December 2007

Q. I have a question regarding estrogen replacement. I am currently on the Climara patch and the dose is at .0375. Every other month I switched from Provera to Prometrium after reading your book and I like it much better, I could tell the difference right away. I still have healthy menstruation and I am 57 year's old. Both my grandmother's went late into menopause. I could not tell with my mother because she had two ectopic (sp?) pregnancies and lost her ovaries (she was under a lot of stress). That's my history. How long can I or should I stay on the Climara patch with Prometrium?

A. Thanks for writing to me. This is a tough question - and not knowing why you are on hormones in the first place or knowing anything about your health risks, etc. it is hard for me to answer. If you are taking hormones because of severe hot flashes, etc. then usually a few years is enough although not in every woman. Although I can't recommend this for you, I have stayed on hormones past menopause for a few years because of the benefit to my bone density (which was low) and to my low estrogen vaginal tissues...and I believe the research which states that the earlier you start at menopause, the more likely your heart will be protected to by estrogen (and I have heart disease in my family). Every woman's circumstance is different. Because you still bleed a lot however, I would take the Prometrium up to once a month or so until the bleeding gets less. Heavy bleeding means you have not fully balanced out the estrogen - and maybe making extra estrogen too (especially if you are overweight with mostly deep belly fat).

Q. I am 34 years old and have been dealing with thyroid disease for 6 years, (6 months after my first son was born.) My mom has thyroid disease also. I now have 4 children and I have goiters. My hormone level each time I was pregnant would be all over the place then straighten back out and after I would have the kids it would be crazy then it would straighten back out again. Except for my last child, I didn't have to change my prescription levels while I was pregnant at all, but after I had her I did. I have been seeing my endocrinologist at Vanderbilt University Hospital for about 4 years now and she said we are going to just watch for the symptoms of this goiter (if it continues to grow larger.) and we will probably take my thyroid out. I was wondering if there is anything I can do myself without medication to shrink the goiters and help my thyroid. Can you help me?

A. It sounds like you have a common condition called multi-nodular goiter and you are lucky to be followed by a specialist at a great medical center. Rarely surgery is needed - unless you have a history of radiation or x-ray treatment to your thyroid as a young woman or girl of if one of the nodule significantly changes size. Although taking thyroid hormone in doses just enough to "turn off your own thyroid gland" is probably what you and your doctor are trying to accomplish,this is not a complete guarantee that one of the nodules won't grow. The critical thing is to have your doctor follow you closely, get occasional ultrasounds if any questions, and take generally good care of yourself. Radioactive thyroid would only be used if your gland was overactive - not sluggish or hypo active. What is your TSH level? IS it in the low normal range which would be ideal for you??

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Q. How do your theories in The Body Shape Solution to Weight Loss and Wellness correspond to this recent Framingham Study on diet soda?

A. In the book, I caution against drinking both regular soda (pure sugar with no nutritional value/raises insulin levels and increases hunger in the long run?) and diet soda (not only do we not really know the long term safety of the artifical sweeteners/think of trans fats and although we thought a safe substitute for butter at first, now know they are MUCH more dangerous - diet drinks have shown in other studies as well to lead to weight gain!!) Although no one has any certain idea why, there is something about the behavior/environment/diet drink itself that leads the diet soda addict (and they ARE addicts of sorts - just ask them) to eat more and gain more. Do they increase our appetites for other foods? change our metabolism? who knows? just guilt by association??!! In my practice, I always found a link between dieters and heavy diet soda consumption. My own sister who I discuss in the book is hooked on diet soda - always has a diet pepsi in her hand and has a hunger for food on a constant basis.

Q. I�m not sure how to ask this, but my daughter is 2 � years old and she has been getting UTI�s since she was 6mos. And we recently had VCUG and a NVCUG. The VCUG showed that she had reflux of a grade 2 and the NVCUG confirmed the results, she also has scarring on her right kidney and is smaller than the left so we have her on an antibiotic for now but the Urologist is suggesting surgery. Is this in your opinion the only way to resolve her problem or will the antibiotic over time be something we should consider, please help.

