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LONG LIFE[A SURVIVAL STRATEGY] Prolonging the Productive, Fulfilling Lives of Women
RONALD M. CAPLAN, M.D. WWW.LIVINGLONGER.WORDPRESS.COM
LIVING LONGERThe Take-Home Message To Live Long and Healthfully
AS A COMMUNITY WE MUST PROVIDE: • Universal Education • Public Health • Security for the individual and the society.
AS INDIVIDUALS WE MUST: • Avoid high risk behaviors, including illegal drug, tobacco and alcohol use • Limit diet to a healthful level, preventing obesity • Exercise moderately • Get adequate sleep
AS INDIVIDUALS WE MUST: • Educate ourselves to understand what is available to us medically, and insure that we get what we need early enough in the disease process • Understand what ‘prevention’ really means
THE SCIENCE OF MEDICINE MUST: • Continue its rapid advance to understand disease at the genetic and molecular level • Ensure the quality of medical care • Ensure that treatments offered are based on solid evidence • Learn to detect those individuals who are prone to various disease states, and to intercept disease at an earlier time
THE SCIENCE OF MEDICINE MUST: • Continue to develop specific treatments that are tailored to arresting each disease process, with a minimum of side effects • Inform people of the various valid options available for the treatment of their particular condition
UNITED STATES: FEMALE POPULATION • AGE 2000 2025 (Projected) • 40-49 years of age 21,626,476 21,441,586 • 50-59 years of age 16,089,564 20,476,390 • 60-69 years of age 10,830,138 21,306,682 • 70-79 years of age 9,319,776 15,585,682 • 80-89 years of age 4,900,800 7,120,900 • 90-99 years of age 1,179,200 2,042,000 • 100 years and over 65,300 179,200 • *US Census Bureau, 2000
UNITED STATES: MALE POPULATION • AGE 2000 2025 (Projected) • 40-49 years of age 21,139,450 21,559,526 • 50-59 years of age 15,260,203 19,859,536 • 60-69 years of age 9,568,547 19,468,524 • 70-79 years of age 6,955,548 12,722,767 • 80-89 years of age 2,671,600 4,433,400 • 90-99 years of age 351,400 698,200 • 100 years and over 10,100 24,900 • *US Census Bureau, 2000
AGING: IT CAN BE DELAYEDThe Take-Home Message • Immortality does exist for body cells. • Stem cells evolve into the specialized cells that make up all the cells of the human body
AGING: IT CAN BE DELAYEDThe Take- Home Message: • Genetic makeup is important in determining how long we live. • Genetic manipulation to change the odds is possible.
AGING: IT CAN BE DELAYEDThe Take-Home Message • We are each genetically unique
AGING: IT CAN BE DELAYEDThe Take-Home Message • Environment, including the life of the fetus in the womb, is important in determining longevity and health • Environment can be changed to our benefit
AGING: IT CAN BE DELAYEDThe Take-Home Lesson • We can scan the body to a precise level, identifying possible disease very early
AGING: IT CAN BE DELAYEDThe Take-Home Message • Targeted drugs now do exist that go directly to receptors on affected cells, blocking disease at a microscopic level, anywhere in the body that the disease is present
AGING: IT CAN BE DELAYEDThe Take-Home Message • It is possible to grow new, healthy tissue
DISEASES OF AGING IN WOMEN AND THEIR PREVENTION • Stop Smoking • Eat healthfully • Women and their physicians must pay attention to the prevention of, and early detection of, heart and cardiovascular disease • Methods for the early detection of breast and ovarian cancer do exist-but better methods are needed
HEART DISEASE AND HYPERTENSIONThe Take-Home Message • Heart Disease • Coronary artery disease is a significant concern for women • It can be prevented, helped or delayed in onset • It can be effectively treated • Prophylaxis against heart attack is easily available for most women who need it • Better early diagnosis is available
HEART DISEASE AND HYPERTENSIONThe Take-Home Message • Congestive heart failure can be effectively treated • Heart transplantation is no longer experimental • Heart muscle actually undergoes repair, and new heart muscle can be grown
HEART DISEASE AND HYPERTENSIONThe Take-Home Message • High blood pressure (hypertension) • Is increasingly common as a woman gets older • It can be prevented, helped, and delayed in onset
HEART DISEASE AND HYPERTENSIONThe Take-Home Message • High cholesterol (hypercholesterolemia) • Is associated with obesity • Genetic factors are involved • It can be prevented, mitigated, and treated effectively
HEART DISEASE AND HYPERTENSIONThe Take-Home Message • Stroke • There are two different mechanisms: hemorrhage, or blood clot • Early identification of women at risk, and specific treatment of these women, is possible in some cases • Prompt treatment is of vital importance
HEART DISEASE AND HYPERTENSIONThe Take-Home Message • Aneurysm • Weakening, and bulging, of a blood vessel wall • Early diagnosis and treatment is important
CANCERThe Take-Home Message • Early diagnosis and treatment is vital: act decisively • Very specific DNA cancer markers for early detection of cancer are becoming available • Know the characteristics of a woman’s individual tumor cell, to see if targeted therapy is available • Specific drugs do exist that can go directly to the cancer cell
CANCER The Take-Home Message • Keep the tumor tissue removed at surgery for further testing • Stay away from carcinogens that cause cancer • Test for gene mutations that cause susceptibility to cancer
CANCERThe Take-Home Message • There are now drugs available that can protect against Breast Cancer • Cancer can be converted from a killer to a chronic disease condition • Anticancer vaccines now exist
THE REPRODUCTIVE ORGANSThe Take-Home Message • Early diagnosis and decisive treatment is the key • A sexually transmitted virus, HPV (human papilloma virus) is responsible for most cervical cancer, and precancer. It is easily detected by DNA probe, often before there is significant cell change seen on a “Pap” (Papanicolaou) smear • A vaccine that prevents HPV infection is available • DNA probes are highly precise
THE REPRODUCTIVE ORGANSThe Take-Home Message • The Pap smear was one of the great early advances in true “preventative” medicine: cervical disease was detected microscopically before it turned to cancer, or at an early stage of cancer. Women could be and were effectively cured by definitive treatment. However, Pap smears have both false positive and false negative results.
