Heart-to-heart: gender differences in cardiac careWhy men and women may need different tests and treatments.

For quite some time it was assumed that the male and female heart func-tioned in essentially the same way.

But as science advances, it’s become clearer that there are gender differences in how hearts grow, and how diseases develop and manifest.

“While most risk fac-tors for heart disease affect both genders, some more actively promote disease in women,” says Karol Watson, MD, and director of the UCLA Women’s Cardiovascular Center. “Risk factors such as insu-lin resistance, being over-weight or obese and having high triglycerides tend to be more harmful in women.”

Analyzing gender differences in aging hearts A federally funded study analyzed MRI scans of aging hearts as part of an ongoing, long-term project called the Multi-Ethnic Study of Atherosclerosis (MESA), which is following thousands of men and women of different ethnic backgrounds across the country. Several institutions, including UCLA, were involved in the MRI study.

Researchers studied scans of nearly 3,000 older adults, ages 54 to 94, with-out preexisting heart disease. Participants were tracked between 2002 and 2012. Each participant underwent MRI testing at the beginning of the study and once more after a decade.

The MRI scans revealed significant differences in the way male and female hearts change with age. The research was

published online in the Octo-ber 2014 edition of the

journal Radiology. The results don’t explain why there are gender dif-ferences. It does, however, shed light on the differ-

ent forms of heart failure seen in men

and women. Those dif-ferences indicate that there may be a need to develop gender-specific treatments.

The standard practice has been to develop both diagnostics and treatments based on the male heart. With this study and others that approach is changing.

Heart failure: similarities and differencesIn both genders, the main heart chamber, the left ventricle—which fills with and then forces out blood—gets smaller with age. As a result, less blood enters the heart and less gets pumped out to the rest of the body. But in men, the heart muscle that encircles the chamber grows bigger and thicker with age, while in women, it retains its size or gets somewhat smaller.

According to the researchers, a thicker heart muscle and smaller heart chamber volume may increase the risk of age-related heart failure. The gender variations suggest that men and women may develop the dis-ease for different reasons.

A condition that affects more than five million Americans, heart failure is a gradual weakening of the heart muscle and eventual loss of pumping ability. To lower the risk, cardiologists often prescribe medications

Continued on page 7

February 2016Volume 13 • Number 2

4 Don’t ignore joint pain

Know when to self-treat and when to call your doctor.

8 Ask Dr. Ferrell

■ Are natural sexual enhancement products safe?

■ Is my spouse a hoarder?

■ What can I do about yellowing toenails?

2 News Briefs

■ New breast cancer screening guidelines.

■ Seniors prescribed more antipsychotics.

■ Math equation can detect dehydration.

3 Reduce stress with mindfulness

Simple practices can boost your wellbeing.

5 Stronger muscles for longer life

Increased muscle mass can reduce fall risk and improve quality of life.

6 Build memory with your life story

Create better social bonds and improve recall through memoir.

7 Eat more protein Heart and other muscles need protein. Most seniors don’t get enough.

Some risk factors are the same for both genders. But there are also some important differences.

EDITOR-IN-CHIEFBruce A. Ferrell, MDUCLA Division of Geriatrics

EXECUTIVE EDITORJoAnn Milivojevic

GROUP DIRECTORJay Roland

ADVISORY BOARDRandall Espinoza, MD, MPH; Arash Naeim, MD; Michelle Eslami, MD; John FitzGerald, MD; Ellen Wilson, PT

Healthy Years (ISSN # 1551 4617) is published monthly for $39 per year by Belvoir Media Group, LLC, 535 Connecticut

Avenue, Norwalk, CT 06854-1713. Robert Englander, Chairman and CEO; Timothy H. Cole, Executive Vice President, Editorial Director; Philip L. Penny, Chief Operating Officer; Greg King, Executive Vice President, Marketing Director; Ron Goldberg, Chief Financial Officer; Tom Canfield, Vice President, Circulation. © 2016 Belvoir Media Group, LLC. Postmaster: Send address corrections to Healthy Years, PO Box 8535, Big Sandy, TX 75755-8535.

