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HRT - dementia - NP - the role of KI Xu?

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Hi All, & Hi Will,

 

Will Morris wrote:

> Estrogen-progesterone combination shown to increase dementia. Has

> anyone identified a correlation between neuropsych findings and

> presenile dementia? Will

 

Interesting stuff, Will. Would you [or other Listers] care to discuss

your ideas on the roots of post-menopausal problems from the

viewpoint of TCM Patterns, and their Tx?

 

I am seeing a lot of what I read as " KI Xu " S & Ss in people,

especially women, >60 now. This evening, a school-friend (female,

aged 61) came for help with the following S & Ss: severe right

shoulder pain - typical " frozen shoulder with inability to raise arms

above elbow height.

 

Her right shoulder joint is clearly enlarged and slightly warm

(relative to the left). It is very sensitive to light pressure directly on

the joint, and ant-post. Passive movement causes little pain, but

active movement above elbow-height is very painful. She has no

detectable trigger points in the neck, shoulder, scapular, forearm or

pectoral muscle area. area.

 

She has three healthy, happy children, aged 24-35, and a history of

chronic arthralgia (lowback, hips, shoulders, wrists and fingers),

with definite tendency to humped back. She is a " sun worshipper " ,

well tanned, but aged way beyond her years. Her face and skin are

wrinkled unbelievably and her comportment is that of a woman of

80.

 

She has her uterus intact (rare amongst my Irish female friends of

her age!) but complains of dryness everywhere (mouth, vagina, and

skin). She also complains of a dry sensation in her thorax/upper

abdomen, but I cannot figure out exactly what she means by that.

 

Her mother, now about 91, has severe osteoporosis, multiple joint

pain and very humped back, but her mind is razor-sharp. She is a

difficult woman and my friend becomes very stressed and hyper

when her mother comes to stay for a few days. They " fight " and

argue a lot - both were/are very strong-minded women because

both are perfectionists but disagree on the details.

 

My friend complains of feeling COLD (she has definite Cold

Aversion and has been on HRT (hormones unspecified)). She has

intermittent ankle oedema, but does not have to get up to urinate at

night. Without specific questioning on the issue, I gather (mainly

from her husband) that they still have a very active sexual life (and

had since their marriage, > 30 years ago).

 

She is a nurse, off work now because she cannot lift her patients,

and is pragmatic and practical about basic bodily functions.

 

Her mind is definitely regressing - she slurs some words, repeats

herself a lot, forgets common things and words, and often cannot

find the appropriate words in routine conversation.

 

She had been a VERY heavy smoker (60-80 cigs/d) but stopped

smoking about 10 years ago. She also had a severe alcohol

problem, but quit drinking on medical advice, about 10 years ago

also. She has a wheeze [and had it since her smoking days], and

gets easily breathless but has no known cardiovascular problems

or headaches. Gastrointestinal and urinary Fxs are nomal.

 

Her pupils are blue-green and she likes/wears greens and reds a

lot.

 

Ignoring her past LV and LU problems past [and ignoring the fact

that one of her brothers is severely diabetic)] I read her " root

problem " as KI Xu with Cold, complicated with Hot Bony Bi and Qi-

Xue Stasis in the right shoulder area. The shoulder Bi/Obstruction

has become worse since her mother came to stay some days ago.

 

I started treatment tonight with simple AP at KI07, SP06, BL23 for

that, plus GB34, LV03, LI15, GB21, GB20 and TH05 for the right

shoulder [the most acute sign at the moment]. I have advised her

to take high doses of Cod Liver Oil, to exercise her lowback area,

to take great care to keep her KI area warm, and to have massage

of the neck/shoulder/sacpular area with MOOV (Ayurvedic deep-

heat rub) before bed every night. Her husband has great hands [is a

" natural " masseur,and that contact may have added benefits for

both of them!

 

I am not confident enough yet to prescribe herbs for her [i am still

studying CHM and it will be several years before I will attempt to

use CHM]. Anyway, because of very tight regulations by the Drugs

Board, it is very difficult to acquire and legally use CHM in Ireland.

