One of the most important things for women to grasp is that they must take care of themselves before they can adequately take care of anyone else. The second thing to recognize is this can't be done with an annual trip to the gynecologist or a weekend fitness camp; it must be incorporated into a lifestyle that includes maintaining a reasonable weight, exercising regularly, eliminating stress, having regular screenings for a range of potential health problems, protecting yourself against sexually transmitted diseases — and not smoking.
"Smoking is one of the biggest health problems women have," says Kathleen Sullivan, an obstetrician/gynecologist at Lakeside Women's Specialty Center. "Women who smoke are at greater risk for all cancers. Women who don't smoke clear out human papillomavirus (HPV), which causes cervical cancer, much faster than women who do smoke. We think [HPV is] common enough that 80 percent of us will be exposed to it by the time we're 50.
"Also in women who smoke ... you have a greater risk of heart disease and stroke."
At the Mary Amelia Douglas-Whited Community Women's Health Education Center, part of the Tulane Xavier National Center of Excellence in Women's Health, researchers are seeking to improve women's health outcomes by rebuilding social support systems that were blown asunder by Hurricane Katrina, and by optimizing community assets to better serve the people who live there.
"Louisiana and New Orleans have often had very poor statistics about health outcomes," says Stacey Cunningham, senior program manager for the center. "We see chronic diseases like heart disease, high blood pressure and diabetes that women have here.
"One of the things we've looked at is stress and social support and how important they are to health outcomes. We found that the support systems women had always had and taken for granted were torn apart by the storm."
The center not only provides information but works closely with community members and organizations to identify an area's needs, then gives them training and tools to find their own solutions based on the assets at hand. Since Katrina, the center has worked with groups in Treme, Algiers, Broadmoor and St. Bernard Parish.
One of the most important preventative measures for breast problems is for women to become familiar with their own breasts through monthly self-exams from the time breasts develop in puberty. This should go hand-in-hand with annual visits to the gynecologist, beginning at about age 18, for a clinical breast exam. In addition, Sullivan recommends a mammogram at age 35 to set a baseline for future comparison, followed by annual mammograms for women 40 and older. These often can detect the development of tumors and cysts before they can be felt by a doctor or through self-exams.
"Most cases of breast cancer occur in women post-menopause, and most don't have a family history," Sullivan says. "Important things you can do are not smoking, not drinking excessively and keeping a healthy weight."
Debbie Schmitz, a registered nurse and cancer care navigator at East Jefferson General Hospital, which is affiliated with the University of Texas MD Anderson Cancer Center, adds family history to the list and warns that frequently consuming large amounts of alcohol also increases a woman's risk for other types of cancer. She delivers speeches at high schools, churches and community groups, discussing what changes in the breast are healthy and which (lumps, pain or discharge from the nipples) warrant further diagnostics or intervention, such as a mammogram, ultrasound or biopsy of a suspicious tumor or cyst. If a woman is diagnosed with breast cancer, Schmitz guides the patient, her family and friends through treatment and recovery so the cancer survivor can focus on regaining her normal life.
"I'm a resource to make it easy for the patient and their family to access information and services we offer," she says. "When you are diagnosed, you don't know where to go or what to do, and you see so many people it can be overwhelming. We try to make it easy so they can concentrate on getting well.
"Any diagnosis of cancer is emotionally devastating, not only to the patient but to everybody in that person's support group. Everybody who is in the group will make this journey with her. The diagnosis of cancer does not just affect that person's body, it is going to touch all areas of her life."
Schmitz recommends women with breast cancer join a support group where they feel comfortable and can exchange information and experiences with other cancer patients and survivors. She also connects them with community and online resources.
"[Support groups help] in keeping them well in mind, body and soul," Schmitz says. "With any type of life-changing event ... where you are affects mental stability. When you get anxious and depressed and withdrawn, it has a mental effect which affects the physique." Support groups often have experts visit to address nutritional needs before, during and after treatment, technological advances and the importance of staying active and taking care of their bodies even after the cancer treatments are completed. They also provide resources to help with prosthesis, undergarments, special hair and makeup tips for women going through chemotherapy or radiation and more.
