Julia Kagan

How to Stay Healthy: Final Words of Wisdom from Julia

December 24, 2009 at 10:27 am , by

s_womandoctorThe end of the year is a traditional time to both look back and to think about the future, but I’ve got an especially compelling reason to do that. After four years at Ladies’ Home Journal (and many more editing elsewhere) I’m leaving my job as Health Director to study for a Master of Fine Arts in creative nonfiction and write books. This is my last chance to share some things I’ve learned on this beat.

Whatever you do, keep moving. Even really elderly people get stronger if they exercise and lift light weights. Exercising improves your health in almost every situation, from high blood sugar to heart disease to lowering depression and your breast cancer risk. My New Year’s resolution is to go from twice a week to four times—we’ll see if I make it. (Don’t I have till Chinese New Year, February 14th?)

Take control of your health. If you don’t understand what the doctor says, keep asking until you do. And do go to the doctor—and the dentist. How often you need to go changes depending on your age and health history. Always come with a list of questions: Visits are short so it pays to be organized.

• Eat well, but don’t obsess about your weight. Yo-yo dieting can be worse than being a little overweight—and can leave you undernourished. Focus on good nutrition and portion control.

• Defuse when you can. Stress can undermine your health in a multitude of ways. Take some time every day to take a few deep breaths, hug someone, zone out as you watch the clouds in the sky.

Do your own research. Whether you’re trying to lose weight, control diabetes or fight asthma, go online for more information. That goes double if someone is suggesting surgery or just prescribed a new drug. My favorite place to start is the Mayo Clinic website. And don’t forget to check out our health coverage. Also visit websites from organizations that specialize in your condition, such as Susan G. Komen for the Cure for breast cancer.

Find ways to save on health care You may be able to use a lower-cost physician’s assistant or dental technician. Major drug companies have programs if you can’t afford your medicine. States and cities may fund mammograms or flu shots. Hospitals can work out payment plans. See these ideas from our sister magazine, Parents.

It’s amazing how much you can help yourself. That’s the biggest lesson I’ve learned.


Holiday Survival Guide: 7 Healthy Ways to Enjoy the Season

December 9, 2009 at 4:29 pm , by

Christmas Dinner

I think diet experts are right when they say your holiday goal should be holding the line on your weight. Trying to actually drop pounds during the eating season takes superhuman self-control (to say nothing of how upset your aunt will be if you don’t have at least one bite of her chocolate pie). Here’s what I’m doing:

Breakfast every day. It keeps the metabolism running and your body out of calorie-saving starvation mode. Include protein to stave off hunger later.

Staying calorie-conscious. Pick the one high-calorie treat you really want at the party and steer clear of the rest. And make your non-holiday meals less caloric than usual.

Wine spritzers. Alcohol has calories: 85 for a 4 oz. glass of wine has 85; 65 for  1 oz. of vodka or scotch and almost 150 in a regular beer. For both health and weight, have no more than one alcoholic drink a day. Steer clear of sweet mixed drinks, especially eggnog. I rely on wine spritzers (wine and sparkling water)—you can have several and end up drinking no more than 4 oz. of alcohol.

Sugar-free gum. Chew some just before you leave for a party; the minty taste will make you feel less like eating when you get there.

Passing the hors d’oeuvres. If you’re holding a big tray of them, you can’t eat them—and it’s a good way to circulate at a party.

Bringing the hors d’oeuvres. The best way to make sure there’s at least one platter of raw veggies with low-fat yogurt dip is to bring it.

Keeping moving. Exercise not only burns calories (not as many as we wish, but some), but lowers your blood sugar.

Come New Year’s I’m going to try to lose 10 lbs. For help, see our weight loss planner.



First Mammograms, Now Pap Tests

November 25, 2009 at 2:01 pm , by

3360002123_cb852b7011_tThe week before Thanksgiving was supposed to be peaceful. Let’s not talk about the fact that both your health editors were fighting bad colds, but the moment we finished dealing with the new guidelines for mammograms, the American College of Obstetrics and Gynecology (ACOG) announced that it was recommending women delay the age they start being tested for cervical cancer.

So now the annual Pap test bites the dust, too—also based on research that “screening at less frequent intervals prevents cervical cancer just as well, has decreased costs and avoids unnecessary interventions that could be harmful,” according to Alan G. Waxman, M.D., professor of obstetrics and gynecology at the University of New Mexico School of Medicine. What it means for you:

If you’re age 30 or more, you can now be tested every three years once you’ve had three negative results on consecutive tests. This isn’t a big change—starting in 2004 ACOG recommended testing every two to three years if you had negative results on three annual tests. Cervical cancer usually grows very slowly, so the interval is considered safe except for women with medical issues, such as abnormal results on previous tests. At 65 or 70, if you’ve had three negative tests in a row and no abnormal results in 10 years, you can stop completely.

