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livingdebNote: the last few sections of this post are relevant to everyone who visits doctors, not just the smallish population implied by the title.
I've been wanting a book on how not to be an idiot about getting older and when I saw Barbara Seaman and Laura Eldridge's The No-Nonsense Guide to Menapause: A comprehensive resource with simple, unbiased advice on managing this important life stage (2008), I thought it might be part of the answer.
Hormone Replacement Therapy
Check out this quote from the introduction:
By 1990, HT [hormone therapy] had been on the market for forty-eight years but there had still never been serious clinical trials to demonstrate its effect on the heart, as well as other symptoms it was being used to treat. Despite this, Wyeth-Ayerst Laboratories (now Wyeth Pharmaceuticals), the makers of Premarin, attempted to get the drug officially approved for the prevention of heart disease, hoping to expand its already lucrative market. The FDA refused. Taking the advice of the National Women's Health Network, a grassroots group that eschews pharmaceutical funding and functions as an advocate for women's health rights, the FDA called for the creation of the WHI, a massive randomized double-blind clinical trial set to last for more than a decade and a half. Almost everyone was convinced that trial would affirm what everyone already knew: HT was a wonder drug for "women of a certain age" that should perhaps, as one doctor suggested, be put in the drinking water alongside fluoride.
When the Prempro (premarin and progestin) arm of the trial came to a screeching halt in 2002, doctors and patients alike were shocked by the reasons. Women taking hormones had more heart attacks, more breast cancer, more strokes, more pulmonary embolisms, and more blood clots than women taking sugar pills.
That result never quite made it to my consciousness back in the day, so this was good for me to read. And based on real science like we used to have in the olden days. So I checked the book out of the library.
(By the way, those results are for women who have not had hysterectomies.)
I found this to be a thorough book in a boring, hot-flash-heavy way. So I didn't read the whole thing, just the first half and other parts of interest to me.
Osteoporosis
I read about bone health because I have pretty much every risk factor for osteoporosis except being old, and I plan to acquire that one as well. I learned that bone density scans give you different results depending on what machine is used, what norms are used, what bones are scanned, and even what parts of bones are scanned, plus bone density is only one part of bone health.
I had thought I wanted to start testing my bone density, but these tests now sound almost useless to me. So I've decided I'll just act like I got mediocre or bad results and do weight-bearing exercise, drink milk, take vitamin D and maybe magnesium, and consume more produce. (And if I'm wrong and still fine, this action I plan to take is not something I'm going to regret.)
Hypothyroidism
Hypothyroidism runs in my family, so I read the section on that. It turns out you can do thyroid self-exams. This is basically feeling for lumps along the sides of your esophagus between your Adam's apple and sternum, which is easiest while you're sitting up straight, pointing your chin out or up, and swallowing. I can't actually feel anything, though one would think I could tell the difference between the side that has been removed and the side that has not. Oh well.
Finding a good doctor
They also have advice on finding a good doctor. The doctor should:
* have gone to a medical school in the US or well-reviewed other medical school
* have performed a residency somewhere good (find out where by asking the doctor's staff or checking the American Medical Association's Medical Directory at a library or online at the AMA's website)
* be board certified (not just board eligible) in his or her specialty (find out by contacting the American Board of Medical Specialities)
* have continuing medical eduction, preferably through membership in a medical specialty society rather than through a program underwritten by a pharmaceuticals company (check the society to see if your doctor is a member)
* have hospital affiliation (hospitals have good resources for researching qualifications of, malpractice payments by, and disciplinary actions against doctors and would not want to allow questionable doctors on staff)
Preparing for appointments
The authors give this advice for preparing for appointments:
* when making the appointment, explain what it is for to make sure you are given enough time
* ask the cost--you can comparison shop if you like
* visit the office of a new doctor so if your spidey-sense says to run away, you still have time to cancel the appointment
* write up your medical history
* write up your list of concerns you want to discuss and prioritize them
* have relevant medical records sent to your doctor
* talk about everything of concern or that might be relevant, even if it's embarrassing--remember, doctors have heard and seen a lot more things than you're thinking about and they can do a better job with more information
* research your symptoms ahead of time so you can ask more relevant questions--the Mayo Clinic and the government-run MedlinePlus are good resources--trustworthy and written in simple English
* feel free to print out articles you have questions about
* if your doctor interrupts you (a common occurrence), make sure you get back on track and discuss everything you want to
* if you don't understand something, speak up
* ask questions about proposed treatments such as any risks of getting the treatment as well as risks of forgoing treatment
Drug questions
They also have this checklist of things to ask about prescription drugs:
1. Is this drug FDA-approved to treat my symptoms/health problem? (It's not illegal to prescribe a drug for off-label use, but it can be unwise.)
