Today I am so thankful that I had my best friend, my “sister” for so many years. We shared so much together, good times, bad times, birthdays, secrets, hackers, PITAs.
I think it was 2 or 3 years ago now when we went to see Hamilton in NYC.
We got to our location (Hamilton in NYC) faster than expected and walked around the block. I was stunned when we saw Cafe Un Deux Trois!
Cafe Un Deux Trois has a special memory for me. November 2, 2003, Michael decided to run the New York Marathon. We went to NY to see him run. (He finished in 4:21:57. The average for males that year was 4:28:56).
The New York City Marathon (branded TCS New York City Marathon and formerly branded ING New York City Marathon for sponsorship reasons) is an annual marathon (42.195 km or 26.219 mi) that courses through the five boroughs of New York City. It is the largest marathon in the world, with 50,304 finishers in 2013. Along with the Boston Marathon and Chicago Marathon, it is among the pre-eminent long-distance annual running events in the United States and is one of the World Marathon Majors.
My best friend, Alice, and her brother (David) were living in Brooklyn and they decided to meet us in Manhattan on Saturday night. Michael and a friend went to a comedy show while Alice, David, Tom and I walked around Times Square, just talking. We turned down a side street and saw… Cafe Un Deux Trois. We decided to go in to eat.
I remember nothing about the meal. But, at the next table was Ben Gazzara, Gena Rowlands, Peter Bogdanovitch and 3-4 others I didn’t recognize. After about half an hour, Carol Kane came in, too. It turned out that Ben Gazzara was in a one man show across the street which had just opened: Nobody Don’t Like Yogi. All this made the meal very exciting.
For the last several years, every time we’ve been near Times Square, I’ve looked down the side streets for this restaurant and never saw it again until this day.
A very nice memory of Alice.
Another birthday is here and I’ve now passed you age-wise. 😦 I had always taken such delight being able to say that I was the younger one. Not any more 😦
Each year, the non-birthday-girl would be planning and plotting online, as well as real-life, surprises. We had hand-made wrapping paper and all sorts of exotic and non-exotic gifts. Right now, I’m wearing a cozy robe from a zillion years ago.
Way back in 1998, when I was learning web design, I posted a whole mini-site for that birthday. Unfortunately, HTML code no longer allows for the music to play, but I had carefully thought out tunes for each day. The page titles aren’t showing, either.
The main page title was “Happy Millennium Birthday, Alice!” and played a simple Happy Birthday
The theme to Perry Mason aka “Peri MasonPause” on the “Flora” page
the “Born” page had the theme to Alice’s Restaurant with no special title
the “Robert Redford” page had The Way We Were. The title was “To Alice, from Bob (with lust)”
the “musician and his music” page was Bach’s Toccata and Fugue and the title was “Happy Bachday, Alice!”
the “flowers” page was The Rose with no special title
The last page of that site was particularly important. I’d emailed all of Alice’s past guest speakers and other PS members and compiled this list of great wishes: http://www.oconnormusic.org/aliceBD/guests.htm
We’d be up at 12:01 am, posting wishes, decorating message boards and doing the final touches for websites.
In 2003, I’d apparently posted a picture of Flora Dora (again!) and Alice responded:
MaryO, what can I say other than that it was a wonderful and beautiful surprise to see my guest announcement area turned into a beautiful, sparkling birthday greeting — and Flora Dora, Power Surge’s mascot and RR — but especially your beautiful wishes.
I responded:
After all these years, it’s getting harder and harder to come up with new ideas for how to do an online surprise. There have been a variety of different things for different birthdays, but I have to keep you guessing I hope that you don’t mind that I’m holding the announcement area hostage for a little longer.
I’m sure that many of the newer people don’t know who Flora Dora is, but she’s an essential part of Power Surge so she have to be included somehow – kinda like inviting your maiden aunt to Thanksgiving 🙂 Of course, RR is welcome – anytime! I’m so glad that I could make an online surprise for you again this year – maybe I should start planning for NEXT year already.
