

Considerations

Heart disease is the leading cause of death in America today.

Causes

A heart attack occurs when the blood flow that carries oxygen to the heart is blocked. The heart muscle becomes starved for oxygen and begins to die.

Symptoms

Heart attacks can cause a wide range of symptoms, from mild to intense. Women, the elderly, and persons with diabetes are more likely to have subtle or atypical symptoms.

Symptoms in adults may include:

• Chest pain
  • Usually in the center of chest
  • Lasts for a more than a few minutes or comes and goes
  • May feel like pressure, squeezing, fullness
  • Pain may be felt in other areas of the upper body, such as the jaw, shoulder, one or both arms, back, and stomach area
• Shortness of breath
• Cold sweat
• Nausea
• Lightheadedness

Women are more likely than men to have symptoms of nausea, vomiting, back or jaw pain, and shortness of breath with chest pain.

Babies and children may appear limp and unresponsive and may have bluish-colored skin.

First Aid

1. Have the person sit down, rest, and try to keep calm.
2. Loosen any tight clothing.
3. Ask if the person takes any chest pain medication for a known heart condition.
4. Help the person take the medication (usually nitroglycerin, which is placed under the tongue).
5. If the pain does not go away promptly with rest or within 3 minutes of taking nitroglycerin, call for emergency medical help.
6. If the person is unconscious and unresponsive, call 911 (or your local emergency number), then begin CPR.
7. If an infant or child is unconscious and unresponsive, perform 1 minute of CPR, then call 911.

Do Not

• DO NOT leave the person alone except to call for help, if necessary.
• DO NOT allow the person to deny the symptoms and convince you not to call for emergency help.
• DO NOT wait to see if the symptoms go away.
• DO NOT give the person anything by mouth unless a heart medication (such as nitroglycerin) has been prescribed.

Call immediately for emergency medical assistance if

• If sudden chest pain or other symptoms of a heart attack occur.
• If an adult or child is unresponsive or is not breathing.

Prevention

Adults should take steps to control heart disease risk factors whenever possible. If you smoke, quit. Smoking more than doubles the chance of developing heart disease. Keep blood pressure, cholesterol, and diabetes in good control and follow with your doctor's orders.

Lose weight if obese or overweight. Get regular exercise to improve heart health. (Talk to your doctor before starting any new fitness program.)

Limit the amount of alcohol you drink. One drink a day is associated with reducing the rate of heart attacks, but two or more drinks a day can damage the heart and cause other medical problems.