2. Why do you think a drug approach is the best way to go?
3. What might be some nonmedical things we could do that might also work?
4. What will happen if I decide not to treat this problem?
5. What kind of studies have been performed on this drug (including size, nature, and duration of the study)?
6. What are some of the known side effects of this drug? Which ones are either serious or potentially life-threatening?
7. How long do you think I should take this drug? Is it a long-term prescription?
8. How much does this drug cost? Will it add a financial burden to my life?
I don't see them knowing the answer to #5 or maybe even #6, but a pharmacist might, plus you could research these yourself later.
Bias
After reading as much of the book as I did, I can see that there is a strong bias against drug companies. It's the same bias I'm growing toward any large company where I can't help assuming that you just don't get large unless you're willing to do things that other companies are not willing to do in the name of profits.
In this case, companies can make a lot of money by finding drugs that treat but do not cure long-term common problems. The ideal situation is to define some common characteristic as a disease and find a drug they've already invented that helps with the symptoms. Prevention and cures are not as profitable.
It's now difficult for me to read the cheap women's magazines I picked up from the give-away pile at the library because they are full of gigantic ads from pharmaceutical companies.
I've been wanting a book on how not to be an idiot about getting older and when I saw Barbara Seaman and Laura Eldridge's The No-Nonsense Guide to Menapause: A comprehensive resource with simple, unbiased advice on managing this important life stage (2008), I thought it might be part of the answer.
Hormone Replacement Therapy
Check out this quote from the introduction:
By 1990, HT [hormone therapy] had been on the market for forty-eight years but there had still never been serious clinical trials to demonstrate its effect on the heart, as well as other symptoms it was being used to treat. Despite this, Wyeth-Ayerst Laboratories (now Wyeth Pharmaceuticals), the makers of Premarin, attempted to get the drug officially approved for the prevention of heart disease, hoping to expand its already lucrative market. The FDA refused. Taking the advice of the National Women's Health Network, a grassroots group that eschews pharmaceutical funding and functions as an advocate for women's health rights, the FDA called for the creation of the WHI, a massive randomized double-blind clinical trial set to last for more than a decade and a half. Almost everyone was convinced that trial would affirm what everyone already knew: HT was a wonder drug for "women of a certain age" that should perhaps, as one doctor suggested, be put in the drinking water alongside fluoride.
When the Prempro (premarin and progestin) arm of the trial came to a screeching halt in 2002, doctors and patients alike were shocked by the reasons. Women taking hormones had more heart attacks, more breast cancer, more strokes, more pulmonary embolisms, and more blood clots than women taking sugar pills.
That result never quite made it to my consciousness back in the day, so this was good for me to read. And based on real science like we used to have in the olden days. So I checked the book out of the library.
(By the way, those results are for women who have not had hysterectomies.)
I found this to be a thorough book in a boring, hot-flash-heavy way. So I didn't read the whole thing, just the first half and other parts of interest to me.
Osteoporosis
I read about bone health because I have pretty much every risk factor for osteoporosis except being old, and I plan to acquire that one as well. I learned that bone density scans give you different results depending on what machine is used, what norms are used, what bones are scanned, and even what parts of bones are scanned, plus bone density is only one part of bone health.