I hope we share many more birthdays together as the close friends we’ve become over the years.
On a more serious side, you’re very welcome for the “beautiful wishes”. Sometimes, words fail me and I don’t do things justice, but you and Power Surge have changed my life in so many ways that go beyond “simple” menopause issues. When I first came to Power Surge on AOL, I was a confirmed lurker, reading only, never posting.
The first chat I tried to hide out until you asked me a question, encouraging me to talk. This was all so scary for me, communicating with others – online or off. I can say with confidence, that I’m no longer a lurker on the boards and in the chats like I was, and that was all your doing. Thanks so much for that!
Now I just have to work on my real life lurkership! The knowlege I got here in Power Surge, even when I was lurking, helped me so much with my menopause, my symptoms, my everyday life. Like most everyone else, I learned about the way to help my meno symptoms and I’m so thankful of that, that I could be feeling better.
When my husband was very sick, close to death, my first December in PS, I wouldn’t post, but I would come home from the hospital and read everything that other people were posting. It seemed so great to me, and it was such a comfort to me to know that everyone was out there. I recognized people’s names and enjoyed “listening” to the banter and chatter, and that gave me something other than the hospital and my own worries to think about. No matter what the time of day was, I could always read and see that things were ok with the world, and know that we were going to survive this. What a wonderful community Power Surge is!
Things have come along way since then. My husband made it, thanks to a skilled surgeon and a LOT of prayer. And I gradually changed, too. I’m obviously not afraid to post anymore, or go to chats, and I really have you to thank for that. Over the years there have been many changes, the boards have moved, been started again from scratch, updated, all kinds of things, as have the chats, but one thing remains clear and unchanged – and that Power Surge isn’t just another “website”. It is a true community for women in midlife, something we can gain daily strength from. (sorry about the preposition!)
And it’s all because of you, Dearest Alice Stamm. Thank you so much, and I hope it was a wonderful birthday – you deserve the very best!
Hugs and thanks from the bottom of my heart! Mary
From the message boards in 2004:
From 2005:
We have decided to let you accept the responsibilities of a 6 year old again.
If you want to sail sticks across a fresh mud puddle and make ripples with rocks, that’s great.
If you want to think M&Ms are better than money, because you can eat them, they are calorie-free (today only!).
If you want to lie under a big Oak tree next summer and run a lemonade stand with your friends (and fellow Surgettes) on a hot summers day, we’ll give you a voucher.
That summer-time voucher is also good for walking on the beach and thinking of the sand between your toes and the prettiest seashell you can find. Or you can spend the afternoon climbing trees and riding your bike.
We are returning you to a time when life was simple. When all you knew were colors, addition tables and simple nursery rhymes. But that didn’t bother you, because you didn’t know what you didn’t know and you didn’t care. When all you knew was to be happy because you didn’t know all the things that should make you worried and upset.
You’re going to go to school and have snack time, recess, gym and field trips.
You’ll be so happy, nothing will make you upset.
We’re going to let you think that the world is fair. That everyone in it is honest and good…that anything is possible.
For today, you’re going to be oblivious to the complexity of life and be overly excited by little things once again, returned to the days when reading was fun.
No worries about time, bills, websites that crash, guest chats where the guest can’t get in, excess email, time….No more worry about computer crashes, mountains of paperwork, depressing news, aches, pains, doctor visits or illness.
We’re going to help you believe in the power of smiles, hugs, a kind word, truth, justice, peace, health, dreams, the imagination, mankind and making angels in the snow.
You’re going to be 6 again, for today (and probably some of us will want to join you!). From all of us…
QUOTE (Dearest @ Nov 10 2005, 09:23 AM)
Thank you all for your warm and wonderful birthday wishes.
A very special thank you to my friend, MaryO, for the beautiful greeting, for including Power Surge’s mascot, Flora Dora at the top of the screen — and especially for allowing me to be six again even if only for a day 🙂
And I said:
You know, you can always apply for an extension of the day being 6. Click here to apply.
