Welcome to MediZine’s Healthy Living Fall
issue in its digital format! This quarter, we
introduce an exciting new department – “Click It” –
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Your health-care provider is pleased to present you with
MEDIZINE’S ?<[email protected]@E>
[email protected]<DFJKG<FGC<#you probably work hard
*' Hands-on Help
Ounce of Prevention
Vaccines aren’t just for
kids —not by a long shot.
What you need to know
about adult vaccines.
Keeping your knees
strong and supple
Easy ways to cope with
the pain and stress of
The legendary Mary Tyler
Moore talks about her life
with type 1 diabetes
Edition Code: MQ309-1000-4
to make wise decisions about your well-being and
that of your loved ones. But sorting through the
overwhelming abundance of health information
in magazines, on TV and on the Internet to find
Hot shots: Jennifer Lopez
what you need can be a tough task.
and Marc Anthony
Welcome to MediZine’s Healthy Living! In
partnership with your health-care provider, MediZine’s
Healthy Living can help guide you toward the best health
choices. We also offer strategies for smart living, inspiring
real-life stories and the latest news and views on general
health, nutrition and weight loss.
For a wealth of in-depth health resources, visit our newly
expanded website, RemedyLife.com. With just a few clicks,
you’ll find easy-to-use interactive features, solutions to
health problems and simple wellness tips.
Superstar Jennifer Lopez is the proud mom of toddler
twins Max and Emme. And to protect them—and other
children—she’s speaking out about the importance of the
pertussis booster for adults. See what she has to say about
shielding youngsters from this contagious disease on page 42.
Confused about cholesterol? So are millions of other
Americans. We’ll clear a path for you with our special
section, starting on page 46. Also in this issue: how to keep
your knees strong; exercises to help with arthritis pain; tips
on kicking the cigarette habit and much more.
With information-packed new editions published quarterly,
MediZine’s Healthy Living is always current. You’ll find yourself
returning to it time and again. Save your issues and use them
in conjunction with advice from your health-care providers.
)+ Getting Control
How to handle BPH and
What to do in a heart-health emergency
*+ Kick the Habit
If you have COPD, it pays to quit
The multitalented mom speaks out about
protecting kids from whooping cough
more! ag and
page p to
Decade Diets: Eating right
at every age
For great giveaways and
health tips online
What’s the deal with cholesterol, and why
is everyone so worried about it?
HEALTHY LIVING INSIDE & OUT
Vaccines aren’t just for kids—not
by a long shot Yp;`Xe\LdXejbp
:[email protected];I<EI<:<@M<a veritable slew of
vaccinations to prevent diseases such as rubella,
diphtheria and tetanus. But few adults are aware
that they need vaccines for continued protection.
The result? “We may see a couple of hundred
deaths a year in children due to vaccine-preventable disease, but we see around 50,000 deaths a
year in adults,” says Gregory A. Poland, M.D.,
professor of medicine at the Mayo Clinic and
director of the Mayo Vaccine Research Group
in Rochester, MN.
What vaccinations should adults be getting?
Your doctor can advise you about what’s right
for you. The Centers for Disease Control and
Prevention recommends protection against:
■ K\kXelj Every 10 years
■ ;`g_k_\i`XXe[g\ikljj`j Before age 65
■ Ge\ldfZfZZXc[`j\Xj\ For those who are 65
and older, the immunocompromised and anyone
with a chronic health condition
■ J_`e^c\j For those 60 and older who have had
chicken pox. The vaccine cuts the risk in half.
■ ?ldXegXg`ccfdXm`ilj?GM HPV causes
70 percent of cervical cancers. This relatively new
vaccine is primarily for females up to age 26. ■
Seasonal flu, a viral
illness marked by fever,
chills, cough, headache
and sore throat, kills
36,000 Americans each
year. The H1N1 “swine flu”
virus—a different strain
from the seasonal flu
the importance of flu
vaccines. The seasonal
vaccine is recommended
for everyone; only babies
less than six months old
may be exempted. Ask
your doctor what’s right
for your family. The best
time to get a shot? “From
the time it’s released until
its expiration in June,”
says the Mayo Clinic’s
Dr. Poland. “You don’t
have to have it by
November or December.”
IMAGINE THIS BLISTERING RASH
ALONG WITH STABBING PAIN
IF YOU HAD CHICKENPOX AS A CHILD,
YOU COULD GET SHINGLES NOW.
The chickenpox virus is still in your body.
It can resurface as Shingles, a painful, blistering rash.
The Shingles rash usually lasts up to 30 days, and for
most the pain lessens as the rash heals. But some
people who develop Shingles experience long-term
pain that can last for months, even years.
ZOSTAVAX is a vaccine that can help
ZOSTAVAX is used to prevent Shingles in adults 60
years of age or older. Once you reach age 60, the
sooner you get vaccinated, the better your chances
of protecting yourself from Shingles. ZOSTAVAX is
given as a single shot. ZOSTAVAX cannot be used to
treat Shingles, or the nerve pain that may follow
Shingles, once you have it. Talk to your health care
professional to see if ZOSTAVAX is right for you.
AND YOU’LL HAVE AN IDEA OF
WHAT IT CAN BE LIKE TO HAVE SHINGLES.
Important Safety Information
ZOSTAVAX may not fully protect everyone who gets
the vaccine. You should not get ZOSTAVAX if you are
allergic to any of its ingredients, including gelatin and
neomycin, have a weakened immune system, take high
doses of steroids, or are pregnant or plan to become
pregnant. Possible side effects include redness, pain,
itching, swelling, warmth, or bruising at the injection
site, as well as headache. You are encouraged to report
negative side effects of prescription drugs to the FDA.
Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Before getting vaccinated, talk to your health care
professional about situations you may need to avoid
after getting ZOSTAVAX. Please see the Patient Product
Information on the adjacent page.
Before you get Shingles, ask about ZOSTAVAX.
For more information on the availability of ZOSTAVAX through the Merck Vaccine Patient
Assistance Program, visit ZOSTAVAX.com/freevaccines or call 1-877-9 SHINGLES.
of of What
do I need
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care care shingles.
if ZOSTAVAXthe immune
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ONE to bend
ONE to be you again
ONE injection. Up to 6 months of pain relief.
MECH: Kelly R
Introducing Synvisc-One for osteoarthritis knee pain relief.
FREE Knee Pain Relief Kit
Call toll-free 1-800-470-4279 or visit
Live: 4.75” x 6.8125”
Trim: 5.25” x 7.3125”
ONE to move
NEW FOR OSTEOARTHRITIS KNEE PAIN.
File Name: GM09006_MHL_5.25x7.3125_FLO
Title: Synvisc One Print Ad
Spot Colors: NA
Bleed: 5.5” x 7.5625”
to grab a ringing phone, pedaling a bicycle
or crouching to pick up a fallen object, your
knees are taking the heat. “The knee is a real
workhorse,” says Jonathan Scott Coblyn, M.D.,
director of the Center for Arthritis and Joint
Diseases at Brigham and Women’s Hospital,
N?<K?<IPFLËI<;[email protected]>up the stairs
Most knee problems are
caused by osteoarthritis
(OA), the wear-and-tear
arthritis that’s marked by
the breakdown of cartilage
(tough connective tissue)
between joints. As cartilage wears away, the joint
becomes unstable, and bones
rub against each other, causing pain, inflammation, even
difficulty moving normally.
“Women are more likely to
develop OA than men,” says
Dr. Coblyn. “Other types of
arthritis, such as rheumatoid
arthritis, are also much more
common among women.”
Women are also susceptible to anterior cruciate ligament (ACL) injuries. Small
tears develop in the ACL,
one of the four major ligaments connecting knee bones
to the knee joint. Women
have smaller, weaker leg
muscles, leaving more weight
Keeping your knees strong and
Acct. Mngr: Beth
Pub/Notes: Medizine’s Healthy Living
Boston. As the fulcrum of
so much activity, the knee is
highly susceptible to injuries
and arthritis. Here, why our
knees need help and how to
take the pressure off.
