MOVEMENT MATTERS - NewYork-Presbyterian Hospital

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S U M M E R 2 017HEART DISEASEAND MENOPAUSEBE GONE, BED-WETTINGMOVEMENT MATTERS:A PARKINSON’S DISEASE PRIMERTHE INFORMATION YOU NEED.THE CARE WE PROVIDE.THE COMMUNIT Y WE SHARE.

Brooklyn:home of coney island,the brooklyn bridge,and nownewyork-presbyterianbrooklyn methodist hospital.We’re bringing the people of Brooklyn the type of care that comes from beingpart of NewYork-Presbyterian. We’ve expanded our services and added moreworld-class specialists from Weill Cornell Medicine. They join the skilleddoctors already here serving the community. Learn more at nyp.org/brooklyn.

We Want toHear from YouAGING GRACEFULLYBALANCE IN THE HOMEDo you want to comment“Community Forum” section,24where we feature letters fromreaders and tell you how toNewYork-PresbyterianBrooklyn Methodist Hospital506 Sixth Street, Brooklyn, NY 11215718.780.3000KID ZONE16Thrive is published byNewYork-PresbyterianBrooklyn Methodist Hospital.The material in Thrive should not beconsidered specific medical advice,as each individual circumstance isdifferent. Consult your physicianbefore undertaking any form of medicaltreatment or adopting any exerciseprogram or dietary guidelines.BE GONE, BED-WETTINGNewYork-Presbyterian Brooklyn Methodist Hospital complies withapplicable Federal civil rights laws and does not discriminate onthe basis of race, color, national origin, age, disability,or sex. For more information, see link on our home page atwww.nyp.org/brooklyn.CONSUMPTION JUNCTION22DINNER IN A BOWLPHOTO CREDIT: DAVID GROSSMANshare your opinions with us.TA B L E O F C O N T E N T Son an article you’ve read inThrive? See page 31 for our13TOUCHING BASESAVING THE SPINEATENCIÓN: si habla español, tiene a su disposición serviciosgratuitos de asistencia lingüística. Llame al 718.780.33758am - 5pm or 718.780.3556 5pm - 8am(TTY: 718.780.3375 8am - 5pm or 718.780.3556 5pm - 以免費獲得語言援助服務。請致電 718.780.3375 8am - 5pm or 718.780.3556 5pm - 8am(TTY: 718.780.3375 8am - 5pm or 718.780.3556 5pm - 8am).THRIVE SUMMER 2017RICHARD S. LIEBOWITZ, M.D.PRESIDENTLYN HILL VICE PRESIDENT FORCOMMUNICATION ANDEXTERNAL AFFAIRSMEGAN SCHADE DIRECTOR OFPUBLICATIONS,DEPARTMENT OFPUBLIC AFFAIRSTRUE NORTH CUSTOM PRODUCERLISA PRICE SR. MANAGING EDITORSANDEE CURRY CONTENT DIRECTORJENN TAYLOR ACCOUNT MANAGERSTEPHANIE BATES WHEELER SR. DESIGNERALSO IN THIS ISSUE3 Message from the President/ ViewpointBy the NumbersInsightsDo’s & Don’ts/ How to Curb Muscle CrampsThe Right Choices/ Balancing BedtimeWomen’s Health/ Getting to the Heart of MenopauseAnatomy Insider/ Arthroscopy: Healing the KneeSpecial Report/ Movement Matters: Parkinson’s DiseaseMen’s Wellness/ Turn Up the VolumeRelax, Refresh, Refocus/ The Gift of ForgivenessQ&A/ A Caring Approach to Better OutcomesHealth Quiz/ What Do You Know about Barrett’s Esophagus?Take Five/ Your Health Cheat SheetReader Letters/ Community ForumEngage with NYP Brooklyn Methodist/ Support Groups & Events4567810121826272829303132P H Y SI C I A N RE F E RR A L / / 718 . 49 9.C A RE

