Joan’s Boomer Blog

Creative Commons License photo credit: Divine Harvester

The subject of healthcare is a vital one for boomers and seniors and the more information we have about it the better off we will be when it comes to Medicare and choosing a plan.

Today I have a guest post by Laura Rossman, who heads up marketing and communications for iQuote by Longevity Alliance, an independent national insurance broker who helping seniors compare Medicare insurance plans from multiple providers.

By Laura Rossman

If you have retiree health insurance benefits from your employer, you better plan for your costs to increase this year. Here’s the grim news for retirees pocketbooks:

• 78% of employers expect to increase premiums on retiree health insurance in the year ahead.

• 53% of employers plan to increase cost-sharing in the year ahead.

So for many that’s a double whammy of monthly premium increases plus increases in co-pays and deductibles. The research is from consulting firm Aon Hewitt.

While most retirees stay with their employer retiree health insurance, as costs rise some may find that shopping for an individual plan could result in more cost effective Medicare coverage. It largely depends on how much of a subsidy the employer provides which could include payment of Part B premium, health insurance premium and or drug insurance coverage.

If you decide to look at Medicare health plans, begin by understanding the difference between a Medicare Advantage and a Medicare Supplement plan. Medicare Advantage generally requires use of a network and you pay co pays and deductibles as you use services.

You’ll also have to pay Part B premium and probably a Medicare Advantage premium though there are some zero premium plans. Medicare Supplement is a more comprehensive plan- paying the 20% of costs that Medicare does not cover - that gives you a choice of where you go for care.

So if you see your retiree health care insurance costs creeping up, you might want to take a look at individual plans. But that won’t save you from higher costs in the future as those plans tend to see price increases each year, too. And make sure before you make any change in your insurance you speak with your former employer.

Once you exit the plan, the door closes.

With over 20 years in health and senior care services, Laura Rossman heads up marketing and communications for iQuote by Longevity Alliance, an independent national insurance broker who helping seniors compare Medicare insurance plans from multiple providers.

Today’s guest post is by Lauren Bailey and the topic is sex, baby boomers and healthy aging.

Anti-aging facial creams and a nutritious diet may help keep the wrinkles away and help keep your body in shape, but according to health experts, the real secret behind the fountain of youth may be found in the boudoir.

According to recent study conducted by HealthyWomen, a national independent organization that is dedicated to women empowerment and education, having sex at least four times a week can make couples appear 10 years younger than their actual age. Of course, the problem remains at the fact that most women have sex out of obligatory duty not pleasure, and thus don’t want have sex as often. But intercourse four times a week has many health advantages that can keep you looking younger and living longer.

Why is this exactly? Health experts say that sex causes you to release adrenaline, noradrenaline, and dopamine-three chemicals that work to fight against aging factors such as depression and stress. They also activate the production of a special growth hormone that is specifically designed to block the absorption of free radicals in the air such as pollution and smoke that can cause deep wrinkles.

Lastly the three chemicals released during sex have also been linked to help ward of cardiovascular diseases, fight high blood pressure and improve renal function-all factors that can contribute to a longer, healthier life. But if you are not married and choose to use “casual sex” as an age-stopper, don’t forget about the importance of protection.

According to another study, there is an alarming number of baby boomers who do not engage in safe sex practices-especially among Caucasians. The study, which was commissioned by Indiana University, surveyed the sexual habits of 5, 865 people ranging between the ages of 14 to 94 and concluded that a majority of those over the age of 50 had unprotected casual sex-91% of men did not use condoms when having intercourse with a casual acquaintance, and 70% didn’t use condoms when having sex with someone they’d just met. While women on the other hand were a bit more careful, a good chunk still did not use protection.

Experts say that this behavior can partly be contributed to the fact that most baby boomers dive-into the dating market after years of having unprotected sex with a spouse and thus think that having unprotected sex with others is safe. But remember: no matter how old you are, sexually transmitted diseases are still a serious issue.

By-line:

This guest post is contributed by Lauren Bailey, who regularly writes for accredited online colleges. She welcomes your comments at her email Id: blauren99 @gmail.com.

Baby boomers are at the age when they will deal not only with their own medical issues and the maze of Medicare requirements, but also with their parents’ who will suffer different health crisis requiring care and oversight. Recently, I planned a visit to my parent’s home to help out after my dad’s hip replacement surgery and as things fell apart, I am seeing first hand how difficult it is to navigate this maze. If you are not aware right now of what Medicare covers and how it works, and what proposed deep cuts will do to this program which will affect you personally, it might be a good time to find out.

My own home is nearly 2,000 miles away from my parents and as we get older and our parents get older, this becomes problematic. Up until now, my 80+ year old parents have been in good health for the most part. Last month, though, my dad had a hip replacement. He was doing very well getting back on his feet, and then he suffered a mild stroke.

