Menopause-Update
As soon as it becomes available, the latest news from the medical, scientific and pharmacological industries will be presented here. It will be written in non-scientific, non-medical language.
HRT Help
HRT or hormone replacement therapy has suffered a highly publicized setback. The National Heart, Lung, and Blood Institute of the National Institutes of Health announced that the Women's Health Initiative (WHI) study; evaluating combined estrogen and progestin use in postmenopausal women was halted. The healthy postmenopausal women in the halted segment of the WHI series of randomized trials were taking what is called combined hormone replacement therapy. The women had an intact uterus and were receiving two hormones Premarin (a specific brand of estrogen) and progesterone. After a review of early data, the study safety monitoring board concluded that the risk of combined HRT use in this study population outweighed the benefits. However the other part of the study, women who had had a hysterectomy and were taking estrogen alone is continuing. The study reported if 10,000 women take the hormones for one year, are compared to 10,000 women who don't, in the hormone group, eight more will develop invasive breast cancer, seven more will have heart attacks, eight more will have strokes and eight more will have blood clots in their lungs. The benefits were six fewer cases of colorectal cancers and five fewer hip fractures. Clearly the risks outweighed the benefits.
So what should the estimated six million American women who are taking HRT do? Taking into consideration that significant risk was observed after an average of 5.2 years of use; short-term use to treat hot flashes and night sweats may be appropriate. In a press release by Wyeth the manufacturer of the combined HRT used in the study, Dr Victoria Kusiak, vice president of clinical affairs stated that even though the studies findings were significant we need to recognize "the critical role combination HRT plays in… [treating the symptoms of menopause] for healthy women beginning therapy in early menopause". Her sentiments were echoed in a statement by the American College of Obstetricians and Gynecologists (ACOG) "Hormone replacement therapy for the treatment of acute menopausal symptoms, when indicated, continues to be appropriate for short-term use without an apparent increase in risk of breast cancer for up to 4 years." Dr. Jacques Rossouw, a study author commented that in women already taking combination HRT for short-term relief of menopausal symptoms "the benefits are likely to out weigh the risks".
The consensus seems to be, if you are already on HRT or suffering from hot flashes and night sweats, short term (4 years or less) of HRT seems safe and effective.
If you don't have a uterus, because you have had a hysterectomy, you can continue on HRT.
If you are taking HRT for more than 4 years for the symptoms of menopause your doctor will probably recommend an alternative treatment. Treatments can include antidepressant drugs herbs such as black cohosh, soy foods or high dose vitamins.
ACOG also recommends:
- Women at risk for heart disease who choose to discontinue use of combined estrogen and progestin therapy should explore alternative therapies to hormone replacement, including the use of (cholesterol lowering) drugs and lifestyle modifications such as regular exercise and smoking cessation.
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Women at risk for osteoporosis who choose to discontinue use of combined estrogen and progestin therapy should explore alternative therapies such as Fosamax (alendronate).
Don't Let the Sun Get Down on You.
Now that winter vacation season is here people are uncovering and exposing themselves to harmful ultraviolet radiation. Of course what we are talking about is sunburn, or suntan and the trouble it can cause. Wrinkles are out, and many women undergo expensive and painful treatments from peals and laser treatments to microdermabrasion to rid themselves of wrinkles and blemishes, most of which have been caused by the sun.
Some blemishes can be more dangerous. Actinic keratosis (AK) is called precancerous since it has the potential to turn into skin cancer. AK is usually a red, scaly area that feels rough to the touch. Basal cell carcinoma is the most common form of skin cancer. It usually develops on sun-exposed areas, if detected early the chances of cure are good. Squamous cell carcinoma, the second most common skin cancer, also develops on sun-exposed areas. It often starts out as AK and slowly grows and spreads. Both basal cell and squamous cell can be disfiguring but are usually curable, however malignant melanoma is deadly. Some moles have the potential to turn into malignant melanoma especially those exposed to the sun.
Some people express concern with the chemicals they are applying in sunscreens. "I tell my patients the chemicals will not do as much harm as the sun," says Dr Kristina Conner, Naturopathic Resident at the University of Bridgeport, School of Naturopathic Medicine. "There are more gentle sun screens available at your local health food store which are effective."
What skin type are you?
The Food and Drug Administration recognizes six skin types.
- Always burns easily, never tans, extremely sun sensitive skin -Red-headed, freckles, Irish/Scots/Welsh
- Always burns easily, tans minimally, very sun sensitive skin -Fair-skinned, fair-haired, blue-eyed, Caucasians
- Sometimes burns, tans gradually to light brown, sun sensitive skin -Average skin
- Burns minimally, always tans to moderate brown, minimally sun sensitive- Mediterranean type Caucasians
- Rarely burns, tans well, sun insensitive skin Middle Eastern, -some Hispanics, some African-Americans
- Never burns, deeply pigmented, sun insensitive skin -African-Americans
Whatever type of skin you have, the American Academy of Dermatology recommends the following nine steps to avoid skin damage, wrinkles and cancer.
