Category Archives: sexual impairment

TOURISM HEALTH: SAFARI HEALTHSPANLIFE HEALING CAPE TOWN HOLIDAY 2013.

Health- slante, l’chaim!, hayah, sawubona! – in any country or language  is a blessing, a gift- not a right. It is insurance that has to be planned and enforced. Leaving it to fate, illness and hoping for a cure is often too late, sometimes crippling if not often  fatal. With comprehensive natural supplements, we can and should all die peacefully at an  active fit advanced  age  90years +  –   not old, incapacitated and demented. We owe this prevention to both ourselves, our  kids and our aging seniors.

So sensible lifestyle aside, promoting health  includes simple low-cost  (no-xray/no-laboratory) periodic screening:  for all,  from childhood:  of weight,  girth, eyes, teeth, bloodpressure, brainfunction- memory; and ultrasound bones – at any pharmacy/ optometrist, school or clinic;                         and  for women:  checking the breasts and pelvis for risk of  cancer.

The HealthSpanLife  South African Natural Medicine Clinic SANMC next to Cavendish Mall on the slopes of Table Mountain in beautiful Cape Town – one of the favourite world tourist  and heritage centres-  is a specialist clinic  staffed by experienced  registered professional practitioners- a medical internist specialist  (also UK registered);  a homeopath;  and a Muslim nursing sister.

It provides  one-stop holistic screening and diagnostics, and – uniquely-  evidence-based  natural remedies- nutritional support for all symptoms and chronic conditions-  also  for menopause-andropause-genitourinary- breast-sexual dysfunction- obesity-pain/headache –chiropractic  and detox ,

as well as if needed  appropriate modern specialized  testing and prescription medicines for all chronic major conditions including bio-identical hormone replacement for both genders (including implants);

and integrated referrals nearby (and in Gauteng)  as patients desire eg for autism, acupuncture, aromatherapy, physiotherapy, aquarobics,  advanced scopes, delicate restorative micro (eg hands, toes)-as well as major (eg bariatric, spinal,eye-, ear- neuro-)  surgery, infertility, xray/other scans, cancer, hyperbaric oxygen, spiritual intervention, psychiatric-hypno- therapy, and eg genetic profiling and counselling,   dialysis and transplantation, and stem cell therapy. …

Gentle Non-xray  ultrasound bone-density measurement (recommended by Cape Town , UK, and USA universities),  and tactile mechanical breast mapping (recommended by CANSA, UK, USA, Indian and Chinese studies) are available at SANMC (and in Gauteng) by appointment, and are covered by some medical aid plans;  whereas menopause consultations are covered by all open plans.

As typified by a new review last month,    World opinion is to use xray  mammography and  xray bone density imaging  only as last resort and only  in the elderly – or in staging those with breast cancer- because of the major problems and risks of xray imaging..   As world experts Profs Cornelia Baines epidemiologist in Canada, Mike Baum breast surgeon  in London and Peter Gotzsche epidemiologist  in Denmark  say,  there never has been any independent scientific evidence to support hazardous routine mass mammography crush xray screening of well women, let alone any repeated mass xray screening for decades, or the dangerous fictitious marketing hype of the American radiology-Breast Surgeons and Curves International nonsense  that xray mammo screening saves lives ..

While health tariffs must rise with inflation,  where med aid doesn’t cover, New Year 15% discount applies through January on cash-paid clinic services and in-house products. . .

For out-of-town/ overseas  visitors, accommodation and travel locally and throughout Africa and beyond can be arranged by outside experts around  clinic appointments. .  http://www.capetown.gov.za/en/visiting/Pages/default.aspx

For appointments visit  the SANMC at 1st floor no.  15 Grove Medical Bldg on Pearce St  cnr Grove Ave (parking opposite at ABSA on Grove);    or  phone +2721-6831465/  -6717415; or fax  +27865657215; or email the manageress, doctors or Sister at   sales@healthspanlife.co.za  to discuss needs,  timing and preliminary costing. For details, references  and rationale for screening and prevention,  see https://healthspanlife.wordpress.com/?s=screening.

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CHRONIC ILLNESS- MANAGED ANTIAGING & GENERAL PRACTICE CLINIC SOUTH AFRICA

update 6 April 2015

In Claremont  Cape Town

A  Specialist Family Internist Clinic offers consultations by appointment especially for managing (and ideally preventing)  the major chronic degenerative diseases of aging  and  maintaining physical, mental (and why not sexual?) vigour to a ripe and healthy old age; as well as preventing and managing acute disease at all ages.

The clinic (a specialist physician and a nutritionalist)  offers all-system evaluation and if available, natural  (as well as essential prescription orthrodox) prevention/treatment including metabolic – weight-endocrine-diabetes; heart-lung -kidney; hypertension; neurological-pain; joint & muscle; abdominal, immune system ie infection, cancer and auto-immune  support;  genito-urinary, & sexual problems;

and appropriate screening – ECG, non-xray ( no-touch thermography- eg thermomammogram;   SureTouch tactile) mammograms, non-xray (ie  ultrasound) BMD ie  bone fracture risk measurement, body composition, and appropriate hormone profiling/replacement.

Phone during office hours for appointment: for Claremont office  ph 021-6717415  or 6831465 (or 083-6299160) – at Grove Medical Bldg 1st floor no 15 (opp ABSA Bank Parkade c/o Grove Ave Pearce Rd)  , or neil.burman@gmail.com ;  or consultation by telephone/Skype or email .

by appointment only:        OFFICE HOURSby appt: ph office:  9am-5pm weekdays, 9am-1pm Saturdays.  AFTER  HOURS up to 9pm any day generally at office: –  email doctor   neil.burman@gmail.com  or ph 6am to 9pm  0836299160. EMERGENCIES  cannot be dealt with- acute emergencies and trauma, bleeding cases  must go to any  Emergency Unit .

Billing according to means ie specialist professional rates:  eg as a preferred provider for Discovery Health-  consultation procedure  0190; for needy patients, what the medical scheme pays  Detailed medical report and advice protocol provided at R300. Even Hospital Plans have to pay for outpatient consultation for scores of PMBs ie Prescribed Medical benefit conditions like Menopause.