We are lucky in that the stroke wasn’t as bad as it could have been but at 86 years of age, the comeback road will be very long for him. I personally, am also lucky that my parents have my two sisters and their husbands living close by who are able and willing to devote time to seeing that my parents now get the help they need. While I’ve been here, though, it’s become my responsibility as the oldest in the family, to help them.

My dad was on the local fire department board for 40 years of his life and they vowed he would never pay for ambulance service. When we called them at 230 am after my dad woke up completely numb on his left side, the guys who came out knew my dad and they gave him wonderful care. So back to the hospital we went.

We spent several early morning hours waiting to see what tests found and what would be done. At first, they even contemplated sending my dad home with us, until he showed he couldn’t even walk with a walker. They admitted him for 48 hours observations status for more tests.

Here lies the rub with Medicare. By Monday, even before a proposed MRI was done, the “discharge specialist” had visited with a dizzying array of options but the bottom line was, dad would be discharged and since he was on observation status and not inpatient status, Medicare would not pay for further care, ie transfer to a rehabilitation facility (read nursing home with name change). Medicare would also not pay for him to stay in the hospital to see if he would regain some ground and we could manage at home. Forty-eight hours was all he was allowed.

I decided very quickly that my dad couldn’t be left at the hospital alone. The doctor had come in Monday morning, without us there, and asked him where he wanted to be discharged to and Dad said “home.” It was perfectly obvious to me, he couldn’t come home yet but the people at the hospital, with their little Medicare forms, were not above talking to a very sick and befuddled 86 year old man and demanding solutions from him.

My advice to anyone who lands in this situation, whether it is a spouse or parent, be present, be observant, ask questions! In the guise of routing out “medicare fraud and abuse” very sick old people are being put out onto the street with few options. My parents pay $10,000 a year for insurance and yet, if my dad was to receive more care, it would be up to my parents to pay, upfront, the $250 a day out of pocket. My parents, luckily for our family, have money saved for this situation but for those who have no resources, or even a family to fall back on, would actually be put out onto the sidewalk, I guess.

What saved our family, and I’m forever grateful for this, was my father’s physical therapist at the hospital. She said my dad seemed very motivated to get better and she recommended an intense inpatient therapy program at a larger hospital about 35 miles away. She spoke to the discharge planner and the doctor and on her recommendation, they all agreed if he could get into this program, it would help him.

So, as luck would have it now, since everyone recommended this intense therapy, then Medicare will pay for that. The discharge specialist at the hospital hadn’t even thought of this option so we were lucky.

So now my dad is in this program for at least 2 weeks, then after that, Medicare will cease to pay for any other care facility and he will come home. The staff at the hospital did tell us, however, if he needs home care or more out-patient therapy, then Medicare would pay, at least as far as we know.

(My dad was told at the inpatient rehab facility that to get in there the patient needed motivation to get better, doctor’s recommendations and good insurance! Which means my parent’s supplemental insurance is kicking in,)

If you’re a baby boomer or have parents who are on Medicare, it would be wise for you to keep abreast of the coming changes to funding. President Obama is proposing $320 billion in cuts to Medicare and Medicaid, programs which have already seen serious cuts.

Here is an article I found which lays out the coming cuts.

I know first hand, at the little fire department in our town where my dad was on the board, they have had cuts to the Medicare funding of ambulance service runs. Since there are many seniors on Medicare in this community, and since the fire department’s operations depended on Medicare funding, they are now tittering on the edge of serious financial problems.

My niece works at the hospital my dad was in and she said everyone is bracing for cuts to services after the Medicare cuts go into effect. Departments have already laid off personnel so they are operating on less staff.

My husband and I have kept up somewhat with Medicare funding issues because we are on Tricare and Tricare’s funding levels are tied to Medicare. I can tell you that even living in a very large area, we have trouble finding primary care doctors who will take Tricare patients because of red tape and low rates of re-embursement. The doctors we do get are overworked and push pills just to get you out of their offices (my personal opinion!)

I think many times we don’t keep abreast of these issues because they are daunting and confusing and we feel there isn’t anything we can do anyway. I’m not sure myself what can be done except to write to your Congressmen and tell they they will be voted out if they don’t stand up against cuts to Medicare funding.

If you’ve had experience with Medicare and Medicaid on either a personal or professional level, I’d love to hear from you. If you have any ideas of what readers can do to become involved, please feel free to comment. Medicare funding and getting older are issues we all need to be informed about.

Medicare is a very important subject for baby boomers and retirees. Since I’m not an expert in this field, I turned to expert Ross Blair is President and CEO of Plan Prescriber, Inc., a leading provider of comparison tools and educational materials for Medicare-related insurance products.

Here Ross presents tips to help you avoid paying too much for your prescription medications.

Is the donut hole closing fast enough for all Medicare beneficiaries?

