Focus 580; Womens Health

Well we will come back here this morning to our program one of a group of guests that are on the show every month. And the guest is Dr. Suzanne Tripp and she's an obstetrician and a gynaecologist. She also teaches at the med school here in Urbana-Champaign and has a private practice here in our area and each month always on a Monday she is here on the program we talk about women's health. She usually comes prepared to talk about some things that are new may have been in the news and there certainly are some. But also the idea of the program is if you have questions about your own health or someone who is close to you call in and discuss it with the doctor there are obviously some limitations because we're here working over the phone. We can't diagnose over the phone we always like to try to remind people of that but. We do these programs to try to help you and to add to your store of health knowledge and it would be a place to start and of course if you have other questions you should pursue them with your own doctor. Having said all that let me give you the number here in Champaign Urbana 3 3 3 9 4 5 5. That's for local folks. But if it would be a long

distance call for you. Use the toll free line eight hundred to 2 2 9 4 5 5 3 3 3 wy yellow and toll free 800 to 2 to WY. Well thanks very much for thank you and good morning. A lot of stuff actually new exciting month for women's health. Well where would you like start. Well we had the release of the first new contraceptive agent in five years Lou now it's a contraceptive injection. We were part of what's called the phase three clinical study which is the final phase of research that a product must go through before being approved by the FDA and it was approved last Friday. Week ago Friday excuse me by the FDA and we're anticipating Lou now hit the pharmacies in December and it's going to be a once a month injection. It is going to be different from Depo Provera in that depo provera is is an a three month

injection. It's only progesterone estrogen and women do not have menstrual periods. In contrast Lunel the new product is an estrogen progesterone combination. It is designed if you take the shot every 28 days you will have a modest period every 28 days so you will be more likely to have regular periods and it will. Offer women get another contraceptive choice. Also another important feature about low now compared to Depo Provera is its reversibility. About 60 percent of women are pregnant and three months of trying to get pregnant after their last injection so that is a big benefit because Depo Provera was so potent it actually stays in your system significantly longer. Well what other than perhaps that that advantage that if you are if you decide that you want to get pregnant it will it will move out of your system more quickly.

What would be some of their as a woman is thinking about her various choices of contraception. What would be some of the reasons that you might want to choose this. Well it's only once a month. So you do have a little bit more immediate reversibility if you don't like it you could switch to birth control pills you can get an IUD whatever did so only good for a month still. So I think the time courses is significantly important. It also does have some estrogen so would avoid some of the theoretical disadvantages of low estrogen particularly for young individuals that depo provera has. And it also allows you some flexibility in when you get it so even though it's a once a month shot we've got a 10 day window as to when you can come in to get your shot so you can get your shot in 23 days or you could get your shot in 33 days. It will produce a little bit more regular bleeding if you do that. Neuwirth me there was a question of whether or not there would be a little bit less weight

gain on the loo now than Depo Provera also we think that may be true. OK we have a caller here with a question that we want to talk with and other folks who are listening you certainly can call as well. Three three three. W. Wilde toll free 800 1:58 W while callers in Mansfield on our toll free lines is line number four. Hello. That's going to I have a question I think sort of at the other end of the spectrum. I'm in my 50s and I'm very concerned about bone density and I know that you know this is going to be a mass of information off there and then you see the screenings that they have at health fairs you know they you can line up and get a bone density. And I've never done that. So I thought that I could schedule my own you know that you can call up and get a bone density screening. And I was told that I would have to get that prescribe through my gynecologist and then my kind of causes that I wasn't eligible for bone density screening so I guess I'm kind of asked

about that. It is a bone density that is a great question and actually some some radiology departments are a little bit more flexible or they will allow for your primary care physician to prescribe. I don't know if if you're on a health plan and you don't have to tell me I'm just saying that in some health plans they've used insurance guidelines to sort of be the rationale for who they order tests on who they don't order tests on. And perhaps your gynecologist felt that they didn't want to approve therefore your insurance was going to cover for self referral. If you just said to your gynecologist nurse I would really like to get this test can can you just let me just give me a referral so I can just go ahead and get it. Usually that's a pretty flexible approach and many offices will comply. But just to stand back a little bit there is a ton of confusion about who should or should not have bone density testing and if you should have it

