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• WH - A Guide to Women's Health
• June 2008
• Healthy You
• Being a Mom
• At the Doctor's

WH - A Guide to Women's Health

A Primer on Easy Bruising

Among all the things that can come with increasing age, add one more: easy bruising.

Most bruises form when the impact of a blow or an injury breaks blood vessels (capillaries) near the skin's surface, causing blood to leak. The main culprit in aging adults' increased bruising is their typically thinner skin, which has lost some of the fatty layer that helps protect blood vessels against injury. (Excessive exposure to sunlight can have similar effect.) Aging capillaries—more fragile and prone to rupture—can also play a role. So can medications, including blood-thinning drugs such as warfarin that reduce the blood's ability to clot and corticosteroids, which cause skin to thin.

Most bruises go away without treatment; the body eventually reabsorbs the blood. Consult a physician if for no known reason you have unusually painful or large bruises; you're bruising easily and experiencing abnormal bleeding elsewhere; or you suddenly experience bruising but have no history of the ailment.

Source: American Academy of Family Physicians

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Benign Changes in the Breast

What is fibrocystic breast disease? Many of today's healthcare providers prefer to call this noncancerous breast condition "fibrocystic breast changes" because it's so common that it's believed to be a variation of normal.

The cause of this ailment isn't completely understood, but it's thought to be associated with the menstrual cycle's hormone fluctuations. Typical symptoms, peaking just before the start of menstrual periods and improving after they end, include the following:

• Dense, lumpy breast tissue
• Persistent or intermittent breast discomfort—including dull, heavy pain and tenderness
• Feeling of fullness in the breast
• Changes in nipple sensation, itching

While restricting dietary fat and caffeine may help self-care, it's important to perform monthly breast self-exams and wear a well- fitted bra with good support. Consult your doctor if you find a new change or lump in your breast or have severe or persistent breast pain that doesn't fluctuate with your period.

Source: www.nlm.nih.gov/medlineplus

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When Depression Strikes

We see examples of brooding teens so often—in books, on television and in movies—that adolescent moodiness seems to be almost a rite of passage. But when a child's behavior noticeably changes, it may signal more than a harmless phase. It might be a sign of depression. In fact, experts say that one in eight teens and one in 33 children are depressed.

While this is sobering news, depression is largely treatable. Coupled with cognitive or "talk" therapy, young people often respond well to antidepressant medications, which can help them rise out of their despair and start to feel better.

How do antidepressants work? "There are two neurotransmitters in the brain—serotonin and norepinephrine— whose levels usually change in depression," says Kiran Koka, M.D., medical director of Child and Adolescent Services at the John Muir Behavioral Health Center. "Antidepressants help increase these neurotransmitters or make them more available so mood improves." The most commonly prescribed antidepressants are selective serotonin reuptake inhibitors (SSRIs) such as Lexapro, Prozac and Zoloft.

Dr. Koka says getting a proper diagnosis is important and advises concerned parents to schedule their child for an evaluation with a child psychiatrist. Unlike a primary care provider, a psychiatrist is specially trained to key in on lesser-known behaviors that might be associated with depression, such as stealing, drug use, and oppositional, defiant behavior.

Arriving at the right diagnosis is particularly important when prescribing medication. A well-meaning family doctor might see a child with depressive symptoms and prescribe an antidepressant, for example. But that child might actually have bipolar disorder and simply have been depressed at the time of the doctor's appointment. A psychiatrist can do a complete mental health evaluation, provide an accurate diagnosis and prescribe the best medication.

About 70 percent of children and teens with depression get better after taking an SSRI, and those who don't are often switched to a different SSRI or SNRI, again garnering positive results for nearly half. Also, most kids can be weaned off of antidepressants within six months to two years under supervision.

Parents may be concerned about having their child take antidepressants, but if a child is suffering from chronic depression and thoughts of suicide, proper medication could help save his or her life. Like all medications, of course, antidepressants may have side effects, so parental involvement is important.

"Properly monitored and under a doctor's care, these medications can be used safely," says Kevin Lane, Pharm.D., pharmacist at the John Muir Behavioral Health Center Pharmacy. "And ultimately the family can help with that monitoring. For example, if the child becomes more anxious or agitated when they're on the medication, or if they have panic attacks or become irritable or hostile or impulsive, they should let their doctor know. At that point, the physician can make modifications, such as changing the dose, switching to another antidepressant or stopping the medication."

Watching a child struggle with depression is painful. But a qualified doctor, working closely with the patient and his or her parents, can help pave a path to sunnier days ahead.

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New Solutions

Hip problems can make even simple motions—walking, climbing stairs, bending—excruciatingly painful. So when orthopedic surgeon Adam Lazzarini, M.D.,

was completing his fellowship at New York's renowned Hospital for Special Surgery, he was excited to learn about an innovative procedure called hip resurfacing that could relieve severe hip pain and might even let younger, more active patients get back to activities like running and other sports.

Last fall, Dr. Lazzarini partnered with orthopedic surgeon John Knight, M.D., to bring this exciting surgery to John Muir Health, where both are on staff and which has earned a reputation for introducing leading-edge orthopedic procedures to the East Bay. The Birmingham Hip Resurfacing System has been used worldwide for more than a decade but was only recently approved for use in the United States. Drs. Lazzarini and Knight, are two orthopedic surgeons in the Bay Area who perform this technically challenging orthopedic procedure.

Patients who have arthritis, dysplasia or avascular necrosis (dead bone tissue) can benefit from hip resurfacing, which eliminates painful bone-on-bone rubbing. And the beauty of the procedure is that much of the patient's own hip bone is conserved. "Rather than cutting away the entire femoral (thigh bone) head and a part of the femoral neck like we do in hip replacement surgery, in this procedure, we reshape the hip and then put a metal cap on top of it," Dr. Knight explains. "Because you're preserving bone and replacing it with something that's going to transfer the stress into the bone a little better, you can actually do more with a resurfaced hip, like running, jumping, and other activities that we would normally discourage in people with a traditional hip replacement."

Another advantage is that the metal components are carefully crafted for optimum functioning and represent an improvement over previous hip joint components. "The benefits are more normal weight distribution across the femur for better stability, better range of motion and minimal risk of dislocation," says Dr. Lazzarini. "And because we use a metal-on-metal bearing, theoretically that bearing is going to last longer than the traditional metal-and-plastic hip." (Studies show that 98 percent of resurfacing components still function well after 10 years.)

As with any surgical procedure, hip resurfacing does have its risks. So it may not be a good option for everyone. Age, weight and pre-existing conditions are all taken into account and should be discussed thoroughly with your surgeon prior to surgery.

At John Muir, however, qualified patients ranging from age 27 to 63 have had the procedure, with great results and no complications. "John Muir is one of the busiest orthopedic hospitals in California, and we have a dedicated staff who are skilled in orthopedics, both in the operating room and on the medical unit," Dr. Knight says.

After resurfacing surgery, patients remain in the hospital for two or three days, the same length of time as for hip replacement, and undergo the same type of physical therapy. Patients who have undergone resurfacing need to wait about four to six months before placing too much stress on their hips. But once they get the go-ahead from their doctor, they can get back to activities they thought they'd never enjoy again. As Dr. Lazzarini says, "We have patients who've returned to martial arts, and some have even returned to running."

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