 

Any ideas on other useful Tx for my friend?

 

Best regards,

Phil

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

 

Will Morris posted:

> JAMA. 2003 May 28;289(20):2651-62. Estrogen plus progestin and the

> incidence of dementia and mild cognitive impairment in

> postmenopausal women: the Women's Health Initiative Memory Study: a

> randomized controlled trial. Shumaker SA, Legault C, Thal L,

> Wallace RB, Ockene JK, Hendrix SL, Jones BN 3rd, Assaf AR, Jackson

> RD, Kotchen JM, Wassertheil-Smoller S, Wactawski-Wende J; WHIMS

> Investigators. Department of Public Health Sciences, Wake Forest

> University Health Sciences, Winston-Salem, NC 27104, USA.

> sshumake CONTEXT: Postmenopausal women have a greater

> risk than men of developing Alzheimer disease, but studies of the

> effects of estrogen therapy on Alzheimer disease have been

> inconsistent. On July 8, 2002, the study drugs, estrogen plus

> progestin, in the Women's Health Initiative (WHI) trial were

> discontinued because of certain increased health risks in women

> receiving combined hormone therapy. OBJECTIVE: To evaluate the

> effect of estrogen plus progestin on the incidence of dementia and

> mild cognitive impairment compared with placebo. DESIGN, SETTING,

> AND PARTICIPANTS: The Women's Health Initiative Memory Study

> (WHIMS), a randomized, double-blind, placebo-controlled clinical

> trial, began enrolling participants from the Women's Health

> Initiative (WHI) estrogen plus progestin trial in May 1996. Of the

> 4894 eligible participants of the WHI study, 4532 (92.6%)

> postmenopausal women free of probable dementia, aged 65 years or

> older, and recruited from 39 of 40 WHI clinical centers were

> enrolled in the WHIMS. INTERVENTION: Participants received either 1

> daily tablet of 0.625 mg of conjugated equine estrogen plus 2.5 mg

> of medroxyprogesterone acetate (n = 2229), or a matching placebo (n

> = 2303). MAIN OUTCOME MEASURES: Incidence of probable dementia

> (primary outcome) and mild cognitive impairment (secondary outcome)

> were identified through a structured clinical assessment. RESULTS:

> The mean (SD) time between the date of randomization into WHI and

> the last Modified Mini-Mental State Examination (3MSE) for all

> WHIMS participants was 4.05 (1.19) years. Overall, 61 women were

> diagnosed with probable dementia, 40 (66%) in the estrogen plus

> progestin group compared with 21 (34%) in the placebo group. The

> hazard ratio (HR) for probable dementia was 2.05 (95% confidence

> interval [CI], 1.21-3.48; 45 vs 22 per 10 000 person-years; P

> =.01). This increased risk would result in an additional 23 cases

> of dementia per 10 000 women per year. Alzheimer disease was the

> most common classification of dementia in both study groups.

> Treatment effects on mild cognitive impairment did not differ

> between groups (HR, 1.07; 95% CI, 0.74-1.55; 63 vs 59 cases per 10

> 000 person-years; P =.72). CONCLUSIONS: Estrogen plus progestin

> therapy increased the risk for probable dementia in postmenopausal

> women aged 65 years or older. In addition, estrogen plus progestin

> therapy did not prevent mild cognitive impairment in these women.

> These findings, coupled with previously reported WHI data, support

> the conclusion that the risks of estrogen plus progestin outweigh

> the benefits.

 

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

 

 

Best regards,

 

 

WORK : Teagasc Staff Development Unit, Sandymount Ave., Dublin 4, Ireland

WWW :

Email: <

Tel : 353-; [in the Republic: 0]

 

HOME : 1 Esker Lawns, Lucan, Dublin, Ireland

WWW : http://homepage.eircom.net/~progers/searchap.htm

Email: <

Tel : 353-; [in the Republic: 0]

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