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After she fought so hard against breast cancer, Rosemary wasn’t about to just sign up for HRT as she went into menopause. She simply tolerated the menopausal symptoms she had as best she could, until they subsided after a couple years and she figured her hormonal troubles were over.

But when I sent her for a bone scan when she was in her mid-SOs, it showed she had osteoporosis. Fortunately, her NTX was 37, within the normal range, so her fracture risk was still manageably low. I prescribed Miacalcin and she started taking nutritional supplements, including calcium. After a year, however, her NTX levels were up to 57, putting her at higher risk for fracture and indicating an increasing rate of progression of bone loss. For Rosemary, Miacalcin wasn’t doing enough.

I had her hormone levels analyzed, and found her estrogen levels were very low. Because of her fear of a breast cancer relapse, Rosemary decided to add the estriol and ipriflavone to the Miacalcin. She felt comfortable with the natural estrogen since it does not increase the risk of breast cancer while still providing some of the benefits of synthetic estrogen. Since estriol has been less studied than other forms of estrogen, and it remains unproven that the bone benefits equal those of synthetic estrogen, Rosemary uses the ipriflavone—with its proven bone benefits—to ensure her bones are covered.

Rosemary pays attention to her diet, and is generally active. She considers herself a spiritual person, and copes with the many stresses in her life with regular meditation. But with her hormones finally in balance, she feels better than she has in a long time, and she now encourages her friends facing menopause to look carefully into alternatives for HRT. If a breast cancer survivor could find a regimen that suited her, she figures, anybody can.

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Inadequate amounts of even one mineral can have serious consequences. That’s why, for individuals with eating disorders, a complete nutritional workup is vital to address mineral needs. Treatment programs should always include concentrated sources of minerals, such as those found in sea vegetables, including dulse, kelp, sea palm, and nori. Such foods are excellent aids for overcoming malnutrition. For people not yet able to eat solid food, pieces of seaweed can be added to soup. Other sources of condensed minerals are the so-called superfoods, such as spirulina, blue-green algae, barley grass, and alfalfa. Just a small amount added to water or juice will replenish missing nutrients. These foods are easy for people with eating disorders to digest, and when taken with liquids they help to rehydrate the person, which is important because people with eating disorders often are dehydrated without realizing it. In addition, the superfoods are low in calories and therefore nonthreatening to the recovering individual.

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Skeletal muscle-Pain due to muscle spasm usually responds to diazepam or other benzodiazepine, although sedation may be troublesome. Non-benzodiazepine skeletal muscle relaxants may also be effective in relieving pain secondary to muscle spasm, although the relief of spasm may lead to reduced function. Baclofen (Lioresal) acts at a spinal level and often causes sedation. Dantrolene (Dantrium) which acts directly on muscle, causes less sedation but may be hepatotoxic.

Smooth muscle-Nifedipine, a calcium channel blocker, is reported to be effective in the treatment of rectal tenesmoid pain and pain due to oesophageal spasm.

Other drugs for bone pain-Bisphosphonates-The bisphosphonates are chemical analogues of pyrophosphate and inhibit bone resorption. They are used for the treatment of hypercalcaemia and metastatic bone disease. Following treatment with pamidronate (Aredia, APD) some patients with metastatic bone disease have less pain.

Radioisotopes-The systemic administration of strontium (89Sr) is effective in relieving pain due to bone metastases which show osteoblastic activity, although response takes two to four weeks. The side effects relate to bone marrow suppression.

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