Dr. Erika | Bioidentical Hormone Expert

New Guidelines for Mammography : A Reason For Celebration

Last week the US Preventive Services Task Force came out with new guidelines for mammography. Simply stated, the new guidelines recommend that:

1.    Routine mammography screening start at age 50 instead of 40  (guidelines provided in 2002).

2.    Frequency of screening to be reduced to every two years rather than the previously recommended
       every year.

3.    Breast self-examinations are no longer recommended.

4.    Clinical breast exams (performed by physicians) only minimally improve outcome in patients who
       have mammograms.

These guidelines encountered a furious backlash in the media immediately after its publication in the Annals of Internal Medicine from special interest groups, patient groups and politicians with special agendas.

As a practicing physician, women’s health advocate and opinion leader in the prevention movement and a healthier America, I welcome the guidelines and would like to share with you my personal and clinical understanding of their meaning.

Guidelines represent recommendations to be used by the medical community, researchers and public health officials to analyze outcome. Guidelines do not necessarily apply to the individual and should be used to guide the physicians and the patient to a well informed position from which individualized decisions should be made.

For those of us who are in primary care, who see patients every day with various questions about choices and options in health care, guidelines serve as resources to provide better patient care.
Guidelines are developed as a result of years of extensive research by intelligent, physicians and researchers who are assigned the task of reviewing the entire scientific literature on a particular topic and to provide unbiased data on a particular subject matter.

To better clarify the situation with mammography:   

1.    The members of the US Preventive Services Task Force are all doctors, MDs and PhDs who work at academic institutions around the country. They are not government employees.  They are not oncologists or radiologists or breast cancer surgeons who may have a biased perception of the realities of breast cancer. The US Preventive Services Task Force spent almost 2 years reviewing all the studies on mammograms, biopsies, treatment, risks and benefits and prevention since the last guidelines were issued in 2002.

2.    Dangers of mammography and biopsy are generally overlooked and minimized in our present healthcare system. Marketing of the business of medicine does not include the downside of too much testing and treating associated with millions of yearly mammograms, biopsies, chemotherapies and radiation therapies. Rarely if ever does a woman get informed of the risks of mammograms and biopsies in the mainstream media, from cancer groups, radiology clinics or academic center physician groups which specialize in the diagnosis and treatment of breast cancer. 

    - The potential dangers of mammograms occur from too much radiation to the most radiosensitive tissue of the body which does increase breast cancer risk as more mammograms are given to women over extended periods of time 

   - False positive mammograms prompt unnecessary procedures, fears and treatments which include biopsies, chemotherapy and radiation for often precancerous lesions or slow growing cancers which do not warrant treatment. These procedures carry risks of their own rarely addressed.

   - Biopsies disturb breast architecture and body immunity preventing the body from healing itself which scientific data support as a safe and previously unaddressed option.

   - Emotional stress caused by all of the above and the fear of cancer increases risk of cancer.

Women are scared to death by the prospect of being diagnosed with breast cancer. In our society women have been taught to believe that the sooner they are diagnosed and the cancer is removed, the better their chances for survival. That is not always true. Deciding to delay treatment or not have mammograms is met with disapproval by conventional physicians even if there is no scientific basis for pushing the patient into mammograms and biopsies.

The Task Force has taken the first significant step toward cutting down cost of healthcare and helping the economy. This is a major step forward in prevention and the change of the health care paradigm.  It cannot and should not be perceived as a personal attack on women. Politics cannot be allowed to taint this immense positive step forward.

I am not against mammograms or biopsies. Women at high risk by virtue of genetic factors, environmental exposure and other factors must be addressed under a different category which only serves to reinforce the importance of the connection between the doctor and the patient and the need for women to take responsibility for their own health.

Self-examinations are important since women need to know how their breasts feel and they are most likely to find the breast mass first. Physician examinations are important but caution has to be exerted that the doctor represents the patient’s best interest and is not afraid of malpractice suits. When the physician and the patient are aligned philosophically, women will benefit the most.

Dr. Erika speaking at NYC 92nd St. Y

While everyone is worrying about swine flu, let's make sure you know the difference between Common Cold or Fall Allergies? Learn the Difference to Feel Better Faster

It's that time of year again when ragweed pollen and mold spores fill the air leaving millions of Americans suffering from fall allergies. Allergy symptoms present in a similar fashion to the common cold: runny nose, itchy eyes, sneezing, wheezing, sore throat, coughing and nasal congestion. Similarly to a cold, often only 1 or 2 of these symptoms appear, making it even more difficult to decipher between the two. And not to mention the fact that this year, every time you get a sore throat or feel a little bit under the weather, the media hype makes you think you have the swine flu. In fact, most people don’t have the swine flu but rather suffer with either the common cold or fall allergies or a combination of the two.

