In previous columns, we have discussed what happens to a woman during perimenopause and into menopause. Changes in the estrogenic environment create an “estrogen roller coaster” that is associated with a myriad of symptoms including hot flushes or flashes (they are the same thing), vaginal dryness, and difficulty sleeping that may leave a woman exhausted.

Changing Sex Lives
During perimenopause, women’s sexual desires may be affected by the symptoms they experience. Many symptomatic perimenopausal women are so tired from sleep problems resulting from hot flushes that their sex lives may suffer. Let’s face it, when we are exhausted, we like to rest. Curling up with a warm blanket and some Ben and Jerry’s ice cream may be more enticing at times than having “Ben” or “Jerry” in our beds.

It’s important that our partners acknowledge that the refusal is not from a lack of attraction or sexual interest. It is probably from sheer exhaustion. Perhaps resting together, cuddling and sharing that pint of Ben and Jerry’s may recharge a woman so that she has energy for other types of “playing.”

Vaginal dryness is a normal phenomenon associated with menopause. Vaginal lubrication decreases during menopause. Lubricants such as Astroglide and K-Y Jelly can increase moisture to help improve intercourse.

Handling Mood Swings
Women undergoing the physical changes of menopause can lose their patience with family members. Husbands or children may describe these women as “crazy” or “hyper.” These mood swings result from exhaustion, which is a result of the hot flushes. It is important that your family realize that your body is undergoing changes that may affect your mood, memory and cognitive function. Assure them that your “crankiness” is not a result of loss of love for them.

However, discuss these changes with your healthcare provider to rule out other causes such as thyroid disease, which is more common in maturing women.

Memory Loss
During this transition, you may forget where you put your keys, if you turned off the oven, or if you locked the door. These memory and mood changes may be the result of not getting enough sleep because of nightly hot flushes. It is important to discuss your symptoms with your healthcare provider so that you can determine whether you are a candidate who may benefit from hormonal therapy.

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When you do your initial screening and interest profile on members, this is the time to note high-risk candidates. These members should be targeted for active recruitment into set programs with schedules. It is easier to fit your workout into your daily calendar if you have a specific appointment to keep. There should be a rotation of programs that people can sign-up for about every eight to 12 weeks. This allows you to get new members into new programs pretty regularly.

Another way to involve people is to find out what their interests are and begin smaller “clubs within the club.” Diane Hess, formerly of the Lakeshore Athletic Club in Chicago, had over 10,000 members to manage. She organized mini-clubs to give people the feeling that they were part of a smaller club, a more intimate group. She got local vendors to sponsor the programs with different mini-clubs for just about every interest.

There was a bicycling club, culture club (theater, museums, restaurants, music), adventurer’s club (field trips for hiking, skiing, shooting, etc.), in-line skating club, investors club and many more. Each mini-club had anywhere from 10 to 200 members, all paying a small fee so that they could get their own newsletters and be notified of upcoming events. These mini-clubs were successful at providing people with ways to meet other people with like interests, and they were profitable for business.

Whether you have a small club with limited membership or a large club with high membership numbers, all fitness facilities have people, and these people like to be with other people or they would have stayed home to work out.

Even if they don’t participate in your events, they like to know that they are available, and they will talk about them to their non-member friends who, you never know, may be inspired to join and participate.

While these smaller programs may not initially seem related to fitness, you can often get people to cross train in preparation for one of these trips. For people going on ski trips, canoeing, whitewater rafting or shooting, there are sports-specific exercises that can help them prepare for these activities. They can build endurance and train specific muscle groups. What could be more motivating (except of course having to fit into the same size gym uniform you had in high school for a reunion photo!).

Another benefit of a newsletter is community exposure. Says Kove, “Our newsletter is sent to various local and national publications, local radio and TV stations, as well as health and fitness columnists, public organizations such as chamber groups, and schools. Radio and TV [stations], and newspapers will pick up information regarding events at our center, and run it within their mediums. The schools will include relevant information within their school newsletter.” She continues, “The newsletter also is a synopsis for reporters to see the events and activities within our center, and, on countless occasions, [they have called] me to get additional information to run a story or teaser. This exposure is invaluable to us.” What a simple way to get the word out, and take advantage of some free advertising for your facility.

An unexpected benefit of your newsletter may be ad dollars. Prairie Athletic Club in Sun Prairie, Wis., features ads from local merchants in its newsletter. Those ads can be fee-based, or you can set up an agreement with merchants to pay for the cost of printing and mailing the newsletter in exchange for a free ad.

