Focus 580; Womens Health

Good morning I'm Craig Cohen This is focus 580 on the information advantage I'm sitting in for David in Chanda. This is our daily telephone talk program. In this hour of focus the topic is women's health. Our guest Dr. Suzanne trooping who is let me make sure I get this right professor of obstetrics and gynecology at the University of Illinois College of Medicine She joins us once a month to answer your questions on women's health. And our phone numbers are 3 3 3 9 4 5 5 or 1 800 to 2 2 9 4 5 5 That's 3 3 3 WRAL 1 800 2 2 2 W I L L. Good morning Suzanne. Good morning thank you for having me. I'm glad to have you back as we do every month and I don't know if you came prepared to talk about anything in particular. I had been following some of these same stories in the news as you did and I brought some new pictures for you I think some day we'll be able to just flash those up on your Web site. That's right you can see the pictures even while listening to radio. But I think that you know I can do a good pictorial essay for our listeners on some new alter sound advancements. And there's actually been quite a few things in the news so we'll have

plenty to talk about this morning. All right well why don't we jump right in talk about these these pictures. Explain what these are three dimensional. All right. Most people know that ultrasound is using sound waves to bounce off the fetus and acquire an image through computer. Interpretation of the balancing sound waves. And actually when we get an ultrasound picture a traditional ultrasound picture that most women are familiar with we're sending pulses of about one thousandth of a second back to the machine and so most of the time there's there's no sound actually even going towards the baby so it's very very safe. And we're using a computer to generally generate what we call a two dimensional image. And we've been able through the use of what we call gray scale enhancements in other words making certain part of the structures look darker or more less dark. We've been able to generate the illusion of three dimensions because our eye

sort of can can imagine a little bit. About the dimensions but basically doing two dimensional sound was sort of an acquired phenomenon so that a trained physician or an ultra Sanaa grapher could really understand the image they're looking at whether it be a baby face or the inside of the baby's brain. But it took a little bit more understanding on the part of the family to be able to really see the features that we are looking at to try to understand anatomy. Well they've been able to with an additional way of naming the bee and using the computer and training snog refers to generate a 3-D image with all the information coming in from the three dimensions so you get two dimensions in one direction and two more in the other direction but the one of the other two is the same as the first right. If you can if it would be accurate that's you get three dimensions and then you can use the computer

to put this together and generate an actual three dimensional picture and I brought some for you to see. And I think you'll agree this one shows the here's the baby's brow there's an eye there's an eye here's the nose Here's the mouth and you can really see very clearly three dimensional. Features now when we want to see more like focused on the finger or something like that we would have to aim our beam in a slightly different direction. And I pulled some of these pictures quickly together and I'm not sure but I think this one for instance shows the hand a little bit different image so you have to you have to play with the image a little bit. It's not always something somebody can see when they walk in the front door and get their ultrasound. They can see the two dimensional pictures but usually the three dimensional image we have to work with computer wise to really generate the good picture but I think you can see on some of these pictures you can really see the baby's features and you could be able to really detach to

certain kinds of. Things that the doctors would be looking for the patient saying oh this is Uncle Harry's chin but the doctors looking to see that there is a chin there are certain all right if that were you don't even have that in or the the with that the eyes are a part or actually whether there are cleft lips cleft palates. And then we can begin to translate this technology I was reading in one of the lay put press journals that and you know there's so much medical information out there that this technology prize will become standard of care in the next five to 10 years but actually it already is here now and will be able to take this technology and apply that to the heart or the liver or other parts of the baby's anatomy to really try to help even increase more understanding of certain kinds of birth defects. I did bring this one picture I thought it was pretty dramatic. That's a color flow picture for you to

see down there in the corner and that baby is 14 weeks from conception. That is a very young pregnancy just moving from the end of the first trimester into the second trimester and I think you can see pretty clearly these hatch marks that represents the spine and the this and the color flow represents the flow of blood through the baby's blood system. So the little bulb area is actually the heart and then the little stripe down the back is the aorta. And when we do color flow the blue in the red represents the flow to and from the direction the machine doesn't always represent Remus and arterial the way you might think it could. You can set it up that way if you want to but that's not what's so important. But using the collar to really set off the vascular features away from the rests this. See this is the head that's where the neck is hopefully you're getting pretty oriented. You can see at a very very early age. Even the chambers.

