As an
Ob/Gyn with Kaiser Permanente, I feel compelled to respond to statements
in the Summer 2000, Volume 4, No. 3 issue of The Permanente Journal,
in the article entitled "Proposed Care Management for Women with
Estrogen Deficiency: Identification, Risk Stratification, Treatment."
In this article, Dr Tuso states "For women with a uterus, these
regimens commonly prescribe 0.625 mg equine estrogen taken orally every
day with daily or cycled medroxyprogesterone at a dosage of 5 mg to
10 mg per day." Today the use of continuous combined (25 days per
month or every day) is with 2.5 mg of medroxyprogesterone acetate.
Dr Tuso
also states that "Hormone replacement is contraindicated in women
who have a history of ... uterine cancer ...." Uterine cancer is
usually broken down into cervical (no estrogen effect) and endometrial
(associated with unopposed estrogen). Today there are many gynecologists
who are prescribing estrogen to selected patients who have had cancer.
Arthur
Fleisher, MD, Ob/Gyn
Kaiser Permanente, Panorama City, CA
I agree
completely with Dr Fleisher's comments.
Philip
Tuso, MD
Kaiser Permanente, Lancaster, CA
I just
ran across an article on fat embolism from the Spring 1998 issue of
The Permanante Journal (http://www.kaiserpermanente.org/medicine/
permjournal/spring98pj/perspective.html) with comments by Jerry
L. Schilz, MD: Kaiser Permanente Medicine 50 Years Ago: Fat Embolism
By A. Bernard Gray, MD; Nathan Meadoff, MD.
Dr Nathan
Meadoff was my father. It was such a surprise to run across this article,
something only possible now courtesy of the Internet and my curiosity.
I am an Emergency Physician, but started medical school a month after
my father's fatal MI (1967). Reading this article is the closest to
professional interchange I've ever had with my father. What a thrill!
Thanks.
Thomas
Meadoff, MD
