Morris M. Elstein, MD 8/3/08
Global warming had probably been progressing at a relatively steady speed until July of 2002. Little did we realize that a secondary consequence of the WHI study would be global warming!
After the WHI study, millions of women stopped talking estrogen, with the consequences being: higher body temperatures on average, more power surges releasing excessive heat, and more frequent night sweats and flushes. Each one of these “personal summers” increased the surrounding temperature, and looking at the massive numbers of “personal summers”, it is no wonder that the world’s temperature has been rising. Because women in such large numbers stopped estrogen, there was also less estrogen and estrogen by-products eliminated in their urine. Consequently, less estrogen made it into the waterways and oceans. The seas responded with their subtle but gradual increase in temperature.
Who would of thought that one study, reported and interpreted by the press, would have had such profound effect on global warming and our environment.
Dr. Morris Elstein
During the first week of October 2007, I attended the annual meeting of the North American Menopause Society, better known as NAMS. The NAMS meeting is both a clinical educational meeting and a scientific research meeting and is attended by members from all parts of the world. Thus, the leaders in menopause research and clinical practice present their findings, experiences, and interpretations of the leading studies in the area of menopause research and medicine.
One take-home message for me (and hopefully for you) is that my personal philosophy and practice exhibit a cutting-edge approach to menopause management. Secondly, we have a long journey to educate women about options in dealing with menopause based on factual information.
The keynote speaker, Tara Parker-Pope, gave an insightful look at how the press interacts with researchers and presents materials to the public. Some of you may know her as the health editor for the “Wall Street Journal.” She has now left that tabloid and now writes for the “NY Times” in hopes that the wider circulation will have a greater impact for her readers. She was one of the first writers to question the interpretation and legitimacy of the reporting surrounding the WHI study.
As we move forward, I will endeavor to stay current on the many aspects of menopause medicine. I challenge each of you to educate yourselves, so that your decisions will be based in knowledge and not fear. Dr E
Is being pre-diabetic similar to being perimenopausal? Many patients chuckle as they stand on the office scale and look at the certificate that hangs above it. This certificate is my specialty certification as a “Menopause Practitioner” from the North American Menopause Society. We frequently laugh over the fact that I had to pay to get into this society and my patients qualify for free!
So what does diabetes and menopause have in common? I try to look for similarities in conditions and occurrences in life to help in understanding these issues better. As all of my patients are aware, menopause is “a happening.” We can not stop the process, but we can prevent the symptoms and moderate many of the system processes which occur as a result of menopause. Menopause is gradual or in some cases a sudden drop in hormones, particularly estrogen. This change in hormone levels is responsible for the host of symptoms and physical changes in the female body. I am amazed at the power of these hormones that zip around the body, having an effect on every organ system from the hair on your head to the toe nails on your foot.
Diabetes represents either a gradual or sudden loss in the production of or the effectiveness of the hormone, insulin. This hormone, too, has a wide range of effects on the body. Insulin is primarily responsible for the control of sugar levels, deposition of fat, and maintenance of all organ systems. A chronic lack of sugar control leads to renal (kidney) failure, neuropathy (particularly painful extremities), blindness, accelerated cardio-vascular disease, bladder and bowel dysfunction, impotency, to name a few conditions.
The onset of menopause and diabetes can be a slow, progressive process, as hormones decline in both cases. As levels get lower, symptoms become more prominent and in many cases intervention is necessary. Many patients want to know if there are alternatives to taking hormones; and indeed, there are options. First, it is impossible to predict when menopause will occur exactly (except surgical menopause) and how severe the symptoms will be. Family history illuminates only a small part of the picture for menopause, while diabetes clearly has a strong genetic component.
Both processes can, however, be moderated with certain steps before full blown symptoms occur. Many of us seek the magic pill or supplement that will slow or stop the process, but I promise you that it is not there. The numerous advertisements for over-the-counter products can be enticing, but these rarely have been shown to have a clear positive effect on the process. Oh, they may temporarily make us feel better, since we seem to be doing “something” for ourselves. But in the long run, most of these products fall short of the mark.
So what can be done to minimize the symptoms of menopause and avert the ravages of diabetes? Activities boil down to one effort: improved personal self-care. This self-care comes down to a better diet, regular exercise, and improved mental wellbeing. As all of us age, continuing on the same diet that we have been using for the first part of our lives proves to be ineffective at managing our weight or controlling our sugar. We tend to be less active and therefore burn fewer calories. Our serenity also suffers as challenges in balancing the needs of family, work, and personal self care come into conflict. What is a human to do? The tasks seem to be overwhelming!
I, as well as all of you, must remember or must be constantly reminded that the process is a journey. I must constantly make small course corrections in all aspects of my life to cope with aging and pre-diabetes. I must be reminded that while it is acceptable not to perfectly adhere to my program I cannot give up on my efforts at self improvement. Those of us who strive for the best balance tolerate the aging process far better. This includes diabetes and menopause. I encourage you to keep up the good efforts. More to be revealed! Dr E
Embracing New Technology
For at least the last five years, I have been building a data base for Pap smear results and annual reminders. The feedback that I receive makes me think that everyone appreciates this service. So, now I need to know how I can use this technology to communicate more effectively with each of you.
