Good bone health is essential for all women. Osteoporosis and osteopenia, or low bone density, are diagnosed based on a bone mineral density (BMD) test.

Low bone density increases the risk of fractures and is very common in women, increasing in risk as we age.

Fortunately, bone loss is not inevitable.

Here are 5 ways you can ensure good bone health.

DRINK YOUR MILK: Calcium is a necessary building block for healthy bones, and builds bone density. In people who do not have enough calcium, the body will actually take calcium from the bones to meet its needs. It is very important for all women to make ensure that their diet is high in calcium. Children, postmenopausal women, and women who are pregnant have the highest calcium requirements. The best sources of calcium are dietary and include dairy products, leafy green vegetables and fish.  A general rule is that one serving of calcium-rich foods contains approximately 300 mg of calcium. Current recommendations are for 1000-1200 mg of calcium daily, either in the diet, as a supplement, or both, for all women over the age of 50.

GET OUTSIDE: Vitamin D is necessary for healthy bones because it helps your body absorb calcium. The best source of vitamin D is from sunlight. Low levels of vitamin D are common in many women, especially women who live in colder climates and spend less time outside in the sun. (In case your wondering, sunscreen probably does act as a barrier, but it’s not a good reason not to slather it on!). Dietary sources of vitamin D include fish, eggs, and foods fortified with vitamin D, such as certain cereals. Vitamin D can also be taken as a supplement, but because Vitamin D requirements can vary from person to person, ask your doctor to check your levels before starting on a supplement.

KEEP MOVING: Any activity that places weight on your bones stimulates bones to increase in density. I always encourage my patients to focus on activities that they already like to do, like running, walking, dancing, playing tennis, yoga, and Tai chi. Resistance exercises, like using free weights or weight machines are another great option. It is a good idea to speak with your doctor about which exercises are good for you.

DON’T SMOKE: In addition to all of the other terrible side effects of smoking, it can also worsen your bone density. The bottom line is, if you smoke, stop. If you need help stopping, reach out to your doctor as there are lots of options available to help you.

KNOW YOUR HISTORY:  It is important to understand if there are other family members with osteoporosis, as family history can be a risk factor. All post-menopausal women should be screened for osteoporosis with a bone mineral density test (also called a DXA scan) regardless.

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Now that the weather’s cooling off, if you live in a cold climate you may be thinking about winterizing your pipes, your car, your garden… and your skin??

Dry itchy skin (xerosis cutis) is a common reason for visit in a dermatology clinic, especially here in Alaska. For the most part, dry skin is never going to hurt you or affect your overall health, but it can certainly be a nuisance.

There’s no magic bullet, but here are some tips for dry, itchy, winter skin:

Moisturize! You may think I’m stating the obvious here, but I’m shocked at the number of patients who come in for complaints related to their dry skin, who aren’t using a moisturizer daily.  There is no one brand of moisturizer that’s better than the others, but I do have one rule: your moisturizer needs to come in a tub or jar.  I’m talking about the kind of moisturizer that you scoop out with your hand to apply.  If you can pump your lotion out of a bottle, or squeeze it out of a tube, then it has too much alcohol in it to properly moisturize your skin.

Dial down the shower heat.  This is the request that elicits the most groans from my patients.  Everyone loves a hot shower!  Unfortunately, that hot shower water (while it feels great on a cold winter day) is not doing nice things for your dry skin.  Limit bath/shower time to 10 minutes, and go for lukewarm water instead of steaming hot.  Pat dry afterwards and then moisturize.

Beware of soap.  Most people use too much and too harsh of a soap.  Avoid anything “antibacterial”, and anything with fragrances or dyes.  Or, avoid soap altogether and just wash with water.  Areas that tend to sweat/get dirty can be washed with gentle cleansers.

Watch what you wear. Layers of cotton clothing are best.  Some synthetic fibers and scratchy wool can further irritate dry skin.

Stay out of the sun!  Changes to collagen and other supporting structures in the skin from sun damage make it harder for skin to hold on to water.

Stay hydrated.  While drinking more water won’t fix your dry skin if you’re not also moisturizing it, it’s never a bad idea.
And remember – always talk to your doctor.  You may be dealing with eczema, or the dry skin may be caused by certain medications you are taking. Chronic medical problems like liver or kidney disease, thyroid issues, and diabetes are all associated with dry skin. Your doctor can help you decide what testing, if any, needs to be pursued, or what additional treatment options there are.