 Needy patients desiring brief consultation can be seen by arrangement at GP rate.    Bone density scan  (covered by some medical schemes)  procedure 3612..  Non-xray mammograms are not yet covered by medical schemes codes: R650 for SureTouch including clinical consultation, R800 for thermomammogram.

SPECIALIST CHRONIC DISEASES CLINIC OF EXCELLENCE

   a Specialist Internist Physician [MB,ChB(UCT 1966), MRCP (UK 1974),   (fellow of the     Kronos Longevity Research Institute, Phoenix, Arizona 2004)  has opened a   CHRONIC DISEASE CLINIC    

 at Grove Medical Bldg, Grove Ave Claremont Cape Town  bewteen

ABSA Bank Parkade &  Warwick Sq opp. Cavendish Sq (also at Fish Hoek).

MISSION: To address the underlying causes of disease not just the symptoms,  to delay by decades all-cause disability and deaths.    Integrating natural and modern medicine.

managing and if possible delaying all common concurrent diseases of aging

including especially fatigue, frailty, diabetes;

 hypertension, cardiovascular, neurological, respiratory,

 abdominal, pain, headache, neurological -memory, renal, genitourinary,

endocrine , musculoskeletal, sexual and  immune diseases . 

Appropriate physiological Menopause and Aging Male HRT .

No-xray osteoporosis/BMD measurement by quantitative ultrasound.

Distance consulting.

phone/fax  +27216717415  for appointment, or respond below. .

update: ACQUIRING/JUGGLING THE BEST SEX HORMONE HRT REGIME FOR WOMEN.

Joey Basson writes January 28, 2010

I used Primogyn Depot for about 20 years, but I believe it has been discontinued in South Africa. I am now really struggling to find something that really works for me.

The injection was perfect. Do you have any suggestions?

reply: Hi Joey,
DRUG COMPANIES GANG UP  TO SUPPRESS CHEAP EFFECTIVE AGENTS -AS THEY DID FOR 25 YEARS EACH WITH LITHIUM AND METFORMIN IN USA, STILL BLOCKING HUGELY BENEFICIAL USE OF CANNABIS; AND  at the end of 2008, without notice or warning,  they conspired to abolish  CHEAP APPROPRIATE  NON-ORAL HRT IN RSA- the depot injections MIXOGEN, DEPOTRONE, even PRIMODIAN DEPOT, PRIMOGYN DEPOT.

NOW APPROPRIATE NON-ORAL HRT COSTS ALMOST 5 TIMES AS MUCH TO USE, AS eg CREAMS, PATCHES, SPRAYS, IMPLANTS FOR BOTH MEN AND WOMEN- AND FOR WOMEN WITH FAR MORE BOTHER.

Now the only way we are going to get such injections back in RSA is if there is enough interest to fight through the red tape to import from overseas. But South African administration is now so degenerate   under the corrupt  Zumas that it takes 2 years to get desperately needed doctors and sisters registered here – and who cares about appropriate HRT for the aging? Certainly not the notorious “doctor” or “Rev”  Zumas since they dont give a fig for evidence or human -especially  the poor and womens’-  rights..

if you live too far away, we can do a personal consult by email+- phone +- skype – via the necessary questionnaire by email- for you to discuss and implement with your local GP.

see numerous updates the past year at  https://healthspanlife.wordpress.com/?s=HRT

22 March 2009

An update review by Barry Wren from an Australian Menopause Clinic again debunks the myth that appropriate HRT in postmenopausal women PMW increases the risk of breast cancer, cardiovascular  disease CVD and thrombosis. It  stresses that “benefits of HRT include  less:  symptoms of menopause;  osteoporotic fractures,  ischaemia and cardiovascular-related death, forgetfulness, dementia and colorectal cancer; and  improved well-being, quality of life,  vagina, sexual enjoyment and bladder capacity,  with increased longevity. Oral  OHT doubles the risk of thromboembolism”. But on it’s own  in the young women in the Womens’ Health Initiative, oral equine estrogen (premarin)  reduced all major risks even new breast cancers and death from breast cancer.

As we hear regularly in women who have unwisely followed hysterical advice to stop HT,  stopping appropriate HT leads to fairly rapid loss of many of the above benefits. It has been  obvious for a century if not millennia   that permanent appropriate Human Hormone Replacement HRT of any of the dozens of our hormones that run out   is  (like a complete supplement of all the vitamins, minerals and the biologicals other than HRT)  prudent if not essential.

But we have to understand the reasons, risks and different regimes available. Nobody may prescribe or administer any sex HT Hormone Therapy without the necessary up-to-date training and experience, ensuring that the patient is having the necessary periodic examinations to ensure both safety and that the SHRT is appropriate. So patients must not self-treat with over-the-counter  supplements.

But only doctors and pharmacists who have costly current dispensing licenses may dispense and compound any hormone creams. And oral HT including phyto/plant hormones are  under suspicion of promoting cancer long term, let alone hepatic first pass effects like thrombosis and gallstones, and fluid retention oedema and hypertension (Genazzani ea 2008) .

INJECTION: tiny safe self-injection of combined hormone subcutaneously  (like insulin) is easy every one to three weeks, as most men use for HRT.  Monthly injection of depot preparations that last about three weeks  is not advised for anyone, especially not women with a womb as they are liable to have break-through periods. But unlike men, many women prefer to use hormone creams daily. The Depot hormone injections have climbed in price – what is now available averages about R75 per month. BUT (unless she gets the injection from her doctor regularly & proportionately every 1 to 3 weeks), women have to lay out about R1000 for self-injection (since  pharmacists will not likely  split a multi-vial or a set of three vials).

