HealthLink Spring 2006

1. Brown & Toland’s
HealthLink
A Wellness Magazine for the San Francisco Bay Area
SUMMER 2006
Stay Safe
This Summer
Tips for Enjoying Your
Vacation at Home or Abroad
For Women
Conquer Heart Disease
and Menopause
The Right Shots
Vaccinations Lead to
Healthier Kids — and
Communities

2. STAYING HEALTHY
Summer Vacations and
Out-of-Country Travel:
Play Safe, Stay Well
By Mark Finch, M.D.
HealthLink
Summer 2006
5 Healthy Children
Vaccinations don’t just
protect your kids —
M any people cite summer as their favorite season. The days of rain
and wind are gone and the flu bug is put to bed for another year.
If you are making plans for summer vacation, remember that there are
they also protect your
community. some health risks associated with fun in the sun and travel. Here are some
7 Diabetes Care tips on how to reduce or avoid injury and illness during this season.
Learn how exercising Sunburn Injuries
regularly can control
this chronic condition.
Summer brings increased exposure to Injuries may occur with certain
solar radiation, which can be damaging outdoor activities, such as swimming,
8 Men’s Health to the skin, and cause sunburn and skin hiking, camping, cycling, boating and
Putting off a visit to the
doctor could put your
cancers. This especially is true for light- automotive road trips. Children and ado-
health in danger. skinned people (generally people of lescents may be particularly at risk for
northern European ancestry), who are injuries associated with these activities.
10 Women’s Health
Follow these simple steps
exposed to the sun during midday out- Here are some tips:
to reduce your risk for door activities. Minimize your risk by Make sure everyone wears seat belts and in U.S. travelers to developing countries,
heart disease. taking these precautions: during road trips. “traveler’s diarrhea,” Montezuma’s revenge
Teach children and adolescents about or “Bali Belly.” Here are some tips to prevent
Brown & Toland’s HealthLink
editor: Richard Angeloni, Associate
safe practices associated with certain food and waterborne illnesses, as well as
Vice President, Public Relations and activities, such as swimming (life jack- traveler’s diarrhea:
Communications, Brown & Toland
Medical Group, 415.972.4307. Brown
ets, lifeguard services and adult supervi- Avoid eating undercooked meats and
& Toland’s HealthLink is published sion present), bicycling (helmets), and shellfish.
quarterly and printed in the
United States. Copyright 2006 by
hiking and camping (buddy system). Avoid eating food at outdoor picnics
StayWell Custom Communications, Make sure everyone is cleared by their that has not been kept refrigerated or
780 Township Line Road, Yardley, PA
19067, 267.685.2800. Articles in this
family physician before undertaking has been left at room temperature for
newsletter are written by professional strenuous activities such as backpack- several hours, particularly on hot days.
journalists or physicians who strive
to present reliable, up-to-date health
ing or intense aerobic sports. Stay well Avoid drinking untreated water such
information. Our articles are hydrated with nonalcoholic drinks as water from streams or wells.
reviewed by medical professionals
for accuracy and appropriateness. No
and foods containing salt during If you must drink untreated water,
magazine, however, can replace the these activities. first add water-sterilizing agents
care and advice of medical profes-
sionals, and readers are cautioned to
Be sure to bring any required medica- used for drinking (chloride or iodide
seek such help for personal problems. tion with you on outdoor trips, such as agents) or boil or filter water. Your
Some images in this publication
were provided by ©2006 PhotoDisc,
asthma medication. local outdoor equipment store will
Inc. PhotoDisc models used for illus- Avoid alcohol when undertaking any usually sell these products.
trative purposes only. (206)
Use high-level sunblock (with an intense or high-risk activity, such as Avoid drinking raw milk.
SPF of 15 or more), and wear wide- boating and off-road cycling. When preparing food for others,
brimmed hats and sunglasses when be sure to wash hands with soap and
outdoors on sunny days for more than Food and waterborne illnesses make sure cutting surfaces are vigor-
an hour. Alternatively, wear long- Food and waterborne illnesses occur ously cleaned if used after chopping
sleeved shirts and pants, which will more frequently in the summer and fall. or cutting raw meats.
protect skin even more. Typically, this is a result of some contam- If traveling in developing countries, in
See your physician right away should ination of food served outside the home, addition to the above recommendations:
you notice any skin spots or discolor- often at large gatherings. Affected persons Drink bottled fluids or hot liquids.
ation associated with a change in skin may develop nausea, vomiting and perhaps Avoid adding ice to your liquid drinks; it
texture that is like sandpaper. diarrhea, otherwise known as gastroenteritis is likely the ice is made from tap water.