ViewpointMESSAGE FROM THE PRESIDENT4I AM SO HAPPY TO BE HEREAND EXPERIENCEFIRSTHAND THE VALUENYP BROOKLYN METHODISTBRINGS TO THE NEWYORKPRESBYTERIAN REGIONALHOSPITAL NETWORK.WE ARE A CRITICALCOMPONENT OF THEAs I write this, I can look back on my first three months at NewYork-PresbyterianBrooklyn Methodist Hospital with much pleasure and pride. The Hospital has exceededmy hopes and expectations in nearly every area. I am so happy to be here and experiencefirsthand the value NYP Brooklyn Methodist brings to the NewYork-PresbyterianRegional Hospital Network. We are a critical component of the Network, and at thesame time, benefit from the resources now available to us.During my first months, I spent much of my time walking the various inpatient floors—getting to know the members of our dedicated and talented staff and seeing firsthand thegreat care and treatment given to our patients. Naturally, I was especially drawn to thehappiest floors in the Hospital—the Labor/Delivery and the Mother/Baby Units.In recent years, much has changed about the way in which babies are born and caredfor. The experience is now centered on the needs and desires of patients and families.At NYP Brooklyn Methodist, women labor, deliver and become acquainted with theirbabies in one of our comfortably furnished private birthing rooms. Fathers, co-parentsand/or other family members can be present, if that is their choice and that of the mother.Many have marveled at the way in which the home-like room easily converts to a hightech clinical area. Our obstetricians and midwives offer a variety of birthing choices.Following a postpartum opportunity to bond, women are taken to the Mother/BabyUnit, where they generally share a room with their new babies. The same nurse caresfor mother and child, and new mothers receive informal lessons in newborn care and agreat deal of encouragement and support in breastfeeding from our lactation team. Formost new mothers, the stay in the Mother/Baby Unit is brief—just a day or two, thoughwomen who have delivered via Cesarean section may remain with us a little longer.Premature babies or those requiring special attention stay in our Level III NICU(neonatal intensive care unit), where pediatric physicians and nurses provide the mostadvanced care for these infants and also offer emotional support for parents.If you, or someone you know, is choosing a hospital for childbirth, I invite you tocheck out NewYork-Presbyterian Brooklyn Methodist. You can find out more about ourchildbirth program, register for a tour or enroll in childbirth classes by going to ourwebsite, www.nyp.org/brooklyn, and clicking on the “Life Begins” tile on the homepage.Whether you are anticipating a new baby or are currently at an entirely differentstage of life, I hope that you will find useful information in this issue. Our goal is to helpBrooklyn stay healthy and thrive! Have a great summer.Sincerely,NETWORK, AND AT THESAME TIME, BENEFIT FROMTHE RESOURCES NOWAVAILABLE TO US.Richard S. Liebowitz, M.D. rooklynSUMMER 2017/ / W W W.NY P.ORG / BRO OKLYN

