Dr. Elizabeth Lee Vliet
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Dr. Elizabeth Lee Vliet |
 About Dr. Elizabeth Vliet |
 Order "Screaming To Be Heard" |
(Dr. Vliet's 3rd visit to Power Surge) Dearest: Elizabeth Lee Vliet, M.D., Internist, women's health advocate with a special interest in the integration of mind and body is a nationally recognized speaker and expert on women's health issues. Dr. Vliet founded and is Medical Directory of HER PLACE: Health Enahacement and Renewal for Women, Inc. located in Tucson, Arizona and Dallas-Ft. Worth, Texas where the focus is on the integration of hormonal changes with physical and emotional aspects of women's lives. Dr. Vliet has dozens of other credits to her name, which you can read in her bio. Dr. Vliet is the author of the groundbreaking, SCREAMING TO BE HEARD: Hormonal Connections Women Suspect ... And Doctors Ignore" Originally published in 1995, a newly revised edition is due out this August. Screaming is a rallying cry to every woman whose body has been dismissed as hypchondriacal, neurotic or hysterical. It's a pleasure to have you back as a guest in Power Surge, Dr. Vliet. Elizabeth Vliet, M.D.: Thanks Dearest! Dearest: I'm always facinated not only by the exemplary content of your book, but by the title. Why do you suppose women have to scream to be heard? Elizabeth Vliet, M.D.: Oh, that's a long answer. Women and their body observtions have not been valued in our culture or in many medical settings. And male patients are taken much more seriously than are women -- many studies to show that. Dearest: I'm always disheartened by women being prescribed tranquilizers and anti- depressants without their physical issues even being addressed, while men with similar complaints are run through a battery of tests. Not that there aren't, of course, occasions when these medications may be necessary, but it seems so unfair to almost arbitrarily prescribe these strong drugs. Elizabeth Vliet, M.D.: So am I - a tremendous over use of those medicines. Yes, that is why I began doing the systematic hormone evaluations many years ago - got a lot of flack from other doctors but it has paid off hugely for the women who all along knew that their symptoms weren't "psychiatric" and were clearly related to times of hormonal change such as post-partum, post-tubal ligation, perimenopausal, etc. Women have to speak out and demand that these reliable tests be done before taking so many other meds. The women's stories we see really wrench at your heart at what they have been through. Dearest: Thank you, Dr. Vliet. Let's go to some of the audience questions. Jinger, go ahead, please. Thanks. Jinger: I'm honored to be first! Hello Dr. Vliet. This is your patient Jinger from San Diego. I am also honored to share this chat space with you. You have been such a blessing to me. Elizabeth Vliet, M.D.: Great to hear from you Jinger! Thank you - it is very meaningful that I could help you. Jinger: After 12 long years of screaming to be heard ... Dr Vliet was the first doctor who not only heard me but also helped me anyway .. my question to you is this ... recently I started taking a diuretic and have lost eight of the 20 pounds I have gained since my hyst/ooph. My question is: ... long term ... is taking a diurectic safe ... as long as I am drinking a ton of water and replacing calcium/magnesium and potassium? Dearest: How wonderful, Jinger. I've heard this from others as well :) If any woman hasn't yet read Screaming To Be Heard, I strongly urge you to do so. Elizabeth Vliet, M.D.: It depends on which diuretic -- spironolactone is safer than are the thiazides, and is a potassium-sparing diuretic, so you don't need replace the potassium. Jinger: I am on microzide Elizabeth Vliet, M.D.: That's one of the thiazides, but it may contain a second ingredient - check with your doctor! Dearest: Thanks, Dr. Vliet (and Mary) :) Eliz: Thank you for all your work with women's health *issues*. Question: in your experience, could you speak to the issue of the *neuro* changes such as formication and also the *internal vibrations* that many women speak of on the power surge message board. Also regarding women's strengths evolving from the perimenopause. Elizabeth Vliet, M.D.: Formication, or the "crawly skin" as well as the vibration feelings, are quite common -- and appear to be related to increased sensitivty of the nerve endings to stimulation as estradiol levels are declining -- there are many "neurological" changes that occur with falling estradiol (E2) -- and I have gone into a great deal of detail on those aspects, particularly in the revised edition of my book. Now the last part of your question has moved off my screen - could you repeat the second part please. Eliz: please speak to the strengths that women experience through going through perimenopause. Dearest: Dr. Vliet, are you following the preliminary results of the WHI (Women's Health Initiative)? I have a question for you. Elizabeth Vliet, M.D.: I am not sure what you are asking with regard to women's strengths but I see many aspects of women coping incredibly well with very demanding lives and jobs at a time their body is changing unpredictably and I am often in awe at how some of my patients keep going in light of all that is happening to them Yes, women are definitely the "stronger" sex when it comes to things like that! To Dearest - yes I am following the WHI results -- and there are some important points to keep in mind. eliz that's