For example, women diagnosed with breast cancer in one breast, even at early stages, often choose to undergo a double mastectomy out of fear that the cancer might spread to the other breast. But the latest findings from a double mastectomy trial, published in the Journal of the American Medical Association, in July, show

that having both breasts removed when cancer is found in only one does not increase survival rates. (Importantly, the study notes that these results may not apply to those who test positive for the BRCA gene, which puts them at greater risk.)

Targeted therapy with drugs such as datopotamab deruxtecan (Dato-DXd), patritumab deruxtecan (HER3-DXd), and trilaciclib (Cosela) also illustrate the value of a less-is-more approach. Dato-DXd and HER3-DXd hone in on specific proteins within cancer cells. This precision means these treatments can be more effective, while sparing women many disruptive side effects. Similarly, trilaciclib, which is a CDK4/6 inhibitor, not only enhances the response to immunotherapy, it helps reduce the harsh impact of chemotherapy. Trilaciclib shows great promise particularly for women battling triple-negative breast cancer.

These milestones are not just beacons of hope. They allow physicians to select which patients would benefit the most from certain targeted therapies, thereby saving many other women from unnecessary chemotherapy or radiation. As a result, fewer women need multiple modalities of treatment, but can still look forward to the best survival statistics.

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If tingling, numbness, or pain in your hand, as a result of carpal tunnel syndrome, is affecting your ability to sew, garden, or do other hands-on activities, there are several treatment options to consider. The primary goal is to relieve pressure on the median nerve, which runs through the carpal tunnel in your wrist.

Conservative treatments are usually recommended first. Splinting with a wrist brace, especially at night, prevents further irritation of the median nerve. The brace looks like a fingerless glove that has a rigid support that keeps the wrist in a neutral position. You can buy one at your local drug store, which makes it an excellent first step. However, it may take weeks to see improvement, and the relief might be minimal. Corticosteroid injections offer a more direct approach by reducing inflammation and swelling in the carpal tunnel. These injections can provide significant relief; however, the effects can be temporary, and repeated injections are generally not recommended due to potential side effects like weakening of the surrounding tissues. Acupuncture can also be an effective alternative for managing carpal tunnel syndrome; however, it is generally considered less predictable compared with traditional methods.

For persistent or severe cases, surgical intervention might be warranted. Carpal tunnel release surgery involves cutting the ligament pressing on the median nerve, thereby relieving pressure. This procedure has a high success rate and can provide long-term relief, but it may take several months for full strength and sensation to return.

Ultimately, the best treatment depends on the severity of your symptoms and how they affect your daily life. Discuss your options with an orthopedic specialist, who can tailor a treatment plan that’s best for you, ensuring that you can continue to enjoy your activities pain-free.

I generally take care of my feet, but no matter what I do I cannot escape an ingrown toenail on the third toe of my left foot that keeps coming back. What can I do?

A recurring ingrown toenail despite a diligent foot-care routine can be frustrating and painful. The primary reason for this persistent issue often lies in the way the nail grows or how pressure is applied to the toe. Factors like tight-fitting shoes, improper nail trimming, or even genetic predispositions can contribute to the problem. In some cases, repeated activities that put stress on the nails—such as an exercise routine that includes running—can exacerbate the condition.

First, ensure proper nail care. Trim your nails straight across, avoiding rounded corners, which can encourage the nail to grow into the skin. Opt for comfortable, well-fitting shoes that provide ample toe space. If these measures do not resolve the problem, soak your foot in warm water several times a day to help reduce swelling and alleviate pain.

If you have tried all of these measures and none are effective, it’s probably time to consult a foot specialist. A podiatrist can assess the situation and may recommend procedures like lifting the nail to allow it to grow out properly or, in more severe cases, removing part or all of the nail in a minor surgical procedure called a partial nail avulsion. This involves removing the problematic section of the nail and sometimes the underlying nail bed to prevent regrowth in that area. The procedure is quick and done under local anesthesia, providing long-term relief with minimal risk. Consistent follow-up care and adhering to your podiatrist’s advice can help prevent future occurrences.