YOUR HEALTH IN A HEARTBEATIT’S NOT EASY TO STAY CURRENT WITH HEALTH NEWS ANDTO KEEP YOU IN THE KNOW.ON GUARDWhen you think of sports-related injuries, what may come to mind are strains, sprainsand concussions, but dental injuries are also common, especially in children and youngadults. Dentists estimate that more than one-third of pediatric dental injuries occur whilekids are playing sports.About 80 percent of dental injuries involve at least one of the front teeth, althoughinjuries to the tongue and cheek also occur. For these reasons, dental experts at NewYorkPresbyterian Brooklyn Methodist Hospital recommend wearing mouth guards for allcontact sports.Mouth guards are the top preventive measure against sports-related dental injuries,lowering the risk by 60 times.“Mouth guards help protect the soft tissues of the lips, cheeks, gums and tongue bycovering the sharp surfaces of the teeth, minimizing the risks of injuries to the mouth,”says Reneida E. Reyes, D.D.S., section chief of pediatric dentistry in the division ofdental medicine at NYP Brooklyn Methodist. “Properly fitted mouth guards also reducethe force of impact, helping to protect the jaw from fractures.”DECLINE IN CANCER DEATHSWhile the leading causes of cancer death—lung, colorectal, prostate and breast cancers—remain the same, the number of deaths due to these conditions is lower than it was twodecades ago. The decrease translates to an estimated 2.1 million lives saved.The reduction in cancer deaths is due to several factors, including a decline in the numberof people who smoke. Since 2002, former smokers in the United States have outnumberedcurrent smokers, and nearly 70 percent of current smokers report wanting to quit.Another reason for the decline is an increase in the number, quality and availabilityof cancer screenings. Screenings like colonoscopy and mammography allow cancerto be detected and treated at earlier stages than ever before, saving lives and improvingpatient outcomes.“Improved treatment methods also play a role in the decrease, and lifestyle changeson the patients’ part could certainly have an effect,” says Alan Astrow, M.D., chief ofhematology and medical oncology at NYP Brooklyn Methodist. “I encourage everyone toconsult their primary care doctors about the appropriate timing for cancer screening tests.”600,000 BY THE NUMBERSINFORMATION. HERE’S A QUICK RUNDOWN OF DEVELOPMENTSESTIMATED NUMBER OFANNUAL ER VISITS FORSPORTS-RELATED DENTALINJURIES AMONG AMERICANSAGES FIVE TO 2425%PERCENTAGETHATCANCER DEATHSDECREASEDIN THE U.S. FROM1991 TO 2014VITAMIN D FROM THE SUN?5Obtaining the recommended amount of vitamin D is important for absorbing thecalcium that the body requires to maintain bone health.The safest way to meet daily vitamin D requirements is to ingest it from certainfoods and supplements—a three-ounce serving of salmon, one of the best foodsources for vitamin D, has about 447 IU (international units, a measurement usedfor fat-soluble vitamins) per serving.The other way to get vitamin D is through sun exposure. Five to 30 minutes in thesun—depending on skin tone—can produce all the vitamin D that the body requires.People with dark skin need up to six times as much sun exposure to produce thesame amount of vitamin D as people with light skin due to higher degrees of melanin(pigment) in dark skin. But sun exposure comes with inherent health risks like skincancer, skin dryness and premature aging.“Spending time in the sun’s ultraviolet rays is a very efficient way to get anadequate amount of vitamin D,” says Baquar Bashey, M.D., chief of general internalmedicine and ambulatory medicine at NYP Brooklyn Methodist. “People limited tothe indoors or concerned about sun damage can turn to diet or vitamin D tablets toget 600 to 800 IU daily.”600 IUTHE DAILY RECOMMENDEDAMOUNT OFVITAMIN D FOR PEOPLEAGES ONE TO 70** 400 IU daily for babies younger thanone and 800 IU daily for people 71 P H Y SI C I A N RE F E RR A L / / 718 . 49 9.C A RE

