Something for the women in our lives to watch

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AJMD429
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Something for the women in our lives to watch

Post by AJMD429 »

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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.

https://www.youtube.com/watch?v=_W0nRGhl3xE
or
https://www.youtube.com/watch?v=FYqFn1uNwIk

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 - https://www.youtube.com/watch?v=2xdYkUpFwAM&t=40s
Doctors for Sensible Gun Laws
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AJMD429
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Re: Something for the women in our lives to watch

Post by AJMD429 »

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Here's what I send my female patients -

TOPIC: Reducing Breast Cancer Risk, and Addressing Menopause

I've been sharing this with my female patients - it has several articles and links of importance. Some are intended for physicians, so get kind of deep into terminology, but I think if you just listen to them without trying to take in every detail, you'll get a feel for what kinds of things many physicians are doing now, and changes we've made in our approach to menopause and to reducing breast cancer risk. The 'more patient oriented' video down further in the text here may be the one to watch first if you aren't into the 'biology' aspects of things, but the first one shows the 'integrative medicine' approach in detail.

This information is applicable to patients who are young, old, or in between, and ones who have already had breast cancer, as well as ones who haven't, with either high risk or unknown risk.

Sadly, this is not addressed much these days, because it takes too much time, and nearly all physicians are employees of hospitals now, and have financial incentive to see high volumes of patients, which means keeping visits short. Also, there is a mindset of many physicians that I find troubling. Several years ago, I started one of my patients who is herself an ob-gyn, on what we now call 'bioidentical hormone replacement' and although she could prescribe them to herself, it isn't anatomically possible to do one's own physical and Pap, so she was seeing me since she didn't want her ob-gyn partners involved in her personal medical life. At the appointment, I asked her if she had any pamphlets she used to help explain to her own patients the 180-degree changes that happened with regards to 'hormone replacement' since around 2002 or so when we found that Premarin and Provera were killing women, and she said "I don't really get into that with my patients". I must have looked surprised, since she clearly understood the benefits of the 'new' way of treating menopause, so she clarified "Don't get me wrong - I'm definitely an advocate of bioidenticals - I'm on them, I've got my sister on them, and several of my friends, but there's no way I'd get into all that with regular patients..."

Yeah - we mustn't waste time on the peasants.

I remember taking the Hippocratic Oath, and as far as I recall, it didn't say we were to deliver two tiers of health care - one for 'important' people, and one for the riff-raff. I try to treat ALL patients as if they were friends or family.

Anyway.................here's some information I've found helpful to convey to patients some of the current thinking in the realm of hormone replacement in women.

First a commentary on the great flaws in the Women's Health Initiative, which led to 50,000 or more women dying needlessly due to the irrational fears the media flamed by taking the data out of context and failing to use hormone properly, or even at all.

Podcast #1 - http://peterattiamd.com/caroltavris-avrumbluming/ - long but quite worth listening to...!

Lest you think that Dr. Attia is too 'controversial', because he dares go against the mainstream - even the Principal Investigator of the WHI study, Dr. JoAnn Manson, goes into how deeply flawed the WHI was, and how incredibly distorted and sensationalized not only the 'news' media coverage was, but the 'prestigious' medical journals like NEJM and JAMA went obligingly along with the party-line.

Podcast #2 - http://www.youtube.com/watch?v=8bRuzA-qd0s - not as up to date, actually, but something perhaps skeptics would find reveals that even those running the WHI knew it was deeply flawed. Not vital to watch.

There are more up-to-date studies and talks on the topic, but this one is a good foundational talk, and the newer information relating to progesterone as beneficial/protective is alluded to in the next podcast below, which also starts exploring the concept of how can we move from “not significantly increasing” breast cancer risk, to “potentially REDUCING” breast cancer risk, by looking at the metabolic pathways which estrogen is processed, and how the dozen or so metabolites differentially affect breast cancer risk, so can be therapeutically manipulated, often just by diet and/or simple supplements.

This testing can assess (and unlike just doing BRCA testing, potentially reduce) risk of breast cancer in all women (whether on hormone replacement or not). It also helps us monitor the effect of any added hormones. This is an in-depth video intended for medical practitioners, but worth at least a glance, to see the science behind what we are doing (there is a more patient-oriented video later in this letter as well):

Podcast #3 - https://dutchtest.com/video/an-integrat ... st-cancer/ - a very good talk, although more 'clinical', because it gets into the more updated knowledge on hormone subtleties, and potentially being proactive to actually reduce breast cancer incidence and risk, instead of just relying on predicting risk and trying to intervene early.

The cool thing is we are learning enough now to modulate the metabolic pathways of a woman's own (or added) estrogen, and should be able to reduce whatever her inherent risk of breast cancer is. Not likely to zero, but reducing it even a little would be awesome.

Although we may discuss adding 'hormones' at any age, for various reasons, to both men and women, the term 'sex' hormones is a misnomer, in that the estrogen and testosterone and progesterone have MANY wide-ranging effects on parts of the body, and body functions, that have nothing to do with 'sex'. For instance, the first of the three to drop in most women is progesterone, and it often drops in their 30's (or even in their teens in some cases) sometimes causing no symptoms (other than perhaps an increased risk of breast cancer), and other times causing subtle changes in breast architecture a physician may notice (though many don't bother to mention or treat), or on occasion the woman will begin to receive 'breast density disclaimers' on her mammograms. Some women will notice breast pain or lumpiness before their cycles, or be told they have 'fibrocystic' breasts. Some women will notice unwanted mood and emotions prior to menstruation, and just be told they have 'PMS' and need some Prozac, when the real issue is progesterone deficiency. Perhaps the most common side effect of dropping progesterone during the 30's is lessened quality of sleep, so the woman may be lucky enough to get eight hours of sleep, yet only feel like she had four (so the doctor will give her Ambien along with the Prozac). She may also have difficulty relaxing enough to get to sleep easily, or have trouble relaxing during the day when appropriate. (then comes the Xanax...). Eventually the high estrogen/progesterone ratio may result in heavy cycles and/or uterine fibroids.