Glad you had a great birthday and much-needed vacation. If you want to extend either of those, please let me know and I’ll see if I can locate an extension for either of those.
Happy Post-Birthday!
In 2006, Alice said:
Thank you ALL for your wonderful birthday wishes and beautiful sentiments about how much Power Surge means to and has done for you. That makes all the years of work that’s gone into this “community” worthwhile (with, perhaps, the exception of dealing with HACKERSSSSSSSSSSS!!!!!) 🙂
I don’t know some of you very well. Others I know well and have established lovely friendships with. You know who you are. Thank you, too, for your beautiful flowers, birthday cards, online greetings, etc.
And thank you, my dear friend, MaryO, for starting this topic and for being the sister I never had 🙂 I’m so glad I impulsively decided to give myself a birthday present last month and called saying, “C’mon, let’s go to see Streisand!!” That was the highlight of my/our year. To be sitting so close to her, and SO close to and watching people mingle like: Bill and Hillary Clinton, Lauren Bacall, James Brolin, Katie Couric, Stephen Sondheim, Rosie O’Donnell, Sting, Hugh Jackman, Steven Spielberg, Regis and Joy Philbin, Sara Jessica Parker — and many, many others.
It was like the first time we met a few years ago and stopped into a restaurant [Cafe Un Deux Trois] only to find a few minutes later that Gena Rowlands, Ben Gazzara, Peter Bogdonovich, Carol Kane and others, whose names elude me at the moment, came in and sat at the table next to us. Knowing me, I had to go over and talk to them, especially Gena Rowlands, who’s still beautiful and elegant and was so gracious.
The past few years, starting with my emergency surgery and all the ensuing complications, my mom’s fall down the stairs and subsequent need for constant care, my dad passing away only four months later and my own ongoing and confusing health issues — too much stress.
The past few months have been better — we’ve both been through a LOT this year especially!
Special thanks to those of you who’ve generously given donations (some of you even more than once) to the site to help defray some of the expenses of running it.
I’m grateful to be alive and very proud of Power Surge and all the women (and men) it’s helped over the years plus all the wonderful women who participate in it 🙂
Alice
And I responded:
To be sitting so close to her…
You mean me…or Barbra? LOL
It was so amazing how that trip worked out. It was the most spontaneous thing I had ever done.
My son was home from grad school for “fall break” formerly known as Columbus Day weekend. He was flying back on Wednesday, through JFK.
After Alice got the tickets for Barbra on Monday (amazing in itself), I was able to get on Michael’s flight to JFK – only one trip to the airport! The flight number was the same as Alice’s street address. Do I hear Twilight Zone music?
What a great birthday gift you got for yourself – thank you so much for sharing it with me 🙂
Happy post-birthday!
From 2007
The top header on the boards:
Followed by
And Alice said…
Firstly, {{{{{MaryO}}}}, my old and dear friend, thank you for starting this topic and for the beautifully creative graphic and sentiments you made for my birthday. I don’t have to tell you what your friendship has meant to me all these years (you already know). Hugs!
Thank you all for your good wishes. Someone wrote to me, “I hope you had a peaceful birthday.” That’s exactly what it was . . . peaceful.
Thank you also for your kind words about Power Surge. It’s been a labor of love for 14 years . . . about to start its 15th year Feb. 3rd, 2008. I have a pretty good idea how many women’s lives have been impacted by this “community.” In all these years, including the start-up years on America Online, I’ve probably posted in the area of 100,000 messages on the numerous PS message boards. I can’t post as much as I used to any longer for many reasons, but I’m always working in the background to maintain this site that’s become a tremendous source of information and haven of support for all the visitors who come to it every day.
What started out as a blank page in an HTML editor has grown to exactly what I’d planned. I’m very proud of every facet of Power Surge including this message board.