Beginning to form within the heart and really increase your accuracy in terms of figuring out for instance heart anomalies which about oh let's say I think we would expect three to four per 1000 babies something like something like that on the order of that. So it's a that's considered a common anomaly. But it's not that common if you think about it most of the babies we scan will will have normal heart so we're using these technologies to be able to take even snog refers who mostly scan healthy babies and allow them the ability to find abnormalities that they just couldn't see before because of the technology. I've got to be honest with you this one picture where you talk about the color scheme looks like weather radar. I used to have a professor that said that about ultrasound in the early days but and that's what I mean some of these older techniques. You really do.

You have to be trained to know what you're like Well it's interesting you bring that up because you know whenever I have seen an ultrasound in the past it's always you know the doctor will say well here's the baby's head and I'll go Sure yeah it kind of looks like it could be round I well you know it but your hands are much more detailed it is really very impressive. It is impressive. It's exciting. So it's exciting in medicine when we get new technologies or those of us that work with the technologies get pretty excited so that's the clinical professor of obstetrics and gynecology at the University of Illinois College of Medicine and she's here for our monthly chat on women's health if you have any questions or comments on that subject. By all means give us a call at 3 3 3 9 4 5 5 or 1 800 to 2 2 9 4 5 5 That's 3 3 3 WRAL 1 800 2 2 2 W I L L. I want to ask you about a conference that you attended in Chicago. You gave a lecture on. A certain combination of drugs that can help women who are dealing with the side effects of menopause.

Well as many of us have come to realize that estrogen is fairly ubiquitous meaning that it affects so many parts of our body affects the brain it affects our eyes it affects our teeth it affects our colon. Lots of organ systems that we haven't come to think about as traditionally organs that are our female hormones effect. Also we've known for a long time that estrogen of course affects the bone system and the heart system as well. So that as we have begun to treat women in Menippus we started to discover that there are many women who do get adequate response in many of these body areas so that if you go on hormone therapy you have half your risk of heart attacks half your risk of strokes if you have a heart attack or stroke it's less likely to be fatal. Your bone density tends to be preserved to some extent. Women have less macular degeneration of the eye. Blessed colon cancer lots of these things which we have talked about yet. Scuse me

there are many women who do not have full therapeutic effect in other words about 10 to 15 percent of women on good levels of estrogen will still continue to lose bone in menopause. About 3 to 5 percent of women will still have severe hot flashes and another 5 to 15 percent of women will occasionally have hot flashes. Some women still do get heart attacks and strokes so we're starting to look at the patients in the big picture of the way and talk about what other things that we can do for our patients to get full benefit of medical therapy in menopause and what that is going to mean for some women is to is to take more than just their typical hormone replacement therapy so that they need to for instance be taking estrogen. But if they have very high Lipitor cholesterol levels they may also need a staton drug. They may need to be taking their estrogen if they've got osteopenia which is low bone mass or osteoporosis

which is the actual bone thinning. But these patients may also need to to take something like a bi fascinate. And with the business mandates There are two there's Fosamax and then there's the new medication that was just released act and now has a slightly better side effect profile so they may need to add that in with their estrogen for women who have to reduce a sex drive reduced muscular energy. They may need to add testosterone in with their estrogen so that we're starting to talk about not just adding progesterone in to hormone replacement therapy which helps prevent breast cancer but looking at our patient as a whole patient and then realizing that they're going to need more than just estrogen for the next 40 to 50 years to preserve their menopausal health. It's interesting that we can now use patches to deliver hormones to Patches our great system with hormones

