Focus 580; Womens Health

Now we're going to our regular topic here something we do every month on the program women's health and the guest is Dr. Suzanne troupe and she's an obstetrician and a gynecologist. She also teaches at the med school here in Urbana-Champaign and does this program with us every month. Usually she comes in prepared to talk about a couple of things that are new but they're really the purpose the idea of the show is she is here to respond to your questions and all you need to do is call 3 3 3 9 4 5 5 toll free 800 to 2 2 9 4 5 5. Welcome back. Thank you going here. So we have at least one thing we can talk about. We do. OK. I think sometimes this time of year they concentrate on other news rather than medical releases so much. One of the new things that. I think that is part of the whole revolution and how we take care of patients is a is a new rapid test for herpes. And this is actually done on blood as opposed to other sexually transmitted disease infections where

you have to go in and have a public examination to to get a test. This is the way we've always previously done her priestesses by public examination at the time that you think that you have a lesion. And one reason that we think that the herpes epidemic is so extraordinarily big and there are calculations that actually there are probably millions of undiagnosed cases of general herpes because some people have do not get these terrible. Debilitating infection some women get very very mild infections and don't in fact know they have a herpes infection and they just get an irritated area every now and then didn't really think about it maybe even thought they were getting a yeast infection or a little bit of allergic reaction they in fact have a herpes infection. And there's this new test that specifically tests for the antibody to herpes simplex type 2

virus. If you recall I think we've talked about this before there's a type 1 virus in a type 2 virus and the type 2 virus is much more typically associated with general infections although it is true that type 2 viruses can cause oral herpes. It's not very typical and it is true that Type 1 virus can cause Joe herpes also not not typical. So this is just for the average typical gentle infection. And it's really for individuals who think they may have herpes or an undiagnosed uncomfortable area that has never been proven to be herpes ois before with the actual cultures you have to have a lesion to culture that shedding virus. And actually a lot of people with herpes infections don't really shed virus very often. And that's what's so tricky and that's what is so difficult about protecting your partner if your partner's uninfected and. This test is designed we just

prick the finger and get a drop of blood. And it's a sort of kit kind of tests that can be done very simply in a doctor's office and takes about 10 minutes and we've got a result and it's very accurate and it's a real breakthrough in technology. We're already using these kinds of tests to diagnose ulcers. There's a there's a H pylori test to to diagnose soldiers that has done this way actually on urine. This this test is is a similar kind of test that we do for pregnancy tests. You put a drop of urine in and you get the report while this one is done with a drop of blood. So it is done in a doctor's office and the particular company that that has brought this test to the market has done a lot of advertising on the test so I gotten some e-mails from patients and I've gotten calls from people in faraway cities that say I want this test but

we still need your finger to get a drop of blood. But hopefully it will start being available in lots of doctors offices. Well maybe we could talk a little bit about treatment for for genital herpes. I guess one of the things a difficult sort of frustrating about the herpes virus and I think it's true of both types is that what happens is that once you are infected the virus kind of goes and hides in the body. And just every once in a while emerges you to have an attack and it can be really uncomfortable for a while and it sort of goes away and then you may go for a while and it may happen again and I guess that at least it's true of the oral type I believe. I'm not so sure about the general herpes is that in over a period of years it may be a problem and eventually it seems to kind of burn itself out. And I'm not sure that we really know why it does but it does but that could you know one person could have years and years and years of problems with it. And there seems to be. Not very much that we can do.

Well we don't currently have. You're absolutely right what you're talking about and it is true that infections tend to burn themselves out but not true for all people with General herpes we tell our patients that for most patients it's about a 20 year disease process but I have had patients that I know have had it for more than that amount of time and typically in this process of burnout the early case infections are more frequent and then later on they're less frequent but some of that's based on the typical case of a really bad first infection and then over time less. I think now that we're going to make diagnoses in more subtle cases we're going to find that some of these the scenarios aren't really true. But it does seem that herpes simplex virus seems to be able to live in nerves and they travel from skin nerves up into the lower spine. Whole area of what they called the basal ganglia of the spine

