Several types and forms of estrogen are available (with and without several varieties of progestins or progesterone), in a variety of doses. There are no hard-and-fast rules about which way of taking estrogen is right for who, and you may have to experiment a bit to figure out what works best for you. Your needs may change as time goes on; what works, say, during your transition to menopause may not be the best thing for you a few years later, when a much smaller dose will probably do.Estrogen comes in pills, patches, creams, and now even a ring that is placed inside the vagina. It can be synthetic or natural. Different forms may help some problems and symptoms more effectively than others. Pills and patches have FDA approval for osteoporosis prevention (give appropriate dosages— see below), but creams and the ring are localized and come in extremely low doses, so they are more targeted to specific issues and won’t benefit bones as much. For that same reason, they are less likely to increase your risk of breast cancer. That won’t do your bones any good, but may still allow you to relieve some menopausal symptoms.Another of the twists and turns on the road to making decisions about using estrogen is that the more you take and the longer you take it, the more your risk of breast cancer goes up. The trick is to get enough estrogen to receive the benefits, but not so much that side effects become too risky or too unpleasant. For protection of bone in the hip and spine, the standard daily dose is .625 mg of “conjugated estrogen” (the kind made from horse urine, brand name Premarin), which is the most common prescription. For “micronized estradiol” (pill form, brand name Es-trace) the usual dose is .5-2 mg, which is proven to protect the spine, with less clear results at the hip. For estradiol in a patch(brand name Climara, Estraderm, Vivelle), .05-1 mg daily is the usual dose and is protective of both the back and hip. And 0.625 mg a day of estrone sulfate protects the spine but not necessarily the hip. Estropipate (Ogen and Ortho-Est) requires .625-3 mg to work in the vertebrae, but 1.25 mg to help in the hip. Ethinyl estradiol (Estinyl) is usually prescribed at .03-. 1 mg a day for the spine, and “esterified estrogens” (Estratab) at .3-2.5 mg, though in both cases the results at the hip are unknown.Heavy women may be able to use smaller doses because estrogen is made and stored in body fat, so their own supplies may be higher. Thin women and smokers, on the other hand, may need higher doses to realize all the benefits to their bones. Smokers should try the patches, as transdermal estrogen may be more effective for them than pills.Take the smallest doses that work for you in order to limit side effects large and small. Taking calcium supplements will help you reap the full benefits of HRT even at lower doses. We know low doses can help your bones in part because of the effects on bone density seen in patients who have taken oral contraceptives for years. Birth control pills are estrogen based and use much smaller amounts than HRT. Even so, women get increased bone density as a side benefit.No matter what hormones you are taking (or not taking), you should be following the other guidelines in this book to maximize the benefits and minimize any risks. Be sure to get enough calcium, magnesium, and vitamin D, as well as all the other nutrients described in Chapter 8, so your bones have enough of what they need to create healthy bone even as the rate of loss is slowing. Women taking (and absorbing) calcium and other supplements may be able to use half the dose of estrogen and still get the full benefit. That’s good news for anyone who experiences side effects from the hormones (and might not at lower doses), and may also lessen the increase (if any) in breast cancer risk.*137\228\2*
” I don’t want to be part of a group. I don’t need them, and I don’t need to hear about someone else’s problems. I have enough of my own.”We often hear this statement from parents. Or else one parent will say, “I’d like to go, but my husband (wife) won’t have anything to do with it.” Groups are generally helpful, but some people are just not ready to join a group at a particular time in their lives. Some people are embarrassed to talk about their feelings or problems in public. But you are not the only one who has had to deal with such problems. Hearing how other parents have coped is often far more helpful than hearing similar advice from your physician. Parents choose different words, have a different tone to what they say. And they have “lived” it, not just learned about it. Talking about your problems can help put them in perspective.If you feel you do not need a group, or feel that you can’t cope with counseling just now, reconsider it later. Remember: If you have adjusted so well that you can’t use any help, perhaps you have a responsibility to join a group so that you can help someone else.Children who have both cerebral palsy and/or mental retardation as well as epilepsy need considerable support. And so do their families. The combination of these disabilities may seem overwhelming, but remember you are not alone. There are many organizations to help you and available services. Every child, regardless of disability, is entitled to an appropriate education, for example. Handicapped children are eligible to receive services as soon as their handicaps have been identified, at whatever age. Ask your doctor, your school system, or your local health department about these services. You don’t have to wait until your child is old enough for school.For the child who has cerebral palsy, and for the parent of that child, United Cerebral Palsy (UCP) provides excellent support services with appropriate guidance and advice. The Association for Retarded Citizens (ARC) can provide similar services for the retarded child and his family. Parents’ groups sponsored by these organizations talk about managing mental retardation or coping with cerebral palsy. They don’t talk about seizures. Yet for parents of children who have intractable seizures, and where mental retardation and cerebral palsy frequently co-exist, the focus is often on seizures: “If only the seizures were controlled, it would be easier to deal with the other problems.” *207\208\8*
Despite all these remarkable and interesting anemias, the one chief reason for a lack of blood is bleeding, whether by a sudden great hemorrhage or by steady day-by-day little losses. Of course all of us bleed at times and, were it not for the remarkable phenomenon of blood clotting, we could not exist; for we are bound to have injuries. The manner in which blood does clot is very complex, various different substances taking part and a whole series of intricate changes being involved.There are unfortunate people who are born with some lack of these substances; at least the above changes cannot take place in their blood. We say they have hemophilia. This is a remarkable disease which was recognized almost as far back as biblical times and was clearly described nearly a century and a half ago. Because of its spectacular characteristics and the fact that some of the royal families of Europe have been afflicted with it, the general public is fairly well acquainted with its chief characteristic, which is a lifelong tendency to prolonged hemorrhage in affected males.If a man is a hemophiliac, all his sons are normal and cannot pass on the defect to any of their descendants. None of his daughters will be “bleeders,” but half of them may pass on the disease to half their sons. Likewise the same proportion of granddaughters may be “conductors” of the trouble.Naturally all affected male children of such stock must be protected against wounds and abrasions. Transfusions of whole blood or plasma increase the speed of clotting. Even such small amounts as thirty to forty cubic centimeters of blood have been found to help when hemorrhage occurs. The results are not long lasting but the treatment may be repeated as often as necessary.It has been said that hemophiliacs improve when manhood is reached. Probably the answer is that (1) the most severe cases die in early life, (2) the teething period is passed, (3) more discretion and less activity result in fewer injuries.Little of value has been developed for prevention or treatment of this affliction. Theoretically the disease could be eliminated if all the children in such families, except the un-afflicted males, would refrain from marriage or at least from propagation. Of course if we could get such cooperation as this we would put an end to nearly all human ills.During the recent war a group of workers under Edwin J. Cohn, Ph.D., extracted from the blood a large number of different substances known as plasma fractions, with varying and remarkable functions. One of these, globulin fraction, hurries up the coagulation of blood and a portion of a teaspoonful of this is almost as potent in stopping bleeding as a small cupful of whole blood. It is thought likely that even more potent fractions will be obtained and furnish some further protection to these unfortunate “bleeders.”*15/276/5*