they avoid what we call the first pass effect so what that means is that if you swallow a pill it first goes to your liver so you will get full liver effects not good if you want to lower your cholesterol maximally but that's bad if you want to avoid some of the clotting factor abnormalities and some of the potential blood sugar abnormalities as you get up into higher levels. Of estrogen therapy so you get you avoid the first pass effect and you also can deliver a very very even stream of hormone so that the hormone leaks from these patches across into your system. And we currently have patches that just have estrogen. We have patches that have estrogen progesterone and they're about to release patches with testosterone. Now they've got a just as there are some patches that are coming out with male levels of testosterone and were looking at different patches that have female. And then I guess what now that we're all watching the Olympics together we're going to have to

wonder Well now if you take a male fads that's going to have a near Does does drown it. It will go up definitely is really there's a shoulder pad I need that for the race. Well and that's exactly right that some medications do require such a big patch that that is that is a problem in terms of effective delivery but part part of modern medicine is to make the individual particles of hormones so tiny that they leak effectively from very very tiny patches So for instance one of the estrogen patch companies just came out with this thing they call the Bible doc and the vibe literally is the size of a Dari and it's quite comfortable to wear. I was noticing in the Olympics some of the runners put stuck their name tags on their legs or their numbers you know your running numbers they actually stuck them on their legs and that those things look pretty good size so I was thinking on my patients complain

about a little patch now and then. Well in your patients are running in a race as necessary. Exactly. But that seemed uncomfortable there. But yes those patches are much much bigger than anything we give our patients. There's a survey out by the World Congress on fertility and Sterility which suggests that women sometimes resort prematurely to technologies like in-vitro fertilisation become pregnant. Maybe they don't fully understand what some of the things that they could do to become pregnant before going to that route. I saw that report and we have to understand it's one thing to walk into a grocery store buy a bottle of aspirin and say we take we take an aspirin too soon for a headache and I think to say that a patient does in vitro fertilisation too soon. This requires a tremendous team of technologists to give her those treatments. So I would I would say that maybe the doctors are advocating in-vitro fertilisation a little bit too soon. And I think part of that.

I think it's a whole mass when it when it comes to infertility treatments. There there become a whole lot of other issues around getting pregnant the timing of your pregnancy relative to your work the timing of your pregnancies relative to your other children. The fear of getting too old everyone knows that as we age our fertility goes down and so suddenly some women who for start trying to get pregnant in their mid to late 30s may feel like just because of their age alone they need to get fertility treatments. And I think these are the kinds of issues that push women to premature fertility treatments. And I think that. Women need to sit down with with a more primary care type provider first when they're there planning their pregnancy and go over what their risk factors really are. Go over the kinds

of reasonable things they can do on their own to enhance fertility their partners can wear boxers instead of jockeys because that they keep the sperm temperature more normal and actually increases your sperm count. You can both abstain from alcohol. You can get plenty of rest be as low and stress as you can possibly be. You can use basal by temperature charting to help detect obvious lation. There are over-the-counter. Test kits that you can get in any grocery store or pharmacy that can help you pinpoint obvious lation to enhance your chance of conception. Just some of these basic strategies that that women can do for first before they ever get into the hands of somebody that that delivers tertiary care in fertility then it also is probably important to to stand back and get somebody to

interpret some of the studies for you. Just because say in-vitro fertilisation may have had a say 20 to 30 percent chance of conception Perseid goal whereas for instance maybe accurate timing Leisha induction would have a 15 to 20 percent chance per cycle. The number of months it's going to take you to become pregnant may not be that different in your particular case and so you have to interpret the data a little bit rationally before you make a decision on which technologies to use. We were we're talking a few minutes ago about some of the hormones that can be used to deal with the side effects of menopause as suddenly occurred to me. There is also a study out I guess from the Netherlands which suggests that there's another benefit to some of the hormone replacement therapy that if you take female hormones for at least a year it could reduce a woman's risk of hardening of the arteries. Right.