In 2011, many Medicare recipients could hit the Medicare prescription drug donut hole faster, and pay more out-of-pocket on their way to the donut hole if they don’t have the right Medicare prescription drug benefit.

Why? The average cost of brand-name prescription drugs increased by the highest percent in 11 years according to an analysis by Barclays Capital.   Prices for some drugs increased by more than 10%. Popular drugs like blood-pressure pill Benicar® (29.3% increase), blood thinner Plavix® (13.2% increase), and cholesterol drug Lipitor (12.4% increase) all saw double-digit increases.

Last year 3.8 million Medicare beneficiaries got $250 rebate checks hitting the donut hole. In 2011 a 50 percent discount on brand-name drugs is available. But, price increases in the cost of branded drugs can negate some of the savings from that discount. And, drug prices may increase more as drug manufacturers try to maximize last-minute profits on popular drugs like Lipitor®, Lexapro®, Seroquel®, and Plavix® that go generic in 2011 and 2012.

What does this mean for people on Medicare? It means that you could hit the Medicare prescription drug donut hole faster, pay more out-of-pocket on your way to the donut hole, and while you’re in the donut hole if you don’t have the right Medicare prescription drug benefit.

The Medicare prescription drug coverage gap - the donut hole - begins when the customer and insurer spend a combined total $2,830 on medications. That number includes the co-pays and deductibles paid by the customer. Once the customer reaches the donut hole, they pay for pay for their own drugs but receive a 50% discount on brand drugs and a 7% discount on generic drugs. The donut hole continues until the customer has used $4,550 worth of branded and prescription drugs. This year the customer only pays 50% of the price for a brand-name drug, but the entire price of the drug counts as out-of-pocket spending, which gets them out of the donut hole faster. Once you’re through the donut hole, you reach the catastrophic coverage level. At this point,  your drug plan steps back in to cover almost all your remaining drug costs for the rest of 2011.

Here’s where it gets complicated. All Medicare prescription drug plans are not the same. If the medication you’re taking isn’t covered by your prescription drug plan, you’ll have higher co-pays, and pay more out of your own pocket before you reach the Medicare prescription drug donut hole, while you’re in the donut hole, and once you reach the catastrophic coverage level.

Here are four tips to help you avoid paying too much on prescription drugs:

1.       Take advantage of available discounts on prescription drug costs: By enrolling in a Medicare Advantage plan with Medicare Prescription Drug Coverage (MAPD) or a Medicare prescription drug plan (PDP), you get the benefit of these 50% rebates on Medicare prescription drugs when you hit the donut hole.  An analysis of 337,000 user sessions between January 1, and March 31, 2010 on PlanPrescriber.com estimated that PDP enrollees would save an average of $586 by switching to a lower cost plan.  Actual savings on prescription medications depends on a variety of factors like geographic location, the actual plan selected and other factors. Benefits and coverage may vary between plans; the average savings examines only plans presented by PlanPrescriber that offer only prescription drug coverage.

2.       First-time enrollees be sure to choose the right plan: Medicare prescription drug plans do not have to cover the same drugs in the same quantities or for the same price. Medicare only requires Medicare PDPs to cover two drugs in each therapeutic class. If your drug isn’t on the plan you choose, expect to pay more. There are several PDP comparison tools available online like PlanPrescriber.com and eHealthMedicare.com. A good online tool can point you to the lowest cost plan based on the specific drugs you take.

3.       With an existing Medicare prescription drug plan, talk to your doctor about alternatives: Outside of the annual enrollment period, most people cannot switch drug plans. If you’re one of those people, and you feel you are paying too much for your drugs, talk to your doctor about other possible copayment/coinsurance exceptions and medications that may be available to treat you. Then, use a plan comparison tool to see if any of those alternatives are covered by your existing plan. If so, your doctor may be able to switch your prescription to save you money.

4.       Talk to an expert if you have questions: Advice from a licensed agent doesn’t cost you any additional money. The price of the plan you choose must - by law - be the same, no matter how you enroll in it. You can contact a PlanPrescriber agent at no cost by phone at 800-404-6968 or call your State Health Insurance Assistance Program (SHIP). SHIPs receive federal funding to counsel people with Medicare questions. The federal government has created 1-800-MEDICARE to provide information about Medicare coverage.

Ross Blair is President and CEO of Plan Prescriber, Inc., a leading provider of comparison tools and educational materials for Medicare-related insurance products.

Medicare enrollment can be a confusing issue. Today I have a guest post to help you plan for Medicare Enrollment by Ross Blair is President and CEO of Plan Prescriber, Inc.

In 2011, a record 2.8 million Americans will turn 65 and become eligible for Medicare. If you’re a newcomer to Medicare in 2011 there is one piece of advice I recommend you take to heart: don’t wait until the last minute to start planning your Medicare enrollment.