- Apply a broad-spectrum sunscreen with a Sun Protection Factor (SPF) of at least fifteen.
- Reapply sunscreen every two hours when outdoors, even on cloudy days.
- Wear protective, tightly woven clothing, such as a long-sleeved shirt and pants.
- Wear a wide-brimmed hat and sunglasses when outdoors.
- Stay in the shade whenever possible.
- Avoid reflective surfaces, which can reflect up to 85 percent of the sun's damaging rays.
- Protect children. Minimize sun exposure and apply sunscreen to children aged six months and older
- No shadow...seek the shade! If your shadow is shorter than you are, you're likely to sunburn.
- Avoid tanning beds.
Get Scanned
An add in the New York Times reads; $299 lung scan special or 25% off full body scan. There is no physician referral or appointment necessary. You can walk in off the street pay the fee and get scanned. Scanned or scammed? The results of the CAT scan are sent off to a radiologist hundreds of miles away who then sends you a report in a few days. Of course when you receive the report you can only understand a few key phrases like tumor, mass, cannot rule out malignant process, etc. You then call your doctor, but which one? Your internist says you should see a specialist but he can't see you until next month, after all it is not an emergency, or is it? The surgeon sends you for more tests, which are also inconclusive, and finally says to you "what do you want to do?" After all you decided to go down this path, you found the mass, now no one can be sure what it is, the only way to be sure is to operate. Sound unlikely? As a gynecologist I have found myself counseling a patient in this situation more than once. If you look close enough you can find something unusual in virtually everybody.
"I recommend cat scans of the chest for smokers and other people at risk for lung cancer." Dr. Laurie Margolies Chair of the Department of Radiology at Griffin Hospital in Derby Conn. and a specialist in CT tells ThirdAge. "Spiral cat scans of the heart are also helpful for early detection of heart disease but I recommend it only for those at risk. When they [the mobile scanners] do scans of the whole body they are done without bowel preparation or intra venous dye, so they can miss small tumors."
While the CAT scan companies have their poster children giving testimonials such as "the CAT scan that saved my life", my experience has been different. How many unnecessary operations, with the attendant risks and complications have to be done to save one life? That question hasn't been answered yet. Dr. Margolies cautions, "A whole body CAT scan will expose you to a significant amount of radiation. The truth of the matter is that there is no magic test that's going to be able to detect all cancers. If you think you have a problem of are at risk for a certain disease, see your doctor. Then the right test with the correct preparation can be ordered."
Find a Doctor .com ?
Boston MA.-
As a user of the Internet you may think that with all of the resources available on the web it would be an ideal place to find a doctor or check on your doctors credentials. There are dozens of web sites that claim they can help. Some are commercial like MyDoctor.com others are run by hospitals, governments, health plans or physician organizations. They profile form several dozen to tens of thousands of doctors. There is a great potential for a successful search. However, a recently published white paper characterizes all of the web sites as inadequate.
According to a paper from the Midwest Business Group on Health entitled How We Choose Doctors: What Is and What Could Be, "almost 50 million households in the United States changed, added, or selected a physician within the previous two years." Considering the power of the Internet to compile and search data, physicians from the Massachusetts Health Data Consortium (MHDC), and the Commonwealth Fund (a private, nonprofit corporation established in 1978 to collect and analyze large health care databases), have published a comprehensive report called "Accessing Physician Information on the Internet". The report studied 40 popular web sites and conducted interviews with prospective users.
The authors, lead by Elliot M. Stone, M.U.A., the executive director and CEO of the MHDC, found consumers search for specific information. They want a description of the physician including gender and race, location of the office and average waits, the doctors expertise, his medical school, as well as how well his patients like him, in other words his bedside manner. Other important measures of quality were; number of specific procedures performed, complication rate, complaints and malpractice suits.
The Commonwealth Funds report found that web sites do not include all relevant physicians, some individual state sites do include all physicians licensed in the particular state, however only a minimal amount of information such as medical school and specialty board certification is provided. The prevailing problem with all of the web sites was a paucity of information. When information is provided there is no evidence that the data was verified, often web sites will ask physicians to provide and update their own data. Many of the data fields for each individual physician are left blank with no explanation as to why.
Mr. Stone has called for a minimum set of standards including disclosure statements and notification if independent verification of information has been done. The authors concluded, "…there are pervasive problems with the quality, quantity, and accuracy of information on physician directory websites. Improving these sites should become a priority for those responsible for them and for physicians themselves. As the Internet in general, and individual sites with physician information in particular, continues to evolve and improve, all users will benefit. The best sites will become essential tools in educating and empowering consumers and enabling medical professionals to improve health care."