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With that being said, hormonal changes in the menopausal and postmenopausal years can introduce physical issues that diminish the pleasure of intimacy. If you’re experiencing discomfort or pain during sex, it’s important to know that help is available. This common issue often stems from vaginal atrophy (VA), in which hormonal changes cause the vaginal tissues to thin, dry, and become inflamed. You’re not alone—over half of postmenopausal women experience these symptoms, but many don’t discuss them with their doctor due to embarrassment or misconceptions about aging.

Decreased estrogen and VA are primary culprits of postmenopausal painful sex. Other factors include changes in pelvic floor muscles, pelvic organ prolapse, and urinary tract infections (UTIs). It’s crucial to talk openly with your health–care provider about these symptoms to find the right solutions. There are several strategies to help ease painful sex. Water–based or silicone-based lubricants can alleviate dryness, while regular use of vaginal moisturizers can hydrate tissues. Non–systemic estrogen therapy, which is applied locally to the vagina, can also be beneficial and is safe for most women.

Painful sex can impact overall emotional well–being and quality of life. Addressing this issue with your doctor can lead to effective treatments and improved sexual health. Don’t hesitate to seek help and explore the many options available to regain comfort and pleasure in your intimate life.

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Hiatal hernias are common. Approximately 55 percent to 60 percent of adults over 50 have this condition, which occurs when part of the stomach pushes through the diaphragm— the muscle separating the chest from the abdomen. As women age, diaphragm muscles can weaken, increasing the risk of a hiatal hernia. Additionally, postmenopausal women often experience changes in abdominal pressure related to weight gain and this is a risk factor, as well.

A small hiatal hernia can become larger over time due to aging, increased abdominal pressure, or repetitive strain. To prevent a small hiatal hernia from worsening, maintain a healthy weight, lose weight if you have overweight or obesity, and avoid heavy lifting to minimize abdominal muscle strain. A small hiatal hernia is often symptom-free, whereas a larger one can cause stomach acid to back up into the esophagus, causing heartburn and chest pain. To prevent hiatal hernia symptoms, eat smaller, more frequent meals; avoid eating close to bedtime; and steer clear of alcohol, spicy foods, citrus fruits, coffee, chocolate, and tomatoes. To treat hiatal hernia symptoms, several medications can be used:

Antacids: These help neutralize stomach acid and provide quick relief. Examples include: Rolaids, Tums, and Mylanta.

H-2 Receptor Blockers: These reduce acid production. Examples include Pepcid, Tagamet, and Zantac.

Proton Pump Inhibitors (PPIs): These also reduce acid production, but are more potent than H-2 blockers. Examples include Nexium, Prilosec, and Aciphex.

If medications fail, surgery may be recommended. Discuss your concerns with a health-care provider, so you can get personalized advice.

I am considering trying a Pilates class. I’m 65 and have arthritis and lower back pain. Can Pilates help alleviate my pain?

Pilates, developed by Joseph Pilates in the early 1900s, focuses on strengthening core abdominal and back muscles, which support the rest of the body. It can improve flexibility and balance, making it beneficial for individuals with arthritis and lower back pain. Exercises are performed on a mat or a machine called a “reformer” that uses resistance for a low-impact workout. Due to its low-impact nature, Pilates is often easier on the joints and less strenuous compared with other exercises.

When researchers performed an analysis of several studies in an effort to find out if Pilates was helpful for older adults with chronic musculoskeletal conditions, they gave it a thumbs up. Their review of seven studies that included close to 400 adults over age 50 (about 75 percent were female) showed that Pilates was quite effective for reducing back pain, as well as other osteoarthritis and osteoporosis pain.

Many senior centers, health clubs, and YMCAs offer Pilates classes tailored to older adults. Attend classes led by a qualified instructor to ensure proper technique, and be sure to inform the instructor about your arthritis and back pain in case position or equipment modifications are warranted. It sounds like Pilates will be an excellent choice for you, but just as with any new fitness program, it’s a good idea to check with your doctor to make sure that this form of exercise is appropriate for you.