 

To protect yourself best is to understand how to differentiate between colds and allergies and then treat them without delay.

 

Keep in mind the main points of differentiation are that the common cold lasts about 1 week while seasonal allergies linger for several weeks to months and that most allergies symptoms are not associated with muscle aches, pains and fever while colds can be without being diagnosed as flu.

 

If you think your symptoms are fall allergies here are several tips to keep allergies at bay as much as possible.

• Keep your windows closed and use air conditioning.
• Don’t mow your lawn or rake the leaves in the yard.
• Keep outdoor activity to a minimum; especially during morning hours when allergens peak.
• Take a shower after spending time outside.
• Drink lots of water and green tea
• Exercise regularly
• Avoid food allergens
• See an allergist to determine what you are most allergic to and follow the recommendations of staying away from allergy causing foods
• Change detergents and soaps if allergies commence or are worsened by introduction of new products
• Do not leave clothes you used outside in the closets or laying around your home. Shake them out outside first.
• Make sure ventilation in your house is good
• Eliminate dust from your home. Keep it clean with natural cleaning products
• Change air conditioning and heating filters regularly at least twice a year.

 

 

Should your allergies continue to be a nuisance try using a mild decongestant or Benadryl at night. And don’t forget fall allergy season ends with the first frost or by the end of November/December.

Stay away from decongestant nasal sprays as they can often aggravate your other symptoms, leaving you feeling worse and even increasing the chance of respiratory infections. Decongestants decrease your immune system’s ability to fight infections so avoid them. Your body actually does get rid of allergens by giving you a runny nose and runny eyes. Stopping that reaction stops your body from fighting the allergen and you may not want that.

A cold is usually associated with sore throat, feeling sick (malaise), runny nose, headaches, muscle aches and even a low grade fever.

 

If you think your symptoms are caused by a cold here are some tips for nipping the cold in the bud:

·       Start taking Lactoferrin 3 capsules twice a day for five days at the first sign of the cold. Lactoferrin is a natural immune booster that supports and enhances your body’s own immune function. ( for more information go to www.drerika.com)

·       Take EmergenC- 1 packet in a glass of water 5 times a day for the first three days of the cold (You can always buy EmergenC at the drugstore, gas station, deli, etc.)

·       Vitamin C 5000-10,000 mg a day for five days)

·       If you have a sore throat take a tip of a teaspoonful of cayenne pepper and mix it with a tablespoon of water and drink it fast.

·       Take a tip of a teaspoonful of powdered ginger and mix it with a tablespoon of water and swallow it in one gulp.

·       Soak your feet in hot water for 15 minutes the first evening you feel crummy. Put on a pair of socks and go to bed early. Do not watch TV.

·       Increase your intake of protein (chicken soup, Detoxification Powder, tofu)

·       Drink 5 cups of green tea or Throat soothing teas

·       4 Glasses of room temperature water ( avoid iced drinks)

·       Spend 10 minutes in the shower in the morning and breathe in that great healing steam!

·       Stay away from junk food, alcohol, soda or caffeine. They will only delay your body’s healing powers

·       Stay home from work or school so you do not infect your colleagues.

·       Unless you have a fever, do not take medications like ibuprofen or acetaminophen.

There is no such thing as medication without side-effects.

Give your body a chance to heal itself, it usually does a really good job with minimal support from us in the health care system.

 

 

Resveratrol: Leaning toward the fountain of youth or just another marketing hype?

In a test tube, resveratrol does a great job of scavenging free radicals and other bad oxidants that lead us to get old, grumpy and sick. The question is how does resveratrol fare in a capsule, as a dietary supplement to keep both men and women sharp and healthy through the decades?

 

Resveratrol, which is found in red wine, is in the family of chemicals called polyphenols and are thought to provide protection from atherosclerosis, cancer and heart disease. They may also decrease the chances of getting Alzheimer’s and prolong life according to some studies.

 

Some people believe resveratrol may be the reason for The French Paradox, the fact that fewer people die of heart attacks in France even though they probably smoke more, drink more and eat a diet high in saturated fats (just think croissants, not McDonald’s).