Well estrogen has very very potent vascular effects. We know that the disease atherosclerosis is something that's rampant in most industrialized countries but particularly in the United States unfortunately autopsy studies done even on children show their children as young as 8 10 12 years of age will already have the process be gone. Plaque formation which is leads to eventual clogging of the arteries and eventually if there's enough damage to the artery wall becomes less resilient and becomes what's called harder quote unquote. And there are many factors that affect this process. Your level of cholesterol there's just tons more cholesterol circulating some of it may stick in parts of your arteries particularly It's very tiny arteries like the arteries that feed the heart muscle. Also the plaque formation

has to do with our blood clotting factors and anything that increases the overall levels of inflammatory compounds in our arteries will affect that. And we actually know that certain types of diet that are deficient in B vitamins can affect that as well. And it turns out that Aster gin is one of the very potent factors that has to do with not only what the overall level of cholesterol is but the types of cholesterol that are circulating in the body. The amount of clotting factors estrogen seems to have a direct effect on the vascular lining or the end at the end. Of the vessel so that the plaques may not stick in also estrogen may as well stabilize the plaque we don't think that the plaque being there is this big of a problem as in fact when the plaque breaks off and causes a

clot and that that clot then blocks off an artery seems to be the precipitating event for many disasters of the cardiovascular system such as a heart attack or a stroke. And so that estrogen can affect all those things so that we really think that estrogen is very very important for cardiovascular health for the average woman. Now you have to take that into context they did a study last year called The hers study that was published in the JAMA the Journal of the American Medical Association and her study took women that already had heart disease. They had they were over the age of 65 I think the average participant was about 67 in that study they had had a heart attack or they had some other. Consequence of cardiovascular disease. And they started all these women on estrogen and they had a control group they

didn't take estrogen and they had increased numbers of heart attacks that first year the study in the estrogen users. And that scared a lot of us. We didn't know how to explain that study it was only one study but there's a large other couple of trials the Nurses Health Study another couple of studies coming out of Europe like you were referring to. And those studies seem to indicate the same kind of information that there's a couple of different things going on. There's somebody that takes good care of herself has pretty good heart status as she's going into menopause and gets started on estrogen therapy versus someone with established heart disease. Maybe think twice if she never took yesterday in therapy on getting her on. But once those patients in the her study got past that first year the study by the third to fourth year the estrogen users were outliving the placebo

users so that we think that there's an acute effect and a chronic effect we're going for that chronic long term effect. But we have to. Account for the the New START problem and exactly how we're going to account for that. Do you put them on statens do you start them on baby aspirin a day Dia given full of acid supplementation to reduce their homocysteine level. Those are the kinds of things that can probably be done and what I am advocating for my patients is to carefully step back be evaluated for what. Where are your risk factors really. Does everybody in your family live to Hundred and not have heart attacks up until that time. Never have strokes. Does nobody go into heart failure. If that's your family history then we don't need Asterix ins to prolong your life as reasons or maybe cannot they do less for your cardiovascular system not

more. But if you are too inactive maybe a little overweight maybe your cholesterol's up a little bit perhaps even a smoker at some point in time perhaps your blood pressure is creeping up a little bit. Those individuals are going to very much benefit in terms of their heart from hormone replacement therapy and it's because of all the powerful effects of estrogen on the vessel wall estrogen can help relax the vessel wall and can bring the. They sowed dilating substances substances that actually locally increase the blood flow through a certain passage and really help your heart. Should stress that. Of course some of these studies are simply suggesting that there is a possible benefit here and so that is this is no excuse to go out to fast food restaurants every every meal and shout out on fried food. Well you know it's interesting they did a monkey study like that a

mile sampler in a very famous monkey study where they took some mechanics and they have a very similar cardiovascular system to humans and they fed one group what what you would call fast but very high cholesterol diet and they found another group the same high cholesterol diet. But the first group they also gave them in this study they were using birth control pills which are very similar to hormone replacement therapy medicines but stronger much stronger higher estrogen level and the progesterone are little bit stronger although we've released some products that have some similar compounds but in a way the group. Pastor Jones which were in the form of birth control pills didn't have so much of a lower cholesterol level. Both groups ended up with fairly high cholesterol as with the diet that they fed them. But when they they did studies the monkeys