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In specialty care, particularly in fields like oncology, precision medicine has already made significant strides. For instance, in the case of a patient who has a tumor, by analyzing the patient’s genetic profile and the unique molecular characteristics of their tumor, oncologists can identify targeted therapies that are more likely to be effective and potentially less toxic. Multicancer early detection tests are a prime example of precision medicine. These tests use

a patient’s blood sample to analyze DNA fragments, and have the potential to detect a broad spectrum of cancers, ideally prior to the onset of symptoms. An example of precision medicine that is particularly relevant to women is the use of a technique known as cascade testing, which allows for the early detection of people at increased risk of developing breast or ovarian cancer due to BRCA1 or BRCA2 mutations.

The potential of precision medicine extends beyond specialty care. As our understanding of genetics and disease mechanisms continues to deepen, the integration of precision medicine into primary care practices becomes increasingly feasible. Instead of relying solely on family history and general population-based guidelines, evolving precision medicine practices will ultimately equip your health-care providers with the tools to recommend personalized screening tests based on your genetic profile, identifying potential health risks early on. Furthermore, treatment plans could be customized to account for variations in metabolism that impact your response to medications, maximizing therapeutic efficacy while minimizing adverse reactions.

As research continues to advance, the era of precision medicine draws ever closer to promising a future where health care is truly tailored to the unique needs of each person.

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A calcium scoring test is a diagnostic imaging procedure used to assess the amount of calcium deposits in the walls of the coronary arteries. These deposits, known as calcifications, are a marker of atherosclerosis, a condition that can lead to coronary artery disease, carotid artery disease, peripheral artery disease, and aneurysm. During the test, a computed tomography (CT) scanner takes detailed images of the heart, and this provides your doctor with measurements that describe the extent of calcium buildup—or its absence.

There are several reasons why a doctor might recommend a calcium scoring test, and the primary one is it can help assess an individual’s risk of developing coronary artery disease, which is a leading cause of heart attacks. In your case, the test was probably recommended to get a clearer picture of the extent of your heart disease because of your risk factors and family history. Depending on the results, your doctor will either confirm that your current blood pressure and cholesterol treatment regimen is sufficient or modify your medications and implement a plan for lifestyle modifications, such as weight loss and regular exercise.

If you are still on the fence about scheduling the test, discuss this with your cardiologist. If you are concerned about the cost, discuss that with someone in the business office at the imaging center. They may offer to set up a payment plan that breaks down the fee into affordable monthly payments.

I am going camping, and I’m concerned about Lyme disease. I’ll be sleeping in a cabin, but will spend most of my time outdoors. What can I do to minimize my risk?

Lyme disease is caused by bacteria transmitted by ticks, which are most often found in wooded or brushy areas with high grass or leaf litter, so it’s natural to have concerns about Lyme disease when planning a camping trip. To minimize your risk, take preventive measures such as wearing long sleeves and pants, using insect repellents that contain 20 to 30 percent DEET on exposed skin and clothing, and using products that contain permethrin on gear such as your backpack and hat. DEET repels ticks, and permethrin can immobilize them on contact. They are both safe, but permethrin should not be used on skin. Perform regular tick checks during and after outdoor activities using a handheld and/or full-length mirror, and shower as soon as you return from a hike. If you find a tick attached to your body, you can remove it with tweezers; or you can use rubbing alcohol on a cotton ball to smother the tick.

Symptoms of Lyme diseaseinclude a bull’s-eye-pattern rash, along with flu-like symptoms such as fever, headache, fatigue, and muscle aches. If left untreated, Lyme disease can progress to more serious complications affecting the joints, heart, and nervous system.

Most cases of Lyme disease respond well to antibiotics, especially when diagnosed and treated promptly. However, if the infection is not detected early or if treatment is delayed, it can sometimes lead to persistent symptoms known as post-treatment Lyme disease syndrome. Prognosis is generally good with early diagnosis and treatment, but it’s essential to seek medical attention if you develop symptoms suggestive of Lyme disease.

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The Mediterranean diet, which is rich in fruits, vegetables, whole grains, legumes, nuts, and olive oil, is an anti-inflammatory diet that many of my patients have begun to follow. Studies show that anti-inflammatory diets can be effective at improving chronic health conditions such as rheumatoid arthritis and inflammatory bowel disease; can lower the risk of developing chronic diseases like heart disease and diabetes, and may even preserve cognitive health and reduce the risk of dementia.

