HRT & SLE

[Guest guest]

HRT, Old Sol & Uncle Sam - A

Triple Whammy?

Part 1

Hormone

replacement therapy (HRT), whether estrogen only (ERT),

or estrogen-progestin combined (EPRT), was once viewed as high hope for women

in menopause and possibly for those with AI illnesses such as lupus. Now, the

future of current treatment is doubtful, with both and especially HRT

considered high risk for most of us. In the U.S., the National Heart, Lung and

Blood Institute of the National Institutes of Health, along with the Women's

Health Initiative, has been engaged in a clinical HRT study of 16,608 healthy,

menopausal women, from the ages of 50 to 79 years and in the observation of

women clients at 40 American clinics.

This

study of the long-term effects of combined estrogen/progestin use had been

intended to run for 8 years but was pulled to an abrupt halt after just over 5,

when tests revealed an increased risk of breast cancer, coronary heart disease,

pulmonary embolism and stroke. There is also heightened risk of uterine cancer,

gallbladder disease and blood clots. Visit http://www.ama-assn.org/sci-

pubs/amnews/pick_02/hlsb0729.htm#rbar_add to read the AMA report.

HRT

was never advisable for women who've had fibrocystic breast disease, uterine

fibroids, liver disease, breast or uterine cancer or endometriosis. Those who

live with migraine headaches, have diabetes with vascular disease, epilepsy,

high blood pressure, a history of blood clotting, or have " severe "

lupus were considered equally ineligible for HRT all along.

Lupus

can increase our risk of complications including heart attack, bone loss, and

injuries like hip fractures, odds that can rise higher when we take steroids.

It was thought that HRT might be just what the doctor ordered but using HRT in

SLE could turn out to be like standing under the apple when Tell lets

his arrows fly. Each woman's risk factors will vary but in healthy women, HRT's

side effects can include severe headaches, nausea and gastrointestinal irritation,

vaginal bleeding and tender, swollen breasts, extras that can already come as a

free bonus with lupus.

As for

long term estrogen replacement therapy (ERT), a 20 year clinical study of

44,241 women by the National Cancer Institute or NCI, found that postmenopausal

women, with or without hysterectomies, were at greater risk of contracting

ovarian cancer than women not using HRT. Though short term use isn't considered

dangerous, after 329 study participants were diagnosed with ovarian cancer, it

was determined that the risk rises a significant 7% during each year of use.

Short and long term usage will now be subjected to more scrutiny before the

next round of announcements are reported.

These

study results needn't cause overall panic but they can be excellent food for

thought. In the wake of this report, most doctors are still as unsure as the

rest of us, the results are now being pored over by others and we can expect a

torrent of debate over how this will affect the possibility of future hormonal

therapy. The American College

of Obstetricians and Gynecologists (ACOG) has already created a task force to

investigate these findings further.

Approximately

14 million American women are said to be receiving some hormonal treatment,

with about 6 million women on HRT, for relief of their menopausal symptoms. If

you've been getting estrogen alone or in combination with progestin, it's

important for you to have a detailed face to face discussion with your doctor

about any potential risk factors that may or may not apply to you.

If

you've been on this regimen for a prolonged length of time and are experiencing

any problems or just want to quit, the general recommendation is to taper off

use for one month to as long as three (depending on your individual circumstances)

to minimize surging hot flashes. You should, of course, be thoroughly and

regularly monitored throughout therapy and after. Well informed and working

together well with your doctor, you'll be better able to decide for yourself

what is best for you.

There

are alternatives to hormone therapy such as those described at Web MD

http://cssvc.health.webmd.compuserve.com/content/article/1728.54974 and Well

Span Health (scroll down) http://www.gettysburghosp.org/breakingnews/ which are

worth investigating before deciding for yourself. ACOG has a May 2001 bulletin

posted at http://www.acog.org/from_home/publications/press_releases/nr05-31-

01.htm with guidelines for herbal use. Butterfly News issues of October 2001,

November 2001 and February 2002, archived at

http://www.uklupus.co.uk/bnews.html discuss the uses of soy, herbs, other

alternatives and a lupus healthy diet.