Important Safety Information. Synvisc-One is used to relieve knee pain due to osteoarthritis (OA). It is for patients who do not get
enough relief from simple painkillers such as acetaminophen, or from exercise and physical therapy. Synvisc-One is generally well tolerated.
However, it may not work for everyone.The side effects most commonly seen in a medical study were knee pain, stiffness, and swelling
or fluid buildup in or around the knee. Side effects were generally mild to moderate and did not last long. Other side effects, such as
rash, may also occur. Before trying Synvisc-One, tell your doctor if you are allergic to products from birds — such as feathers, eggs or poultry — or if your leg is swollen or infected. Talk to your doctor before resuming strenuous weight-bearing activities after treatment. SynviscOne has not been tested in children, pregnant women or women who are nursing. You should tell your doctor if you think you are pregnant
or if you are nursing a child.
Please see additional important Patient Information on the next page.
©2009 Genzyme Corporation. All rights reserved. Synvisc-One is a trademark and
GENZYME is a registered trademark of Genzyme Corporation.
Be sure to read the following important information carefully. This information does not take
the place of your doctor’s advice. If you do not understand this information or want to know
more, ask your doctor.
Glossary of Terms
What are the benefits of getting a Synvisc-One™ injection?
File Name: GM09006_MHL_5.25x7.3125_FLO
Acct. Mngr: Beth
Pub/Notes: Medizine’s Healthy Living | 1.25 PBW – 1/4 Page
Title: Synvisc One Print Ad
As shown in a medical study of 253 patients with osteoarthritis (OA) of the knee, where approximately half received either a single injection of Synvisc-One or an injection of the same
volume of salt water (a“Saline Control”injection), the major benefits of Synvisc-One are pain
relief and improvement in other symptoms related to OA of the knee.
Hyaluronan (pronounced hy-al-u-ROE-nan): is a natural substance that is present in very
high amounts in joints. It acts like a lubricant and a shock absorber in the joint and is needed
for the joint to work properly.
Non-steroidal anti-inflammatory drugs:also known as“NSAIDs”; medication used to treat
pain or swelling. There are many examples of NSAIDs, including (but not limited to) aspirin
and ibuprofen. Some of these are over-the-counter drugs, and some can only be obtained
Osteoarthritis (pronounced OS-te-o-arth-RI-tis): (OA) is a type of arthritis that involves
the wearing down of cartilage (the protective covering on the ends of your bones) and loss of
cushioning fluid in the joint.
Other side effects seen with Synvisc or Synvisc-One are: rashes, hives, itching, muscle
pain/cramps, flushing and/or swelling of your face, fast heartbeat, nausea (or feeling sick to
your stomach), dizziness, fever, chills, headache, difficulty breathing, swelling in your arms
and/or legs, prickly feeling of your skin, and in rare cases a low number of platelets in the
blood (platelets are a type of blood cell that are needed to help your blood clot when you are
cut or injured). Rare cases of knee joint infection have been reported. If any of the above side
effects or symptoms appear after you are given Synvisc-One, or if you have any other problems, you should call your doctor.
What do I need to do after I get a Synvisc-One™ injection?
MECH: Kelly R
Live: 4.75” x 1.25”
Spot Colors: NA
Trim: 5.25” x 1.75”
Bleed: 5.5” x 2”
It is recommended you avoid strenuous activities (for example, high-impact sports such as
tennis or jogging) or prolonged weight-bearing activities for approximately 48 hours followWhat is the Synvisc-One™ product?
Synvisc-One is a gel-like mixture that comes in a syringe containing 6 mL (1½ teaspoons) and ing the injection. You should consult your doctor regarding the appropriate time to resume
is injected into your knee. It is made up of hylan A fluid, hylan B gel, and salt water. Hylan A
What other treatments are available for OA?
and hylan B are made from a substance called hyaluronan (pronounced hy-al-u-ROE-nan),
also known as sodium hyaluronate that comes from chicken combs. Hyaluronan is a natural If you have OA, there are other things you can do besides getting Synvisc-One. These include:
substance found in the body and is present in very high amounts in joints. The body’s own
hyaluronan acts like a lubricant and a shock absorber in the joint and is needed for the joint to
• Avoiding activities that cause knee pain
• Exercise or physical therapy
How is the Synvisc-One™ product used? (Indications)
• Weight loss
The FDA-approved indication for Synvisc-One is: Synvisc-One is indicated for the treatment of
• Removal of excess fluid from your knee
pain in osteoarthritis (OA) of the knee in patients who have failed to respond adequately to
conservative nonpharmacologic therapy and simple analgesics, e.g., acetaminophen.
• Pain relievers such as acetaminophen and narcotics
How is the Synvisc-One™ product given?
• Drugs that reduce inflammation (signs of inflammation are swelling, pain or redness),
Your doctor will inject Synvisc-One into your knee.
such as aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs, for
example ibuprofen and naproxen)
Are there any reasons why I should not receive a Synvisc-One™
• Steroids that are injected directly into your knee
Your doctor will determine if there is any reason why you are not an appropriate candidate When should I call my doctor? (Troubleshooting)
for Synvisc-One. You should be aware that Synvisc-One:
If any of the side effects or symptoms described above appear after you are given Synvisc-One,
• Should not be used in patients who have had any prior allergic reactions to Synvisc,
or if you have any other problems, you should call your doctor.
Synvisc-One or any hyaluronan-based products. Signs of an allergic reaction may include What did the clinical studies show?
swelling of your face, tongue, or throat; difficulty breathing or swallowing; shortness of A study was conducted in 6 countries outside the United States with 21 physicians. The pabreath; wheezing; chest pain; a tightness in your throat; sleepiness; rash; itching; hives;
tients in the study had mild to moderate knee OA, moderate to severe pain, and did not have
flushing; and/or fever.
sufficient relief of their pain and symptoms with medications taken by mouth.
• Should not be used in patients with a knee joint infection, skin disease or infection
A total of 253 patients in the study were assigned by chance to receive either a single injection
around the area where the injection will be given, or circulatory problems in the legs.
of Synvisc-One (n=123 patients), or an injection of the same volume
What should my doctor warn me about?
of salt water (a“Saline Control”injection) (n=130 patients). Neither the patients nor the docThe following are important treatment considerations for you to discuss with your doctor and tors evaluating them knew which treatment they received. Any fluid that was present in the
understand in order to help avoid unsatisfactory results and complications:
patient’s knee was removed before the injection. The patients were seen by their doctor at
standard times over 6 months. Information was
• Synvisc-One is only for injection into the knee, performed by a doctor or other qualified
health care professional. Synvisc-One has not been tested to show pain relief in joints other collected about how much pain they were experiencing doing various types of activities, how
much they were limited in their daily activities by their OA, and on their overall condition. Their
than the knee.
doctor also provided an overall rating of their OA.
• Synvisc-One has not been tested to show better pain relief when combined with other
The main measure of the study was how much pain the subjects had doing five The main
• Tell your doctor if you are allergic to products from birds such as feathers, eggs, and poultry. measure of the study was how much pain the subjects had doing five common types of activities over the 6 months duration of the study. Daily activity limitations and overall evaluations
• Tell your doctor if you have significant swelling or blood clots in the leg.
• Synvisc-One has not been tested in pregnant women, or women who are nursing. You should were also compared between the group of patients receiving Synvisc-One injection and the
group receiving salt water injection. The study showed that patients receiving Synvisc-One had
tell your doctor if you think you are pregnant, or if you are nursing a child.
significantly less pain over 6 months, and felt significantly better than the patients who re• Synvisc-One has not been tested in children (≤21 years of age).
ceived the salt water injections. The difference in pain score reduction from baseline to 6
What are the risks of getting a Synvisc-One™ injection?
months between the Synvisc-One and salt water control injection was 0.15 out of a 5 point
The side effects (also called reactions) sometimes seen after any injection into the knee, inscale for the measurement of OA pain in the knee.
cluding Synvisc-One, include: pain, swelling, heat, redness, and/or fluid buildup around the
knee. These reactions are generally mild and do not last long. Reactions are generally treated What adverse events were observed in the clinical study?
by resting and applying ice to the injected knee. Sometimes it is necessary to give pain reliev- The following are the most common adverse events that occurred during the clinical trial of
ers by mouth such as acetaminophen or NSAIDs, or to give injections of steroids, or to remove Synvisc-One:
fluid from the knee joint. Patients rarely undergo arthroscopy (a surgical inspection of the knee • Pain in the knee or at the injection site
• Stiffness, swelling or warmth in or around the knee
joint) or other medical procedures related to these reactions.