Finally, thank you to all those who have made donations to Power Surge. I have thanked each and every one of you individually. Your donations have been helpful in defraying some of the ever-increasing costs involved with running Power Surge.
Again, thank you.
Best,
Dearest
Then, 2008
And that’s enough for this year. I have to save some out 🙂
~~~
So, it’s 20 years since I made that first silly website. I’m no longer scrambling to get something to post by 12:01 am for your birthday.
I still can’t believe that you won’t be reading this later, calling me when UPS / amazon / FEDex arrives with gifts so we can open them “together”.
We’ve said it once, we’ve said it dozens of times. Even when we’re apart we’re
It has been just over 5 years since Alice died – I’ve kept this blog and her message boards basically the way she started them. I decided – finally – that life goes on and new discoveries are being made to help women going through menopause.
To that end, I decided to include news items of relevance here and here’s the first…
Officials with the FDA have approved TherapeuticsMD’s Bijuva (estradiol and progesterone) capsules, 1 mg/100 mg, the company announced Monday. According to TherapeuticsMD, Bijuva is the first and only FDA-approved bio-identical hormone therapy combination of estradiol and progesterone in a single, oral capsule for the treatment of moderate to severe vasomotor symptoms due to menopause in women with a uterus.
“The approval of Bijuva represents an important and new opportunity for menopausal women suffering from moderate to severe vasomotor symptoms. Menopausal women and their healthcare providers have been seeking bio-identical combination therapies for many years without an FDA-approved option,” said Dr. Brian Bernick, Co-Founder and Director of TherapeuticsMD, in a prepared statement. “Bijuva is the first and only FDA-approved combination of bio-identical hormones, offering a proven balance of bio-identical estradiol to reduce moderate to severe hot flashes combined with bio-identical progesterone to reduce the risks to the endometrium.”
The approval is based on the Bijuva clinical development program that included the pivotal Phase III Replenish Trial. This trial evaluated the safety and efficacy of Bijuva in generally healthy, postmenopausal women with a uterus for the treatment of moderate to severe hot flashes. Consistent with FDA guidance, the co-primary efficacy endpoints in the Replenish Trial were the change from baseline in the number and severity of hot flashes at weeks 4 and 12, as compared to placebo. The primary safety endpoint was the incidence of endometrial hyperplasia with up to 12 months of treatment.
Bijuva demonstrated a statistically significant reduction from baseline in both the frequency and severity of hot flashes compared to placebo while reducing the risks to the endometrium. The most common adverse reactions (≥3 percent) were breast tenderness, headache, vaginal bleeding, vaginal discharge, and pelvic pain. Additionally, there were no clinically significant changes in lipid, coagulation or glucose parameters as compared to placebo. There were no unexpected safety signals.
“For the first time, we have a combination hormone therapy of bio-identical estradiol with bioidentical progesterone evaluated in a large, well-controlled, randomized clinical trial that has demonstrated both safety and efficacy for the treatment of moderate to severe hot flashes due to menopause,” said Dr. James Liu, M.D., President of the North American Menopause Society and Chairman of the Department of Obstetrics and Gynecology, UH Cleveland Medical Center, in a prepared statement. “The approval of Bijuva represents an important, novel and effective treatment option for women and their healthcare providers to manage the vasomotor symptoms of menopause.”
Bijuva is expected to be available in the United States in 2019.
Reference
TherapeuticsMD Announces FDA Approval of TX-001HR: BIJUVA (Estradiol and Progesterone) Capsules for the Treatment of Moderate to Severe Vasomotor Symptoms Due to Menopause [news release]. Boca Raton, FL; October 29, 2018: TherapeuticsMD.
From October 15 to December 7 every year, the Centers for Medicare and Medicaid (CMS) gives you free reign to change your Medicare coverage. Take advantage of the Medicare Open Enrollment Period or you could be stuck with your plan for the coming year, premiums and all.
What You Can Do During Open Enrollment
Open Enrollment is your time to pick the Medicare plan that gives you the best coverage for the best price.
