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Ask the experts.

Q I get different numbers each time I check my blood pressure using my home monitor. Is this a cause for concern??

A Blood pressure naturally rises and falls depending on what you're doing, so it is normal to see some variance in readings. However, there are some steps you can take to keep the readings as accurate as possible. If possible, check your blood pressure at the same time each day. Blood pressure tends to be higher in the mornings, but if you see a sudden, sharp rise, consult your doctor.

Avoid doing anything beforehand that might cause your blood pressure to spike, including smoking, drinking caffeinated beverages such as coffee, exercising, and/or using medications that can raise blood pressure, such as decongestants. When you're taking a reading, sit in a comfortable chair with your feet flat on the floor, and relax for a minute first. After you position the cuff, rest your arm on a table, bent so that your upper arm is level with your heart. Don't talk or move during the reading.

I'd also recommend that you take your monitor to your doctor's office to get a comparison to the reading your doctor's monitor registers, as home monitors may not be accurate straight out of the box. He or she also can check that you're using the right size cuff, as too small or too large a cuff can affect the accuracy of the reading.

Rosanne M. Leipzig, MD, PhD

Geriatric Medicine

Q Is it true that air pollution could raise my risk of cognitive decline, and if so, how can I protect myself given that I live in the city?

A While air pollution and poor air quality have long been associated with respiratory and cardiovascular complications, 2012 research suggests it also may accelerate cognitive decline. In the study, the longer a person was exposed to high levels of air pollution, the faster his or her cognitive decline occurred. Previous research from Mexico City (which has some of the highest air pollution on record) shows that even young adults there already have Alzheimer's pathology.

More research is needed to determine whether interventions that reduce air pollution exposure can reverse or slow cognitive decline in people who have already been exposed to high levels of airborne pollutants. However, given the deleterious impact of pollution on heart and lung health, it is advisable to limit your exposure to polluted air.

If moving to a less polluted community isn't an option for you, try to avoid going out at times when the roads are heavily congested. If you need to drive at those times, keep your windows up (although keep in mind that some contaminants will likely still enter your car). You also might want to consider having a high efficiency particulate air (HERA) filter installed in your home to remove pollutants from indoor air.

Sam Gandy, MD, PhD


Q I'm scheduled to have a mastectomy, and my doctor broached the topic of breast reconstruction to me. Can you clarify whether this is a safe option for me at age 66?

A Older women often pass up breast reconstruction after mastectomy, but the procedure is usually safe no matter what their age, and studies suggest it improves women's quality of life after mastectomy.

There are two main types of breast reconstruction, and both involve several stages or surgeries. One requires that a tissue expander be inserted behind the chest muscle--these are filled with saline over time to create a space for an implant. The other main type of reconstruction uses a woman's own tissue, usually from the lower abdomen, to reconstruct the breast.

Recovering from either type of reconstruction can last from six to 12 weeks, but may take longer if chemotherapy or radiation is needed as well. There are some risks to consider--these range from painful and restricted arm and shoulder motion to breast asymmetry and nerve loss due to implant ruptures and implant hardening. However, older women are not at any greater risk of complications than younger women.

Marco Harmaty, MD

Plastic and Reconstructive Surgery
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Publication:Focus on Healthy Aging
Article Type:Interview
Date:May 1, 2013
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