Another benefit is possible sponsors for programs or events. Highland Park offers cross promotions with local retailers, and runs information on its cross promotions in its newsletter. Says Kove, “These are promoted [in our newsletter], along with the retailer’s logo, which is loved by the particular cross promoter.”

“When a facility is accredited, it means that it has met strict criteria and measured up. It’s proof that you’re doing a good job,” said Bridwell, head of the accredited student health center at the University of Maryland in College Park, Md.

“Accreditation is a good sign that the school is taking extra steps to provide the best care possible,” added Harriet Bogdanowicz, marketing and communications manager of the AAAHC.

The biggest obstacle to accreditation is often cost, which can range between $2,000 and $5,000, an amount that can represent a significant portion of the total annual health center budget at some smaller colleges, Bridwell says. Also, some university officials view the accreditation process as labor intensive, which adds to their reluctance.

Even if a school’s health center is not accredited, parents and students can learn a lot about it by asking good questions, such as about the staff’s credentials, Bridwell says. “Students and parents need to ask for a ‘Guide to Services’ that outlines what a health center does and how it works. Most universities and colleges have them. And parents need to talk to their children about the limits of the facility.”

Bridwell also advises students and parents to visit the health centers at schools that they are considering. “Check the facility’s hours — when are they there on the weekdays and the weekends? Is it clean? Does it appear to be well run? Are people wearing nametags identifying themselves as doctors, nurse practitioners or simply RNs? Ask what kind of outreach and education they do for students.”

Services vary widely from center to center. Some college health operations offer a registered nurse on staff who decides whether an ill or injured student can stay at the facility or should be sent to a hospital. The registered nurse can hand out rx drugs.

That’s far different from the services offered at the University of Maryland, for example, whose health center is accredited and offers a full array of services, including a staff of internists, allergists and gynecologists. They offer acupuncture, massage therapy and biofeedback, nutritionists, and three psychiatrists.

Michel’s parents Marlene and Laurence Goldberg, of Fort Lee, N.J., sued Northeastern for malpractice, arguing that the university had put their daughter in danger by relying on nurses rather than more highly trained and costly doctors to treat her. “No one ever thought to take a blood test,” complained Marlene Goldberg, still incredulous over what she believes was a lack of proper care for her daughter. “Many of these college health centers just a put a Band-Aid on students who come to them, and then they just send them off.”

Over the next five months, Michel, a high school athlete who normally was in robust health, visited the Lane Health Center at least three times, suffering from fatigue and chills. It wasn’t until one of her last visits that Michel finally saw a doctor. But the doctor agreed with the nurses’ diagnoses, telling Michel to take aspirin, drink plenty of fluids and get rest.

Two weeks later, on February 28, 1993, the 18-year-old coed died.

Michel had been suffering from anemia brought on by a rare and virulent form of leukemia, called acute myelogenic leukemia. Treating her complaints as symptoms of standard college-age ailments, the center did no tests to determine whether some deeper cause might be at work.

These details emerged only after Michel’s parents sued the school for malpractice, contending the clinic did not provide anywhere close to proper care, such as administering a blood test.

In February, a Massachusetts jury agreed, awarding the Goldbergs $4 million almost seven years after Michel died. The university has not decided whether to appeal the decision. Officials contend that Michel received proper care, but they have begun examining the possibility of accrediting its health center.

“We still believe that the proper care was given to the student,” said Siobhan Houton, a spokesperson for Northeastern University.

As thousands of students head off for college this fall, few of them or their parents are thinking about their school’s health center and the kinds of services it can provide. But judging from the wide variability in care on campus these days, medical authorities suggest that parents and students ask tough questions about whether those clinics are prepared.

Learning about the clinics, the availability and credentials of doctors on staff, and even the hours of operation could make the difference between catching a cold and succumbing to pneumonia.

A growing number of healthcare advocates have been calling for accreditation of the nation’s more than 1,500 student health centers. Such a move would ensure uniform standards of care, they argue. But there has been little movement on the matter over the past decade. Only 107 two- and four-year college and graduate school healthcare facilities have been accredited by the Accreditation Association for Ambulatory Health Care (AAAHC), an organization that inspects student health centers. About 70 were accredited a decade ago.

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How many times have you heard a frustrated member complaining that they are exercising regularly but haven’t lost a pound? Performing the same activity repeatedly at the same level leads to increased efficiency — which eventually results in lower caloric expenditure and fat loss from the activity. As efficiency increases, the body uses fewer of its secondary muscle groups for movement and proprioception (balance). In fact, research shows that by sticking to just one activity, exercisers actually can decrease the amount of calories burned by as much as 25 percent.

