The first question most patients as is: Do bioidentical hormones cause cancer? The answer is no. But many doctors and patients simply do not understand the difference between bioidentical and synthetic hormones. It is time they do.

It is now known that synthetic estrogens like Premarin and  progestins like Provera, increase the risk of breast cancer. Multiple studies have shown that natural estrogens and natural progesterone are protective against breast cancer as well as some other types of cancer. But mention that to traditional physicians and they will undoubtedly say that’s not true. Tell them to read the literature and take their heads out of the sand!!!

Most bioidentical estrogens contains estriol which is much safer than synthetic estrogen. Studies have shown that women with high estriol levels have a lower incidence of breast cancer. Not only that, but one study showed that when giving estriol to postmenopausal women with a history of breast cancer, some women demonstrated a halting of the cancer. In addition, many studies have shown that giving women estriol had a protective effect on breast cancer while synthetic estrogens were shown to increase breast cancer risk.

The same can be said of natural, bioidentical progesterone; it inhibits the growth of breast cancer cells. Synthetic progesterone has time after time been shown to increase the growth of breast cancer cells.

Now would be a good time to discuss the WHI or Women’s Health Initiative. The WHI studied synthetic Premarin and Provera. It concluded that the two hormones increased the risk of heart attack and stroke. As a result, millions of women went off the hormone replacement therapy and suffered and continued to suffer tremendously. Many of these women were not offered bioidentical hormones.

Provera has been shown to inhibit the heart protective benefits of estrogen and therefore increase the risk of heart disease. On the other hand, natural progesterone has also been shown to increase HDL or good cholesterol.

As mentioned in Part I of this series, synthetic hormones are significantly more potent than natural hormones. This goes to show that stronger is NOT necessarily better.

The take home message here? For women who want to try hormone replacement therapy- bioidentical is the way to go. Bear in mind that topical hormone replacement therapy is NOT the same as bioidentical. Many pharmaceutical companies have jumped on the bandwagon and are trying to cash in on bioidentical hormones. They are hoping that patients and doctors won’t know the difference. But these prescription creams are not tailored to the individiual and true bioidenticals do just that. So keep informed, read and question your physician about bioidentical and if he or she does not know about them, find one who does.

When should you seek medical attention for a sting: if at any time you develop hives all over your body(away from the sting site), or you are short of breath or wheezing; if you feel faint or feel confused- these are all signs of a general reaction which require immediate medical attention. This smartest move would be to go to your closest ER and tell them you’ve been stung. After assessing you, they should give you an injection of epinephrine(adrenalin) which in over 90% of the time will reverse the reaction. After you been stabilized and sent home, you should make an appointment with an allergist to find out if you are allergic to any bees, hornets or wasps. The testing is important because in people highly allergic to insect stings a future sting could be worse or fatal. There is proven allergy immunotherapy that does protect against insect stings.

My approach to find out what is causing the hives is a good history: I find out what you are eating and drinking and see if their are any potential allergens. I will ask any medications that you may be taking- any medication, an antibiotic or common pain reliever like aspirin or motrin can be a cause. And of course, I will try to see if you have had any unusual exposure by an environmental or contact allergen. After the history, I will usually do some form of testing either simple skin tests(which are like plastic toothpicks) or with a blood test to investigate for any internal problems. Finding the cause in chronic hives takes a good medical detective, and a good patient to give the clues.

Interesting case: Several years ago, a man in his 50’s came to me suffering terribly from chronic hives. He brought in a bagful of medicines that he was given by other doctors. He still wasn’t better. He was on cortisone pills and antihistamines, but still had daily hives. After a few visits, and carefully reviewing all his medicines I had the answer: he was taking aspirin for prevention of heart disease and I had him stop the aspirin and within a week the hives disappeared. The funny part was he was great for several years, when I got a phone call from him that the hives had come back- he was panic stricken. I carefully reviewed with him if anything was different. He mentioned his stomach was upset recently and he took Alka-seltzer for relief.