and that's where they live and local irritation can bring them to the surface. The viruses to the surface and one of the reasons we think that it burns out is because our body does form antibodies and that's what this test is looking for those antibodies to that organism and the antibodies do seem to be able to control the infection to some extent. And this is where the vaccination trials have gone although for some crazy reason they have the first vaccination. I believe we even touched upon this the model in the last radio show or to show that the vaccinations only seem to work against women in work against men. So there may be something hormonal that has to do with women versus men were. We're not sure about that at all it's just what the first trial showed. And there will be more vaccination trials. But other than vaccinating and preventing you from ever getting it the only thing we know how to do is give you anti-viral agents that can solo or the virus titres in your system that it prevents

outbreaks and really to prevent most outbreaks you get stand the medicine all the time. And these medicines are expensive they're very safe with. It's Eclipse are they original one they studied individuals very intensely for four years but we know that some women have now been on it for six eight years 10 years probably in some cases. And it seems to be extremely safe over time. But in order to get really good suppression with that medicine you have to take three pills a day. The rest you know for years on end. And so obviously if we get the epidemic under control and they're predicting with the vaccination that we can we can get at least 43 percent last cases and we're predicting that if we start using these rapid tests more generally in the population that just by getting people under control because if you give somebody a medication to control the virus in your system you're so much less likely to pass it on to somebody else. So that's where all the research is going.

OK. Our guest this morning here on focus 580 is Dr. Suzanne Tripp and she's an obstetrician and gynecologist she has private practice in her area. Also she teaches at U of I med school here in Urbana-Champaign. And once a month on a Monday she's here we talk about women's health. Your questions are welcome. The number here in Champaign Urbana 3 3 3 9 4 5 5. Also we have a toll free line good anywhere you can hear us 800 to 2 2 9 4 5. A first caller here is on line number 1. Hello. Hi. A change of subject I wondered if you would comment on this as an alternative to primer and cycling. OK a Vista is a a sermon. Se r am for selective estrogen receptor modulator. You can think of it as the nickname has been designer estrogen. I like to think of it as a synthetic estrogen. It turns out that we have estrogen receptor alpha and beta due to different types of Ester germ receptor

throughout our body and some hormones act on certain receptor is and not an other receptor. And it turns out that a Vista works on the same estrogen receptor as estrogen for bone. So it can help prevent bone loss in women just going through menopausal transition who do not have bone loss. And it can actually help prevent bone loss in women with osteoporosis. There's not as much good fracture data out there as there is for the bi fascinates the bisphosphonates that are different kinds of bone hormones that have don't act in the exact way that estrogen does. Also a Vista has. Some of the same positive type benefits on the heart as estrogen although it works through a slightly different mechanism. What's unties saying about a Vista as a as an Astor Jhon is that it seems to not stimulate the lining of the uterus so you don't need to take it with any progesterone so you don't need this. When you take They have Vista therefore it does not

produce any more bleeding than a woman in menopause would get if she were just naturally in menopause and some people naturally in menopause get a little bleeding but wouldn't be caused by the investor. And also there is some early data that says it may prevent breast cancer. So we think that it may be an ideal treatment for menopause for some women the problem is the following. It can cause some hot flashes it can cause some leg cramps. It doesn't prevent or treat gentle dryness or any of the symptoms of your to gentle atrophy so some of the bladder symptoms and things that women get menopause and it's too soon to say whether it has positive effects in the brain or not. And as Trojans track record with prevention and gum disease with prevention of colon cancer with prevention of macular degeneration of the eye a Vista may do many of the same things. It's just too new we don't know. But that's a summary as it was of a vist as an alternative that of this.

