Women over 35 need to focus on four primary areas of their health: heart, hormones, metabolism and bone strength. Cardiologist Dr. Nieca Goldberg makes that case in “Dr. Nieca Goldberg's Complete Guide to Women's Health.” Here's an excerpt:
Step into My Office
It’s very hard for many of us to take care of ourselves.
We are busy and stressed out and managing the care of the people around us and working ridiculously long hours and ... I bet I don’t need to tell any of you who have picked up this book about juggling twenty things at once. But what happens when you don’t feel quite right, not quite your normal self? Do you know what to do and when to do it? Do you know what to watch out for and what to wait out? As I know from firsthand experience, women in midlife are often busy taking care of their families, young and old, as well as advancing in their careers, and they often feel as though their bodies are changing overnight. They may lack stamina, have difficulty sleeping, find themselves gaining weight, suffer from backaches and headaches, or have other symptoms of stress. Many of us are part of the so-called sandwich generation, responsible for caring for both children and elderly parents while we work at demanding jobs. It’s no wonder we don’t take good care of ourselves.
When you’re trying to do it all and taking care of everybody else, it’s very easy to neglect your own well-being.
Every day in my practice, I meet women who have gone from doctor to doctor with symptoms of exhaustion, sleeplessness, and low back pain. They have had enough blood tests and X-rays to last a lifetime, yet they have no diagnosis to explain their symptoms or any help in reducing them. None of the physicians seems to have taken the time and trouble to ask these women how they were feeling or to discuss what was going on in their lives. Maybe the physicians were pressed for time or didn’t have the communication skills to elicit the information from these patients. But these women were left high and dry, without help. This is not okay! Stress takes a physical as well as emotional toll on us all, which is why it’s extra important to stay fit and be healthy.
I also juggle too many things at once, and I have a family history of heart disease. I learned the hard way about how stress could lower my resistance to illness. Shortly after the publication of my first book, The Women’s Healthy Heart Program (originally published as Women Are Not Small Men), I was admitted to the hospital with a fever of 104 degrees and blood pressure of 70/50 — signs of a serious infection. Now, looking back on that time, I realize I was doing too much: lecturing in the evening, seeing my patients by day, constantly responding to my cell phone and e-mail, and not getting enough sleep because there was so much to do. Hindsight is always 20/20, as they say.
But at the time, all I knew was that I had a lot to do in very little time, and that everything I had to do was very important — everything, that is, except taking care of myself. Finally, one Saturday morning I found that I couldn’t get out of bed. I had a severe case of the flu and was unable to fight it off because I had such low resistance. Even though I know (I’m a doctor, after all) that stress lowers your immunity, I had to feel it firsthand to make some real changes in my life. After that experience I have become much more alert to what stresses me out and how my body reacts to being on overload. I want to share that information with you — before you too collapse and end up in the hospital.
But it’s hard to get good information, and it’s even harder to know whom to get it from. Yet unless we have reliable and accurate information about our bodies and our health care, we won’t have the basis to make good decisions for ourselves. Everyone I talk to, including my friends and my patients, wants advice from someone they can trust. They want to hear straight talk, with clear explanations. Let’s say your arm hurts. Where do you go? To an orthopedist? Is that really the right specialty? Maybe, maybe not. How do you know? Or you are managing your elderly mother’s care and she faints. What do you do? Whom do you call? Or you realize after leaving the doctor’s office that there were terms you didn’t understand and you want to know what they mean.
I have many friends who end up calling on me for help, and I am really glad that they do. I can interpret symptoms, explain treatments, translate medical jargon, and give them the information they need to make good decisions. I want to do the same for you in this book: teach you about your body and about good health. I want to alert you to those symptoms that should send you running to your doctor, and distinguish those from the ones that are less serious and easily treatable. Knowledge is indeed power, but only if the information is good. And it’s perfectly reasonable to be confused and not know what to think. All the controversy around hormone therapy is a good example. One day estrogen is touted as the cure for everything under the sun, and the next thing you know, it’s in the news that it could cause serious harm. Clearly, common sense, intelligence, and experience are needed to interpret what is being reported.
But most doctors give patients just enough time during an office visit to figure out what specialist to send them on to. My friend Genevieve complains about the forty-five minutes her doctor makes her wait, only to spend six minutes with her. She says it takes her more time to get her clothes off. The venerable old-fashioned family doctor who took you from birth to death and literally knew you inside and out is becoming a mythic figure from the past. In this era of specialists, we have trouble finding someone to filter the barrage of sometimes confusing information about medicines, treatments, and diseases that seems to be coming at us from all directions. What I hope to do in this book is to give you the inside track on how to effectively handle this information so as to better negotiate the system and improve your health.
A good friend of mine called me when her mother, Beth, was hospitalized because she needed a pacemaker. Beth had been told to stay in bed, and the doctors kept asking her if she was short of breath. My friend didn’t understand why they were asking about that, and the doctors were not quick to return her phone calls. After listening to her, I asked her if anyone had said the word “pneumothorax.” When she said yes, I was able to tell her that her mother’s lung had collapsed. I then explained the typical course of treatment, what she could expect, how long it would take, and so on, and she was comforted. Why didn’t her mother’s doctors give her this information? How hard is that to do? I want to be able to provide that comfort to all women.