Building healthy bones involves more than drinking milk. Ob-gyns are gatekeepers for osteoporosis, making sure patients who are menopausal have their bone densities checked and ensuring they take the recommended amounts of calcium and vitamin D supplements, Sullivan says. Weight-bearing exercises are important in maintaining bone strength, but they also can help repair the effects of osteoporosis, according to physical therapist Rich Baudry of Baudry Therapy Center in Metairie.
"A lot of times people come here because they have back pain ... and end up having osteoporosis," he says. "Women 50 to 70 years old is a big group of individuals we treat. We initiate weight-bearing and resistance exercises, which are shown to stimulate the growth of bone."
Several factors contribute to bone loss, he says. As people age, they lose calcium in their bones, but lifestyle — specifically inactivity — also is a factor. "Our generation in general is less active than generations before us," Baudry says. "Our treatment is functional in nature. Our evaluation looks at flexibility, strength and balance. Our goal is, if someone is having trouble going up and down stairs, for example, to get them able to do that."
Women usually feel better in a short period of time, though it may take longer for bone density improvement to show up on tests. "In a couple of weeks people start moving better; we notice they are walking better and getting up from a sitting position easier," he says, adding it is important to continue the exercise program after the pain is gone or the problems will return.
"It's a long-term thing and it needs to be done on a consistent basis," Baudry says. "You have to make it a priority and a part of your lifestyle."
Protecting a woman's reproductive system is key to her overall health. From the age of about 18, women should have annual pelvic exams, which often include colon cancer screenings, and Pap smears and make sure they are free of sexually transmitted diseases (STDs), which can lead to infertility and other health problems.
Sullivan says she recommends all females between the ages of 9 and 26 receive the Gardisil vaccine against HPV to protect against cervical cancer. The vaccine now is also available for boys.
"Obviously, girls and women are getting the virus from somewhere," she says. "We have a better chance of fighting transmission if both parties have been immunized."
There is no vaccine for chlamydia, but the STD can cause infertility when it goes untreated, says Dr. Belinda Sartor of the Fertility Institute. "Chlamydia often is asymptomatic in women," she says. "Many do fight it off and develop antibodies, but it can leave a nasty battlefield in the fallopian tubes; it can leave them scarred or obstructed. You really want to avoid chlamydia at all costs." Treatment is relatively simple and prevention is as simple as using a condom during sexual intercourse.
Endometriosis, in which cells that normally are sloughed off during menstruation escape into the abdomen and become implanted in the wrong place, also can lead to infertility, Sartor says.
"All women, when they have their periods, do have some bleeding into the abdomen," Sartor says "For some reason — we feel it's probably some immunological defect — some women's bodies allow those cells to develop into islands of inflammation and scarring. If enough scarring is produced, the fallopian tubes cannot swing over and pick up the egg or the lining does not create a hospitable environment for the egg or sperm."
Birth control pills sometimes can help slow endometriosis, but Sartor says it tends to run in families and often is an aggressive disease. If women are not trying to get pregnant, the treatment often involves surgery or taking a medication that induces menopause.
Other fertility problems include ovulatory dysfunction and polycystic ovarian syndrome, which often are found in obese women and those who suffer diabetes. Women who are underweight or over-exercise (such as professional athletes) also can develop ovulatory dysfunction, which is believed to be grounded in metabolic abnormalities, Sartor says.
"The most important thing, if you are interested in having a family, is that you do it early," she says. "You don't want to start having a family when you are 38. A woman's ability to conceive is stable from the mid 20s to the mid 30s, then it drops after 35 and really drops after 40." To help women maintain fertility, Sartor recommends they stay at a reasonable weight by exercising and eating a healthy, Mediterranean-type diet with lean meat, fish and nuts and avoiding foods with high glycemic indexes.
The pressures of work and raising a family often mean women put the things they need for optimum health on the back burner. "It's sometimes hard to get women to prioritize and understand ... that you need to take care of your health first before you can take care of others," Cunningham says.