 

In our bodies somehow other things happen when resveratrol gets introduced as a supplement. The anti-oxidant activity of resveratrol seems to be much lower than that of Vitamin C, Vitamin E or even Glutathione, but for reasons that are not exactly clear or scientifically proven for now people do feel better. Maybe it is the placebo effect at work, or maybe what science is showing in vitro, may actually apply in vivo.

 

In the presence of estrogens, like the ones our bodies make before menopause, or the ones we take in the form of biodientical hormones (estradiol), resveratrol appears to act in a cancer-protective fashion. In vitro, breast cancer cell cultures, resveratrol appears to attack the cancer cells in the presence of estradiol and not, when there is no estrogen around.

 

To get cells to turn to cancer cells, a biochemical reaction has to occur in the cell. Cytochrome P450 enzymes have to metabolize compounds to create a carcinogen. In preliminary studies, resveratrol protects the body from this transformation by increasing activity of the phase II enzyme NADPH which promotes elimination of potentially toxic or carcinogenic chemicals as well as stopping cells from growing haphazardly.

 

In translation, that means resveratrol may help protect us from cancer if in the proper environment.

 

Anti-inflammatory effects are also attributable to resveratrol along with its significant inhibitory effect on atherosclerotic plaque formation in a number of studies.

 

As for anti-aging: a recent study in mice (they are mammals after all) demonstrated that resveratrol altered gene expression in heart, brain and skeletal muscle similar to that created by calorie restriction as well as causing blunting of the natural age-related decline in heart function. There are clinical trials under way to determine the relevancy of these findings in humans but for now, this type of results even in mice, lead to an entire industry being built in a hurry. Remember, glucosamine and chondroitin? You probably take it still and believe it is making your aching joints better. You may be interested to know the studies were all done on dogs and only 50% of the dogs treated with the supplement actually had positive results on their arthritic joints. Not exactly a glowing endorsement, but it sure beats getting a bleeding ulcer from an anti-inflammatory like ibuprofen.

 

Back to resveratrol.

 

While you could increase your intake of resveratrol by chewing on the skin of red grapes and downing gallons of red wine and boiled peanuts, you might consider taking a resveratrol supplement.

 

The supplements contain extracts of the root of Polygonum cuspidatum as well as red wine and grape extracts. The supplements may contain from 10-20 mg of resveratrol which is actually a very low dose of the active ingredient that does all good.

 

There are no known toxic effects of supplemental resveratrol in humans based on the few trials conducted and completed on the topic so far. The most recent trial found a dose of 5 gm a day was safe in humans. The most common dose is now around 300 mg/kg body weight which is very much lower and proof of safety for those concerned with over dosing.

 

During pregnancy I would not recommend women take resveratrol. You don’t need it. Suffice it to say, stay away from wine in general. There is no good reason to even consider it during pregnancy.

 

Resveratrol may increase bleeding in patients who take Coumadin or Plavix and even NSAIDs. The way to get around that problem is to follow your tendency to bleed with a simple blood test that will help you and your doctor properly balance of the drugs and the supplement. By the way, do tell your doctor about every supplement you take. You may think supplements aren’t medications so they do not interact. You would be very wrong. Everything interacts.

 

For now, resveratrol looks promising. There may be some hype associated with its promise, but I found no reason not to take it. Make sure you take it from a reputable source, since many supplements promise doses their capsules just don’t deliver. Just because the brand gets a lot of publicity doesn’t mean it is the best and just because it is discounted it doesn’t mean you are getting a bargain. Do your research and take the highest quality at reasonable prices.

 

Take your resveratrol and while it may turn out to be a great addition to your anti-aging, age management regimen, remember, it is only one piece of the larger puzzle of health.

L-Carnitine

L-Carnitine
500 mg

L-carintine is made in the body from the amino acids lysine and methionine. Its most important role is to help move fatty acids inside the cell into the mitochondria (the energy making factories inside every live cell in the body).Natural Energy – my first book is entirely dedicated to this amino acid and its partner, conezyme Q 10. L-carnitine’s role in protecting the heart, increasing exercise capacity, muscle strength, and improved immune system response is documented through numerous studies across the world.

Where is it found?
Dairy and red meat contain the greatest amounts of L-carnitine. Deficiency is rarely reported although deficiencies exists in people who are strict vegetarians. A genetic disease where carnitine is deficient produces significant muscle and energy production disabilities. Carnitine deficiency is found in people with chronic kidney disease, diabetes and cirrhosis.

Dose
Therapeutic doses of 1000-3000 mg a day are commonly used in people with the illnesses outlined above. The usual supplementation dose is between 500- 1000 mg a day.