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Having “an accident” as an adult can be extremely embarrassing – something you might not even feel comfortable discussing with your doctor. Know that you aren’t alone. It’s estimated that about 5% of women over the age of 60 will have experienced an involuntary loss of stool.

This can arise from any number of medical conditions that weaken the body’s ability to hold stool in, such as diabetes mellitus, multiple sclerosis, dementia, and spinal cord injuries, just to name a few.

But did you know that even pregnancies and childbirth that may have happened many years prior can lead to incontinence of stool decades down the road?

You might be especially at risk if you had a vaginal delivery, particularly one with known trauma to the anal sphincter, or one that required forceps. Big babies (especially those over 9.5 pounds) can also put you at increased risk for troubles down the road.

Another surprising reason some women have fecal incontinence is chronic constipation. Though it seems counterintuitive, hard stool sitting in the rectum for prolonged periods of time can actually result in overflow of loose stool, and even relaxation of the sphincter, or muscle that holds stool in, resulting in incontinence of even formed or hard stool.

Depending on the cause of the incontinence, there are various treatment or management options that exist. So don’t suffer in silence, and don’t be embarrassed to bring this up with your doctor. The sooner you do, the better, especially if you are older than 40, or have chronic diarrhea or risk factors for colorectal cancer. Take control of your symptoms before they take control of you.

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What’s up with preventative Botox?

Botulinum toxin injection (brand names including Botox®, Dysport®, and Xeomin®…I will just say “Botox®” for simplicity!) is one of the most commonly performed cosmetic procedures today – and I like to refer to it as a “gateway drug.”

Botox® relaxes the muscles into which it’s injected, smoothing wrinkles formed from facial expression.

But what about preventing those wrinkles in the first place?

Short of never smiling/frowning/squinting/concentrating, there’s one true way to go – preventative Botox®!

The concept is simple: relax the muscles so certain facial expressions aren’t physically possible (no forehead scrunching or frowning) and a “set-in” wrinkle will never form.

The most common locations for preventative Botox® are the glabella (frown line area between the eyebrows) and the forehead.

Can people look weird if their facial expressions are limited? Well, yes, but not usually if the Botox® is injected properly.

For my patients I have no problem fully relaxing the glabellar area (not so noticeable when someone can’t frown), but I tend to take it easy in the forehead. Not being able to raise one’s eyebrows at all = the “plastic” look everyone dreads.

There was a study published in Archives of Facial Plastic Surgery which illustrated the concept of preventative Botox® well. It was done on sets of twins, where one twin received preventative Botox® injections regularly starting at a young age, the other twin did not. The images speak for themselves, no-Botox® twin on the left and Botox® twin on the right.

Now, before you get too excited. There is another school of thought in the Botox® community that preventative injections can eventually result in atrophy of the muscles, or muscle loss, and, unfortunately, a prematurely aged appearance. While atrophy is possible with long-term use of Botox®, as muscles are gradually trained not to move in certain ways, the idea that it will actually cause worse cosmetic results has not been shown.

Personally, I got my first Botox® injection as a dermatology resident, at age 29.

I wanted to stave off the onset of those worry lines. And today, 5 years later, despite the stresses of medical school and residency, I’m still pretty much wrinkle free!

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Earlier this month the The U.S. Food and Drug Administration approved Addyi (flibanserin) to treat acquired, generalized hypoactive sexual desire disorder (HSDD) in premenopausal women.

Viagra, or the male equivalent to this medication has been on the market since 1998, and was certainly a great achievement in aiding male erectile dysfunction patients. There have been no similar drugs to help women who have issues with sexual desire on the market as of yet.

Addyi is the first drug that has been developed to treat HSDD in the female population.

While this seems like a much overdue accomplishment for women who suffer from this disorder, the pill is not without its faults.

In order to understand why this pill is not the panacea for HSDD, let us first discuss its mechanism of action.  Flibanserin was first developed as a drug for depression and works on the chemical serotonin where it acts as an inhibitor at receptor sites that allow serotonin to be taken up into the cells. Serotonin is a “feel good” chemical, and by allowing more of it to be around receptors, it increases good mood feelings.

When this medication was first trialed, it did not work well as an antidepressant.  It is also unclear why it would work for treatment of HSDD, but it was approved anyway…

As with any serotonin reuptake inhibitor (SSRI) it takes at least two weeks to take effect, and must be taken every day in order for it to work.  This is very different from Viagra, which is taken only when needed.