Relax. You’re not locked into the same Medicare plan forever. You can change your Medicare Advantage coverage and prescription drug coverage once a year, and some Medicare supplement plans allow you to enroll at any time. If you take your time before your 65^th birthday, the decision-making process should be easier.

Learn the basics. Trying to understand Medicare can make anyone’s head spin. Medicare is a different type of health insurance plan than you may be used to, so before you get inundated with sales pitches and unsolicited advice, try to understand the basics.

There are three basic ways to cover yourself: Original Medicare (Part A and Part B), with a Part D prescription drug plan; Medicare Advantage Plan, which can include vision, dental and prescription drug coverage; and a Medicare Supplement plan which fills certain gaps in Original Medicare.

Figure out what you can afford. It sounds simple, but if you haven’t estimated what your retirement income will be, start doing that math before you enroll in Medicare.

Calculate your income after Social Security benefits, pensions, IRA and 401(k) savings, etc. Then, create a list of monthly expenses including rent, utilities and food, as well as other things like your prescription drug costs. Subtract your expenses from your income to develop a good sense of what you can afford to spend on Medicare on a monthly basis.

Next, look at your savings and think about what kind of a Medicare deductible you can afford if you have a large medical expense.  Once you know what you can afford to pay each month for premiums and prescription drugs, as well as what type of annual deductible you could afford if you have an unexpected illness or injury, you’re ready to start comparing plans.

Consider your health when making decisions. Your health status will help determine the type of Medicare coverage that best suits your needs. Talk to your doctor about the types of illnesses you’re at risk for later in life, based on your current health status and family history.

Some Medicare Supplement plans don’t allow you to enroll later in life, and those that do may cost you more money. So, you want choose a plan that will fit your budget today, and in 15 years. And, if you take prescription drugs use a drug comparison tool, like PlanPrescriber.com, to help you pick a plan that covers your drugs at the lowest possible cost.

Consider your travel plans. Whether you travel internationally or to different states, it’s important to understand the circumstances under which you’ll be covered. There are Medicare supplement plans that provide travel emergency health care coverage when you’re in foreign countries. If you migrate to another state for several months each year, look for Medicare plans that will cover you outside of designated networks. However, original Medicare and most Medicare supplement plans are good in any location in the United States.

Question brand loyalty. Some Medicare supplement and Medicare Advantage plans come from companies you’ve heard of. If there is a brand you trust, investigate their coverage and consider it as an option. But, price is also an important factor. Don’t pay more for the exact same coverage, because you like the name of the insurer.

All Medicare supplement plans are required to offer the same benefits, but the costs can vary widely. So a Medicare supplement K plan from one insurer must – by law – cover the same services as a Medicare supplement K plan from another insurer in your area. Again, using a good online comparison tool helps you compare plans and prices side-by-side so you can make an informed decision.

Ask for help. Medicare is complex, but there are a number of resources available online, by phone and in person. In addition to online sites, you can contact your State Health Insurance Assistance Program (SHIP) for assistance. SHIPs receive federal funding to provide free local health insurance counseling to people with Medicare. Also, the federal government has created 1-800-MEDICARE to provide information about Medicare coverage and costs, as well as health plan options.

Giving yourself the time to research and consider your Medicare coverage options can pay off.

Ross Blair is President and CEO of Plan Prescriber, Inc. (www.PlanPrescriber.com <http://www.PlanPrescriber.com>), a leading provider of comparison tools and educational materials for Medicare-related insurance products.

The Centers for Medicare and Medicaid Services (CMS) has neither reviewed nor endorsed the information provided by PlanPrescriber.

Most of us are familiar with goal setting. We set goals to lose weight, to build a career, to save money for

Our dogs enjoying our future retirement home

retirement. How often did you achieve the goals you set out for yourself? Do you really know an effective way to set and achieve retirement goals.

I recently wrote an article Preparing for Retirement - It’s About More than Money which has proven to be one of my most popular posts. Well, goal setting for retirement is about more than money too so it’s important to learn more about how to set and achieve goals for a creative retirement.

How to Set Goals and Achieve Them

1. Deciding on Your Goals

Believe it or not, this is the step that most often stumped me. I read many books on the Law of Attraction and the number one advice they all give is Know What You Want. It seems like a no-brainer but setting definable goals is hard for many people.

When setting goals for retirement, create a list of questions for yourself to help you define your idea of a happy retirement:

• Where do I want to live when I retire?
• How do I want to spend my days?
• What things in my life bring me happiness that I’d like more of?
• What new things would I like to try out in retirement?
• Do I need extra income after retirement?

Come up with a list of your own questions and brainstorm for a while. Write down all the ideas that come to you, no matter how far fetched.