2 Brown & Toland’s HealthLink, Summer 2006 www.brownandtoland.com

3. What to do if you become
seriously ill while out of
country
If you develop a serious illness while in
a foreign country, contact the U.S. Embassy
or consulate for help. Also inform your pri- Make sure
mary care physician or Brown & Toland everyone is
Medical Group should you require hospi-
talization. Coverage for emergency care
cleared by their
out of country may or may not be cov- family physician
ered by your health plan. Consult your before undertaking
Evidence of Coverage or call your health
plan for more information. For a com- strenuous
plete list of embassies and consulates, activities such
go to www.state.gov/travel/.
as backpacking
Vaccines for foreign travel or intense
There are vaccines for a number of aerobic sports.
infectious diseases that may be prevalent
— Mark Finch, M.D.,
in the country of your destination. Some senior medical director,
examples include typhoid fever, yellow Brown & Toland
Medical Group
fever, hepatitis A and B, polio and Japa-
nese encephalitis. For more information
on which vaccines are recommended for
Eat foods that have been cooked Insect-borne illnesses your itinerary, please consult with your
and are served hot. In the United States, summer physician, your travel agent or this
Eat fruits you peel yourself. increases exposure to mosquitoes and Web site: www.cdc.gov/travel.
other biting insects, such as ticks. Lyme
Additional prevention measures for disease occurs in the Pacific Northwest,
traveler’s diarrhea: Northeast and North Central regions. It
Bismuth subsalicylate (Pepto-Bismol, also occurs in temperate forested regions
Bismatrol or Bismed) may prevent or of Europe and Asia. Lyme disease does
lessen the symptoms of traveler’s diar- not occur in the tropics. Malaria and
rhea. Take 1 or 2 tablespoons (or two dengue fever can be transmitted by mos-
tablets) every 30 minutes beginning at quito bites in certain tropical and sub-
the earliest indication of diarrhea up to tropical countries. (Consult sources for
eight doses or when symptoms subside, information listed at the end of this
whichever comes first. Patients intoler- article for specific countries.)
ant of aspirin, however, should not take To prevent mosquito, tick and other
this over-the-counter medication. Read insect bites, use DEET, a colorless, oily
the directions on the label for more liquid that has a mild odor and is used
information on side effects and usage. as an insect repellent on clothes and Post-travel care
Antidiarrheal medications such as exposed skin, but not eyelids, lips or Contact your physician immediately
Imodium AD and Lomotil may reduce mouth. Mosquito coils also will reduce if you become ill (fever, diarrhea, unex-
symptoms, but avoid using if you have mosquitoes in the immediate vicinity plained weight loss, rashes or other symp-
blood or pus in stool and associated high and, along with mosquito netting, is toms) after returning from foreign travel.
fever. Consult the directions on the label especially useful on campouts and other Some illnesses, such as malaria or hepati-
or your physician for further information. outdoor activities. Malaria medication tis, may not be apparent until weeks or
Antibiotics may be taken to prevent prophylaxis also is recommended for months after your return, so be sure to
traveler’s diarrhea. However, these regi- certain countries. Consult with your inform your physician of any recent for-
mens only should be used per your primary care physician, or the sources eign travel or wilderness exposure. ■
physician’s recommendations, and only listed at the end of this article, for
when traveling to countries where information relevant to your travel Mark Finch, M.D., is a senior medical
access to medical care may be difficult. itinerary. director at Brown & Toland Medical Group.
www.brownandtoland.com Brown & Toland’s HealthLink, Summer 2006 3

4. EDUCATION
Brown & Toland
Physicians Educate
Their Community
on Vision Loss
B rown & Toland, Health Net
Seniority Plus and St. Mary’s
Medical Center were proud sponsors of
The physicians spoke on a variety of
topics, including glaucoma prevention
and treatment, macular degeneration and
cataracts. Dr. Kutzscher noted that vision
a March 25 community event designed loss in the elderly is quite common, with
to educate people on vision loss. one out of three seniors experiencing
some type of loss by the age of 60.
The standing-room-only event in He informed the audience that macu-
Morrissey Hall drew nearly 300 spectators. lar degeneration is the most common
Those who attended learned how to take type of vision loss in the elderly. Risk fac-
care of their vision through the free seminar tors include age, fair skin, family history
Common Eye Diseases in the Senior Popula- of macular degeneration and smoking.
tion, which featured dynamic presentations Glaucoma is the second most com-
from Brown & Toland physicians Bernd mon cause of vision loss in the elderly.
Kutzscher, M.D., Lee Schwartz, M.D., and There are 2.5 million people with glau-
Michael Hee, M.D., of Pacific Eye Specialists. coma, and of those, nearly 80,000 are
Free glaucoma screenings were provided blind. Early detection and treatment can
by the physicians throughout the day. prevent blindness.