Provided that they ensure that they are appropriately trained in such therapy, all doctors are licensed to give periodic chronic injections – which should always be exclusively by tiny subcutaneous injection to avoid the notorious ie potentially crippling complications of intramuscular injections. But if nothing else is required, doctors are entitled to charge about R100 fee for the responsibility of an injection visit. Like insulin, patients easily learn to give it themselves- for men about 160mg depot-testosterone every 2wks (as opposed to 1gm testosterone undecanoate Nebido every 3 months- or about 1/10th of the male dose for women deficient in testosterone).

Synthetic ie xenohormones – those not normally produced by humans- eg progestins, ethinylestradiol-  may be invaluable (although by no means essential)  for birth control; but should not be used for PMW, especially not orally.

USING CREAMS: it is indeed best for women to (initially) juggle the balance of the three hormones  (all of which are made to the highest standard in South Africa)  until you have determined what ratio and quantity suits you best.

For the slim small older woman who needs both hot flash control and energizing, memory, ache relief:  the first priority is to control hot flashes, skin & hair without arousing breast and womb discomfort:

so try the 0.25% Bies(trogen) (E2 + E3- usually 1:4 ratio)  initially 1/2 ml scoop 1 – 2 x/day with the progesterone 3% cream initially just ¼ to 1/3 ml scoop a day ie 4 to 1 or 3:1 . This is ideally rubbed into the face as makeup- or if you like, dilute them in simple aqueous cream. Increase the combined dose to double if necessary to get control of the flashes – but the higher the Biest dose, the higher the risk of waking the breasts and womb, or getting thrombosis and ankle swelling.

And (unless your androgen level is still high) use just enough Testosterone cream 0.5% eg 1/2 to 1 scoop once (or twice) a day – below the waist ie vaginally or between the thighs or on the soft sole of the foot – to energize, improve alertness, libido, muscle and bone strength. Supplementing estrogen and progesterone alone may suppress necessary androgen.

In the bigger plump younger woman, who desires memory, energy, fat loss and libido rather than hot flash and skin improvement, using testosterone below the waist and progesterone on the face in the above gradually increasing doses often suffices, without the fattening and breast-womb arousing risks of extra estrogen. Such women often make enough estrogen from testosterone and in their excess fat stores.

But once the average women is well past 60yrs, low-dose estrogen often becomes advisable anyway for balance.

Old women benefit from and tolerate perhaps 1/6th to 1/10th the doses of appropriate balanced  human sex hormones of younger women.

THE THREE PRIME HUMAN SEX HORMONES: there are no risks from any appropriate HRT, only risks from avoiding it. Progesterone alone lacks some of the benefits of testosterone and estrogen eg on muscle- bone and hearing. Of the three hormone types, only androgen protects and improves muscle mass and strength. Testosterone excess (hairy face, acne, anger, clitoris growth, husky voice) is easily avoided with sensible balanced dose adjustment. Progesterone and testosterone have major benefits that estrogen may lack eg on hyperimmunity and inner hostility- issues that may not concern the gyne surgeon.

(Bi)Estrogen excess-  especially if used  alone-  does the reverse (of testosterone): promotes endometriosis and breast activation; excess actually weakens muscle eg bladder leak by melting collagen; it fattens; has little benefit directly on depression (although it does reduce dryness and pain); may promote thrombosis since unlike testosterone it does not diminish clotting; and may promote anxiety, hostility- this is why progesterone cream is often the best for monthly PMS and for perimenopausal anxiety (against the raging hostility from estrogen swings).

Above all else, remember that estrogen stimulates both breasts and womb- so estrogen must always be balanced by enough progesterone and(/or) testosterone. And if the hormones are allowed to run out by widening the gap between injections beyond two weeks, or between cream doses by more than two days, vaginal bleeding likely will occur.

The initial outlay cost of the three different hormone creams is up to R500 retail- you find out for yourself how long each tub lasts; as opposed to having an experienced pharmacy eg the manufacturing AntiAging pharmacy in Gauteng  compound ie mix what you want in one or two tubs that will last a few months. Try your local pharmacy – but finding one with experience is difficult.

PREVENTION? OR WAITING FOR DISEASE FROM NEGLECT TO CRIPPLE YOU? Many  gynecologists (like urologists) are primarily surgeons concerned with reproduction, menstrual, pelvic and cancer problems, and treat the menopause years often with fattening hormone pills (HT- which have more risks) and surgery..  They do not have to deal with the much wider irreversible medical problems of old age (obesity-diabetic, insulin resistance, lipidemia, vascular, immune, fracturing, arthritic, visual and hearing loss,  depression, and dementias – and no least, common sudden premature death)# – which are largely AVOIDABLE with appropriate natural supplements from the beginning, including balanced non-oral human sex hormones. As a BBC news report this month  says, memory (ie cellular) deterioration  begins on average  before age thirty.

It is not the gynecologist, but patients  and Family/ general practitioners GPs and specialist physicians including endocrinologists and geriatricians who have to deal long term and medically (not surgically)  with these easily preventable crippling killer diseases..  Surgery cannot address the basic pathogenic cause of chronic degenerative disease.

The discomfort and fattening of the 5-10 MENOPAUSE years is a concern for all doctors – and the earlier the menopause (whether natural or surgical), the more important it is to start appropriate simple balanced non-oral HRT and other effective medical prevention of fattening and diabetes eg other insulin sensitizers like metformin. Avoiding the late postmenopausal  silent killer degenerative diseases of aging (# above) is crucial  essential duty of doctors – but mostly of patients themselves,  since- obstetrics and trauma  aside-  most doctors earn more by disease than by prevention..

ndb

PER ASTRA AD ARDUA: ASTROLOGY, STATINS AND SCAMS: AN ASTEROID AND AN AURORA FOR JUPITER.

ASTEROID-   a new study from Harvard and the Cleveland Clinics – boasts the safety and efficacy of achieving very-low low-density lipoprotein cholesterol LDLC with highdose  rosuvastatin Crestor.

But it notes carefully: “on-treatment atheroma volume, change in atheroma volume, and the high % of patients with atheroma regression did not differ by the achieved LDLC level. ”

Since the trial lasted only 2 years in only 471 average obese (BMI ~28.5kg) patients aged around 58yrs, it was far too small and short to determine whether there was any non-cardiovascular benefit or risk from the drug in this high-risk metabolic syndrome population, 95% of whom were hypertensive, 13% diabetic, and who have a high risk of future cancer, dementia, arthritis.