Alternatively, if you have insurance through an employer, you may be able to delay your initial enrollment. This is only the case if the company you work for employs at least 20 full-time employees. Your special enrollment period begins when you leave your job or you lose your employer-sponsored health coverage, whichever comes first, and lasts for eight months.
If you miss your Initial Enrollment Period, you need to wait until the General Enrollment Period to sign up for Part A and/or Part B. The General Enrollment Period happens once a year from January 1 to March 31.
Menopause is a natural part of aging in women. It affects each woman differently, and the symptoms associated with menopause can be difficult for some.
Learn from Wen Shen, M.D., director of the Menopause Consultation Clinic, about menopause symptoms and the latest treatment options. Knowing what to expect can help you stay as healthy as possible during this phase of your life.
Menopause has gotten a bad rap. Women in their 40s and 50s who have any symptoms – from moodiness to insomnia and headaches – may believe that it’s a normal part of aging and there’s not much they can do about it.
Fluctuating hormones caused by the normal decline of ovarian function can trigger the typical symptoms associated with menopause. One approach is to give the body a drug that mimics ovarian function, such as estrogen or hormone replacement therapy. This was a common treatment, until multiple studies showed increased risk of urinary incontinence, stroke, dementia and breast cancer from using menopausal hormone therapy.
Fortunately, there is another approach to improving the body’s ability to adjust to hormone fluctuations that doesn’t increase the risk of breast cancer and dementia. This approach looks at the other organ systems that are involved in addition to the ovaries. For instance, hot flashes will be greatly exaggerated in a woman who has blood-sugar problems – even if those don’t show up on a standard blood test.
BIOIDENTICAL HORMONES
Some women use bioidentical hormones instead. While they appear to have fewer immediate side effects, there is no evidence that they have fewer long-term risks.
At a recent functional medicine conference I attended, there were several discussions on how to address hormone “saturation” – the experience many women have after being on bioidentical hormones for several years and then having a return of their previous symptoms. We’re learning that underlying imbalances in gut function, adrenal hormones and blood sugar can have a major effect on a woman’s experience of her perimenopausal years.
IT’S NOT JUST THE OVARIES
Technically, menopause occurs when a woman hasn’t had a period for 12 consecutive months. The symptoms that can occur for years before that are due to the ovaries becoming less predictable in their hormone production. This means that estrogen levels can spike and fall like a roller coaster.
Unfortunately, once a woman knows that her hormones are fluctuating, she is likely to explain away all her symptoms as perimenopausal. But ovaries are not the only glands affected by hormone changes. The pancreas, thyroid and adrenal glands play key roles in determining how easy or difficult the perimenopausal years will be.
The most common, end-stage effect of pancreas dysfunction is diabetes. But long before the body reaches a disease state, there are more subtle effects. For instance, a woman with low blood sugar or insulin resistance will experience more severe hot flashes than a woman with normal blood-sugar regulation.
Following are common symptoms associated with perimenopause and factors that can determine the severity of those symptoms.
• Heavy or frequent periods. These can be worsened by blood-sugar and thyroid imbalances that don’t show up on routine blood work. Checking free and total levels of T3 and T4 as well as thyroid antibodies can be helpful.
• Hot flashes or low libido. Underlying adrenal stress can result in cortisol levels that are too high or too low, or reduced DHEA (precursor to several hormones). Cortisol levels are best tested with multiple saliva samples over a 24-hour period.
• Insomnia. With or without hot flashes, insomnia is often due to chronic stress, which causes the adrenals to produce excess cortisol.
• Mood changes and brain fog. Moods can be affected by the stress hormone cortisol as well as imbalanced neurotransmitters. Neurotransmitters such as serotonin are made primarily in the gut and can be evaluated with a urine test. Low levels of serotonin can also increase overall pain levels.
• Hair loss and weight gain. There may be underlying thyroid stress that doesn’t show up on routine blood work but requires a more detailed look at free and total levels of T3 and T4 and thyroid antibodies.
