Re: HRT Problem
From: Barry Mizes (bmizes@MO.NET)
Sat Apr 27 23:28:07 1996
Dr. Goodman -
Have you tried a sublingual route of administration? While this is not
available as a manufactured drug, a sublingual estradiol tablet can be
compounded in any strength the patient would need. If we can assist you or
this patient in this regard, please let us know.
At 12:40 PM 4/27/96 -0500, you wrote:
>Please, group, I need help on a case:
>
>A 43-year-old G2P2002 underwent TAH/BSO for hard indications four years
ago. Since then
>she has gone through every oral, vaginal cream and transdermal preparation
available in
>Arizona. We were unable to get her euestrogenic, judged by symptoms,
physical exam or
>serum estradiol levels, until we went to Depo-Estradiol q 3 weeks. By
training and
>experience (twenty-two years in a busy community OBG practice) I would
almost rather eat
>okra than have somebody on injections, but I am a realist. She suffers also
from
>multiple food and environmental allergies, sees an allergist for ongoing
desensitization
>injections. She is very slender, has perhaps 3 - 5% body fat. A few months
ago, she
>started getting an immediate (within 15 - 20 min) reaction around the
injection site
>(in the only fat pads we can find on her, on her buttocks) about 3 - 4-cm
radius from
>the site, erythematous, firm, not tender. This persists for several days.
Her allergist
>is convinced that it is not allergic. I tend to agree with him, but . . .
>After the same thing occurred with every injectable we can try, the
allergists suggested
>that the problem is a chemical or mechanical reaction to the oil in the
subQ fat/muscle.
>This usually sweet lady, her husband and her gynecologist cannot deal with
her(self)
>when her serum E2 is down. We are now trying a very small dose every week,
but I am not
>hopeful, nor is she. Any suggestions? Anything (an implantable or a vaginal
ring, etc.?)
>available to help her?
>
>Thanks!
>
--
Barry Mizes
Bajamar Women's HealthCare Pharmacy
"Innovations in Pharmacy Compounding"
9609 Dielman Rock Island
St. Louis, MO 63132
1-800-255-8025 toll free
314-997-3414 voice
314-997-2948 fax
bmizes@MO.NET