This drug was trialed only in premenopausal women and is only recommended for this poupulation. Which would be fine, if the majority of patients who suffer from HSDD weren’t post-menopausal…

And now for the side effects:  this drug may cause severe drops in blood pressure causing people to “pass out,” a side effect unfortunately exacerbated by alcohol intake.

The drug will only be allowed to be prescribed by physicians who are certified to prescribe it and will only be sold at pharmacies certified to sell it. So pretty hard to get.

So basically the only person who would benefit from this drug is a premenopausal woman who abstains from drinking and doesn’t mind taking a pill every day of her life, and is OK with the possibility of passing out without warning. Oh, and who is able to find someone who is able to prescribe and sell the drug.

While it is wonderful news that HSDD in women is finally being addressed 17 years after Viagra was first introduced, it seems that this drug is not quite the answer we’ve all been waiting for.

The post Up, Up and Away? The Truth About the “Female Viagra” appeared first on Talia Zenlea.

If doctors’ appointments in general make your heart race, your first visit to a dermatologist can seem particularly intimidating due to the intimacy involved.

Yes, we DO want to look at (nearly) every inch of your skin! But don’t worry, it doesn’t have to be embarrassing, awkward, or uncomfortable in any way.

Here are some tips to prepare for your first skin cancer check.

DOs:
• Expect to undress. You might be surprised by how many patients come in for a “skin exam” only to hesitate to strip. You may be given the option to leave your underwear and/or bra on, and that’s up to you. Just remember, we don’t have x-ray vision, so if it’s covered, we can’t see it!
• Come prepared. Consider coming with a list of “spots” that are worrisome to you. If your list is longer than 4-5 “spots,” we’ll likely skip the detailed verbal history of each area, and start the exam, pausing at each of your sites of concern to tell you what they are.

DON’Ts:
• Don’t get scary ‘cuz you’re hairy. Don’t worry if you didn’t shave your legs or underarms, or if you’re sweaty, or your feet stink. We’ve seen it all! And we don’t mind.
• Don’t stress. We sometimes stop and examine tiny spots with our hand-held magnifiers; it’s not necessarily a cause for concern – we’re good at identifying many benign lesions at first glance. If you’re not sure that we saw on your area of concern, please speak up! But chances are that we saw it, diagnosed it as benign, and we moved on.

Recommendations differ, but I tell my patients to come in for their first “baseline” head to toe skin cancer check before the age of 50. Based on your sun history and what we find at that visit, we’ll tell you how often to come back.

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Dermatologists see myriad of skin issues ranging from cancer to chronic disease to acne to cosmetic treatments.

One of the most common questions we get is, “What is the best anti-aging routine for my skin?”

Here’s my no-frills answer to that one: Everyone’s skin is different, so in order to design the most ideal regimen for your particular skin, you should visit a dermatologist for an individualized plan. BUT, there are some basics that any anti-aging routine should include.

If you do nothing else, following these three recommendations is a great start in your youthful journey:

• SUNSCREEN. You knew that would be #1 on any dermatologist’s list. Sunscreen starting in childhood is ideal, but for most people asking about anti-aging routines, that ship has sailed! Fear not though, it’s never too late to prevent ongoing and future damage. A broad spectrum sunscreen (covering BOTH UVB and UVA rays, not all of them do!) with SPF 30 for daily use, SPF greater than 45 for any time you’ll get  over 30 minutes of sun per day. We will discuss sunscreen specifics another time, just the basics for now!
• RETINOID. Over the counter versions are plentiful, look for “retinol” or “retinaldehyde”. Prescription retinoids are available from your dermatologist, but I typically recommend an over-the-couter cream first, to get used to it. Once your skin is “retinized,” it will tolerate a stronger version with a lot less peeling and redness.
• GLYCOLIC ACID. Usually in the form of a cleanser, toner, or in your moisturizer. Oh, the stinging! So worth it!

So that’s it! Simple as 1-2-3.

Certainly depending on your skin type, pigment, amount of sun damage/pigmentation/wrinkling other beneficial products and procedures can be recommended. I personally like Vitamin C products, various moisturizers and exfoliants, chemical peels, botulinum toxin injections (like BOTOX®), filler injections, and laser depending on your particular concerns.

I recommend making a separate appointment for an anti-aging discussion, as trying to fit it in with your annual skin check can result in an incomplete or rushed plan!

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