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A healthier you for the New Year

On “Today’s Woman”, medical contributor Dr. Judith Reichman, talks about new medications and diagnostic tests available that can improve quality of life.
/ Source: TODAY

As we approach the holidays, we give and receive (presents). New medications and diagnostic tests have been developed that will “present” us with the opportunity for a brighter and healthier holiday and New Year.  On “Today’s Woman”, Dr. Judith Reichman, our medical contributor, will tell us about a few of these medical gifts. Let’s start with diagnostic tests:

Ovarian Cancer Screen (Ova Check)
This test analyzes a blood sample and checks for the presence of a unique subset of proteins that have been identified in the blood of women with ovarian cancer.  It will become commercially available next month.  This proteomic pattern testing has been used in a “blinded” study to examine blood samples in 50 women with known ovarian cancer and 63 women with non-malignant disease.  The test was found to “predict” ovarian cancer, even early Stage I cancer, 94 percent of the time (whereas the blood test for ovarian cancer that has been available up to now, called the CA125, predicted ovarian cancer less than 10% percent of the time).The Ova Check blood test is undergoing further analysis on larger groups of women.  Meanwhile it will be made available by Quest Diagnostic Laboratories and Lab Corp for testing of high-risk women (women with a strong family history of breast and/or ovarian cancer, certain colon cancers or women who have a known BRCA gene mutation).  The test will cost between $100 and $200 and initially will not be covered through insurance.

Virtual colonoscopy
This month, virtual colonoscopy received a virtual boost of scientific approval in an article published in the New England Journal of Medicine.  Three dimensional CT scans were performed in over 1200 symptom-free patients who underwent bowel cleansing, swallowed a substance to tag any remaining stool (which makes it show up on x-ray), and who then had air injected into their large bowel through a small rectal catheter.  The same patients subsequently underwent colonoscopy and the results were compared.  Both tests were equally effective in finding polyps larger than six millimeters. So will “virtual” replace the “real” colonoscopy procedure? Perhaps for individuals who are at low risk, especially if a previous colonoscopy showed them to be free of any polyps. Two issues still need to be considered:A scanning machine cannot do a biopsy so if something is detected; a second bowel cleansing and full colonoscopy will be necessary.  Most centers still offer just two-dimensional scans which will not be as reliable as the 3 dimensional scanners. Until the latter are widely available and physicians can establish when to just watch a polyp to see if it grows and when to remove it; colonoscopy will have to continue to be the gold standard for early colon cancer detection.

Medical therapy 'presents'
There have been scores of new medications that have received FDA approval over the past year and hundreds of previously approved drugs were approved for new indications.  This year approval was given to new medications for heart disease and hypertension, treatment of depression, irritable bowel syndrome, urinary incontinence, as well as therapies for cancer.  Here are just a few of the meds that have become available that specifically impact women’s health:

Hormone therapyThere are several new forms of hormone replacement therapy (HRT).  Lower is now considered better and the FDA suggests that women who choose to use HRT use the lowest amount for the shortest time to reach their treatment goal.  For most women and their doctors, the goal is to treat their hot flashes, night sweats, and a sense of “ill-being” that can occur in the first few years of menopause.  The phamaceutical company that makes Prempro received approval for a low dose Prempro containing 0.45 milligrams of Premarin and 1.5 milligrams of the progestin MPA.  (The latter has been halved from the original Prempro.) An estrogen ring called Femring is now available for estrogen replacement therapy. The ring, which looks like a hollow diaphragm, is placed in the vagina and left for three months until it needs to be changed. It slowly secretes a moderately low dose of the same estrogen made by the ovaries (estradiol) at a rate of 0.05 milligrams daily.  But since it contains no progestin, a supplemental form of progestin has to be added for women who have not had a hysterectomy, in order to limit their risk of developing cancerous changes in the uterine lining. Many researchers and physicians feel that there are benefits to giving hormones in a non-oral form (i.e. not a pill).  If a hormone is slowly and consistently absorbed through the skin (or the vaginal lining), it does not go through “first bypass” in the liver, where it is metabolized and broken down.  This first bypass can increase clotting factors and heart-disease-causing fats (triglycerides).  A new patch, called Climara Pro, has just received FDA approval and will be available in January.  It combines a low amount of estradiol (0.045 milligrams) with a low dose of the progestin called levonogestrel (which has been extensively used in birth control pills).  This is one of the very simplest and perhaps physiologic ways to get an even steady dosing of HRT, requiring just a skin patch change once a week.  For women of reproductive age who have severe cramps, headaches, or a sense of ill being when they get their period, Seasonale is now available as a three-tiered birth control pill pack that gives eighty-four days of active pills, followed by seven days of placebo (inactive pill).  Withdrawal bleeding occurs once the placebo pills are taken, just four times a year. ( This can also be accomplished with other birth control pills simply by taking the active pills of three packs consecutively.)

For osteoporosis
Finally, I want to mention a medication that was approved last year for women and men with severe osteoporosis who are at very high risk for osteoporotic fracture or who have failed or are intolerant of previous osteoporosis therapy.  It’s called Forteo (teriparatide) and is a synthetic form of parathyroid hormone that is naturally found in the human body.  All other medications used to treat osteoporosis work by preventing “bone eating” cells from drilling cavities in the bone. Forteo actually encourages bone-building cells to lay down bone.  The drug is given via a daily injection under the skin with a disposable pen device that can be used for up to twenty-eight days.  It increases spinal bone mineral density in most patients by 5 to 10 percent in just three months.  After 19 months of therapy, it can reduce the risk of new vertebral fractures by 65 percent, and risk of non-spinal fractures in other parts of the body (hip, wrists, ribs ankle/foot etc.) by over 50 percent.  Forteo can be taken for up to twenty-four months.  At a cost of six hundred dollars a month, it’s expensive but certainly cheaper than prolonged hospitalization after disastrous fractures and the long term nursing home care that often follows.The above are just a few of my “favorite (medical) things” that may enhance our health in the New Year.  Have a happy and healthy holiday!