FUNDRAISING
Brown & Toland Steps Up
Support for AIDS Fund-raiser
AIDS; to educate the community about HIV
T his summer, Brown & Toland
will demonstrate its commit-
ment to stamping out the AIDS
and prevent its spread; and to lobby the
government to increase its support of HIV
care, prevention and the search for a cure.
epidemic by sponsoring the 20th “2006 marks the 20th Anniversary of
AIDS Walk San Francisco,” says Event
We’re excited Annual AIDS Walk in San Francisco. Director Erika Zlatkoff. “That’s certainly
to be a part of The event, which drew more than 25,000 not something to celebrate. But, it is Foundation and other Bay Area AIDS
walkers in 2005, is scheduled to take place something to reinvigorate us — a good service organizations. Marketing Man-
rallying against on July 16 in Golden Gate Park. Participants time to look at all that we have accom- ager John Fisher is proud that the medi-
this disease. form teams of friends or family members and plished and to recommit to reaching the cal group will again be associated with
—John Fisher, register, raise money and walk together, log- end of this monster.” this important event.
Brown & Toland ging 10 kilometers, or a total of 6.2 miles. Brown & Toland sponsored the 2005 “We’re excited to be a part of rallying
Marketing Manager
Over the years, the walk has generated event, which raised more than $3.6 mil- against this disease,” says Mr. Fisher.
$55 million to help people with HIV and lion in support of the San Francisco AIDS The sponsorship underscores Brown
4 Brown & Toland’s HealthLink, Summer 2006 www.brownandtoland.com

5. The third most common cause of vision
loss in the elderly is cataracts. Correcting
cataracts is not possible through glasses or
medications, but cataract surgery can be
done successfully on an outpatient basis.
The physicians advised those in atten-
dance to get regular dilated eye exams,
especially those suffering from diabetes.
People with type 2 diabetes should be
tested every year, while those with type 1
diabetes should schedule a visit to the eye
doctor every year, starting five years after
their diagnosis. In addition, women who
become diabetic during pregnancy
should have exams every three months
while pregnant.
Macular degeneration is the
most common type of vision
loss in the elderly.
“Brown & Toland is committed to HEALTHY CHILDREN
addressing the special needs of the senior
population,” says Brown & Toland Mar-
keting Manager John Fisher. “It is impor- Vaccines Can Save
tant for us to provide educational
opportunities on some of the more uni-
versal health care concerns that affect
Children’s Lives
seniors and their family members.” ■
W hen was the last time you saw a child with polio or measles? Vaccines have
all but done away with these once-common ailments. Still, that doesn’t
mean they don’t exist. It just means the vaccines are doing their jobs.
Immunizations have cut most vaccine-preventable diseases by more
than 99 percent, according to the Centers for Disease Control and Pre-
vention (CDC). Yet illnesses that are rare in this country thrive in parts
of the world just a plane ride away. Each year, for instance, dozens of
cases of measles cases slip into America from abroad, putting at risk
those who haven’t had their shots.
During a drop in immunization rates a decade ago, a measles outbreak
Vaccines protect of 55,000 cases across the United States hospitalized 11,000 and killed 125,
according to Carden Johnston, M.D., former president of the American
your community, Academy of Pediatrics (AAP).
as well as your “There was a 25 percent mortality rate from pertussis [whooping cough]
before there was a vaccine,” says Keith R. Powell, M.D., who serves on the
children. AAP Infectious Disease Committee.
Vaccines protect your community, as well as your children. When more
& Toland’s longstanding commitment to children get their shots, it’s less likely that an outbreak can spread. This is
provide quality care for members living sometimes referred to as “community immunity” or “herd immunity,” the
with HIV or AIDS. Patients have access point at which enough people are vaccinated to protect those who are not.
to a free HIV Management Program Severe side effects of vaccines are very rare, the CDC says. Many studies
that offers personalized HIV medication, have tested whether vaccines cause autism or other childhood diseases,
nutritional counseling and case manage- says Dr. Powell, and none have found a link.
ment from a licensed nurse practitioner “I was in grade school in the ’50s, and every class had a kid with polio,”
and registered dietitian. ■ Dr. Powell recalls. “Now, you just don’t see it, and that’s because of the vaccine.” ■
www.brownandtoland.com Brown & Toland’s HealthLink, Summer 2006 5

6. TECHNOLOGY
How to Properly Manage
Your Medical Devices
W hether it’s placing a thermometer under your
tongue or standing on a scale to weigh your-
self, chances are good you’ve used a personal medical
you’re not well enough to do it your-
self. Your support system is crucial; it
may include a family member, friend can’t just toss sharps in a trash can,”
or neighbor. notes Ms. Carey. “Use an approved
device at one time or another. Post clear instructions — for sharps container, or place them in
Many people with chronic illnesses example, whom to call if the equip- any sealable container, such as a
depend on more elaborate medical ment breaks down, you run out of 2-liter soda bottle.”
devices, such as cardiac pacemakers or supplies or your health worsens. Blood pressure monitors. Take
blood glucose monitors, for their health Address any barriers to proper these with you on your doctor’s visit
and well-being. Countless others help equipment use. For example, ask to ensure they’re properly calibrated
their loved ones, young or old, deal with the manufacturer if the owner’s man- as often as the manufacturer
an oxygen machine, asthma medication ual is available in your language of recommends.