when should you have it. Let's start with the areas. Who makes recommendations while the World Health Organization makes a recommendation. The American College of Radiology makes a recommendation Merican College of Obstetricians gynecologists make recommendations and needless to say that they aren't all the same. And then there's just sort of expert opinion. I think that anybody who has risk factors for osteoporosis should probably have a screening at some point and again exactly when to get that is questionable. But risk factors would be any low estrogen States smokers. People who have had a bone fracture. People who have parents that have had osteoporosis particularly at a young age. These are a few of the literally couple of dozen risk factors we use to formulate in. Once you get over the age of 65 some physicians haven't been interested in getting their

patients bone densities because. Such a huge percentage of the patient population has osteoporosis. They don't necessarily see the value. Also most physicians are taught that if they're going to get a test they need to be able to act on that test. In order for it to be worthwhile and if they don't understand how to interpret the test or they don't understand what the different options are for therapy based on the various test reports they're not going to be real anxious to get that report in our practice. We think a couple of things. One I think these these peripheral scans are very useful. They can be done on the finger they can be done on the wrist they can be done on the heel and those are the usually the ones that you will see in health fairs and they are in some physician offices. There are great screen. They're inexpensive. They're quick they're painless. And if the readout is very high or very low in other words very normal or very much

austere product they're extremely accurate. Then from those we use that testing combined with with a few other factors to decide who to get. More the the so-called full densitometer rescreening which isn't fully there it's the lower spine in the hip but it but it's considered more accurate. We usually get up anybody over the age of 40 a peripheral screen and when to repeat is an issue some doctors say every two years some doctors say every five years and then I like most of my patients by the age of 65 to have a full a full deck. Unless we've ordered one before that and then you use the then you use that information in planning medication because the medications long term is expensive there are different options and if you really don't need to start it even yet in your early 50s Perhaps it's something that that you want to hold off on and with proper use of bone density testing some some people can

hold off on their medication for years. It's a big topic I hope that was a good enough summary but good luck trying to. Had a bone density. Thank you. All right we have another caller here and we'd welcome others that maybe I should again mention Our guest is Dr. Suzanne troop and she is an obstetrician and a gynaecologist. She's on the program with us every month. It's always a Monday and we talk about women's health. This is your opportunity to call and ask questions can be about anything that she deals with in her practice so that's a very wide range of possibility. The number here in Champaign Urbana 3 3 3 9 4 5 5 toll free 800 to 2 2 9 4 5 5. Here's a local call next in our Bana line one morning and always a pleasure to listen to Dr. trooping My question is how many loci. And Champaign-Urbana provide a bone density.

Christy does the university and you know all the you know OK it's a good question the university does have a machine but it's only used in research settings so we do send some of our patients there at the present time but it's only for specific research studies. The Christie Clinic does have a bone density testing Carle Clinic has bone density testing and those are I think Christie is at the clinic and Carl's at the hospital but I don't think so and I think at Weaver radiology they have a bone densitometer and I know I have a peripheral scan and I can't tell you exactly who else might have one for peripheral testing but that's all I know about us. Weaver I radiology you said had a full bone density test. Yes and you know that because of these various locations. I don't exactly I know ballpark usually for peripheral scans you would expect to pay about 75 80 dollars and usually for a full blown testing. It's more in the 250 to 300 range something like that.

And where's the Christie machine located. I'm not sure but I think at their main facility clinic. OK. Thank you so much for the information Laurie and we'll proceed again to another caller here this is also Urbana and it's lined to follow. Hi good morning. Have a quick question about Vista and what's the name of the other bone builder that is not a hormonal replacement. The Fosamax and there's also acted now which is a cousin to Fosamax that was released in the past few months. Yeah I'm talking about five Maxwell you can include that other one down in this question. Jury always remaining out I know on these things but at this point how do you evaluate the difference between them and what they give you what their benefits are. I have used the Fosamax and I'm now using is this. And I didn't you know before I am at this point going to preorder and I want to know at this point what's what's the best for bone building.