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2

N E W S B R I E F S

New breast cancer screening guidelines Late last year, the American Cancer Society (ACS) released its new breast cancer screening guidelines. The changes include when women should start having mammograms, at age 45 (previously 40) and then every other year beginning at age 55. These ACS guidelines apply to women at average

risk, which are most women. Although breast cancer is more common in older women, after menopause, breast cancer tends to grow more slowly. It is also easier to detect early because the breasts are less dense. On average, the majority of women are postmenopausal by age 55. According to researchers, there was no statistical advantage to annual screen-ing in postmenopausal women, hence the move to screening every two years. The ACS has also removed the recommendation for physical breast exams by physicians becu-ase there was no evidence that they reduced breast cancer. Women should, however, be familiar with how their breasts normally look and feel, says the ACS, and discuss any changes with their health care providers. Women should report any lumps, nipple dis-charge, and swelling around their armpits or collarbones. As a preventative measure, diet can make a difference. A recent trial in Spain among women in their 60s found that those who followed a Mediterranean diet had a lower risk of breast cancer compared to the con-trol group. You can calculate your estimated risk by using the online Breast Cancer Risk Assessment Tool at cancer.gov/bcrisktool.

Prescriptions for antipsychotics increase with ageAntipsychotics can be appropriate for some mental disorders such as schizophrenia and bipolar disorder, but researchers from the National Institute of Mental Health (NIMH) recently found that more than three-quarters of seniors receiving an antipsychotic pre-scription in 2010 had no documented clinical psychiatric diagnosis during the year. Known side effects include metabolic problems and weight gain. For older adults the potential side effects are more dangerous, including risks of strokes, fractures and kid-ney problems. Of special note is that the FDA has issued warnings of increased mortality regarding antipsychotics in elderly patients with dementia, particularly for “atypical” (or second generation) antipsychotics, according to Michael Schoenbaum, PhD, senior advisor for mental health service, epidemiology and economics at NIMH and one of the co-authors of the report. About 80 percent of antipsychotic prescriptions among adults 65 and older were for atypical medications. The study also found that the percentage of people receiv-ing an antipsychotic prescription increased significantly with age. The percentage with an antipsychotic prescription was approximately twice as high among people aged 80 to 84 compared to those aged 65 to 69. Psychiatrists, who generally are more familiar with the properties of antipsychotics, did not write the majority of prescriptions.

Early dehydration can be detected by a mathematical equationSeniors are particularly at risk of water-loss dehydration, which can lead to confusion, falls and other disabilities. Older people drink less water for a variety of reasons. For example they may want to avoid frequent trips to the toilet, or they simply may not feel thirsty. A serum osmolality test is widely recognized as the best test for diagnosing dehy-dration, but it’s expensive and not currently viable for wide-scale screening. New research reported in the British Medical Journal showed how a mathematical equation applied to routine blood tests could be used to screen for dehydration. A variety of mathemati-cal equations already exist to detect dehydration in blood, but none have been identi-fied as being especially useful for elderly patients, according to the researchers. So, the team studied 595 people over age 65, including those who were healthy and lived inde-pendently, frail people living in residential care, and those in hospitals. The group also included those with poor kidney function and diabetes. Researchers assessed the diagnos-tic accuracy of 39 equations, and found that one particular equation had the greatest uni-versal accuracy across a spectrum of healthy and frail older men and women at all levels of dehydration. The researchers suggest that clinical labs could apply the equation to rou-tine blood tests, which could lead to more cost-effective and pragmatic screening for the early identification of dehydration among seniors.

February 20162

H E A L T H Y A G I N G A N D P R E V E N T I O N Sh

utter

stock

Mindful awareness practices for stress reductionHow doing nothing reduces stress and enriches life.

More than 30 years ago, Jon Kabat-Zinn, a molecular biol-ogist from MIT, introduced

mindfulness practices to Western medicine in a program called Mindfulness Based Stress Reduction (MBSR). Today, mindfulness prac-tices are taught in many programs, including UCLA’s Mindful Awareness Practices classes (MAPs). “The applicability of mindfulness- based practices are wide,” says Jus-tin Laube, MD, an internal medicine provider at the UCLA Center for East-West Medicine. “It’s helpful for psy-chological traumas as well as various medical conditions.”

Skeptical war vets experience the benefits Left untreated, trauma can be a life-long heavy burden leading to depres-sion, violence, substance abuse and suicide. It has been 40 years since the Vietnam War ended, but it’s estimated that about 271,000 veterans who served in a war zone have posttrau-matic stress disorder (PTSD) accord-ing to an article published in the Jour-nal of the American Medical Associa-tion Psychiatry.