vessels they found that the groups taking the birth control pill had much less hardening of the arteries and plaque formation. And so you're right. For many of us we need to be moderate in terms of our diet. But actually the research is there that even poor living could be overcome by by to some extent in some people by the right combination of medical therapies. Well I'm certainly not one to just suggest you know how well somebody should eat. I have my issues with that. Let me take a moment to reintroduce our guest of this is Dr. Suzanne Truman clinical professor of obstetrics and gynecology at the University of Illinois College of Medicine this is our monthly chat on women's health. If you have any questions or comments for Dr. trooping give us a call at 3 3 3 9 4 5 5 4 1 800 2 2 2 9 4 5 5. That's 3 3 3 WRAL. 1 800 2 2 2.

WRAL we have another 20 minutes or so so plenty of time for for calls if you'd like to call us. Another thing I know we seem to keep jumping back and forth between it's OK to pause in pregnancy but actually we might be getting a call so I don't know. All right well well I just want to mention this one other. OK. Study which suggests that a woman's diet in early pregnancy might affect the baby's health. What are some of the things that women want when they first become pregnant what are some of this may be. Are there specific foods that they should be looking for types of foods. Well most of the research on what you should eat as you are really pregnant has to do with I mean most of the studies on what you should eat in pregnancy look specifically at the big picture of pregnancy how much iron a baby will need to fully form its blood system how much calcium the baby will need to fully form its bones so forth and so on and for sheer growth of the baby it's primarily sugar. We actively pump sugar across the placenta

into the baby so that it's generally been felt that women don't need so many extra calories in the old days we used to say that over the course of pregnancy you need about 300 extra calories per day which you know piece of bread is one hundred fifty right. And in the early pregnant stage we've never told women to get extra calories and in late pregnancy they need more of these calories. But now most of the research shows that so many of us take in so much extra caloric content just from portion control problems that we have in the United States because of it. That would be me. Yeah. Well I'm going to take it as I've gone from being one potato to being three and you know you still grab one object and stick it on your plate but it's grown for you and so they out. That is some of the problem with our nutrients and then some of the research studies and there are large institutes like the Institute of Medicine and American college OBD Y.A. and

and various national nutrition groups that have come out with their recommendations have pretty much the civically looked at things like what do you need in terms of all the vitamins and so forth and mostly have concluded that prenatal vitamin supplement ation is probably only necessary if you have to restrict your calories for any reason or to get at least the specific level of full of acid in. Because we know that that folic acid specifically in the right quantities can help prevent things like the neural tube defects affecting the brain and affecting the spinal column. So that's where most of the research has gone. And now there are there are some of these these new studies creeping into the media that are talking about other kinds of nutrients that may very specifically affect the baby's health. And I'm not sure enough of the enough Orks been done in large enough patient populations to

change from eating a balanced diet with a little extra protein and taking a prenatal vitamin onto something else that that they're mentioning. I'm not sure which study you're specifically quoting but I know there were a couple in the U.S. was out of England. Tom Fleming of the University of Southampton. Yes I conducted this study. And was was he making any other specific recommendations passed was what we usually tell women to do. Well apparently this is they based it on on rats to study with rats which indicate a low protein diet for four and a quarter days after they made it then a normal diet for the remainder of the pregnancy would cause. Let's see it looks like low birth weights growth retardation. Well unfortunately the only studies that have been done in humans were pretty much done during war time where they specifically looked there was a famous Dutch study where they specifically looked at women who were deprived of