Well really when we step take a couple of steps back and we talk about bone building you really should include a stretch on the Vista isn't it is a synthetic. It acts like an Astra tin on bone but it's a so-called designer estrogen so Vista and estrogen have much more potent general body effects. And then you get to see the medications that only treat boat act NL and Fosamax are both approved for both prevention of osteoporosis and treatment of osteoporosis. There is a cousin that is not approved specifically except for. Other kinds of bone kinds of things called a Tinder date that I don't use much of I think. Endocrinologists May. And then there's the tone and that's only proof for osteoporosis and it's a different kind of horrible but again specifically works on bone. So a lot depends on what you're trying to accomplish with estrogen. You're treating the whole

menopausal range and it practically affects every organ in your body. Well I'm not going to use estrogen so let me thank you so right now and just say I'm interested in what I understand and I just have a judgment now about that I usually am as opposed to Fosamax I understand but I'm trying to sort of give the big picture for others who may be listening so that they kind of understand. When you step back and you talk about a bone treatment and then you can talk about the percent that you expect your bones to gain in density in thickness exactly what we're talking about with these measurements. You can also talk about what you can expect to gain in Fracture prevention. And it's not just the bones that aren't fracturing. There's something else that goes on because we know that some people may not gain in thickness that's where you have to wear this whole bone density testing becomes so confusing. Not all bones gain in thickness but some get fracture prevention. OK so then this

is how I try to decide. Absolutely. Number one some people aren't going to take estrogen. Number two if it is an estrogen it's synthetic It's a designer estrogen it works a.m. gin in some forms but it's going to act like estrogen in many other tissues besides bone for instance on the heart system. So that's it. Good thing there are probably other ways as a Vista acts as an estrogen that we haven't discovered because it's so new Fosamax act in no tone and only act on the bolts and that is where if you only if you need medication that's going to act in other organ systems for instance of histamine help to prevent breast cancer. Then the pendulum's going to swing towards Vista. But if you talk about which is best for bones then there are two measurements one the thickness and they all actually overlap in percent gain thickness in the menopausal woman on the average she can gain about 2 percent a year on these

medications maybe some studies Fosamax have a little bit more maybe some studies of just a little bit less. However it's about 2 percent although we tend to have about 10 to 15 percent complete non-responders Fosamax as a medicine is the only one out there that has been shown to prevent hip fracture. It's why it's a big gold star on my piece of paper when I'm weighing risks and benefits because Fosamax shows to prevent hip fracture and women who get hip fractures are the women who suffer the most the consequences of osteoporosis. OK also with Fosamax there is one other thing that most doctors don't know but hopefully we're going to be getting this message out soon is that you can take it just once a week and that is a big benefit. But most doctors don't prescribe that what you can do that with actin L2. They're coming out with a 70 milligram tablet for Fosamax so that if you're on the 10 milligram dose you just take 70. But they already have a 40 milligram tablets so if you're on the 5 milligrams a day you can take

140. If you're on the 10 milligrams a day you can take two and you just have to take once a week. But many physicians aren't aware that dosing. OK thank you. All right thank you for the call. Why should that we're only talking there about a difference in convenience that is. Well you don't have to remember to take it every day or does it make it makes a big difference medically because Fosamax interact in our little bit tough to take their absorption is sort of poor you've got to take it on an empty stomach. You've got to take it with a big glass of water it's a little bit caustic to the lining of the soft I guess and the straw make. And it turns out that soften some of the cells particularly in the softness that are delicate and sensitive to the Fosamax will regenerate in five days. Feely take it once every seven days or so much less likely to get that stomach upset. And same with acting out now the one benefit I didn't get a chance to mention with ACTA now that I like a lot is that with ACTA now it's approved for use two hours after meals Fosamax only approved for first thing in the morning. Acta Now you could

you could eat lunch there not eat anything for a couple hours and actually take it on an empty stomach so that's that's a big benefit to you. And again to another caller this is again Urbana number one. Yes I have a sister who takes Fosamax and does have a steel corrosive. And now my brother has been diagnosed as having osteoporosis and it seems to me in the news. I did hear that Foster not yes can be used by man. Correct. They should maybe talk to his primary care provider. OK. Do most doctors know that Fosamax has been approved for men. Maybe not but I think Merck the manufacturers of one of the biggest you know pharmaceutical companies in the world is trying to get the information out. But but absolutely. You mentioned another drug that was used similar to Fosamax back to now has that been approved for men.

