Women’s health update-relieving migraine and other pain

In this post I review some new drugs that treat conditions exclusive to or common in women.

I illustrated this post with covers of books written by women; I have reviewed all of these books on my blog, so I’ll include those links also. Please note these are affiliate links, so if you do happen to use them for a purchase you will help me fund this blog.

This information is current as of the publication date; it is general medical information that helps a doctor and patient make decisions about what is right for her. Medical recommendations and practice changes as we learn new things. If you deal with any of these issues , please discuss with your doctor before taking any action.

Photo by rawpixel.com on Pexels.com

Relieving the pain of endometriosis

Women with endometriosis can suffer infertility, heavy menstrual bleeding, painful periods, and pelvic pain unrelated to their periods. In endometriosis, uterine tissue grows outside the uterus; laparoscopy, an invasive procedure us used to diagnose it. Treatment depends on the goal, whether pregnancy, pain relief, or both. Short of surgery, hormonal therapy has been the mainstay of treatment.

A new hormonal drug released in 2018, elagolix, brand name Orilissa, is the first of its kind specifically developed and approved to treat “moderate to severe” endometriosis pain, but not infertility. AbbVie, the pharmaceutical company which developed the drug,priced it at $844 per month, or about $10000 per year, retail.( per Reuters report) Patients may pay less depending on insurance.

 

Easing dyspareunia

After menopause many women develop atrophy of the vagina, making it thin, dry, and easily irritated, leading to painful sex, or dyspareunia. A new intravaginal medication, prasterone,brand name Intrarosa, can help relieve the discomfort. Studies show it may also help improve sexual desire and arousal, but it is not labeled for this.

Manufactured by AMAG Pharmaceuticals, it is for “moderate to severe” symptoms. Also known as DHEA, a steroid, it transforms into estrogen in the vagina; administered as a once daily vaginal insert at bedtime, applied with an applicator. According to goodrx.com, a 30 day supply costs about $213.

DHEA can be purchased as an over-the-counter, non-regulated product, whose effectiveness and safety are unknown. A one-month supply of 50 mg tablets may cost $5.

Other options for treating vaginal atrophy symptoms are oral or vaginal estrogen and/or vaginal lubricants.

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Prevention of migraine pain and disability

Migraine, although not exclusive to women,occurs more frequently in them than men. For infrequent headaches,doctors recommend non-prescription pain relievers since they are effective, safe, and have few side effects. For more severe and disabling headaches, prescription meds designed specifically for migraine are tried next, usually those in the triptan class of drugs.

But when headaches are severe, frequent, or persistent, patients should also consider preventive medication to improve quality of life. In addition to several effective oral meds there are two injectable drugs which work differently

The Food and Drug Administration has approved several new drugs in the past two years.

a new use for Botox

Yes the same drug used to treat wrinkles,Botox, can prevent migraine

Botox, onabotulinumtoxin A, treats chronic migraine, meaning patients with frequent headaches and other migraine symptoms for at least 3 months.

Manufactured by Allergan, a vial containing 200 units costs $1452, per goodrx.com. For migraine, the drug is injected in the upper facial muscles by a physician specifically trained in its use.

It’s in the genes

Another novel therapy uses the immune system to fight migraine. Monoclonal antibodies bind to a calcitonin gene-related peptide receptor which transmits migraine pain. The antibodies are produced in a laboratory but work like antibodies naturally produced by the body. They are being used to treat cancers and some forms of arthritis. They are called calcitonin gene-related peptide (CGRP) receptor antagonists.

Three of these drugs are available for migraine prevention. (generic name-brand name)

  • Erenumab-Aimovig
  • Fremanezumab-Ajoovy
  • Galcanezumab-Emgality

 

Administered as subcutaneous injections (under the skin) monthly, according to a Medscape,the average cost is $600 per month.

In early 2020 the FDA approved another drug that works the same way but is taken by mouth, rimegepant (Nurtec ODT). But unlike the others, Nurtec treats acute migraine pain rather than preventing it. ODT means it is orally dissolvable.