food when they were either in their first trimester second trimester or third trimester depending on when. When the war time famine hit and where exactly they were in their pregnancy and in terms of the first trimester that's when all the. Feel parts are being formed so you have slightly higher rates of miscarriage and more serious kinds of long term anomalies. By the third trimesters babies are kind of like us they put on a little bit of extra reserve and it's not as serious in terms of their weight. Other than that you pretty much have to switch to animal research and rats are attractive model because they we can get them to mate fairly frequently and they have very short just ational cycle so you can carry out an entire study in fairly short time. Well when we take some phone calls we have someone on line number four on a cell phone Hi welcome to focus 580 I thank you. I would like to know. I've heard this fancy trick didn't catch

the issues from by many women. It's not as effective it's hard to see. Please require that you take or only have cars so far. Is that correct. To some extent yes that is correct because the estrogen patch won't have as potent effects on the limpid levels so that the patch will slightly increase total cholesterol will very slightly raise HDL cholesterol and slightly lower LDL cholesterol. Where's pills. Now all this is dose dependent so a lot depends on the dose of the patch and the dose of the pills but the pills will raise total cholesterol but dramatically raise HDL cholesterol that's the good kind of cholesterol and more dramatically lower the LDL cholesterol so that your ratio to good bad cholesterol is very much more favorable. But some of these other kinds of vessel wall effects on the cardiovascular system should be the same with the patch and bells.

OK thank you. Thanks very much for the call. And let's go on now to line number one caller from Charleston. Good morning. Hi. I'd like some information about the procedure that's used for Dex to skim. When they check bone density. OK DEXA scans it's very simple it stands for dual energy x ray absorbed geometry. Don't ask me to spell simple. They play an x ray beam in one direction and another x ray beam in another direction and they get and those beams are 90 degrees perpendicular to each other and they get a two dimensional area calculation of your bone thickness. Now most of us think of our bones as three dimensional and in fact they are and the true when we talk about when they talk about the thickness or the quote unquote density measurement of bone. Most of us who had to suffer through. And actually I love physics oceans but most of us here took physics in high school and college remember that that density is the thickness it should be at area but what the computer

does is it calculates. The third dimension because most of us stop growing. That's why the sum of these measurements are not so accurate in very young individuals because they're still growing the computer can't take into account as to where they should be in terms of their growth. So it's actually a two dimensional reading and the computer compares you to a standard and what you get is a T score in a z score and your z's score compares you to everybody else your age. And that's not so important because if you get to be 85 all of us are going to have. Very thin austere product bones so that the the score that we kind of look at and interpret is called the T score and that compares you to what a young adult now that tells you whether or not your bone thickness is at normal fracture risk meaning that if we get hit hard enough that all of us are going to break our bones when we know that. But as we get thinner and thinner thinner bones

we move from the normal t score down to what is called osteo pain make t score down to even lower T score. That is called an austere product score and the World Health Organization has the main classification that most of us goal by now there are other organizations that have their own classification system so if if two ladies went to a different spot to get their bone density and they both sat there with their reports trying to make heads or tails may not be identical interpret it. But I used the World Health Organization greater than 2.5 standard deviation to score below below normal t score is considered osteoporosis. Is there an alternative to using x rays such as ultrasound available. There is an ultrasound of the heel and it's a little bit less accurate but it's pretty good there. You can use peripheral bone density measurements on the finger in the wrist or the heel and the heel also has an ultrasound

test. When I do the perf roll measurements I've compared them side by side at fairs and things like that. The profile measurements all measure about the same. But because you're you walk on your heel and you can get actually a little bit a compression of the heel the heel could measure denser without really meaning that all your bones are quite THAT dense usually peripheral scans whether they be the heel or the finger the wrist are pretty accurate if they say your bones are really good or really bad. But if you get in that osteopenia Grange then you really want to know what your your hip in your lower spine are. Thank you. Thanks very much for the call. And if you would like to talk with Dr. Susanne trooping by all means you can call us at 3 3 3 9 4 5 5 or 1 800 to 2 2 9 4 5 5 That's 3 3 3 WRAL 1 800 2 2 2 WRAL Well let's go on now to line number two called her on the cell phone. Hi there.