I know it would work for a man off the top of my head. I don't remember because I truly do not follow the literature for men as well. So you would have to just check with call pharmacy. OK they would know. Thank you. Thanks. We certainly because of the kind of coverage the issue of osteoporosis in women gets. We tend to think of that as being a women's problem. What what percentage of men have osteoporosis. Well you get over to a certain age and everybody has osteoporosis and but with men it it's much much later in life primarily because their testosterone production continues so steadily till they are fairly old. But I think the majority of men and in their in their late 70s and 80s probably do have osteoporosis. And I think it's probably an untapped area really looking into to those older men but I really don't know because I don't treat the older man so I can't. I think would be a great

question to ask are primary care doctors learned and all have done and I don't know maybe shoot him an email and warn him. OK get spiffed up on the new indications for the new medications. OK. Again to Bloomington Indiana line number four. Hello. I Dr. Drew been responding to the approval of the abortion drug RU 486. Yes. The the serial drug company issued a warning about their drug a drug that you do Cyril makes and this drug is called Cytotec and I think it's a process. The grand and yes it is. Well what would you explain what a prostate gland and what a prostate gland is and would you explain why. What would you do Cyril said Is there a drug Cytotec profitable and should not be used. They say off label is it but please don't use this drug off label and how would you explain what process learning is what it has to do with RU 486 and why

G-d's would not want their drug use off label. OK it's such a complicated topic basically RU 486 is an anti progesterone. It does not work to actually cause an abortion in and of itself it works in many different ways that in many different conditions where an anti progesterone would work. But first what it it causes is sort of a death of the lining tissue of the uterus so that the actual pregnancy begins to pull away from the lining of the uterus and then on. If an abortion is going to be induced medically you have to follow up that RU 486 treatment with another treatment that would cause the uterus to contract and to then expel the pregnancy. And. There are many prostate gland in analogs analogues meaning that a type of prostitution available but the Missa Prost all under the brand name side attack is the one that

is the cheapest The widely available the safest the most extensively studied and the medication that we already use for medical abortions which are being done completely off label with the Methotrexate messa Prost all combination that's been widely available from abortion providers for many years now. The the problem is is that the pregnancy then expels over time so it expels over about 50 percent of patients after they take that second drug will expel their pregnancy in 4 hours but it for the complete 96 percent effective that we've been hearing in the media. You may have to wait four to six weeks. This is a long process. Some of the pregnancies will still be continuing. It's a very complicated process and for that reason what Cyril is somewhat responding to is they want to be sure that the most responsible use for medication is going to go on out there. And they've also felt like the

FDA has somewhat left them in limbo in that even though their product is. Not approved for abortions by the FDA releasing specific information with RU 486 that talks about the use of Misoprostol as follow up. They feel since it's the package insert of RU 486 maybe that will be misconstrued that it's their package insert and if something goes wrong with that process that they don't want to be caught in a position where they didn't properly warn consumers that this isn't there. They haven't been part of that process. I think that's my best explanation. So I think that's why they're there issuing this warning. But in fact these protocol for in fact many many medicines are used off label. Actually the use of estrogen every time we talk about the use of estrogen for for instance other than the treatment of

hot flashes and the treatment of osteoporosis pretty much everything else in the treatment of agile atrophy. We talk about estrogen use for the heart. That's off label. That has nothing to do with the package insert. When we talk about Depo Provera approved for contraception we talk about using it for control of menstrual periods off label so it off label as a concept is very. Complex issue thank you very much. Is is it the case that just curious on you can we can talk about off label uses for medicines that any physician can prescribe any drug for any reason that he or she sees fit. Absolutely. What that means is that you can write it. I as a physician can write you an order for a medicine you can go into a pharmacy they will give you that pill and you can swallow it. Now it's strictly up to

physician judgment and care as to whether or not the use was appropriate. And this whole label off label situation has arisen for many many reasons. First of all. Not all uses of medication are are readily apparent to begin with. For instance the discovery of RU 486. They didn't even understand they were looking for something that was more similar to a glucose cord a cord or a stick. They were looking for a different purpose when they discovered it was a potent anti-protest. So you sometimes and other medicines for instance banned for anti-smoking It's a well-known anti-depressant but one psychiatrist noticed hey you're not smoking as much when I give you this anti-depressant poof. It works for smoking cessation. Now this became known became in the literature before it's necessarily something that's FDA approved. Now this