INSIGHTSThe Subway6MicrobiomeAbout 637 microbial species—562 of them bacterial—sharea ride with New York City subway commuters, according toa study conducted at Weill Cornell Medicine. From subwaystations across the city, researchers collected 1,457 samplescontaining billions of DNA strands.“New York City is the epitome of a busy, diversemetropolis, and our findings reflect that the same is truewith the city’s microscopic residents,” says ChristopherMason, Ph.D., geneticist and associate professor inthe Department of Physiology and Biophysics at WeillCornell Medicine.Nearly half of the uncovered DNA matches no knownorganisms, which demonstrates that there is a lot moreto learn. One important takeaway from the study is thatthe vast majority of organisms inhabiting the subway arenot harmful.“The subway system is a diverse and safe ecosystem,”Dr. Mason says. “More than 99 percent of bacteria that wefound aren’t associated with disease and don’t carry anypotentially pathogenic genetic markers. Still, it’s easyto pick up a viral or bacterial infection wherever peoplecongregate, so practice good hygiene.”Good hygiene for public spaces like the subway includessanitizing your hands following a ride and before touchingyour face, eyes or mouth, and coughing and sneezing intothe crook of your arm.A GentlerApproachA gentle Cesarean section, or C-section, incorporates the parents’choices as much as possible, similar to creating a birth plan for anatural delivery but tailored to the surgical nature of the C-section.“We’re trying to make the operating room more like the deliveryroom so that the parents feel more involved in the delivery,”says Thomas Paone, M.D., obstetrician and gynecologist atNYP Brooklyn Methodist. “For instance, during a gentle C-section,parents can opt to use a clear drape so that they can see their babyas soon as he or she is born.”In addition, if mom and baby appear healthy, the child can beplaced skin-to-skin with the mother while a pediatrician examinesthe baby. The mother is then moved to the recovery area with thebaby still on her chest. This element of the gentle C-section processeliminates a 20- to 30-minute separation period, allowing motherswho deliver by C-section to immediately become acquainted withtheir babies.Infants &Peanut allergies, which can cause negative reactionsranging from hives to anaphylactic shock (a lifethreatening response to an allergen that can cut offair supply and cause a drop in blood pressure), arereported to have risen dramatically in Americanchildren in recent decades.New research, however, shows that exposingchildren to peanut protein at ages four to six monthsmay help them avoid developing peanut allergies.These findings led to the reversal of federal guidelinesthat advised parents against giving peanut-containingfoods to children younger than age three.“The revised guidelines vary based on whetherthe child has eczema or egg allergies, the degree ofSUMMER 2017/ / W W W.NY P.ORG / BRO OKLYNPeanutProteinsexisting allergies, and the results of allergy screeningtests that may be needed before exposing the child topeanut proteins,” says Cascya Charlot, M.D., chiefof pediatric allergy and immunology at NewYorkPresbyterian Brooklyn Methodist Hospital.The new recommendation is to introduce peanutproteins to babies along with other solid foods.“Parents should be mindful that peanuts are achoking hazard and exercise caution when feedingpeanuts or peanut butter to children younger thanage four,” Dr. Charlot says. “Peanut butter mixedin with other purees—such as apples or bananas, forexample—is a good alternative.”