Hi I have a I have a just a quick question for you. I'm close to 30 years old and I my husband I would like to start a family. We probably went you start really trying. And I'm currently on birth control and we probably want to start trying. Oh gosh early next spring. And my question for you is I think seeing my nurse practitioner for all of my regular pelvic exam and perhaps mirrors and that kind of thing because really my only relationship is with her is it. Is it necessary for me to cite you since we know it. We'd like to try to start a family. Should I start building a relationship with you know bt why and at this point or is it OK to do that once I've conceived. Well it's certainly fine to go out and find a provider once you've conceived and that is certainly something that most Americans probably do in this day and age. Midwives can birth a patient family practitioner board certified ups Rishon

gynecologist or in fact some women who are high risk select to start their care with a perinatal just for somebody who actually specializes in high risk pregnancy. So there are lots of different kinds of practitioners. And maybe at your next visit with your nurse practitioner you guys can sit down talk about your individual case and whether or not you'd like the kind of care a midwife would deliver vs. an obstetrician gynecologist. It's also worthwhile for most people to go in for what's called a pregnancy planning visit. I thought your question was going to be when does my pill. Does that mean. Yeah cause that's a good question don't have a lot of people ask when actually I have my nurse practitioner and I have I have already you already covered that what I did we've covered on immunizations that I've had we've we've looked at it we've looked at my complete medical records. I think she'd like me to start right away. Get busy. Well so that I think that the other issue for other women listening not even necessarily for yourself

is well how many providers do you have a choice of getting on on your insurance company. There's only a couple of choices or there are there are some plans that are so limited there may only be one or two physicians that are fully covered on your plan. Well you know maybe you're going to have to see that provider one way or the other. But there are definitely there's no time like the present to go over different issues you know what your call system how do I get a hold of you. How often am I coming in for my visits when do you want me to have my first visit. Is there anything else that I should be doing in terms of we were just talking about nutrition so when to start prenatal vitamins so forth and so on are good issues to cover with the individual that's going to be delivering your baby. However I will say that for those individuals who aren't going to meet meet their provider in advance that those are things that some nurse practitioners do cover very well. Great. You very much. Thanks for the call. And if you would like to talk with Dr. Seuss Andrew can call

3 3 3 9 4 5 5 4 1 800 2 2 2 9 4 5 5 3 3 3 WRAL 1 800 2 2 2 WRAL. You know that is one of those moments in time of the course of a life when maybe it's a good time to re-examine or evaluate your own health care plan and decide Oh absolutely based on the fact that a lot of folks are in plans that are limiting in different ways. And maybe if suddenly you're thinking it's time to start a family maybe now's the time to go back and say well do I have the right access to the right doctors who are the experts that I want to deal with. And that's true on the other hand some individuals like our town we have a lot of new individuals coming into our community to start school or to be graduate students and they just don't have in-depth knowledge of of local providers the way maybe some individuals that live in more you know stable communities where they've been in the same town for quite a while and they can spend some time interviewing different physicians and looking

specifically at what plans cover what physicians course all the best laid plans go awry if your employer suddenly wakes up the next day and says We got a new boy. And. I see quite a few transfers of care even in the middle of pregnancy and I'm sure most going to colleges that still do obstetrics will also say there are about 7 or 8 minutes left. Still time for a couple of calls if you call right now at 3 3 3 9 4 5 5 4 1 800 2 Choo-Choo 9 4 5 5. Let's let's shift gears a little bit here and talk about another study that's out or not. That's a study of a vaccine for herpes that only works for women. I saw that and I hadn't really had time to really completely understand why that might be. And I suspect there may be more to this than we understand. Most of us realize that there are two main kinds of

herpes viruses that circulate around the so-called type 1 virus that generally causes fever blisters or the so-called cold sores that most people get on their lips and this type too. Herpes simplex virus that primarily causes the genital infections and we think of about five hundred thousand cases per year that we see in the United States. A new herpes cases each year. But now most of the research has indicated that many people have subtle cases that they never roll eyes that they even have herpes and that it's quite a problem and that the chronic taking anti-viral therapy can reduce the amount of outbreaks that you have. But in fact if we could just prevent this disease all together with some sort of vaccination you'd probably have to vaccine against type 1 and Type 2 eventually to really have good

