To learn about egg freezing options, join our free, live webinar next Wednesday, May 22, from 7 to 8 p.m. We’ll explore how egg freezing preserves fertility and address your queries during a question-and-answer session. For more information, please call 1-855-850-5494.

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Strokes kill more women than men: twice as many than by breast cancer every year. So women need to know not only about the risk factors and warning signs of stroke, but also Moyamoya disease–a little-known cause of stroke that is more common in women and often goes misdiagnosed for years.

Moyamoya disease was originally diagnosed in Japanese patients. Moyamoya is the Japanese word for “puff of smoke.” It is a rare brain artery disorder caused by the slowly progressive narrowing and blockage of the large branches of the internal carotid artery at the base of the brain. To feed the brain tissue that is starving for blood flow, the body forms a network of dilated and weakened blood vessels that resembles a “puff of smoke” on angiography.

While this new blood vessel network allows blood to continue to flow to the brain, it is weak. Patients with Moyamoya disease may experience signs of stroke due to insufficient blood flow, termed an ischemic stroke, or to a bursting of these new vessels, called hemorrhagic stroke.

Treatments Can Ward Off Stroke

Fortunately, there are effective Moyamoya treatments available if the disease is diagnosed in time. The treatments are designed to bypass the blocked arteries at the base of the brain and provide sufficient blood flow to prevent ischemic stroke. These bypasses also take the strain off of the “puff of smoke” blood vessels and can decrease the chance of bleeding.

There are two types of bypass:

The direct bypass immediately restores blood flow to the starved arteries by directly connecting an artery in the scalp to an artery in the brain.
The indirect bypass (called an EDAS procedure) involves laying the scalp artery on the brain itself and relies on the starving brain to stimulate new blood vessel growth from this artery, which can take months.

A vascular neurosurgeon can perform the procedures alone or in combination, based on blood flow tests and the patient’s individual needs.

The bottom line is that the keys to successful stroke treatment remain time and prevention. The earlier stroke treatment is initiated, the higher the likelihood of a good outcome because “time is brain.” Smoking cessation and blood pressure control are vitally important, along with an active lifestyle and a healthy diet.

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Everyone has the BRCA gene. But a very small change in the gene, called a mutation (BRCA1 or BRCA2),  can increase the lifetime risk of developing breast cancer more than 80 percent and ovarian cancer more than 30 percent. Other cancers may develop at a higher frequency in BRCA2 patients, such as prostate cancer.

There’s a lot of discussion about what can be done to prevent breast and ovarian cancer from developing in patients with a BRCA mutation. Like Ms. Jolie, many women choose to have a double mastectomy with immediate reconstructive surgery of the breast. In addition, some women between 35 and 40 choose to remove their ovaries after completing their family.

Completing their family–can that be done safely? What if you’re a young woman diagnosed with breast cancer, and haven’t started your reproductive life yet? What if you don’t have cancer but a DNA test reveals you have a BRCA mutation?

Fertility Options for BRCA-Positive Patients

Physicians who specialize in fertility can help BRCA-positive women to take control of their reproductive life–with or without cancer.

For instance, BRCA-positive women without a partner can freeze their eggs. This requires a short course of treatment with fertility drugs, and retrieval of the eggs under anesthesia in a procedure that takes about 20 minutes. Eggs can stay frozen for years, then thawed and fertilized when a woman is ready to have a child. New technologies allow excellent survival of eggs coming out of the “deep freeze,” with good fertilization and pregnancy rates.

BRCA-positive women who have a partner can undergo a similar procedure, only their eggs are fertilized immediately and frozen as embryos.

Children of patients who carry the BRCA mutation have a 50 percent chance of inheriting it. Through preimplantation genetic diagnosis (PGD), physicians can determine which embryos carry an abnormal BRCA gene and only implant embryos without the mutation into the womb that. This practically guarantees the genetic abnormality will not transmit to the child. The more BRCA-positive patients know about preimplantation genetic diagnosis, the fewer women and men will carry that gene in the future.

