Casey Templeton photo
The first time we focused our "Top Docs" service package on women's health was in 2001, so we had some catching up to do on this go-round. In the past eight years, research studies, technological advances and even social attitudes have helped enhance the well-being of women. In 2006, data from a 15-year study on postmenopausal females began to be tabulated, revealing significant findings, including an increased risk of stroke and blood clots for women undergoing hormone-replacement therapy. Statewide initiatives such as April's Women & Girls Wellness Month, organized by the Charlottesville-based Women's Health Virginia, began in 2002. "Our focus recently has been on girls, teens and young women," explains Miriam Bender, the organization's CEO, "because that's when health behaviors are formed." Read on for insights that can save your life or the life of a woman you love.
Heart disease remains the No. 1 killer of women in the United States; one in three female adults has some form of cardiovascular disease (CVD), and since 1984, the number of CVD deaths for females has exceeded those for males, according to statistics from the American Heart Association. Women are now becoming more aware of this problem and the beneficial role a proper diet can play in preventing it, says Dr. Christine Browning, a cardiologist with Richmond Cardiology Associates at the Bon Secours Heart & Vascular Institute. "Public awareness has changed," she emphasizes, adding that even television shows such as The Biggest Loser have contributed to this increased knowledge.
Still, there's room for improvement. In November 2008, the HCA Virginia Health System sponsored a telephone survey of 500 Central Virginia women ages 40 to 70 and found that 86 percent of those surveyed had one or more risk factors for CVD — and 51 percent had no idea they were at risk. "The grass-roots coordination around breast cancer in this country is tremendous," says Dr. Carolyn Burns of Virginia Cardiovascular Specialists. "But the reality is that we are losing far more women to cardiovascular disease than to breast cancer. For women 40 and older, we need to change the annual exam to heavily feature a heart-health assessment."
In response to the survey results, the health-care network launched the HCA Virginia Women's Heart Network in January. The network offers educational seminars and screening events that include a full panel of heart assessments: weight, body-mass index, blood glucose and cholesterol.
Another new resource is the Bon Secours Heart & Vascular Institute at Reynolds Crossing, which opened in February. Browning says the institute will give women access to cardiac services such as stress-testing. "The institute takes cardiology out of a hospital setting to a community-service setting," she explains, noting that this can be more appealing than a trip to the hospital.
The seventh leading cause of death for women in the United States is breast cancer, according to the Centers for Disease Control and Prevention. In the past eight years, there's been a lot going on, says Dr. Harry Bear, medical director of the Breast Health Center of the VCU Massey Cancer Center. He points to magnetic-resonance imaging, a diagnosis technique that "more accurately determines risk and screens high-risk women." Dr. Ellen Shaw de Paredes, of her eponymous Institute for Women's Imaging, agrees that breast MRI "is huge." (See Page 92 for a feature article on this topic.) She also says that a major clinical trial from 2005 validated the use of digital mammography over the traditional film, and more doctors are now relying on this method. On the surgical side, Bear says, more oncoplastic techniques for mastectomy have been developed in the past three to four years. Possibly because the reconstruction techniques have improved, he adds, more women are choosing mastectomy (removal of the entire breast) over lumpectomy (removal of the tumor). He also highlights molecular-profiling tools, which help determine how the cancer is likely to behave and if the body would or would not respond to particular chemotherapies. "We have the ability to customize therapy based on molecular profiling," Bear says.
The top five cosmetic surgeries for women, according to the most recent annual statistics from the American Society for Aesthetic Plastic Surgery, are breast augmentation (about 400,000), liposuction (about 400,000), eyelid surgery (about 210,000), abdominoplasty (about 180,000) and breast reduction (about 150,000). Dr. Burton Sundin of the Virginia Institute of Plastic Surgery at Retreat Doctors' Hospital notes that silicone-gel implants for breast augmentation have become safer. "Saline implants are still a wonderful option," he says, but women tend to prefer silicone because they're more natural-looking. He adds that facial-rejuvenation fillers (such as Restylane and Juvaderm) have been refined in the past few years, and in 2008, the Food and Drug Administration approved Evolence, which features a new form of collagen. Techniques also have evolved, says Dr. Doug Rowe of VCU's division of plastic and reconstructive surgery in the department of surgery. With regard to eyelid surgery, cosmetic surgeons now focus more on muscle tightening rather than fat removal, Rowe says.
The field of gynecology also has experienced breakthroughs in the past eight years, with minimally invasive techniques expanding significantly, says Dr. Catherine Matthews, associate professor of urogynecology and reconstructive pelvic surgery at VCU Medical Center. Perhaps most noteworthy is the da Vinci Robotic Surgical System for laparoscopic (small-incision) hysterectomies, which Dr. Danny Shaban, director of minimally invasive gynecologic robotic surgery at Henrico Doctors' Hospital, says got a big push here in Richmond about three years ago. Shaban compares a traditional abdominal hysterectomy to a surgeon's using chopsticks that move back and forth, while the surgeon-guided robot "moves like fingers," as he puts it. With the robot, women experience less blood loss, as well as reduced postoperative pain and infection, and can recover in about six days, as opposed to six weeks with the traditional method.
Other examples of advanced, minimally invasive techniques include the Essure technique for tubal sterilization (performed without any incisions and approved by the FDA in 2002); outpatient endometrial ablation with local anesthesia (a process in which a layer of the uterine lining is destroyed for the management of heavy periods); and synthetic slings for the treatment of stress incontinence (involuntary loss of urine during physical activity), Matthews says.
"Wait a Minute" is the name of a new delivery campaign that Dr. Bonnie Makdad, director of neonatology at Bon Secours Richmond Health System, is passionate about promoting. "By waiting just one minute before cutting the umbilical cord," Makdad explains, "[the obstetrician or father] can give the newborn baby 30 percent more blood." And it's the best blood the baby can receive, she emphasizes, because it comes from the mother. This is not uncomfortable or detrimental to the mother, she adds — "and it's so beneficial to the baby." Benefits to the newborn include fewer respiratory issues and less chance of anemia. Makdad says there's no rationale for why obstetricians have not been waiting a minute — it's just the way it's been done.
Women's mental health is often linked to their physical well-being. The current issue of the Journal of Women's Health includes a report, for example, indicating that older African-American women exposed to high levels of family violence during their lifetimes are at significantly greater risk of poor health. Here in Richmond, Dr. Susan Kornstein, executive director of the VCU Institute for Women's Health (and editor in chief of the Journal of Women's Health), is working on her own research study regarding medication for severe premenstrual mood changes. The study is testing the effectiveness of using an antidepressant at the onset of symptoms, Kornstein explains, which would give women control over their condition. Kornstein points to initiatives like the International Congress on Women's Mental Health (launched in 2000 and held every three years) and VCU's annual Women's Health Research Day (launched in 2004) as examples of increasing commitment to issues related to women's health. (See the article on Page 90 for insights into living with anxiety.)