For the average exerciser whose goal is to lower their percentage of body fat, cross training is important to minimize the conditional efficiency that results from performing the same exercise repeatedly. The goal of cross training is to work alternate muscle groups. This enhances muscle utilization and can minimize isolated muscle fatigue, thereby encouraging greater intensity or longer duration. Increased intensity or duration of exercise then results in additional caloric expenditure.

By cross training and participating in some activities that the body isn’t conditionally efficient in, exercisers can break plateaus. This is one of the key advantages of cross training. Furthermore, cross training can help improve overall fitness levels by encouraging use of different muscle groups and placing different stresses on the muscles. This is particularly true when including both cardiovascular and strength training as part of a workout routine, because they produce different physiological results.

Other physiological and psychological benefits of cross training include reduced boredom, prevention of burnout, lowered risk of injuries, and enhanced member morale and retention.

It is no surprise that exercisers who repeatedly perform the same activity are likely to become bored or burned out. Engaging in different exercises breaks the mold of the daily routine, provides manageable variety and can help prevent burnout. In addition, cross training can help reduce the risk of injuries. Excessive repetition in one specific exercise or activity puts exercisers or athletes at risk for overuse injuries, which can lead to loss of training time and an inability to compete.

Sports such as running, tennis and basketball can predispose participants to specific overuse injuries. Some of the common repetitive use injuries are patellar tendonitis, anterior or posterior tibial tendonitis (shin splints), plantar fasciitis and rotator cuff injuries.

Although specificity and the S.A.I.D. principle are important in planning an athletic training program, by incorporating cross training, athletes can help maintain the intensity and quality of their workouts and minimize the risk of injury. Diversifying an exercise routine through cross training provides recovery time for highly-used muscles, thus reducing the chance for an overuse injury to occur. Regardless of whether it’s on-season or off-season, incorporating different activities at various intensity levels ultimately can maximize athletic performance.

Then, after the bikes arrive, don’t let anyone on them except the instructors for the first week. Have the instructors work out together during prime time to build the members’ interest.

If you plan to charge for classes, offer three to five classes to each new participant so they can get excited about the program before it arrives, too.

Find out if there is a cycling club in your area. This is a great place to make contact with cyclists who may want to teach. It’s also a great place to find cycling enthusiasts; these people will love this program.

Impaired lung growth and development occur independently of respiratory problems associated with exposure to environmental tobacco smoke, also known as ETS or “second-hand smoke,” during childhood.

“Maternal smoking in utero has persistent effects throughout adolescence and perhaps longer,” said Dr. Frank D. Gilliland, the study’s principle investigator and associate professor of occupational and environmental health at the University of Southern California School of Medicine. “These findings show that we can’t just emphasize ETS in terms of kids’ health.”

The study considered the lung function of more than 3,000 school children between the ages of 10 and 16 drawn from 12 Southern California communities. Parents of the study subjects completed a questionnaire on maternal exposure to smoking during pregnancy, and current and past household ETS exposure. The children also underwent lung function testing.

Results showed that children whose mothers had smoked during pregnancy experienced reduced respiratory airflow. This finding could not be attributed to household ETS exposure.

Gilliland and his colleagues are now working to determine how early in pregnancy respiratory impairment occurs, and if that impairment depends on how much the expectant mother smokes.

“Women need to stop smoking not only for their own health, but also for their unborn kid’s health. Since we don’t know how early in pregnancy the damage occurs, it would be prudent to avoid smoking at all if a woman is thinking about getting pregnant,” said Gilliland.

Other studies have shown that smoking during pregnancy is strongly associated with poor fetal growth. The carbon monoxide inhaled with cigarette smoke reaches the fetus and diminishes its ability to absorb oxygen, resulting in significant oxygen deprivation. This lack of oxygen is an important cause of low birth weight. Low birth weight increases the risk of health problems in infancy and childhood.

According to a 1995 study in the Journal of Family Practice, maternal smoking during pregnancy was responsible for an estimated 32,000 to 61,000 low birth weight infants each year.

Other complications from tobacco use during pregnancy include decreased blood flow to the uterus, which results in diminished transfer of essential nutrients from mother to fetus.

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“No, no, no. The sea creature needs to eat Helen so that his genes recombine to break the evil spell so that he can once again be a knight in shining armor. Apparently, he’s a distant relative of hers. Mine, too, which I don’t understand, but he needs female genes, nonetheless. Otherwise, he would’ve eaten me,” says Ted.

