Monthly Archives: November 2017

Compounded HRT and the Sunday Newspapers.

This old perennial issue raises it head again. What a Beat up. A direct quote from the article: “However, when News Corp searched the database it found six adverse events reports linked to compounded progesterone, including three cases of endometrial (uterine) cancer, three cases of vaginal haemorrhage, one case of breast cancer and one case of endometrial hyperplasia (precancerous thickening of uterine tissue).”

So from the article, they have found 6 cases of adverse events using compounded progesterone. That would be from many hundreds of thousands of women using compounded hormones in Australia. I will repeat a blog I carried some years ago here:

FDA admit no adverse report on Bioidentical HRT

One of the criticisms of Bioidentical HRT is that it is not FDA approved. It does not need to be, as it is not synthetic. It is interesting however that there has never been a complaint of an adverse event to the FDA – yet there are numerous adverse event report about the synthetic HRT. Here is part of a transcript from a recent Press conference run by the FDA.

The FDA had a press conference on BHRT. They generally were negative about BHRT.Here is one of the questions put to Kathy Anderson of the FDA (USA):

 

“Anna Matthews(Reporter): Hi. Couple of questions; one is have you guys received any reports of adverse events or other harm to patients from these products?

Kathy Anderson: Sorry, this is Kathy Anderson. With your respect to your question about whether we received any adverse event reports, we have not.”

 

Furthermore, the article did not mention the amount of damage done by synthetic HRT :

Prempro Causes Breast Cancer  and Loses Court Case with Huge Punitive Damages

by Jeffrey Dach MD

A 112 million dollar punitive is a very loud statement.  It states that the jury was outraged by the “wanton and reckless” conduct by Wyeth.  112 Million Dollars in punitive damages was awarded to two breast cancer victims who took Wyeth’s synthetic hormone, Prempro, all the while thinking it safe. The jury was outraged that Wyeth ignored and suppressed evidence that Prempro causes breast cancer. Wyeth paid consultants and ghostwriters of medical journal articles to play down concerns about breast cancer, and declined to study known risks. Once again, company profit was placed ahead of patient safety. This is the tip of the iceberg, as another ten thousand cases are waiting for their day in court.

Premrpro is similar to premarin or premia, as used in Australia.

I have been using these compounded products for the last 25 years, and have had 1 case of uterine cancer in that time. She was cured by a hysterectomy and is still fine today.Endometrial thickening can occur in women, with or without hormones, and, as the article stated, may be caused by obesity.

I will have more to say on this topic tomorrow.

Looking after a dying loved one at home? Here’s what you need to know

Looking after a dying loved one at home? Here’s what you need to know

Caring can be very rewarding for both the carer and the patient. from shutterstock.com

 


When someone dies at home, everyone in the family is affected. Looking after a relative who is at the end of their life can be enormously rewarding, but carers have many unmet information and support needs. This can take a toll on their physical and emotional health.

Here are some tips if you are looking after someone nearing the end of their life.

1. Look after yourself

Carers looking after someone with a life-threatening illness have higher levels of emotional distress, including depression and anxiety, than the general population. It’s important you look after yourself.

Self-care might mean finding time to take a break from caring by signing up for yoga classes where calming breathing techniques are practised, or seeking counselling or support groups.


Read more: How to get your stress levels in check


Caring can be very rewarding for both the carer and the patient. Research shows caring can make people feel closer to those they’re caring for. Carers often feel proud that they have been able to look after someone in their last years, months or days of life.

It can be a positive experience to think about the rewards of caring, like spending more time together or knowing you’re making a difference to a loved one at a difficult time.

It’s important you look after yourself.

2. Get informed

Caring for a relative at the end of life is likely a new experience. Many carers are learning on the job and often don’t feel practically or emotionally prepared for the task. Research consistently shows carers want to know how to safely carry out practical caring tasks, like moving the person in and out of bed, preparing suitable meals, and giving medication.

Emotional tasks might include listening to the patient’s worries and helping the patient write down their preferences for care and treatments in an advance care plan. When patients have an advance care plan, carers report less stress because key decisions have already been made and documented.