So the only purpose it served is to show that there is no shortterm benefit in highdose versus lowdose statin, in more than moderate lowering of LDLC and raising of HDLC.

In the  AURORA* trial in dialysis patients, “although the mean LDL cholesterol was reduced by 43% in the rosuvastatin arm of the study at three months, no difference in the primary end point (death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke) was demonstrated at an average follow-up of 3.8 years. [1]

The stark reality- which ( fungus extract) statin, and more modern  antidiabetic drug   proponents hate- is that metformin (a plant derivative)  is the only panacea, patented drug ever that reduces not just heart attack by half in type 2 diabetes but also reduces all-cause mortality by at least one-third; and when used preventitively and to optimal titrated tolerance  in the overweight, reduces the incidence of new diabetes by up to 90%. That just about puts it ahead of vitamin D and fish oil and appropriate HRT  as miracle agents.

And statin proponents  studiously remain silent that while titrated metformin has zero persisting adverse effects in controlled trials of up to 20years, statins produce insidious adverse effects (depression; myo-hepatorenal, memory loss,  non-natural deaths, lowering of sex hormones and erectile function) in up to a quarter of longterm users – with  significant increase in cancer (especially of the breast) when the LDLC is  severely depressed; and fail to influence insulin resistance and diabetes long term.

So, like most statin trials ,  JUPITER and ASTEROID reports  are twisted to promote statins, whereas they do nothing to recommend statins,   show that they are anywhere near as good and safe for longterm mortality reduction as   natural non-patent agents-  metformin, appropriate HRT and eg fish oil and vitamin-mineral-biological-plant supplements – which lack the insidious adverse effects of the statins. .  After some 40 years of use, the only indication for statins remain (if any) those rare patients with severe resistant hypercholesterolemia above perhaps 8 or 10 mmol/L.

And rosuvastatin is apparently the strongest as well as the youngest (preteen) of the current statins; so it should be used in low dose if at all. Have we learnt nothing from stilboestrol, thalidomide, practolol, cerivastatin,  troglitazone, Vioxx?

It is obvious why statin promoters- the manufacturers and their hirelings- continue to spend $millions promoting the $billion statin trade. But it is doctors and especially Authorities- academics and regulators-  who must explain why they are jeapordizing patients’ lives, why  a high percentage of older patients- especially the overweight- are on  the hugely advertized statins when they should be on the safe and highly beneficial metformin, fish oil and the other proven  multibeneficial supplements eg vits-minerals, biologicals including appropriate HRT, and plant extracts.

PER ASTRA AD ARDUA ET LUCRUM:

The promoters of rosuvastatin – Crestor-  make studious use of astrology- ASTEROID, JUPITER, AURORA–  astronomical eponyms – to deviously promote the mystique of statins through their trial titles. But at least astute astrological physicians like Shakespeare’s contemporary  Dr Simon Forman had some justification- there was seldom better treatment at the time, often far worse, and it was harmless (with romantic overtones)  apart from perhaps distracting from more onerous changes in lifestyle and diet; and  had  grains of truth in the as-yet not scientifically recognized planetary and solar-lunar changes in weather etc which influence health..

And rosuvastatin studies only appear on Medline from 2001- barely a decade ago -so there cannot be any longterm experience let alone trial (as there is for metformin)  on this wannabe chronic prevention drug for at least another decade. And  the history of rosuvastatin, it’s discoverer and place of origin, is mysteriously not apparent  on the AstraZeneca or any other website. This at 20 times the cost of simvastatin in UK .

Clearly  Big Pharma and their lobbyists – with the glad connivance of Regulators and Medical Schemes-  – still depend on age-old psychology to bluff doctors let alone patients.

*Aurora has two meanings, both of which are apposite for their use in statin ie Astra-Zeneca marketing :

  • while Astra refers to the wandering stars!

Clearly the manufacturers of Crestor (Astra-Zeneca)  wish  these glowing images and more as their $reward for boosting their protege drug. And Zeneca is also under fire that “Women concerned about breast cancer are being bombarded with a massive advertising campaign for the drug tamoxifen” – which like all other modern drugs has no evidence base for longterm preventitive use.

WARNING re HEAVY DAMAGES FOR NEGLIGENT PRESCRIBING: BISPHOSPHONATES – FOSSY DRUGS- FOR OSTEOPOROSIS?

This column last considered bisphosphonates BPN in February. This  reviews some new papers published since.

ADVANCED  CANCER with bone spread:  Recent major (Cochrane)  reviews confirm that BPNs may be  valuable in   advanced prostate and  breast cancer ,  for reducing skeletal events and maybe pain, although they   do not clearly  influence disease progression or patient survival.

OSTEOPOROSIS: It is now almost 5 years since the balloon went up on the unnecessary major risks of BPN for osteoporosis.  So anyone who was prescribed these dangerous drugs since then for osteoporosis, without the rare special  indications, and who develops BNP-related complications  (or osteoporosis-related fractures) has a strong case for heavy damages against the prescriber, the dispensing pharmacy  and regulator eg the State clinic or medical plan who/which advised/ allowed use of the drug for that condition. .

Bisphosphonates were invented over a century ago but developed over the last 40years  for clinical treatment of metabolic bone diseases,  with the first human trials reported about 35 years ago (Heaney 1976). Why have they been exhaustively tested and now routinely used for prevention and treatment of aging osteoporosis, despite their considerable cost especially risks, and lack of global benefit?