A recent study by research-ers at the Minneapolis Veterans Affairs Health Care System ran-domly assigned 116 veterans with PTSD to receive nine sessions of MBSR, which teaches participants to be present in the moment in a non-judgmental, accepting manner. The others attended group therapy, pri-marily focusing on current life prob-lems. The veterans were monitored before, during and after treatment. Results found that among veterans with PTSD, mindfulness-based stress reduction therapy, compared to group therapy, resulted in a greater decrease in PTSD symptom severity.

A healthy way to ease disease symptomsA wide variety of studies have shown that mindfulness practices can be effective in reducing symptoms of anxiety and depression, high blood pressure, chronic pain, inflammatory bowel disease and stress-related skin conditions such as psoriasis. It does so because it is effective at reduc-ing stress, which can wreak havoc in the body.

Mindfulness helps you become more aware of how stress feels. It could be a tense jaw, shallow breath-ing or repetitive negative thoughts. With practice and expert guidance, mindfulness allows you to break down problematic experiences into smaller, more manageable parts, according to Natalie Bell, a certi-fied mindfulness instructor for the UCLA Mindful Awareness Research Center (MARC).

“When you are mindful you are seeing, listening and feeling with the purposeful intention to notice your-self and your surroundings with a quality of curiosity and openness,” says Bell. “You are developing a com-passionate awareness that can be with you no matter what is happening.”

The practice simply uses the breath as a focal point. Consciously breathing in and out helps you stay present and aware of thoughts and feelings. Knowing that thoughts and emotions constantly shift and change can help you be less judgmen-tal and more accepting of yourself and others.

Learning online and in groupsWhile there are online resources, it is helpful to attend a live instructor-led mindfulness course. The instructor can help you get started, and com-mitting to a weekly group class can help you stick with the practice. In groups, you also learn that there are others who may be dealing with simi-lar challenges. “Realizing that others are also suffering can be therapeutic,” says Dr. Laube.

Each time you meditate, it’s like putting a deposit in your mindful awareness bank account. Through time you’ll find yourself becoming more patient and less reactive to life’s inevitable stresses. And when you do find yourself overwhelmed, you’ll have a reserve of resources to help calm and support yourself.

WHAT YOU CAN DO

This short meditation can help you feel calmer in just a few minutes:

1. Set a timer for three minutes.

2. Sit upright and relaxed.

3. Close your eyes.

4. Focus on your inhale and exhale.

5. When your mind wanders, notice and refocus on your breath.

For free guided meditations and more about the benefits of mindfulness, go to marc.ucla.edu.

Whether seated or lying down, mindful breathing can help refresh and relax body and mind.

3February 2016

B O N E S A N D J O I N T S Thinkstock

Ignoring joint pain can make matters worseKnow when to self-treat and when to see a doctor.

Joint pain increases with age for many reasons, including lack of muscular strength, inflexibility,

genetics, and damage from overuse or misuse. Joint pain is not something to be endured as a normal part of aging. It is a signal from the nervous sys-tem that something is wrong, and it should not be ignored.

“Cartilage damage, such as a torn meniscus in the knee, can get worse,” warns Brad Thomas, MD, orthopedic surgeon and faculty member at the UCLA Department of Orthopedics. “The earlier you address the damage the better because the outcomes of repairing small tears are better than trying to repair larger cartilage tears.”

Understanding pain from joint injuries can help you seek relevant treatment earlier. Health profession-als often use a 10–point pain scale to rank pain: one meaning no pain, and 10 meaning excruciatingly unbear-able. If your pain is consistently more than three on the pain scale, it’s likely a problem that needs professional assessment, says Dr. Thomas.

Acute versus chronic painHow long pain has affected the qual-ity of your life determines whether it is categorized as acute or chronic. Has it been a few days or several months? What causes pain is also an important factor to note and tell your doctor.

“If you are achy or sore after exercise, that’s normal in your 60s,” explains Dr. Thomas, “but if daily liv-ing activities such as walking, going up and down the stairs, or reaching up causes pain or if you have reoccur-ring site-specific joint pain, such as around the hip, knee or shoulder, see your doctor.”

Acute pain is generally the result of a sudden mishap, such as when you tweak your back lifting a heavy

box. Acute pain generally passes in a few days. Or if the injury is severe, it may take several weeks. The point is acute pain goes away with treat-ment or sometimes it passes on its own as the body naturally heals. But when pain persists for more than three months, it is considered chronic and you’ll likely need an ongoing treatment strategy that might include physical therapy, massage and medication.

