It seems the controversy surrounding the use of hormones for menopausal women never ends. A recent report in the October 20th issue of the Journal of the American Medical Association reviewed further evaluations of women from the Women's Health Initiative Study. It reported that those who used PremPro had a significantly higher incidence of breast cancer and of more advanced breast cancer than the women in the placebo group who did not use PremPro. The incidence of breast cancer in the placebo group was .34% per year compared to .42% per year in the PremPro group.

Does this mean that hormone use in menopause leads not only to more breast cancers, but also to more advanced cases of the disease? Truthfully, we really can't say for sure. Unfortunately, the women in the study only used Premarin or PremPro - neither of which is a bio-identical hormone replacement. The only obvious conclusion from this recently reported analysis is that the use of PremPro should be ended immediately.

Why might the data not be applicable to women using bio-identical hormones? The reason is clear - the human body was designed to use, process, and eliminate bio-identical hormones. It was not designed to do this for any of the non-human or synthetic pseudo-hormones found in PremPro. Particularly with the Provera part of PremPro, which acts more like a xeno-hormone than a real, human hormone. Xeno-hormones are substances which react with human hormone receptor sites in unexpected ways, often at variance with the way "real" human hormones work and frequently with disastrous results.

Unfortunately, we only have a limited number of studies on the long-term effects of bio-identical hormones on the breast. The ones we do have are all very favorable, showing no increased incidence of cancers of the breast. However, long-term studies take a long time to run, so we won't have useful data any time soon. Consequently, each woman needs to make up her own mind on this subject, carefully weighing the positives and the negatives.

For those of you who feel overwhelmed with hard to interpret data, please come in to discuss your individual situation with Dr. Gersh. Hormonal therapy in menopause has many benefits and may also have some negatives. Each woman needs to have her unique situation reviewed so as to create a plan tailored for her personal needs.

A few months ago WMGI added a physician assistant (PA), Alison Gracom, to our team. Since she is the first PA to work with us, it naturally created many questions among those of our patients who are unfamiliar with a PA's education and skills.

A physician assistant is a highly trained healthcare professional licensed by the state to practice medicine. They are concerned with preventing, maintaining, and treating medical problems by providing a wide range of services that are traditionally performed by physicians. PAs can conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel on preventive health care, assist in surgery, perform minor surgical procedures, and write prescriptions. Physician assistants can exercise great autonomy in medical decision making and are educated in the same model as are medical doctors.

The educational path followed by most PAs begins with a 4-year college degree and includes all the same course prerequisites necessary for applying to a typical medical school for MDs. This is then followed by 3 years of PA medical school, consisting of classroom and laboratory instruction in medical and behavioral sciences, such as anatomy, microbiology, pharmacology, pathophysiology, hematology, pathology, clinical medicine, and physical diagnosis.

These classes are then followed by clinical rotations in internal medicine, family medicine, surgery, pediatrics, obstetrics and gynecology, oncology, emergency medicine, and geriatric medicine, as well as elective rotations. Many of the medical schools that also offer PA programs do not differentiate between first-year PA students and first-year medical students, combining all students in the same classes. Although not required, there are "residency" programs in certain specialties for PAs who choose to continue their formal education in such a format.

Physician Assistants are very much medical professionals and are employed in both primary care and in all medical and surgical specialties. They have their own medical licenses and do not work under a physician's license. They are required under their licensure to have physician supervision, but they essentially function in a manner identical to that of an MD, commensurate with their experience. Supervision need not be in person, as long as phone access is available, and many PA's practice alone in remote or underserved areas in satellite clinics.

Like all medical professionals, the quality of the provider is determined as much by the dedication, intelligence, caring, and interest in continuing education as by the coursework done in medical school years earlier. Our PA, Alison Gracom, is the ultimate professional, with many years of experience working as an endocrine specialist. Patients who have met with her have been impressed with her thoroughness, knowledge, and compassion; and many have commented that they have never had such a thorough examination or visit. She shares our love and vision of integrative medicine and utilizes lifestyle medicine as either a first-line therapy or an adjunctive treatment in all cases.

November is the start of the holiday season and we want it to be a special and healthy one for all of our wonderful patients, their friends, and family. To celebrate this year, we are offering huge discounts on all of our aesthetic services for the months of November and December. Deals like this come only once a year!

All of our Laser Services and Skin Care Treatments are being discounted an amazing 50%! Every single laser package and all facials, peels, and microdermabrasion treatment sessions are yours for only half the regular cost. We don't want cost to stand in the way of your getting that special aesthetic service you have been dreaming of. If you are not sure what would be best for you, call for a free aesthetic consultation with our aesthetician, Kris. She will evaluate your unique needs and work with you to create a fantastic beauty plan.

Dermal Fillers are all being reduced by 30%, and we are basically giving our BotoxCosmetic away at a mere $9 a unit with a minimum 40-unit purchase. You will look years younger after only a few minutes of treatment.