Obviously because as patented designer drugs they are profitable to the Disease Industry – despite the fact that their biggest section on Wiki is about their rare but major adverse effects- to quote Wiki :

  • Oral BPN can cause upset stomach, inflammation and erosions of the esophagus,
  • Intravenous BPN can give fever and flu-like symptoms after the first infusion. The  slightly increased risk for electrolyte disturbances is not enough to warrant regular monitoring.
  • BPN have been associated with osteonecrosis of the jaw – the mandible twice as frequently affected as the maxilla- and most cases occurring following high-dose intravenous administration  for cancer patients. Some 60% of cases are preceded by a dental surgical procedure (that involve the bone).
  • severe bone, joint, or musculoskeletal pain has been reported.
  • BPN  use ( zoledronate and alendronate) is  a risk factor for atrial fibrillation in women. The inflammatory response to BPN or fluctuations in calcium blood levels have been suggested as possible mechanisms..
  • Matrix metalloproteinase 2 may be a candidate gene for BPN-associated ONJ since it is the only gene known to be associated with bone abnormalities and atrial fibrillation, both of which are side effects of BPN.
  • Long-term BPN  use resulting in severe or over suppression of bone turnover especially at the  femur sub-trochanteric region.  Micro-cracks in the bone maybe  unable to heal and eventually unite and propagate, resulting in atypical fractures, which  tend to heal poorly and often require some form of bone stimulation eg bone grafting.

NO COMPELLING INDICATIONS FOR BPN IN OSTEOPOROSIS: the Wiki entries for BPN  and osteoporosis are cleverly written by BPN promoters / marketeers – they fails to justify  why BPNs are “the most popular first-line drug”… and the overwhelming evidence that favours combined natural supplements: eg that in the Womens Health Initiative, appropriate hormone replacement HRT ie started soon after menopause is safe up to 10 years of use, halved fracture rate and colon cancer, and lowered all other chronic major degenerative diseases AND breast cancer AND  premature deaths by a third.  BPNs have risks but no  benefits other than fracture reduction- ie for osteoporosis, no compelling indications  and the legal eagles are hungry.. .

BPN-ASSOCIATED OSTEONECROSIS IN LONG BONES: Guanabens from Spain first described long bone fractures related to BPN in 1994,  and more such cases (iatrogenic Toulouse-Lautrec disease) are reported now from the UK.

ATRIAL FIBRILLATION:   Denmark reports some 30% increase in potentially crippling atrial fibrillation in patients with fractures treated with BPN  – whereas it is common cause that appropriate supplements drastically reduce arrhythmia eg fish oil halves sudden death.

Italy now reports increase in hypocalcemia and raised serum creatinine ie kidney impairment after BPN  for cancer . . Sweden reports no benefit of 2 years’ BPN   on knee prosthesis migration. The incidence of metabolic bone disease and all other system complications in intensive care is notorious – and a   Princeton report gives no justification for BPN use in ICU when all the safe natural supplements are essential and ensure better protection globally..

Canadian study shows that ” managed intervention” after osteoporotic hip fracture prevented  4 new hip fractures and gained 4 quality life-years –   but the available abstract omits what the interventions were, and whether survival was increased.

And while all rational evidence-based appropriate prevention and treatment of osteoporosis – the permanent baker’s dozen of safe natural supplements- reduce all-cause chronic degenerative disease and mortality by at least a third, without any risks, – BPNs  have increasingly recorded risks both short term and long term, with no extraskeletal benefits, despite reducing the fracture risk (spine -Cummings 2002; hip Nguyen 2006) by up to a half.

OSTEONECROSIS OF THE JAW ONJ:   first reported in 2003,   only 26 cases of ONJ  on oral BPN could be found  reported worldwide up to Sept 2006  in a  2007 University Pennsylvania study . Only  15 % were men, and the majority involved the mandible.    Now Israel alone reports another 100 cases of BNP- related jaw osteonecrosis – fossy jaw  – and 16% were on oral BPN. The incidence of OJN is  speculated to be between 5% and 11% in cancer patients treated with BPN.

A world-wide  panel produced the  2008  Canadian Consensus Practice Guidelines for BNP Associated Osteonecrosis of the Jaw, but did not estimate  the incidence of ONJ.   It concludes  that “High-dose intravenous BNP have been identified as a risk factor for ONJ in the oncology patient population. Low-dose BNP use in patients with osteoporosis or other metabolic bone disease has not been causally linked to the development of ONJ”  “BPNs have become a cornerstone in the management of skeletal complications of malignancy as well as osteoporosis and metabolic bone disease, as these agents offer tremendous benefit to those with malignancy or metabolic bone diseaseDue to limited and misleading public information regarding ONJ, many patients have discontinued  BPN treatment, resulting in inadequate care of the underlying skeletal condition.”

But the Canadian Consensus paper fails to clarify in what way BPN offers “tremendous benefit” to those with osteoporosis? The  consensus of the majority of practitioners who do not recommend BPN for osteoporosis is that evidence still shows that appropriate HRT with other standard supplements is  the best prevention and treatment not just of osteoporosis but of all the common major degenerative diseases of aging. (The International Menopause Society). This eternal truth and aim- the wellbeing of seniors- is the imperative, not the wishful thinking of Big Pharma to replace natural supplements with designer magic bullets for each disease.

By far the most comprehensive and objective review is  the American Association of Oral and Maxillofacial Surgeons   Position Paper January 2009 Update on Bisphosphonate-Related Osteonecrosis of the Jaw BRONJ: Indications and benefits of BPN therapy:

Intravenous (IV) BPN are primarily used and effective in treatment and management of cancer-related conditions including hypercalcemia of malignancy, bone metastases such as breast, prostate and lung cancer, and multiple myeloma- for which the clinical efficacy of IV BPN  is well established.

BPN have not been shown to improve cancer-specific survival, but they have had a significant positive effect on the quality of life for patients with advanced cancer involving the skeleton.

Oral BPN: By far the most prevalent and common indication is osteoporosis and  osteopenia. They are also used for a variety of less common conditions such as Paget’s disease of bone, and osteogenesis imperfecta of childhood.

INCIDENCE OF BRONJ: Based on case series, case-controlled and cohort studies, estimates of the cumulative incidence of BRONJ range from 0.8%-12%.

