06-21-2023 Primetime Living - Flipbook - Page 26
26 A Special Advertising Section of Baltimore Sun Media Group | Wednesday, June 21, 2023
of HRT: transdermal patches, vaginal rings
and creams. Transdermal patches are
absorbed directly into the bloodstream.
Oral estrogen pills have to go through the
liver, which can cause other problems.
Not everyone needs to be on HRT, and
not everyone qualifies. It’s about living
in the best possible health into your 80s.
We also cover all the other non-hormone
treatments available today for those who
cannot take HRT/ERT. These are fine
points to grasp, and you need a counselor, a doctor, to explain them to a patient.”
Compounded Bioidentical Hormone Therapy
One of the latest fads is something
called bioidentical hormones. An article
by the Mayo Clinic asks, “Are they safer?”
“No, they aren’t,” it states. “According
to the Food and Drug Administration (FDA)
and several medical specialty groups, the
hormones marketed as “bioidentical” and
“natural” aren’t safer than hormones used
in traditional hormone therapy. There’s
also no evidence that they’re any more
effective.”
The article goes on to provide two
strong warnings:
• They’re produced in doses and
forms that differ from those in FDAapproved products. For many nonstandard combinations, you need to
go through a compounding pharmacy.
A compounding pharmacy is one that
specializes in making medications
customized for your individual needs.
However, products from compounding pharmacies haven’t been subject
to the same rigorous quality assurance standards that standard commercially available hormonal preparations have to meet.
• They’re custom-made for you, based
on a test of your saliva to assess your
unique hormonal needs. But, unfortunately, the hormone levels in your
saliva don’t reflect the levels in your
blood or correspond to menopause
symptoms.
The American College of Obstetricians
and Gynecologists (ACOG) provides its
own warning: “Not only is evidence lacking to support superiority claims of compounded bioidentical hormones over con-
ventional menopausal hormone therapy,
but these claims also pose the additional
risks of variable purity and potency and
lack efficacy and safety data.”
Shen had one warning to which
patients should pay heed. “Be careful
about what’s on the internet. Choose
wisely when doing research. Look for
information that is evidence-based, where
studies show actual results from medical
trials. Celebrities don’t have a medical
degree. They hold themselves out to be
experts, but they are far from it. In our
reality-based society, people are so influenced by influencers, they end up doing
real harm. Here are websites that provide
evidence-based information and recommendations:
• Society for Women’s Health Research
(SWHR), https://swhr.org/about/
SWHR offers a free downloadable
Menopause Preparedness Toolkit.
• The North American Menopause
Society, https://menopause.org/
• Wellness + Healthy Aging Program:
Dr. Shen’s program provides podcasts
by experts on a variety of subjects
that women face as they age and are
worth listening to:
www.hopkinsmedicine.org/womens_
wellness_program/podcasts_
webinars.html
Wrap-Up
Menopause is complicated. As mentioned above, you could breeze through
it. Or, like many others, you could have a
variety of symptoms that throw your life
into disarray. Take time to have a discussion with your medical professional. I was
fortunate. At the beginning, my internist
spent time with me to discuss what I was
going through. Then, when I needed it,
he referred me to someone who could do
more than he could offer.
Shen points out women are not talking about menopause when they should
because they think it means they’ll
be perceived as getting old. Not true.
Menopause should not detract from living
a full and healthy life. So, ask questions,
learn what will work for you, and choose
what will let you thrive. You are an individual, with your own medical history.
Primary Care, continued
from page 10
body. If the blood pressure is exceedingly
high, it can lead to serious concerns like
stroke and blood vessel rupture.
*High cholesterol – the collection of fatty
deposits in blood vessels leads to the development of plaque that can cause narrowing and make it difficult for blood to travel
through the body. This can lead to high
blood pressure and starve other parts of the
body of oxygen. Depending on the location
of the plaque, this can lead to heart attacks,
strokes or peripheral vascular or arterial disease, which can require bypass or cleaning
out of the arteries to enable blood flow.
*Diabetes – the body can become less
sensitive to the insulin that it produces to
assist in the removal of excess sugar from
the bloodstream. Long-term high sugar levels can cause the pancreas to work overtime
to produce enough insulin and eventually
the body stops responding, causing damage to nerves, tissues and organs. This can
result in heart disease, kidney disease and
issues with the eyes and vision.
“You are not going to feel your blood
pressure being elevated in most cases. In
the early stages of diabetes, you are not
going to feel that your sugars are high,” Dr.
Delapenha explains. “It’s really at the late
stages where you’ve had the disease for a
number of years and it’s gotten out of control that you feel those symptoms and end
up in the hospital.”
The primary care provider, in monitoring
blood pressure and sugar levels, can work
with patients to change their diet, encourage exercise and refer to a nutritionist to
minimize the factors that contribute to the
development and worsening of these diseases.
If they haven’t seen the specialist in a
while, Dr. Delapenha makes sure the patient
returns for a follow-up visit.
Regular check-ups also help physicians
watch for signs of cancer. “Routine screenings help us keep an eye out for prostate
cancer, colon cancer and lung cancer. Most
cases of cancer are caught early enough
to be treated and managed to enable the
patient to live a pretty healthy and productive life. It’s a lot of care coordination and
direction to really make sure things keep
moving and don’t get lost,” he explains.
Partnering with a specialist
If levels are indicated or other concerns present needing additional care, Dr.
Delapenha refers to the appropriate specialist like a cardiologist for the heart, a
gastroenterologist for digestive concerns or
an orthopaedist for musculoskeletal injuries
and pain. Although he defers to their expertise, Dr. Delapenha monitors the patient’s
results and progress, communicating with
the specialist and tracking issues to ensure
the patient is meeting milestones and following up with specialist recommendations.
When to seek care
Reach out to your PCP first if you are
feeling ill, as they know your detailed health
history best. Chronic ailments, especially
those that have been persistently nagging
for months or years, should be brought to
the physician’s attention. Dr. Delapenha
attests the most common concerns are
chronic back pain or shoulder pain that has
been disregarded for some time. Twinges of
chest pain should not be ignored, especially
as the patient ages, since this could signify
coronary artery disease that may necessi-
tate a change in lifestyle and treatment.
Significant chest pain should necessitate
a call to 9-1-1 and a trip to the emergency
department.
“But often patients will complain to me
about chest pain or shortness of breath
following exercise or going up a flight of
steps that goes away,” Dr. Delapenha says.
“Those are concerning symptoms of coronary artery disease and the patient should
see a cardiologist for a stress test.”
Maintaining a relationship with a primary care doctor helps to build a comfort
level and trust between the provider and
the patient. The PCP may be more apt to
pickup on signals due to the familiarity built
up over time and the patient may divulge
more information based on the relationship.
Dr. Delapenha encourages patients to call
with concerns and questions, even if minor.
“That’s what I’m here for,” he says. “I
like to educate and teach, and help patients
understand what’s going on with their bodies and how to get their health back on
track.”