Not all inflammation is bad for you; inflammation is the body’s way of fighting infection. Chronic inflammation, on the other hand, is the culprit behind many diseases and conditions. If the benefits of an anti-inflammatory diet sound appealing to you, talk to your doctor about modifying your nutritional habits to implement anti-inflammatory components. If you get the go-ahead to explore this nutritional plan, it may have a positive impact on your overall health.

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Hives are an outbreak of red bumps, patches, or welts on the skin that appear suddenly. They usually itch and sometimes can sting or burn. They can appear anywhere on the body, including the face, lips, tongue, throat, or ears, and can vary in size and shape. Different factors—including allergies, chemicals in foods, insect stings, certain medications, and hormone imbalances can cause hives. Menopause can be responsible for an outbreak of hives because menopause causes imbalances between the two most important hormones in a woman’s body: progesterone and estrogen. Autoimmune diseases, such as thyroid disease, lupus, and celiac disease, can also cause hormonal imbalances that lead to hives.

It’s often difficult to determine the exact cause of hives. There’s no specific test for hives, so you will have to work with your physician to try to figure out what is causing them. The doctor will probably take a medical history and ask about foods you’ve eaten recently and medications you’re taking. Preventing a future breakout of hives will depend on what is causing them. For example, if you’re having a reaction to a certain food, your doctor may advise you to avoid eating that food. If the hives are caused by medication, ask about alternative treatments. Antihistamines may offer relief from hives. If your hives become a regular problem, your doctor may advise you to take an antihistamine on a regular basis to prevent future outbreaks. When you have hives, if you experience chest pain or difficulty breathing, seek medical attention immediately, as this could be a severe allergic reaction called anaphylaxis that causes your throat or tongue to swell up and block your airway.

A visit to your doctor or an allergist can help get to the bottom of what caused your case of hives, and develop a plan for how to prevent or manage potential future outbreaks.

My sense of smell is not as strong as it used to be. Is this a sign of something serious?

As people age, they often experience a natural decline in various sensory functions, including the sense of smell. While this is a common part of the aging process, there are also numerous medical conditions that may be responsible for the changes to your sense of smell. Neurological conditions such as Alzheimer’s disease, Parkinson’s disease, and multiple sclerosis can affect the nerves involved in the sense of smell. In fact, about 90 percent of people with Parkinson’s disease (PD) lose their sense of smell. But a diminished sense of smell does not necessarily mean you have one of these neurological conditions. There are many other things that can affect your sense of smell. For instance, nasal polyps, which are noncancerous growths in the sinuses, can obstruct airflow and impair the sense of smell, and sinusitis (inflammation of the sinuses) can block the nasal passages and lead to a diminished sense of smell. And COVID, as you probably know, reduced some people’s ability to smell while symptoms were active, and in some cases even after they recovered.

There are also medications that can affect the sense of smell. Some medications that are commonly associated with smell disturbances include over-the-counter nasal decongestants, which can cause temporary loss of smell with prolonged or excessive use. Intranasal corticosteroids, which are often used to treat conditions like allergic rhinitis or nasal polyps, can also sometimes cause changes in smell perception. If medication is responsible for your loss of smell, discontinuing the medication may lead to improvement or resolution of symptoms. However, it’s essential to do this under the guidance of a health-care provider, because abruptly stopping certain medications can have adverse effects. Schedule an appointment with your doctor or with an ear, nose, and throat specialist so the cause of your reduced sense of smell can be identified and treated.

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Ovarian cancer often remains silent in its early stages, making it challenging to detect. However, as it progresses, subtle clues may emerge, including abdominal bloating, changes in appetite, pelvic or abdominal discomfort, and irregularities in bowel or bladder function. Infertility, hormone replacement therapy (HRT), and endometriosis elevate the risk of ovarian cancer. Other risk factors include a family history of ovarian cancer, breast cancer, or the BRCA1 and BRCA2 genes. Genetic testing has emerged as a powerful tool, shedding light on one’s susceptibility to gynecologic cancers, particularly ovarian cancer, thereby empowering women to take proactive measures to lessen their risk.