Part 2

Nearly

every home has at least one junk drawer but we're likely to have one in every

room. With our hypersensitive skin, we're liable to toss in pots, tubs, tubes

and bottles of cosmetics, sunblocks, hair treatments, hand and body lotions,

eye drops and more failed but once bright hopes. Maybe we should call those

bins " money pits " since they surely suck in plenty of it. Most of the

products we've bought because of glowing ads, doctors' recommendations and

suggestions from family or friends, along with our own little discoveries, wind

up rotting into expensive gunk, deep in the bottom of a drawer.

We

soon learn that just because a product is described as

" hypoallergenic " , " for sensitive skin " or

" dermatologist tested " , doesn't mean it won't cause problems for us.

We're better off shopping where there are demonstration bottles or " demos "

on the counter or, at the least, where we can make trial size purchases first.

It's also a good idea to confirm the stores' return policies so we need not be

stuck with every single dud.

It's

economical for us to buy small bottles or tubes of sunblocks or skin creams

since lupus so readily adapts to chemicals and Ol' Wolfie quickly maneuvers to

out-fox them. Because of the adaptive behavior of this illness, even if one

cream is friendly for a while, it's likely to work against us eventually,

leaving us to find yet another bottled balm.

Whether

demos, trial size or jumbo-king, we'd be wise to do a skin patchtest before

slathering anything on. To patchtest a product, apply just a drop of cream to

an area of your body you can bear not to wash for a while and wait for a skin

reaction. Generally, experts advise leaving it there for up to three days but

we may spot, blotch, itch, blister, peel or ooze sooner. As for the potency of

sunblock, 40 SPF is our best bet and those that resist moisture will endure our

hot flashes best but they'll still need to be frequently and smoothly applied,

to stay on the safe side. Remember, the higher SPF rating doesn't mean we can

dare, like " mad dogs and Englishmen " , stay out in the noonday sun or

at any time. Check out http://www.stormfax.com/uvtable.htm for the (non-lupie) UV Safety Recommendation Chart.

Finding

comfortable clothing that shields us from the sun isn't easy either.

Lightweight, loosely woven clothing is cool in the heat but it isn't much of a

defense so it's most safely worn indoors or when twilight falls. Now, the

American Society for Testing and Materials has set scientific standards for the

manufacture and labeling of sun protective products such as clothing. UPF

units, (Ultraviolet Protection Factor) assess a fabric's ability to bar

sunlight from penetrating to the skin. There are three categories, classified

as Good UV Protection (UPF 15-24), Very Good UV Protection (UPF 25-39) and

Excellent (UPF 40-50). So far, compliance is strictly voluntary so it'll be a

while before we can buy a whole new wardrobe but just knowing of these new

standards might help us to be sharper shoppers.

Our

eyes are just as sensitive to harmful radiation as our skin and they're

especially vulnerable to damage which might precede eye disease such as macular

degeneration, a leading cause of blindness even in those who are healthy. The

sun's rays intensify as they reflect off bright surfaces (windows, mirrors,

chrome, steel, aluminum, snow, ice or water, the gleam in a loved one's eye -

no, that's a different danger) so any reflective surface can zap us right in

the orbs.

The

safest sunglasses or contact lenses are 100% UVU protected. Contact lenses

should be oxygen permeable and the sunglasses should wrap around the sides to

block more rays. Some sunglasses have little side flaps for even more

protection and you won't get that with contacts since they can't cover the

entire eye, except, of course, in Sci-Fi movies.

Part 3

While Canada

and the United Kingdom

have long offered their citizens access to a broad range of medical services

and medications, many residents of the U.S.

can't afford basic medical care, let alone treatment for their illnesses and

essential medications priced at four times their cost in Europe.

That's right, Americans are charged quadruple prices

for the same medications their friends overseas are buying. Many Americans

visit Canada or

Mexico on

regular daytrips, just to maintain their medications. Amazing, isn't it, that these drug makers are usually based in the U.S.

yet brazenly jack up profits in their own backyard and get away with it.

This

is more than just unneighborly, it's outrageous when

the average American family now pays more in taxes than for food, shelter and

medical needs. Nowdays, their healthcare costs are

higher then the level of inflation or income and, with epidemic corporate greed

running amok, this gap is rapidly becoming a bottomless pit.

Most

of those forced to deal with Health Maintenance Organizations (HMO's) must pay

the piper and can still have crucial medical services denied for not being

" cost effective " . No matter what their illness, they and their

families can be dumped at any time without just cause or reasonable explanation

and their recourse is often limited to an arbitration process slanted in favor

of the HMO.