It's way past that I'm in the late sixties and had been on the hormones for only three years and I don't know whether it's even worth it to do the same or not. Well I think that a lot of physicians would say that you could sit down with your healthcare provider and say Should I take a bisphosphonate should I take a Vista or should I get back on hormones. There would be potential benefits to all three of those strategies and probably significant health benefits over doing nothing. Thank you very much. Thank you for the call and let's go to line number four for the next caller hello. Hi I have been getting bad pap smear results for years and having to have it rechecked every six months and most recently I went in for my six month checkup and got a note from my physician. Saying everything is fine don't come back for a year now I'm wondering can you just do it yourself that way or what happened. Well since I don't know what the exact reports are I can't give you a specific or but I can give you a general answer that may in fact be the case and

it can be one of a number of things that can be viral changes of your cervix that in fact your body has cleared. It can be air. There's about Summers we used to quote about a 10 to 15 percent pap smear right now if you had one of the new kinds of pap smears. There's supposed to be a significantly lower error rate but we regularly do pap smears like every year instead of going to every three years to account for that error rate. We know that in many cases it would be safe to wait even longer stretches to do repeat pap smears. But on the off chance that that was an error then what we're we're compensating for that with these frequent pap smears. It could have been I can't tell your age by your voice but it could have been a hormonal change our whole hormone affect say a birth control pill affect that cause some sort of abnormality it could have

been a local infection that you cleared like a bacterial type infection for younger individuals if if they had. Something we were talking about herpes earlier this is a possibility it's not typical that you clear your own case of herpes but it can happen as well as with other viral infections but for younger individuals they could have had a or a gonorrhea infection or chlamydia infection that cleared up and that wouldn't typically be something that would occur over years without your physician knowing about it so I think what the best strategy might be is is to call your physician and say what what do you think went on with my case why suddenly is my pap smear OK or do you think this is just a bleep button or you're taking a chance that it's not going to be serious if the same condition has persisted. What about. Human Papilloma Virus. Is that the same as a virus category that you were talking about with a just that just clear it can

clear up. We do think just like we get colds. It's a virus. We clear our cold. No one treats it. This can happen with the human problema virus but it's such a tough resist virus that has so much natural resilience to our mechanisms for fighting it off that we don't typically clear it. Now there are some new human papilloma virus tests out there about $200 or that's approximately what I charge for them so I'm not sure how much other physicians would would charge for them but they're not run in all labs. A lot of physicians don't know about it because so many insurance companies don't cover them. Lot of physicians that work in group plans that they take on new tests as a group rather than as an individual. So there there are these tests that you can find out. Maybe you had there different types of human papillomavirus you may have had one of the types that was more likely to resolve over time and never be a serious problem. And that's where

these human papillomavirus tests can be very very helpful for mildly abnormal paps that we can't explain any other way. But without knowing what your pap smear report showed I can't say whether you had that or not. Probably just need to gather up your reports and sit down with your doctor and and say OK what do you think is the best explanation for what's going on with my case. But if it's safe to wait a year to do well without seeing the reports I can say that you know right. Yeah do most doctors know how to read pap smears that are giving him. I say sure and so I think that it's probably worth just sitting down and you know having communication with your physician or perhaps his or her nurse and saying Is this what you really meant or did you lose sight of the fact because sometimes sometimes nurses check those peps without your whole chart in front of you is there if they're checking dozens of paps in one setting this can be it can be something that's

missed so it probably would be worth checking in with them. All right thank you. OK thanks for the call let's go to line number two for the next person. Hello. Hi yes I got it. But I am a runner and my husband and I are considering having our first child and what I'm wondering about running while pregnant. Well there are lots of famous cases of women who've even run the marathon very late in pregnancy. Most studies of exercise and pregnancy show that naturally women who exercise even very intensely tend to naturally sort of workout less them last and less as they get farther into their pregnancy in some ways between 20 and 26 weeks. A lot of women who naturally exercise quite intensely get down to pretty modest exercise levels more the pregnancy exercise kinds of things. Water tends to support your weight more and

compensate for some of the Joint Distribution problems that you have in pregnancy. You get what's called. A lumbar lordosis so I'm more of a swing of the bat more arching to your back because to compensate for the expanding front and so you're positioning soft and also our ovaries make the hormone called relax and it tends to loosen up the ligaments of our body so that that's why if you look from middle pregnant woman if you look at her from behind when you see her walk she does wiggle more and it's because in fact her joints are looser and for some runners that the balance changes the looseness of their joints just seems to have an effect on them of being uncomfortable. Now in terms of the pregnancy itself unfortunately the placental blood flow only. It only gets blood flow from what is presented to the uterine

