In search of ‘natural’ hormone replacement therapy

Drs. Tristi Muir and Catherine Hansen

Drs. Tristi Muir and Catherine Hansen

Our Bodies, Our Lives

For women going through menopause, current popular advice about the safety of different kinds of hormone replacement therapies can be confusing.

It’s important that every woman trying to make a decision about hormone replacement find a knowledgeable health-care provider with whom to discuss this important issue.

Your menopause is yours. Don’t let entrepreneurs and celebrities determine what you put into or onto your body.

Historically, women have used hormonal therapies long before they even lived long enough to experience menopause. Thinking that it would promote youthfulness and vigor, women used preparations made from female or male urine, crushed tissue or fluid from animal ovaries.

Eventually, commercial preparations became available. The first “bio-identical” hormone, extracted from the urine of pregnant women, was discovered in 1928 by a German chemist, earning him a Nobel Prize. Mass production of hormone medication made from the urine of pregnant mares began in 1942.

Major advancements in hormone production began in the 1950s and 60s, culminating in a new treatment for menopause symptoms — estrogen replacement therapy. Continue reading

Develop a personal plan if still fatigued

Dr. Victor Sierpina

Dr. Victor Sierpina

I took a look at the common medical complaint of fatigue in last week’s column.

Frequent causes of chronic fatigue are poor sleep hygiene, lack of exercise, depression, boredom and lack of motivation.

To those, I would add poor nutrition. Without the essential energy provided by a healthful diet, the body’s cells can’t get the fuel they need to function optimally, resulting in just feeling tired a lot.

Eating sugary, highly refined carbohydrates and saturated fats might give you an energy burst, but it is like a rocket going up, then quickly falling down like a stick.

Without sustained energy provided by whole grains, lean proteins, fruits, vegetables and healthy fats, the body is quickly starved of reliable, steady sources of energy.

It is like a fuel pump in your car that is partially blocked or works on and off. It is hard to get much distance without the right amount or kind of fuel.

If you suffer from chronic fatigue and it doesn’t seem to be from any clear cause, you definitely need to have your physician do a comprehensive history and physical examination including blood work plus other tests as needed.

Fatigue can come from multiple causes and as a result of problems with any organ system. Continue reading

For some men, it’s “T” time – test or no test. Dr. Baillargeon explains.

Prescriptions for testosterone therapy have increased significantly during the last 10 years, according to a study in the current issue of JAMA Internal Medicine conducted by researchers at the University of Texas Medical Branch.

About 50 percent of the men in the study who had received testosterone therapy had been diagnosed as having hypogonadism, a condition where a man is unable to produce the normal levels of testosterone.

But the study also found that, among new users of a prescription androgen product, about 25 percent did not have their testosterone levels tested before starting the treatment.  In addition, it’s unclear what proportion of the 75 percent who were tested had a low level of testosterone.

Dr. Jacques Baillargeon, lead author of the study and an associate professor in preventive medicine and community health at UTMB, said that he believes this is the first national population-based study of testosterone-prescribing patterns.  

(See video of Dr. Baillargeon explaining main findings of the study) Continue reading

One-Third of Women Undergo Unnecessary Breast Biopsy Surgery

By Molly Dannenmaier | UTMB at Galveston

MINIMUM INTRUSION, MAXIMUM RESULTS— Jennifer Thomas, a mammographer at The University of Texas Medical Branch at Galveston, shows the needle used to extract breast tissue in minimally invasive breast biopsies.

MINIMUM INTRUSION, MAXIMUM RESULTS—
Jennifer Thomas, a mammographer at The
University of Texas Medical Branch at Galveston,
shows the needle used to extract breast tissue in
minimally invasive breast biopsies.

Roughly a third of Texas women with a breast lump end up having an old-fashioned surgical biopsy to determine whether the lump is cancerous.

Yet since 2001, the American Society of Breast Surgeons, the American College of Radiology, and the National Cancer Center Network have recommended nonsurgical, minimally invasive biopsies as the first course of action for women with breast lumps or masses. These less invasive methods of sampling breast tissue provide results that are as accurate as surgical biopsies, the organizations say.

“We need to get the word out to women across the state that surgery is not the procedure of choice for definitive diagnosis of a breast mass,” said Taylor Riall, M.D., associate professor of surgery at the University of Texas Medical Branch at Galveston.

Riall is a lead investigator of new research performed by UTMB researchers and published in the Journal of the American College of Surgeons, which reveals that despite national recommendations, invasive and expensive surgical breast biopsies were the first diagnostic step for 35 percent of Texas women diagnosed with a breast mass between 2000 and 2008. The findings were based on an exhaustive analysis of Texas Medicare data during that six-year period which gleaned information on a total of 87,000 breast biopsies. Continue reading

Laser procedure new option for cancer treatment?

KTRK-TV Reporter Christi Myers  reported recently on a procedure being performed by UTMB’s Dr. Eric Walser. “There may soon be a new option for men suffering from prostate cancer. The treatment involves a laser and has already shown promising results in studies overseas. This laser procedure is something in between watchful waiting and the radical prostate surgery. And right now they’re testing it with men who have early cancer.”