Use

• Congestive heart failure
• Angina
• Chronic fatigue syndrome
• Chronic obstructive pulmonary disease
• Diabetes
• High triglycerides
• Infertility
• Athletic performance
• High cholesterol
• Hormone imbalances

Side-effects
L-carnitine has not been connected to any side-effects.

Bogged Down By Special Interest, Health Care Reform Becomes A Political Tool Instead Of A People's Right

Prevention is a crucial element of healthcare reform. President Obama said that through prevention, Americans will become healthier and thus substantially reduce the costs of healthcare. He extolled the importance of training more primary care physicians, encouraging each and every one of us to take responsibility for getting and staying healthy and focusing on prevention.

But that was a few months ago when the president first presented his plan for a government run overhaul of our severely ailing healthcare system.

I for one, along with many of my patients, applauded the president.

We who live and work in the trenches where healthcare actually happens know how desperately needed a change of direction is.

We know first hand that all too often our hospitals are sources of more disease than cures, that patients get shuffled from specialist to specialist and test to test for years without improvements in their condition, that the insured are often treated just as poorly as the uninsured. We in the trenches watch in horror as some of our peers care more about how much money they make from a particular test, by prescribing a particular drug or by giving a lecture for a drug company, then spending an extra 5 minutes with a patient listening and caring. We in the trenches know that the system is overtaxed and the training of physicians is not of the quality or purity we need to keep the country healthy and thriving. We also know that the most advanced technologies or drugs will never make up for the humanity and care we are often unable or unwilling to give our patients for lack of time or maybe fear of getting sued.

Of course, each one of us is responsible for creating a positive outcome in our own lives, but in the case of healthcare we need a little more than good attitudes and perspective. We need some serious support. Support from our government was promised by President Obama during his campaign. We agreed it was needed. We needed change and voted for it.

Unfortunately, not much of what we truly need is included in the HS 3200 plan and the increasingly heated discussions we are faced with today.

Personally, as a practicing physician for more than 30 years, I felt betrayed and horrified to read the President had gone back on his word to avoid involvement with special interests by making a deal with the pharmaceutical lobby.

The White House secretly made a pact with the drug companies that was hammered out several months ago but only came to light a few weeks ago in all too few media outlets.

Although quite sketchy, this much we know: The drug companies, through their powerful lobby, agreed not to oppose any form of healthcare reform and offered $80 billion in cost savings over 10 years if the White House would protect them from having to shoulder additional financial burden in upcoming legislation.

Please note this is not about giving free drugs to poor people who cannot afford them and actually need them -- this is about keeping the drug cartel running the healthcare system.

This type of deal will make drug companies even more powerful and the country more addicted to prescription and other forms of "legal" drugs. Not exactly a promising start for a trend towards prevention. True prevention is about preventing disease and inherently diminishing the need or more drugs, regardless of cost.

The $80 billion "giveback" deal is a drop in the ocean for drug companies. If healthcare reform legislation is passed as is, it will give millions more American access to their products and result in windfall profits. That is, as long as the health care system continues on the path of status quo: more disease diagnosing, more testing, more drugs, less doctor-patient interaction.

The deal with the Administration guarantees drug companies a "seat at the table" as the reform process plays out and perpetuates their position as one of the most powerful lobbies in Washington regardless of which political party is in power. This does not bode well for the American public.

Never mind that too many drugs are proven to harm people more than help them, that drug companies influence physician practice, not only by paying for medical education but also through ghostwriting scientific articles published in respected medical journals. Never mind that drug companies advertise their drugs directly to the public while also sponsoring some of the most senior and highly respected medical groups and academic centers in this country.

Increasing access to drugs takes the focus off the real problem and allows the drug companies which already have destroyed the concept and reality of a free and safe health care system to continue their plan to benefit from America being sick and using drugs instead of shifting the focus to eating right, exercising and preventing disease.

Instead of worrying Americans about "death panels" and rationing of health care which is already in place with HMOs and other large insurance carriers, let's put the focus back where it belongs.

Do not allow America to continue being manipulated by special interest groups and help the people of America understand that they must control their own fate.

Let them start by learning how to eat right, exercise, sleep and be kind to themselves. Once these basic health care tips become part of the fabric of our society, we can focus on demanding that physicians and other health care providers work for us.

Healthcare is the ultimate service industry and should become exactly that. Once healthcare becomes solely about serving the public and not special interests, the solution to all our health care problems will be found.