A single 75-mg dose of rimegepant provided rapid migraine pain relief with patients returning to normal activities within 1 hour, with sustained benefit lasting up to 2 days in many patients. The majority of patients (86%) treated with a single dose did not need a migraine rescue medication within 24 hours.

You may want to review my previous post about non-drug ways to manage migraine.

Simple and effective ways to manage chronic pain

exploring the HEART of health through books

Thanks for joining me to review new steps in women’s health and review some fine women authors. I hope you will follow the links to my reviews and read some or all of these books. When you do, I would love to know your reaction. I might use your comments in an update.

I appreciate all of you who follow this blog; there are numerous other blogs to choose from so I am honored you chose to spend some time here. A special welcome to all my new followers from this past month.

I would love for you to start following Watercress Words : use this form to get an email notification of new posts . Please find and follow me on Facebook, Pinterest and LinkedIn. Thanks so much.

                              Dr. Aletha 

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A son remembers, a nation mourns on D-Day

I often think today how lucky I was to have had a father wise enough to save his own life by channeling his PTSD pain into paintings and sketches, (rather than) losing himself from unwelcome suffering. He often expressed to me that he never feared death, but instead viewed it as yet another adventure.

In the United States and in Europe, people observe June 6 as D-Day. On June 6, 1944 Allied troops invaded Normandy,liberating France from Nazi occupation and ultimately ending World War II.  

Remembering D-Day by the Numbers
(source-The American Legion Magazine) 
  • 156,000 troops from Allied nations, including the United States, the United Kingdom, Canada, France, Norway, and others 
  • 5 beaches along 50 miles of Normandy coast 
  • 6000 ships
  • 50,000 vehicles
  • 11,000 planes
  • 12,004 killed, wounded, missing or captured 
Remembering D-Day by a man, his art, and his son

I learned about D-Day from my late friend Bill Hart, who died in 2014. Bill served in the U.S. Army during World War II , and his unit was part of the force that invaded Normandy.

Bill wrote an illustrated memoir about his military experiences. Through his written and visual account, he left us a first hand account of an experience that changed his life and changed the world.

In this updated version of a previous post, I share some of Bill’s art and memories of Bill shared by his son Terry (my thanks to Bill’s wife Greta who graciously gave me permission to share from Terry’s social media post)

He was a true artist and entrepreneur who always enjoyed laughing and meeting new and interesting people. He was wise enough to not limit his conversation to only sports, religion or politics most men comfortably slide into. But instead, he always talked about real thoughts and feelings as well as the history of his Irish roots.

Bill’s son, Terry Hart
D-DAY VET REMEMBERS NORMANDY
Fighting the war in Europe

As a young 18-year-old, he volunteered into World War II seeking adventure way before he was called to serve.

Terry Hart

In 1943, Bill deployed to England, and prepared for the invasion. What he thought would be a grand adventure turned into a nightmare which he vividly captured in his book.

Several days into the fighting on the beaches at Normandy, he was assigned to pick up and transport the bodies of fallen soldiers. Thereafter, as he worked his way across France and Belgium into Germany, he found himself dodging enemy soldiers, liberating concentration camps, dealing with angry and defeated POWs, and famished, humiliated civilians struggling to survive.  Bill described what he saw and felt this way.

2 SOLDIERS AND A JEEP
“At night I would think about the poor GI’s family when they got the news of his death. I tried not to think too much about this “dead guy” job. It seemed to go on forever.
For the next month and a half I was really alone, not attached to any outfit. I found my own food, water, gas for the Jeep and slept alone beside the Jeep in an open field. I shaved with cold water in my helmet and used my Jeep mirror to see.
The Germans were always near. I was scared I would be killed or captured. “Who knows where I am? Who would tell my mother if I died?”
In the beginning it had been exciting being alone with the invasion action all around me. But now I have panic attacks and nightmares of the dead bodies waking me as I sleep in the open field alone.
Most GI’s have other soldiers around them to feel safety in numbers. I had no one. I can’t get their dead faces out of my mind. I wait for the bright morning sun to erase the terrible images.”
Fighting and winning war within in Terry’s words