Chronic pain may arise from a small untreated injury, such as a knee sprain, or torn rotator cuff. It can be the result of osteo arthritis.

Aging and arthritis are common companionsArthritis is an umbrella term for more than 100 rheumatic diseases and conditions that affect joints, the tis-sues that surround the joint and over-all connective tissue throughout the body. The pattern, severity, and loca-tion of symptoms can vary depend-ing on the type of disease. You may feel pain and stiffness around one or several joints. Symptoms can develop gradually or suddenly.

The Centers for Disease Control

and Prevention estimates that 50 per-cent of people over the age of 65 have some kind of arthritis. Osteoarthri-tis (OA) is the most common form of arthritis. With OA comes pain, inflam-mation and stiffness in the joints. Areas most commonly affected are knees, hips, shoulders and hands.

When to call the doctor Back pain can be quite excruciating. Generally it’s not a medical emer-gency but sometimes it is. If you experience any of the following along with your back pain, call your doc-tor immediately:

• Numbness in genital area • Loss of bowel or bladder control • Progressive weakness in arms or

legs • High fever that doesn’t respond to

fever reducers

Treatment and prevention strategiesThe standard protocol for acute and increased flare-ups of chronic pain is R.I.C.E (see above). NSAIDs (nonste-roidal anti-inflammatory drugs) can also help reduce swelling and pain.

You can reduce risk of further joint injury by staying flexible and strong says Dr. Thomas. “Flexibility is key to youth. A regular stretching rou-tine, such as with yoga, and postural stability through methods such as Pilates, are both very important.”

WHAT YOU SHOULD DO

R.I.C.E is the standard protocol for treating acute pain and is recommended within the first 24 hours of injury. It’s useful for flare-ups of chronic conditions, too.

➢ Rest. Take a break from the activity until the pain subsides.

➢ Ice. Apply a cold pack to the area as soon as possible.

➢ Compression. Lightly wrap the area to provide stability and reduce inflammation.

➢ Elevation. Elevate the injured part on a pillow at or above heart level to minimize swelling.

To reduce the risk of further damage, it’s best to treat joint pain as soon as possible.

February 20164

Think

stock

Consider strength training for longer lifeIncreasing muscle mass can reduce disease and fall risk and lengthen your life.

According to recent UCLA research, maintaining muscle mass can reduce risk of diabetes

and cardiovascular diseases, and it may help you live longer, too.

The study, published in the Amer-ican Journal of Medicine, led by Pre-ethi Srikanthan, MD, assistant clini-cal professor in the endocrinology division at the David Geffen School of Medicine at UCLA, found that building muscle mass is important in decreasing metabolic risk.

“Greater muscle mass is associ-ated with improved insulin resis-tance, which is at the root of both diabetes development and cardiovas-cular disease risk,” says Dr. Srikan-than. “We also found there was an association between the level of mus-cle mass and total mortality.”

Worry less about body weight; focus on building muscleEveryone starts to lose a little mus-cle mass starting at about age 30. The loss can accelerate when you get older because people tend to be less active and at 65 years and older, muscle mass also declines at a faster rate. Sarcopenia is the medical term for severe skeletal muscle loss, which is typically associated with older adults. Preventing muscle loss through regular exercise helps guard against sarcopenia. But don’t worry if you’ve been sedentary for a while. You can increase your muscle mass at any age.

Even small changes in muscle strength can make a real difference in daily life especially in people who have lost muscle mass. A stron-

ger body can make it easier to get up from a chair, climb stairs, carry gro-ceries, open jars and play with your grandchildren.

Analyzing data from seniors reveals value of muscle massThe researchers analyzed data col-lected by the National Health and Nutrition Examination Survey (NHANES) III, conducted between 1988 and 1994. They focused on a group of 3,659 individuals that included men who were 55 or older and women who were 65 or older at the time of the survey. The authors then determined how many of those individuals had died from natural causes based on a follow-up survey done in 2004.

Muscle mass of study subjects was measured using bioelectrical impedance, which runs an electri-cal current through the body. Muscle allows the current to pass more eas-ily than fat does, due to muscle’s water content. This is how research-ers could determine a muscle mass index—the amount of muscle relative to height—similar to a body mass index. They looked at how muscle

mass index was related to longevity.According to the researchers, the

study does have some limitations. For instance, researchers point out that you cannot definitively estab-lish a cause-and-effect relation-ship between muscle mass and sur-vival using a cohort study such as NHANES III. “But we can say that muscle mass seems to be an impor-tant predictor of risk of death,” says Dr. Srikanthan.