I asked him to check the ingredients on the Alka-seltzer- sure enough, it contained aspirin. My advice to him, next time he has stomache upset, choose Mylanta.

If you are concerned you can read more about this in my book, Dr.Dean Mitchell’s Allergy and Asthma Solution(Marlowe 2006). Meantime, if you feel good, just go out there and hit the road…..

What exactly are bioidentical hormones? They are hormones that have the exact same structure as the hormones made by the human body.Premarin, Provera and Prempro are synthetic hormones made by a pharmaceutical company. These are NOT exactly identical to the hormones made by the body because a drug company, by law, is not allowed to patent a bioidentical substance. Therefore, in order to get a patent and sell a substance, they must change its structure.

Many people question “why replace hormones that are supposed to decrease with age?” That is like saying why take care of our teeth. As we age, without proper dental hygiene, most people would lose their teeth. Modern medicine has allowed the aged to keep their teeth. So why not take hormones to offset some of the signs and symptoms of aging? Modern medicine has prolonged the human life. It makes sense to improve the QUALITY of that life.

As a result of patient demand, pharmaceutical companies have developed topical hormone replacement therapy. Most patients equate topical creams to being bioidentical. That is not true. These hormone replacement therapies are not individualized and the key to successfully using hormones is to treat the individual. Before taking any hormone replacement, it is important to take a series of blood tests that include estrogens, progesterone, testosterone (yes women need some!!), DHEA and pregnenolone. Once starting therapy, careful monitoring of bloods and symptoms allows the patient to be on the lowest dose required to alleviate symptoms.

The question most people ask is :are bioidentical hormones better than synthetic? Bioidentical hormones are better but they are still drugs. As we know, no drug is one hundred percent safe. However, bioidentical hormones are natural and mimic the body’s own rhythm. Synthetic hormones are much more potent and can have many more side effects.

Stay tuned: Part II- Bioidentical Hormones and Cancer

The over-the-counter antihistamines can be helpful, but they are definitely not as effective as prescription nasal sprays or prescription eye drops. The question I get from patients is: will this problem ever go away? Do I always have to be dependent on nasal sprays and medications to control my symptoms? There is a more natural and long-term solution to Hay fever problem, as well as other air-borne allergens- it’s called immunotherapy. If you are not sure what immunotherapy is, you probably recognize when someone with allergies says,” I go for allergy shots”. Allergy shots work but they can be painful and inconvenient- and sometimes dangerous. The good news is that you can now get that same benefit in a natural way by doing allergy drops. It’s fancy name is Sublingual allergy immunotherapy. It’s been done all over the world for two decades- mainly in Southern Europe,but also in Canada and England. I’ve been doing it in my office the past 12 years with very good success. Many of my patients need minimal or no medications while they are taking the natural drops under their tongue- and the better news is that even after stopping patients in most cases retain this immune protection. Why haven’t you heard more about this therapy? Well, in 2006, my book- Dr. Dean Mitchell’s Allergy and Asthma Solution tried to get it to the masses, but since Oprah or Dr. Oz hasn’t invited me on, the work lingers in semi-obscurity. But I have faith, that in the next two years this therapy will be widely available to allergy patients all over the country.

In the meantime, keep an eye on those pollen counts and have your medicine ready- don’t wait until your miserable. The best part of being an allergist/immunologist is that we can get people better- and keep suffering to a minimum, or get rid of it completely.

Yes, the stomach can cause a chronic cough. Many of you are familiar with the term, ” reflux”, and you see enough ads on TV for heartburn medications. However, interestingly, the patients with chronic cough that have reflux many times have no heartburn symptoms, like burning in the stomache area or chest tightness. These patients may have a form of  laryngeal reflux- meaning, the acid from the stomach flows back up the esophagus and irritates the layrnx(your voice box area). Sometimes, the only symptom a patient may have is constant throat clearing- it is very annoying to them and others.