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Preventive mastectomy (also called prophylactic or risk-reducing mastectomy) is an operation that removes one or both breasts to prevent or reduce the chance of breast cancer for women at high risk for developing it. Preventive mastectomy may reduce the chance of developing breast cancer in moderate- and high-risk women by about 90 percent, according to the National Cancer Institute.

A family history of breast cancer and/or ovarian cancer is common in women diagnosed with breast or ovarian cancer, but inherited genetic mutations are associated with less than 10 percent of all breast cancers and less than 15 percent of ovarian cancers.

Most inherited genetic mutations are associated with the BRCA1 or BRCA2 genes. These mutations are inherited from one parent only, so it may affect several generations with breast and/or ovarian cancer. Women with the mutations have a markedly higher risk: Up to a 85 percent risk developing breast cancer and up to a 40 percent risk developing ovarian cancer. Men who carry BRCA1 or BRCA2 mutations are at increased risk of breast cancer and prostate cancer.

Arm Yourself with Information

Anyone who has a strong family history of breast or ovarian cancer or a relative with a BCRA1 or BCRA2 mutation may choose to undergo the test. Talk to a doctor first, and consult with a genetic counselor before and after testing.

Blood DNA tests for BRCA1 and BRCA2 mutations—ordered by a physician or genetic counselor–take about two weeks to return results. The test is not recommended for the general population, according to the American Association for Clinical Chemistry.

It is vital for young women to know about the importance of identifying family medical history, good breast health, and BRCA1 and BRCA2 mutations and everything they involve. Treatment of a “positive BRCA” test is a very personal choice, but knowledge empowers individuals to make their own well-informed decisions.

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A helpful tool to stay on the right track for heart health is the USDA’s MyPlate site. It  divides food into five groups:

1. Vegetables. Choose a variety of vegetables with a spectrum of colors, including dark green, red, and orange; legumes (peas and beans); and starchy vegetables.
2. Fruit. Fruit can be fresh, frozen, dried or canned (in water, not syrup).
3. Grains. Whole wheat, brown rice, oats, barley, or another cereal grain are grain products.
4. Dairy or dairy substitutes. Calcium-rich selections from this food group include fat-free or low-fat milk or food made from fat-free/low-fat milk. Soy, rice, and almond “milk” drinks (130 or fewer calories per 8 ounces) are good alternatives too.
5. Lean protein. Choose low-fat or lean meats and poultry. Vary your protein routine — choose more fish, nuts, seeds and beans.

Let’s Talk About Heart Health

Join me for our Nourish Your Heart Health Chat next Wednesday, May 15, at 7 p.m., at the Long Island Marriott in Uniondale. We’ll chat about cardiovascular health and enjoy a wine and chocolate tasting and healthy refreshments. Registration is required and admission is $35. To register, visit the North Shore-LIJ events calendar and enter “Health Chats” in the search field. For additional questions, call the Katz Institute of Women’s Health Resource Center at (855) 850-KIWH (5494).

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The leading cause of cervical cancer, HPV infection is so common that about 34 percent of all 14- to 24-year-olds (male and female) carry the virus. Whereas condoms are only slightly effective against spreading HPV, the vaccine provides up to 99 percent protection against acquiring and spreading it. The Gardisil vaccine prevents the development of cervical, vulvar and vaginal cancers, pre-cancers and lesions, and genital warts.

HPV alters the cells of the cervix, causing changes that can lead to abnormal cells or cancer. Often cervical cancer does not develop until a woman is in her 60s.

It’s optimal to administer  three full does of the HPV Gardasil vaccine by 12 years old. The second dose should come one or two months after the first, and the final dose six months after the first.

For those who are not vaccinated during childhood, inoculation is most effective when administered before sexual activity starts.

Find out more about the HPV vaccine during the free webinar hosted by the Katz Institute of Women’s Health tomorrow, May 8, at 7 p.m. Register today to reserve your spot.