arteries so the blood that comes to the uterus is all the blood flow you're going to get. And being a runner you probably know that blood when you exercise it still goes to your heart it still goes to your brain but it gets shunted away from your internal organs to your muscles to feed the muscles more and that's what happens in pregnancy also. So there's always been this sort of lingering concern. Is there a problem with less blood flow to the placenta as the pregnancy gets farther along. And could this cause problems and there's been a tremendous number of research studies that have tried to tackle this and sort of the long and the short of it is that if you look at national organizations like the American College of Obstetrics and Gynecology they Warry And so they say don't get your pulse over 140. Well that's not an exercise to most women that exercise a lot and so on. It doesn't really help because they've made their guidelines just too wimpy for real

exercisers just to sort of protect themselves because they're just worried there's no real data to say it's a big problem. And then on the on the flip side most physicians that are that of taking care of patients that are very you know really truly athletes because some athletes even compete in an early pregnancy they know that unless your pregnancy is showing a problem lack of growth or some sort of other problem with their pregnancy that those guys they just say well ignore some of those guidelines and and do pretty much whatever you want. That's that's the information for when you're actually pregnant. The other issue is is to run enough to slow down conception because if you're one of those runners that run so much that you go into periods of time or you you don't menstruate. Yeah I don't have a problem. But yet so that for those women and that I get called all the time from say magazines and they want a one line what's

my best guideline for in terms of weight or the amount of exercise they want to one line or formula and unfortunately our bodies don't really work that way. It varies but it takes about three months for the average woman to can see 30 percent of couples are pregnant after three months. Sixty percent of couples are pregnant after six months and we usually say that it's perfectly normal to take up to one year to conceive. So if fall within that guideline doesn't really matter if you occasionally don't ave light because of the amount of exercise that you do all right Will thank you. Very much. All right. Well we are a little past the midpoint in this hour of focus 580 our guest Dr. Susanne troupe and she's an obstetrician and a gynaecologist she's on the program every month and we talk about women's health. And if you have questions you are welcome to call 3 3 3 9 4 5 5. That's for champagne Urbana folks. We do also have a toll free line. Go anywhere you can hear us 800 to 2 2 9 4 5 5.

Maybe we could just for a second return to the issue of reading pap smears of something we've talked about on the program before where the concern is that people read them. They are looking at the slides they're looking at Slide after slide after slide and the concern is that after a while you know maybe they're they're not going to not going to see things as clearly as when they started out and it's possible they might miss something. And we've also talked about the fact that there have now been some computerized systems introduced as an additional kind of check that we have computer programs that will look at the slides and the hope is that between the machine and the human being. They're one of the other is going to. If there's a problem they're going to catch it. How how common now is it that some of these machine programs are also using are being used to supplement humans who are reading this lot. Well there's actually been three changes and you mention two important ones one is the individuals their training how many slides they're reading and that's tried

to we tried to set some standards to back them off. The second issue is these computer programs and let me get back to that in a second. And the third issue which I think the most important breakthrough is how the pap smear is taken and how the slide is prepared. If you would if I could bring in these pictures I think we have before when you when you collect a payout a typical pap smear with the brush or a Q-tip or spatula and smear it on the slide the whatever blood you get whatever mucus you get what. And the cells themselves are layered on top of each other and they're very difficult to read. It be like if there was some writing on a on a very very thin sheet of paper that you could actually. Read and if you put two sheets on top of each other you might be able to even read the second layer but by the time you layer up four or five layers there's no way you're going to see that underneath layer. And so the new technologies have taken that into consideration and what they do is they perform

a centrifuge process and then they put a micro fine drop on the slide and prepare what's called a model layer of cells so it's only the individual cells and they're nicely laid out on the slide. The mucus is washed away the blood's washed away whatever other particles we might have gotten in collecting the PAP it's washed away and this slide preparation technology has been the biggest food that's expensive because the machine itself to do that is different technology and you have to train your side to side to technologists these individuals who are talking about a little different look to the slide itself. So a lot of companies nationally have gone to paying for these more expensive hops about three times more expensive than the old paps used to be. But I know locally a larger organisations do not cover these new kind of pap smears. And so most people aren't getting availed of this new kind of technology. Then the computer readout can the computers can be

