Something for the women in our lives to watch

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Something for the women in our lives to watch

Post by AJMD429 »

This is a topic so instrumental to women's health and happiness (and thus ours), and so changing, that they should become informed on it.

One of my patients is an ObGyn herself, and since it is anatomically difficult to to a complete "well woman exam" on oneself, she was in for her physical and I renewed her "bioidentical" hormone replacement therapy. This was a few years ago, when the concept was new, fresh on the heels of the results of the Women's Health Initiative which had found increases in heart disease, stroke, and breast cancer in women "on hormones", and doctors essentially quit prescribing hormone replacement to menopausal women.

The PROBLEM with all that was that it was very complex data, the hormone regimens being studies were diverse, and conclusions debatable. (an analogy would be like "we studied the effect of throwing fluid on fires to put them out, and the study showed it is dangerous and should not be done" when 20% of the studies used water that safely put out the fires, and 80% used gasoline).

Anyway, I asked my patient "With all the changing evidence and so on involving hormone replacement, what kind of literature do you give patients to help them understand why bioidentical hormone replacement is so different and worth considering, since all they see on television is how bad 'hormones' are...?" I hoped she had some brochures or resources I could use as well. (the problem is that there are no big drug companies standing to profit with bioidentical hormone replacement, since you can't patent hormones - you can only patent the synthetics, which were the 'gasoline' versus the 'water', so there is no money to advertise or promote bioidenticals).

Her response was "I don't really get into that with my patients much..." I was surprised, as she was obviously on BHRT herself, so knew about it and felt it safe and useful. I thought maybe her practice was skewed to pediatrics or something (she practices in a different town so I don't refer to her), so I gave her a quizzical look. She went on to explain "...don't get me wrong, I'm a big advocate of BHRT - I'm on them, and I've got my sister, sister-in-law, and several other family members and friends on them - but I just don't have time to explain all that to patients, so unless they specifically request it, meaning they've already informed themselves, I don't bother getting into it." All I could think was "I'm glad my wife doesn't see you, because it sounds like you save your good advice and time for 'important' people like your friends, but the peasants that are your ordinary patients just get whatever bare-bones treatment insurance makes convenient."

I asked her what led her to that point (knowing mostly it was that she worked for a hospital, and even as a physician, she was an 'employee', so subject to time-monitoring and other constraints that focused on 'productivity'. She commented that "We know that one in eight women will get breast cancer in the U.S., whether they wear red shoes or blue shoes, and we know that the OLD hormone regimens, which were incomplete, used the wrong hormones, given the wrong way, increased the risk. We also know that the PROPER new regimens not only don't increase heart and stroke risk, but actually decrease heart and stroke risk, and it seems like the data on breast cancer with the new regimens is that the risk probably doesn't change much one way or the other. However, EVEN IF the breast cancer risk was cut in half, you'd still have one of every sixteen women you put on hormones who would get breast cancer, and that one would be convinced she wouldn't have gotten cancer except because you gave her those 'hormones' she heard were bad." I saw her point - if you treated 1,600 patients, you'd expect 200 cases of breast cancer if you gave them placebo, but instead you'd get only 100. Would the 100 women who were going to get cancer, but didn't, bring you cookies and thank you...??? No, because they have no way of knowing they wouldn't have been cancer-free anyway. Would the other 100 women who got cancer anyway, despite your treatment lowering their risk, assume that if you hadn't prescribed them hormones, they would have been cancer-free, be angry and blame you for 'causing' what would have happened anyway...??? Yep - that's human nature.

So unless you're "a personal friend" of physician who is familiar with BHRT, the conversations won't even happen. THAT is sad.

It isn't that the women all should be on BHRT, because 'one size fits all' is rarely good, but the problem is that the discussion won't even come up, because the patients have been misinformed, and most of the physicians spend more time playing golf than keeping up with the current literature, and the few who do keep up, seem unwilling to share information with their patients unless the patients are "special".

So the only alternative, like much else that goes along with being healthy, is for the patients to become informed, learn things, and if the treatment isn't stuff they can do with nutrition and exercise, and requires prescription medications, they will have to find a knowledgeable physician, AND likely will have to initiate conversations rather than be 'passive' and just accept the level of care for the 'peasants'.

This applies to MANY other facets of medicine, and may be one reason men don't live as long as women; many opportunities are there to prevent, and often fairly easily delay, ageing and death, but men are notorious for the "if it ain't broke don't fix it" attitude with their health. They treat their trucks and fishing gear better than they do their bodies, when it comes to preventative maintenance. So instead of starting at age 35 to do minor things that will postpone their heart attack from age 55 to age 85 without much drama, they wait until they are having chest pain at age 54, something is already 95% clogged, and the interventions have to be dramatic and risky, and much underlying damage has happened that really can't be un-done easily. Plus, the interventions at that point are all focused on the 95% stuff, and typically little attention is paid to anything other than that.

Another fascinating thing is the emerging understanding of how CoVid virus impacted adrenal and thyroid and sex hormones -
Doctors for Sensible Gun Laws
"first do no harm" - gun control LAWS lead to far more deaths than 'easy access' ever could.

Want REAL change? . . . . . "Boortz/Nugent in 2012 . . . ! "
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