Monthly Archives: July 2016

Menopause sometimes requires a survival guide

Posted on by MaryO

Menopause has gotten a bad rap. Women in their 40s and 50s who have any symptoms – from moodiness to insomnia and headaches – may believe that it’s a normal part of aging and there’s not much they can do about it.

Fluctuating hormones caused by the normal decline of ovarian function can trigger the typical symptoms associated with menopause. One approach is to give the body a drug that mimics ovarian function, such as estrogen or hormone replacement therapy. This was a common treatment, until multiple studies showed increased risk of urinary incontinence, stroke, dementia and breast cancer from using menopausal hormone therapy.

Fortunately, there is another approach to improving the body’s ability to adjust to hormone fluctuations that doesn’t increase the risk of breast cancer and dementia. This approach looks at the other organ systems that are involved in addition to the ovaries. For instance, hot flashes will be greatly exaggerated in a woman who has blood-sugar problems – even if those don’t show up on a standard blood test.

BIOIDENTICAL HORMONES

Some women use bioidentical hormones instead. While they appear to have fewer immediate side effects, there is no evidence that they have fewer long-term risks.

At a recent functional medicine conference I attended, there were several discussions on how to address hormone “saturation” – the experience many women have after being on bioidentical hormones for several years and then having a return of their previous symptoms. We’re learning that underlying imbalances in gut function, adrenal hormones and blood sugar can have a major effect on a woman’s experience of her perimenopausal years.

IT’S NOT JUST THE OVARIES

Technically, menopause occurs when a woman hasn’t had a period for 12 consecutive months. The symptoms that can occur for years before that are due to the ovaries becoming less predictable in their hormone production. This means that estrogen levels can spike and fall like a roller coaster.

Unfortunately, once a woman knows that her hormones are fluctuating, she is likely to explain away all her symptoms as perimenopausal. But ovaries are not the only glands affected by hormone changes. The pancreas, thyroid and adrenal glands play key roles in determining how easy or difficult the perimenopausal years will be.

The most common, end-stage effect of pancreas dysfunction is diabetes. But long before the body reaches a disease state, there are more subtle effects. For instance, a woman with low blood sugar or insulin resistance will experience more severe hot flashes than a woman with normal blood-sugar regulation.

Following are common symptoms associated with perimenopause and factors that can determine the severity of those symptoms.

• Heavy or frequent periods. These can be worsened by blood-sugar and thyroid imbalances that don’t show up on routine blood work. Checking free and total levels of T3 and T4 as well as thyroid antibodies can be helpful.

• Hot flashes or low libido. Underlying adrenal stress can result in cortisol levels that are too high or too low, or reduced DHEA (precursor to several hormones). Cortisol levels are best tested with multiple saliva samples over a 24-hour period.

• Insomnia. With or without hot flashes, insomnia is often due to chronic stress, which causes the adrenals to produce excess cortisol.

• Mood changes and brain fog. Moods can be affected by the stress hormone cortisol as well as imbalanced neurotransmitters. Neurotransmitters such as serotonin are made primarily in the gut and can be evaluated with a urine test. Low levels of serotonin can also increase overall pain levels.

• Hair loss and weight gain. There may be underlying thyroid stress that doesn’t show up on routine blood work but requires a more detailed look at free and total levels of T3 and T4 and thyroid antibodies.

Once these underlying issues are identified, they can be addressed through food choices, lifestyle factors and specific supplements.

Marina Rose, D.C., is a functional medicine practitioner, certified clinical nutritionist and chiropractor with an office at 4546 El Camino Real in Los Altos. For more information,  visit DrMarinaRose.com.

From http://www.losaltosonline.com/special-sections2/sections/your-health/53300-

Go for new cancer treatments

Posted on by MaryO

WHEN it comes to cancer, many healthcare professionals advocate early detection to increase the chances of successful treatment. In reality, this is hardly the case. Although there are no Malaysian-centric statistics, research has shown that almost 50% of cancer patients in Britain are diagnosed late, making treatment less likely to succeed and reducing their chances of survival.

What this means is we need to ensure that patients with late diagnosis are able to access treatment without compromising their quality of life.

Renal cell carcinoma (RCC) or kidney cancer is often diagnosed late. This is because the symptoms for RCC are similar to those of other diseases and may only surface in the late stages. In fact, 49% of patients in Malaysia are diagnosed with RCC when the cancer is in the final stage (Stage IV). A study showed that the five-year survival rate of patients with Stage IV RCC was only 13%.

Kidney cancer is among the top 10 cancers in Western communities. According to the 2007 Malaysia National Cancer Registry Report, RCC accounts for 43.8% of new kidney cancers. However, these statistics are quite dated as it has been nine years since the data was collected.

Advances in medical research have led to new treatment modules. A revised healthcare policy should ideally be aligned with innovation in cancer treatments. Despite new targeted therapies being approved for use in the US and Europe, these therapies are still limited in most parts of South-East Asia, including Malaysia. And even if they are available in the market, patients have to purchase the drugs from private medical facilities, excluding the majority of Malaysians (75%) who seek treatment at government hospitals.

In the treatment for RCC, there is only one drug approved in the government formulary. More options are needed because a single drug may not be right for every patient. For those who are not able to respond to this particular treatment, access to an alternative drug is often a lengthy and uncertain process. For some patients, the options available to them are so dismal, there is almost a case of no option at all.

In developed countries, drug choices are fully funded by the government, leading to patients having equal access to various drugs of treatment that best suit them. In Malaysia, drug choices are limited. Patients may have to pay out-of-pocket to access these treatments, putting them in a financial dilemma of cost versus survival.

In fact, a recent study by Universiti Malaya showed that 5% of cancer patients and their families were pushed into poverty, and that cancer resulted in “financial catastrophe” for almost half of the patients who suffered from economic hardship.

The policy of approving new drugs is based on an analysis of the quality of life years patients gain versus the cost of the drug. Unfortunately, drug affordability is determined by pharmaceutical companies based on the affordability of developed countries. This leads to a mismatch in drug affordability in a country like Malaysia, where Malaysians have a diverse range of economic situations. Furthermore, no matter how clinically effective a drug is touted to be, no drug has been approved in the government formulary in recent years.

Cancer is set to be a major burden of disease worldwide and the leading cause of morbidity and mortality. It is imperative for policy makers to review and update the targeted cancer therapy treatments currently available in the national formulary so that efficacious medicines are accessible to the majority of the population in public hospitals.

We hope increased funding will be made available to assist patients in their treatment, allowing them to live longer with a better quality of life and without putting them at risk of financial catastrophe.

While Malaysia’s public healthcare system continues to evolve to meet the needs of a growing and aging population as well as alarming rate of non-communicable diseases (NCD), let us be aware of the imperative need for this country to also keep abreast of breakthrough therapies available for patients and to champion for these therapies to be accessible at our public hospitals.

Cancer does not discriminate. Every patient, regardless of their economic status or cancer stage, deserves access to treatment.

DATUK DR MOHD IBRAHIM ABDUL WAHID

Medical Director, Beacon International Medical Centre

Vice President of College of Radiology (COR) Malaysia