Once these underlying issues are identified, they can be addressed through food choices, lifestyle factors and specific supplements.
Marina Rose, D.C., is a functional medicine practitioner, certified clinical nutritionist and chiropractor with an office at 4546 El Camino Real in Los Altos. For more information, visit DrMarinaRose.com.
The aim of the study was to evaluate the short and long–term effects of acupuncture on vasomotor symptoms (VMS) and quality of life–related measures. The authors found that a course of acupuncture treatments was associated with significant reduction in VMS, and several quality–of–life measures, compared with no acupuncture, and that clinical benefit persisted for at least 6 months beyond the end of treatment.
Methods
A total of 209 perimenopausal and postmenopausal women aged 45 to 60 years, experiencing four or more VMS per day, were recruited from the community and randomized to receive up to 20 acupuncture treatments within the first 6 months (acupuncture group) or the second 6 months (waitlist control group) of the 12–month study period.
The primary outcome was mean daily frequency of VMS.
Secondary outcomes were VMS interference with daily life, sleep quality, depressive symptoms, somatic and other symptoms, anxiety, and quality of life.
Results
The VMS frequency declined by 36.7% at 6 months in the acupuncture group and increased by 6.0% in the control group (P < 0.001 for between–group comparison).
At 12 months, the reduction from baseline in the acupuncture group was 29.4% (P < 0.001 for within–group comparison from baseline to 12 months), suggesting that the reduction was largely maintained after treatment.
Statistically significant clinical improvement was observed after three acupuncture treatments, and maximal clinical effects occurred after a median of eight treatments.
Persistent improvements were seen in many quality of life–related outcomes in the acupuncture group relative to the control group.
February is American Heart Month. Learn about heart disease in women and what you can do to keep a healthy heart.
Get Informed: Facts on Women and Heart Disease
Heart disease is the leading cause of death for women in the United States.
Although heart disease is sometimes thought of as a “man’s disease,” around the same number of women and men die each year of heart disease in the United States.
Some conditions and lifestyle choices increase a person’s chance for heart disease, including diabetes, overweight and obesity, poor diet, physical inactivity, and excessive alcohol use.
High blood pressure, high LDL (low-density lipoprotein) cholesterol, and smoking are key risk factors for heart disease. LDL is considered the “bad” cholesterol because having high levels can lead to buildup in your arteries and result in heart disease and stroke. Lowering your blood pressure and cholesterol and not smoking will reduce your chances for heart disease.
Symptoms
While some women have no symptoms of heart disease, others may experience heavy sharp chest pain or discomfort, pain in the neck/jaw/throat, or pain in the upper abdomen or back. Sometimes heart disease may be silent and not diagnosed until a woman has signs or symptoms including:
Heart Attack: Chest pain or discomfort, upper back pain, indigestion, heartburn, nausea/vomiting, extreme fatigue, upper body discomfort, and shortness of breath.
Arrhythmia: Fluttering feelings in the chest.
Heart Failure: Shortness of breath, fatigue, swelling of the feet/ankles/legs/abdomen.
Stroke: Sudden weakness, paralysis (inability to move) or numbness of the face/arms/legs, especially on one side of the body. Other symptoms may include confusion, trouble speaking or understanding speech, difficulty seeing in one or both eyes, shortness of breath, dizziness, loss of balance or coordination, loss of consciousness, or sudden and severe headache.
Healthy Hearts
Heart disease is largely preventable. Listen to CDC’s Dr. Bowman discuss ways to prevent heart problems.
[00:04:06 minutes]
What You Can Do for Heart Health
You can lower your chance of heart disease and a heart attack by taking simple steps.
Eat a healthy diet with fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products. Choose foods low in saturated fats, cholesterol, salt (sodium), and added sugars.
Exercise regularly. Adults needs 2 hours and 30 minutes (or 150 minutes total) of exercise each week. You can spread your activity out during the week, and can break it up into smaller chunks of time during the day.