effective levels. Of coverage and there may be some viruses out there that don't have the same biology as other viruses and so these so-called quote unquote intermediate type viruses it can exactly qualify as a class two can exactly qualifies class one that may escape. So exactly how they design this vaccine eventually is going to be very very important. And I know that they were testing one new one that seemed to only get good antibody levels in the women that they were testing and not the men and I don't know that they came up with an explanation as to why that was. You know I I don't think they have think so. They just said by the way by the way I think it's important to point out if it you know as and as with many vaccines this is only really works if you never had a cold sore. As is I understand. Well that is the idea is that we would vaccinate young individuals the way we do for hepatitis now we vaccinate babies at birth

against hepatitis B and before they've been exposed unless in fact they cut it from their mother while she was pregnant and then it helps establish effective antibodies and then you never get the disease down the line. There are some vaccines that are low counter intuitive that way. I'm working with one vaccine that specifically is against cervical cancer and or the human papilloma virus that causes cervical cancer and we are looking at one group who seems based on testing not never to have been exposed to human papilloma virus but we're also looking at using the vaccine in individuals that were previously exposed to high risk types of human papillomavirus and seeing if that will prevent the progression to pre-cancerous changes that could lead to cervical cancer so there may be some vaccines down the line that can help other individuals as well. Well we have a few minutes left let's go down to color on the cell phone line for high.

When I was twenty five hundred forty two predecessors in my family. What kinds of estrogens you think I should get. Well the most important thing for. I know we're getting a fair amount of static you want to hang up and listen but the most important thing for individuals with a potentially high risk situations the way you've had with it and I'm presuming your ovaries were removed at the time your hysterectomy because that they left her ovaries intact you're no different than anyone else or at least theoretically you're not. But the most important step is to have a diagnosis and get some testing. Figure out where you stand. Are your bones normal healthy now. In which case you only need low dose therapy either with an estrogen or with a bisphosphonate or are you already into a pattern of accelerated bone loss and

in which case either need a higher dose of estrogen a higher dose of the bisphosphonates or possibly a combination therapy. There are several new medicines out there there's cowslip tone and there's something called CERN which is selective estrogen receptor modulators that are sort of some people call them the designer estrogens or their non steroids type estrogen. There are also new compounds that are going to be released probably would possibly parathyroid hormone so other compounds that we can also use. Let's try and get in one more call why number one from Urbana High. I started listening late so I don't know if the doctor discussed extra tests to check. We didn't really discuss it in depth. I had a question. Does it benefit the heart and does it matter whether it's half our whole strength now. OK well for those who don't know Ester test is a combination of estrogen and testosterone and exactly what should its effect on the heart be and I

don't know that we have all the answers. Definitely it will have some heart benefit. But being an androgen has some adverse effects on Lipitor. They had that estrogen doesn't have having that testosterone will lower SH BGM we didn't get into this but sh b g is sex hormone binding globulin it binds up hormones so that when testosterone lowers that there is more circulating testosterone and more androgenic effect on the limpid which is a little bit. Counterbalancing the good effects of estrogen on the heart. On the flip side a lot of testosterone is converted in the body to estrogen so that with that Esther test there are other potential benefits. Extra benefit on the bone extra benefit on your muscular strength as extra benefit for sex drive. And so at the dosage that they've formulated that Esther test

either the full strength or the so-called H.S. which is stands for half strength those dosage ranges are still considered heart healthy. But if you had a specific heart problem you might want to take pure estrogen or some other combination like an estrogen stat there. Suzanne thanks for bringing by the debate you know. And we'll hope that more women out there get get to have a three dimensional look at their babies there and we will talk to you again next month. All right thanks. That is Suzanne trooping clinical professor of obstetrics and gynecology at the University of Illinois College of Medicine She joins us each month for a chat on women's health.