2. Look at your list and focus on the goals that seem most important to you. Simplify the wording and Write it down! Be clear and focused. Write your goals on 3×5 cards and put them where you will see them every day.

In her book Write It Down, Make It Happen: Knowing What You Want And Getting It, Henriette Anne Klauser says “Writing down your goals and aspirations is like hanging out a sign that says ‘Open for Business’.

Writing down your goals, looking at them every day, brings you one step closer to achieving them.

3. Now that your goals are formalized and written down, create another list of goals within each, steps to bring you closer to the desired goal. For instance - My husband and I decided we’d like to retire near a lake. Our goals within that goal were:

a. Decide what specifications we wanted in property. We wanted 3-5 affordable acres, someplace where we could put an RV while we built our house. Many lakes in Texas have subdivided tracts of land with acreage but have strict rules about leaving an RV on the property, unless there is already a house and a covered area to store it.

That was our first requirements and our “wish list” included being able to have chickens or perhaps small farm animals, like alpacas or sheep. We looked for about 4 years and had about given up when we found the perfect spot that filled all of our goals for a retirement home. It proved to be even more affordable than we’d every dared hope for too.

b. Our next goal within the first one is to shop for an RV. We listed goals for that too and since we want to buy used, it may take some time to find the perfect one.

The idea is to take each goal and ask yourself “What can I do today to help me achieve that goal?” (I learned that from my short career selling Mary Kaye). If your goal is downsizing to a smaller home, you can scope out real estate ads, getting a feel for what’s out there. If you want to move to another place when you retire, you can research best places to retire.

My husband wants to spend time playing golf when he retires, something he hasn’t done in 25 years. So he bought some newer clubs (he was told his old ones were antiques now-lol) and he goes out a few times a month to play some golf and shoot practice balls, looking forward to the time when he can spend even more time on it.

If one of your goals is to set up a new business for some retirement income, you can begin progressing toward that goal by doing it on a small scale before retirement or doing research to see what you’d like to do, something you’d enjoy.

By coming up with active steps that you can take now toward your goals, it keeps your mind focused on them and also makes them seem closer because you are actually doing something toward making them a reality.

Create a Vision Board

This is another tip I learned from the Law of Attraction folks. I bought a cheap bulletin board to hand over my desk. On it are pictures I cut from magazines of RV’s the garden I want with raised beds and paths, the back deck where I want to sit in evenings at our retirement home, places we want to visit in our RV.

I look at those pictures every day and imagine my retirement life when those pictures are my reality. This helps to put energy and thought behind any goal you have.

Be Open to Things that Can Help You

Once you’ve written down those goals and decided what steps you can take to bringing them closer, be open to what happens. I believe we do attract what we think about the most. If you’re focused on those goals, you may start seeing sign posts along the way to help you toward them.

Retirement goals are different than other goals like losing weight or career goals. Retirement goals should be about fun and what you want from your life after retirement. Believe it or not, it does take planning and goal setting to get the most our of these years.

I read an article recently that suggested “older” people were starting to balk at being called seniors. Even AARP was beginning to use the term “medicare eligible” for those over a certain age. Baby boomers seem to be the generation who never thought we’d get old and now that we’re here, we don’t like being reminded of it.

How we see ourselves and how the world sees us are, of course, two different things. I read lots of blogs about boomers, seniors and retirement. Some bloggers have the general opinion that boomers should just move out of the way and die to make room for the younger generation. Others say the boomers will be the saving of the economy, while yet others say the current economic mess is the fault of greedy, materialistic boomers. The peace and love generation turned into evil Wall Street broker types and ruined the country. One blog I read yesterday suggested we should collectively pay off the national debt when we die by reinstating the estate tax and taxing social security - just as a favor for the younger generation.

Personally, I get tired of my generation getting the blame for the world’s ills but I know when all these generation X, Y, Z people turn 55 they will be singing a different tune. Wasn’t it our generation who said “Don’t trust anyone over 30?”

I guess, when it comes to aging, we always tend to see ourselves through rose colored glasses (maybe we’re losing our vision, along with our waistline?) I find myself listening for people at my Y exercise classes to mention their age and then I think “Wow, I’m older than them but I look so much younger!’

Of course, one place us boomers don’t mind the term senior is when it comes to “senior discounts!” Here on my blog, posts about senior discounts are among the most popular. I guess since some of these discounts can start as young as 50, and since they do involve getting a bargain, we don’t think of it as something negative.

I remember one time quite a few years ago, I went into Taco Bell just to get something to drink. The high school kid waved away my money and said, “It’s free.”

I said “Really, are you sure?” I thought, what a nice young man, giving me a free drink. It wasn’t until quite some time later that I found out Taco Bell gives free drinks to “seniors.” I guess to a high school kid, all of us “old people” look like we qualify so they don’t even bother to ask.