FDA approval process is time consuming paperwork consuming. It would even if I wanted to the day I discovered that I banned work for smoking cessation if I wanted to tell every other physician if I wanted to say to the FDA hey this works. Get it on the label make it approved. The FDA would say do a study. Well by the time you design the study and go to your institutional review boards and get the data and compile the data and submit the data this can be yours. It can be years worth the process. And some companies basically either they don't want to do this study maybe Sorel doesn't want to do the abortion study for instance. Or maybe they don't want to spend the money because if by the time you do you put in millions of dollars to that that development and that drugs are already out there and maybe the literature is already in good scientific journals so that physicians and patients can go that scientific journal get the information they need they don't

necessarily need the backup on the label for a complicated process. This is why for instance only ortho try cyclon birth control pills have what's called Class labeling. In other words by law if you're a birth control pill for the most part your package insert has to look exactly like every other package insert. They have to talk about the same pregnancy rates they have to talk about the same side effects they have to talk about the same indications the same contra indications. By law but also the FDA has allowed a particular company ortho tri cycle and to submit their data and say hey look at our actual research on acne prevention. And sure enough they then got the package indication in addition to the class labeling. They're the only pill that can put on there helpful against acne. But why does it work against acne. It raises sex hormone binding globulin So the male hormones aren't as high a level circulating and it probably has some direct of

effect is as well. And because it's a birth control pill it suppresses the amount of testosterone made by the ovary. Every birth control pill there does the same. Are some better actually some may even be better than ortho try cycling or some more sure Summer Wars. But it's the only one that has FDA approval for that. But for most gynecologist if you walk in and say hey I've you know got some acne but I'm on this pill other brand X marks that I'm on does it and I'm on something else. Should I be switched ortho tri cyclic most going to colleges they'll say well if that's your only reason for switching these pills do the same. So you know this is where this whole off label thing is is very complicated but in the case of the cereal company and the Missa Prost all the tiles are drug a side attack. I think the companies particularly

concerned because in all the FDA approval of the myth of press stone the RU 486. Talk about the use of it. So it's it's an it's a gray zone it's a it's a really exciting breakthrough because most of us thought this kind of thing would be the whole stumbling block and prevent it from coming to market. And it probably is going to have tremendous other uses. And the metro system fibroids I know I know there are indications in men I just don't know the model. And so it is pretty exciting. Well I want to I want to go on forever on this. This is the me one more question I'm just sort of again curious on this point if so going back to the example if you say now you can write me an order for any drug I go to the drugstore get it and take it. And I would expect that if if there's a bad outcome. Right I can always go back to you and say you made a mistake and right you're in big trouble. Ken though can I go to the drug company. They didn't have anything to do with it. If it's not if they it's not a proof there it's not a label for that.

Can I sue the drug company for bad. Probably not. Now. I don't know. You know if you have a legal issues ask and I think I think it would be. I think it would be important but absolutely I think that may be the roadblock and because of that and take shouldering a lot of personal responsibility and not having shared shouldered responsibility with the drug company may in fact stop many physicians from writing for certain off label things. For instance in the treatment of pre-term labor probably in the city today probably in our state today there are many women getting turbulent medication for the treatment of pre-term labor not indicated it's an asthma medicine not FDA approved for the preachment treatment of pre-term labor. However there's tons of literature on its effectiveness and rigid DRI in the drug that is approved for the treatment of preterm

labor. Not only may and some research studies have more side effects but it's extraordinarily expensive because they did the work of going to the FDA and getting their drug approved for the treatment of pre-term labor. But no one uses it. Well I won't say no one. There must be some doctor out there listening who can call and say I use that. But and they were. Probably say I use it because it's approved interviewed only Nisan approved and if my patient goes ahead and delivers prematurely I don't want to be accused of not using the FDA approved medicine. Well it turns out none of the medicines work very well so we're all in the same boat with whatever we choose Same with magnesium sulfate. Not approved for the treatment of pre-term labor. Use that all the time. So it's. You're right it leaves you in a sort of a legal pitfall but this is something doctors do a particularly gynecologist I guess I can't comment so much on other fields but it's something we do all the time. Well our guest this morning here on focus 580 Dr. Seuss and trooping she's an obstetrician

