Ideally, your doctor is your equal partner and advocate for your health. But sometimes, even a doctor you generally respect prefers different approaches than you do. That can be intimidating, but remember no one knows more about your body than you do. An insurance company or HMO policy can also complicate matters. You have to take the best advice and information from your health care providers, and work within the insurance system as best you can, but then make your own decisions according to what feels right to you. That’s just what Lynn did when she found herself facing a gynecologist who was a great believer in prescription hormones for almost every woman, and an insurance company that wouldn’t pay for the bone density testing that could help her make crucial decisions about what, if any, drug therapy her bones needed.
Lynn was already a decade into menopause, and had long ago decided against hormone replacement therapy, when she began to get worried about her bone density. She’d never been bothered by any other menopausal symptoms, but now it seemed like she was reading more and more about the dangers of low bone density every day, and it was a topic of much discussion among her friends. Each time she went to the gynecologist, he urged her to reconsider taking estrogen, reeling off its benefits to bones and the heart. Then, at her last annual exam, the doctor told her she’d be a good candidate for the newest drug for low bone density, Evista, which had estrogenlike protective effects on the bone, without the increased risk in breast cancer that makes HKT unacceptable to many women.
Lynn’s insurance plan wouldn’t cover a bone density scan. Her doctor was satisfied with a standard x-ray from an old knee injury from when she was perimenopausal that showed she had “good bones” (in a general sense). He just assumed she’d been steadily losing density since, given her age and her refusal of HRT. He sent her home with an Evista sample and a prescription slip.
Instead, she had a bone density screening at a health fair at her neighborhood community center, where it cost only $35 for a DEXA scan of her wrist. She never even broke the seal on that Evista sample because the scan showed only a tiny loss in density compared to average. And who knew if a —.01 standard deviation even meant any loss at all in her particular case? She knew she was past the years when bone loss is usually most rapid, so she decided that she’d keep on with what she’d been doing for her health for years, with no pharmacological intervention. After all, it appeared to be working!
Lynn has been a competitive synchronized swimmer for over twelve years, and counted her bone density as a bit of proof that swimming can help develop your bones, just as traditional weight-bearing exercises can. She knew the party line was that in the water you don’t have the same gravity pulling against your bones, and that without it, your bones wouldn’t be building in the same way. While she did believe that water workouts were much easier on the joints, she agreed with the articles in her swimming magazines about how anything that worked muscle against bone would build both muscle and bone. She knew for sure that it took a lot of strength and hard, hard work to make graceful water ballets look effortless.
She began lifting weights twice a week years ago to build her strength for the lifts required in her sport. She is on the treadmill three or four times a week—any day she doesn’t swim—for half an hour. She swims at least three times a week, for an hour to an hour and a half each time, which would include 3/4 mile of laps just for warm-up. This combination keeps her limber, strong, and aerobically fit so she can keep up with the much younger swimmers on her team without batting an eye.
To control high cholesterol levels, Lynn started eating a largely vegetarian diet, with chicken or fish once or twice a week, and meat a handful of times over the course of a year, and she believes that plays a large role in keeping her bones healthy as well. She’s careful to get three major sources of calcium in her diet every day, usually milk on her morning cereal, a yogurt or cottage cheese with lunch, and something dark green and leafy with dinner. She takes 500 mg of calcium in a supplement to get up to the 1,500 mg total recommended for menopausal women not taking HRT, along with vitamin E (for her heart) and a multivitamin with trace minerals to cover all the bases.
After such an encouraging bone scan, the only change Lynn made was to add even more soy to her diet to reap the benefits—to both her bones and her cholesterol level—of phytoestrogens. She’s long been a fan of tofu—in fact, goes out of her way to get to a particular store where they sell excellent fresh tofu—but now is using a soy protein powder regularly, sprinkled on her cereal and in her yogurt-fruit smoothies. The only other major thing she’s done as a result is to encourage her friends to get their bone density tested and to talk to her swimming buddies about how much the sport has done to keep her healthy.
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