• Changes in the way that you walk (e.g. limping)
5:@415:61/@107:115:@41&E:B5?/#:1/85:5/[email protected]>5-8'419;[email protected]/;99;:8E;//A>>5:3-0B1>?1
1B1:@?;[email protected]?501;[email protected]:61/@107:11C1>141-0-/41.-/7<-5:?;>[email protected]>;[email protected]:[email protected]#:1<-
How do I get more information about the Synvisc-One™ product? (User Assistance)
2E;A4-B1-:[email protected];:?;>C;[email protected];25:0;[email protected];>1-.;[email protected]&E:B5?/#:1E;A9-E/-88
Manufactured and Distributed by:
&E:B5?/#:[email protected]>-019->7;21:FE91;><;>[email protected];:
SYNVISC -:0GENZYME ->1>[email protected]>[email protected]>-019->7?;21:FE91;><;>[email protected];:
for knees to absorb. In addition, women’s pelvises tend
to be wider, causing thigh
muscles to pull kneecaps out
of line and destabilize knees.
Whether you’re saddled with
OA or a nagging knee injury,
or want to avoid future knee
problems, try these tips:
■ DljZc\lgIt’s wise to
work on the hamstrings in
the back of your thighs, the
quadriceps in the front and
the muscles in your core.
abdominal muscles can help
with everything from your
back down,” explains Alexis
Colvin, M.D., assistant
professor of sports medicine
and orthopedic surgery at
Mount Sinai Medical Center
in New York City.
For hamstrings, stand
on one leg, with the other
knee bent at a 90-degree
angle and your foot behind
you. Hold for five seconds,
then repeat with the other knee. For quads, lie
on your back, bend one knee, foot flat on the
floor, and lift the other leg 12 inches. Hold for
five seconds, then repeat with the other knee.
For your core, do simple sit-ups or crunches.
■ Df[`]ppfliXZk`m`k`\jActivity is key for
maintaining a healthy weight, but avoid highimpact sports such as running, especially if you
have OA or a knee injury. Instead, swim, bike,
walk on flat surfaces or try an elliptical machine.
■ Glk]\\kÔijkKnee problems often originate
from foot abnormalities, such as flat feet; have
your feet checked by a podiatrist. Also, avoid
high heels, and make sure exercise shoes fit
properly and aren’t worn out.
■ ?\Xklg#`Z\`k[fneIf heat helps, stick
with the heating pad. If ice dulls the pain,
use it. Otherwise, use heat for loosening tight
muscles, and ice for swelling. Over-the-counter
(OTC) pain reducers, such as ibuprofen and
naproxen, can also provide temporary pain
relief. Use them in moderation.
■ Befnn_\ekf^\k_\cg If heat, ice and
OTC pain relievers don’t help after three days,
it’s a good idea to see your doctor. Pain that
keeps you up at night—particularly if accompanied by swelling, redness and fever—and doesn’t
respond to pain relievers could indicate a more
serious problem, and you should seek immediate
medical attention. ■
@E [email protected]>?K
The FreeStyle Promise.
Free Access to Live Certified Diabetes Educators.
@ËDD8IPKPC<IDFFI<#and I am . . . an
actress, an animal lover, the chairman of the
Juvenile Diabetes Research Foundation [JDRF],
the wife of Dr. Robert Levine and—I don’t want
Be Informed. Be Supported. Be You.
to give away the whole
story from the very
start. Suffice it to say,
there are a lot of ways
to end that sentence,
and I don’t think I’ve
come close to living
through all the
heavens. For our
purposes here, though,
I am going to talk
about who I am in
relation to diabetes.
Let me tell you what
I know (not necessarily
what I do). We can
When you have diabetes, you are responsible for making sure
that you are moderate
in all things. And if
moderation is not
really your natural
state, well, then try
moderate, because the
middle ground is your
Garden of Eden. Your
blood sugar can’t be
too high—or too low.
Your weight needs to
be trim, not heavy, but
being too thin makes it
With the FreeStyle Promise™ Program,
you now have access to:
s Live Certified Diabetes Educators
s Support with insurance
s Savings on test strip co-pays*
s Free meter upgrades
*Not valid for persons eligible for reimbursement of blood glucose test strips in whole or in part, under Medicare, Medicaid or
similar federal or state programs. Restrictions apply. Abbott may modify or discontinue this program at any time without notice.
Offer valid until 12/31/2009.
©2009 Abbott. ART17635-003_Rev. A 03/09
@E [email protected]>?K
tough to get a handle on your blood sugar. Stress?
A little intensity keeps you alert and vigilant.
Too much sends glucose levels soaring and adds
to cardiovascular complications. You need
enough sleep but not too much; some carbs, not
too many. You get the picture.
For me, the whole process of asserting control
has come into sharper focus since I started going
to see Carol Levy, M.D., a physician at Weill
Cornell Medical College with board certifications in diabetes, endocrinology and diabetes in
pregnancy. At my first appointment I knew
immediately that her personality and way of
Mary details her life with
diabetes in her autobiography
Growing Up Again: Life, Loves,
and Oh Yeah, Diabetes!
thinking were what I needed.
In her small paper-stacked office, she looked
more like the mom of three young children,
which she is, than a world-respected diabetes
clinician and researcher, which she also is. Her
long brown hair framed an open face often
crossed by a smile that seemed to say, “Isn’t this
a great challenge we share?”
I had the wonderful feeling that this down-toearth woman had common sense and she would
help me become the person my fellow diabetics
assumed me to be.
Since that first meeting, she has helped me see
that at some time or another, everyone gets angry
and frustrated about
having diabetes. This is
particularly true when
your blood sugar is out
of whack, and you
don’t know why.
It happens to me
sometimes when my
diet is pretty stable,
exercise is pretty
consistent and I’m not
fighting a cold or the
flu, and yet the fasting
readout can be over
250. And my bedtime
reading is often too low
for comfort, so I drink
some orange juice or
cherry juice to cover
sleep without having to
greet a low at three or
four in the morning.
I asked Dr. Levy,
“What’s going on with
my blood sugar, and
what are you going to
do about it?”
Calmly she explained, “Ten to fifteen
percent of the time we
just don’t know what’s
gone wrong. Perhaps
you injected into a bad
spot. Or we have failed
as physicians to come
up with the right
creative tools we need.
Sometimes it is a matter
of not having enough
data. It’s hard to keep
records, so we can’t
figure out why blood
sugar levels are all over
the place. But sometimes, if you really tease
it out, you find out the
person ate a lot more
carbohydrates than she
thought, or we didn’t
realize how a certain
kind of exercise—and
you do a lot of exercise—was going to affect
someone,” said Dr. Levy.
So, together we
began this brand-new
(to me) process of
figuring out exactly how
I could establish better
control. She gave me a
chart to fill out with
what I ate each day and
what my glucose levels
were before and after
eating, so I could learn
how the food I took in
was affecting my blood
sugar. I also kept tabs on
my carbohydrate intake
and my insulin, both
CfYYp`e^]fiXZli\%Mary campaigns for more diabetes research funding during JDRF Children’s Congress.
regular and fast-acting. I entered exercise information too and an occasional test result for ketones.
Tracking your every move—or so it seems to
me—is a lot of work and occupies a lot of thought
and time until it becomes a habit. Then you can
do it without it interfering with day-to-day living.
Of course, you have to work out a diabetes
self-management schedule with your doctor. But
the lesson here is that no matter how long you
have had diabetes, you should always continue to
ask questions. Learning to manage your diabetes
takes time and patience and persistence, but the
rewards are real. You feel better immediately, and
you may avoid serious complications. ■
Individual results may vary.
