(Dr. Isadore Rosenfeld's 1st visit to Power Surge)

Dearest:  My guest tonight is ISADORE ROSENFELD, M.D., widely recognized as one 
of this country's preeminent doctors. Dr. Rosenfeld is currently an attending 
physician at New York Hospital and Memorial Sloan Kettering Cancer Center and a 
Rossi Distinguished Clinical Professor of Medicine at New York Hospital/Cornell 
Medical Center.

Dr. Rosenfeld is health editor of Parade Magazine, medical consultant for Fox 
TV's popular program, Sunday House Calls. He was a member of The Practicing 
Physicians Advisory Council for the Secretary of Health and Human Services.

In addition to maintaining a private practice in Manhattan, Dr. Rosenfeld also 
served as a consultant to the NIH, he is the recipient of the first award for 
achievement in cardiovascular medicine in science by the New York affiliate of 
the American Heart Association and was named 'The Citizen of the World for 1999' 
by the United Nations.

Dr. Rosenfeld's consistent appearances on network television have garnered him a 
devoted nationwide following. Dr. Rosenfeld is one of the leading and most 
effective proponents in the education of the American public in medical matters. 
The author of seven New York Times bestsellers, his newest book is "Power To The 
Patient: The Treatments To Insist On When You're Sick." 

Welcome! It's an honor to have you as a guest in Power Surge, Dr. Rosenfeld. 


Dr. Isadore Rosenfeld:  Thank you 


Dearest:  Dr. Rosenfeld, Power Surge is a community for women at midlife and in 
menopause. Many of our mothers have lived long, healthy lives without hormone 
replacement therapy, without developing osteoporosis and/or heart disease. The 
results of many of today's studies on HRT contradict the original benefits 
proposed by the use of HRT. Would you kindly share your your wisdom regarding 
women and HRT. Thank you. 


Dr. Isadore Rosenfeld:  This a very good and timely question.  I must tell you I have 
lived through all the debates and discussions about HRT. 

For a long time and until quite recently most Doctors recommended estrogen 
replacement.  The reason being, that estrogen minimizes menopausal symptoms such 
as the hot flashes and even the emotional fluctuations that sometimes occurs. 

However since many women do not have such symptoms, or and if they do they are 
very mild, the main reason for using estrogen over the years has been protection 
against osteoporosis. And more recently heart attacks, strokes, and Alzheimers 
Disease. 

The down side has always been the danger of uterine cancer when estrogen was used 
without progestin. Cancer of the breast was also implicated. What has happened 
now is that the downside has remained intact. There has been more evidence that 
estrogen supplements may lead to breast cancer. 

However the most surprising findings have been that the alleged protection 
against heart disease and stroke has not materialized. In fact, there is evidence 
that vulnerable postmenopausal women may increase their risk of heart attack and 
stroke by taking estrogen. 

So, my recommendation at this time is to take estrogen supplements only if your 
menopausal symptoms are so unpleasant as to impair the quality of life. Take 
these supplements only as long as these symptoms persist.  Remember that there 
are other ways to protect your bones and that estrogen in themselves can produce 
side effects.


Dearest:  Thank you, Dr. Rosenfeld. Very informative answer. Let me just ask you 
one follow-up question -- your thoughts on soy isoflavones/phytoestrogens in 
treating menopausal symptoms, providing bone and heart health, et al. 


Dr. Isadore Rosenfeld:  Isoflavones, we think are beneficial, especially in the area of 
heart health.  The benefits of tea are largely believed to be due to isoflavones.  
As you know, Asian women are said to have fewer menopausal symptoms than western 
women.  They have less osteoporosis and fewer breast cancer that may be due to 
their consumption of soy. 


Dearest:  Thank you, Dr. Rosenfeld.   


JHKDaisy:  My 86 year old Grandmother in Richmond VA suffers from Neuropathy. She 
does not have diabetes. Do you know of a Richmond, VA specialist she can contact 
or any books/literature that she can read to find alternative treatments? Thank 
you.


Dr. Isadore Rosenfeld:  Peripheal Neuropathy for the benefit of the others in the room, 
is a physical disorder of the nerves and causes such symptoms as numbness, 
tingling, and pain in the extremities. 

Diabetes is one of the commonest causes but, others include tobacco, alcohol, and 
cerebral vascular disease, as well as diseases of the spine such as disk disease 
and arthritis in which the nerves are affected. 