I had thought I wanted to start testing my bone density, but these tests now sound almost useless to me. So I've decided I'll just act like I got mediocre or bad results and do weight-bearing exercise, drink milk, take vitamin D and maybe magnesium, and consume more produce. (And if I'm wrong and still fine, this action I plan to take is not something I'm going to regret.)
Hypothyroidism
Hypothyroidism runs in my family, so I read the section on that. It turns out you can do thyroid self-exams. This is basically feeling for lumps along the sides of your esophagus between your Adam's apple and sternum, which is easiest while you're sitting up straight, pointing your chin out or up, and swallowing. I can't actually feel anything, though one would think I could tell the difference between the side that has been removed and the side that has not. Oh well.
Finding a good doctor
They also have advice on finding a good doctor. The doctor should:
* have gone to a medical school in the US or well-reviewed other medical school
* have performed a residency somewhere good (find out where by asking the doctor's staff or checking the American Medical Association's Medical Directory at a library or online at the AMA's website)
* be board certified (not just board eligible) in his or her specialty (find out by contacting the American Board of Medical Specialities)
* have continuing medical eduction, preferably through membership in a medical specialty society rather than through a program underwritten by a pharmaceuticals company (check the society to see if your doctor is a member)
* have hospital affiliation (hospitals have good resources for researching qualifications of, malpractice payments by, and disciplinary actions against doctors and would not want to allow questionable doctors on staff)
Preparing for appointments
The authors give this advice for preparing for appointments:
* when making the appointment, explain what it is for to make sure you are given enough time
* ask the cost--you can comparison shop if you like
* visit the office of a new doctor so if your spidey-sense says to run away, you still have time to cancel the appointment
* write up your medical history
* write up your list of concerns you want to discuss and prioritize them
* have relevant medical records sent to your doctor
* talk about everything of concern or that might be relevant, even if it's embarrassing--remember, doctors have heard and seen a lot more things than you're thinking about and they can do a better job with more information
* research your symptoms ahead of time so you can ask more relevant questions--the Mayo Clinic and the government-run MedlinePlus are good resources--trustworthy and written in simple English
* feel free to print out articles you have questions about
* if your doctor interrupts you (a common occurrence), make sure you get back on track and discuss everything you want to
* if you don't understand something, speak up
* ask questions about proposed treatments such as any risks of getting the treatment as well as risks of forgoing treatment
Drug questions
They also have this checklist of things to ask about prescription drugs:
1. Is this drug FDA-approved to treat my symptoms/health problem? (It's not illegal to prescribe a drug for off-label use, but it can be unwise.)
2. Why do you think a drug approach is the best way to go?
3. What might be some nonmedical things we could do that might also work?
4. What will happen if I decide not to treat this problem?
5. What kind of studies have been performed on this drug (including size, nature, and duration of the study)?
6. What are some of the known side effects of this drug? Which ones are either serious or potentially life-threatening?
7. How long do you think I should take this drug? Is it a long-term prescription?
8. How much does this drug cost? Will it add a financial burden to my life?
I don't see them knowing the answer to #5 or maybe even #6, but a pharmacist might, plus you could research these yourself later.
Bias
After reading as much of the book as I did, I can see that there is a strong bias against drug companies. It's the same bias I'm growing toward any large company where I can't help assuming that you just don't get large unless you're willing to do things that other companies are not willing to do in the name of profits.
In this case, companies can make a lot of money by finding drugs that treat but do not cure long-term common problems. The ideal situation is to define some common characteristic as a disease and find a drug they've already invented that helps with the symptoms. Prevention and cures are not as profitable.
It's now difficult for me to read the cheap women's magazines I picked up from the give-away pile at the library because they are full of gigantic ads from pharmaceutical companies.
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Hormone replacement therapy
on 2014-11-17 08:51 pm (UTC)In the meantime, the answer seems to be "it depends" on health, age, when menopause starts and all sorts of other stuff.
http://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-therapy/art-20046372
Interesting. Thanks for posting about it. I feel like I will be more prepared to talk to my doctor about this. Which I clearly need to do.
Re: Hormone replacement therapy
on 2014-11-18 03:07 am (UTC)That link surprises me. But page 2 is more like what I expected.