inhaler or other device. No matter how choice. Is the equipment’s display big Nebulizers. Cleanliness is the rule with
sophisticated or simple the piece of and bright enough for you to read? these devices, used to administer medi-
medical equipment is, it’s crucial to Have backup supplies. You always cations for asthma, emphysema and
use and maintain it properly. should have enough medications, other lung diseases. Follow the manu-
“A number of the rules for managing batteries and other necessary supplies facturer’s guidelines for cleaning it and
medical devices apply to just about any for 72 hours of use. Also, keep on routinely change the filter. You can dis-
device you can use,” says Penny Carey, hand an emergency stash, such as a infect it with a solution of three parts
R.R.T., director of durable medical equip- jar of orange juice for a diabetes insu- hot water to one part white vinegar.
ment and respiratory services for Johns lin attack, which you won’t touch for Asthma inhalers. When using pre-
Hopkins Pharmaquip in Baltimore. any other purpose. Make sure you scribed meter-dosed inhalers, always
For example, you need to consult the never run out of important supplies. include a spacer — so medication
manual, understand what the equipment Plan well ahead when traveling. won’t be lost to the atmosphere.
does, get additional instruction if neces- For example, investigate the airline’s Oxygen machines.
sary and know whom to call if something policy for bringing your medical equip- – The nosepiece (nasal cannula)
seems out of order. ment on board. Anticipate everything always should be pliable, not hard,
you might need at your destination, and always should be free of any
On your own where some necessities may not be nasal secretions.
The following advice applies to nearly available for purchase. – Keep any bubble bottle filled with
any medical device you might use. Take care with electrical devices. distilled water, and make sure all
Follow your doctor’s prescription. Ensure that wires or long oxygen hoses tubing is intact and clean.
Always consult your physician before don’t pose a tripping hazard. To avoid – Always keep on hand a nonelectri-
making a change. a fire hazard, use the appropriate cal backup oxygen source, in case
Ask questions. “Don’t let health care power sources as described in the of power failure.
people rush through the how-tos for your owner’s manual. – Never allow anyone to smoke
medical device,” advises Susan Martin, Note unusual equipment readings. around an oxygen machine
senior director of business development Bring your blood sugar monitor with because the oxygen is highly
Make sure and marketing at Johns Hopkins Home you to office appointments. Your pro- flammable.
your blood Care Group in Baltimore. “If necessary, vider can make sure it is calibrated – Be sure to place signs on the front
pressure moni- say, ‘Wait, I don’t understand that, correctly and giving you the correct and back entrances to your house
tor is properly please explain it again.’” information. indicating oxygen is in use.
calibrated as Do a return demonstration. After – When traveling with an oxygen
often as the you’ve been instructed how to use the Specific pointers tank, never place the tank in a
manufacturer equipment, show the health care pro- Ms. Carey and Ms. Martin offer these impor- car trunk. Always keep it in a well-
recommends. vider how it’s done, to make sure you tant suggestions for using medical devices: ventilated place not exposed to
understand. Hypodermic needles. People who extreme temperatures.
Teach a support person how to self-administer shots need instruction in And no matter what device you use,
manage your equipment, in case how to dispose needles, or sharps. “You call your doctor if you have questions. ■
6 Brown & Toland’s HealthLink, Summer 2006 www.brownandtoland.com

7. Brown & Toland’s
Patient Bill of Rights
Patient Rights
The physicians of Brown & Toland Medical Group are
dedicated to quality patient care. As a patient of a Brown
& Toland Medical Group physician, you will receive:
Courteous, considerate and respectful treatment
at all times
Candid discussions of appropriate or medically nec-
essary treatment options for your conditions, regard-
less of cost or benefit options
DIABETES CARE Access to preventive health care services
Information about benefits, where and how to seek
Activity Can Help care, and the risks involved in treatment
Timely response to requests for services, inquiries
and complaints
Control Diabetes Second opinions when medically appropriate
Titles and specialties of the health care professionals
responsible for your care
B eing active is a great way
to help control diabetes.