Read more: What you need to know about advance care directives


Palliative care services often have support groups or information sessions, which help carers feel more prepared and better informed. Such groups help meet carers’ information needs. They also increase self-efficacy (the belief of being able to personally succeed in caring tasks).

Recently, distance learning has been offered to carers and evidence shows this helps them feel more prepared to carry out their duties.

A carer’s emotional tasks might include listening to the patient’s worries. from shutterstock.com

3. Ask for help

Many current approaches to supporting people nearing the end of life involve working with whole communities. Known as compassionate communities, these approaches are based on the concept it is not just up to an individual carer, or the health service, to look after people approaching the end of life. Support can be everyone’s responsibility, from pharmacists, librarians and teachers to employers and colleagues.

Apps, such as Care For Me, and websites can help co-ordinate help from friends, family and the community. The website Gather My Crew offers a way for carers to list tasks they need help with, to take some of the pressure off themselves.

4. Talk about it

When someone is critically ill or dying, family members often decide not to share their worries with each other. Psychologists call this protective buffering. People do it to try to protect their family and friends from worrying more.

Although it is well-intended, protective buffering can make people feel less close. It’s OK to share worries with each other. Being able to talk about feelings means being able to deal together with the difficult things like pain or fear.

Talk about your anxieties. from shutterstock.com

Using the “d” words (death and dying) can be difficult, and is an outright taboo in many cultures. Find language that suits you: be direct (death), or use metaphors (pass away) or less direct phrases (getting sicker) so that you can talk about worries together.


Read more: Passed away, kicked the bucket, pushing up daisies – the many ways we don’t talk about death


5. It’s OK to think about the future

It’s hard to balance feeling positive and feeling sad about the person approaching the end of their life. Many family members and carers say they feel guilty for thinking about the future or making plans for after the person has died.

But research in bereavement has shown it’s normal and healthy to move between focusing on the here and now, and on the life after the caring role ends. This might be reassuring if you’re the kind of person who doesn’t always want to face emotions head on – distracting yourself by thinking about the future is actually a natural and healthy thing to do.

New Guidelines Advise Less Frequent Pap Smears

New Guidelines Advise Less Frequent Pap Smears

The annual Pap smear, a cornerstone of women’s health for at least 60 years, is now officially a thing of the past, as new national guidelines recommend cervical cancer screening no more often than every three years.

In recent years, some doctors and medical groups, including the American College of Obstetricians and Gynecologists in 2009, began urging less frequent screening for cervical cancer. Even so, annual Pap smear testing is still common because many women are reluctant to give up frequent screening for cervical cancer.

The new guidelines, issued on Wednesday by the United States Preventive Services Task Force, replace recommendations last issued in 2003 and use more decisive language to advise women to undergo screening less often. Other groups, including the American Cancer Society, released similar recommendations on Wednesday. The new guidelines were published in Annals of Internal Medicine.

“We achieve essentially the same effectiveness in the reduction of cancer deaths, but we reduce potential harm of false positive tests,” said Dr. Wanda Nicholson, a task force member and an associate professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill. “It’s a win-win for women.”

Cost is not a factor in the task force recommendations. Instead, its members focus on the effectiveness of a screening test to reduce cancer deaths, balanced against the potential harms that accompany the screening. The worry about frequent Pap smear screening is that tests can result in a large number of false positives that lead to sometimes painful biopsies and put women at risk for pregnancy complications in the future, like preterm labor and low-birth-weight infants.

The new guidelines focus on four key areas, including frequency of screening, age at which women should begin screening, age at which women should stop screening, and testing for human papillomavirus, or HPV, which can cause cervical cancer.

Under the new recommendations, the task force says women should be screened with a Pap smear no more than every three years. In 2003, the language was weaker, recommending screening “at least every three years,” which left the door open for annual tests.

In addition, women now are advised to begin screening at age 21 regardless of sexual history, and the task force specifically recommends against screening women younger than 21. In 2003, the advice to women was to start screening within three years of sexual activity, but no later than 21.

