Information on popular complementary and alternative medical topics

A person who has been covered previously under a group plan, but who can no longer work, may have the option of continuing in the group plan for eighteen months under the Consolidated Omnibus Reconciliation Act of 1985 (COBRA). Under COBRA, the former employee would pay a premium that is 102 percent of the premium previously paid by the employer—the extra 2 percent is for administrative fees. Some states will pay these premiums for you, to delay Medicaid coverage. Requirements for coverage under COBRA are as follows: COBRA applies only to businesses with twenty or more employees; the former employee must pay the premiums; the former employee must be ineligible for Medicare; the employer must continue the group plan for continuing employees; and the former employee cannot join another plan.     People who are eligible for Social Security disability benefits when employment ends may obtain eleven months of additional coverage (for a total of twenty-nine months) with the same insurer, although the premium may now be 150 percent for the additional eleven months.     People who are not eligible for COBRA because they worked for a company with fewer than twenty employees may still be protected under the Continuation of Comprehensive Benefits laws in thirty-five states; the duration of coverage of the employer’s group policy varies with different states, and ranges from three to eighteen months.     The alternative to COBRA, if COBRA is not available or if it runs out, is a conversion policy: the former employee converts the group policy to a type of individual policy. Conversion policies cover less than group plans and cost more. Thirty-five states require employers to offer conversion policies to former employees when COBRA benefits run out. Premium rates tend to be high, since most people who buy conversion policies are in poor health. Nevertheless, the person with a serious disease might have few other options, and conversion policies are available regardless of health status or preexisting conditions. The remaining option is an individual plan, which costs even more than a conversion policy.*204\191\2*

Estrogen effectively protects bones for 85 percent of users, especially when used for ten years or more, in particular right around menopause. Since it isn’t enough for some women, you should monitor your progress with the tests, so you will know if you need to add another treatment (see following chapter) or discontinue this one. Studies are under way to determine the effectiveness of combining HRT with the more aggressive treatments described in the next chapter. Given what we know now, I recommended adding one of them if HRT alone is helping you make progress, but not enough progress. (If HRT is doing nothing for you, you might as well discontinue it.) You should have a baseline bone density scan, and repeat it after two years on hormones to gauge your progress. Following your NTX levels will also be helpful. You should see a decrease in the NTX level, and can reasonably expect estrogen to keep your number under 30. Lower NTX levels are always better. If you follow healthy eating and exercise guidelines, that is a goal well within your reach.For women with breast cancer or uterine cancer, or with two close relatives with breast or ovarian cancer, the risks of HRT clearly outweigh the benefits. (Some women with breast cancer can actually be treated with estrogen, but that’s another subject altogether.) Women with abnormal vaginal bleeding shouldn’t use HRT until the cause is discovered, and those who have had problems with blood clots should also be wary, though there’s no proof of increased danger. Anyone with fibrocystic breast disease should be aware that mammograms may be less accurate with that condition, making it difficult to detect breast cancer as early as would be desirable. Uterine fibroids should also make you think twice about taking a drug that can make them grow, or you may wind up needing a hysterectomy you might otherwise avoid.With these few exceptions, HRT is the best traditional medicine has to offer when it comes to maintaining bone density, and all women should consider it seriously as they approach menopause. When talking the decision over with a health care professional, keep your bone health in the front of your mind, along with heart disease and cancer risks, and you’ll be able to achieve a healthy balance. The charts above will help you sort through the many types of hormones available to help with bone density and how they affect a range of other health concerns. The “alternative” hormones covered in the next chapter are included here, too, for the sake of comparison, but the highlighted options are the traditional options this chapter covers. If you learn nothing else from this book, I want you to remember that although we tend to use “HRT” to mean estradiol pills, or estradiol/progestin combinations, there are actually a host of choices, each with its own pluses and minuses, and only you can pick the best one for you. You should have very specific reasons for taking any hormone, and those hormones should be geared at creating balance within your body. There may be things that can create that balance other than hormones, so when you choose hormones, you want to be clear on the point that this is the best option for you. The current trend of making a blanket recommendation for HRT for every woman at menopause is a mistake. For you as an individual, estrogen may not be the best thing. Or maybe it is. The only way to know is to take into account all the details of your own particular situation.*140\228\2*

What about people who already have coronary problems detected by tests, or who have angina pectoris, or who have had a heart attack? Is the “jam” as far as cholesterol is concerned for these individuals? Evidence is mounting that lowering cholesterol in this group retards the further development of c nary blockages and most intriguingly may even promote some regression blockages that are already pres These changes have been observe as little as 2 years.Because of the possibility for regression of disease in patients with coronary artery atherosclerosis, physicians are not satisfied with levels that they consider “adequate” for people who do not have heart disease. If you have heart disease, expect that your physician will want you lower your cholesterol below a level that is considered adequate for someone else.To summarize: People with relatively low LDL-cholesterol levels (and low VLDL cholesterol) or relatively high HDL-cholesterol levels experience fewer coronary artery problem and live longer, on the average. People included in this group are those who have lowered their LDL-cholesterol level or raised their HDL-cholesterol level by means of diet, exercise, or medications.  Everyone can benefit from lowering their cholesterol level, but the people with the most to gain are those who start out with high cholesterol levels.*246\353\8*