Pascal J. Goldschmidt, M.D.	William O’Neill, M.D.	Bart Chernow, M.D.	Michele Chulick, M.B.A.

Dear Faculty, Staff and Students,

At this holiday season, we would like to say thank you for a fabulous year just past, for all your hard work and dedication, and take the opportunity to wish you and your family only the best in 2008. This year we would like to ask all of you to add a special UM New Year's resolution for good health.

The road to good health “Miami style” focuses on four areas, and in each of these areas YOU are in control: prevention through a healthy lifestyle, recommended screenings to pick up problems early, active preventive measures such as vaccinations, and having a meaningful relationship with your health care providers.

To help you get started on your good health resolution, we have concocted a few "holiday recipes" for each age group: 

If you are age 18-30, man or woman, our advice is to manage the risk-taking propensity that studies report is higher for this age group than older people.  In particular, stay away from smoking, any substance abuse including drinking excessively, and other risky behavior. Do not drink and drive. Refrain from staying out late; as our football coach, Randy Shannon, says, nothing good happens in Miami after midnight. Maintain a vigorous dose of daily physical exercise and consider techniques of stress management. Women in this age group should have a regular yearly visit to a gynecologist (or more often as needed). Pap smears and HPV vaccines are supported with strong data indicating they reduce the risk of deadly cervical cancer. For those with a strong family history of a specific disease, such as cardiovascular disease or diabetes, make sure you consult a physician at least yearly to assess your inherited risk for such health disorders.

For those who are young parents, remember to give yourselves a bit of breathing room to remain fit as a parent and better organized. As they say on airplanes, “If there is a drop in oxygen in the cabin, a mask will fall from the ceiling. Place it over your face before helping those around you.” Make sure you provide your children with regular visits to the pediatrician for adequate prevention, vaccinations, and vision and hearing screenings. And remember that as an adult you set the stage for the health of your children. If you smoke, your children are exposed to second-hand smoke. If you eat fatty goods and don't watch your weight, your kids may do the same. Set an example for your children by eating healthy, exercising regularly, and controlling TV viewing and other time spent on electronic devices. When children become capable of learning about money and how to tell time, also teach them how to measure caloric intake; it is never too early to start a good habit.   And critically important for children as well as adults is wearing seat belts in any vehicle! 

In the age group 30-40, the risk of accidents and other injury-related problems is slightly less than earlier in life. More attention needs to be placed on prevention of chronic illnesses. It is recommended that both men and women visit their physician for a complete physical exam, including gynecological and breast examinations for women and prostate examinations for men. Blood tests for cholesterol, diabetes, and other chronic disorders are also appropriate. Blood pressure control is critical to avoid strokes, heart attacks and kidney disease. For those at risk, eye examinations are also recommended. Dental hygiene remains a critical factor, not only for oral health but for distant organs such as the heart and vessels. Abstinence from smoking remains critical and substance abuse needs to be addressed, including excessive drinking of alcohol in all its forms. Maintaining regular physical activity is essential. For women having children after 35, we recommend discussing specific risks with your obstetrician. 

For the age group 40-50, watch out, your resting metabolic rate is dwindling and that is challenging. While all calories enter the human organism through food and drink, calorie expenditures come with three types of processes. First is the resting metabolic rate, the number of calories being consumed each day while you are at rest or sleeping. The number of calories consumed during such resting states by all the cells of the organism can vary substantially from one individual to another, but in general it decreases when you reach age 40. Hence, even if you do not change your diet, your likelihood of increasing body mass index becomes greater. A very small number of calories are expended in processing the food and drink you absorb daily. The third way to expend calories is through exercise, which is the only truly controlled way to expend calories. It is critical, perhaps more than ever in your life, to maintain a regular exercise routine as well as a carefully designed diet to keep an ideal weight (body mass index, calculated as the weight in kilograms divided by the square of the height measured in meters: hopefully 25 or below). 

Sleeping is more important than ever as an appropriate amount of rest helps with the “repair” of the organism from eyes to vessels. Hence, lack of sleep can lead to chronic illnesses because of lack of tissue repair. The same advice applies as to younger ages about the need for a regular (at least yearly) visit to your doctor to check for chronic illnesses, and for women our/your gynecologist.  

Additional issues can occur in this age group, for both men and women. Vision can degrade rather rapidly, particularly short-distance vision. The process results from a change in the material that forms the lens of the eye. The lens is normally a rather elastic material that is kept in place and stretched by a group of muscles called ciliary muscles. With aging, and at an accelerated rate after age 40, the transparent lens material becomes stiffer and unable to stretch to adapt to close-range vision. As a consequence, most adults in this age group need glasses to read and perform other close visual functions. 

For women, the 40s is the time of life when menopausal symptoms develop. This is often a complex time as changes in hormone status can be associated with various side effects, in particular hot flashes. Treatments for such symptoms have usually been based on hormone replacement therapy, which has been more carefully studied recently and shown to not be adequate for every woman experiencing menopause and its symptoms. Adequate treatment for menopause symptoms should be sought from your general practitioner or gynecologist.  Furthermore, menopause, which coincides with the end of ovulation and menstrual cycles, can be challenging from a contraception viewpoint, as cycles may become irregular and the end of ovulation misinterpreted. These medical issues require careful consideration and discussion with your gynecologist. 
 