When I was in my 30’s I did a short stint as a waitress in a Mexican restaurant. Our restaurant gave senior discounts and I remember not liking to insult anyone by asking if they were old enough to receive one. Some people were insulted if you did ask them and they weren’t old enough. Other people jumped right in there and told you they were old enough and expected to get it.

Fast forward to 2008. I was 58 years old then and checking out at Kohls. The 30-something woman at the register informed me it was senior discount day and asked if I qualified. I said, “It depends on what age it is.” She said the senior discount started at age 60. I laughed (thinking of course that I certainly didn’t look 60!) and said “No, I’m not old enough yet.”

At this point she got rather insistent, really wanting me to have that discount. She said, “Well, is it near your 60th birthday? I can still give it to you.”

Gone are the days when we fear insulting someone about their age! -lol.

How we define ourselves is important. The term “Older American” seems to be catching on.  I always liked “baby boomer” because it makes us sound young and important but maybe that’s getting passe. Advertisers are sure struggling to define us, having suddenly woken up to the improbably idea that our age group too spends money, not just that coveted 18 to 39-year-old age group. Although ads directed at us older Americans most often involve hemorrhoid creams and cholesterol medications, rather than the latest iPhone or iPad.

Personally, I think advertisers are missing to boat there. Us senior, boomer, medicare eligible, older Americans also covet iPhones and iPads and all the latest gadgets.

Do you have any thoughts on what you’d like us older people to be called? If senior is out and -Heaven forbid - elder, what new word can we come up with to define ourselves? I’d love to hear ideas. Maybe we can start a new trend.

The following is a guest article by Lovera Wolf Miller, M.D., F.A.C.O.G. N.C.M.P., and David C. Miller, M.D., M.A., D.A.B.P.M., N.C.M.P. authors of WOMENOPAUSE: STOP PAUSING AND START LIVING. It provides vital information for women about hormone therapy.

There is probably no single subject concerning women’s midlife health that is more disputed than the use of menopausal hormone therapy. It is a subject with enduring questions. The proper use of hormone therapy for menopausal women has been contested for the past one hundred years, and the arguments are not likely to go away anytime soon. Scientific investigations of the past decade have revealed four important new caveats concerning the effectiveness and safety of postmenopausal hormone therapy, and that is the subject of this communication.

Before launching into the new information it might be useful to briefly review the old. The fact that menopausal hormone therapy quickly and reliably reduces or eliminates menopausal symptoms has never been seriously disputed. Vasomotor symptoms prevalent during perimenopause and postmenopause, including hot flashes, night sweats, vaginal dryness, and insomnia are corrected with hormone therapy consisting of estrogen or estrogen plus progesterone for women with a uterus. The long-term disputes have to do with whether or not menopausal hormone therapy is safe and whether it aids in the prevention of serious health diseases.

#1. The window of opportunity: It is now quite clear that menopausal hormone therapy (MHT) is safer if it is initiated at or near the time of menopause, (menopause being defined as the final menstrual period). Certainly for women who start taking hormones within ten years of menopause the risks of MHT are substantially less. In fact, for healthy menopausal women there appears to be only substantial long-term health benefits. This “window of opportunity” was not understood at the time of the WHI publication in 2002. That study lumped all ages of women together and since there was a preponderance of older postmenopausal women the data was skewed toward potential harm of MHT.

Subsequent reanalysis demonstrated a striking difference. If women began MHT within ten years of menopause, all of the health benefits became clear; reduction of cardiovascular disease (the #1 killer of women by far), reduction of osteoporosis, reduction of dementia, reduction of depression, reduction of hypertension, reduction of diabetes, reduction of metabolic syndrome, and to top it off, a reduction of all cause mortality by 40% (including an important reduction of breast cancer death). If women initiate MHT 10 to 20 years after menopause (no periods and no hormones for 10-20 years) there appears to be less benefit in prevention of cardiovascular disease, dementia, and so on. If women initiate MHT more than 20 years after menopause (no periods and no hormone therapy for more than 20 years) there appears to be an increased risk of cardiovascular disease for the first year of therapy that is higher than the incidence of women who remain off of MHT, but that risk disappears after the first year and then the risk remains below non-hormone users for all subsequent years. That piece of the puzzle, the “window of opportunity” is considered the most important new information about both the safety and effectiveness of menopausal hormone therapy in the prevention of serious health problems for women.

#2. Trasdermal estrogen therapy has advantages over oral estrogen pills: Orally consumed hormone therapy had been the standard mode of taking HRT in the past. Recent data points out the benefits of taking estrogen through the skin as apposed to taking it by mouth. All orally consumed hormones are absorbed from the intestines into the portal vein that drains the gut and transports the hormones directly to the liver. The liver processes the hormones into modified hormones, and at the same time the liver gets stimulated into producing inflammatory compounds and clotting factors.