designed to read the old slides or read the news live. And it turns out that a lot of the computer programs were set up for the old slides and were not going to be using those old slides so much so the issue is finding a computer program that can also re read your your new slide and then deciding how you're going to best apply that technology. Going to re read every slide you can to read read every fifth slide. You now have the computer readout normals to see if they can pick up something abnormal or are you going to have the computer re read abnormal and exactly how the computer technology is being applied is a big controversy so that most places the computer really reads in one of those companies that does that is auto pap but there been 6 or 7 of these computer designs that do that. They aren't being very widely applied. It was felt that there wasn't enough gain in sensitivity but once you apply that new preparation technique your false positive rate should just go

way down and your false negative rate should go way down. So it's a much more accurate pap smear so particularly in my patients that are moving to pap smears every couple of years every three years even if they're low risk they should get the newer kind of pap. If you want the most kind of you want the most accurate pap smear there is out there. So has that. We have a caller here I promise we'll get to them or just one quick follow up. When you take a look at now the kind of results we get in the places where they're using this technology so we're getting better slide preparation and we're getting a machine check in addition to human check. Are they picking up more problems than they were before. The idea is yes that we're we're being more accurate that yes were more accurately finding the abnormals but we're also hopefully being more accurate on the slightly abnormal like the one patient said she had a bad pap for years. She didn't go into details but it didn't sound like they had ever made a real diagnosis of a precancerous change or didn't sound like they'd ever done a treatment to her cervix.

So we're hoping that these new technologies can actually decrease the number of slightly abnormals. So just a more clear diagnosis from the pap smear itself. And a lot of the big plans the blues the Cygnus you know care with university are picking up the cost of the new paps. They're there. They were only started to be covered by many insurance companies at the beginning of the year that's when I switched to them. I do remember you brought in once a brochure that had the pain. Had the pictures and I said that well OK even I think I can tell the difference between the normal cell and the the most abnormal right. I could do that for you but the ones that are in these in-between stage right. It's really difficult because it seems that it's a continuum right and the changes as you go along can be pretty subtle You got to know what you're. And you get that subtle category that we're going to probably soon be adding. What I like to do is add in that human papillomavirus test but that's another couple hundred dollars that most companies are

not yet picking up but I'm hoping within the next year or two we will see companies picking up that test. And what I'm what I try to do for my patients is educate them about the tests that are available and help them make the decision about whether this is good money to spend or money they should wait on spending and that that's a tough concept because it's not clear in every different case which way we should go. OK. Well we do have another caller here it's Line 1. Hello. For a number of years I've had Perry formis syndrome is a problem with a muscle in my lower back. I developed this when I had my daughter 10 years ago and I have noticed that before my cycle my lower back really after bothering me and I was wondering if I have anything to do with my cycle I've been told in the past it doesn't. And also the second question. And also before my cycle if there is any flu or anything going

down I feel like I am going to get it. I was wondering if I could do anything about it. Well I'm not like you the other physicians you've talked about I'm not aware off the top of my head of any worsening of syndromes like that that specifically relate to menstrual cycling. It's an it would be an easy thing for you to check you if you were willing to take some hormones like birth control pills if you were a candidate for those. And you can use hormones to elongate your cycle So in other words instead of getting a once a month cycle you could you could design it such that you get your cycle once every two months or once every three months. There are women who delay their cycles literally permanently that may not be something that you want to do right away and see if by delaying your cycle you only get those symptoms less frequently. If so great you're getting a good medical response rate it may not be worth pursuing any

further trying to figure out why it happened if you could fix it from happening. And that's probably the first strategy I would try for many conditions that are are worsened around the cycle. This works for menstrual migraines. It works for dysmenorrhea which are menstrual cramps. It works for women who have a worsening of their endometriosis. So in fact it may work in your case as well. And what about the second. QUESTION If there's any sort of stress before you know if there's a flu or cold around and if it's sort of an endless circle in the winter time you know there's always something around you feel like every month you're getting. Well again I would probably say if you tried to work on the first strategy delay your cycles out. If you're only going to get those symptoms right around the time of your period perhaps you can stretch stretch