If you’re 21 to 30—the group that used to get an annual test—you’re now supposed to be tested every two years, unless you have medical reasons to have them more often.

If you’re under 21, you shouldn’t get tested. A woman is supposed to wait until 21 for her first test, no matter how early she starts having intercourse. Previously, she was supposed to start about three years after her first intercourse or at 21, whichever came first. Why the change?

• invasive cervical cancer is very rare under 21
• most young women who get an HPV infection fight it off on their own, and
• treatments for cell abnormalities increase the risk of premature births.

Not all doctors agree. “For younger women, Pap smears save lives; 21 is way too late for most women in our culture,” says oncologist Elaine Schattner, MD, clinical associate professor of medicine at Weill Medical College of Cornell University in New York.

Unlike the mammogram changes, the American Cancer Society (ACS) supports the new cervical cancer guidelines and will be releasing its own revision next year. My own reading—I’m not a doctor, remember—is that the under 21 ban is the biggest question. As always, discuss what you should do for yourself (or your daughter) with your physician.


New Mammogram Guidelines: Should You Wait Till 50?

November 18, 2009 at 5:20 pm , by

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UPDATE December 2, 2009
The mammogram debate continues. If we screen only “high risk” women, we’ll miss 75-90% of those get breast cancer, says Daniel B. Kopans, M.D., professor of radiology at Harvard Medical School and director of breast imaging at Massachusetts General Hospital, at a Radiology Society Of North America press conference.

Earlier this week, the distinguished U.S. Preventive Services Task Force (USPSTF) announced its new breast cancer screening guidelines, reversing many of its 2002 recommendations. In a move that has already become a point of controversy, USPSTF now recommends that women start getting mammograms later in life and less frequently. But after years of preaching  “prevention, prevention, prevention,” what should we do now?

What changed:
1. USPSTF advises women to start getting routine mammograms at age 50—not 40—until age 74.  However, those between ages of 40-49 who are at high risk for breast cancer should talk to their doctor whether to begin regular screenings sooner.
2. USPSTF suggests getting a routine mammogram every two years, instead of every year—again, women in high-risk groups may need a greater frequency.
3. USPSTF recommends that doctors should not teach women how to do breast self-exams.

The reasoning: USPSTF found that among women ages 40-49, mammograms save one cancer death per every 1,904 people screened for 10 years.  Among those ages 50-74, this number increases to 1 in every 1,339 women, and to 1 in every 337 women ages 60-69.

Based on these findings, the USPSTF concludes that for women ages 40-49, the risk of overtreatment (unnecessary biopsies, stress) from a mammogram outweighs its benefits.  There is also data showing breast self–exams don’t find cancers in a more treatable stage or decrease deaths (read a Q&A with Susan M. Love, M.D. about this topic from our October 2009 issue after the jump, below).

The controversy: Not everyone agrees with USPSTF’s interpretation. “The panel acknowledges that screening mammography for women in their 40s saves lives, but considers it too costly in dollars per woman saved and in false positives. This seems inappropriate to me and would be to most women in their 40s, I think,” says Etta D. Pisano, M.D., Kenan Professor of Radiology and Biomedical Engineering and Director of the UNC Biomedical Research Imaging Center at UNC School of Medicine in Chapel Hill, North Carolina.  “I do think the data support less frequent screening for older women,” she adds—but whether that should “start at 50 or later when women have fatty breasts…would be important to study.”

Moreover, the American Cancer Society still recommends women get an annual mammograms starting at 40. And so does Susan G. Komen for the Cure. And in terms of limiting mammograms from age 40 to 50 to just those with identified high risk factors: It turns out, according to Komen, that most women diagnosed with breast cancer in the U.S. do not have any risk factors aside from being female and getting older, and breast cancer that occurs in younger women is often more aggressive than breast cancer in women in their 50s or older.

The bottom line: Right now you still get to choose which recommendation you want to follow.  And for women who hate mammograms, this is medical confirmation that you can have them much less often. But if you want to keep being tested according to the old standards, be prepared that insurance companies and Medicare may look at whether they should reduce the number of mammograms they are willing to cover.