To build muscle mass, you must fail in order to succeedMuscles love a good challenge. They build by straining against a resis-tance. That resistance can be a your own body weight, such as with push-ups, using hand weights or a flex band. What’s key is that you work your muscle to a failure point, mean-ing that you cannot lift it again. You know you’re at the proper resis-tance level if it’s difficult to lift the weight when you reach about the eighth repetition. If it’s easy to get to 10, then you need more resistance. Generally you should perform three sets of 8-10 repetitions with about a minute’s resting time between each set. By your last set, you should not be able to complete 10. In other words, you’ve failed to lift the weight and therefore you have reached the point where muscle will build more efficiently.

Strengthening core muscles is just as important as building up the muscles of your arms and legs. Core muscles include abdominal, hip and shoulder muscles. They wrap your torso like a corset. A stronger core can improve balance and reduce risk of falls and fractures.

An active 70-year-old can be bio-logically younger than an unfit, sed-entary 50-year-old. Exercise vigor-ously at least three times per week and you should see some results within a month. Experiencing the energy of stronger muscles can revi-talize your body, mind and spirit. That may be enough motivation to maintain a healthy muscle-building habit for life.

E X E R C I S E

Using dumbells requires you to balance and control the weights as well as to work both arms equally. Avoid using momentum. Lift and lower slowly.

5February 2016

Memory builder: How researching your own story helpsDocumenting life events benefits you and your loved ones.

F rom memoir to scrapbooks, doc-umenting your life story is an enriching creative process that

has many profound benefits for you and for the people with whom you share it. The process involves mem-ory, creativity and organization–all good for your brain. It also provides valuable insights on what you have accomplished in your life.

“Sometimes people think they haven’t done much,” says Erica Cur-tis, board-certified art therapist and instructor for the UCLA Arts and Healing Social Emotional Arts (SEA) certificate program. “But when they start to tell their stories, it puts expe-riences in perspective. It’s a very affirming process to look back and helps people find meaning and value in their lives.”

Telling your stories can also cre-ate closer relationships. The elderly aren’t always given respect for hav-ing lived a full life, says Curtis. This can be especially true in assisted living and long-term care facili-ties, where the relationship between caregiver and resident can be rather perfunctory and detached. Sharing life stories can create warmth and understanding.

How to kick-start your creative processIt can be rather intimidating to docu-ment an entire life. Instead, think about documenting particular times and special moments of your life. A good place to start is with questions your children or grandchildren ask you. These questions can also spark a starting point:

➥ What was your childhood like? Describe a favorite game, or your neighborhood.

➥ What did you do as a teenager? Share school experiences such as classes, sports you played.

➥ What kinds of pets did you have? Describe names and adventures with your pet.

➥ How did your spouse propose marriage? Provide details on your honeymoon. Some people choose to docu-

ment their work life, creating a flow of interesting travels, projects and experiences related to their jobs; oth-ers may choose to tell about major events, such as emigrating to Amer-ica. It really is up to you what and how much to tell.

“Some older adults have lost some control and choice in their lives,” explains Curtis, “and this helps them exercise choice in their world.”

Creating your story in words, pictures and other art formsMemoir is a classic method by which to tell a life story. There are many books and online resources that can

help you write your story. What it comes down to is telling your truth and providing details of what it was like to live at a particular time. The details matter and will add interest as well as context to those who read it. For example, the price of gas and type of car you had growing up, com-munications in the non-computer age and living through major historical events, such as the Great Depression.

Collages are another way to assemble a life story. Thumb through magazines and tear out images that inspire you. Once you have a pile, you can assemble them onto a sheet of paper, add your own photos, and memorabilia as well as drawings, doodles and captions. Make it fun and use what inspires you, be it glit-ter glue, gold stars or ribbons.

Other ways to document the events of your life can be through quilts, paintings, audio or video recordings. Search online for the year you were born, and look at the images. Chances are many memo-ries will rush back into your mind. Our memories are very connected to images and images help our brains remember.

Be aware and ready for emotionsDocumenting the events of your life is an emotional process. The reflections can bring up feelings of joy, regret and sadness. It’s normal, healthy and perfectly OK to have these feelings. If difficult emotions and unresolved matters linger, talk with a family member, friend or a health care professional.