it out. It is possible that your immune system waxes and wanes with your menstrual cycle there has been some research to indicate that so. But I've never seen it go any further to figure out what you can do. There's a a lot of warke now done in sort of the. Internal Medicine circles and the naturalist group that is specifically looking at say levels of antioxidants in your body. Levels of certain vitamins in your bloodstream and if you can find a deficiency that you can treat. The theory is that perhaps you could improve your immune system but immune system boosting is not really my my specific err area of expertise I would think our family practitioner that I know comes on the show Dr swear engine. He may have some inside specially if we give them advance warning to to look it up for us but other than that again I don't know of any

specific studies that address the symptoms you're having. OK thank you. Right well other questions are welcome. We have a little more than 10 minutes left in this part of focus 580 Our guest is Dr. Seuss encroachment. And if you'd like to give us a call you are welcome to do that here in Champaign Urbana 3 3 3 9 4 5 5. And we also do have a toll free line. That was good anywhere that you can hear us. Eight hundred to 2 2 9 4 5. Well the only other thing I was going to add to our last caller is that if her symptoms are in fact related to pre-menstrual syndrome and if in fact any of her symptoms have any kind of neurologic overlay to them that might respond to the treatments for PM. And I don't know if we talked about within the last month. They just released Sara fam which is a treatment specifically for pre-menstrual syndrome and it's actually a very

low dosage of Prozac that you take intermittently just when you're getting your pre-menstrual kinds of symptoms. And that would be another strategy that that someone could try who's just having sickly symptoms. One thing about taking a medicine cation like that is you should know within a cycle or two if it's working at all for for your symptoms if in fact they aren't physical. It's unlikely that surf is going to. Treat all the physical symptoms so in other words if breast tenderness was accompanied by a mass the Serafin may may help your anxiety it may help your moods but it doesn't tend to have any inherent activity against breast enlargement which we think is the cause of breast tenderness So that could be a nother potential strategy. And just thinking about the case she was describing. Well certainly if there are other folks who have questions you can give us a call. 3 3

3 9 4 5 5 here in Champaign Urbana toll free anywhere that you can hear is 800 to 2 2 9 4 5 1. Was there anything else that you were. Fine about. I know that I know in the in the general media there was a lot of attention given to a test where you put a few drops of liquid on your palm and it reads your cholesterol out. And yeah it's been on as I saw it on the web myself and I and a couple of patients were asking they had noticed it was talked about on I think a morning talk show and I do think that it's probably worth going over cholesterol issues for women especially this time a year well. When everyone probably is over indulging in cholesterol are there anything like me they are it any rate this test is not yet available. So no you can't rush into an office and get it. Yes I think I'm jumping right in there on that. This test assumes it is available because they thing where you don't have to prick a finger or draw blood. It's great in my book. And I

think that that is important but it's also important for women to know that a simple general cholesterol number wallets can be invaluable in managing certain cases of hyperlipidemia. It is not the only sign or symptom of heart disease. And it's important to look at the bigger picture. Within the past year they have talked about adding in Tests like a homocysteine level which is a general measure B vitamin status in your body. They've looked at cardio C reactive protein levels which is a general measurement of inflammation that speaks to whether or not that cholesterol is going to. Go into plaque formation and it also is important to reduce the other factors of cardiovascular disease like smoking high blood pressure obesity blood sugar abnormalities.

So getting a blood sugar screen at the time you get cholesterol testing and these other markers. For most women who are healthy and do not think they have cardiovascular disease getting these these kinds of tests is probably reasonable about every five years. OK we have a caller here on our line 1. Hello good morning Dr. open I wonder if you could. Are there any research on the comparative effectiveness of its own or none of it. True. OK. Well for our listeners who maybe didn't tune in early Fosamax is a bisphosphonate. It's strictly is a bone medicine. There's a newer medicine called ACTA Now that's also bisphosphonate. And we think that in general the tubas fascinates that are available for treatment of postmenopausal osteoporosis worked very very