These products from the liver may be responsible for the increases in cardiovascular disease seen in older postmenopausal women who had increased risks when initiating hormone therapy. If estrogen is administered through the skin, then estrogen bypasses the liver and goes directly to the target tissues unchanged and without stimulation of the inflammation or the clotting factors. In this way, transdermal estrogen may have all of the benefits known to standard HRT but none of the major risks (heart attacks, strokes, and blood clots). It may be important to remember again that the risks of heart attacks, strokes, and blood clots with hormone therapy was only seen in women who initiated hormone therapy beyond the “window of opportunity”. The majority of women who begin menopausal hormone therapy do so to control the symptoms of menopause (hot flashes and so on) and they are all safely within the ten year time frame.

#3. 17 Beta-estradiol is “BodyIdentical” and is preferred over non-human estrogens: Human women make estrogen primarily in their ovaries and the predominant estrogen is chemically called 17 Beta-estradiol, or E2. The chemical structure of this molecule has been known for over fifty years.

There is only one place in the universe where this substance is made naturally—within the human female ovary. 17 Beta-estradiol does not occur in horses, soybeans, yams, or anywhere else. It does not grow on trees or come from organic gardens. Importantly, there is no such thing as a human estrogen donor. An exact duplicate of naturally occurring 17 Beta-estradiol is available by prescription. It is produced under the strictest quality controls, tested, and approved by the FDA for use by symptomatic menopausal women. When it is applied to the skin as a spray, patch, cream, gel, or via the vagina BodyIdentical estrogen is distributed throughout the body and works exactly like a woman’s estrogen that she made naturally during her reproductive years. 17 Beta-estradiol that is BodyIdentical relieves all of the estrogen withdrawal symptoms of perimenopause (hot flashes, night sweats, insomnia, vaginal dryness, and osteoporosis) and helps prevent all of the estrogen deficiency health-related problems (heart disease, stroke, dementia, diabetes, and depression). There are no advantages of taking menopausal hormone therapy that is not 17 Beta-estradiol transdermal BodyIdentical.

#4. Menopause Hormone Therapy is safe: There are several legitimate reasons some healthy women choose not to take menopausal hormone therapy. Safety should not be one of them. If a symptomatic menopausal woman initiates transdermal 17 Beta-estradiol BodyIdentical hormone therapy at or near the time of her menopause there are documented long-term safety benefits. The case could be made that MHT is the safest drug around. If one were to compare the use of other commonly prescribed medications such as aspirin or Lipitor, BodyIdentical estrogen has a superior safety/benefits profile.

When all the dust is settled, the estrogen therapy trump card is a 40% reduction in overall mortality. Forty percent! Nothing even close to that has been shown about aspirin or Lipitor. Also, as drugs go, 17 Beta-estradiol is not really a drug in the same sense of the word. A woman’s body naturally makes estrogen up until menopause but it never makes any Lipitor. Lipitor is a drug introduced into the biology of a person to counteract the effects of high cholesterol (since none of us seem eat right or exercise enough!) in the hopes of reducing cardiovascular disease and death. Menopausal Hormone Therapy does the same thing by resupplying estrogen that the ovaries used to make. That’s good news.

For a few women, hormone therapy is not recommended: undiagnosed vaginal bleeding, recent heart attack, hormone induced blood clots, severe liver disease, and a personal history of estrogen positive breast cancer. All told, for the typical fifty year old considering whether or not menopausal hormone therapy might be right for her, only about 3% are excluded by contraindications.

#5. Lifestyle: Many women underestimate the immediate and long term benefits that exercise and a whole food diet has on both the control of menopausal symptoms such as hot flashes, as well as the prevention of serious diseases such as cardiovascular disease and diabetes.

For a complete and balanced discussion about how to be healthier at sixty than you were are forty read our book: WOMENOPAUSE: STOP PAUSING AND START LIVING by Lovera Wolf Miller, M.D., F.A.C.O.G. N.C.M.P., and David C. Miller, M.D., M.A., D.A.B.P.M., N.C.M.P.

www.womenopausebook.com

www.menopause.org

I always laugh when I hear about people who have a million dollars saved for retirement and want to know if that’s enough! I suppose there are people out there who have millions saved, but I don’t know any personally. Money is undoubtedly important in planning for retirement, especially for us non-millionaires, but retirement is also a time for reassessing your life and deciding what things are most important to you in the second half of life.

Some questions to ask yourself when you’re facing retirement in the coming years:

1.  How do I see myself spending my days?

If you are working and choose a retirement date, what do you see yourself doing on day 1 or day 2 of retirement? How about day 352? If you retire with no plan in mind for how you will spend your time, you may just end up being one of those old guys or gals who sits on the front porch in a rocking chair. There’s nothing wrong with relaxing but you’ll soon get bored if that’s all you do.