G R E G P FA F F
D E L I OW N E R
TA K I N G I N S U L I N S I N C E 2 0 0 3
“I tried to manage my type 2 diabetes with diet, exercise,
and pills, so when my doctor said I should add insulin
to my therapy, I felt like I’d failed. But he said adding
insulin is just replacing what your body should
make naturally, and it unlocks your cells so sugar
can get in to make energy. Millions of people with
diabetes take insulin every day to help reach their
blood sugar goals. That’s not failure — it’s success. Now
when I look at my blood sugar numbers, I have only one
regret: that I didn’t add insulin sooner.” R E T H I N K I N S U L I N
“ I ST OPPED THINKING
WHEN I S AW M Y N U M B E R S.”
INSULIN EQUALS FAILURE
G REG ’ S
WWW .G O I NSULIN . COM
Important Safety Information About Insulin
Possible side effects may include blood sugar levels
that are too low, injection site reactions, and allergic
reactions, including itching and rash. Tell your doctor about
all other medicines and supplements you
are taking because they could change the
way insulin works. Glucose monitoring is
recommended for all patients with diabetes.
Ask your doctor about insulin today.
Or to get more information and a
FREE Diabetes Meal Planning Guide,
call 1-800-862-9131. While Supplies Last
You are encouraged to report negative side effects of prescription drugs to the FDA.
Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.
RE THINK INSULIN
© 2009 sanofi-aventis U.S. LLC
Easy ways to cope with the pain
and stress of rheumatoid arthritis
[email protected]?<DFJKdangerous exercise for
someone with rheumatoid arthritis (RA) pain?
None at all. “In addition to appropriate
medication, an often-forgotten way to lessen
the long-term functional disability caused by
RA is physical activity,” says Patience H.
White, M.D., M.A., chief
public health officer of the
People with RA who
exercise regularly experience
less anxiety and depression,
manage stress more effectively and feel better overall.
Exercise also appears to be
key in keeping weight off. “A
lower body weight translates
to less stress on weight-bearing joints, fewer symptoms
and lower rates of disease
progression,” says arthritis
researcher Susan Bartlett,
Ph.D., associate professor of
medicine at Montreal’s
In general, “walking,
cross-country skiing and
bicycling are good calorieburning activities,” she says,
“and these weight-bearing
exercises help keep bones
and muscles healthy and
strong and ensure nutrient
exchange in cartilage.”
Aquatic exercise programs may also be a good
option. “As with land-based
exercise, pool-based exercise
can increase joint flexibility,
strengthen muscles, provide
a good aerobic workout and
Media Bakery; Jupiter Images
boost self-confidence,” Bartlett says.
“Because water supports much of the body’s
weight, pool exercise allows you to move
about with minimal joint stress. For people
with impaired balance, it eliminates the risk
of falling. And warm water is therapeutic
and can provide significant pain relief.”
Experts have also been looking at
therapies that offer both physical and
psychological benefits. The Arthritis Foundation endorses the Sun style of tai chi, which
has been shown to reduce pain and improve
mobility in those with arthritis.
A gentle yoga class can teach movements
that help build strength, balance and
flexibility. “Yoga incorporates postures,
stretches and breathing techniques to
promote physical and mental health,” says
registered yoga therapist Steffany Haaz, a
doctoral candidate in public health, who is
coordinating a pilot study on yoga and
arthritis at the Johns Hopkins Arthritis
Center in Baltimore. Early data, she says,
suggests that after eight weeks of twice-weekly
hour-long yoga classes, previously sedentary
people with RA reached normal ranges in
physical and emotional health.
Because of its meditative nature, yoga can
boost mental energy and mood and foster
alertness and enthusiasm. It also can reduce
negative feelings. “This may be especially
helpful for people who are coping with a
chronic illness such as RA,” says Haaz. Talk
with your doctor before embarking on any
workout program. ■
Worth a Try?
You may want to ask your
doctor about employing
other strategies, such
as hot/cold therapy, in
concert with your regular medication. “Some
people love heat therapy
for painful joints; others
find relief only in cold-application techniques,” says
Dr. White of the Arthritis
Foundation. Gentle massage may relieve stress
and aid circulation for
some, but be too painful for others. And “it’s
important to find a massage therapist who knows
about arthritis,” she says.
Biofeedback, a relaxationtraining technique, may
allow people to exercise
some control over pain,
notes Dr. White.
Moderate to Severe Rheumatoid Arthritis
Can you pull this?
Still finding it tough
to do everyday things?
ORENCIA may help.
ORENCIA® (abatacept) is an RA treatment that works differently.
It’s a prescription medication used to treat adults with moderate to severe
RA and has been shown to:
s2ELIEVETHEPAIN SWELLING and fatigue of RA
Important Safety Information about ORENCIA:
Before you receive ORENCIA, tell your doctor if you:
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Please read the Important
Facts on the following page.
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for RA TVDI BT &OCSFM® 3FNJDBEF® )VNJSB®, or
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Oh, yes I can!
ORENCIA has been proven to make a difference for many patients, including those who haven’t
been getting enough help from treatments such as methotrexate, Enbrel ®, Humira®, and Remicade®.
There are several treatment options for RA. Ask your rheumatologist if ORENCIA is right for you.
Find out more about ORENCIA
QSPGFTTJPOBM FWFSZ XFFLT BGUFS JOJUJBM EPTJOH SFHJNFO *G
You are encouraged to report negative side effects of prescription drugs
to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
© 2008 Bristol-Myers Squibb Company 427US08AB29302 Oct/08
ORENCIA is a registered trademark of Bristol-Myers Squibb Company.
All other trademarks are property of their respective companies.
The information below does not take the place of talking with your healthcare
professional. Only your healthcare professional knows the specifics of your condition
and how ORENCIA® may fit into your overall therapy. Talk to your healthcare
professional if you have any questions about ORENCIA (pronounced oh-REN-see-ah).
RHEUMATOID ARTHRITIS (RA)
RA is a disease of the immune system which causes joint pain and damage, and impacts the ability to perform
ORENCIA (abatacept) is a prescription medicine that reduces signs and symptoms in:
for RA. ORENCIA may prevent further damage to your bones and joints and may help your ability to
perform daily activities.
In RA, ORENCIA can reduce pain and joint inflammation, but it can also make your immune system less able
to fight infection. ORENCIA can make you more likely to get infections or make any infection worse. It is
important to tell your doctor if you think you have any infections.
BEFORE YOU START ORENCIA
Tell your healthcare professional about all your medical conditions, including if you:
ORENCIA, you may have a higher chance for getting serious side effects.
"7& )"% 56#&3$6-04*4 03 )"7& #&&/ */ $0/5"$5 8*5) 40.&0/& 8)0 )"4 *5 &-- :063 )&"-5)$"3&
professional right away if you get a dry cough that does not go away, weight loss, fever, or night sweats.
3& "--&3(*$ 50 "/: 0' 5)& */(3&%*&/54 */ 46$) "4 "#"5"$&15 ."-504& .0/0#"4*$ 40%*6.
phosphate, or sodium chloride for administration.
should not take live vaccines.
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certain types of blood glucose monitors the day you receive an infusion of ORENCIA.
Tell your healthcare professional about all the medicines you take, */$-6%*/( 13&4$3*15*0/ "/% /0/
prescription medicines, vitamins, and herbal supplements.
Especially tell your doctor if you take other biologic medicines to treat RA such as:
biologic medicines for your RA.
you get a new prescription.
IMPORTANT INFORMATION ABOUT POSSIBLE SIDE EFFECTS WITH ORENCIA
ORENCIA can cause serious side effects including:
Serious infections. "5*&/54 3&$&*7*/( )"7& " )*()&3 $)"/$& 0' (&55*/( */'&$5*0/4 */$-6%*/(
pneumonia, and other infections caused by viruses, bacteria, or fungi. Call your doctor right away if you
feel sick or get any of the following symptoms of infection, which may be early signs of a serious infection:
&&!+#% +!-%)(, Allergic reactions can happen on the day of treatment or the day after receiving
ORENCIA. Tell your doctor or get emergency medical help right away if you have hives, swollen face,
eyelids, lips, tongue, throat, or trouble breathing.