Why do I ask this question? I frequently notice messages that I send out, whether they are individual or broadcast, may not be read for weeks or months. The annual reminders are distributed at least six weeks in advance of your annual due date. Clearly this is your prerogative not to read emails in a timely fashion; but when it comes to scheduling that annual appointment, I hope you are not disappointed when all the slots are filled.
Lately, I have been experimenting with adding a message for “free services at the Pardes Skin and Wellness Center” in the middle of my emails. This may appear in all the broadcast messages stating that the first three callers will receive a free service or the message may appear randomly on a “test results” email. Thus far from the October annual reminder, only two people have called for a free service out of the three offered. None of the “test result” emails have responded.
What do I make of this phenomenon? Am I sending out too much info? Are you only scanning parts of the message or ignoring the message all together? I for one receive loads of email daily, but I generally know which senders have important information for me to digest. I hope that you will take a moment to keep up with emails coming from drestein@cox.net, and please keep me posted on changes to your email address. For those of you who are not aware, I personally administer this data base and send out every email….a labor of time and love.
Your thoughts and comments about this service are always welcome. I can assure you that I will read each one and respond when appropriate. I believe your health care is enhanced only through optimal communication. Also if you have subjects that you want me to touch on in my blog, please send these my way.
Wishing you the Best of Health! Dr E
Coastal Gynecology Blog
Written by Dr. Morris M. Elstein
As I speak with patients, I realize that baby boomer’s, in particular, have difficulty taking time for personal self care. Sometimes called “the sandwich generation,” we are stuck caring for aging parents and growing children, leaving little time for ourselves. We find it difficult to ask for personal time or much less schedule. Knowing that even 30 minutes of exercise per day can stave off the many diseases of aging is not enough to motivate us to action.
As I approach my personal annual exam next month, I move closer from becoming a pre-diabetic to one who will need interventional therapy. My personal approach to exercise has not been as rigorous or regular as it should be. I have practiced yoga for some six years, but now I find that expending the time for a consistent practice is more difficult. Excuses abound as to why exercise can postponed – too tired, too hot, too busy, other engagements, too much work, etc., etc., etc; hence, the importance of having at least the annual exam
This annual inventory and review gives us a chance to sit down with a neutral third party and look at the past year critically with care and understanding. Hopefully there are subtle changes that will enhance our lives from a change in diet to making time for a vigorous walk around the block.
Growing older is a process; getting old is the end of the journey. My personal efforts at self care wax and wane; and I need the jolt from looking at my lab work and talking to my personal physician to jump start my efforts. As someone with a strong genetic predisposition for diabetes, I constantly try to live the adage: “while I have the tendency, I don’t have to accelerate the process.” Even when I get to the point that I will need medication to control my blood sugars, I hope that I can find the energy and strength to continue my personal efforts to maintain good health and minimize the effects of diabetes.
The attached picture is a testimony to my efforts at getting into reasonable shape. At this point I am at feet on a  plateau just below the 13,300 foot crest of Mount Crested Butte in Colorado. I made this climb with my wife in July 12th of this year. Since then, my exercise program has literally been “all down hill.”
I hope you will all join me in reaffirming our goals for a healthy life! Dr E
Coastal Gynecology Blog
Written by Dr. Morris M. Elstein
I thought I would add my thoughts to the ever widening scope of information, and I pray not misinformation. As information is more widely available, there is a greater need for interpretation of the available data. Thus, I will begin a series of blog entries to look at how we currently use data in our decision making.
How do we make decisions, especially regarding our medical health? As a general rule, more of us are turning to the internet, as witnessed by your reading this blog, or to any number of the other media sources such as television, newspapers, or magazines. Most of us have allowed the media to interpret various studies, and the "network medical experts" are more than happy to shed their bias and limited knowledge on the subject.
The media are happy to jump to conclusions especially when a report can generate fear, the emotion that sells copy. Studies which show a "negative" outcome get front page press; while, any "positive" event is relegated to the back pages of the paper.
The case for and against hormone therapy is a case in point, affecting the lives of almost all of my patients. When the WHI study was initially released, the scientific community was not given the study to scrutinize and analyze. Instead, the writers of the WHI released their information to the "press." The media then disseminated the information to an eagerly awaiting public, a public that would come to believe that estrogen would cause breast cancer, heart disease, dementia, and blood clots. Shortly after the WHI study was published in various media sources, an article appeared asking if perhaps there were excellent reasons to use hormone therapy. Sadly, most of my patients and women of this country did not read this well researched newspaper article, as it appeared in the Wall Street Journal.
Now some six years later, there has been a vindication of the use of hormone therapy. Carefully examining the WHI and breaking the data down into usable age groups did not show the same fear producing information as originally thought. We now recognize that women who are transitioning into menopause and who are roughly in their early 50's are not at the same risk for breast cancer, heart disease, and dementia. In fact, the data suggests that cardiovascular health is maintained and risks of dementia maybe decreased if there is a smooth transition to hormone therapy once menopause occurs. The data for women 50 - 59 is clearly different from each age group 60 and above and shows a favorable health response.
Articles began to appear lending support to early usage of hormone therapy, usually published on page 10 or beyond. Again, the Wall Street Journal published a well researched article on the front page and dedicated several columns to this important finding. Sadly, most of the nation's publications did not see this positive finding worthy enough to educate the public.. . .only fear sells the paper.
Watch the media as they promote one side of a medical issue or another. Ask what ulterior motive might they have in how they report information? Lastly, ask can I use this information to promote a healthier lifestyle. More to follow!
MME
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