a little more active in the things you do
every day. For instance, take the stairs
when you can, get off the bus one stop
Privacy and confidentiality regarding your medical
and health conditions
Information regarding the medical group and health
How will exercise help? earlier, do chores in the yard or house. plan grievance procedures
Exercise helps lower your blood Ideally, you should build up to 30 to Recognition of your rights to make decisions regard-
sugar. Active muscle can use glucose 60 minutes of moderate activity most days ing your medical care and to complete an advance
(blood sugar) without insulin being of the week. Your activity should include directive, thereby extending your rights to any per-
present. Inactive muscle must have insu- exercises that build strength and increase son who may make decisions on your behalf regard-
lin present to get glucose into its cells. flexibility (such as gentle stretching) as ing your medical care
Exercise helps you lose weight. Being well as aerobic exercise (exercise that The right to make recommendations to your patient
overweight makes it harder for your increases your heart rate and breathing). rights and responsibilities
cells to use insulin, a condition called
insulin resistance. Shedding extra Are there safety measures Patient Responsibilities
pounds can help you control your glu- I should take? As your health care partner, we ask that you:
cose levels. Losing weight also helps you Before and after exercising, measure Provide professional staff with all health care infor-
avoid other health problems, such as your blood glucose level. Doing so will mation needed to ensure the best possible outcome
heart disease, osteoarthritis and hyper- help you find out if it’s safe for you to Communicate with your primary care physician when
tension. Activity helps lower cholesterol, exercise. Do not exercise if your blood you have questions or concerns about your health care
another risk factor for heart disease. sugar level is high (greater than 300). Adhere to instructions and guidelines given for
A regular exercise program may That is a sign that your diabetes is out health care services
help some people with type 2 diabetes of control. If your blood sugar is low Cooperate with health care professionals providing
decrease — or even stop — insulin or (less than 70), drink 4 ounces of fruit service to you, except in those instances when you
oral medication use. juice or take a few glucose tablets to have exercised your right to refuse service
Regular physical activity can relieve bring your blood sugar up. It is a good Educate yourself on your health benefits and services
stress; strengthen your heart, muscles idea to eat a small snack, such as a and how to correctly obtain them
and bones; improve your blood circula- piece of fruit, before exercising. Also, If you have questions about your benefits, call
tion; and keep your joints flexible. drink plenty of water to prevent dehy- Brown & Toland Medical Group’s Customer Service
dration. If you notice signs of low blood Department at 415.972.6002, or your health plan’s
What kind of activity sugar, such as shakiness, during exer- member services division. ■
is best for me? cise, check your blood sugar level to
The California Department of Managed Health Care is respon-
Find out from your health care pro- make sure it has not fallen too low. sible for regulating health care plans. The department has a toll-
vider what types of exercise will be safe for There is no limit to the activities free number (888.HMO.2219) to receive complaints regarding
you. The best approach is to start at your you can do. But to be safe, always talk health plans. If you have a grievance against a health plan, you
should contact the health plan and use the plan’s grievance pro-
own pace and be realistic. If you are inac- with your doctor before you start an cess. You may call the California Department of Managed Health
tive, start by taking a brisk walk for five or exercise plan. Then take one giant step Care for assistance with an emergency grievance or a grievance
10 minutes a day. You also can try to be into action. ■ that has not been satisfactorily resolved by the plan.
www.brownandtoland.com Brown & Toland’s HealthLink, Summer 2006 7

8. MEN’S HEALTH
Why Real Men
See the Doctor
I t’s easy to get most men to a ball game
or a hardware store. But for a lot of guys,
a trip to the doctor is not a high priority.
One reason is pride. In a culture that
equates being male with being healthy
and strong, a hint of vulnerability to ill-
I think men are ness might be seen as a sign of weakness.
This is dangerous thinking. Waiting can mean a kidney stone or prostate cancer, president of the American Academy of
getting better at until you are ill before you see your and it’s always cause to visit a doctor. Family Physicians. “Many men still have
seeing the doctor, health care provider can put your health But seeing the doctor also can aid your to be pushed to the doctor by their wives
but there’s still in jeopardy. peace of mind. Symptoms that could sig- or children.”
If you let shortness of breath or chest nal a serious illness also can point to sim- It’s not just better for a man’s health if he
hesitancy and discomfort go unchecked, you might face ple, easily treated problems. That blood in visits a doctor. It’s better for his son’s health,
denial. a heart attack. A change in bowel habits the urine, for instance, could come from too. Boys often model their fathers’ behavior.
— Larry S. Fields, M.D.,
could warn of diseases like colon cancer. an infection. If dad sees the doctor, there’s a better chance
president of the Headache or dizziness might stem from “I think men are getting better at see- his son will grow up to do the same.
American Academy
of Family Physicians.
high blood pressure, which can lead to kid- ing the doctor, but there’s still hesitancy “There’s a rather good and simple
ney damage and stroke. Blood in the urine and denial,” says Larry S. Fields, M.D., reason for men to see their doctors,”
PREVENTION
Getting the
Most From Your
Mammogram
T here are lots of reasons for putting off a
mammogram: You’re nervous. You’re
shy. You’re busy. Or you just don’t like it.
There’s also one great reason for not
putting it off: Mammograms save lives.