(!+'&%#((%!, Certain kinds of cancer have been reported in patients receiving ORENCIA. It is not
known if ORENCIA increases your chance of getting certain kinds of cancer.
may also cause some vaccinations to be less effective. Talk with your doctor about your vaccination plans.
!,*%+-)+1 *+)&!', %( *-%!(-, 0%-$ $+)(% ,-+.-%/! .&')(+1 %,!,! !06 .": (&5
Tell your doctor if you have any side effect that bothers you or that does not go away.
These are not all the possible side effects of ORENCIA. For more information, ask your doctor or pharmacist.
GENERAL INFORMATION ABOUT ORENCIA
&%*$*/&4 "3& 40.&5*.&4 13&4$3*#&% '03 $0/%*5*0/4 5)"5 "3& /05 .&/5*0/&% */ 1"5*&/5 */'03."5*0/ -&"'-&54
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©2008 Bristol-Myers Squibb Company
ORENCIA is a registered trademark of Bristol-Myers Squibb Company.
Enbrel, Humira, Remicade, Kineret and Rituxan are trademarks of their respective companies.
Based on 1186240A4 04/08
Printed in USA
Are you currently taking FLOMAX
for urinary symptoms due to BPH,
also known as an enlarged prostate?
For many men, FLOMAX reduces
male urinary symptoms due to BPH in
one week. Symptoms such as:
stopping and starting
8><[email protected]<a man’s
waking up to go
Continue to take FLOMAX, as directed
by your doctor, once a day, every day.
See if you qualify to get
In men with BPH, the prostate enlarges, gradually
constricting the urethra, the tube through which
urine passes. “Men frequently complain they don’t
have the stream they used to,” says Cy Stein, M.D.,
head of the medical genitourinary oncology program
at the Montefiore-Einstein Cancer Center in NYC.
Men with BPH also may experience frequent
urination, an urgent need to urinate and a burning
feeling. In addition to such annoyances, BPH can
eventually cause a backflow of urine, triggering bladder
up to $40 off your prescriptions!
See attached card for details.
9<[email protected]>[email protected]:?PG<[email protected]?
or none at all.
So whether or
not you have
important to talk
with your doctor
about your prostate health.
judgment and enrich his wisdom.
But it’s no friend to his prostate,
the walnut-size gland that sits
below the bladder and manufactures seminal fluid.
As men age, the prostate grows
larger and more prone to inflammation, which can cause troublesome symptoms. At
any age men may develop infections that affect the
prostate. Here we explain two of the most common
Important Safety Information
FLOMAX is approved to treat male urinary symptoms due to BPH, also called an enlarged
prostate. Only your doctor can tell if you have BPH, not a more serious condition like
prostate cancer. Avoid driving or hazardous tasks for 12 hours after your ﬁrst dose or
increase in dose, as a sudden drop in blood pressure may occur, rarely resulting in
fainting. If considering cataract surgery, tell your eye surgeon you’ve taken FLOMAX.
Common side effects are runny nose, dizziness and decrease in semen.
You are encouraged to report negative side effects of prescription drugs to the FDA.
Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Please see Important Patient Information on following page.
Copyright © 2009, Boehringer Ingelheim Pharmaceuticals, Inc. All rights reserved.
FOR UP TO
$40 IN SAVINGS ON YOUR PRESCRIPTIONS.
See eligibility details inside.
IMPORTANT PATIENT INFORMATION
Please read the Patient Information that comes with FLOMAX capsules before you start taking it and each time you reﬁll your
prescription. The information may have changed. The Patient Information does not take the place of discussions with your
doctor about your medical condition or your treatment.
What is FLOMAX?
FLOMAX is a prescription alpha blocker medicine used to treat the signs and symptoms of benign prostatic hyperplasia (BPH),
a condition your doctor may refer to as an enlarged prostate.
• FLOMAX is not for women.
• FLOMAX is not for children.
Who should not take FLOMAX?
Do not take FLOMAX if you are allergic to any of its ingredients. See “What are the ingredients in FLOMAX?” for a complete
list of ingredients in FLOMAX.
What should I know before taking FLOMAX?
Only your doctor can tell if you have BPH and not a more serious condition, such as prostate cancer. BPH and cancer of the
prostate cause many of the same symptoms. It is important that you see your doctor ﬁrst to rule out prostate cancer.
What Should I Tell My Doctor Before Using FLOMAX?
Before taking FLOMAX, tell your doctor about all your medical conditions including:
• any kidney or liver problems.
• any history of low blood pressure.
• any allergies to sulfa or any other medicines.
• if you are planning to have cataract surgery.
Tell your doctor about all the medicines you take including:
• any prescription medicines, including blood pressure medicines.
• any non-prescription medicines, including vitamins and herbal supplements.
Some of your other medicines may affect the way FLOMAX works. Especially tell your doctor if you take a medicine for high
blood pressure. You should not take FLOMAX if you are already taking certain blood pressure medicines.
Know the medicines you take. Keep a list of them and show it to your doctor and pharmacist when you get a new medicine.
How should I take FLOMAX?
• Take FLOMAX exactly as prescribed by your doctor.
• Do not crush, chew, or open FLOMAX capsules.
• Take FLOMAX one time each day, about 30 minutes after the same meal each day. For example, you may take FLOMAX
30 minutes after dinner each day.
• If you miss a dose of FLOMAX, take it as soon as you remember. If you miss your dose for the whole day, continue with
your next dose on your regular schedule. Do not take two doses at the same time.
• If you stop or forget to take FLOMAX for several days, talk with your doctor before starting again.
• If you take more FLOMAX capsules than prescribed, call your doctor right away.
What are the side effects of FLOMAX?
Possible side effects of FLOMAX may include:
• Decreased blood pressure when changing positions. FLOMAX capsules may cause a sudden drop in blood pressure upon
standing, especially after the ﬁrst dose or when changing doses. Symptoms may include:
Change positions slowly from lying down to sitting up or from a sitting to a standing position until you learn how you react
to FLOMAX capsules. If you begin to feel dizzy, sit or lie down until you feel better. If the symptoms are severe or do not
improve, call your doctor.
• Allergic reactions. Make your doctor aware of any allergic reactions you may experience while taking FLOMAX.
Allergic reactions may include:
Rare and more serious allergic reactions may also include:
• swelling of face, tongue, or throat
• difﬁculty breathing
Get medical help right away if you have swelling of the face, tongue or throat, or difﬁculty breathing.
• A painful erection that will not go away. FLOMAX can cause a painful erection (priapism), which can not be relieved
by having sex. If this happens, get medical help right away. If priapism is not treated, you may not be able to get an
erection in the future.
• Eye problems during cataract surgery. During cataract surgery, a condition called intraoperative ﬂoppy iris syndrome (IFIS)
can happen if you take or have taken FLOMAX. If you need to have cataract surgery, be sure to tell your surgeon if you
take or have taken FLOMAX.
Common side effects of FLOMAX may include:
• runny nose
• decreased semen
These are not all the possible side effects with FLOMAX. Tell your doctor if you have any side effect that bothers you or that
does not go away.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088, or by visiting
What should I avoid while taking FLOMAX?
Avoid driving, operating machinery, or other dangerous activities, until you know how FLOMAX affects you. FLOMAX
capsules may cause a sudden drop in blood pressure upon standing, especially after the ﬁrst dose or when changing doses.
See “What are the side effects of FLOMAX?”
What are the Ingredients in FLOMAX?
• Active Ingredient: tamsulosin hydrochloride
• Inactive Ingredients: methacrylic acid copolymer dispersion NF, microcrystalline cellulose, triacetin, calcium stearate, talc,
FD&C blue No. 2, titanium dioxide, ferric oxide, gelatin, and trace amounts black edible ink.
General information about FLOMAX
This medicine was prescribed for you by your doctor for your condition. Do not use it for another condition. Do not give
FLOMAX to other people, even if they have the same symptoms that you have. It may harm them.
