Can you list here, a source showing that local estrogen doesn't promote breast cancer? I need to teach my new Gyn... (I have a hx of ADH, excised, so she gave me Rx lasting only till my next mammogm...).
Very helpful to learn about the various phases of drug testing. Do you know if certain people tend to have more sensitive liver responses than others and what might cause that?
Thanks so much Dr. Gunter. You are definitely right on the doctor follow up - but I also know that many doctors are so overloaded. But perhaps the bigger concern is if the patient will do the follow up and get the lab tests done as prescribed. I appreciate your expertise, as always!
Dr. Gunter - I shared a summary of your blog on this topic on LinkedIn. I received this comment from an OBGYN “ Liver damage is a big concern for my patients and when they heard how frequent the liver tests needed to be before now, most were adamant about not considering the drug. Also, how are busy providers supposed to keep up monitoring at such frequent intervals? Patients will forget to go, refuse to go and once on the med with normal LFT during month 1 and 2 will not understand continued risk and how it applies to them. Also, to continue informed consent and monitoring may require more office visits and cost to patient. Venlafaxine seems to be a much better choice in the non hormonal arena for treatment.”
Here was my response: “Eve Ashby DO FACOOG Thanks for sharing your experience with patients and this very practical perspective. Yes, repeating these liver tests is a major inconvenience and cost that many might want to forego or continue. The only pushback I have on venlafaxine is that many women want to avoid antidepressants (other side effects and it can be challenging to get off the medication) and there are many for which this medication does not alleviate hot flashes. Hopefully Bayer’s elinzanetant, assuming it is approved by the FDA, will provide another option.”
It sounds like that person isn't a very experienced doctor. The idea that providers can't arrange and follow up on labs means that I guess she has never cared for a pregnant person. Many people need multiple labs for many reasons. And it's our job to explain these things. What a narrow scope of practice. I don't think much of the reply at all!
Can you list here, a source showing that local estrogen doesn't promote breast cancer? I need to teach my new Gyn... (I have a hx of ADH, excised, so she gave me Rx lasting only till my next mammogm...).
Very helpful to learn about the various phases of drug testing. Do you know if certain people tend to have more sensitive liver responses than others and what might cause that?
Thanks so much Dr. Gunter. You are definitely right on the doctor follow up - but I also know that many doctors are so overloaded. But perhaps the bigger concern is if the patient will do the follow up and get the lab tests done as prescribed. I appreciate your expertise, as always!
Dr. Gunter - I shared a summary of your blog on this topic on LinkedIn. I received this comment from an OBGYN “ Liver damage is a big concern for my patients and when they heard how frequent the liver tests needed to be before now, most were adamant about not considering the drug. Also, how are busy providers supposed to keep up monitoring at such frequent intervals? Patients will forget to go, refuse to go and once on the med with normal LFT during month 1 and 2 will not understand continued risk and how it applies to them. Also, to continue informed consent and monitoring may require more office visits and cost to patient. Venlafaxine seems to be a much better choice in the non hormonal arena for treatment.”
Here was my response: “Eve Ashby DO FACOOG Thanks for sharing your experience with patients and this very practical perspective. Yes, repeating these liver tests is a major inconvenience and cost that many might want to forego or continue. The only pushback I have on venlafaxine is that many women want to avoid antidepressants (other side effects and it can be challenging to get off the medication) and there are many for which this medication does not alleviate hot flashes. Hopefully Bayer’s elinzanetant, assuming it is approved by the FDA, will provide another option.”
What are your thoughts?
It sounds like that person isn't a very experienced doctor. The idea that providers can't arrange and follow up on labs means that I guess she has never cared for a pregnant person. Many people need multiple labs for many reasons. And it's our job to explain these things. What a narrow scope of practice. I don't think much of the reply at all!