gynecologist. She has a practice in her area. She also teaches at the you know my med school. And once a month you hear on the program we talk about women's health questions welcome three three three. W I L L toll free 800 1:58 doubled while well we probably should get back to the topic. Sure. One other time. While we have many we talked we did at the very beginning the program talked about one thing that was new that is a new contraceptive possibility. Yes. What what else you adopt. October is ultrasound Awareness Month. And actually I think that it's particularly exciting because there are new clinical developments and ultrasound we a few years ago had the development of through three dimensional imaging and ultrasound and now these machines have become clinically available. I know we have one and it's a it's a expensive machine it's difficult to learn how to use that technology because the examiner the

technician performing the ultrasound also has to generate the three dimensional image with the use of computer enhancement. And yet we think that it will allow capability of much more accurate measurements. It's also very exciting to be able to see the real features. I was going to bring some pictures but I ran out the door with that next month. I'll bring the pictures to show you but as I view this as one exciting new development and really it's the first truly new development ultrasound in about 20 years. OK. Well we have another caller here let's talk with him. This will be in Champaign. It's one one. Hello hello. Hi Dr. Truman. I have a question about epidurals used in childbirth and I'm wondering if they've changed a lot in the last 10 years because a lot of the books I read on childbirth talk about the increased risks that

a woman and that baby would have if they if the person chooses to use an epidural and I have one I wonder if that's changed much over the years. Well I'm not sure sure what books you're reading. There are some risks with epidurals and there are always going to be some arrests. The catheter has to be inserted in it does slightly have a risk of some local infection and bleeding with the insertion. It also does cause some discomfort going in and there are is some risk of continuing discomfort. There's also a risk of the epidural medication converting and becoming a spinal medication. And that has to be. Observed for as well. But these risks are very very low. I think there have been enhancements over the past 10 years. We've used other compounds so that for instance I think it was may have been will more than 10 years ago but about

during that time period we started using narcotics as well as local anesthetics to provide additional pain relief so we got the quote unquote walking epidural in other words an epidural that doesn't completely numb your leg so that you can actually still walk around in labor and still have an epidural which has been pretty exciting for some women. Certainly much more comfortable. And I think that we've learned how to manage labors. For instance it's still a little bit of an argument between the obstetricians and the anesthesiologist as to whether or not it slows down your labor some and if it slow down your labor too much whether you would then have to have a Syrian birth that you may not have had to have otherwise. So that would be a slightly additional risk. But on the other hand if your pain is such that you're not progressing in labor the right time epidural can actually allow you to progress along that agilely

whereas others may have given up and had scissor in bars. So I think some of the birds birthing books sometimes focus on the negatives no really given off true credit to all the positives of a situation but with the epidural timing we know better about the timing of giving it and not only that we know a little bit more about using medications like pitocin. However I don't think that we would argue that more pitocin is definitely given to women with epidurals than women who labor spontaneously and then use the Potosi it has its own risk benefit profile. So I think that's what the book's referring to. But epidurals are very safe they're fairly widely used there are many hospitals across the United States where 85 90 percent of their patients actually get epidurals. We don't have that here in our community near that highest or to stick but they've really helped many women and should be definitely considered as an alternative for laboring women who might be

interested in them. Thank you. Thanks. What we're essentially what we're talking about here is medication is given to you to do to reduce pain for women in labor. Are there other. Are there other things that one can do either in the run up to delivery or even once a woman starts to go into labor. If the idea of having that medication makes you uncomfortable or at least you'd like to say well let's sort of let's hold off on that and what can we do before coming to that point. Well I think maybe I better explain below a bit better what an epidural is. We have our spinal cord where our nerves are and in the lower part of the spinal cord. Our nerves that are the lumbar region nerves in the sacred reachin nerves and those lower lumbar and the upper sake roll region nerves that innervate the whole uterus and then the para name so when we talk about labor pain

relief we talk about relief from the contractions itself and relief for the birthing process itself in the birthing process itself. It would mean the parent where the baby comes out. Pain relief in that area so that if you're talking about alternatives there are alternatives that are for the labor process the contractions the progress progress and there are alternatives for the actual birth itself and alternatives for the labor process are primarily psycho profile axis or most of us call it breathing learn. Understanding what your labor is going to be like. Understanding what the contraction is are going to be like understanding a little bit about what the contraction patterns are how they present how fast they come on how fast they go away. And that alone seems to allow most people. A lot of pain relief and then they teach these methods to