fine, what I was thinking of is that each phase of our lives lends us an opportunity for physical-mental-emotional and spiritual growth? Thank you for your response. Dearest: Well, in the HERS Study on HRT and heart disease, it is my understanding that the women on HRT who had increased heart attacks had actually had pre-existing heart disease. However, isn't it so that in the prelimary results of the WHI, increased "heart episodes" and "heart attacks" were found among those on HRT who did NOT have previous heart disease? Elizabeth Vliet, M.D.: Yes, I see many opportunitities for growth of all kinds! With HERS study - which I address in the book people, including doctors, forget that the hormones being used were Premarin and Provera (combined as the product PremPro) and there has been data for many years (over 20) showing potentially adverse vascular effects of both of these compounds that are not found with the natural 17-beta estradiol and progesterone products that have been used for 30-40 years and are well-studied. I would have expected to see adverse vascular effects of using PremPro in women with existing heart disease especially and I am surprised that the HERS investigators did not take this into account. I would never use that product, especially if a woman already has any heart disease! Dearest: Right So, I am correct in that in the WHI study, the women on HRT who did have heart attacks did not have pre-existing heart disease, yes? That is my understanding of the updates I've been reading. Elizabeth Vliet, M.D.: That is my understanding, but keep in mind that the only estrogen being used in that study is Premarin, and there is research going back many years showing that the equine estrogens have the potential to raise blood pressure, and to cause other unwanted changes (like elevated triglycerides) in some women, which is what I think we were seeing with those WHI results. You don't see that same pattern in the studies using 17-beta estradiol, especially if given in the transdermal patch form. Women in this country are getting a sadly skewed picture of estrogen risks based on US studies only using Premarin -- one has to look at the international research for a more balanced picture -- and those are the types of studies I have referenced in my book. I hope that helps -- I do explain this more in depth in the book just can't type fast enough to do it here!! Dearest: But no long-term studies have ever been done to prove that HRT prevents heart attacks, correct? haven't most of these results been observational? Prior to the WHI, that is. Elizabeth Vliet, M.D.: Yes, they have -- check international literature- and there are over thiry mechanisms by which estradiol regulates all phases of cardiovascular function, blood pressure, and all kinds of steps in the process of vascular health -- the list is too long for here! Dearest: Interesting, here's what I copied and pasted from the WHI site: No study has proven that HRT will reduce heart attacks. In any event, let's go ahead with the audience questions :) Elizabeth Vliet, M.D.: WHI information is based on Premarin as I said. linkaloo: I'm on Bi-Est 2.5 with 200 mgs. progesterone. Should I be cycling with this or take it all month, no break? My pharmacist says to take it everyday. Should I have my period with this? I am perimenopausal, 47 years old. My main problem with the "change" is skipped heartbeats! Anything you can suggest other than the Bi-Est, Revival and Zoloft 50 mgs.? I love your book, it's right by my nightstand! Elizabeth Vliet, M.D.: Thanks for the comments. The 200mg dose of progesterone is higher than recommended for daily use - that is the dose for 10-14 days a month on a cyclic regimen. Your skipped heartbeats could possibly be related to suboptimal estradiol relative to the amount of progesterone but that would have to be checked carefully by your physician. I don't typically use Bi-Est - for the reasons I outlined in my book - it doesn't make physiologic sense to give estrone for many reasons -- that is the form of estrogen more associated with endometrial, and breast cancer, as well as with weight gain, higher Tg and impaired glucose tolerance-insulin resistance. linkaloo: I though Bi-Est was Estradiol and Estriol, not estrone? Dearest: That's right Elizabeth Vliet, M.D.: Depends on which formula a pharmacist is using - I have seen patients on both. Dearest: It's the tri-est that contains estrone linkaloo: Mine is estradiol and estriol, NO estrone. Elizabeth Vliet, M.D.: Not all Bi-Est formulas in use contina E2 and E3 - you have to be sure what is being used in each pharmacy. Dearest: Thank you, Dr. Vliet. Chloecake, go ahead with your question for our guest. chloecake: Good Evening Dr Vliet and thank you - for helping me too!! Elizabeth Vliet, M.D.: You're welcome! chloecake: I would like to know if there is anything new and exciting in the medical future for controlling menopause...new things perhaps? Like a cure it all pill or patch or something for libido LOL thanks! Elizabeth Vliet, M.D.: Not sure what you are looking for here -- haven't heard of any research on ovary transplants!! :) Hard to beat what mother nature gave us -- so now that we are living longer, we have to evaluate what other ways may help address the problems that occur when our ovaries no longer make the metabolically active forms of our hormones! The hype about designer estrogens is over-blown and risks underplayed. I wish we had a testosterone patch for women -- it works