Lunch Bunch: An ounce of prevention — check-ups and health screenings

On May 14, 2013, UTMB’s “Lunch Bunch” health information series presented Drs. Catherine Hansen and Pamela Havlen with “An Ounce of Prevention: Check-Ups and Health Screening.” A video of the talk is online.

 

 The Lunch Bunch series offers great speakers, new insights and a free light lunch. For additional details, links to other videos and upcoming sessions, visit utmbhealth.com/LunchBunch, call 832.505.1600 or email VictoryLakes@utmb.edu

Treating kidney cancer when you can’t afford to lose a kidney

One of the biggest problems with kidney cancer (also known as renal cell carcinoma or RCC) is removing it. Obvious, you say.

However, the reason is not what you might think.

 The surgical options for resecting (cutting-out) kidney cancer are well-developed and usually pretty straightforward. The kidney containing the tumor is removed (nephrectomy) or just a part of the kidney might be removed if the tumor is small (partial nephrectomy). All of this is just fine– as long as you have a second kidney that is normal and can pull duty for the one you are about to lose. But some people don’t have this option due to chronic kidney disease from diabetes or high blood pressure.

Two cancers in the right kidney (arrows)-- oh my. You are looking at a CT "slice" (cut section of the human body) from the patient's feet looking toward the head.

Two cancers in the right kidney (arrows)– oh my. You are looking at a CT “slice” (cut section of the human body) from the patient’s feet looking toward the head.

Years of these conditions can lead to so much kidney damage that these patients cannot afford to lose even a part of one kidney– They risk permanent renal failure and may need kidney dialysis treatment for the rest of their lives.

 The patient in this picture has 2 kidney cancers in his right kidney (arrows) and has no options for surgery due to long-standing kidney disease and poor function. What are his options?

renal cryo

Several “cryoprobes” inserted through the back. The tips are guided into the tumors using guidance from CT scanner images

  1. Remove the kidney and probably start dialysis treatments three times per week for the rest of his life. This is very difficult for families’ finances/schedule and for the patient’s sense of well-being
  2. Do nothing and hope the cancers grow slowly and don’t spread. This is unlikely to happen.
  3. Perform regional tumor therapy consisting of needle-puncture and ablation (destruction) of the tumors only, while preserving as much of the kidney as possible. This option was chosen for this patient to treat his cancer in a way that maximized tumor destruction but minimized risk of permanent renal failure. 
Grey fuzzy blobs (“iceballs”–white arrows) surround the bright needles that are embedded into the kidney cancers

Figures 3 (right) and 4 (below) show the “Cryoprobes” inserted into the tumors with guidance by a CT (computed tomography) scanner. “Ice-balls” (white arrows)  form as the freezing process envelopes the tumors. This treatment takes about 2 hours and involves admission overnight. Post procedure pain is minor and goes away in less than a week with pain medications or just Advil/Tylenol.

 By the way, the patient’s renal function dropped slightly after the procedure but returned to baseline about a week later and he requires no dialysis. To monitor how successfully we killed these tumors, we repeat a CT or MRI scan in about 3 months. If some tumor remains alive, further treatment is considered and is generally easier and safer than the first procedure.

UTMB Perinatal Hospice

We have recently updated the website for our Perinatal Hospice Program at UTMB and we are honored to have a contribution from the parents of our first enrolled family.  Please visit our site and see Abby’s story.  If we can be of help to anyone dealing with a lethal diagnosis in an unborn baby, please feel free to contact us through our website’s contact page.  http://www.utmb.edu/perinatalhospice/

Perinatal Hospice and Palliative Care

Cara Geary, MD, PhD, is an associate professor of pediatrics in the Division of Neonatology and director of UTMB’s Perinatal Hospice and Palliative Care Program. Among her interests, she works to enhance humanism and compassion in medicine.

UTMB uses 3-D brain simulator teach neurosurgery students

In brain surgery, a mistake can mean a disability or death. So how do you teach a neurosurgeon without mistakes? In this recent newscast by the Houston ABC affiliate KTRK, Christi Myers shows how Dr. Jaime Gasco uses a 3-D brain simulator. UTMB has one of only five simulators in the United States. In the first two UTMB studies, they found that medical students who were going into neurosurgery were 30 percent to 50 percent more accurate if they trained on the computer brain simulator.

Kale: Can you really eat it?

Dr. Victor Sierpina

Dr. Victor Sierpina

At a recent fundraiser for Meals on Wheels, the wonderful chef at the Galveston Country Club served a lovely salad made with kale.

A friend sitting with us who runs one of Galveston’s finest healthy eating establishments expressed an opinion that many of us may hold about kale: it is a nice ornamental in your garden or a garnish on the plate, but who would eat that bitter stuff?

So why, when a friend of my wife’s gave us a couple big bunches of organically homegrown kale was I as happy as a 10-year-old with a new pony? Because kale is a really healthy, nutrient-dense addition to the menu plan and offers many ways to enjoy it. Americans are falling in love with kale like never before, even raw kale. Continue reading