The task force also recommends against screening women over the age of 65, as long as they have had adequate prior screening and are not otherwise at high risk for cervical cancer. That advice has not changed since 2003.

Finally, the group also recommends against regular HPV screening for anyone under 30. In 2003, the task force said it did not have enough evidence to make a recommendation about HPV testing. It now says the test is unnecessary because many women exposed to the virus will eventually eliminate the virus without any intervention.

“HPV in women under 30 is highly prevalent but also highly transient,” Dr. Nicholson said. “Women under 30 may get infected with HPV, but they have a high likelihood of clearing that infection on their own, and it not causing any long-term change to their cervical tissue.”

HPV testing should be used in certain cases where women receive atypical test results from a Pap smear. In addition, the task force said that women over 30 who do not want to undergo a Pap test every three years could instead opt for a Pap test every five years along with an HPV test.

The task force recommendations apply only to healthy women. They do not change the advice for women who have unusual symptoms, an unusual Pap test result or a history of dysplasia, cervical cancer, H.I.V. or other illnesses.

Fitness versus fatness: which matters more?

Fitness versus fatness: which matters more?

November 9, 2015 10.05pm AEDT .

A metrobus driver performs squats at Rio de los Remedios metrobus station in Mexico. To combat growing obesity, lawmakers have introduced a new campaign encouraging physical activity. Edgard Garrido/Reuters
..
Authors
Tammy Chang
Assistant Professor, Family Medicine, University of Michigan

Caroline R Richardson
Associate Professor of Family Medicine , University of Michigan

Disclosure statement

Caroline R Richardson receives funding from NIH, VA,BCBSF, RWJF, AJPM, NEJM. She has recently been or is currently affiliated with the University of Michigan and the Ann Arbor VA.

Tammy Chang does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond the academic appointment above.

There is a longstanding debate in the research community about the importance of fitness versus fatness in health. Are exercise and improving fitness more important than eating well and maintaining a healthy weight?

Some researchers argue fatness does not affect health as long as you are fit, which means your heart and lungs are strong. And national campaigns like Let’s Move are focused on exercise for health without a specific focus on weight loss.

But for people who are obese, losing weight might be more important to their overall health than focusing on fitness. In fact, evidence shows that exercise alone is not an effective way to lose weight. Rather, effective weight loss is mostly about what you eat, though it should also include exercise.

As family physicians, we see obese patients who have heard the message to “just be fit” and have added 10-15 minutes of walking to their daily routine or have bought a Fitbit to track their physical activity. We applaud these efforts.

But for many obese people, the message that physical activity is more important than managing weight is not only unhelpful but also not true. When it comes to health and wellness, fatness can matter more than fitness. And of course, for most people, fatness is related to fitness, because excess weight can make exercise much harder.

How are fitness and fatness are linked?

Multiple studies have looked at fitness and obesity as two separate entities because they are seemingly separate concepts: one measures how well your heart and lungs work to supply oxygen to your muscles while the other is a measure of your body height and weight.

However, the measures of fitness and fatness are both influenced by how much you weigh. Because of the way fitness is calculated, for two people with the same oxygen-transferring power, weighing more typically means lower fitness.

Likewise, what researchers mean by fatness is really body mass index (BMI), a measure of body fat based on height and weight. People are often surprised at what is considered normal weight. To be in the normal weight range, a person who is 5’7″ needs to weigh less than 160 pounds. If this same person weighs over 190 pounds, he or she would be considered obese.

Strictly speaking, obesity does not mean you are automatically unfit. There are obese people who run every day, and then there are thin people who couldn’t run a mile for their life. A muscular individual can also be considered obese, because muscle weighs more than fat, and be very fit.

But these are exceptions, not the rule. Studies show that when someone is categorized as obese, the likelihood of them being fit is very low. So in our society, being obese still generally means lower fitness.

Extra weight can make it harder to move.
.

Fatness makes it harder to improve fitness

For people who are obese, focusing on losing weight is a better place to start than just focusing on fitness. That’s because extra weight can make it harder to move, and thus harder to exercise. Obese individuals often have a difficult time doing physical activity due to body size, limited mobility and joint pain.