A. Although I am not a pediatric urologist or expert in this area, I can generally answer that pediatric reflux often improves over time however if indeed she has already lost kidney function (I am presuming the kidney size difference is significant) and is not getting better, surgery is clearly an often recommended and successful option. I guess the bottom line for you - do you trust the urologist, is she seeing the best/most specialized doctor who deals with this all the time, does her pediatrician agree??

Q. Can you refer me to a site re: Cervical polyps I was just diagnosed with that.

A. Cervical polyps are very common, rarely mean anything of concern, although they may signal an excess of estrogen. I usually use Medline and Medline Plus for information or AHRQ site which is the clearinghouse for all the major health organizations/expert societies information/recommendations about things.

Q. Here are my symptoms - 51 years old female in the early stages of menopause, fatigue (horrible) brain fog, slower pulse, higher blood pressure (130/90 and on meds for it), hoarse voice at times and feeling of a lump in my throat, feeling "off-balance", sleep disturbances. I am seeing a family practitioner who is now starting to practice "age management" type medicine. He tested me for different hormone levels (saliva test and did routine blood work also). My thyroid levels were in the "normal" range - 1.58 and tests showed adrenal fatigue. He put me on a supplement for low thyroid/adrenal (wants my thyroid levels a little higher) that is made from procine. I had to look that one up to find out it is from pigs. I don't know that they are helping - have new saliva/blood tests on order. DO you think this type of supplement is the right thing for a sluggish thyroid? I had a thyroid ultrasound done by an Endo earlier this year which showed a couple of nodules that she said were probably benign. Doing my own research I feel that my thyroid is not functioning where it should be and I think I should be on something other than "pig" thyroid meds. What do you think?

A. I will try to answer your questions as best I can - but as I know so little about you it will be more general than specific to your unique circumstances. Three concerns for me: 1) you have a multinodular goiter on ultrasound? I presume? is there a dominant nodule? any reason to do a fine needle biopsy? are they palpable on exam? did you have x-ray/radiation exposure when you were younger which would increase your risk of cancer? are they growing? Please keep original copies of all your test results. 2) according to your TSH of 1.58 (that was your TSH and not your T4, correct?) it is hard for me to believe your thyroid is underactive - however if you have muliple nodules, that alone may justify an empiric trial of thyroid to gauge your response. If your thyroid is truly inactive, then treatment should make you feel better. What did your endocrinologist say about thyroid treatment. 3) Porcine thyroid was the very first available thyroid hormone replacement and has been widely and safely used for years. Because it is "natural" although from pigs, it contains both T3 and T4. Most other prescription thyroid contains pure T4 - and there is no question some patients feel better on Armour thyroid (porcine thyroid) rather than synthetic levothyroxine. It sounds like I have more questions for you - and fewer answers.

Q. I know you advocate saving copies of ALL test results- but are there some tests that are more important generally than others? Are mammogram results the most important thing for women to keept? What about for men? what about for kids?

A. Kids: know immunization schedule (immunization form); no other blood test except hemoglobin or lead level is routine in kids; no x-rays routine. OR for kids: keep copies of any surgery/hospitalizations, etc. for when they go off to college (in addition to shot records) Young women: Pap test results for women; Pap show if inadequate specimen, serve as reminder when to schedule again, helps women be aware of inconclusive results etc. which need HPV testing too; gives women chance to make sure an abnormal result requiring colposcopy doesn't fall through the cracks!! happens ALL too often. Older women: Mammorgram report key - report mentions any suspicious areas, notes if old mammograms were compared (important and IF you don't have confirmation on report that old films were used for comparison - ask and make sure they do compare. Older men and women: copy of EKG, especially if abnormal or have heart disease (VP CHENEY had emergency heart cath when first elected to office 7 years ago because he carried his EKG with him and the ER docs noticed the changes and got him the emergency care he needed. on other hand, if NO CHANGE in EKG, could spare you an unnecessary trip to ICU. Older men: PSA result as the NORMAL result is usually less than 4 whereas depending on age and last result- even a NORMAL result could spell trouble (e.g. PSA should NOT double in a year - if so means too fast/maybe cancer growing EVEN IF PSA overall is normal. Only is you track your own results will you spot a change...many docs don't have system to compare to previous results.