While taking FLOMAX, you must have regular checkups. Follow your doctor’s advice about when to have these checkups.
This Important Patient Information summarizes the most important information about FLOMAX. If you would like more
information, talk with your doctor. You can ask your pharmacist or doctor for information about FLOMAX that is written for
health professionals. For more information call Boehringer Ingelheim Pharmaceuticals, Inc. at 1-800-542-6257, or (TTY)
1-800-459-9906, or visit www.4FLOMAX.com.
Keep FLOMAX capsules and all medicines out of the reach of children.
Boehringer Ingelheim Pharmaceuticals, Inc.
Ridgeﬁeld, CT 06877 USA
Astellas Pharma US, Inc.
Deerﬁeld, IL 60015 USA
Astellas Pharma Inc.
Tokyo 103-8411, Japan
Astellas Pharma, Inc.
Norman, OK 73072
Astellas Pharma Inc.
Copyright ©2009, ALL RIGHTS RESERVED.
Rev: April 2009 Printed in USA
relax the muscles in the prostate,
relieving the pressure and allowing
urine to flow more freely. Medications
called 5-alpha reductase inhibitors
retard prostate growth and actually
shrink the prostate to reduce symptoms. They work by blocking enzymes
that act on testosterone, a hormone
that promotes organ growth.
When symptoms can’t be managed
with medication, your doctor may
recommend removing or destroying
excess prostate tissue. Surgical
techniques may involve trimming
the tissue or destroying it with lasers,
radio-frequency energy, electrical
currents or microwave energy. These
procedures carry a small risk of
incontinence and sexual dysfunction.
include anti-inflammatory drugs,
antibiotics, analgesics for pain or
alpha-blockers to relax the muscles
in the prostate.
appears as a sudden infection triggered
by bacteria. Symptoms include fever,
chills and blood in the urine and
warrant an immediate trip to the
doctor. Treatment is an initial high
dose of antibiotics, followed by several
weeks at a lower dose.
condition, also caused by bacteria,
results in recurring bladder infections.
A 4- to 12-week course of antibiotics
is usually prescribed to clear up the
According to the National Institute
of Diabetes and Digestive and Kidney
Diseases, 10 to 12 percent of men
experience prostatitis-like symptoms.
The term prostatitis means inflammation
of the prostate, but doctors use the
word to describe the following four
■ :_ife`ZgifjkXk`k`j Also called
chronic pelvic pain syndrome, this is
the most common form of the disorder.
It causes pain or discomfort in the
groin or bladder area. Treatment may
problem, but a longer-term, low-dose
antibiotic may be needed for cases
that don’t respond.
gifjkXk`k`j Because it has no symp-
toms, you may learn you have this
condition when a doctor evaluates
you for another problem, such as
prostate cancer or infertility. Often
a blood test revealing an elevated
prostate-specific antigen (PSA) level
triggers an investigation. Men with
the condition usually go on antibiotics for four to six weeks and then
repeat the PSA test. ■
or kidney infections, urine blockage
or even kidney failure—so seek
An enlarged prostate usually
begins to bother men after age 50;
almost all men are affected by the
time they reach 80. Luckily, having
BPH does not increase your risk for
Help is available, but you need to
be open with your doctor. “Unfortunately, men are often hesitant to
disclose urination problems to their
doctor,” notes Muta Issa, M.D., associate professor of urology at the Emory
Clinic and chief of urology at the
Atlanta VA Medical Center. “They
consider it part of aging,” he observes,
“and tend to tolerate these symptoms
for too long.”
■ Ki\Xkd\ek For many men, the first
step is to change behaviors that may
worsen symptoms, such as drinking
too much liquid before bedtime. In
addition, “many patients don’t realize
that some medications exacerbate
symptoms,” Dr. Issa says. These
include over-the-counter cold and
sinus medications as well as certain
antidepressants, tranquilizers and
Two classes of drug therapies can
help if the condition becomes more
bothersome. Alpha-blockers help
Current guidelines advise that all men have an
annual prostate exam beginning at age 50 (40 if
you are African-American and/or have a family
history of prostate cancer). Your doctor should
perform a digital rectal exam (DRE) to search for
prostate enlargement and irregularities associated with BPH or prostate
cancer. Your physician should also give you a blood test to measure your
PSA level; when elevated, this protein produced in the prostate may be a
marker for prostate cancer. (Some doctors advise that all men have their
first PSA test in their early 40s.) Urinalysis may be performed as well,
to detect prostate inflammation or infection. —Sid Kirchheimer
What to do in a heart-health emergency
by Sid Kirchheimer
The worse a man’s oral
health, the greater his risk
of heart disease. That’s
the conclusion of a study
that tracked 1,203 men
for up to 35 years. All
were young and healthy
at the start, but as they
aged, those who developed severe gum disease
were twice as likely to
also have heart disease
as those with healthy or
less damaged gums. The
theory: Bacteria in the
mouth travels through the
bloodstream and causes
that lead to heart and
blood vessel damage.
Even Easier Assistance Think the CPR guidelines
above might be hard to remember during a crisis? Try
memorizing these two steps instead. 1) Call 911. 2) Push
hard and fast in the center of the chest.
Media Bakery; Jupiter Images
What would you do if someone near you seemed
to be having a heart attack? Giving CPR (cardiopulmonary resuscitation) may seem daunting, but
the American Heart Association (AHA) says simply
doing chest compressions, without mouth-tomouth breathing, may save an adult until help
gets there. The AHA’s Hands-Only CPR guidelines: call 911; put the victim on the floor face up;
place one hand on top of the other in the middle
of the victim’s chest; press hard and fast on the
chest, depressing it about 2 inches, roughly 100
times a minute. Continue until paramedics arrive.
Note: Kids and drowning victims still need
mouth-to-mouth resuscitation. ■
The 20s: folic acid and iron
The 30s: calcium
Simple tips for healthy eating through the
years by Elizabeth Somer, M.A., R.D.
Women in their 20s may still be growing and are still
building tissue. Two nutrients to ensure that you get
enough of are folic acid and iron.
Now’s the time to fill
bank and protect bones
from future fractures.
Calcium Women build
bone tissue until around
age 30. The stronger you
keep your bones now,
the less likely it is you’ll
later. Include three servings a day of milk, soy
milk or fortified orange
juice. At every age, ask
your doctor about
40s plus: omega-3s
As we age, heart disease
looms larger as a health
threat, due primarily to
hormonal changes. Plus,
after 40, women may lose
five to ten pounds of
muscle mass each decade.
As muscle diminishes,
causing weight gain—
which can adversely
affect heart health.
Omega-3s Diets should
be low in saturated fat and cholesterol and include
monounsaturated fats from olive oil, omega-3 fats
from fish, and foods fortified with the omega-3 DHA.
Phytonutrients High-fiber plant foods such as beans
are full of heart-healthy compounds known as
saponins, phytosterols and
One Less Slice of Pie
Cut 300 to 500 calories from
Jupiter Images; Getty Images
omen’s nutritional requirements change as
we age. Fortunately, we can get most of the
40-plus nutrients we need by consuming
plenty of whole grains, colorful fruits and vegetables,
legumes, seafood and nonfat dairy or soy milk. It’s
also wise to augment our diets with the specific
nutrients we need during each stage of life.
Folic acid Found in
greens, orange juice
and beans, this B
vitamin prevents birth
defects, but is most
effective in the first few
weeks of pregnancy—
often before a woman
knows she is pregnant.
Since one in every
two pregnancies is
unplanned, all women
in their 20s should get
plenty of these foods
every day and take a
multivitamin with 400
mcg of folic acid.
Iron Tired? Can’t think
straight? Instead of
coffee, reach for ironrich foods such as lean
meat, dark-green leafy
vegetables and legumes.
Boost iron absorption
by adding vitamin
C–rich foods, and avoid
tea and coffee with
meals; their tannins
block iron absorption.
your daily diet and you might
live to bounce your greatgreat grandchildren on your
knee. Researchers from
School of Medicine in St.