“Oh. A sea creature looking for specific human genes to break an evil spell. Why didn’t you just say this in the first place,” Jake says.

“You see, I tell people that I come here to speak with my kids every morning, but this is only partly true. I definitely talk to my kids, but also, during the first week, I began communicating psychicly with a sea creature. During this episode, it promises to show itself,” explains Ted.

Jake hears this and thinks aloud, “That sounds almost… erotic.”

“Excuse me?”

“Oh, wait. I just remembered something Penny said,” Jake says. “So, you have to feed Helen to the sea creature? That’s heavy stuff. I came here to explain that I voted for you because Brian and Clay told me you were going next but geez, Ted, communicating with a sea creature sure beats my adventure stories. Would you mind if I told everyone that it was, in fact, me doing this after I saved the sea creature’s life while lost at sea?”
Unbeknownst to Jake and Ted, something surfaces in the distance for a quick breath of air…

Reward Challenge
Sensing too much lovey-dovey action at Camp Chuah Jai, the producers begin a series of challenges geared to alienate each other. Jeff Probst explains the challenge:

“In a moment, I’m going to stun everyone with a quick ‘Pick-a-partner-on-your-marks-get-set-go!’ statement leaving Jake abandoned, lost, hurt, and confused. I’ll say it so fast that people won’t have time to plan and instead just pick the person next to them. Because Penny was next to Ted and because Jake stood next to Clay who was standing next to Brian (and is secretly falling in love with Brian and his Hollywood-permanently-nice hair and delicious ass), Jake will be left to wimper and wallow in a pool of rapidly-aging self-pity…”

“Excuse me, Jeff,” Clay interrupts. “How do you know what’s going to happen? You’re just explaining the rules of the challenge.”

“Understand this: You are but pawns, little puppets we control back in the editing room. We can make anything happen that we think will improve ratings,” Jeff laughs maniacally. Everyone else squirms.

“After you pick partners, the three teams must put their thinking caps on and devise ways to build little bridges across these little towers. Because thinking caps are required, whomever partners with Jan will lose.

“This will leave Ted & Penny to compete in a live-fire military training drill against Clay and Brian. You’ll have to crawl beneath this contraption. If you raise your heads too high, you will be shot and our ratings will skyrocket.

“Unfortunately, Penny can’t think of anything but her wedding that’s planned but a few months from now. She’s worried that if she leaves the planning to her fiance, he will think of stupid sh`t for the ceremony because that’s just what guys do when they plan weddings. Deep in thought, she doesn’t lift her head high enough for our guys to kill her, but she still loses, which I guess is the same result.

“The next stage is called the ‘Yank off Clay’s arms’ course. Clay will get boosted to the top of a wall and then Brian and Ted will pull down on Clay’s arms until they get yanked off in a very explicit and gross act of TV sensationalism.”

“Cool,” Penny says.

“I’m not sure if I’m gonna like this challenge,” Clay says.

Jeff smiles lovingly, “And Brian will win the walking across the bamboo pole challenge. But it won’t be him who does this part. Instead, a poor kid with old, ratty shoes will be forced to run the course in the place of the wealthy, two-cars-in-the-garage, white grand piano, babe-wifed Brian.

“He will then choose Clay to go with him on a special Thailand day on an elephant that farts.”

Helen is always the skeptic, “Oh come on. You’re just making this up. An elephant that farts?”

Meanwhile, Tom had the most brilliant idea while flapping his arms, “And I’m going to have this feather in my ass…”

This is how Tom described Boran’s distress signal (dialect included): “We’ve got a black man with white… thangs on. We’ve got a big fat man with a flag waving (and a feather stuck in his butt crack). We’ve got two little skinny men with flags running around… a woman in her THONG, thar. We’ve got a young lady shakin’ and bakin’ up thar. I don’t know what else we could do. If that ain’t gonna stop the plane, I wanna talk to the pilot!”

Boran clearly had the best design. It had color. It was out in the open. It had butt cracks a-shinin’. However, Linda gave a far greater reason for losing…

“I believe there are a lot of spirits out here and I believe our Idol Goddess will not live in a home with conflict… And that’s why she left us. She went to find some peace. I believe that. I BE-LIEVE that.”

I would believe this if the Samburu lost while having the same distress signal design. However, their signal sucked. So maybe instead of the Idol Goddess going somewhere to find peace, she instead went with the team who had a clue as to how to build distress signals.