Mu s cleCrampsD O s A N D D O N ’ TsHOW TO CURBMuscle cramps can occur at any time.Learn why they happen, how to preventthem and what to do when they strike.EVERYONE EXPERIENCES MUSCLE CRAMPS—sudden, severe involuntary musclecontractions—at some point. These painful spasms often materialize as nighttimecramps in the legs or feet, disrupting sleep, but they can affect any muscle. In fact,muscles that stretch over two joints are more vulnerable to cramps.The muscles most commonly affected by cramps include the calf muscles,hamstrings and quadriceps, but muscles in the feet, arms, hands, abdomen and ribcage are also susceptible.WHY THEY OCCURMuscle cramps can occur due to dehydration, failure to stretch before exercising,overusing or straining a muscle, or holding a position for a long time.Certain medications like diuretics and blood pressure medicines can also inducemuscle cramps—especially in the legs.While everyone is susceptible to muscle cramps, some people are at a higher risk ofhaving them. Older people, for instance, are more prone to cramps due to age-relatedloss of muscle mass, which makes their muscles more vulnerable to overstress. Otherrisk factors include being pregnant, having certain medical conditions—such asdiabetes or nervous system, liver or thyroid disorders—and participating in sports orother strenuous activities that place participants at risk for fatigue and dehydration,especially in warm weather.“Muscle cramps are particularly prevalent in athletes and people who are olderthan 65, overweight or on certain medications,” says Ramon Vallarino Jr., M.D.,rehabilitation medicine specialist at NewYork-Presbyterian Brooklyn MethodistHospital. “Less frequently, muscle cramps are spurred by underlying medicalconditions like compressed spinal nerves, deficient blood flow to the muscles, or alack of essential minerals in the diet—namely, potassium, calcium and magnesium.”Consult your doctor if cramps are severe, occur often, fail to respond well to hometreatments or do not seem to stem from recognizable causes.“Your medical history and the characteristics of your cramps—like how long you’vebeen having them, when they occur and a family history of muscle cramps—can helpyour doctor narrow potential medical causes and put you on the right path to feweroccurrences,” Dr. Vallarino says. “Preventive measures can often lessen the frequencyand severity of muscle cramps [see “Do’s and Don’ts”], but in cases where preventiondoesn’t help, a doctor might recommend testing for an underlying disease, massage orphysical therapy, or the short-term use of prescription medications like muscle relaxersor botulism toxin.”DO’s and DON’TsTry these strategies to help prevent oralleviate muscle cramps:apply heat to tight muscles andcold to tender muscles.DON’T say “no” to water—stayinghydrated can help ward off musclecramps. If you are exercising, drink waterbefore, during and after your workout.stretch and properly warmup before working out orplaying sports.DON’T participate in activities orexercises that place a lot of strain onyour muscles. old a cramping muscle in ahstretched position while gentlymassaging it to help easethe discomfort.DON’T just let it happen. Muscle crampsmay subside more quickly if you use andflex the muscle. Flexing the muscle groupopposite of the cramping muscle canoften provide relief. If you experienceleg or feet cramps, try walking. If youexperience calf cramps, use a wall tobrace yourself as you lean into a calfstretch. For hand and arm cramps, tryflattening your palms against a wallwith your fingers pointed downward oroutstretching your arm, palms out andfingers down, and gently pulling yourfingers back toward your body.P H Y SI C I A N RE F E RR A L / / 718 . 49 9.C A RE7