Be smokefree. If you are ready to quit, call 1-800-QUIT-NOW (1-800-784-8669) or 1-855-DÉJELO-YA (1-855-335-3569 for Spanish speakers) for free resources, including free quit coaching, a free quit plan, free educational materials, and referrals to other resources where you live.
Limit alcohol use, which can lead to long-term health problems, including heart disease and cancer. If you do choose to drink, do so in moderation, which is no more than one drink a day for women. Do not drink at all if you are pregnant.
Know your family history. There may be factors that could increase your risk for heart disease and stroke.
Manage any medical condition you might have. Learn the ABCS of heart health. Keep them in mind every day and especially when you talk to your health provider:
The purpose of this study is to investigate whether the study medication can help people with mild to moderate Alzheimer’s Disease improve their mental abilities such as understanding, reasoning, and judgment. The study medication will be given together with an FDA-approved Alzheimer’s medication: Aricept® (donepezil), Exelon® (rivastigmine) or Razadyne® (galantamine).
More about the study:
The study drug (MK-7622) is administered in the form of one capsule a day in the morning.
There will be 830 participants in this trial
If you are interested, please find the full study details and eligibility criteria listed here.
Eligibility Criteria:
Participants must:
be between 55 – 85 years old
be diagnosed with mild to moderate Alzheimer’s Disease (12 – 24 MMSE)
have a trial partner who is able to attend any study visits that require assessment
be currently taking a stable daily dose of acetylcholinesterase inhibitor (AChEI) such as Aricept® (donepezil), Exelon® (rivastigmine patch oral), or Razadyne® (galantamine)
Participants must not:
have a history of seizures or epilepsy within the last 5 years
have a history of mental illness
have been diagnosed or treated for cancer within the past 5 years (excluding basal cell, squamous cell skin cancer, in situ cervical cancer and localized prostate cancer)
If you’re not familiar with clinical trials, here are some FAQs:
What are clinical trials?
Clinical trials are research studies to determine whether investigational drugs or treatments are safe and effective for humans. All new investigational medications and devices must undergo several clinical trials, often involving thousands of people.
Why participate in a clinical trial?
You will have access to new investigational treatments that would be available to the general public only upon approval. You will also receive study-related medical care and attention from clinical trial staff at research facilities. Clinical trials offer hope for many people and an opportunity to help researchers find better treatments for others in the future.
DEAR DR. ROACH: My question is about symptoms for women’s heart attacks. I have always heard that symptoms for women can be much different from men’s. Instead of the chest-clutching, sharp pain that men can have, I have read that women’s symptoms can be any of these: heartburn or indigestion; pain in the jaw, neck, shoulders, back, one or both arms; fatigue and troubled sleep; dizziness and nausea; or extreme anxiety. Are you KIDDING me? I am a healthy, active 63-year-old woman. I have had all of these symptoms at one time or another. If I acted every time I had one of these symptoms, I would be at the doctor’s office every day. How is one to know which symptoms to take seriously and act on immediately, and which to wait a few days to see if it is temporary?
Thank you for addressing this confusing issue. — J.
ANSWER: I have seen many letters similar to yours. The confusing problem is that it’s true: In women, heart attack symptoms and the symptoms of angina before a heart attack can include all of those vague symptoms. The same is true of men as well, although it’s more likely for women than for men to have symptoms other than the classic left-sided chest discomfort (people are much more likely to describe angina as “discomfort” or “pressure” than “pain”).
So your question is entirely valid: How do you know when to take common symptoms seriously? The first thing I would say is that the greater your risk for heart disease, the more seriously you should take any symptom. Age, family history of heart disease, high blood pressure and cholesterol, lack of regular physical exercise and diabetes are among the most important risk factors.
The second thing I would say is to take new symptoms seriously. If you never get heartburn, for example, then heartburn at age 63 should prompt concern.
