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	James L. Holly, M.D.

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Your Life Your Health - Women's Health - Self Care at Any Age

Norma Duncan,MSN, APRN-BC, FP

May 22, 2003

Your Life Your Health - The Examiner

As a provider of primary care I see for people of all ages. The advice I give is always individualized according to what the patients tell me and what their family histories describe. I begin by considering normal human development when counseling about health care matters for my female patients.

Beginning with the school age girl, I am careful to reinforce positive food choices when counseling about nutrition. We talk about the importance of getting plenty of calcium and trying to eat whole foods (not processed). A good question is "What did you eat for breakfast?" The key is "whole foods," just like they came from the garden without added salt, sugar, preservatives, dyes and flavorings. While vitamins and supplements are good, they can never substitute for natural occurring nutrients which we call "phytochemicals." "Phyto" means plant. The chemicals which we naturally received from unprocessed foods are healthy and beneficial to our bodies. There are many "phytochemicals" whose purpose we do not yet understand but they are all beneficial to us. And, while you can "overdose" on vitamins and supplements, naturally occurring "phytochemicals" have never been shown to be harmful.

Another topic is sports participation. I consider dance a sport. All the ballerinas I know are superb athletes. Cheerleading is also a demanding sport in terms of sheer strength, flexibility and endurance. Of course, many of my young female patients participate in soccer, softball, track, volleyball and basketball. I encourage every parent to support their child in an athletic endeavor. It sets the stage for a balance in life. A healthy body can be acquired at any age, but it is easier to sow the seeds of fitness early.

Most mothers of girls note that before puberty their daughters gain some weight. This extra weight "turns on" their supply of estrogen that is necessary for upcoming changes in the girl's body. We need to be sensitive about making any remarks about it. Menses come early for some girls and it is a smart mother who prepares her daughter for the event.

The teenage years bring on tumultuous changes for parents as well as the young girl. From a physical point of view it is very necessary to encourage daily physical activity. The television and the computer can foster inactivity. When this is combined with an unhealthy diet and an unfortunate genetic background, we begin to see obesity take hold. Adolescent and teenage obesity is an epidemic health problem in America today. It is, however, an epidemic you can avoid.

More and more girls are developing diabetes at younger ages. This is particularly true of African American children. It is important to note that this is not "juvenile" diabetes or, more properly, Type I diabetes. Type I diabetes destroys the pancreas. This is Type 2 diabetes and it is the result of insulin resistance that is enhanced by obesity. The pancreas makes plenty of insulin but the cells can't use it efficiently. The danger of diabetes is what it is doing to the blood vessels that feed nutrients to our heart, kidneys, and eyes.

Another plague of teen girls is acne. Although our mothers always told us that our pimples came from chocolate, ice cream, and pizza, we now know that it is a hormonal condition. The high testosterone level in young women helps them develop muscles appropriate to a fit girl's physique. It gives them that inexhaustible energy. However, it also causes acne. We prescribe many topical treatments that can be effective for mild cases. Many girls will need more. Birth control pills can really be helpful in clearing the skin by using female hormones in the pill to fight the testosterone that causes the acne.

College girls tell me that they plan to avoid the "freshman 15", referring to the fifteen pound weight gain that can come in the freshman year. One girl told me she rejected the car her parents wanted to give her and, instead, asked for a bike so that she would get some necessary exercise around the campus. She hadn't gained an ounce when I did her physical the following summer.

I encourage my young working women to establish a daily fitness routine. Being one of the younger people in the work setting, many times they are given odd shifts and lots of overtime. It is at this time that the young woman can begin to make some choices regarding her future health. Many are working and going to school. A few are raising children with or without a husband at this time. It is hard to make them realize that exercise will give them the energy they need.

Young mothers have a hard time accepting the changes in their bodies after giving birth. They tend to want to lose the weight quickly. It is at this time I begin to discourage "scale worship". It is unlikely that they will ever weigh what they did in high school. So I tell them to get over it and begin to alter their behavior in terms of eating properly and getting daily vigorous exercise. If they assume healthy behaviors they will find that the scales do change. Even better, they, and others, will note that they look better. They can begin to feel comfortable in a womanly body.

Middle age brings on the stage we call peri-menopause. This encompasses age 38 to 51. Fifty-one is the average age for most women to go through menopause. The "peri" years are rife with challenges. Women find their menses changing in terms of length and predictability. Some begin to experiences "flushes". Note, I did not say "flash". A "flush" is like a mini-flash. Some women don't even notice this.

Energy can really take a dive for some women during this time. If the woman is not fit she will begin to pick up weight in earnest now. This extra weight lays the groundwork for diabetes, hypertension, and joint replacements. Every decade of a woman's life brings about a decrease in her metabolic rate. Unless she "fires up the furnace" every day with exercise, she can expect to feel tired and "FAT-igued".

The first few years of menopause are critical ones for a woman's skeleton. It is at this time that extra calcium intake is necessary. The woman may elect to be put on hormone therapy. Some women tough out the hot flashes and elect to "go it alone" without the medications. Many will take the hormone therapy. It is now recommended that if hormones are taken that they only be taken for five years after menopause. Many women I see make the choice to stay on hormones much longer. We discuss the benefits, risks, and alternatives of hormone replacement. It is absolutely necessary for them to come in yearly for their well woman exam and mammogram whether or not they take the hormones.

After 50 the exercise pattern should change a little. It becomes more important to emphasize muscle strength and flexibility while still keeping the cardiovascular fitness that aerobic conditioning provides. As I tell my older women patients, "Your joints are bound to deteriorate, but you can keep the muscles, tendons, and ligaments that support them strong by weight lifting". Upright and mobile people stay independent and healthier longer. These women are filling the aerobic classes. They surprise themselves at how "buff" they can become.

Good health is a choice. It is a choice of food, activity, balance and harmony with your age and condition. With the right choices, young women, whether 5, 50 or 80 can enjoy the stage of life in which she finds herself. Without the right choices, women, like men, can become the unwitting victim of their own bad choices.

It is your choice and remember, it is your life and your health.

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