THE RIGHT CHOICESBALANCINGBEDTIME8There are many things that a person should outgrow on the journey from adolescence intoadulthood, but a reasonable, regular bedtime is not one of them.A CHILD’S BEDTIME is often written in stone. Children may begand plead to have it delayed just five minutes, but parents do theirbest to enforce it because they know kids need sleep in order tofunction at their best. Many adults may not realize that grown-upsalso thrive with a dependable sleep schedule.“Everyone has a circadian biological clock that regulatessleepiness and wakefulness throughout the day,” says JeremyWeingarten, M.D., director of the Center for Sleep Disordersat NewYork-Presbyterian Brooklyn Methodist Hospital.“When people don’t follow a regular sleep pattern, theirbodies will try to fall asleep when they should be awake andtry to remain awake when they should be asleep.”When the body’s internal clock is off-kilter, people mayfind themselves in a frustrating scenario of being sleepythroughout the day but unable to doze off at night—leavingthem with inadequate amounts of sleep.SUMMER 2017/ / W W W.NY P.ORG / BRO OKLYN“Adults up to age 65 need seven to nine hours of sleep eachnight, while adults over 65 will need a little less at sevento eight hours of sleep,” Dr. Weingarten says. “Habituallygetting less than this recommended amount of sleep canlead to a host of problems for a person’s mental and physicalwell-being.”A lack of sufficient rest can result in more than justgrumpiness on the next day. Short-term sleep deprivationcan affect judgment, mood, energ y, concentrationand memory, and chronic sleep problems can lead toserious, long-term health concerns like obesity, diabetesand heart disease.“To protect themselves, people must protect theirsleep,” says Dr. Weingarten. “If they don’t make an effort toroutinely get a good night’s sleep, they are likely to find thattheir health is negatively impacted.”

E AT F OR SL EEPIs your diet keeping you from your dreams?What you eat and drink just before bedtime can affect your sleep. While it is rarely a good idea to eatright before going to bed, certain foods eaten throughout the day or snacked on before dozing off canhelp make you drowsy while other foods can keep you up at night.Foods containing tryptophan—an amino acid that acts as a building block for the sleep-relatedchemical, serotonin—are an excellent option to encourage sleep. Tryptophan is found in turkey, eggs,chicken, fish and nuts. Combining these foods with carbohydrates will increase their effectiveness inmaking you sleepy.On the other hand, eating fried, spicy or fatty foods can upset your stomach and should be avoided, asshould drinking alcohol or caffeine immediately before bedtime.MAKING ROOM FOR RESTWhile understanding the importance of havinga consistent, reasonable bedtime may be easy,enforcing a regular bedtime schedule may prove achallenge. Strategies to help you get a more reliablenight’s sleep include committing to a consistentschedule, developing a bedtime routine and creatinga comfortable sleep environment.COMMIT TO A TIMEYour designated bedtime should be a priority, both onweekdays and weekends.“Make time for sleep in the same way that youmake time for exercise or watching your favoritetelevision show,” says Dr. Weingarten. “Designatehours for sleeping and do what you can to stick toyour plan.”Avoid looking at bedtime as something thathappens when everything else is done, and startseeing it as more of a meeting that must be attendedon time. If your calendar is jam-packed withactivities, this may motivate you to develop a morerealistic expectation of the number of things you canaccomplish in a day.DEVELOP A BEDTIME ROUTINEA bedtime routine is an excellent way to prepareyour body for a good night’s rest. Thirty minutes toan hour before bedtime, stop using mobile deviceslike cell phones and tablets—which emit blue lightthat has a negative impact on drowsiness. Instead,read a book, journal about your day, enjoy a cupof decaffeinated herbal tea, or do some light yogaor stretching to help your mind wind down aftera long day.CREATE A COMFORTABLESLEEP ENVIRONMENT“I typically tell people that it’s normal to wakeup in the middle of the night every once inawhile,” Dr. Weingarten says. “However, thisneeds to occur naturally and not be caused by aperson’s surroundings.”Turning a bedroom into a sleep haven is not thatdifficult. Start by setting your thermostat between60 and 67 degrees. Next, ensure that there are nolights or noises that could interrupt sleep. With theexception of an alarm clock, make the bedroom atechnology-free zone with no televisions, computersor mobile devices allowed.SEEK APPROPRIATE HELPIf, despite your best efforts, sleep still does not comeeasily, there may be another issue.“When going to sleep or staying asleep becomesa problem in spite of taking these steps, a sleep studymay be a good idea,” Dr. Weingarten says. “This canbe done in a sleep lab or at home, and the resultshelp doctors comb through the spectrum of sleepingdisorders, such as sleep apnea, insomnia and more,to determine if one of those might be keeping anindividual up at night.”P H Y SI C I A N RE F E RR A L / / 718 . 49 9.C A RE9