Third, context matters. Symptoms such as nausea or jaw pain that occur with exercise — even carrying a bag of groceries or walking up stairs — is definitely a reason to talk to your doctor.
Most women don’t know that heart disease remains their No. 1 killer, far outstripping breast cancer (or any cancer). Both women and men need to take even vague symptoms seriously, especially if the symptoms are new, exertional or if the person has several risk factors. As a primary-care doctor, I’d rather see my patient for her concerns that symptoms may be heart disease than see her in the ICU with a heart attack.
Despite the bold and assertive name by which the hot flash is known, her origins remain elusive. Of course, doctors and scientists understand many of the mechanisms of menopause such as the reduction in estrogen and the important relationship between the ovaries and the pituitary gland, but the central cause of hot flashes – the heating of a woman’s core – is a secret Mother Menopause has yet to reveal.
“I’ve written editorials that we’ve sent men to the moon and we’ve broken the genetic code, but we cannot really explain the physiology of a hot flash,” said Cynthia Stuenkel, M.D., clinical professor of medicine, endocrinology and metabolism at the University of California, San Diego, School of Medicine in La Jolla, Cal.
What is known then? The hot flash seems to be an equal-opportunity phenomenon, plaguing as many as 75 percent of women, regardless of race or reproductive history. Whether you had children, and how many, and at what age, or remained childless, doesn’t seem to have any correlation with hot flashes, their severity or frequency. Nor does breastfeeding history or the age at which a woman began or stopped menstruating.
Smoking is believed to bring on menopause about one to two years early and some inherited tendencies can mean that women in the same family may see their eggs becoming less responsive around the same time of life. Obesity is believed to cause more hot flashes in some medical circles. But other doctors disagree.
What they do agree upon is that the thermoregulatory center of the brain which regulates temperature somehow loses its typical functioning capacity as estrogen decreases. Follicle-stimulating hormone (FSH) is produced by the pituitary gland in the brain. Its job is to stimulate the dominant follicle on one of a woman’s ovaries each month to release an egg.
But as the number of eggs decline throughout a woman’s childbearing years, the ovaries makes less estrogen and communicate this situation to the pituitary by “talking back” to it with a hormone called inhibin. The pituitary responds to the decline in estrogen by sending out more FSH, a hormone that is often measured when trying to gauge a woman’s fertility.
What isn’t more intimately understood is how the declining estrogen levels affect thermoregulation in the brain and specifically a center called the hypothalamus. Internal and external symptoms do not mirror the subtleties going on in the brain.
During a typical hot flash, which lasts from two to five minutes, a woman experiences a feeling of heat, usually in the upper torso, as blood vessels dilate. “In some women that are fair you’ll see some redness,” said James Liu, M.D., chair of the department of obstetrics and gynecology at University Hospitals/MacDonald Women’s Hospital at Case Western Reserve University School of Medicine in Cleveland, Oh.
Liu said the internal core temperature actually drops a little despite the feeling of heat, while fingertip temperature goes up. Epinephrine, also known as adrenaline, courses through the bloodstream, sometimes causing an increased heart rate.
That can be disconcerting to women who have been taught of late not to ignore what can be the more subtle symptoms of heart attack in women. Liu offers simple advice for determining the difference between a hot-flash-induced pounding heart and a heart attack. “A heart attack is unrelenting,” he explains. “A heart attack episode is constant.”
The pounding heart that comes with the hot flash ends with the heat. Unfortunately, that drop in core temperature often sends women on a rollercoaster ride in the other direction, now feeling cold, and, of course, often very wet from copious sweating.
“We don’t know what triggers the temperature instability. That’s something we’re trying to figure out,” Liu said, echoing Stuenkel, and explaining that normally humans maintain a very stable temperature even under warm conditions.
Sources:
Cynthia Stuenkel, M.D. via phone interview July 3, 2015 James Liu, M.D., via phone interview July 6, 2015
In 2003, I’d apparently posted a picture of Flora Dora (again!) and Alice responded:
Healthy Hearts
Power Surge 