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• WH - A Guide to Women's Health
• Fall 2006
• At the Doctor's
• Being a Mom
• Healthy You

WH - A Guide to Women's Health

About Rheumatoid Arthritis

Three times more women than men have rheumatoid arthritis (RA), a disease that strikes multiple joints as well as other tissues and organs. Although the condition can develop at any age, it's more common among older people. Symptoms—which can include muscle pain, swollen joints, weakness, and fatigue—typically begin between ages 20 and 40.

To accurately diagnose RA, doctors use medical history, physical exam, X-rays and lab tests. Treatment may involve lifestyle changes (taking particular care of joints, lowering stress, eating a healthy diet), medicine (to relieve pain, reduce swelling, halt the advance of the disease) and, in severe cases, surgery to reduce pain or improve joint function.

FYI: Medical science hasn't pinpointed the cause of the condition, but it is known that with RA, a person's immune system attacks his or her own body tissue. Among the possible contributing factors, researchers theorize, are genetics, environment and hormones.

Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases, www.womenshealth.gov

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Get the 4-1-1 on Prescriptions

When your doctor writes you a prescription, make sure you are informed about that medication. Here are a few questions to ask your physician or pharmacist.

• What is the medication's name, and what is it supposed to do?
• When and how do I take it (at the same time as other drugs or separately)?
• Is it safe to become pregnant or to breastfeed while taking this medication?
• What should I do if I take a dose incorrectly—or forget one altogether?
• How will the medication make me feel? What, if any, side effects should I expect?
• Is there anything in this medication that can cause an allergic reaction?
• Should I avoid alcohol or any foods, medications or activities?
• Is a generic version available?
• How should this medication be stored?

If any unforeseen problems occur with your prescribed medicine, contact your physician or pharmacist immediately.

Source: American Pharmaceutical Association

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Abusing Prescriptions

Could you or a loved one be vulnerable to prescription drug abuse? The U.S. Drug Enforcement Administration reports that abuse of prescription drugs has quadrupled nationwide in the past decade and that emergency room visits attributed to misuse of prescription drugs, such as Vicodin, Norco and Oxycontin, have soared more than 500 percent. According to Fred Von Stieff, M.D., medical director of the John Muir Center for Recovery, the East Bay has also witnessed a sharp increase in the number of people being treated for prescription drug abuse.

What's causing this phenomenal surge in abuse of medications that are intended to help, not harm?

The answer lies in the nature of addiction. "Addiction is a three-way problem— genetic, environmental and psychological," says Dr. Von Stieff, "and today's fast-paced, highly charged, stress-filled world is a perfect breeding ground for those who may be inclined to addiction."

Genetics plays a big role in addiction, and experts estimate that at least 90 percent of prescription drug abusers are children of alcoholic or drug-addicted parents. "People who abuse can start with alcohol and move to opiates," says Mel McGraw, M.D., a psychiatrist and associate medical director of the John Muir Center for Recovery. "Children of alcoholics may swear off liquor, but if they're prescribed certain painkillers, they could find themselves at risk for another type of addiction."

Addiction also can result from environmental issues, including how a person learns to cope with the world. People who find that they can take a painkiller to alleviate pain—and also relieve stress and be more productive—will be more likely to want to repeat the feeling.

There is a psychological component to addiction as well. Many individuals report using drugs to modulate their feelings. Such individuals may have co-occurring mental disorders, such as depression, anxiety, bi-polar disorder or post-traumatic stress disorder, that have yet to be diagnosed because their substance abuse is masking other disorders.

People have differing reactions to the effects of certain drugs. Vicodin, for example, is an opiate that is widely prescribed as fast-acting pain relief to aid post-surgical recovery and physical injuries. It also can produce a calm, euphoric state. In some individuals with an addiction propensity, dependence can occur within one to four weeks.

With increasingly higher doses, the body builds up a higher tolerance and the addicted person needs more and more of the drug to achieve the desired effect, explains Dr. Von Stieff. Some patients have regularly taken upwards of 120 tablets a day, placing a tremendous physical toll on their bodies. "Before long," he says, "they're spending hundreds or thousands of dollars on drugs from the Internet, even without a prescription."