Skin Care Products are on sale too! Buy one and get half off another of the same or lesser value. You can do all of your Christmas shopping right here in our office. We now have several high-end lines, each with its own unique virtues. We also have an all-organic line of skin care products, ideal for anyone with autoimmune conditions and allergies. We also now have shampoo and conditioner which are 100% organic. These go great with our new all-organic facials.

Massages are always fantastic. Buy a package of 6 and get a 7th for free! You can break up the set and share the massages with friends and family, if you can bear to part from them yourself.

Over 14,000 people between the ages of 45 and 64 were followed for an average of over 12 years while having their magnesium levels monitored as part of a study called the Atherosclerosis Risk in Communities Study. A reduction of nearly 40% in the incidence of sudden cardiac death was observed in those with the highest levels of magnesium. These findings were published in "American Heart Journal."

In a similar, though smaller, study of elderly diabetic patients, those who were given magnesium supplementation had improvement in their endothelial (arterial lining) function. This study was published in the journal "Magnesium Research."

Magnesium is an extraordinarily important mineral and is involved in more than 300 biochemical reactions in the body. A very thorough discussion on the role of magnesium in the body can be found on the National Institutes of Health Dietary Supplements website. We encourage all of you to read it.

At WMGI we carry Chelated Magnesium, which is generally acknowledged to be the best supplemental source. Magnesium oxide and citrate are quite irritating to the GI tract and often cause diarrhea. If, after reading more about magnesium, you wish to learn how this mineral might be related to your health, we encourage you to call for an appointment. We do not recommend that our patients self-treat with magnesium, as anyone with renal dysfunction needs close monitoring since magnesium is excreted through the kidneys.

A recently published study evaluates the benefit of pelvic floor muscle training on pelvic floor organ prolapse and associated symptoms. A total of 109 women were assigned to either pelvic floor muscle training or to a control group.

74% of women in the active treatment group showed evidence of lifting of the bladder and rectum and reduced frequency and severity of bothersome symptoms. Even in the group with the most severe degree of prolapse and related symptoms, 56% had significant reduction of those symptoms. No adverse effects occurred. The study concluded that pelvic floor muscle training is a reasonable therapy, and that surgery need not be the only option offered to women with pelvic organ prolapse.

According to a study reported in the October 1, 2010 issue of the journal "Spine," postmenopausal women who have spinal fusion surgery with instrumentation between vertebrae L1 and S1, are at increased risk of a vertebral fracture at a nearby vertebra, usually within two years of the surgery. All fractures occurred within 4 vertebral levels of the surgery.

The study included 100 patients aged 55 and older who underwent spinal fusion surgery for degenerative disease and were then followed for over 10 years. 24 percent of the women developed spinal fractures, the vast majority within the first 2 years after the surgery. Vertebra nearest to the surgery site fractured first, with all of the closest fractures occurring within the first 8 months after the surgery. The fractures located further away from the original fracture site took the longest time to develop. It is important for women to recognize that spinal surgery in the menopause years increases the risk of spinal fracture.

We hope you've found this issue of our email newsletter informative and enjoyable. We look forward to bringing you more news about opportunities to live better and healthier in the future.

 

If you would like to learn more about the many services provided by WMGI, please visit our Web site at www.wmgi.org.

 

Sincerely,

 

The Healthcare Professionals at
Women's Medical Group of Irvine

 

I spent an entire week in Tucson last month as part of my Fellowship in Integrative Medicine at the University of Arizona. I met doctors, physician assistants, and nurse practitioners from all over the world, who were profoundly dedicated to learning how to apply the safest and most natural therapies first. We spent hours studying nutrition, vitamins, minerals, and herbs, along with being introduced to a variety of complementary therapeutic modalities. I had my first experiences with Hypnotherapy, Healing Touch, Body Work, Art Therapy, Meditation, Yoga, Tai Chi, Tapping, Spiritual Healing, and Breath Work.

I was immensely impressed by everything I tried and learned. To further advance my knowledge, I hope to attend a medical hypnotherapy training course in March and a nutrition course involving Dr. Weil and others from my fellowship in May of 2011.

Although there is still much to learn, I have begun utilizing some of these new skills with my patients and most have responded enthusiastically. Fortunately, other practitioners in our office have advanced training in several of these healing modalities, and I have been able to refer patients for Reiki, massage, reflexology, hypnotherapy, nutritional counseling, aromatherapy, biofeedback, Chinese Medicine and acupuncture. Those adventuresome enough to try these less frequently utilized healing arts have been thrilled with the results.

As I continue my exciting journey into the field of Integrative Medicine, I will share what I have learned. I can say with absolute certainty that acknowledging the importance to health and happiness of consuming "real" food, being physically active, and experiencing relaxation, stress reduction, friendship, loving relationships, fun and laughter is critical. Pharmaceuticals and surgery are important tools, but will never be the full answer if true optimal wellness is to be achieved.

Felice Gersh, M.D.