“Pain in life is inevitable, but suf-fering is optional,” says Curtis. “Suf-fering occurs when we judge the emotion as bad or think we shouldn’t feel a particular way.”

Assembling the narrative of your life can also be a collaborative proj-ect done with a friend or loved one. Many community centers, includ-ing the UCLA arts and healing, offer memoir and collage classes. You can also work directly with an art thera-pist to glean greater insights on your life.

Thinkstock

B R A I N H E A L T H

Working on your life story with others can build deeper relationships with family members, friends and caregivers.

February 20166

designed to reduce the thickness of the heart muscle and boost cardio-vascular performance. But because a woman’s heart muscle tends to shrink or remain the same size sug-gests that women may not derive the same benefit from such treatments.

Compared to men, women with heart failure also tend to have more symptoms such as shortness of

breath and more difficulty exercis-ing. They also have swelling around their ankles more frequently than men. Despite those differences, how-ever, women generally survive lon-ger than men with heart failure.

Heart attack symptoms varyMen and women can experience heart attack very differently, accord-ing to Dr. Watson.

“For men, it’s a like bomb going off—you get a dramatic chest pain that sends you to your knees. But for women, the symptoms can be more subtle.”

Women may experience jaw or arm pain, feel nauseated or very tired. Because of that, women’s heart attacks often go unnoticed. If heart attack is suspected, call 9-1-1 immediately. Heart attacks occur because the blood supply to the heart has been cut off, most often due to blocked arteries somewhere in the body. About 70 percent of men and women in the 60-to-79-year-old age group has cardiovascular dis-ease Age is a factor, but you can take preventative steps to reduce heart disease risk. A heart-healthy diet as well as physical activity that

includes muscle building and cardio-vascular exercises will benefit your heart. The American Heart Associa-tion also recommends an ankle-bra-chial index test for everyone over the age of 60. It’s a simple in-office test. Using the blood pressure cuff, your health care provider measures and compares the systolic pressure in your arms and legs. The test helps diagnosis the presence of peripheral artery disease (PAD), a type of car-diovascular disease where plaque builds up in arteries of the legs.

Cardiac care—cont. from page 1

H E A R T & M I N D

N U T R I T I O N

WHAT YOU SHOULD KNOW

Men’s and women’s hearts age differently.

➢ Heart attack symptoms in men are more dramatic and more subtle in women.

➢ Insulin resistance and high triglycerides appear to be more harmful to women’s hearts.

➢ Women tend to develop heart failure at an older age than men.

➢ Aspirin may be beneficial in preventing heart attack and stroke

➢ Regular exercise and a heart-healthy diet is beneficial to everyone

Protein for heart and other muscles

Decreased dietary intakes of protein, as well as other

nutrients, may contrib-ute to sarcopenia (age-related muscle loss). The current govern-ment protein guide-lines state that women should eat at least 46 grams a day, and 56 grams for men. Some research-ers have found that seniors may need more.

“As we age, our appetites tend to decrease,” says Dana Hunnes, PhD, MPH, RD, at the UCLA Fielding School of Public Health. “If we don’t

consume enough calo-ries, our body begins to break down muscle or protein and use that for energy.”

A typical senior’s daily intake of food may consist of jam and bread for breakfast, a salad for lunch and a small piece of chicken

with dinner. That’s simply not enough, says Dr. Hunnes.

Calculating protein needsSome experts now recommend that seniors consume at least 1 gram of protein for each kilogram of body

weight. To convert pounds of body weight to kilograms, divide your weight by 2.2. For example, a 150-pound adult weighs 68 kilograms and should therefore eat 68 grams of protein per day.

Protein sources can be animal or plant based. One ounce of tofu, chicken, fish, or one egg all have about 7 grams of protein. “Other good sources of protein include grains,” says Dr. Hunnes. “Whole-wheat bread may have 5 grams of protein per slice.”

Planning for protein can be easy. A meal plan for 150-pound person could be two eggs for breakfast, a whole-wheat chicken sandwich with 2 ounces of sliced chicken for lunch and 4 ounces of tofu stir fried with veggies for dinner.

Eggs are a low calorie, and protein-rich food.