ORAL  BPN BRONJ: Surveillance data from Australia estimated the incidence of BRONJ for patients treated weekly with alendronate as 0.01-0.04%. In a survey study of over 13, 000 Kaiser-Permanente members, the prevalence of BRONJ in patients receiving long-term oral BPN therapy was reported at 0.06% (1:1,700).

Demographic and systemic factors:  In the original Position Paper, age, race, and cancer diagnosis with or without osteoporosis were reported as risk factors for BRONJ. Seven studies report increasing age as consistently associated with BRONJ. Sex was not statistically associated with BRONJ.  Other systemic factors or conditions, i.e., renal dialysis, low hemoglobin, obesity, and diabetes, were variably reported to increase the risk for BRONJ. Malignancy type was not statistically associated with an increased risk for BRONJ.

Genetic factors: Sarasquete et al, demonstrated that genetic perturbations, i.e. single nucleotide polymorphisms (SNPs), in the cytochrome P450-2C gene (CYP2C8) gene were associated with an increased risk for BRONJ among multiple myeloma patients treated with IV BPN.

Preventative factors  The AAOMS Taskforce on BRONJ recommended that patients undergo dental evaluations and receive necessary treatment prior to initiating IV BPN therapy.  In addition, given the long-term biologic activity of IV BPN one may hypothesize that different dosing regimens may be equally effective and decrease the risk for BRONJ.

Using a retrospective cohort study design, Coso et al, evaluated the BRONJ and skeletal-related events  e.g. pathologic fracture in multiple myeloma patients using different dosing schedules for zoledronate. These findings suggest that alternative dosing schedules that reduce IV BPN exposure have comparable outcomes in terms of preventing SREs and a decreased risk of BRONJ.

The effectiveness of hyperbaric oxygen therapy as an adjunct to non-surgical and surgical treatment is under investigation at two institutions where a randomized controlled trial is underway. Preliminary results have shown some improvement in wound healing and long-term pain scores, but its use as the sole treatment modality for BRONJ cannot be supported at this time.

Yet despite the fact that osteoporosis and fractures are closely related to and occur along with the major causes of aging disability and premature death – 20% of osteoporotic hip fracture victims die within a year- BPNs have not been shown to reduce any let alone all the other aging diseases let alone premature deaths. The closest a study came to assess the issue was a Singapore analysis of the  30year old clodronate used for up to 2-3 years after breast cancer  – which drug showed no influence on overall survival.

This failure of global benefit of BPNs – which are  in fact never indicated except rarely eg as palliation in preterminal cancer bone lesions – raises the question of criminal negligence when doctors prescribe and medical schemes and Regulators allow BPN use for osteoporosis. Why are BPNs allowed and prescribed when they have no global benefit but numerous serious risks; and when conventional lowcost natural supplements combined do nothing but global good.   eg essential fish oil, essential vigorous-dose blend of vitamins-minerals-biologicals-herbs, essential appropriate HRT , and essential galega-metformin in the overweight let alone obese each lower all-cause chronic morbidity  and death by a third to a half.

It is no defence that adverse effects are rare when  they are  sometimes deadly, and never worth the risk of these drugs since there is rarely overwhelming need to prescribe such drugs- for which there are safe  natural and far more effective alternatives.

CASE REPORTS: In 2007 we saw a well-built  physically active woman of 61years, whose bone density had fallen some 9% on regular DEXA screening  since menopause despite the usual calcium-vitamin D supplement. In 2008  she  decided to delay HRT because of  strong family history of breast cancer. A year later at followup DEXA  on just fish oil plus a modest dose of the standard HealthSpan For-Bone  supplement blend (calmag zinc boron manganese; proline; and vits B6-9-12 – C- D3 & K2), her DXA BMD has risen 2% (2.5% at the spine, 1.5% at the hip).

A small slim 61year old bookkeeper presented a year ago on just calcium &  vitamin D, her 2007 DEXA spinal density 0.99 having fallen 1% from  2005 ie T -1.6  but her hip down 6.3% from 0.792 to 0.764 ie T-2.  Since then, on the Bone Blend and a little estrogen-progesterone-testosterone cream daily, her spine has stayed constant but her hip BMD has risen 2.4% to 0.783.

A new review from Toulouse France has the last word: “Postmenopausal osteoporosis is a chronic disease which justifies long-term treatment.  Efficacious available modern  fracture-reducing drugs raise the question of the best treatment strategy in postmenopausal women .    In this regard, HRT, which allows a more global approach to the menopause-induced consequences of hormone deficiency than the sole prevention of osteoporosis,  should be privileged… Use of BPN or strontium ranelate should be thus (at best) be reserved for a more advanced age, when the prevention of hip fracture becomes mandatory“. .

Yet, because it is profitable, the fashion grows to treat the elderly with grossly expensive designer oral strontium, or designer injections of BNP or hormone analogues (of calcitonin or parathormone) – despite the fact that these experimental agents have no extra-skeletal benefits (ie improving cardiovascular, muscle, immune, brain function),  have never been tested in longterm studies  for at least 6-10 years to test their safety as has eg HRT in the Nurses’ and WHI studies.

But millions of years of bipedal evolution, and numerous studies over the past century, show that all that is required to  maintain maximum mobility, mind and mood to enjoy life is lifelong supplements as listed above, appropriate to youth, parents, the middle-aged and seniors.. including healthy seniors’ sexuality. It is  too late postponing  prevention  till wished-for healthy advanced age- which most do not reach due to early demise, or irreversible crippledom from largely avoidable fractures, strokes, heart failure, arthritis, or dementia.

The Israelis’ maxillofacial team lament that “Solutions for decreasing morbidity and poor outcome of ONJ remain elusive.” The answer is painfully obvious: avoid iatrogenic ONJ by avoiding  BPN -even orally- except for advanced cancer with bone metastases, but back up lower dose  BPN  with all the  anabolic supplements.

A risk of “only” 7 in 10 000 may reassure a patient being offered BPN for  osteoporosis- but if she decides to sue for damages for prescription of totally unnecessary hazardous therapy, the prescriber doesnt have a leg to stand on when the gold standard is appropriate titrated supplements (including HRT)  without risks since  they reduce all risk by at least one-third.