Your grandmother should have a careful neurological exam.  She should abstain 
from alcohol and if she still smokes she should have blood tests to rule out any 
vitamin deficiencies such as folic acid and B12.  Before considering any 
treatment it is always best to have a diagnosis. 

Don't look for alternative therapies until all the conventional ones are 
exhausted. I feel very strongly that some alternative medicines are useful.  I 
wrote a book about it, but I feel equally strongly that they should be used 
together with and not instead of, conventional treatments.  That is why the term 
alternative medicine is not used as much as it used to be and has been replaced 
complimentary or integrated medicine. 


Cindy:  Two years ago my Dr. checked my FSH level and it was 290. My Dr. said she 
had never seen a level that high before. I was 39 at that time and I had an MRI 
on my pituitary, which was normal. Should I be concerned about the high FSH? And 
what could be the cause other than menopause? 


Dr. Isadore Rosenfeld:  Well, the first thing that I would do is repeat the test. I hope 
that this was number was repeated more than once.  Never accept a way out finding 
based on one reading alone. 

In order to interpret such a value, if indeed it is correct, one would have to 
the results of all the other related hormones that interact with FSH. 


Dearest:  FSH = follicle stimulating hormone,  Dustie, go ahead, please. 


Dustie:  I just had a period after not having one for 6 months is that normal I 
am 53 Thank-you


Dr. Isadore Rosenfeld:  It in not usual but it can happen.  You know that menopause is 
not an abrupt phenomenon.  There is a phase called perimenopause in which the 
periods are irregular and come and go. 

The definition of menopause is the absence of periods for a full year. So if you 
haven't had one for six months than you are still in perimenopause and not by 
definition in menopause.  Remember, to qualify for the diagnosis of menopause you 
have missed your period for twelve consecutive months. 


Ry:  If I have used fossomax for 2 years to help with osteoporosis, but it has 
not helped. I also use natural hormone cream. I am told that using hormone 
treatment under the tongue with testosterone and estrogen and progesterone is 
helpful. Is there in research on this?


Dr. Isadore Rosenfeld:  There are so many ways to treat to osteoporosis.  Fosomax is only 
one.  There is Actonel, there are various calitonin, Didronel, Evista, as well as 
the testosterone combination you described.   Exercise is also important and make 
sure you are getting in enough calcium in your diet. 


Dearest:  Today's patient is more educated than years ago. However, many women 
passing through Power Surge say their doctors become annoyed -- are actually 
intimidated by patients who are knowledgeable about medication, side effects, 
and their health in general. Why should that be? I would imagine it could be 
enormously helpful to doctors to deal with an informed patient. 


Dr. Isadore Rosenfeld:  You are absolutely right.  I can only speak for myself and the 
doctors I know.  It is much easier to help a patient who is intelligent and 
informed. Most doctors, especially in this era of litigation, want to share 
responsibility in treating patients with the patients themselves.  When a doctor 
is a patient himself, he gets the best medical exam because the doctor who is 
doing it, knows that the patient can judge whether he is being well taken care 
of. 

In this era of managed health care where you are never sure whether you are 
getting the best treatment rather than the cheapest, it is extremely important to 
know all you can about your own health.  That is why I wrote my book, Power to
the Patient to provide that power to the patient. 


Dearest:  Thank you, Dr. Rosenfeld. 


Redhead:  Does taking testosterone contribute to insulin resistance in post 
menopausal women?


Dr. Isadore Rosenfeld:  I have not heard that this is so.  Testosterone is being used 
more and more in women to improve their libido postmenopausal.  Make sure that 
you don't get too much.  Shaving is expensive.


Dearest:  Dr. Rosenfeld, what about DHEA then - doesn't it convert to 
testosterone in the body and it's sold over the counter everywhere. 


Dr. Isadore Rosenfeld:  As Sadam Hussein would have said, DHEA is the mother of all 
hormones!  Because it is the forerunner of both testosterone and estrogen.  That 
is the reason I don't prescribe to men.  Because there has been some work showing 
that testosterone may play a role in the development of prostate cancer. 


Arline:  I have been on FEMHRT 1mg/5mcg for 3 weeks now.3 days into the 
medication I was having lots of cramping, bleeding for 13 days and pain in the 
lower abdomen.  When I called the Dr office I was told it takes about 3 months 
for your body to get used to things.  I would like to stop taking femhrt,I was 
told that I could stop cold turkey is this true and should I call the Dr and tell 
her I no longer wish to take it. Thank you 


Dr. Isadore Rosenfeld:  I can't answer that question because I don't know much about you 
as a patient.  My philosophy is that no patient should be taking a medication that 
produces intolerable side effects. 