To literally, put the “fire out of the belly” involves a few steps. First, dietary changes are critical. Unfortunately, if you like the heavy tomato sauces with pasta dishes- look out- this is a key culprit for reflux. If you  like having those few glasses of wine each night with dinner- beware, you will be coughing the rest of the night. There are other foods that may cause the reflux as well, and you find lists of foods on-line, but you should review this with your doctor or a nutrionist. Taking acid blocker medications may  give you temporary relief, but it’s best to try natural ways to reverse this condition, because many new studies are showing that these acid blocker medications have side-effects if used long-term: softening of the bones(osteoporosis), increased risk of infection(because the stomach acid doesn’t kill the bacteria in foods) and depletion of other paritally absorbed nutrients.

My other strong belief in reversing reflux is to use breathing exercises. Why breathing exercises? I learned from an excellent osteopath that the diaphram(the muscle in our abdomen that separates the chest from the stomach) if tense and in spasm squeezes the junction where the stomach and esophagus meet, and this is an anatomical cause of the reflux- usually from stress, but totally reversible. I discuss examples of these breathing exercises in my book, Dr. Dean Mitchell’s Allergy and Asthma Solution(Marlowe 2006) which are very helpful.

The classical signs of dark green sputum and a fever point to a bronchitis or pnuemonia; however, some infections like Mycoplasma pnuemonia, so called ” walking pneumonia”, typically have a high fever for just a day or two, but the hacking cough can last for weeks. I remember catching this infection after coming off a plane during a medical school break- I was coughing for weeks until I went to a physician who made the diagnosis and treated me with antibiotics- specifically the group of meds in the erythromycin class, which are more effective than penicillins for Mycoplasma.

The other category in the chest that can cause a chronic cough is bronchospasm. Patients that have increased bronchial reactivity(meaning their lungs “twitch” very easily to allergens and infections) often present with a chronic cough. As an NYC allergist/asthma specialist I have special breathing tests that allow me to assess the nature of the cough and it’s effect on the lungs. I do in my office a test called the Nioxmino, which is a simple breath test(you just blow into a small device) and it gives me a reading of the nitrous oxide in your breath. This simple and safe test can show if you have evidence of allergic inflammation in your lungs. I frequently see patients that have cats and dogs or rabbits in their homes and if they are allergic to them and have a cough I usually see a high nitrous oxide level. This can be easily treated with a mild cortisone inhaler, and stops me from thinking the patient has an infection and needs antibiotics.

A good patient definition of a chronic cough is when your family, friends or loved ones strongly recommend you see a doctor about your cough. A cough is not usually deadly, but it is annoying and exhausting to the patients who can’t seem to shake it. This time of year it’s unusual for an infection to be the main cause of a chronic cough. The reason being: less crowding on subways and buses, people are outdoor more.

My job, as an NYC Allergist, is to explain to new patients with a chronic cough what is the underlying cause for their cough, so we can treat the problem and not just suppress the symptom itself. I sometimes see, unfortunately, a physician will use codeine products to give their patients relief from the severe, chronic cough- this can be problematic. I’ve rarely seen it work long-term and the side-effects are usually intolerable for the patient.

My approach with the patient is to look at 3 systems: the nose, the lung and the stomach. These are frequently the areas where the cough is emanating from. My job as an Allergist and Sinus specialist is to determine if nasal blockage due to airborne allergies or due to anatomical problems(deviated septum or polyps). I specifically test for common outdoor and indoor allergens, such as pollen, pets, dust and mold,which can cause swelling of the nasal passages and ultimately cause post-nasal drip into the back of the throat and lungs- causing the incessant cough.

I find the short-term solution in these patients is to decongest the nose, but without oral decongestants. I use topical decongestants that must be used with a mild prescription spray- so you don’t get the rebound effect from the decongestant spray. I then wean the patient off the decongestant spray and just use the prescription spray. This can be very effective. If the patient has positive allergy tests that indicate this as the cause of the nasal congestion, I will present to the individual the option of sublingual allergy immunotherapy(allergy drops) for a more natural and long-term solution to the chronic cough.

The next installment will be about the lung causes of chronic cough…