WOMENS-HEALTH Messages for December, 2000: Re: 2 Questions: persistent edema and osteopenia

Re: 2 Questions: persistent edema and osteopenia

From: Harvey S. Marchbein, M.D. (anonymous@obgyn.net)
Sat, 9 Dec 2000 17:42:48 -0600 (CST)

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In reply to: AMS: "2 Questions: persistent edema and osteopenia"

At Fri, 8 Dec 2000, AMS wrote: >
>I have developed a moderate, pitting edema in both legs to just below my
>knee. I first noticed this in early August following the beginning of
>what turned out to be 70 days of DUB. I am 49 years old, obese, regular
>periods until this episode and moderately active. The only time the
>edema has abated is the 14 days on levlen and 3 days in the past week
>while on sudafed for a cold. The edema was really pronounced while on
>17 days of provera to induce a bleed (which it did not). I am now, 45
>days later, on a 7 day course of aygestin to induce a bleed and off the
>sudafed and the edema is back in full force. Since I have not yet
>identified a new primary care doc, my gyn ordered a metabolic panel
>which was normal. She dismissed the edema as possibly a hyper
>estrogenic state and said no more. My question is, do I just sit tight
>and wait for nature to take its course, (I can live with that) or become
>more aggressive about getting this managed.

Get that new primarhy care doc to make sure everything's OK. Your gyn is probably right but just be sure.

>Second question: my dentist noticed bone loss over 6 months in my jaw
>unrelated to dental health and so my gyn order DEXA. Came back with
>mild osteopenia both spine and femur at -1.4. Gyn said tx threshold is
>-1.5 so just take calcium and we'll repeat the scan in 2 years. Problem
>with this is I've taken 1000mg of calcium from age 35 to 48 and past 2
>years at 1500mg. Also, I do walk a lot and until we moved I have
>regularly done resistance exercise. And the dental finding is new. When
>I tried to discuss this further, she dismissed me with some sort of
>mumble. THis is new gyn for me and have already decided time to find a
>new one as the office is disorganized and way too busy.) I don't want to
>be behind the 8ball in 2 years - are her recommendations adequate or do
>I need to find someone new sooner rather than later?

Most osteo experts recommend therapy starting at T score -2.0. Interesting about dental bone loss, it may be noted by dentists even when your DEXA is in the range not requiring therapy. An osteo expert should be consulted with to discuss your particular case. Also, make sure that you're taking the calcium in no more than 500-600 mg per dose. More at one setting will not be absorbed.

Hope this helps and write back anytime for more information.

HSM

>
>Thank you for your help.

--
Harvey S. Marchbein, M.D. FACOG, FACS
Great Neck, New York

**Note:  Opinions expressed here are for educational purposes only
and, as such, do not constitute a physician-patient relationship.
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consult with your physician prior to choosing therapeutic options
and/or interventions.

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