As  wise Chinese taught 2600 years ago, Society, Authorities, Regulators, health professionals have a sacred obligation to above all else prevent avoidable premature death and crippledom with the freely available and low-cost well-proven natural supplements. These must prevail despite the best efforts of Big Business, Big Pharma and their academic and political lobbyists (Governments, Regulators) worldwide to ignore if not outright suppress safe effective old natural  supplements  (as the FDA and EU are doing) in favour of Diseases and Modern Drugs that Pay – but do not reduce all-cause  disease and mortality .

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THE CRUCIAL IMPORTANCE OF NON-ORAL ROUTE and LOWER DOSE OF SEX HORMONE REPLACEMENT SHRT in the majority-the overweight, diabetic, cardiac, thrombosis, transplant, dementia and cancer risks.

Obviously our   skin (unless injured or diseased) – arguably our  major organ of heat control, sweating, vitamin D activation  and sexual enticement- serves as a major impenetrable barrier to  absorption or leakage. Unlike amoebae- which live or die by their exterior- we feed and excrete via our digestive tract, using our skin mainly for attraction-  or repulsion!.

It is common cause that, with intravenous injection ivi as the fastest alternative route (to swallowing), absorption is hardly better (than the skin) across aged dry vagina; better across moist ie mucous membranes eg of the eyes, nose, mouth and vagina/rectum; better by deep inhalation or subcutaneous s.c. placement (injection or pellet); and best  by intramuscular injection imi – which is now rarely achieved with  a standard 3/4 inch needle into the upper outer buttock in a fattening population . Such injections are mostly delivered s.c.

Which route is preferable depends obviously on the speed of action required eg high blood peak for an urgently needed antibiotic, analgesic, anaesthetic, antiasthma, acute insulin or resuscitation; as opposed to slow smooth delivery for maintenance eg hormone, antidepressant or analgesic delivery.

For depot injections, why use anything bigger than a 25g 10mm long needle?  so that safe subcutaneous   s.c.i.  is ensured,  guaranteeing  avoidance of the many minor and major risks of intramuscular   imi.

eg Meyer ea at Cornell Univ NY 1990 reported  that subcutaneous administration of the gonadotropin releasing hormone agonist leuprolide took half the time to first response with double the amount absorbed compared to the same dose by the transdermal TD route.

Minto, Handelsman ea in 1997 showed that injection of an oil-based depot sex hormone into the fattier gluteal (ie upper outer buttock) region (as compared to the lean deltoid ie upper arm true imi) gave significantly slower smoother less peaked absorption and action of the hormone.

And obviously total delivery to the body is going to be less absorbed  through the tightly layered  skin than if 100% delivered under the skin by injection/implant. Fatty – steroidal- gonadal hormones are particularly altered by digestion and transhepatic absorption. But so will transdermal absorption fall with aging, drying of the skin.

Hence in postmenopausal women PMW  the average dose equivalence for similar symptom- hot flash- relief has been found to be estradiol 1mg or CEE 0.625mg orally, but about 0.05mg E2  a day by modern TD designer patch (containing 4mg E2, changed twice a week)  or cream;  ie an effective oral: TD dose ratio of about 20:1. But  oral estrogen eg 1mg E2 raises the E1 estrone (the hormone most associated with breast cancer) blood level  5-fold more than the E2 level, and increases urine estrogen excretion about 100fold; whereas the E2 patch 0.05mg/day raises serum E2 to a satisfactory ~120pmol/L  but with  little  increase in E1 level  or urine estrogen excretion. Thus TD but not oral ET restores the youthful healthy balance of blood E2>E1 aout 1.2 :1.

Conversely, in  girls with delayed puberty and growth,   physiological effect appears to be even higher with TD estradiol  E2  than oral conjugated oral estrogen CEE Premarin. In a recent trial undeveloped girls with Turner’s syndrome were randomly assigned to receive initially  CEE 0.3mg/d orally, or TD E2 0.025mg/d patch (17β-estradiol, Vivelle TD) for one year – doses chosen based on published E2  equivalence  about 20:1. After 12 months the girls on TD ERT had better improvement in uterine, height, breast, and bone density growth than oral HT CEE. Hence they too (like postmenopausal  PMW) needed far lower total dose estrogen exposure parenterally than orally. PMW certainly rarely if ever want bigger breasts or womb, so even lower transdermal microdoses are ideal for them.

Nachtigal ea 2009 show that oral but not TDE2 accelerate platelet reactivity ie thrombosis risk in some PMW.

Villa ea 2008 show that low dose 1mg/d micronized E2  lowers insulin resistance, whereas higher dose 2mg/d increases it.

Verhoeven ea 2006 showed that oral micronized E2, but not TD  E2 treatment, significantly reduced arginine compared with placebo – and good arginine levels are crucial in maintenance of immunity; insulin sensitivity;   growth hormone output; wound repair; fertility; and adequate nitric oxide levels for optimal muscle, heart and circulation..

And Shifren ea 2008 showed that compared with oral CEE, TD E2 exerts minimal effects on CRP and the other inflammation and hepatic parameters – more adverse hepatic first-pass effects of oral HT as regards both cancer and cardiovascular disease. .

Thus, given that the higher the rate of breast and uterus proliferation the greater the risks in later life, sex hormone therapy and replacement in women (let alone men) should always be parenteral- the lowest dose to achieve the desired goal- be it feminization in Turner’s Syndrome; contraception; or postgonadopausal HRT in men or women.

The ill-informed reaction to the poorly planned Womens’  Health Initiative led to a massive fall in all HRT use.

MEMORY PROTECTION:

Yet abundant studies reviewed in this column the past two years show the incalculable benefits of appropriate balanced (E+P+T) in PMW.  No-where is this better shown than in neuroprotection especially against Alzheimer’s disease AD, in which- in eg  the Womens’ Health Initiative–  introduction  of oral xenohormones well after age 60years worsened the risk of AD, but  CEE  started soon after menopause greatly reduced AD risk.