Those

who aren't in employers' group insurance plans or HMO's wind up paying twice as

much for their care because, without company cost and tax breaks, they must

cover all their needs from their net or after tax earnings. It's rough all the

way around, especially on those who must choose whether to pay for doctor

visits and prescriptions or buy food to eat. The effects can be devastating for

the over 44 million American men, women and children who are completely uninsured,

with no safety net and a slippery tightrope ending somewhere in mid-air.

Forty

years ago, Congress investigated the pharmaceutical industry, found it sorely

lacking but wound up doing nothing about it. American politicians, who are

themselves fully insured at taxpayer expense, have

somehow managed to stall passage of a patients' bill of rights for those less

privileged. Too many legislators have wasted these four plus decades feudin', fussin' and a'fightin' over who gets the credit while trying not to offend

deep-pocketed corporations. Despite the excuses and partisan accusations, these

well paid officials are flinging around their latest failure, nobody loses but

us.

This

week, they're on the verge of implementing a plan which won't begin until 2005

and will be handed off to tax subsidized private insurance companies, instead

of being covered by the tax-payer dollars that are already funded through

Medicare. Under one version, it's projected that individuals will start paying

about $33. each, in monthly premiums and a $250. deductible apiece, before their coverage begins. While

Medicare makes stabilized payments, private insurers are allowed far more

financial flexibility and these figures aren't enacted into law, so that tab

can be expected to rise like our temperatures during a summer flare.

As for

medication prescriptions, 80% of each purchase would be covered up to a cap of

$1000. for the first year, then 50% covered and capped

off at $2000. for the second year of coverage. After

that second year, all prescription coverage ceases, except for those with

" extraordinary " medication needs costing them over $3,700. a year. Prescription expenses over that yearly $3,700. will then finally be fully covered by the U.S. Government,

thanks to the taxpayers, who happen, by the way, to be you.

An

alternate plan, as of July 28th, would cover all prescription drug costs for

individuals with annual income soaring up to $8, 860 ($738.33 monthly) and

couples, up to $11, 940 ($995. a month). That might allow some folks to splurge

on Fancy Feast instead of Cat Chow, for Sunday dinner, except that full

coverage won't kick in until " catastrophic " medication needs of

$4,000. a year have already been paid by each person.

Since that's almost half the projected top individual income allowed, even Cat

Chow might be over budget. There are other versions floating around Washington

but whatever version might or might not be approved during voting in this first

week of August, it's doubtful any politicians or lobbyists are calling you for

your opinion.

You

might wonder why private insurers would be chosen for this stewardship when

Medicare already exists for exactly this purpose and has been collecting your

hard won dollars for decades. If this were brought to the people for a vote, would

they choose to pay for care from tax financed insurance companies while still

being taxed for Medicare they won't be getting? Worse, while Medicare can

negotiate lower drug costs with drug makers, private insurers don't offer that

benefit. With private insurance companies, the bottom line is always profit so

costs can always go up, allowed services can always change and companies,

having filled their coffers at our expense, can always move on. Sounds an awful lot like the old HMO predicament, with no practical

improvement for the folks who ultimately pick up the tab.

Another

bill (S 812), in support of lower cost generic drugs, is finally coming to a

vote. If passed, that bill will close a loophole that allows drug manufacturers

to sue generic makers for patent infringement, which keeps your drug costs

inflated. Although at least 60 senators have agreed to support this bill,

strong opposition makes it's fate and your benefits

uncertain. If you're an American and you want affordable medication plus a fair,

workable health plan to be enacted within your lifetime, visit Public Citizen

at http://www.citizen.org to send a free fax to your elected representatives.

While you're there, scroll down to " Consumer Corner " at the lower

left for more tips and tools.

Politicians

are public employees and you pay their salaries, plus provide them with piles

of goodies, including new automobiles, free gas and oil and worry free lifetime

health care at your expense. These benefits are called " perks " or

" prerequisites " , meaning they're the little extras required to get

anybody to run for office. Wouldn't it perk you right up, to at least have worry free health coverage of your own?

Our

own silence can work against us in ways more dangerous than our illness alone

can; it can deprive us of recognition, deny us our most basic rights and damage

our health. In the bustling state and national capitols, politicians have

friendly meetings with drug company and insurance lobbyists all the time and

that seems just a bit one-sided ~ shouldn't they know your opinion too?

This

article Copyright © 2002 Shar Phoenix

Hugs,

Deanna