Keep in mind all this is typically against a background of what is often going on at that age for women – kids still at home, a marriage to try to keep going, sometimes even an 'ex' causing drama to deal with, often putting in hours a job outside the home, and sometimes the primary bread-winner or a single-parent, and on top of all that, often they are at a point where at their age, and being female, our culture expects them to start being caregivers for the parents or grandparents. As if all that plus a house-full of kids and maybe even in-laws living with them, isn't enough to interfere with a great libido, the next hormone to drop during the decade-or-so process of 'menopause' for women is – testosterone. A woman with a testosterone level of 40 may have an orgasmic libido and even initiate intimacy, but if her level is 20, she's likely to have problems with all of those aspects of intimacy, causing feelings of frustration or inadequacy or sadness or loneliness. Often the husband is having similar hormonal issues that contribute to intimacy difficulties, and with men tending to have less insight as to the 'medical' connections to this, may not communicate his concerns, and may simply withdraw emotionally or affectionately, further adding to any feelings of inadequacy the woman may be experiencing. All this takes place a decade before the classic 'hot-flashes' and cessation of menstruation that result from the estrogen finally dropping finally cause most physicians to consider addressing the issue of 'menopause'. Sadly, by this time, there is relationship strain, weight gain, and often cardiometabolic consequences of all these hormonal changes that are going to be hard to reverse.

Anyway, the above podcast touches on the reasons we have made great changes in hormone replacement for women, and have gone from having poor results with many side effects, to having excellent results attainable with generally minimal to no side effects.

In the interim, often a couple can improve things by 'scheduling' intimacy – that gives them some planned private-time, takes the pressure off to shift-gears and become horny when hugged, or feel bad for NOT being able to do that. If the couple has agreed to have their intimacy on Sunday afternoon at 2:30, then at that time they will have had a chance to tidy up other errands and have their phones off and so on, plus that means that a butt-grab on Tuesday doesn't have to trigger the dilemma of whether to respond versus reject, because they both know that on Tuesday, a butt-grab is just a butt-grab, because they've agreed that nothing major is on the agenda except on Sunday at 2:30. Taking the pressure off that way can help keep physical affection in the picture, while keeping more intense intimacy limited to times when both partners can be fully engaged in the process.

Here's another podcast more aimed at patients vs clinicians on the topic:

Podcast #4 - https://www.youtube.com/watch?v=kgi7X7Qrep8 - more of an informal interview but similar to the Attia interviews.

This next podcast elaborates further on the 'methylation' issue not just as it affects breast cancer, but many other cardiac, neurologic, childhood, and allergy symptoms. The MTHFR aspect of methylation is the most easily studied and addressed and affects a broad range of medical issues, although the COMT pathways are also important. It is also oriented to clinicians, but illustrates the breadth of the topic:

Podcast #5 - https://www.youtube.com/watch?v=9VexwhkbnPo - Dr. Benjamin Lynch pretty much wrote the book (literally) on the methylation topic, and how what we used to only think was an issue affecting cardiac risk, to realizing it affects neurologic issues (neuropathy, dementia, depression, anxiety), and cancer risks. We now know the molecular and physiologic reasons this makes sense.

Finally, there are a couple links here on the potential of iodine supplementation to make a great difference in the health of women, particularly their breast health.

Article #6 - https://www.jpands.org/vol11no4/millerd.pdf - a more scholarly article on the potential for iodine to reduce breast nodularity, pain, and potentially perhaps breast cancer itself (or at least help us find it earlier by making the breast tissue easier to examine and mammograms more clear to read).

Article #7 - https://jeffreydachmd.com/breast-cancer ... th-iodine/ - a more optimistic, but not too far-out, article on iodine and breast cancer risk.

If you decide to do any of the DUTCH hormone tests (either sex hormones or adrenal hormones, or both) you can get the kits (the test is done at home, on urine and saliva - for the sex and adrenal hormones, respectively) from this website – https://dutchtest.com. There are FOUR tests commonly used for sex and adrenal hormones, but the best deal is the Dutch-Plus if you are curious about adrenal function, and want a thorough evaluation. If you feel great and just want to assess breast cancer risk as reflected by the estrogen metabolism, the Dutch-Female Sex Hormone test is sufficient. Likewise, if you have already assessed the estrogen issue and just need to monitor adrenal status, the Cortisol Adrenal test is fine. Precision Analytical doesn't bill insurance, but you can submit the receipt for reimbursement with some chance of success – we can supply you with the proper “ICD-10” codes.

The DUTCH-Plus – which combines the sex hormones with a more complete adrenal evaluation –

Article #8 - https://dutchtest.com/product/dutch-plus/ - information on the DUTCH-Plus test I find so helpful

See this SAMPLE REPORT showing the kind of information we will glean with the Dutch-Plus test.

Article #9 - https://dutchtest.com/wp-content/upload ... 062022.pdf - a sample report, showing the in-depth information the DUTCH-Plus test provides

Obviously, if you ask ten physicians about an issue, you'll get eleven or twelve different opinions, depending on the day of the week, and there is conflicting information on almost everything medical, but these are links to things that in my best judgment seem to be sensible.

Hopefully this information is of some interest, and may help explain some of the current changes in the approach many physicians are taking towards women's health.
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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