THE REPRODUCTIVE ORGANSThe Take-Home Message • Never take abnormal bleeding for granted; it must be evaluated. • Bleeding after menopause (postmenopausal bleeding) must be evaluated. • Menopause means the menses have stopped. Irregular or abnormal bleeding around the time of the menopause is not a normal symptom of the menopause.
THE REPRODUCTIVE ORGANSThe Take-Home Message • Ovarian tumors may occur at any age, although they are more common in older women. • Minimally invasive surgical techniques have proven to be a great advance in the diagnosis and treatment of disease of the reproductive organs.
MENOPAUSEThe Take-Home Message • The interplay of female sex hormones is choreographed by a feedback mechanism • Menopause means the stopping of the menstrual flow • Abnormal bleeding in a women in the menopausal age group must always be investigated • Women do not normally menstruate beyond the age of 55 • The average age of menopause is approximately 50 • In perimenopause, the periods become shorter, lighter, and farther apart
MENOPAUSEThe Take-Home Message • It is important that symptoms attributed to PMS (premenstrual syndrome) or PMDD (premenstrual dysphoric disorder), be evaluated before concluding that PMS or PMDD is indeed the explanation • HRT (hormonal replacement therapy) must be individualized, after the risks and benefits have been explained as well as the possibility of using other therapy, such as Bisphosphonates or SERM’s (specific estrogen receptor modulators) and after careful examination
MENOPAUSEThe Take-Home Message • In most women, after four years of use soon after menopause, the risk of hormonal replacement therapy with estrogen and progesterone outweighs any possible benefits • Osteoporosis, diagnosed by bone density studies can be counteracted by aerobic exercise, calcium and vitamin D intake, Bisphosphonates, SERM’s, or HRT. Statins, other drugs, or ‘natural’ alternatives may be helpful. It is important that risks and benefits are explained, and the choice of therapy is made with a gynecologist.
SEXUAL FUNCTION • Sexual arousal, a complex phenomenon, is recently better understood • Therapy for sexual dysfunction arising from a wide variety of causes is now readily available
MIGRAINE • Treatment with triptans has been a major breakthrough in the management of migraine.
DIABETESThe Take-Home Message: • Diabetes is a defect in sugar metabolism, along with resistance to insulin • Obesity is a significant factor • Diabetes must be carefully controlled in order to prevent, or retard, complications • Gene therapy shows promise for the definitive treatment of diabetes • Metabolic Syndrome
DISEASES OF THE JOINTSThe Take-Home Message: • High impact sports have a downside • Minimally invasive surgery, microsurgery, and joint replacement have been significant advances in the treatment of joint disease • Autoimmune disease often involves multiple organ systems
DISEASES OF THE CENTRAL NERVOUS SYSTEM • Alzheimer’s Disease can now be diagnosed more definitively, and treatment is available, although not curative • Strides are being made in the treatment of Parkinsonism
DISEASES RELATED TO CHILDBEARING • One of the great hallmarks of modern medicine is the prevention and effective treatment of diseases related to childbearing • Prenatal (antenatal) care has probably been the preeminent success story in preventative medicine • Effective medical and surgical treatments are available for a variety of dysfunctions of the urinary bladder and bowel
DISEASES RELATED TO CHILDBEARING • Reproductive technology has revolutionized the treatment of the couple having difficulty in achieving pregnancy • The biologic ‘clock’ still exists • Immunologic interplay between a mother and her fetus is important in protecting the growing fetus, and has contributed to our knowledge of organ transplantation, and to our knowledge of the aging process
LIFE EXPECTANCYThe Take-Home Message: • No matter how old you are, you have a life expectancy • Theoretically, we should all be able to live healthfully to an age well beyond what we currently experience
LIFE EXPECTANCYThe Take-Home Message: • Early diagnosis and state of the art management of conditions that arise in women can significantly prolong lifespan, with good quality of life • This is one important aspect of ‘prevention’ • Organ transplantation, and the development of techniques to grow new organ tissue, can greatly prolong lifespan
DIETThe Take-Home Message • We are not what we eat • Fat does not (necessarily) make a person fat • Fat intake is necessary, to a degree • Calcium is important • Chances are good that most of us eat too much • Many of the dietary rules we traditionally follow are arbitrary, and do not have much relation to our body physiology
DIETThe Take-Home Message • We should be critical of words that seem to suggest health benefits • Vitamins are necessary, but except in pregnancy, adequate amounts are usually contained within a varied diet
DIETThe Take-Home Message • A vitamin and mineral supplement should usually contain some trace elements such a zinc and chromium. • The best meals tend to be made by master chefs, not by a committee
THREE MEALSA DAY AFTERNOON TEA ?
EXERCISEThe Take-Home Message • Moderate regular aerobic exercise is of proven value • High impact exercise can lead to a variety of sports injuries • Looking good usually makes you feel better. There is such a thing as self image • Get sufficient sleep (but too much sleep is not necessarily a good thing) • Maintain bone density and muscle mass
DISEASE PREVENTIONThe Take-Home Message • It is not yet possible to prevent all disease. It is now possible to identify many potentially major disease states before they cause significant trouble, often before there are any symptoms at all. • A regular physical examination, even when coupled with an electrocardiogram and basic blood tests, will pick up some abnormalities, but will not identify many important, potentially dangerous problems.