Louis conclude that maintaining a healthy weight by
eating well, limiting calories
and exercising regularly may be
the key to longevity.
M.A., R.D., author
of 10 Habits That
Mess Up a Woman’s
Diet and Age-Proof
Your Body, is editor
in chief of Nutrition
Alert, a newsletter
She also appears
on national television
IF YOU HAVE COPD, IT PAYS TO QUIT
SMOKING by Natasha Persaud
ing is by far the leading
cause of COPD, although
secondhand smoke, air
pollution, infection and
allergies can play a role
or worsen the disease.
Quitting smoking now can
offer some significant health
benefits, according to
Norman Edelman, M.D.,
chief medical officer of the
American Lung Association.
Here he answers questions
and offers tips to improve
your chances of success.
@=PFL?8M<FE<of the conditions that fall
under the term chronic obstructive pulmonary
disease (COPD) — and 25 percent of regular
smokers do—the most important step you can
take to improve your health is to quit smoking.
The main forms of COPD are emphysema
and chronic bronchitis, both progressive lung
diseases that make breathing difficult. Smok-
body of research shows it’s
worthwhile to quit, no matter
how advanced your COPD.
The day you quit, risks for
heart disease and stroke go
down. Within a few months,
lung deterioration slows and
your lung cancer risk is cut.
Within nine months of
smoking cessation, coughing,
sinus congestion, fatigue and
shortness of breath from
COPD also decrease.
Continued on p. 38
I<D<;P is dedicated to the health & wellness interests of
adults. Every issue includes valuable lifestyle tips, expert health
advice and relevant medical news. Plus, you’ll get special
offers that will benefit you and your family!
;i%<1The basic issues are surprisingly the
;i%<1A doctor can be a powerful ally when
he or she discusses the risks of smoking,
explains your medical condition and helps
you make decisions about treatment. Your
physician can advise you as to whether you
should use medication and, if so, which one.
For ongoing support, your doctor can refer you
to a smoking-cessation program in your area.
;i%<1The FDA has approved seven
medications, including nicotine-replacement
therapy and nicotine-free smoking aids.
Your doctor will prescribe an appropriate
medication based on your medical condition
and what you’ve tried before. If one method
doesn’t work, you can often turn to another.
And more therapies may come. Researchers
are now investigating several vaccines and
novel medications for smoking cessation.
Vitamin D may help delay
the lung decline of COPD,
according to preliminary
research presented at
the American Thoracic
Society’s 2009 international
conference. Calcitriol, a form
of vitamin D synthesized by
the human body, is an antiinflammatory and may delay
airway remodeling, a process
that gradually reduces lung
function, says lead author
Gautam Damera, Ph.D., of
the University of Pennsylvania.
Researchers plan to conduct
further studies of calcitriol and
to determine optimal dosages.
In the meantime, “talk to
your physician about taking
vitamin D,” says Damera. “A
supplement containing 400 to
600 IU of vitamins D2 or D3
may be beneficial.”
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Does anyone in your household suffer from: (Check all that apply.)
High blood pressure
Irritable bowel syndrome
Night sweats/Hot flashes
OA of the knee
Peripheral Artery Disease
Restless legs syndrome
Sun damaged skin
Weight control problems
Others in HH
mental and a social aspect. Research shows
that pairing counseling with medication is
a very effective tool for smoking cessation.
Programs are available through your county
and state health departments at 800-QUITNOW, the American Lung Association,
the American Cancer Society and many
other organizations. Another tip: Find a quit
buddy—a friend or family member who is also
trying to quit or who is simply willing to offer
support whenever you need it. There is often
a perception that COPD is a self-inflicted
disease; if you didn’t smoke, you wouldn’t have
developed it. According to research, having
a support system predicts
success in the short term.
;i%<1Even under the best
circumstances, only about
one in four people are
successful at quitting after
one year. Most people have
to make the attempt more
than once. Think of your
previous attempts as practice
quits, and try again—it’s
well worth it. ■
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Acid reflux disease/GERD
Benign Prostate Hyperplasia
Coronary artery disease
Deep Vein Thrombosis
Diabetes, nerve pain
Diabetes, Type 1
Diabetes, Type 2
Others in HH
Mealtime can be challenging for those with advanced COPD.
In a study published in the American Journal of Respiratory
and Critical Care Medicine, those with COPD were found to be
more likely to swallow solid food while inhaling, or to inhale
accidentally while eating soft foods such as pudding.
The possible result: Food and bacteria may be
breathed into the lungs, which can cause infection and
a flare-up of symptoms. Sitting upright while eating
and switching from softer foods to harder foods—or
vice versa—may help, says Roxann Diez Gross,
Ph.D., of the University of Pittsburgh, the study’s
lead author. And if you have a problem, ask for
a referral to a speech-language pathologist.
“Evaluation and treatment by a professional may
help preserve lung function and improve the
quality of life,” says Diez Gross.
:<C<[email protected] [email protected]<
Superstar and mother Jennifer Lopez appeals to
parents everywhere to protect their children
J_\[XeZ\jc`b\X[i\Xd# and her voice is strong, clear
and thrilling. Now Jennifer Lopez is lending that voice
to a cause that is very close to her heart as a mother:
protecting children against potentially deadly illness.
“Like every parent, once you hold your baby in your
arms, you know the focus of your life completely shifts,’’
says the mom of toddler twins Max and Emme. “I
needed to know everything there was to know about
keeping my children healthy and safe and well.’’
One key fact she learned early is that pertussis, also
known as whooping cough—after the uncontrollable,
gasping cough it can bring—is a highly contagious
respiratory tract infection.
Before a vaccine became available in the 1940s,
whooping cough was a major cause of childhood deaths.
Today, the vast majority of kids in the United States
receive a five-dose vaccine: primary doses at two, four
and six months, and boosters between 15 and 18
months and ages four and six.
The vaccine can shield kids once they’ve received
three or four of the doses, but until then, youngsters are
BY DIANE UMANSKY
:<C<[email protected] [email protected]<
MediZine Health e-Living
them,” she says. “I felt it was urgent
to let parents know how important it
is that they get vaccinated to protect
themselves and help keep their babies
safe from this dangerous disease.”
Haven’t had a booster? Talk with
your physician. The immunity does
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K\Xd\[LgJennifer and her husband,
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wear off after a number of years, so
you may need booster updates. Ask
your doctor what’s right for you.
Max and Emme are up-to-date on
their pertussis vaccines, and Jennifer
and her husband, Marc Anthony,
have had the booster. “It’s a really
easy thing to do to keep your baby
safe,” Jennifer says. “I don’t mind
getting shots, especially if I know it’s
going to protect my babies.” N
American Academy of Family Physicians
Fragile X Research Foundation
American Association of Diabetes Educators
Multiple Myeloma Research Foundation
American Pain Foundation
Free My Family Health Portrait Tool
Asthma and Allergy Foundation of America
National Heart Lung and Blood Institute
Office on Women’s Health
U.S. Surgeon General
still at risk. “Parents don’t realize
they can get pertussis and transmit
the disease to their babies,” says
Jennifer. “Babies most often catch it
from their parents or people around
them. We’ll just think it’s a cough,
and we’ll survive it fine, but if a baby
gets it, it can be fatal.”
The Centers for Disease Control
and Prevention (CDC) calls for
adolescents and adults between 11
and 64 years old—including new
mothers—to get the Tdap vaccine
(a booster that protects against
pertussis, tetanus and diptheria). But
few do. And that may be one reason
rates of pertussis have been gradually
increasing since the 1980s.
“Despite the CDC recommendations, a 2007 survey showed that
fewer than two percent of adults 18
through 64 years of age had ever
received a Tdap vaccination,” says
Alan R. Fleischman, M.D., senior
vice president and medical director
of the March of Dimes.
Jennifer has teamed up with the
March of Dimes and a pharmaceutical company to urge adults to get the
booster. “New and expectant parents
have so many things to worry about.