Physiologically, it is more difficult for an obese individual to do the same amount of exercise as a healthy-weight person because of the extra weight they carry. Heavier people need more oxygen to do the same exercise as a healthy-weight person. Some obese people report that even walking can seem tough. Fitness is just harder to achieve if you can’t move easily.

Fatness decreases your quality of life

The debate around fitness and fatness centers on studies that show that compared to normal weight-fit individuals, unfit individuals had twice the risk of mortality regardless of BMI. But as these studies show, a relatively small proportion of people are fit and obese.

But mortality is not the only issue. Obesity has been shown to predict diabetes, heart disease, liver disease and a whole host of health problems that may require taking daily pills or having daily injections, or lead to invasive procedures. Even if a higher BMI does not predict earlier death, this does not mean that it “doesn’t matter” to your health.

While exercise can and does improve health, for people who have health conditions like diabetes or fatty liver disease, exercise alone won’t make a huge difference in reversing these conditions. However, these conditions can be improved or even resolved with weight loss (decreasing body fat).

Fatness also has a lot of other implications outside of strictly health effects. For family physicians like us that care for obese patients, the most heartbreaking stories are from obese patients who can’t go on roller coasters with their children or can’t keep themselves clean due to their size.

Increasing physical activity without losing weight will not likely improve these patients’ lives. To improve their health and quality of life, it is important to exercise every day, eat healthy food and, most importantly, lose some weight.

State of the evidence 2017: an update on the connection between breast cancer and the environment.

The evidence is clear – we need to live simpler and more natural lives, trying to avoid all the chemicals, plastics and other toxic substance we seem unable to do without.
Environ Health. 2017 Sep 2;16(1):94. doi: 10.1186/s12940-017-0287-4.

State of the evidence 2017: an update on the connection between breast cancer and the environment.

Abstract

BACKGROUND:

In this review, we examine the continually expanding and increasingly compelling data linking radiation and various chemicals in our environment to the current high incidence of breast cancer. Singly and in combination, these toxicants may have contributed significantly to the increasing rates of breast cancer observed over the past several decades. Exposures early in development from gestation through adolescence and early adulthood are particularly of concern as they re-shape the program of genetic, epigenetic and physiological processes in the developing mammary system, leading to an increased risk for developing breast cancer. In the 8 years since we last published a comprehensive review of the relevant literature, hundreds of new papers have appeared supporting this link, and in this update, the evidence on this topic is more extensive and of better quality than that previously available.

CONCLUSION:

Increasing evidence from epidemiological studies, as well as a better understanding of mechanisms linking toxicants with development of breast cancer, all reinforce the conclusion that exposures to these substances – many of which are found in common, everyday products and byproducts – may lead to increased risk of developing breast cancer. Moving forward, attention to methodological limitations, especially in relevant epidemiological and animal models, will need to be addressed to allow clearer and more direct connections to be evaluated.

Not all trans fatty acids are bad for you

New research suggests not all trans fatty acids are bad for you

European Society of Cardiology News, 09/24/2015

New evidence suggests that low levels of trans fatty acids (TFAs) may not be as harmful to human health as previously thought, even if industrially produced, and may even be beneficial if they occur naturally in foods such as dairy and meat products, according to a study published in the European Heart Journal. The researchers analysed blood samples from the patients to identify the total concentrations of TFAs, as well as distinguishing between the concentrations of industrially produced and naturally occurring TFAs. They linked this with information on deaths, causes of death, medical history, and other factors that could affect results, such as whether or not the patient were taking cholesterol–lowering drugs, such as statins, and risk factors such as smoking, lack of physical exercise, body mass index (BMI), diabetes and high blood pressure. Dr Kleber said: “We found that higher concentrations of TFAs in the membranes of red blood cells were associated with higher LDL or ‘bad’ cholesterol, but also with lower BMI, lower fats in the blood (triglycerides) and less insulin resistance and, therefore, a lower risk of diabetes. We were surprised to find that naturally occurring TFAs were associated with a lower rate of deaths