The hallmark symptom of uterine—or endometrial—cancer is abnormal bleeding, especially postmenopausal vaginal bleeding. The American Cancer Society recommends that women at increased risk of uterine cancer see their doctor when they experience any vaginal bleeding. Some of the risk factors include being over 60 years of age, having obesity, having type 2 diabetes, and never having been pregnant. Use of HRT for more than 10 years also puts women at risk for endometrial cancer.

Cervical cancer is highly treatable in its early stages, but symptoms don’t usually manifest until later in the disease process. This underscores the importance of regular screening, which includes Pap tests and/or human papillomavirus (HPV) testing. Symptoms that may eventually surface include irregular vaginal bleeding, bleeding during intercourse, abnormal vaginal discharge, pelvic or back discomfort, and changes in bowel or urinary patterns.

Understanding the telltale signs of all gynecologic cancers—abnormal vaginal bleeding or discharge, sensations of fullness, bloating, abdominal or pelvic discomfort, and alterations in urinary or bowel habits—is critical for prompt medical attention and intervention.

By recognizing symptoms, understanding risk factors, and discussing concerns with your doctor, you can take proactive steps toward early detection and effective management of these cancers, ultimately safeguarding your health and well-being.

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While there’s no one-size-fits-all solution for relieving headaches through diet, certain dietary strategies may alleviate symptoms. Keep a food diary to help pinpoint specific trigger foods—or foods that may cause headache symptoms. Avoiding trigger foods that are associated with headaches, such as processed foods, aged cheeses, chocolate, alcohol (especially red wine), caffeine, and artificial sweeteners, might provide relief. Adding magnesium-rich foods and riboflavin (vitamin B₂) to your diet may also be beneficial. Magnesium deficiency has been linked to headaches, and studies show riboflavin supplementation may help prevent migraines. Foods rich in magnesium include nuts, seeds, whole grains, leafy greens, and legumes. Good food sources of riboflavin include dairy products, lean meats, eggs, nuts, and leafy green vegetables.

Avoiding food additives such as nitrates and monosodium glutamate (MSG) could potentially help reduce or eliminate headaches. Nitrates are found in processed meats such as bacon, hot dogs, deli meats, and cured or smoked meats and fish. Some foods that may contain MSG include processed snacks such as chips and crackers; instant noodles and ramen; frozen meals, and Chinese cuisine. It’s essential to read food labels carefully, as MSG may be listed under different names such as “monopotassium glutamate,” “hydrolyzed vegetable protein,” or “autolyzed yeast extract.”

If you start your day with coffee, keep this in mind: While caffeine withdrawal can trigger headaches in some people, consuming too much caffeine can also lead to rebound headaches. If you consume caffeine regularly—coffee, iced tea, cola, energy drinks, and dark chocolate— try to do so in moderation.

If your headaches are more severe or more frequent than they were previously, discuss this with your physician. They may want to schedule tests, such as an MRI or CT scan, to rule out other causes of your pain.

I routinely brush my teeth and floss, but lately my gums look red and swollen. Is it possible to develop gum disease even if I take care of my teeth?

Although regular brushing and flossing are essential for maintaining oral health, they may not completely eliminate the risk of gum disease. Even with diligent brushing and flossing, it’s possible for plaque—a sticky film of bacteria—to accumulate on your teeth and along the gumline. If not removed regularly, plaque can harden into tartar, which can be removed only by a dental professional. Also, consider that the way you brush and floss may be inadequate. If brushing and flossing are not done correctly, they may not effectively remove plaque and food particles from all areas of the mouth. It’s essential to spend sufficient time on each tooth and along the gumline.

Even with excellent oral hygiene, there are risk factors that can contribute to the development of gum disease, such as smoking, diabetes, hormonal changes including those that occur during peri-menopause, and taking certain medications, including antihistamines. Antihistamines can cause dry mouth, which can lead to gum disease by reducing saliva production and impairing the mouth’s natural defense mechanisms against bacteria.

While brushing and flossing are essential components of good oral hygiene, they should be supplemented with regular dental visits and professional cleanings. Your dentist can identify early signs of gum disease and provide treatment to prevent it from progressing.

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