GENDER COMPARISON: CARDIOVASCULAR RISK FACTORS

Common for men and women

More likely to affect women

•Obesity•Smoking•High blood

pressure•Metabolic

syndrome: coexistence of high blood pressure, obesity, and high glucose and triglyceride levels

•Increasing high blood pressure during menopause

•Autoimmune diseases such as rheumatoid arthritis

•Stress and depression•Lack of recognition

that the above health issues are risk factors for heart disease

7February 2016

Q I occasionally have erectile dysfunction and I’ve seen nonprescription products in the

store that promise to improve sexual perfor-mance. Are these safe?

A If ever there was a case to apply the cliché “buyer beware” this is it. The Food and

Drug Administration (FDA) does not regulate supplements. Therefore manufacturers can make unsubstantiated claims. They also may not disclose all the ingredients, and that can be dangerous. Reported side effects from popular over-the-counter sexual enhancement supple-ments include: high blood pressure, increased heart rate, manic reactions, insomnia, anxiety, irritability, shivering, sweating, nausea, flushing and headaches. None of this is going to improve your sex life. The FDA has issued a consumer warning about several products, including Cave Diver, X Zen Platinum, and Reload, which con-tain the undeclared ingredient sildenafil, the active ingredient in the FDA-approved prescrip-tion drug Viagra. X Zen Platinum also contains tadalafil the active ingredient in Cialis. If you have diabetes, heart disease, high blood pres-sure or high cholesterol, you may be taking nitrate-containing prescription medications. The undeclared ingredients may negatively interact with nitrates. Weight, lifestyle, psychological factors and diseases that may cause ED are often treatable. Talk to your doctor to find the best route back to a healthy sex life.

QMy spouse insists the growing piles of use-less items are collectables, but I think it’s

a symptom of hoarding. How can I know for sure?

A It’s a good question because one person’s trash, maybe another person’s treasure.

There are however, some distinct differences between a collector and someone with a hoard-ing dysfunction. A collector will seek out spe-cific items, such as model trains, stamps and figurines. These items are typically cataloged and displayed with pride. Hoarding is quite

different. While the items may bring comfort and security to the person, the items are strewn all over, crowding countertops and filling rooms. Stacks of magazines and newspapers, for example, can be piled high and take up a lot of space. This can make it difficult and dangerous to walk through ever-narrowing spaces. Triggers to hoard can be the death of the loved, where the survivor wants to hang on to everything from that moment in time. Symptoms of hoard-ing can include difficulty throwing anything out regardless of value, distress at the idea of throwing anything out, and the inability to use rooms (e.g., kitchens, bathrooms, garages) for the intended purposes. Hoarding is a psychological problem. People who hoard need help to learn better coping and decision-making skills. It may be difficult to convince your spouse of the prob-lem. Consider seeing a counselor together or on your own to help facilitate communications.

QMy toenails are getting rather thick and yellow. I’m embarrassed to wear open-toe

shoes. What’s going on?

AWhat you are describing sounds like a nail fungal infection. People over 60 are more

susceptible to nail fungus infection, as are peo-ple with diabetes or a weakened immune sys-tem. It won’t go away on its own but you can try some over-the-counter (OTC) treatments, such as antifungal creams, lotions, or liquids that you brush onto nails. It can take several weeks to get rid of the infection. While nail fungus may not ruin your nail bed, it could spread to other nails if left untreated. If the skin around the nail becomes inflamed, red lines extend upward from the area, or if you have a fever higher than 100 degrees without anything else causing the fever, call your doctor immediately, as it could indicate a bacterial infection which requires a different kind of treatment. If the fungus spreads to other nails or doesn’t respond to OTC treatments, make an appointment with your doctor. A prescription medication is stronger and may clear the fungus faster.

SEXUAL ENHANCEMENT PRODUCTS … HOARDING … NAIL FUNGUS

IN COMING

ISSUES

NUTRITION —

Food journaling

PREVENTION —

Health care law

and dementia

HEARING —

How hearing

loss can affect

balance

February 20168

Editor-in-Chief Bruce A. Ferrell, MD, Professor of Medicine and Geriatrics

EDITORIAL CORRESPONDENCEExecutive EditorHealthy YearsP.O. Box 5656Norwalk, CT 06856-5656

HealthyYears@belvoirpubs.com

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DISCLAIMERHealthy Years is intended to pro-vide readers with accurate and timely medical news and infor-mation. It is not intended to give personal medical advice, which should be obtained directly from a physician. Acting on any information provided without first consulting a physician is solely at the reader’s risk. We regret that we cannot respond to individual inquiries about personal health matters.

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