DEAR DR. ROACH: I am a 66-year-old female. Even though I use gym weight machines for upper and lower body three times a week, walk daily for 2 miles and spend 15 minutes on a motion trainer at the gym, I cannot stand up easily after gardening on my knees or getting on my knees on the floor. Is there anything I can do to regain the ability to get up off the floor/ground without a struggle? — S.C. ANSWER: It sounds to me that despite your good exercise regimen, you may have weakness specifically in your thighs — what we call “proximal muscle weakness.” There is a very long list of medical illnesses that affect these muscles specifi cally (my textbook lists 28 different diagnoses), including common conditions such as low thyroid levels and vitamin D defi- ciency. I would recommend a visit to your doctor for a careful exam of your nerves and muscles to see if my suspicion is correct. Your doctor may suggest a trial of vitamin D. If no medical cause is found, I would work specifi- cally on strengthening the hip muscles, which extend the thighs. A trainer at the gym can show you those exercises.
. DEAR Both of my daughters are in their 40s and going through menopause (according to their doctors, so they are not guessing about this). Both daughters are having such severe migraine headaches
that they are missing work (and both are practically workaholics who usually are able to tough it through physical problems). The migraines occur almost every time they have a period. Migraines are not daily during that time, but episodic (usually one per period). They do not have migraines except during menses. One daughter was put on estrogen, which has helped her cramping, but she still is getting migraines. The other daughter has been referred to three physicians who all told her there was nothing that could be done but go on estrogen. She is now 49 years old and concerned that if she goes on estrogen at this point, she will simply have the same migraine issues again when she goes off it and wonders if that is actually worth just delaying having to deal with the migraines. Is there any other solution besides estrogen for severe hormonal migraines? — S.S. ANSWER: Estrogen-associated migraine is common. However, it usually is the drop in estrogen that triggers the migraine. That’s the reason many women get
migraines around the time of their periods, as estrogen levels normally decline then. For many women, migraines get worse years before menopause — and by “menopause,” I mean when periods stop altogether. As the periods become erratic, and sleep cycles are interrupted by hot flashes, migraines become worse, as they have in your daughters. However, once periods stop entirely, episodic migraines usually get dramatically better on their own. During the erratic time before menses completely stop, estrogen pills, cream or an insertable ring can be used to maintain a more constant estrogen level, which usually improves the headaches. This can be slowly tapered off when the periods could be expected to be finished. Readers may emai l questions to ToYourGood- Health@med.cornell.edu. To view and order health pamphlets, visit www.rbmamall.com, or write to P.O. Box 536475, Orlando, FL 32853-6475.