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While it is highly treatable when caught early, skin cancer can still be dangerous. Melanoma is the deadliest form of skin cancer—there is almost one US fatality from it every hour.

Most people have moles, and almost all of them are harmless. A normal mole is usually an evenly colored brown, tan, or black spot on the skin. It can be either flat or raised, round or oval. Moles usually don’t change in size, shape and color for many years; some may fade away over time.

A mole can be present at birth, or it can appear during childhood or young adulthood. Ask your doctor to check new moles that appear later in life.

Signs of Skin Cancer

Any unusual sore, lump, blemish, marking or change in how an area of the skin looks or feels may be a sign of skin cancer or a warning that it might occur, according to the American Cancer Society. If a a mole’s size, shape or color change, it may show that a melanoma is forming.

Pay attention to any new spot on the skin; a mark that shows changes in size, shape or color; or a spot that looks different from all the rest. With any of these warning signs, get your skin checked by a doctor.

Could It Be Melanoma?

Use the ABCDE Rule to watch for melanoma:

Asymmetry–one half of a mole or birthmark does not match the other half.
Border–the edges are irregular, ragged, notched, or blurred.
Color–the color is not the same all over and may include shades of brown or black, or sometimes with patches of pink, red, white or blue.
Diameter–the spot is larger than about a quarter-inch (the size of a pencil eraser)–although melanomas are sometimes smaller than this.
Evolving–the mole is changing in size, shape or color.

Other warning signs of melanomas include:

• A sore that does not heal
• Spread of pigment from the border of a spot to surrounding skin
• Redness or a new swelling beyond the border
• Change in sensation – itchiness, tenderness, or pain
• Change in the surface of a mole – scaliness, oozing, bleeding, or the appearance of a bump or nodule

Show your doctor any areas that concern you or that show any of these irregularities. Ask your doctor to check areas that may be hard for you to see.

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• HPV causes almost all cervical cancers—95 percent—and it is the most common sexually transmitted infection. The lifetime risk for HPV infection is almost 80 percent for sexually active adults; 14- to 24-year-olds have a 34 percent infection rate.
• Cervical cancer caused 4,070 US deaths in 2009. This potential killer usually affects women between 30 and 55. African-American women are 50 percent more likely to die from cervical cancer than women in other ethnic groups.
• Condoms are only slightly effective in preventing infection.
• Two vaccines can protect against some types of HPV.
• A Pap test is the best way to detect HPV early.Women should start the screenings no later than 21 and continue every other year until 30. Between 30 and 70, women should get annual Pap tests. If a woman over 70 has three consecutive negative screenings, she no longer needs them unless she remains sexually active.

Arm yourself against getting or spreading HPV with free webinar hosted by the Katz Institute of Women’s Health next Wednesday, May 8, at 7 p.m. Register today to reserve your spot.

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The so-called “challenge” involves trying to swallow a tablespoonful of cinnamon powder in under 60 seconds without drinking anything. Without enough saliva to moisten the powder, people invariably begin to gag, choke and cough violently. Those who manage to swallow all the cinnamon still risk developing wheezing and a chronic cough.

An article in this week’s Pediatrics journal reinforces my experience caring for these patients: Poison centers received 200 cinnamon challenge calls during the first six months of 2012, and 30 of these  patients needed medical attention and treatment. Complications included choking, respiratory failure and collapsed lungs, along with the prospect of developing “reactive airways”—that is, wheezing due to exposure to the cinnamon powder.

Cinnamon powder contains cellulose, an undigestible fiber that can cause a severe inflammation in the lungs. This can lead to long-term wheezing and a chronic cough, placing patients at further risk for bouts of pneumonitis (inflamed lungs) or even aspiration pneumonia.

The cinnamon challenge is especially dangerous for people with asthma, emphysema or COPD (chronic obstructive pulmonary disease). Since their lungs are already vulnerable and at risk for more severe spasm in their lower airways, these patients are more likely to develop complications—or even die.

I urge parents to have a serious discussion with their children about the dangers of this stunt to prevent them from ever attempting it.

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