wonders for the men I see with low testosteorne! Flo: My doctor thinks I should take HRT the rest of my life (I'm on Prempro) have been on HRT for 10 years. He's convinced its good fro my heartin spite of reports.. My problems are libido and vaginal atrophy. Suggestions? and Thanks Dr. Vliet. Elizabeth Vliet, M.D.: FLo, I find that PremPro isn't the best product for those symptoms - - the progestin tends to blunt estrogen benefits on vaginal tissue leading to more dryness, and also blunts libido -- in addition to the studies that show the equine estrogen products deliver mostly estrone, horse estrogens and very little of our own natural 17-beta estradiol. So maybe with your continuing symptoms you could ask to be changed to natural progesterone in a cycle so you don't have those effects all the time, and you could also ask to take a 17-beta estradiol product (like patches - Vivelle DOT, CLimara, Alora, or the tablets Estrace, generic estradiol or the new Gynodiol. There are also some new combination products with 17-beta estradiol and different progestins that may work better for you than PremPro - look into Femhrt, or Activelle. Combi-patch is another one, but it has so much progestin that you would likely have the same problems you are currently having with PremPro. Hope that helps. Dearest: Why do you suppose so many doctors still prescribe Premarin and Provera when there are so many other better options? Elizabeth Vliet, M.D.: Haven't the foggiest - to me it is like trying to drive a model F Ford on a super highway!! I doubt if it were THEIR hormones, they would still use the old stuff if something better and more natural were avaiable. Seriously, I think part of the problem is habit, and part of it is time constraints today -- it takes time with patients to really do an individualized prescription, and many doctors just don't have or spend that kind of time - and women are also being locked into managed (rationed) care formularies that limit their options too -- so it takes outspoken women to ask for or demand other options. That's why I wrote the book and do the consumer seminars - to let women know they have choices and options! Dearest: Thanks, Dr. Vliet. Excellent answer (as always) Vi, go ahead. Vi: After partial thyroidectomy, how frequent should thyroid levels be checked? Low levels, Hypo symptoms, family history, no medication now. Elizabeth Vliet, M.D.: I think they need to be checked more often than I currently see being done-- and especially if women are still having symptoms - I recommend checking not only TSH but also the free T3, and free T4 to see if the replacement therapy is achieving the desired goals. Vi: Thank you. Your book saved me.... Dearest: Thank you, Dr. Vliet. Your knowledge always amazes me :) Elizabeth Vliet, M.D.: Re: Thyroid - more specific answer is that I usually check them about every 2-3 months until stable. Then about every six months for awhile - once clearly stable, then annually can be fine. linkaloo: Should I have a saliva test done to check my estrogen levels? I was never tested prior to starting the Bi-Est. Also, you said 200 mgs. of progesterone was too much to take every day. What mg. of progesterone should you take if you cycle along with your estradiol and estriol 2.5 mgs? Elizabeth Vliet, M.D.: The recommended dose of natural progesterone for daily use to prevent hyperplasia is 100 mg daily (oral) - less than that if non-oral. I stopped using saliva tests about 5 years ago because they were so unreliable and didn't fit with what that women themselves were telling me. The "gold standard" in reproductive endocrinology and the international menopause research field to test hormone levels is the serum assay. There are complicated reasons for this, but basically it has to do with the fact that more is involved in activating the hormone receptors than just the free fraction -- based on more recent reserach. If you really want to have a better picture of where you stand, you would do well to have the serum levels done. There are known minimum thresholds for the various target organ protective effects of E2, progesterone to prevent hyperplasia, testosterone for bone, libido effects etc. linkaloo: Thank you Dr. Vliet, I'll check with my doctor! Val: Some believe there's an over use of tranquilizers and anti-depressents. What options do we have when we are experiencing hellish symptoms? I was having panic and anxiety for many months, and proudly take xanax and found relief. I realize there are addiction risks, but what other choices do some of us have? Dearest: Good question, Val Val: I cannot take HRT and I feel as if I am going through a body war within myself. I never used to have PMS! Elizabeth Vliet, M.D.: Val, I don't say NOT to ever use these medications -- they are safe and very effective -- my point is that there are many endocrine causes of the same symptoms, so it is important to check all this out before assuming a psychiatric diagnosis. Val: Psyciatric? If I am not presenting an endocrine disorder, then it is psychiatric? Elizabeth Vliet, M.D.: But certainly, these meds do give fairly immediate symptom relieft, and I use them too -- just less often than I used to before I did more detailed assessments of the endocrine connections. And some people need both or several to reach a balance -- the key is individualizing the approaches to a given person. Val: You don't believe that do you? Elizabeth Vliet, M.D.: Not necessarily, that's just the usual either-or that is