“Regular mammograms are the best
way we have right now of detecting
breast cancer early, when tumors are
smaller and treatments can be less inva-
sive,” says Elizabeth Woolfe, manager of Mammograms aren’t fun, “but they’re Instead of avoiding the test, Ms. Woolfe
education and special projects for the not something to be feared, either,” says says, “take charge of the process. Learn
National Alliance of Breast Cancer Ms. Woolfe. “If there’s discomfort, it usu- how to make the experience of getting a
Organizations in New York City. “Every ally lasts no more than a few seconds, mammogram a positive one, so you’ll
woman should know how to make the and that’s a very small price to pay for make the effort to do it regularly and
most of this important tool.” peace of mind.” do it right.”
8 Brown & Toland’s HealthLink, Summer 2006 www.brownandtoland.com

9. Dr. Fields says. “It gives the doctor and Depression. Talk to your doctor Maintain a healthy weight. Bal-
the patient the opportunity to catch a if you feel sad or hopeless, or if you ance the amount of calories you eat
problem early, leading to a better quality have lost interest in normal activities with the amount of activity you get.
of life — and a longer life, too.” for two weeks straight. You may Don’t drink or drink in moderation.
have depression. If you drink alcohol, have no more than
Tests you need Sexually transmitted diseases (STDs). two drinks a day. A drink is 12 ounces
The U.S. Preventive Services Task Talk to your doctor to see if you should of beer, 5 ounces of wine or 1.5 ounces
Force recommends that men get regular be screened for any STDs, such as HIV. of distilled spirits. Boys often model
screening for certain diseases and medi- Prostate cancer. Talk to your doctor Keep your immunizations up to their fathers’
cal conditions. Talk to your health care about whether you should be screened date. Talk to your doctor about which behavior. If Dad
provider if you have questions about for this type of cancer. immunizations you may need. sees the doctor,
which screenings are appropriate for you. Consider taking aspirin. Talk to there’s a better
Cholesterol. You should have your Staying healthy your doctor about taking aspirin to chance his son
cholesterol checked at least every five Here are recommendations from prevent heart disease if you are older will grow up to
years, starting at age 35. If you smoke, the Agency for Healthcare Research than 40. ■ do the same.
have diabetes or if you have a family and Quality:
history of heart disease, you should Don’t smoke. If you do smoke, talk
have your cholesterol checked begin- to your doctor about how to quit.
ning at age 20. Follow a healthy diet. Your diet
Blood pressure. You should have should include a variety of foods,
your blood pressure checked every including fruits, vegetables, whole
two years. grains and protein. Watch how much
Colorectal cancer. Screening for this saturated fat you eat.
cancer should begin when you are 50. Be active. Pick an activity you enjoy
Diabetes. You should be screened for and stick with it. Try for a total of 20 to
diabetes if you have high blood pres- 30 minutes of moderate activity most
sure or high cholesterol. days of the week.
Give yourself an edge facilities, have your old X-rays sent After your screening, it’s also impor-
All mammography equipment must to you and bring them to your next tant you follow up, Ms. Woolfe says. The
be certified and inspected annually by the mammogram. FDA requires results to be mailed to you,
U.S. Food and Drug Administration (FDA). Tell your doctor and the radiolo- and many facilities also will phone you
But because a mammogram can give gist about any concerns you have with them. If you don’t hear within
only a picture of how your breasts appear about your breast health — particu- 10 days, call the facility yourself.
at a certain point in time, you must pro- larly if you have noticed something Sometimes, the radiologist will ask
vide the context so the radiologist and unusual. you to schedule another appointment so
your doctor can note and track any additional pictures can be taken. Usually,
changes that occur. this is to clarify an indistinct image and
For the best results: Regular mammograms are the shouldn’t be cause for alarm. To keep
Get regular mammograms as rec- best way we have right now of delays and stress to a minimum, make
ommended by your health plan, your the appointment promptly and keep it.
doctor or a national health organization. detecting breast cancer early, If the radiologist identifies something
Regular clinical breast exams and self- when tumors are smaller and in your mammogram that needs addi-
exams also provide important informa- tional evaluation, you’ll be referred to a
tion about any changes in your breasts. treatments can be less invasive. specialist. Your primary care physician or
Schedule for comfort. Ask for an — Elizabeth Woolfe, manager of education OB/GYN will make the referral, but, once
and special projects for the National Alli-
appointment the week after your period, ance of Breast Cancer Organizations again, it will be up to you to make and
when your breasts are less tender. keep the appointment.
Dress for success. Wear a two-piece At any point, feel free to ask questions
outfit with a top you can slip out Make sure your doctor and radi- about what’s happening and why. Mammograms
of easily. ologist know about any issues in “It’s your life and your health. are a small
Make sure the radiologist has your health history that can aid in Empower yourself to feel in control,” price to pay for
your previous films. If you change interpreting results. says Ms. Woolfe. ■ peace of mind.
www.brownandtoland.com Brown & Toland’s HealthLink, Summer 2006 9

10. WOMEN’S HEALTH
A Woman’s Guide to
Beating Heart Disease
S urveys show fewer than one in 10 women perceive heart disease as their greatest
health threat. But it’s the nation’s number one killer, and women are its prime target.
