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Issue Date: October 2007 Issue


Better Medicine

Sometimes it’s tough to keep up with new treatments, surgical advances or recent medical findings. So we gathered a few  — from a shot for osteoporosis to new findings about estrogen therapy — that every woman should know about. If you didn’t ask your doctor “What’s new?” read it here.
Kristen Hampshire
A Hot Shot for Bones

Sure, it hurts for a second — needles are never fun. But an annual injection of zoledronic acid could replace the daily pills taken by some of the 4 million women on osteoporosis therapy, says Dr. Abby Abelson, director of education at the Center for Osteoporosis and Metabolic Bone Disease at Cleveland Clinic. (About 8 million women suffer from osteoporosis in the U.S.) 

A recent New England Journal of Medicine study showed a 70 percent reduction in vertebral fractures and 41 percent decrease in hip fractures in post-menopausal women with osteoporosis who received the treatment.

Used primarily to treat high levels of calcium in the blood or to combat bone loss in cancer-therapy patients, zoledronic acid reduced the activity of cells responsible for breaking down bone. Injected by IV, the concentrated agent takes 20 minutes and lasts for 12 months, Abelson says. 
 
Botox for Bladder Control

Botox isn’t just for frown lines anymore. The wrinkle-erasing injection has provided relief for some of the 12 million women suffering from overactive bladders, leaking and that constant gotta-go urge, says Dr. Sangeeta Mahajan, head of the division of female pelvic medicine and reconstructive surgery at University Hospitals Case Medical Center. “This is a natural extension for the use of Botox,” she says.

Twenty pinpoint injections (after a local anesthetic) throughout the muscle is just enough to “take the edge off.” The medicine has a 70 percent to 80 percent success rate for six to 12 months and costs from $600 to $1,200.

For many women, the added confidence is worth the price. “This is a manageable office procedure that can dramatically improve the quality of life for women who are desperate and live in fear of their uncontrolled bladders,” Mahajan says.
Viagra for Her

If you’re constantly not in the mood and don’t know why, there may be help on the way. Men have Viagra, but young women with low sexual desire don’t have their own version to “warm up” for sex.

About 5 percent of premenopausal women suffer from hypoactive sexual desire disorder and might benefit from such a drug. “These women are so distressed because they don’t know what to do to treat low sex drive,” says Dr. Sheryl Kingsberg, clinical psychologist and associate professor in Reproductive Biology and Psychology, University Hospitals Case Medical Center.

Flibanserin was initially developed as an antidepressant, but like many promising drugs, it failed miserably in trials. But researchers learned that unlike many antidepressants, Flibanserin had the opposite effect on a woman’s libido. Now the drug is in Phase III of investigational trials as a boost for her sex drive. Physicians hope to learn more about how the drug interacts with the brain, Kingsberg says.
 
“Women are complicated,” Kingsberg says. There will never be a one-size-fits-all cure for low sex drive in females, but having one option for young women would be tremendous progress, she says.
“D” for Decreased Risk

Go ahead and blame our Cleveland weather. But unless you’re walking outside (under intensely sunny skies) for 15 minutes a day, you’re probably low on vitamin D. An estimated 1 billion people worldwide have vitamin D deficiency or insufficiency, according to a July study in the New England Journal of Medicine.
 
That puts you at higher risk for cancer and bone fractures, since the body uses vitamin D to absorb and retain calcium and phosphorus, and studies have also shown vitamin D to keep cancer cells from growing and dividing.
 
Few foods naturally contain vitamin D (try dairy products or cereals fortified with it or fatty fish such as tuna or salmon), so it can be tough to get the recommended intake of 5 micrograms for people under 50. The best bet is taking a multivitamin (though it may not meet recommended dosage for seniors over 70), which can reduce your risk of developing certain cancers, including colon, breast and ovarian.

“By living healthy and boosting vitamin D levels, women can reduce their risk of cancer by 70 percent — that’s incredible,” says Dr. Holly Thacker, director of the Women’s Health Center at Cleveland Clinic.
Hysterectomy Shortcut

It’s tough to estimate the impact a hysterectomy has on a woman. But at least a new laparoscopic hysterectomy can minimize the recovery time and physical scar.

About 600,000 U.S. women have a hysterectomy each year, and a typical abdominal procedure means a large scar at the bikini line and up to six weeks of downtime.