University   Beijing has shown that women who have taken lowdose oral E2 0.5-1mg plus progesterone 0.5-2mg for 4 to 33yrs have  significantly less hippocampal atrophy;   similarly at Univ S California,  studies in AD-prone mice show that early oophorectomy worsens the AD pathology and behaviour changes, but this deterioration is better blocked by E2 + progesterone combined than by E2 alone.

Testosterone replacement is probably brain-protective in men;  it remains to be seen whether it adds  memory protection in women when combined with E+P. A  2006 British study of estrogen treatment in male to female transsexuals showed few and inconsistent changes in memory and cognition.

But a new Spanish study does show that when female-to-male transsexuals are treated with testosterone for 6 months, they show significant improvement in visual but not verbal memory.  And a new Swedish study shows that “The most positive effects of estrogen plus progestogen therapy concerning memory and urinary tract and vaginal complaints were found in women with the highest and/or moderate testosterone levels (P < 0.05).”

recent UK  MRC study shows the critical importance of optimal thyroid function in memory, since excess of either thyrotropin or thyroid hormone can be adverse.

And it has long been known that the more hypoglycemic episodes diabetics experience, the worse long-term memory.

Thus balance of  all three major sex hormones- estrogen, testosterone and progesterone, as well as insulin and the thyroid axis,  is  crucial in cognitive performance especially in women.

HORMONE CREAMS: for those who prefer creams to  pills, implants or injections, a major advantage is that  women  can start low with all three main sex hormones as appropriate, and titrate them individually upwards to tolerance or designated ceilings. Once optimal intake and levels of each have been attained, they can then if wished be combined, compounded.

CONCLUSION:

As this column discussed two weeks ago: mid- twentieth-century women now potentially live to double the age of those born in the early Victorian era; but increasing numbers undergo premature menopause and especially relative androgen deficiency due to  elective sterilization, hysterectomy, survival from cancer and radiotherapy, or increasing cancer risk from smoking, alcohol, suppressed menstruation due to birth control hormones, cortisone use eg for autoimmune diseases and transplantation, nuclear fallout or the feminization of nature .

They thus spend the second half of their lives post menopause, with increasing premature mortality and morbidity from diseases of hormone deficiency:   fattening and diabetes; heart and circulatory disease; muscle and bone frailty; arthritis; infections,  incontinence;  and worst of all, depression,  cancer  or loss of memory; and not least, loss of vital  sexuality. These are all largely avoidable by appropriate early and permanent non-oral balanced HRT and a blend of the other three-score other natural  supplements.

As Prof  Robert Greenblatt from Augusta  wrote in The Menopause Syndrome (Medcom Press)  in 1974, ” the menopause is a physiological endocrine hormone deficiency state. It is good practice to offset endocrine deficiency states by hormone replacement therapy to restore hormone balance”- whether in a teenager or a grandmother.

And Prof Emanuel  Schleyer-Saunders from London stressed in the same colloquium that even 35 years ago, half of all hospital beds were occupied by diseases of old age- obesity-diabetic-vascular, mental and malignant- which (as Masters and Grody had shown 20years earlier) are delayable by decades provided balanced parenteral permanent HRT is started early in menopause- which starts insidiously in the mid-forties if not earlier.

Whereas Masters and Grody in St Louis, and Gelfand in Quebec,  established this by long term injections of testosterone TT and estradiol E2  esters (which for decades have been available as a 20:1 mixture lasting 2 to 3 weeks), Schleyer-Saunders and then Whitehead and Studd  in London,  and Gambrell in Augusta, maintained this long term by pellet implants every few months.  Schleyer-Saunders showed with pellets that continuous balancing TT reduced the incidence of breakthrough bleeding from 20% on E2   alone , and 12% on E2 + progesterone P, to 8% on E2 + TT,  but only 5% on all three ie E2 + P + TT – with reduction in cancers. He generally used a dose of 25mg of each hormone, but (at a time when  women were far slimmer) 50mg E2 implant  in women post oophorectomy.

Yet MacLennan ea from the International Menopause Society now report that in Australia, as a result of the hysteria generated by the wrong Womens’ Health Initiative and Million Women Study reports (in which most women used oral xenoHT), only 12% of postmenopausal use hormone replacement.

Convenience should be the last factor considered. Unless balanced  lowdose mcronized estradiol, testosterone and progesterone are used orally  – since micronized particles largely  bypass  transhepatic absorption- there is no longer excuse for the risks of oral CEE,  progestins and similar hormone therapy with hepatic first pass adverse effects.  “Convenience” is no defense  against charge of negligence  when the patient develops major complications from oral sex hormones. So the patient who insists on oral hormones should sign an informed consent form that she has been warned,  but accepts the risks of the oral (as opposed to the physiological parenteral) regime.

All  women (and men) – especially with chronic or serious acute ill health – should thus be ensured  permanent  youthful sex hormone levels with appropriate physiological HRT that avoids both hepatic first pass metabolism and hormone excess/ imbalance. Traditional American industrial hormone therapy ( dominant the past 50 years due to the connivance of the FDA with it’s supporting drug industry) with oral xenohormones eg CEE, progestins and anabolic steroids cannot provide the physiological replacement required, that is ensured with titrated human hormones  in every other branch of endocrinology for the past generation.

It remains an indictment of American medicine and legislators that their Disease and Drug  Industry- the FDA and mainstream physicians-   put their  commercial interests ahead of  womens’ welfare   in making postmenopausal women the exception to the rule of  evidence-based medicine especially endocrinology. The most vulnerable group (after children)- the older women – are thus as always the main innocent victims of the FDA-led  Disease Industry’s  War on Humanity, the Black Mass of organized commercial Big-Pharma “medicine”- of which 13  USA firms in  about 2006 had half the world’s gross “medicines” turnover of ~ $600billion. Based especially  on womens’ ills and vulnerability- particularly cosmetics and cosmetic surgery, screening mammography and hysterectomy-  the Beauty/Disease Industry is thus truly a multi-$trilliondollar moneyspinner, disaster capitalism targeting women.