One in 10 women ages 45 to 64 has some form of heart disease, and this increases to
one in four women after age 65. Stroke is the number three killer of women.
Every year, more women die of heart cholesterol, as well as triglycerides,
disease and stroke than men. The overall another form of fat in the blood. The toxins in cigarette smoke can shrink
lifetime risk of dying of breast cancer for In general, you’re at low risk if your coronary arteries, making it tough for
women is 3 percent. For cardiovascular total cholesterol is less than 200 mg/dL; blood to circulate.
disease or stroke in women, it’s nearly LDL, less than 100 mg/dL; HDL, greater
50 percent. than 40 mg/dL; and triglycerides, less Get active
The risk for heart attack and stroke than 150 mg/dL. At least 30 minutes of moderate
increases with age, especially after meno- Normal blood pressure is 119/79 physical activity most days of the week
pause. But atherosclerosis, the condition or lower. People with prehypertension, does more than help you burn calories.
in which plaque — thick, hard choles- a condition that indicates high blood It can reduce your risk for heart disease
terol deposits — forms in artery walls to pressure could develop in the future, by raising your HDL and reducing LDL.
constrict or block blood flow and cause have blood pressure between 120/80 and
chest pain or even a heart attack, starts in 139/89. High blood pressure, or hyper- Change your fats
the teens and 20s. That’s why it’s impor- tension, is 140/90 and higher. Switch the fat in your diet from but-
tant to start protecting yourself from Your doctor may advise you to make ter and other artery-clogging saturated
heart disease early. diet and lifestyle changes before prescrib- fats to heart-healthy, cholesterol-busting
ing medication. fat — such as liquid margarine, tub
The following habits can prevent margarine, olive oil and canola oil. But
heart disease: use them sparingly.
Also, limit full-fat dairy products, fatty
Lose weight meats, palm oil and partially hydroge-
Being overweight affects blood pres- nated vegetable oils.
sure, blood cholesterol and triglyceride
levels. It also increases your risk for Eat your fruits and veggies
type 2 diabetes, a condition in which Eat plenty of produce — at least 2½
your body can’t use insulin to help cups of vegetables and 2 cups of fruits
convert food to energy. daily. Studies link diets high in fruits
By bringing your weight to its optimal and vegetables with a reduced risk for
level, you’ll lower your cholesterol level heart disease and high blood pressure.
and blood pressure and make your body
more sensitive to the effects of insulin. Fiber up
A body mass index (BMI) of 25 or Oatmeal, whole-grain bread and
higher is considered overweight. To cal- other whole-grain foods are excellent
culate your BMI, multiply your weight sources of soluble fiber, which helps
in pounds by 703. Divide the result by reduce LDL cholesterol. The USDA rec-
Studies link Check your risk your height in inches, then divide that ommends for adults about 6- to 9-ounce-
diets high in First, you should get your blood cho- result by your height in inches again. equivalents of grain per day, of which
fruits and veg- lesterol and blood pressure checked. The Don’t worry if you need to lose a lot half should be whole grain.
etables with a higher either of them is, the greater your of weight. Even losing 5 to 10 pounds
reduced risk risk for heart disease or a heart attack. A can make a difference. Drink alcohol in moderation
for heart dis- lipoprotein profile — a blood test done For women, that means no more
ease and high after a 9- to 12-hour fast — will measure Quit smoking than one drink per day, the equivalent
blood pressure. the fats in your blood to indicate the lev- Smokers have more than twice the of 12 ounces of beer, 4–5 ounces of wine
els of HDL (“good”) and LDL (“bad”) risk for heart attack as nonsmokers. or 1½ ounces of 80-proof spirits. ■
10 Brown & Toland’s HealthLink, Summer 2006 www.brownandtoland.com

11. WOMEN’S HEALTH
All About
Menopause
M enopause — when a woman’s body stops
menstruating, ovulating and producing estro-
gen and progesterone — is a natural part of a woman’s
life. The average age that women reach menopause is 51.
The years leading up to menopause, quently as a few times a month. They (“bad”) cholesterol and increasing the
called perimenopause, usually occur can happen any time of the day or night. HDL (“good”) cholesterol in the blood
between ages 45 and 55. During this They may wake you from sleep (called and by having positive effects on blood
time, estrogen production declines. night sweats). They may continue to vessels. Although hormonal therapy (HT)
Perimenopause differs from woman to occur for as long as five years, as your may help relieve menopausal symptoms,
woman. Some women menstruate regu- body adjusts to the ovaries’ lower produc- it does not appear to prevent heart dis-
larly until their periods suddenly stop. tion of estrogen and progesterone. ease and increases the risk for breast can-
Others may see changes in the amount Perimenopausal women may have cer. You can take other steps to reduce
of menstrual flow or the length of time sleep problems because of night sweats your risk for heart disease after meno-
between periods. Still others have missed or insomnia. Lack of sleep can affect pause by eating a healthy diet, exercising
periods or bleeding between periods. moods, health and ability to function. regularly, maintaining a healthy weight,
Although irregular periods, heavy Vaginal and urinary tract changes avoiding smoking and, if you have dia-
bleeding or bleeding longer than normal can occur as estrogen levels fall. The betes or high blood pressure, following
often is a normal part of the years leading vaginal lining gets thinner and drier. your treatment plan.