WildFlowers:  By estrogen supplements..are you referring to synthetic supplements? 
As in HRT, prescriptions from doctors. But I believe you answered my question 
with Dearest's question. Thank you. 


Hippieheron:  I have been eating yogurt for breakfast every morning. Will adding 
foods high in calcium or taking a calcium supplement help me to prevent 
osteoporosis? Is soy a better alternative to yogurt or calcium supplements?


Dr. Isadore Rosenfeld:  I think supplements like calcium citrate are most effective but 
calcium supplements and soy are not mutually exclusive. 


Dearest:  Many people use vitamins, herbs and various forms of alternative 
medicine. Some think if 200 IU's of vitamin E is helpful, why not buy the 1,000 
IU's on sale at their local health food store. My understanding is that vitamin E 
has the potential to cause elevated blood pressure, especially in those 
predisposed to hypertension. So, more is not always better. Don't we need to 
remember that even many "natural" remedies, if not taken properly, can cause 
toxicity, illness and even worse?


Dr. Isadore Rosenfeld:  You sound like one of my medical students.  That is a very 
intelligent question.  More is not necessarily better and remember this in every 
medicine, (and herb) there is a little poison.  Vitamin E in large doses can not 
only raise blood pressure in vulnerable individuals, it can also cause cardiac 
rhythm disturbances and interfere with any blood thinners you are taking. 


Cynda:  If you have severe PMS and alot of symptoms during perimenopause, are the 
symptoms likely to worsen if you experience surgical menopause and natural 
menopause? 


Dr. Isadore Rosenfeld:  The symptoms following surgical menopause are not only generally 
earlier, but also more severe than natural menopause because when you enter 
natural menopause the ovaries are still producing some estrogen although much 
much less than they did premenopausally. 

When you remove the ovaries surgically there is no estrogen and so the symptoms 
of deprivation are apt to be more marked. 


AthenaI:  Dr. Rosenfeld, I read that there are so many vitamins, minerals, 
antioxidants etc. used for slowing down the aging process, both physical and 
cognitive. Is that an absolute necessity if I am taking bio-identical HRT and a 
healthy food intake? 


Dr. Isadore Rosenfeld:  I would say that if your nutrition is adequate there is no 
substance that I am aware that measurably slows down the aging process. 


Debrikkia:  Does your recommendation for not taking estrogen supplements unless 
needed, apply to women who have had total hysterectomies as well as those who are 
going through a "natural" transition? 


Dr. Isadore Rosenfeld:  Women who have had total hysterectomies usually require some 
estrogen replacement. 


MaryO:  One of our UK members couldn't attend the chat because of the time 
difference. She wanted to ask what she could eat to relieve the discomfort of 
symptoms from MVP. She knows she should cut out sugars but would like to know 
what carbohydrates should be cut out. Thanks :) 


Dearest:  MVP = mitral valve prolapse 


Dr. Isadore Rosenfeld:  I am not aware that sugars have any impact on the symptoms of 
MVP. Symptoms are generally controlled by beta blockers and anti-anxiety 
medications. Carbohydrates do not play a role in the symptomatology. 


Eileen:  I had a hysterectomy (uterus only)at 31 years old. Is there any medical 
reason why I would need estrogen replacement now, at menopause? 


Dr. Isadore Rosenfeld:  No 


HSpec:  I am a diabetic. I have noticed that since I have started missing periods 
I have a difficult time regulating my blood sugar even though my diet and 
exercise routines have remained the same.(I am on no medication) Once I get a 
period my numbers return to normal. What is the relationship between diabetes and 
perimenopause? Thank you for your time and help.


Dr. Isadore Rosenfeld:  Frankly I am not aware of any such relationship.  I will look 
into it.  I am not aware of relationship of menses and diabetes. 


Dearest:  Dr. Rosenfeld, thank you for joining us tonight in Power Surge. Your 
book, "Power To The Patient: The Treatments To Insist On When You're Sick" is a 
must-read for everyone who wants to take control of his/her health. Everyone 
joins me in thanking you for a most informative and stimulating evening. 


Dr. Isadore Rosenfeld: Thank you.



Read Dr. Isadore Rosenfeld's second transcript




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