People’s Pharmacy: Doctor fired patient after HRT fight

Q: I was listening to your podcast and heard you talk about a woman whose doctor “fired” her as a patient because she decided not to continue hormone replacement therapy.

I, too, was fired by my wonderful OB/GYN about 15 years ago (early post-menopause). He said it was time to discuss HRT, and I told him I’d been considering it. Since I didn’t have familial risk factors that would benefit from preventive HRT therapy, I did not think it was right for me.

He became incensed because I was questioning his professional opinion and essentially kicked me out. I apologized for offending him. I did not dispute his professional opinion, but I did not think HRT was right for me. He still refused to see me any longer.

A: Many physicians used to believe that HRT was essential to keep women healthy after menopause. The Women’s Health Initiative study shocked the medical world by showing that the risks of HRT exceeded the benefits (JAMA, July 17, 2002). In addition to a slightly higher risk for heart disease, women taking hormones were a bit more likely to get breast cancer. That is why the U.S. Preventive Services Task Force now recommends against the use of HRT to prevent chronic conditions such as heart disease after menopause (Annals of Internal Medicine, Jan. 1, 2013).

The most disturbing part of your story is not that your doctor mistakenly believed that HRT would benefit you, but rather that he refused to respect your decision.

Q: I have found that Lactaid provides relief after years of suffering. Since I have milk in the morning, yogurt at lunch and ice cream at dinner (all fat-free or low-fat), my lactose intolerance was causing me problems.

If I have learned anything from reading your column, taking any medication or supplement for a long time might not be good for the body. Are there any long-term impacts I should be aware of?

A: People who lack the enzyme lactase cannot tolerate the sugar in milk, lactose. They frequently have symptoms such as bloating, abdominal cramps, flatulence and diarrhea after consuming dairy products.

Lactaid and comparable formulations contain lactase, the enzyme that breaks down milk sugar. In most cases, taking lactase will control symptoms of lactose intolerance without long-term complications.

Q: My doctor just prescribed metoprolol to control migraines and slightly elevated blood pressure at the same time. At 49, I have been trying to control my BP for more than a year through diet and exercise. It remains just slightly too high for everyone’s comfort, and seems to spike when I take sumatriptan for migraine.

I am concerned about metoprolol. Is it safe, and will it really help me with both migraine and BP? I really do not want to take a drug on a daily basis.

A: The migraine medicine sumatriptan can increase blood pressure, sometimes to a dangerous level. Metoprolol can help reduce the frequency of migraines. It is no longer considered a first-line treatment for high blood pressure, however.

We are sending you our Guide to Blood Pressure Treatment so you will have more information on metoprolol and nondrug approaches to controlling hypertension. Anyone who would like a copy, please send $3 in check or money order with a long (No. 10), stamped (70 cents), self-addressed envelope to: Graedons’ People’s Pharmacy, No. B-67, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our website: www.peoplespharmacy.com.

Side effects of metoprolol include dizziness, tiredness, shortness of breath, slow heart rate and diarrhea.