up to menopause, any of these also can be Sexual intercourse can be uncomfort- Until a woman turns 30, her body
You can take a warning sign of cancer. If your periods able, but this can be relieved by using builds bone; after age 30, bone is broken
steps to reduce become irregular, heavier or longer than over-the-counter, water-soluble lubri- down faster than it is replaced. Mild bone
your risk for usual, or if you have bleeding between cants. The lining of the urinary tract loss will not cause problems, but when the
heart disease periods, keep a menstrual diary and dis- also becomes thinner, and tissue sup- loss becomes excessive, bones weaken and
after meno- cuss it with your health care provider, who porting the bladder may weaken. These fractures occur. Eating a diet that provides
pause by eating may decide to check for uterine cancer. changes can cause urine to leak with 1,200 to 1,500 mg of calcium a day and
a healthy diet, sneezing, lifting or other exertion. This 400 to 800 IU of vitamin D (or taking
maintaining a Symptoms of menopause is called stress incontinence and can equivalent amounts in supplements),
healthy weight Up to 75 percent of women have hot be helped by doing Kegel exercises. doing weight-bearing exercises and taking
and exercising flashes as they approach menopause. The medications that help build bone can help
regularly. flashes — a sudden flushed feeling that Health risks prevent excessive bone loss and fractures.
usually begins near the chest and spreads A woman’s risk for heart disease and Oral HT can relieve vaginal dryness,
to the neck, face and arms — usually stroke increases after menopause. Natural reduce or end hot flashes and help blad-
last three to four minutes and can occur estrogen may help to protect the heart der symptoms. HT, however, increases
as often as once per hour or as infre- and blood vessels by decreasing the LDL other health risks. For vaginal dryness
and urinary incontinence, a prescribed
vaginal cream containing estrogen
SELF-CARE STEPS FOR MENOPAUSE may be helpful. Water-based lubricants,
Dress in layers and wear loose clothing. such as K-Y Jelly, Astroglide, Replens or
Drink plenty of water. Surgilube, can make sexual intercourse
Do weight-bearing exercise for 30 to 60 minutes less painful. Talk to your health care
a day most days of the week. provider to find out what is best for you.
Avoid caffeine and alcohol, which can intensify Nonhormonal measures also are
hot flashes and cause insomnia. available to help relieve menopausal
Eat a balanced diet including fruits and symptoms. Herbal products containing
vegetables and 1,200 to 1,500 mg of calcium estrogen-like substances are not recom-
and 400 to 800 IU of vitamin D a day. mended for control of symptoms because
Achieve and maintain a healthy weight. their quality cannot be assured and many
of their effects have not been studied. ■
www.brownandtoland.com Brown & Toland’s HealthLink, Summer 2006 11

12. BENEFITS FOR SENIORS
Learn More About
Medicare Advantage and
Brown & Toland
P eople who become eligible for Medicare
— including those approaching their
65th birthdays — have choices available to
Brown & Toland is San Francisco’s preeminent physician
network. Brown & Toland doctors practice quality health care
at California Pacific Medical Center, UCSF Medical Center,
UCSF/Mount Zion Medical Center, St. Mary’s Medical Center,
them beyond traditional Medicare. Saint Francis Memorial Hospital and St. Luke’s Hospital.
Brown & Toland contracts with two Medicare Advantage
Plans to provide Medicare beneficiaries with more affordable
and more comprehensive coverage than Medicare. This
includes hospitalization, emergency coverage and access
to an extensive network of private practice physicians.
Seniority Plus is a Medicare Advantage plan offered by
Health Net. Secure Horizons is a Medicare Advantage plan
offered by PacifiCare.
By enrolling in one these Medicare Advantage plans,
Medicare beneficiaries have a wide range of important
benefits including doctors’ visits and Medicare Part D
prescription drug coverage.
We encourage you to find out more about Brown &
Toland’s Medicare Advantage plans: Health Net’s Seniority
Plus and PacifiCare’s Secure Horizons.
To learn more about Medicare Advantage and Brown &
Toland, please call 1.866.488.7088 or return the enclosed
business reply card for a free informational packet. ■
PRSRT STD
U.S. POSTAGE
The Doctors Behind Every Good Health Plan PAID
Effingham, IL
P.O. Box 640469
San Francisco, CA 94164-0469 Permit No. 148