Read more


High-Heel Help

November 11, 2009 at 12:52 pm , by

3335762590_9822628d7eSometimes you learn the best stuff by accident. A few weeks ago I was racing across town to meet friends for dinner when my high heel got stuck in a crack in the pavement. When I yanked it out, the rubber bottom of the heel came off. I was late so I kept running on the heel stub. And I discovered something wonderful—the foot in the broken shoe felt amazingly better because the heel was ¼ inch shorter.

Yes, I do know that stilettos aren’t what the doctor ordered. Heels over 2 inches can cause foot and back problems; over 3 inches and they put seven times the pressure on the ball of your foot that flats do.

The shoes had always been a bit too high to wear every day so, when I had them fixed, I asked the shoemaker if he could make the heels slightly shorter. He could! They’re now 2 inches instead of nearly 2 ½ and so comfortable I wear them all the time. It worked so well I had him cut down some brown ankle boots that had been getting dusty in my closet for the same reason.

As the Shoe Service Institute of America points out, there’s a limit to how much you can cut off and which kinds of heels can be shortened. But it’s worth a try! And if even lower heels don’t make your feet feel better, here’s more advice on what to try.

Photo by geishaboy500.


Cooking with Agave

October 21, 2009 at 1:20 pm , by

CookbookFolks who’ve followed my posts may remember that I discovered agave nectar in my search for sweet things to feed the Jam Man, my family member diagnosed with diabetes two months ago. That’s the sweet syrup of the agave plant (used to make tequila). It has a low glycemic index, which means it’s digested more slowly than many other sweeteners so it’s less likely to spike blood insulin levels. One problem: cooking with agave can be complicated; it’s sweeter than sugar and its insulin fiber means liquids don’t cook away as fast. Here’s how Diabetes Forecast, the magazine of the American Diabetes Association explained baking with it, in a story on sweeteners: “To adjust a recipe, replace each cup of sugar with two-thirds to three-quarters cup of agave nectar, then reduce all other liquids in the recipe by a quarter. Lower your oven temperature by 25 degrees to prevent burning, and shorten the cooking time on cookies by 3 to 5 minutes and cakes by 7 to 10 minutes.” Gulp! I stuck to simple things like using it to sweeten a butternut squash purée I used to make with maple syrup.

Fortunately, a few weeks ago Stephen Richards stopped by the office. He’s the author of Delicious Meets Nutritious, a cookbook where all the sweetening is done with agave. Xagave, to be precise—his company’s blend of blue and white agave nectar. Richards, an amateur cook, created the recipes in his Utah kitchen. Amazingly there’s even a recipe for the Jam Man’s favorite jam—raspberry, which we make every summer (we have a raspberry patch). I may have to indulge in some pricey store-bought berries so we can try it sooner. Meantime, with Thanksgiving coming up, I’m definitely planning to make their cranberry sauce. Do you have any good agave recipes to share?

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Helping the Sickest Survive H1N1 [aka Swine] Flu

October 14, 2009 at 3:36 pm , by

3968592255_15311a8b49Yesterday Emily, my health-blogging-partner-in-crime, and I were standing in line to get our seasonal flu shot like employees all over America whose companies are generous enough to provide them (thank you, Meredith!). Needless to say, everyone in line was talking about H1N1, the kind of flu shot we’re not getting because (1) the vaccine’s still in seriously short supply and (2) most employees are not in the high-risk groups. (See Emily’s story about who is.)

The best way to avoid the flu (either kind) is to wash your hands often; avoid touching your eyes, nose or mouth; sneeze or cough into a tissue or your elbow; and stay home when you have flu-like symptoms until you’ve had no fever (without any medication) for 24 hours. Most people who  get H1N1 have mild cases and recover quickly. But a small number (roughly 4 percent in a new Canadian study) develop sometimes fatal lung inflammation and other symptoms (usually about four days after first getting sick) that land them in intensive care. Studies just published by The Journal of the American Medical Association give us an early look at what might help them survive, Two findings to remember:

Tamiflu. In Mexico, critically ill patients who survived were seven times more likely to have taken Tamiflu. Ask about it even if you think you have a mild case.

Extracorporeal membrane oxygenation (ECMO). This technique—used in heart-bypass surgery—passes a patient’s blood through a machine that adds oxygen and returns it to the body because severe illness can block the body’s ability to get oxygen. ECMO helped patients in Australia and New Zealand pull through.

For the latest H1N1 news, see the Centers for Disease Control. (Photo by quinn.anya.)

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