Chances are, if you are working still, your days are busy and purposeful, even if the purpose is collecting a paycheck so you can put some away for the long-awaited retirement. To be successful in retirement, you will still need a purpose for getting out of bed. What will your purpose be?

When your days stretch endlessly before you, it’s important to have a plan for how you will use them.

2.  Ask yourself what your interests and hobbies are right now.

Do you have interests and hobbies beyond working and paying bills. I have to tell you, these aren’t really classified in the hobby section. If you don’t have any interests that excite you and are fun to do, maybe you should acquire some before retiring to help you pass the time later on.

If money is an issue it might be better not to take up a hobby like knitting (you should see my yarn stash!), collecting old cars or golf. These type of hobbies and interests can get expensive. If you are interested in these things anyway, figure out how to turn a profit from your hobby. Teach classes, write a blog or ebook to support your hobby.

Some interests don’t have to cost money, or at least not much. Interested in Civil War history? Visit Civil War battlefields, research battles on the internet or volunteer at a local museum. Do you love miniature railroads? Find a miniature railroad museum which needs help. Volunteering is a wonderful way to share your interest or hobby with others and still feel you are giving a valuable service.

Some hobbies or interests are free to do and might make you a buck or two. Write that great American novel you’ve always wanted to write or take up hiking, which is great exercise too.

3. Am I healthy and if not, what can I do about it?

The pursuit of good Health can be very time-consuming and retirement is a great place to put your mind to being healthier. Take up walking daily or join the local Y and take classes. You can make friends or join social groups at the Y or at Senior centers too.

Grow a garden so you have plenty of fresh veggies to eat. I have a friend who gets free cuttings for berry plants and other perrenials for his garden. You can also trade seeds or get heirloom seeds so you can save them from year to year if money is an issue. If you life in the city, you can still grow lots of food in containers.

In retirement you can spend some time reading about any health issues you may have and what you can do about them. Many doctors shove a pill at you and head out the door, partly because they don’t feel that patients will follow their advice anyway about what else they can do to improve the situation.

if you need to lose weight, retirement is a great time to put your mind to this health issue. You now have time to keep a food journal, get out and exercise and read up on healthy eating.

4.  Have I made time to cultivate friendships to last through retirement?

When you retire, it’s important to have friends to spend your time with. If you don’t have a few good friends now to have lunch or coffee with, plan on where you’ll look for some when you are retired. Joining a hobby or volunteer group, seeking out the local senior center or Y, or taking a class are good places to begin.

5.  What do I still want to accomplish in my life, now that I have some time?

Maybe at one time in your life, you thought when you retired you’d read every Shakespeare play ever written but do you still want to do that? Goals change over time and when you’re facing retirement it’s a good time to reassess goals. What is important is that you have goals! Choose a top 10 list of things you want to do in retirement - and I don’t mean fixing that hinge that’s been squeaking for the past year. Think bigger. What have you always wanted to do but never had time for?

I used to do a lot of beadwork and when I didn’t have time for it anymore, I thought of just selling my bead stash, books, etc. My mom talked me out of it because she said, “You never know if you might want to take it up again when you have time.” So I kept everything and “when I have time” beadwork is there if I want to do it.

My mom used to sew for us as we grew up and when she retired and had time, she took up quilting. She turned out the most beautiful quilts and we were all able to benefit from her hobby.

I’m sure there are many more important questions you can ask yourself when preparing to retire that have nothing to do with money. What are some of the things you’ve considered?

The holidays are around the corner and coming up with a gift idea for someone who uses a walker or is confined to a wheel chair can be challenging. Giving the gift of health is especially important in these circumstances so here are a few ideas:

• Clip-on Cup Holder for Walkers, Wheelchairs Drinking lots of water is very important for health and with this clip on cup holder, someone confined to a wheelchair or using a walker will always have water handy.

• Walker Basket with Beverage Holder Tray - Walker Accessory This handy basket clips onto the front of the walker to keep water bottles, magazines, medications, just about anything, always within easy reach.

• Walker or Wheelchair Insulated Cup Holder Another cup holder, but insulated to keep drinks hot or cold.

• Carry-All Walker Pouch - Navy Carryall that attaches to the front of the walker in various colors.

• Lotions and bath salts to soothe tired muscles.

• Bain D’esprit - Vanilla Almond Spa Bath and Body Gift Set Relaxing bath and skin products - all put together in a beautiful basket.

• Sloping Orthopedic Seat Cushion - Medium Firm - Arthritis Product for comfort when sitting for long hours.

• A massager for sore, tired muscles.

• Case Logic Lap Organizer for Wheelchair to keep many items within easy reach.

These are just a few healthy gift ideas for someone using a walker or confined to a wheelchair.

Here are more healthy gift ideas suitable for anyone on your list.

Here are some terrific healthy gift ideas from Dr. Andrew Weil.