typically encountered in medical settings, and the common approach to women with anxiety symptoms. I think it is wise to make careful diagnoses, no matter what the field. Vi: Are there any dietary foods particularly good/bad for hypo thyroid conditions? Salt? Magnesium? Elizabeth Vliet, M.D.: A number of nutritional issues have to be considered for hypothyroidism for example, restricting carbohydrates too much can lead to lower levels of free T3, which then may make you feel more hypothyroid. Another problem occurs for thyroid sufferers if they have a high intake of soy - since the goitrogenic effects of soy have been known for decades, but get overlooked in the emphasis on soy today. You may want to read Mary Shomon's book, Living Well With Hypothyroidism for more on this point. Vi: I will and I thank you. Elizabeth Vliet, M.D.: You're welcome. Jinger: Is there any news on when the updated version of Screaming - or any other new books - will be out? Dearest: I mentioned that in the introduction, Jinger. August 2000 there will be an updated version of Dr. Vliet's book. Elizabeth Vliet, M.D.: STBH revision went off in final form to publisher TODAY - Yea! It should be out in August. My next book is due out in the first quarter of 2001, and the one after that Scribner is going to publish in early 2002. I am busy researching all of this! Lots going on. Jinger: Thanks Dr. Vliet ... you are wonderful! Flo: Dr Vliet. You suggested before that I take progesterone cyclically. Does that mean with other types of HRT I would have to have periods? I'm on Prempro daily. I will get your new book. Thanks Elizabeth Vliet, M.D.: Take care, Jinger - talk to you soon,. Cyclic progesterone or progestin does mean periods -- but also means less time on that part of an HRT regimen if you are having problems with it. If you are not having problems, and don't have any medical reasons that make the daily progestin like PremPro a problem for you (those could be such things as weight gain, diabetes, high cholesterol, high blood pressure, and many others then the daily regimen is fine -- you just might want to look into one of the newer products with a better estrogen and progestin option. But if you feel great on what you are taking, it may not be worth changing. Comes down to knowing your options and pros/cons of various choices. Best wishes, what ever you decide. Dearest: Dr. Vliet, the one question every woman wonders about -- do the risks associated with HRT outweightthe benefits? What are your thoughts? Elizabeth Vliet, M.D.: Good question, difficult to answer in short form, but overall, with all my review of the literature and treatment of thousands of patients, I would have to say, yes the benefits outweigh the risks, especially if we are using the more natural forms of the hormones that are available now. Risk profile can be very different depending on which specific formulation you are using. Overall, I am glad we have more options available so women have choices now that they didn't have in our mother's generation. Dearest: Is there any less risk of cancer with the naturally compounded hormones? Elizabeth Vliet, M.D.: Yes, again going back to studies in Europe, as I have outlined in my book. But this is a complex issue -- so that's the short answer :) Dearest: Thanks so much, Dr. Vliet. Everyone, please join me in thanking Dr. Vliet for a stimulating and informative chat in Power Surge :) Elizabeth Vliet, M.D.: You are welcome, hope people had some information that will be helpful. Dearest: If you haven't read "Screaming To Be Heard: Hormonal Connections Women Suspect ... and Doctors Ignore" .. you must get a copy today! The revised edition should be out around August. Elizabeth Vliet, M.D.: You're welcome! Great group! Dearest: You're always helpful, Dr. V :) Thanks so much. Elizabeth Vliet, M.D.: Have a great weekend, and be well! Dearest: Also, let everyone know about HER Place -- we may have visitors interested in visiting. They are located in Tucson, AZ and Dallas-Ft. Worth, TX, yes? Dr. Elizabeth Vliet, M.D. Yes, both places. Hope to see some of you. Check out our website www.herplace.com for further information -- if the site is working properly, you should be able to download an information package. Dearest: Wonderful and I'll let you know when this transcript is done, so you can add it to your site, too :) Elizabeth Vliet, M.D.: Thanks, Dearest, that would be great to have. Dearest: Thanks, again, Dr. Vliet. Always an exemplary guest. Elizabeth Vliet, M.D.: We plan some fun things for the future on the site -- soon as I can get through some of this boook stuff. Take care, all - enjoyed being here with you. Dearest: You, too, Dr. V. Best of luck with the upcoming revised "Screaming" and with the new book :) Elizabeth Vliet, M.D.: One last thought -- for aching legs -- check not only your hormone levels but magnesium intake too! Bye. Dearest: Thanks for the last minute advice :) Goodnight, everyone. Every guest in Power Surge™ is a highly respected professional. Their opinions are their own. Their appearance in Power Surge™ does not constitute an endorsement of their views. Power Surge Disclaimer None of these transcripts may be reprinted or reproduced without the express permission of Power Surge™ and the respective guest. Read the transcript of Dr. Vliet's first visit) Read the transcript of Dr. Vliet's second visit) Dearest aka Alice Stamm Power Surge™ Founder, Facilitator Copyright©1994-2009 by Power Surge. All Rights Reserved.