Because of patient confidentiality, I have not used the actual names of my patients in these stories. I hear story after story after story, and I believe that by sharing them, I will be able to reassure and educate women about how to take good care of themselves. The sister of one of my patients had been recently diagnosed with breast cancer, and my patient wanted me, her cardiologist, to examine her breasts. She asked me to do it because she was afraid that another (male) doctor might think she was being hysterical. Nothing, after all, was wrong with her; it was her sister who was sick. But she sensed that I wouldn’t judge her or find her fear ridiculous, and of course, she was right. I was happy to examine her and reassure her that she was fine.
Another of my patients, who had had a heart procedure, was experiencing pain in her groin. She was convinced the pain was the result of the cardiac procedure — which had occurred two years previously. When I examined her, I had an idea, and I asked her if she had had her legs waxed recently. She was amazed that I should ask about that. But when I removed the ingrown hair and she felt better, we both laughed. I wonder if a male doctor would have been able to help her. I am happy to be a woman’s doctor who’s also a woman.
Providing women with good health information is part of my job. It’s one of the reasons that I established the Total Heart Care Clinic for Women in New York City. As I became increasingly aware that women with heart disease were underdiagnosed, undertreated, and underrepresented in the medical profession, I got upset and wanted to do something about it. I wanted to ensure that women get the treatment they deserve and that barriers come down so that women have the same access to good health care as men do. It’s not just in relation to heart disease that women are getting short shrift but in many other areas as well.
I know something about feeling marginalized. After graduating from a women’s college (Barnard in New York City), I found myself knocking at the door of the world’s largest fraternity — medical school. And I was not always met with open arms. Since I felt uncomfortable and uneasy, despite all my training and determination, certainly it’s not surprising that many women might feel that way too when they interact with doctors.
I remember being an intern and sitting with several other female interns on the stairs at the medical college, all of us angry, frustrated, and upset because there was so little empathy for the lives and concerns of the women in the medical system. With Cyndi Lauper singing about girls having fun in the background, we realized that we definitely were not having fun. One of my friends was sure that her three-year-old daughter wouldn’t recognize her since she was absent so much of the time. I couldn’t imagine finding the time to have dinner with my new husband two days in a row. As we sat together, I vowed then and there that one day when I had my own practice, I would remember that my patients had lives and that they were complex human beings, not merely sets of symptoms or diseases.
Yet after twenty years in practice, I still find myself frustrated by the politics of medicine. As my friends point out, I have serious trouble acknowledging the power of the white male establishment. In fact, anger at what I see going on around me is why I am writing a women’s health book. For too many years the health care system ignored 50 percent of the population, and never even recognized that this was the case. With this book, I hope to provide some of the necessary guidance to help you handle that fraternity, and at the same time to share information with you that will improve your health.
As a champion of women’s health and an advocate for wellness, I want to provide you with the ammunition you need to be armed and dangerous when meeting with a doctor. I want to help you become informed, educated, knowledgeable, and cautious about medical care. I want to help you understand your body — what’s normal, what’s common, and what’s suspicious — and to “talk” to you, woman to woman, friend to friend. I want to share my expertise about the health challenges we women face as we go into midlife and beyond. I want to make sure that women enter these years healthier than ever before. I hope that this book will be an accessible and clear reference guide for understanding how to keep yourself in good health.
However, this is not a one-woman job. I can’t do it alone. You have to join me — learn what to watch out for, what to ask about, how to ask good questions and insist on good answers. I can help. It’s what I do: work hard to keep women healthy.
In the following chapters, I’ll give you some of the basics, a kind of crash course: Dealing with Your Doctor 101. I’ll tell you what to look for in a doctor and how to be an effective patient. I’ll outline what to expect from an office visit, what questions to ask, and what answers to get. I’ll let you know what’s normal and what might signal a problem. And I’ll give you an insider’s perspective on what your doctors are thinking. I want to be the doctor going to the doctor with you.
The chapters that follow outline how the body functions, what can go wrong, what tests should be done to establish a correct diagnosis, what the results of the tests mean, what questions you should expect your doctor to ask you, what information you need to provide in order to be an effective patient, and what treatments are associated with different physical conditions. I’ll also explain some fundamentals about alternatives to traditional medicine and what to beware of if you are contemplating plastic surgery.
The final section of the book is a “get healthy” plan, a diet and exercise program that you can actually stick with, and one that will maximize your energy, lower your stress, and allow you to maintain good health.
So step into my office and let’s start getting healthy!
Excerpted from “Dr. Nieca Goldberg's Complete Guide to Women's Health” by Nieca Goldberg, M.D., with Alice Greenwood, Ph.D. Copyright © 2008 by Nieca Goldberg. Excerpted by permission of Ballantine Books, a division of Random House, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.