Breast cancer prevention is critical for women, and even at a young age, breast self-examination can detect the presence of new masses. Studies have indicated that starting at age 40, a yearly mammogram helps detect early breast cancer that is more likely to be successfully treated. For women with a very strong family history of breast cancer, genetic testing may be indicated. 
 
For heavy smokers, it is never too late to quit. Finally, if people who have been sedentary start an exercise routine, they should consult their physician about the appropriateness of a stress test before beginning the exercise routine. For all ages, a yearly flu vaccine is recommended. Additional vaccination recommendations should be discussed with your physician. 

The next group is people age 50-60. The recommendations for the 40-50 age group remain relevant to this group, but in addition a few new disorders may become more prevalent. For example, the risk of colorectal cancer is becoming more serious, and you should have a colonoscopy soon after your 50th birthday and every ten years thereafter, unless more frequent studies are recommended by your physician. Furthermore, skin cancers are becoming much more prevalent: melanoma, basal cell and squamous cell skin cancers. A complete annual skin exam is recommended to rule out the presence of such tumors. In a region where sun exposure is unusually high, you should be protected with adequate sunscreen against UV light. It is critical to assess the skin for changes, whether in the form of a lump or a changing mole.

Yearly physical examinations with blood tests including cholesterol measurements and blood sugars are indicated. For those who have a tendency, a greater risk of depression may be developing, and signs of depression including changes in sleeping patterns and moods should be recognized. Prostate cancer becomes more frequent in men and an examination of the prostate every year along with measurement of prostate-specific antigen is recommended. Breast examination and mammography on a yearly basis or more often based on your physician recommendation remain a priority. 

Stroke symptoms (sudden speech impairment, weakness of an arm or leg on one side of the body, loss of balance, loss of vision in one eye, etc.) need to be watched for. Signs of deep vein thrombosis (swelling of one arm or one leg with no swelling on the other side) also must be recognized.  Impotence in men becomes more frequent and should be discussed with your physician as solutions are often available. Memory loss needs to be recognized as it may be an early sign of Alzheimer’s disease. Emphasis on a healthy lifestyle with a lot of strength training to maintain muscle mass and other exercising (including of the mind) and good rest plus a well calibrated diet is even more critical to wellness for this age group than ever before.

In the age group 60+, chronic illnesses become increasingly prevalent, particularly cardiovascular disease and cancers. The recommendations applied to ages 40-60 remain valid for this age group, but greater attention should be placed on recognizing signs of chronic illnesses such as ischemic heart disease. Chest pains, with radiation to the left arm or the neck, shortness of breath, lightheadedness, nausea, heartburn, excess fatigue, and passing out are important signs that suggest the development of ischemic heart disease. Cancer prevention with breast examination, mammography, prostate examination, PSA testing, colonoscopy, and skin examination are more important than ever to shelter your body from the dreadful complications of such illnesses. 

A few more words of advice that are likely to improve your health: Keep a sense of humor throughout your life; allow your body to recover with adequate sleep; don’t abuse anything but try to enjoy life; do not engage in risky activities; commit enough time to maintaining a harmonious relationship with your spouse, important other, or partner; if you have them, spend time with your children; exercise your body and your brain. Learning does not end with school -- we should always push ourselves to learn something new whether a language, an art, or a science, every day. The brain needs such stimulation to continue its maturation and successful function. These remedies are particularly good to prevent the development of depression, which is responsible for nearly 20 percent of disability in our society.

We hope that you will find these tips helpful and remember that we are just one phone call away if you need additional information on any of these issues. If you are interested in learning more, the 2007 recommendations of the U.S. Preventive Services Task Force, which was organized by the Agency for Healthcare Research and Quality, contain the best evidence-based medicine to date on all aspects of adult preventive medicine:
http://www.ahrq.gov/clinic/pocketgd07/pocketgd07.pdf. 
The agency has also issued more concise recommendations, “Women: Stay Healthy at Any Age” (http://www.ahrq.gov/ppip/healthywom.pdf) and “Men: Stay Healthy at Any Age” (http://www.ahrq.gov/ppip/healthymen.pdf). More information about children and adolescents is available at http://www.ahrq.gov/research/childfind/childfind.pdf.

As you know, the Miller School is fortunate to have an extraordinary Wellness Center, open to all in our community. To get more information, take a tour, and join the Wellness Center to support your 2008 wellness goals, please call 305-243-7600.   

We wish you an absolutely smashing year 2008!

Warmest regards,
Pascal J. Goldschmidt, M.D.
Senior Vice President for Medical Affairs and Dean

William O’Neill, M.D.
Executive Dean for Clinical Affairs

Bart Chernow, M.D.
Vice President for Special Programs and Resource Strategy