Because early symptoms are hard to detect, prescription drug abuse is often hidden for so long that the first time a family discovers it is when the person becomes critically injured, from a druginduced car accident, for example, or suffers liver disease (drug abusers are at higher risk). "For many spouses," says Dr. McGraw, "their gut first starts telling them something is wrong, but their head doesn't want to believe it."

The best bet is to head off prescription drug abuse before it starts. Be honest with your doctor, especially if you have a family history of addiction. In such cases, a physician can prescribe lower doses or alternative pain medications. Any needed medicine should be taken as prescribed. "Understand your genetics and your personality before taking any narcotic," advises Dr. Von Stieff.

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Where To Get Help The John Muir Behavioral Health Center in Concord offers psychiatry and chemical dependency treatment options, including inpatient programs. all-day, morning or evening outpatient programs. care support groups, an alumni association and family programs. For information or to receive a free brochure, call (925) 674-4100.

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A Safe Home Away From Home

The Chemical Dependency Residential Program is a valuable new addition to services offered by the Center for Recovery at John Muir Behavioral Health Center. Located in a restored Victorian home just minutes from the center, the 15-bed residence provides overnight care for patients for up to 28 days.

"The residential program requires a physician's referral and is best for clients who do not have detox symptoms or medical complications but still require daily structure to learn specific coping skills to avoid relapse," says Nina Ferraris, program manager, John Muir Center for Recovery. "Others who benefit are those who can't commute because of distance or lack of transportation, and those who need a clean and sober living environment for recovery they can't get elsewhere. A solid support system is crucial for success in recovery."

Close proximity to the Behavioral Health Center campus allows clients to walk or shuttle to their treatment activities and meals, then return in the evening to their living quarters. Men and women reside in separate wings, and an overnight house counselor is on-site for their assistance.

Average stay in the residential program is four weeks, which typically is covered by insurance. During the subsequent year, clients are encouraged to return for Continuing Care—a 90-minute process group that meets weekly to discuss ongoing recovery issues. They are also invited to join the Behavioral Health Center's 600-member alumni association, which hosts meetings and social events.

The center welcomes adults of any age, emphasizes Ferraris. "We've had people from ages 18 to 70 sharing rooms and becoming closer due to their shared treatment and recovery. It's really pleasing to see the wide range of people who come here and get excited about life again."

For More Information To learn more about the Chemical Dependency Residential Program, contact the John Muir Behavioral Health Center at (925) 674-4100.

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Heart To Heart

There are positive steps you can take to protect your health and safeguard against heart disease, the No. 1 killer of women in the United States. The Women's Heart Program, located at the John Muir Women's Health Center (WHC), helps you identify your risk, offers valuable information about heart disease and, if necessary, refers you for further tests. The following assessments and screening appointments are available:

Personalized Heart Disease Risk Assessment: Women and Heart Questionnaire™

This free assessment will provide you with a risk profile for heart disease, along with educational material about identified risks. The questionnaires are free to any woman in the community and can be taken online at johnmuirhealth.com or mailed directly to you by phone request.

Women's Heart Program Comprehensive

Screening Appointment This screening appointment typically isn't covered by health insurance and costs $95, which includes a discount coupon for referred WHC programs and the following:

• Full lipid and blood glucose screening (must be fasting).
• Blood pressures (including peripheral).
• Physical Activity Index®.
• Women and Heart Questionnaire, with a five-page custom report.
• Education session with a cardiac nurse.

Who should visit the Women's Heart Program? Any adult woman (age 20 or older) who wishes to know more about her risk factors for heart disease or who may be at increased risk for heart disease. To request a free risk assessment, schedule an appointment, or, for more information, call (925) 941-7965.

Come To The WHC Visit the John Muir Women's Health Center at 1656 N. California Blvd., Ste. 100, in downtown Walnut Creek. For more information, call (925) 941-7900.

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