“He had many adventures to talk about later in his adult life. Growing up in the San Francisco Bay area he jokingly said he wanted to be the big fish in a smaller pond and made a tactical decision to move to Tulsa Oklahoma and to start up an ad agency “Ad Inc.” And as fate would have it, meet the love of his life Greta and started a family, and had three sons (Patrick, Tim, and Terrance)

A few years later he renovated a classic 1920’s Spanish style two-story house and built a large Art studio off the side. Including a photography darkroom and printing stat camera in the basement.

Many years later he admitted suffering PTSD from his unwanted WWII memories, and found a way to deal with his pain by painting his military experiences “as seen through his own eyes”. And then later wrote and published a book full of illustrations. ”

SOLDIER LYING ON THE GROUND
“Later I forced myself to stop thinking about the “dead guys” experience and eventually forgot it.
62 years later, in 2006, when I applied for compensation for war injury during the Battle of the Bulge, the woman who interviewed me kept telling me I was leaving something out, something from my past.
I finally remembered after much writing about my remembered events in the 1944 and 1945 war period and was diagnosed with PTSD (post traumatic stress disorder).
I believe, the greatest event of the 20th century took place during the June 1944 D-Day Normandy Invasion. I am very proud of being a small part of that great historical event that will always be remembered.”

Quotes and drawings from Bill’s memoir, D-DAY VET REMEMBERS NORMANDY (copyright) used by permission of his wife

MAN IN A NORMANDY D-DAY HAT
Bill Hart, World War II veteran

 

“As I was starting my own career in Dallas TX, I would make trips home to see him and my mother as often as I could. And would always enjoy laughing together, plus having real man-to-man conversations at his favorite coffee place McDonald’s…haha.

I often think today how lucky I was to have had a father wise enough to save his own life by channeling his PTSD pain into paintings and sketches, (rather than) losing himself from unwelcome suffering. He often expressed to me that he never feared death, but instead viewed it as yet another adventure. And looked forward to seeing his tough Irish Uncles and Father in heaven along with meeting Jesus.”

Terry Hart posted these memories of his father on the fifth anniversary of his father’s death, the day after Christmas 2014. My husband and I loved Bill and Greta and were honored to attend the graveside ceremony where a military honor attendant presented his family with the flag which draped Bill’s coffin.

 

Bill’s artwork and copies of his book are available to purchase from his wife. If you are interested, contact me here and I will put you in touch with her.

 

POST-TRAUMATIC STRESS DISORDER-PTSD

Once known as “shell shock” or “battle fatigue”, post-traumatic stress disorder, PTSD, has become the most common post-military service disorder. Although it also occurs in civilians who experience severe trauma, it has  been defined, studied, and treated among current and former service members.

PTSD develops after exposure to or experiencing significant traumatic events such as interpersonal violence, death or  threat of death, serious accidents, disasters and combat.

There are 4 types of symptoms-

  • Intrusions, such as flashbacks, nightmares
  • Avoidance- isolating oneself from people and/or certain situations
  • Negative mood changes, such as irritability, anger and depression
  • Hypervigilance- being easily startled, always on edge

PTSD can also lead to depression, anxiety, alcohol and substance abuse and suicide.

It is also frequently associated with traumatic brain injury (TBI)  and chronic pain.

The National Center for PTSD (Veterans Administration)  is dedicated to research and education on trauma and PTSD, working to assure that the latest research findings help those exposed to trauma. They offer extensive information and resources at this link

PTSD: National Center for PTSD

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exploring the HEART of health for veterans

I appreciate all of you who follow this blog; there are numerous other blogs to choose from so I am honored you chose to spend some time here. A special welcome to all my new followers from this past month.

I would love for you to start following Watercress Words : use this form to get an email notification of new posts . Please find and follow me on Facebook, Pinterest and LinkedIn. Thanks so much.

                              Dr. Aletha