basically distract you so you're doing your breathing and you're thinking about your breathing and yes you're well oxygenating that's a good side benefit. And yes you're relaxing your muscles and relax muscles are less painful. But also you're getting significantly distracted you're paying attention to your patterns on and so forth and focusing elsewhere and working with your partner and you're distracted so that's the main type of pain relief. You can also get intravenous injections which or intramuscular injections which are actual pain relief and they can range from types of sedatives to types of narcotics. You can also then for the birthing process get the numbing shots for just that area where the baby's going to come through and that will help relieve the pain of the birthing process as well. So those are the primary alternatives that we have now. OK. We do have about. SIX SEVEN MINUTES LEFT OF SOME wants to ask question 3 3 3 W while all toll free 800 to 2 2 W while

our guest Dr. Susan Tripp and she's here with us. Each month we talk about women's health. You have something else you don't. Well guess and I was actually at the end of August but I don't think I got a chance to talk about it on the September show that talked about. The American College of Obstetricians and Gynecologists issuing advisory on the use of hormonal contraception in women with preexisting medical conditions. And they said that in fact published studies again we're talking off label use here. Published studies have documented the safety and effectiveness in healthy women but they are specifically notifying patients and warning patients and their providers because this directly came from the college too. To me as a board certified obstetrician gynecologist that. That the data are less conclusive with women with underlying conditions such as hypertension diabetes

migraines fibrocystic breasts tissue fibroids or elevated cholesterol. And they said that women with a family history of breast cancer or chronic conditions for instance this morning I was was talking to a patient with a very strong family history of cholesterol disorders and. And you know whether or not this would be an issue for her in contraceptive and they're talking about discussing the risks and benefits and reminding us that unintended pregnancy could pose substantial health risks for the well woman and her unborn child. And it was interesting the 1995 figures you know how these figures lag but 1095 figures ten point four million women in the United States use oral contraceptives and 1.1 million use Depo-Provera injection and 500000 use implants. We're talking to a lot of women. We have at least one more person here to talk with on our show. ELSWORTH is the caller and that's line number four.

Hello. Hello. I have a question. If you are taking this. And what about taking also naturally occurring plant estrogens with such as a soy drink. Well it's been my general philosophy that soy has so many health benefits particularly on your cholesterol that is an excellent addition to our food our diet. It's also been my general belief that most women in United States that are adding soy to their diet are not adding tremendous amounts of soy did their diet and they had it. It can be done beneficially or safely to caviar. However that we do have to consider is one. If you're adding a tremendous amount of soy to your diet would it ever interfere with the use of estrogen medicines. And I think most physicians are inclined to say probably not but I would I would have to say truthfully that we may not know. And the other thing is is that

one thing we've learned from for instance the use of to Mach 7 to Mach 7 is a sort of in a Vista cousin in that it's also considered a sermon selective estrogen receptor modulator. It doesn't have the same hormonal. Chemical configuration is a Vista but it can also act as estrogen in some tissues an anti-acid region and other tissues differently than a vista. Different actions in different tissues but one thing that we've learned from Tom Oxman is that paradoxically if it's given to women before the time of menopause actually can cause bone thinning whereas if it's used in women after the time of menopause it can it can cause the bones. It can help prevent osteoporosis. So that we we know that depending on what your your hormones are different medicines act differently and we don't understand for every patient how to tease that out individually. So I guess the quick answer is probably

beneficial. Don't overdo it and keep watching the research because more will need to be done. OK thank you. Thank you. Well we have about a minute or so left. Is there one more quick thing. There was I thought that it was interesting and kind of continuing on our FDA theme if our listeners want to go to the FDA health site which is on the web which is at FDA dot gov you can specifically do a research under breast implants and I know I don't know the exact number but we have had a large number of women in the United States with breast implants and they specifically have a lot of new information on what can happen to breast implants particularly what they call capsular contracture when the capsule kind of scars often contracts around the implant and they actually have pictures of what it looks like when your breast capsule has developed a problem or when your implant

has developed a problem so you can look at the picture you can do a breast exam and help understand whether or not there have been any abnormalities developed that you need to consult a physician about. And I think that that it would it would be a good source of information for women who have implants or are thinking of getting one. Well thanks very much. Well thank you Dr. Suzanne troop and she's here with us every month on the show I was on a Monday. We talk about women's health.