Getting pertussis themselves, or
possibly spreading the disease to their
own children, shouldn’t be one of
What is the deal with cholesterol, and
why is everyone so worried about it?
by Kalia Doner
EVERY BREATH YOU TAKE depends in part on a
pale-yellow waxy substance that’s a building block
of cell walls, sex hormones, the brain and even the
juices that digest fat in the gut.
This essential element is cholesterol, a fatlike
product of the liver and
intestines that’s carried
through the bloodstream
to every organ in the body.
Our bodies make all
the cholesterol we need.
But we end up with far
too much circulating in
the blood, thanks to diets
loaded with saturated and
trans fats from meat, dairy
products and processed
foods. The liver turns that
excess fat into cholesterol.
We also take in cholesterol directly from foods
such as eggs, but high
blood cholesterol levels are
usually due to too much of
the wrong fats. Lack of
exercise also plays a role.
If you are one of the
99 million adult Americans who has been told
they have high cholesterol, you’ve only gotten
part of the story.
High cholesterol does
indicate that you are at
increased risk of heart dis-
ease. If your total cholesterol is between
200 mg/dl and 239 mg/dl, you are borderline high risk; a level of 240 or higher
means you are more than twice as likely
to develop heart disease as someone
whose cholesterol is below 200.
But that number is not as helpful in
predicting your risk of cardiovascular
disease as your levels of low-density
lipoprotein (LDL, or harmful cholesterol), high-density lipoprotein (HDL, or
good cholesterol) and blood fats called
Elevated LDL and triglyceride levels
don’t usually cause symptoms, so you
may not know you are at risk for heart
disease without a blood test. That’s
why the Third Report of the Expert
Panel on Detection, Evaluation, and
Treatment of High Blood Cholesterol in
Adults (ATP III) recommends that adults
age 20 or older have their total cholesterol, LDL, HDL and triglyceride levels
measured at least once every five years.
LDL lowdown When it comes to coronary heart disease, LDL appears to be
the main culprit, since it produces atherosclerosis, where plaque builds up in
the inner linings of arteries and can
restrict blood flow.
An LDL of 130 to 160 mg/dl and
higher indicates an increased risk of
heart disease. But if you have already
been diagnosed with heart disease,
your LDL cholesterol should be less
than 100 mg/dl, and your doctor may
even set your goal below 70 mg/dl.
Tricky triglycerides If we take in more
calories than we need, the excess is
turned into triglycerides and stored in
fat cells for later use. The National
Institutes of Health guidelines for triglyceride levels consider normal to be under
150 mg/dl; borderline high,150 to 199
mg/dl; high, 200 to 499 mg/dl; very
high, 500 mg/dl or higher. About onethird of adults in the United States have
levels of 150 or higher.
Healthy HDL High-density lipoproteins
carry cholesterol back to the liver and
out of the body. HDL also helps keep
cholesterol from building up in the
walls of the arteries, reduces the risk of
clots and dilates the blood vessels.
According to the National
Cholesterol Education Program (NCEP),
HDL that is less than 40 mg/dl is a
major risk factor for heart disease, 40 to
59 mg/dl is healthier, and 60 mg/dl and
higher is considered more protective
against heart disease.
What is non-HDL cholesterol? This
new category of cholesterol measureContinued on p. 52
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goal. CRESTOR has not been approved to prevent heart disease, heart attacks, or strokes.
CRESTOR is not right for everyone, including anyone who has previously had an allergic reaction
to CRESTOR, anyone with liver problems, or women who are nursing, pregnant, or who may become
pregnant. Your doctor will do blood tests before and during treatment with CRESTOR to monitor your
liver function. Unexplained muscle pain and weakness could be a sign of a rare but serious side effect
and should be reported to your doctor right away. The 40-mg dose of CRESTOR is only for patients who
do not reach goal on 20 mg. Be sure to tell your doctor if you are taking any medications. Side effects
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bad cholesterol. It
raises the good
CRESTOR is also proven to slow the buildup of
plaque in arteries as part of a treatment plan to
lower cholesterol to goal
High cholesterol, family history of early heart
disease, diabetes, and high blood pressure may
play a role in plaque buildup
Talk to your doctor about plaque buildup and
ask if CRESTOR is right for you.
ment was introduced in ATP III and is
believed by many doctors to be an
important number for people with
elevated triglycerides and diabetes. It
combines information about triglyceride levels with information on a
form of LDL called very-low-density
lipoprotein (VLDL). To determine your
non-HDL level, subtract your HDL
number from your total cholesterol.
The NCEP recommends that non-HDL
levels be 30 mg/dl above the goals for
LDL cholesterol levels.
The Balancing Act
Getting cholesterol levels right is a
matter of finding the balance between
TLC (therapeutic lifestyle changes) and
medication. “If your LDL level is above
your goal for heart health, you want to
talk with your doctor about lowering it,”
counsels Scott M. Grundy, M.D., Ph.D.,
who was the chairman of the ATP III
and is professor of internal medicine at
the University of Texas Southwestern
Medical Center at Dallas. “How you do
that is secondary to getting it done. But
you do want to do it cost effectively
and with minimum side effects.”
Lifestyle steps ATP III outlines the steps
that appear to be most effective in
lowering the risk of heart disease. These
include making sure your daily fat
intake adds up to no more than 25 to
35 percent of total calories: 7 percent or
less from saturated fat, 10 percent from
polyunsaturated fat, up to 20 percent
from monounsaturated fats.
Carbohydrates (mainly from
grains—especially whole grains—fruits
and vegetables) should make up 50 to
60 percent of your total calories; fiber,
20 to 30 grams a day; protein, less than
15 percent of total calories; and cholesterol, less than 200 mg a day. Also,
“weight management and increased
physical activity are recommended,”
says Dr. Grundy.
A TLC program can be tough.
“Lifestyle changes, combined with
managing individual risk factors, are
vitally important in terms of initial therapy,” says C. Noel Bairey Merz, M.D.,
director of the Cedars-Sinai Women’s
Heart Center in Los Angeles. “Regrettably, many patients find it difficult to
permanently alter their lifestyle or
follow through on risk management
recommendations. While therapeutic
lifestyle changes have a large role in
heart health and work well when recommendations are carefully followed,
the role of oral medication is also
important—especially because most
people are better at taking pills than
making lasting lifestyle adjustments.”
But “there are no pills that offer the
benefits of exercise,” says Steven
Nissen, M.D., chairman of the department of cardiovascular medicine at
the Cleveland Clinic in
improvements are an
essential partner to
lower total and LDL
cholesterol and triglycerides include statins,
bile acid sequestrants,
niacin and fibric acids.
■ Statins They can lower LDL
by 18 to 55 percent, raise HDL by 5
to 15 percent and lower triglyceride
levels by 7 to 30 percent.
■ Bile acid sequestrants They can
lower LDL by 15 to 30 percent and raise
HDL by 3 to 5 percent, but they have
no effect on triglyceride levels.
■ Niacin (nicotinic acid) This B vitamin
in prescription doses can lower LDL by
5 to 25 percent, raise HDL by 15 to 35
percent and lower triglycerides by 20 to
■ Fibric acids They can lower LDL by
5 to 20 percent, raise HDL by 10 to 20
percent and lower triglycerides by 20 to
50 percent. ■
For many of us, the fight to keep
cholesterol levels under control is
a battle of middle age. But imagine
what it’s like for the 1 in 500
people who have familial
(FH), an inherited
gene mutation that
makes it difficult
for their body to
clear out harmful LDL. In some
cases, the mutation
is inherited from one
parent, but there are
families in which both parents have passed on the problem.
These children may have cholesterol
levels exceeding 600.
How do you know if your cholesterol problems are inherited? Families
with a history of FH have close members who have had premature heart
attacks or been diagnosed with heart
disease before age 60, and often in
their 20s, 30s or 40s. Physical symptoms of FH may include a buildup of
excess cholesterol in tendons in the
legs, hands and fingers. There may
also be yellowish cholesterol deposits
in the eyelids, and grayish deposits on
the surface of the cornea.
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Editor in Chief ............................................ DIANE UMANSKY
Loyd V. Allen Jr., Ph.D.
Editor in Chief
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