W O M E N ’ S H E A LT HGET TING TO THEHeart OF Menopause10Following Diane’s recent wellness exam, her doctor’soffice called with news that her LDL or “bad” cholesterollevels had increased since her previous exam. Shewas eating all the same things, so the 60-year-old wasconfused about the rise in her LDL levels.AS DIANE SPOKE with her doctorabout her lab results, she learned that hersituation is not unusual. As is the casefor many women, LDL cholesterol levelsoften rise after menopause, which putsmiddle-aged women at a higher risk forheart disease.A MYSTERY FOR THE AGESHeart disease is the number one cause ofdeath in men and women, yet women don’talways recognize heart disease as a tophealth threat.“Women are often more concernedabout breast cancer than heart disease,”says Gioia Turitto, M.D., cardiologist atNewYork-Presbyterian Brooklyn MethodistHospital. “In reality, heart disease killsroughly ten times more women than breastcancer every year.”Men usually develop heart diseaseat earlier ages than women, which maycontribute to confusion about the rates ofheart disease in women. Before men andwomen reach age 55, for example, womenusually have a lower risk of heart diseasethan their male peers. However, after age55, women start to catch up.SUMMER 2017/ / W W W.NY P.ORG / BRO OKLYN

“By age 65, women’s heart disease risks tend to matchthat of men,” says Leyda Callejas, M.D., endocrinologist atNYP Brooklyn Methodist. “In fact, our cardiovascular disease riskcan rise to even surpass that of men the same age.”Doctors believe there is a correlation between heart disease andmenopause—the cessation of menstruation, which occurs at anaverage age of 51. During menopause, a woman’s production of thehormones estrogen and progesterone slows down. The reason anincreased risk of heart disease seems to accompany menopause isan ongoing point of investigation. One theory is that estrogen playsa protective role in women’s heart health. According to ChristyMcAvoy, M.D., obstetrician/gynecologist at NYP BrooklynMethodist, estrogen aids in keeping cholesterol levels in check.When women’s bodies stop producing the premenopausal levels ofestrogen, they lose this innate protection.In addition to higher LDL levels, women may also notice risingblood pressure and higher triglyceride levels after menopause—all of which contribute to heart disease. Postmenopausal weightgain typically plays a role in these increases, too, according toDr. Callejas.IS MENOPAUSAL HORMONE THERAPY A GOOD IDEA?As recently as 15 years ago, women were frequently prescribedmenopausal hormone therapy (MHT)—either estrogen alone or amix of estrogen and progesterone—to control symptoms like hotflashes, vaginal dryness and night sweats, and to help minimizethe risk of heart disease, stroke, osteoporosis and dementia. Thatchanged abruptly in 2002 when researchers involved in a largeclinical trial studying the efficacy of MHT, halted the trial due tohealth risks.“The clinical trial showed that hormone therapy may increasethe risk of cardiovascular disease, breast cancer and blood clots,especially in older postmenopausal women,” Dr. McAvoy says.“For that reason, hormone replacement is no longer given to preventdisease. We now only use it to treat moderate-to-severe hot flashesin women who are generally in their late 40s or early 50s and havea low risk for heart disease and breast cancer.”THE REAL PILLARS OF PREVENTIONHeart disease after menopause is not inevitable. By living a healthylifestyle, women can help safeguard their heart at all ages.“Making healthy choices like eating a balanced diet andexercising daily is clearly a better type of prevention than hormonetherapy,” Dr. Turitto says. “If you manage your risk factorsappropriately, you shouldn’t be concerned that the lack of hormonesis going to be a major factor in causing a heart attack.”While heart disease is more common after menopause,premenopausal women aren’t immune to it, so it’s importantfor them to make healthy choices in their 20s and 30s. Adoptinghealthy habits early in life makes it easy to continue those habitslater in life. Besides eating a healthy diet and exercising, notsmoking is a key strategy that women of all ages can use to improvetheir heart health. Staying active is an especially important partof healthy aging because regular exercise helps to control bloodpressure, cholesterol and blood sugar levels.“Muscle mass decreases as we age, which slows our restingmetabolism,” Dr. McAvoy says. “Postmenopausal women oftenneed to increase the time and intensity of exercise to get the sameresults they experienced when they were younger. At a minimum,women should exercise for 30 minutes a day, five days a week.”In addition, women should discuss their family and personalhistories with their doctors, especially if they or a close familymember have had a heart attack or stroke, diabetes, high bloodpressure, or high LDL cholesterol levels.“Menopause is life-changing in multiple ways,” Dr. Callejassays. “But it presents a great opportunity for women to start aconversation with their doctors about their current health and toaddress any potential risk factors.”11L E A RN T HE “ SIL EN T ” SIGNSWomen are more likely than men to experience“silent” heart attacks—heart attacks wherethere are few symptoms or symptoms remainunrecognized. While chest pain or discomfort isthe most common heart attack warning sign inmen and women, recent research reveals thatwomen are less likely than men to have chestpain. Instead, women may notice symptoms thatare not as often associated with heart attack,including fatigue, shortness of breath, overallweakness, dizziness and nausea, and arm orshoulder pain.P H Y SI C I A N RE F E RR A L / / 718 . 49 9.C A RE

A N AT O M Y I N S I D E R12ARTHROSCOPY:Healing the KneeA few weeks ago, you twisted your knee playing soccer with your kids, and you have been dealingwith increasing knee pain and swelling since then. Now you even dread climbing your front steps.YOUR PRIMARY CARE doctor refers you to an orthopedicspecialist. You schedule an appointment, and the orthopedicspecialist asks you to bend, straighten, then rotate your knee.He orders a diagnostic magnetic resonance imaging (MRI) testand diagnoses you with a badly torn knee meniscus—cartilagein the knee that acts as a cushion between the femur and tibia(thigh and shin) bones.When a tear in the meniscus is small and located on theouter third of the cartilage, the doctor may recommend rest, ice,compression and elevation of the joint to give the cartilage time toheal. This usually means walking on crutches, applying cold packsto your knee for 20-minute intervals a few times a day, wrappingthe injured knee in a compression bandage and combating swellingby propping up your leg. The doctor may also recommend taking anover-the-counter nonsteroidal anti-inflammatory medication likeibuprofen to help with pain and swelling.If the tear is large or in the inner two-thirds of the meniscus,a minimally invasive procedure known as knee arthroscopy isfrequently recommended.DID YOU KNOW?People experiencing knee painfor more than a few days shouldbe evaluated by an orthopedicspecialist. Even a slight meniscustear that goes untreated can leadt

Health Quiz/ What Do You Know about Barrett’s Esophagus?29 Take Five/Your Health Cheat Sheet 30 Reader Letters/Community Forum 31 Engage with NYP Brooklyn Methodist/Support Groups & Events 32 NewYork-Presbyterian PHOTO CREDIT: DAVID GROSSMAN Brooklyn Methodist Hospital 506 Sixth Stree

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