June 12, 2003

Q: I have been on hormone replacement therapy for close to five years. I am ready to get off it. I take it for my bones. What are the alternatives? I exercise regularly.

A: Most likely you are taking Prempro, a tablet that contains both estrogen and progesterone. The progesterone, another female hormone, prevents uterine cancer, which sometimes occurs when only estrogen is taken. It is the combination drug that is associated with a slight increase in breast cancer.

Doctors are studying the effect of a low dose of an estrogen-only tablet to see if it has a cancer risk. The answer will come in the near future.

Exercise is keeping your bones healthy. Continue it, and increase the time spent doing it and the intensity.

Don’t neglect calcium and vitamin D. Vitamin D is most important for people living in the North, where time spent in the sun is close to nonexistent during winter. Sunlight converts chemical compounds naturally found in the skin into vitamin D. The recommended daily dose for vitamin D is 400-800 IU, and for calcium it is 1,200 to 1,500 mg.

Evista is a SERM medicine. “SERM” stands for “selective estrogen receptor modulator.” SERMs have some of estrogen’s properties without some of estrogen’s potential dangers. That’s why the “selective” word is in their family name. Evista protects bones from osteoporosis but does not foster cancer development in breasts.

A most important drug family is the bisphosphonates, whose members include Fosamax, Didronel and Actonel. They stop the accelerated loss of calcium from bones that the diminished production of estrogen gives rise to following menopause.

Q: After experiencing headaches, my sister was diagnosed with giant-cell arteritis. A biopsy proved the doctor was right. He immediately placed her on prednisone. The potential for blindness from the disease frightens my sister and the rest of the family. Will you please illuminate us on this problem?

A: To avoid reader confusion, the word here is “arteritis” (artery inflammation), not “arthritis” (joint inflammation).

Giant-cell arteritis, also called temporal arteritis, is an illness that comes on usually after 50 and often after 70. Headaches are its predominant symptom. The headache frequently strikes at the sides of the head — the temples — and often the artery in that location, the temporal artery, is tender when touched. A biopsy of a section of the temporal artery furnishes proof of inflammation.

Prompt administration of cortisone drugs — prednisone being the one most often used — begins to work quickly, and people start to feel better in a matter of days.

The most dreaded consequence of giant-cell arteritis is blindness, for the arteries that supply the eyes’ retinas often suffer the same inflammation that the temporal arteries do. Your sister is past the danger point. Her doctor put her on prednisone quickly, and that saves her sight.

If you would like to know the cause, so would all the medical world. In spite of decades looking for the cause, it remains hidden.

Q: Please explain the term “corpus callosum.” Is it genetic, lifestyle-induced or just one of those things that happen?

A: The corpus callosum is not an illness. It is a place in the brain that contains a bundle of nerve cables. We all have one.

If you can get the name for the illness that involves the corpus callosum, I will have a go at explaining it. —2003 North America Syndicate Inc.

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