similarly Kelso Tonin is a different kind of bone hormone that is specifically used to treat osteoporosis it is not used for prevention at all. So it is not indicated for a woman with with normal bone mineral density on a bone test and it is not indicated for women with us to a piña just low bone mass and a Vista is is the estrogen receptor modulator. All of these things have been studied in terms of their bone density effects centrally in other words on the spine and peripherally in other words mostly talking about the hip. What I like about Fosamax is it is the only medication out there that has hip fracture prevention data and in fact you get 58 percent fewer hip fractures and they have done a study that has gone out for years and they have had additional hip fracture prevention for each year. A woman is taking the medicine. So I think

that in terms of hip fracture prevention the Fosamax really has some benefits in terms of a vista of Vista. It's a lot little bit less likely to put on additional bone mineral density. But approximately that of estrogen and with Kelso tone and it is a little bit more likely to treat bone pain due to due to fractures. So I think that they all have their benefits. They all have similar modes of action. It really depends on the individual woman what is her bone status. Does she have normal bone mass. Does she have osteopenia. Does she have osteoporosis. Is she in a high bone turnover state. That can only be determined by by doing urinary marker tests. And lastly and one thing that even myself as a gynecologist may have missed occasionally but we try not to. Does she have a medical cause for osteoporosis that has nothing to do with menopause. And there are number of

conditions like say a parathyroid gland disease. So there are a number of conditions that we can pick up. So first you establish those factors then you establish whether she has any other risk factors that that might might be treated by the medication like a Vista could prevent cardiovascular disease so it may have some benefits that that the bisphosphonates would not have at all. And then you try to try to look at the big picture of the individual and come up with with the decision about the medicines. But in a normal man a pause You should be losing about 2 percent of your bone per year in terms of the thickness and Vista should put back on about 2 percent Fosamax maybe 2 to 3 percent maybe as much as 4. Well I also have to remember in one thing I never talk about with patients but it's very important to remember that we have a certain percentage of non responders and I have been taking of it.

And then I lost them. Yeah and you may and it may be you would have lost more. But we have a percentage of non responders and there's a lot of talk in the medical literature about why a particular individual might be a non-responder where to go from there. Not completely clear. OK thank you. All right and to another call here lying too. Hello Dr.. I have a question that I developed in my third trimester a case of just ational diabetes. I had my child in the latter part of 2 of this year and we just moved back here from L.A. and I didn't get a lot of follow up because we didn't move so quickly. I didn't when I had my diabetes in the third trimester. I was able to control it with just diet and exercise I didn't have to. Inject any employment. What is the likelihood based just on that factor and I really don't have a direct line of any family Diaby this that I will

develop it later. I'm 36 and I'm worried about that diabetes I think aside now I think by my end that I had was that in that you helped in medical school or learned. Yeah I did say hi right. Wonderful job. I really put you up to this. He was great you did a great job you know. Well the jewelry was one of our smartest doctors that ever went through here. He got a dual degree in his very good doctor so I'm sure his diagnosis was that accurate. Well our statistical risk figures are being modified as you and I speak. Unfortunately most of the statistical risk talks about populations at large and our population at large is large in other words we were gaining so much weight that weight exercise and the diet that you consume seems to have a factor in whether or not you'll become a

diabetic later in life. So the best strategy is to get tested and some physicians would say get tested once a year and others physicians would say well every couple three years is probably reasonable. But some sort of testing is going to be your best strategy regardless of your risk. A lot would also depend on whether you have future children. And in fact if you get pregnant again and you have gestational diabetes again or get pregnant and have gestational diabetes and need insulin again then your risk is going to be even greater in terms of when. But yeah so just the general listener that that would generally be true as well. But it is certainly not true that the majority of women become diabetic and I've seen figures all over the map from 5 to 10 percent up to 30 to 40 percent. But again a lot depends. You keep your weight under control you keep your diet generally good and you

exercise. The chances are going to be significantly minimized. Oh great. OK. Well thank you very much. All right. Thank you well I guess at that point for this time around we'll say. Thanks very much to Ruben for being here. She'll be back with us again next month. She's here every month and show always on a Monday we talk about women's health. She is an obstetrician and a gynaecologist She also teaches U of I med school here in Urbana champagne.