How Good is your Hospital?
New Haven, CT,--
Do you want to read a "report card" on your local hospital? Would you consider shopping around for "the best" hospital in town? If so then read on. It is increasingly common for consumers to access the Internet for healthcare information and advice, physicians are being bombarded with questions raised by Yahoo! searches. Just how accurate is the information gleaned from web sites, comparing hospital A with hospital B? Dr. Harlan Krumholz at the Yale University School of Medicine, New Haven, CT compared HeahthGrades.com ratings with his own research. Their findings were just published in the Journal of the American Medical Association.
HealthGrades.com is a commercial web site with over one million visitors last year it has been featured in USA Today and the Los Angeles Times. They use a star system to rate hospitals, five star hospitals are the best, three stars are average and one star is poor. Ratings are also available for nursing homes and home health agencies.
Dr. Krumholz and colleges looked at data collected by the Cooperative Cardiovascular Project on patients hospitalized for heart attack. They reviewed over 200,000 separate hospital admissions at 3363 hospitals. Researchers looked at whether an important treatment such as clot-busting drugs or bypass surgery was used. They also compared mortality, and checked if the appropriate discharge medications including aspirin, beta-blockers and ACE inhibitors where given.
Dr. Krumholz found, as a group, five star hospitals had lower mortality rates than one star hospitals and were more likely to use aspirin and beta-blockers. However, there was a wide range of quality for hospitals within each rating group. This means that some of the five star hospitals had higher mortality then some of the three star hospitals; therefore consumers looking to find the hospital with the lowest mortality cannot rely on the star rating system.
The authors concluded, " the ratings poorly discriminated between any 2 individual hospitals' process of care or mortality rates during the study period. Limitations in discrimination may undermine the value of health care quality ratings for patients or payers and may lead to misperceptions of hospitals' performance." In an accompanying editorial Dr. C. David Naylor, MD, DPhil, Dean, Faculty of Medicine and Vice Provost, Relations with Health Care Institutions, University of Toronto, commented on the sensationalistic thinking behind 'Health Care Report Cards' "…skulking in the shadows are the incompetent physicians and surgeons of Hospital X… Protecting them is a legion of spineless clinical managers and hospital administrators. Meanwhile, a fearless band of quality analysts has undertaken to shed light on the clinical performance of this and similar institutions." The result is "patients who are trying to "drink from a fire hose" of health information that varies widely in quality." Dr. Naylor goes on to outline steps that can be taken to improve the way hospitals report information to regulators with the hope of improving overall clinical care.
Caution Advised for Kava Users.
Washington DC-
The Food and Drug Administration (FDA) is looking into possible dangerous side effects of the herb kava also known as Piper methysticum. Kava is a root related to the pepper that has been used for centuries in traditional ceremonies of the South Pacific in much the way alcohol is used today. Currently, kava ranks ninth in sales of all herbal dietary supplements, with total sales of approximately $30 million. Kava is touted to relax muscles; calm emotions relieve sleeplessness, and treat menopausal symptoms while sharpening the senses. Research suggests that compounds found in kava root help to soothe everyday anxiety and promote a general feeling of well-being.
Approximately 25 recent reports have implicated kava in cases of serious liver toxicity in Germany and Switzerland. According to the FDA, the regulatory authority in Switzerland has prohibited the sale of products containing the kava extract associated with the adverse effects. Last month, the German authorities issued a proposal to remove all kava extract-containing products from the market. The FDA has sent letters to all health care providers asking that they review all cases of liver toxicity for possible kava involvement.
The American Botanical Council is the nation's leading non-profit organization dealing with research and educational issues regarding herbs and medicinal plants. Founder and executive director Mark Blumenthal comments "What is becoming somewhat clear, however, is that kava is being anecdotally linked to reports of liver dysfunction without any confirming scientific evidence. An expert evaluation of the medical case reports and all relevant scientific literature is warranted to determine the extent of the problem and the necessary steps for the appropriate labeling and regulation of kava." Mr. Blumenthals previous recommendations were that kava products include the following warnings: kava should not be used by people under 18 or by pregnant or nursing women without professional advice, people should not exceed the recommended dose, excessive consumption may impair ability to drive or operate heavy equipment, and kava is not recommended with consumption of alcohol. The FDA now cautions "persons who have liver disease or liver problems, or persons who are taking drug products that can affect the liver, should consult a physician before using kava-containing supplements. Symptoms of serious liver disease include jaundice (yellowing of the skin or whites of the eyes) and brown urine."
MENOPAUSE UPDATE ARCHIVE
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