Rx for Readers: Reduce the risks!

I am a 64-year-old woman who has recovered from breast cancer. I am grateful, but I am nervous because I read recently that the most common cause of mortality in breast cancer survivors is heart disease. Do chemotherapy and other cancer therapies increase the risk of cardiovascular disease? Is there any other connection? I am somewhat overweight but not obese. Besides losing some weight, what else can I do? Why didn’t my oncologist tell me that I had this risk?

E.H., Kiryat Ono

Prof. Nathan Cherny, senior oncologist and director of the cancer pain and palliative medicine service at Jerusalem’s Shaare Zedek Medical Center, replies:

Everyone dies of something. Yes, it is true that if your cancer doesn’t recur (which it probably will not) and you do not succumb to bad drivers, terror, war or dementia, the most common cause of death in the Western world, including Israel, is heart disease or stroke.

Indeed, for all persons who are have a relatively low risk of dying of cancer and for people who never get cancer, the most common cause of death is cardiovascular or cerebro-vascular. It is not that the treatments of the disease have made a major increase in risk. (There are some very minor changes in risk associated with left-chest-wall radiotherapy, doxorubicin chemotherapy or Herceptin.) Rather, when you factor in not dying from the disease that has been cured, this is what awaits all of us as we age.

The good news is that for most cancer survivors, the actuarial curves for overall survival (how long we live) start to approach those of the “never-ill-withcancer” about five to 10 years after treatment, when the risk of dying of cancer starts to become very small.

Everyone – cancer survivors as well – can reduce their risk of heart disease by not smoking, controlling blood pressure and cholesterol and – probably most important – getting regular exercise. For survivors of breast cancer like yourself, healthy diet and regular exercise also reduce the risk of cancer recurrence.

Thus, a healthy lifestyle has a double advantage.

So if you are not yet doing it, get into a routine of 30 minutes to an hour of moderate exercise at least three times per week; get your blood pressure and cholesterol checked; eat fish, vegetables and fruit for fiber and antioxidants; and keep the steak and lamb for infrequent special events. Finally, celebrate in being able to be a survivor.

I have more than once bought shoes or sneakers that seem to fit properly, yet after wearing them several times my big toe (usually the left one) begins to get black and blue. What could be the reason for this? I can’t buy a larger size, since the shoes are really too big. I wear orthotics because of high arches and always put in the orthotics when I try on the shoes.

L.F., via email

Dr. Cobi Lidor, an orthopedist with special expertise in feet at Assuta Medical Center’s Basil Heights Medical Center, a subsidiary of Maccabi Health Services, replies:

When this problem occurs, it is best to go quickly to a foot specialist so the problem can be diagnosed. You didn’t indicate what your weight and height are. The heavier and taller you are, the riskier it is. I can’t tell from your question if you wear proper stockings or socks. If you don’t, friction could be causing the problem. It is best to purchase soft shoes that are flat or near-flat with round toes so they will not press on your feet and they will be more comfortable.

Buy shoes that are half a centimeter longer than your foot.

But the most important thing is never to buy shoes at the start of the day. Buy them at the end of the day, when your feet are somewhat swollen. If you are buying new shoes for a special event like a wedding, don’t buy a pair very soon before but weeks before. This gives you a chance to try them out and make sure they are comfortable before the event. If they are not comfortable, you have time to buy different ones.

Also, when you go to the shoe store, don’t just put on shoes, look at them in the mirror and buy what looks good.

Walk around as much as you can in the shoes so you can really feel if they fit and are comfortable.

I am a 25-year-old woman, and I love the pointy platform high heels that are sold today because they are fashionable and make me look sexy. But I know they are not good for me. For example, they gave me an ingrown toenail and an infection on one foot recently. Do you have any advice for having healthy feet even if I wear these shoes from time to time?

P.T., Tel Aviv

Dr. Lidor answers this question as well:

Many of the women’s shoes sold today are a disaster for healthy feet, including platforms and incredibly high heels that stretch the Achilles tendon and squeeze the toes and put a lot of pressure on  them.

They also put women at risk for falls. As an orthopedist, I cannot endorse wearing these at all. If you suffer from wearing them, you shouldn’t.

But if you refuse to budge and wear them only for special occasions, there are some things you can consider: You should wear clean stockings; if they are dirty, bacteria and fungus could enter the toes and get under the nails, which should be cut straight across. Don’t wear tight hosiery.

Make sure your feet are soft and clean.

Soak your feet for a short time in lukewarm, soapy water and dry them carefully, including between the toes. You can also apply moisturizer. Try very hard to limit the time you wear high-heeled shoes.

Pressure from the shoe on your toes can prevent the nails from growing properly and cause an infection. Infected ingrown toenails (medically known as onychocryptosis) are not only unpleasant but can also be dangerous. In diabetics who do not have normal feeling in the extremities, untreated infections could turn into serious complications and even require amputation.

Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 91000; fax your question to Judy Siegel-Itzkovich at (02) 538-9527; or email it to jsiegel@jpost.com, giving your initials, age and place of residence.