Monday, December 22, 2008

Key to women’s health is education

Pap smears and mammograms are vital tools that help doctors address women’s health needs, but comprehensive health care for women is a lot more complicated.

Dr. Jorge Minera of Piedmont Family Practice has a special interest in women’s health issues; he believes that education is the most important ingredient for healthier living.
Heart attacks in women, for instance, are largely misunderstood. Dr. Minera said, “Heart attacks have always been thought of as a man’s malady. Although equivalent numbers of men and women suffer heart attacks, more women than men die of heart attacks because women’s symptoms are different and are not as easily recognized.”

According to the National Institutes of Health, women’s symptoms can begin as much as a month before the heart attack and can include:

• Unusual fatigue
• Sleep disturbance
• Shortness of breath
• Indigestion
• Anxiety
• Weakness in the upper arms

Major symptoms during the heart attack include:
• Shortness of breath
• Weakness
• Unusual fatigue
• Cold sweat
• Dizziness
Dr. Minera said that although many women are conscientious about getting preventive care, when the issue is acute, they may delay getting help because of their many responsibilities. And the warning signs of heart attacks in women are often overlooked or attributed to other causes. “Often when women do seek help with these kinds of symptoms, their concerns are not validated; they are dismissed because their symptoms are more subtle.”

The doctor said that as a family practice physician, he has an advantage because of his previous experience with his patients. “We have the time to get a complete history, and consider all the risk factors -- tobacco use, cholesterol, blood pressure, is there diabetes in the family, or heart disease? Has there been a recent increase in stress? We can look at the patient as a whole and maybe see things differently.”

Weight management

When Dr. Minera and Piedmont Family Practice nurse practitioner Angelina Harman are asked, “What’s the most serious health problem women face today?” they agree wholeheartedly: obesity.

Dr, Minera said that he spends a lot of time with his patients on weight management education. “As someone who was once overweight myself, I understand that it is a struggle. But the rewards of achieving a healthy weight are tremendous. Sensible eating and exercise are the keys.

“I don’t want my patients to think of exercise as something they set aside time for and have to fit in. Being active, playing with your kids, taking long walks, they should just be part of your everyday life.”

Dr. Minera said that when it comes to weight management, having a previous relationship with a patient is extremely helpful. “Because we have seen the patient -- and maybe their family --- over a number of months or years, there is trust there, and they may feel comfortable telling us things they might not tell someone they are seeing for the first time.

“We want to find out what the stumbling blocks are. Is there a history of weight problems in the family? Has the weight gain been progressive or sudden? What is the diet history? Has there been a change in the stress level? After I have the history, I always get blood work done, test lipids (cholesterol) and thyroid to really find out what’s going on.”
Dr. Minera would like to see the “ideal weight” charts and BMI tests thrown out. “Waist to hip ratios are a much better indicator of health risks than just weight or BMI.”

Sometimes, Dr. Minera prescribes medication to assist with weight loss, but these require close follow-up.

And obesity is not the only weight management concern. Dr. Minera and Harman both see a fair number of adolescent girls and agree that eating disorders are not uncommon. For these teens, their weight can drop quickly into the danger zone. Harmon said, “We see a lot of it.”

Weight issues are complex, long-term problems that require careful monitoring and a lot of listening, said Dr. Minera. “These are not situations where one visit is going to ‘fix it.’ They require the patient and doctor to work together toward a long-term solution.”

The HPV vaccine

Better education is also needed about the vaccine that protects against human papillomavirus (HPV), which can cause cervical cancer. This is especially true now that the state of Virginia mandates the vaccine for rising sixth grade girls. Enacted by the Virginia General Assembly in 2007, the regulation went into effect Oct. 1 of this year.

Dr. Minera said the vaccine has been misunderstood and blamed for causing serious side effects. “There have been a lot of extreme reports floating around about problems attributed to the vaccine, but the connection has never been proven. The fact is that the types of HPV prevented by the vaccine cause 70 percent of cervical cancer cases and 90 percent of genital warts cases.”

Even though the legislation mandates that girls be vaccinated before they enter middle school, parents can opt-opt for their daughters. Dr. Minera believes that with education, parents will see how important the vaccine is and agree to protect their children -- before they become sexually active.

Dr. Minera said he is happy to be in family medicine. “I am able to see children and geriatric patients, and everyone in-between. I do simple biopsies, screen for depression, and even do a little counseling. Between me and my patients, it’s a good partnership.”

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