In  laparoscopic surgery, a tiny camera fits into the bellybutton. Incisions less than a half-inch long on each side of the lower abdomen create “ports” for laparoscopic instruments. Physicians watch TV screens as they remove the uterus and/or ovaries and fallopian tubes through a small incision above the vagina. Patients can go home the same day as surgery and are back to work within a couple weeks on average.
“The purpose of a hysterectomy is to improve a woman’s quality of life,” says Dr. Robert Pollard, director of minimally invasive gynecological surgery at MetroHealth Medical Center. “I have a patient who was back to work teaching classes at Curves in two weeks.”
A Sodium Reminder

Before you reach for the salt shaker, consider this: You probably consume three times the amount of sodium your body needs. “When you have too much sodium, your body collects fluid, and your heart has to pump extra hard to get rid of it,” says Elizabeth Pash Penniman, a registered and licensed dietician at Cleveland Clinic.

Over time, this extra cardiac “workout” strains the heart muscle, which can increase the risk of hypertension, stroke and heart disease, the No. 1 killer of women.

Most of us consume sodium without realizing it, and cutting down to the 1,500 mg recommended level isn’t easy. A can of soup is 1,000 mg, Pash Penniman says. Deli meats, frozen dinners and any prepared/prepackaged foods are culprits.

Check food labels — you’ll be surprised how milligrams add up to mega sodium. So buy fresh vegetables rather than canned, steer clear of the fast food and beware of food that won’t expire for years. “To keep those items fresh, the preservative of choice is usually sodium,” she says.
A Heart Bonus from Hormones

Estrogen can reduce coronary heart disease in women who take it when they are younger, according to a Women’s Health Initiative Coronary-Artery Calcium study.

Why? Estrogen affects calcium metabolism and breaks down deposits that result in harmful coronary plaque.

Yet after a 2002 study found that hormone replacement therapy might do more harm than good in older women, many women instantly rejected it as an option to relieve menopause symptoms, says Cleveland Clinic’s Dr. Holly Thacker. “Estrogen may actually reduce your risk of heart disease if you take it when you are young and healthy.”

The study showed that women under age 60 who took oral conjugated estrogens reduced coronary heart disease by 37 percent and stroke by 11 percent.

Thacker says by no means should these findings be interpreted as a public health statement to take estrogen discretely for the purpose of preventing heart disease. But the information should assure young women that estrogen is safe and effective treatment for menopause symptoms with a heart-healthy bonus.
 
Nipple-Sparing Mastectomy

A mastectomy scar is a constant, visible reminder of breast cancer. “Women have to live with the fact that they’ve had breast cancer even when the cancer is gone,” says Dr. Julian Kim, chief of surgical oncology at Ireland Cancer Center, University Hospitals Case Medical Center.
Reconstructive surgery that preserves as much of the natural breast as possible — skin, nipple and areola — restores confidence and provides a more natural solution to traditional reconstructive surgeries.

A nipple-sparing mastectomy involves only removing breast tissue from the skin/nipple “envelope.” Breast tissue is replaced, and the procedure does not appear to increase a woman’s risk of cancer recurrence.

“I’ve had a number of patients say they have normal [nipple] sensation after the surgery,” Kim adds, though functionality is not a promise.
Nipple-sparing mastectomy is ideal for women with a very high risk of breast cancer who opt for preventive removal of all breast tissue in both breasts. Women with smaller to medium-sized breasts and localized cancer who want to prevent recurrence may also consider the procedure.
 
More Screening for Down Syndrome

Down syndrome screening used to be only for pregnant women 35 and older. But the American College of Obstetricians and Gynecologists thinks that with less invasive first-trimester tests, the screenings should be open to all pregnant women.

The risk of having a baby with Down syndrome increases each year after age 35, from about 1 in 900 at age 30, to 1 in 30 at age 45.
New noninvasive screenings combine blood tests with an ultrasound (called a nuchal translucency test, which measures the back of the fetus’s neck), and is around 83 percent effective.

If these tests reveal an increased risk, then a woman can consult with her doctor about further genetic testing, such as an amniocentesis or chorionic villis sampling (CVS), which uses a sample of fetal cells.

“First-trimester screening is a risk-free way of getting more information early,”  says Jane Corteville, director of prenatal genetic services, MetroHealth Medical Center. “We are getting better at giving women information without putting them at greater risk.”
 
ACL Answers

Title IX changed everything for female athletes. The number of girls participating in high school sports has increased more than 900 percent since its inception in 1972. But the number of injuries has increased too.

Women are up to four to five times more likely to suffer anterior cruciate ligament knee injuries than their male teammates, says Dr. Susan Joy, director of women’s sports health at Cleveland Clinic. An ACL tear translates to six to nine months until you’re game-ready, plus a major surgery.

The Clinic is examining how body build and fatigue come into play in these injuries. “We are trying to find safe and effective ways for women athletes to train that will protect their knees so they can advance in sports,” Joy says.

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