Health and medical information

The sex hormones oestrogen and progesterone are all steroids. They are closely related to the anabolic steroids which some athletes have used as body builders. HRT contains the same combinations of oestrogens and progestogens which make up the Pill. The difference between the Pill and HRT lies in the difference in the oestrogens by dose and chemical structure. Most of the combined oral Pills contain ethinyl oestradiol which is a synthetic oestrogen whereas those used in HRT are usually referred to as ‘natural’. ‘Natural’ in this instance means that they have been extracted from pigs’ ovaries or pregnant mares’ urine, a substance particularly high in oestrogen, (hence the name Premarin, one of the best-selling HRTs, and also Prempak C). Not all the oestrogens in the mixture are natural to humans and some can behave like ethinyl oestradiol, the synthetic hormone, which tends to affect liver metabolism by producing changes in blood clotting and blood fat levels. The progestogens used in the Pill and HRT are the same, but in HRT the progestogen is only given for ten to twelve days of each cycle. Because of the close similarity between the Pill and HRT it is not surprising that many of the side effects reported by women – water retention, weight gain, headaches and depression – are the same.

Some women stopped taking HRT when disturbing reports appeared in the media about its production. In 1995, a representative of the World Society for the Protection of Animals (WSPA) was part of a team which inspected thirty-two farms in Canada, all of which were contracted to supply mare’s urine. The following passage is extracted from WSPA’s report, HRT, published in 1996:

‘…after mares have become pregnant, they arc brought into barns and housed in individual stalls. A harness-type device… is attached to the animals’ rear quarters so that their urine can be collected. The horses spend most of the next six months in these stalls while their oestrogen-rich urine is collected.

Often the horses’ stalls were too small to allow the animals to lie down comfortably. In nearly all of the farms visited, our inspector saw tethers that were so short that mares were unable to lay their head on the ground… In all but a few farms, water was being restricted…it is suspected that this is practiced in order to ensure that urine has a high concentration of oestrogen.’

WSPA’s findings from the visit were shared by other members of the inspection team which included an expert from the Royal School of Veterinary Studies in Edinburgh, which also published a report, Report of Findings During Visit to Pregnant Mare’s Urine (PMU) Farms, Saskatchewan, in which it described the stalls in most barns as ‘totally unsuitable for horses…’.

Since this 1995 inspection, Edinburgh University has reported that,

‘Wyeth -Aycrst [the company which makes Premarin] has announced that changes have been made at certain farms and that veterinary supervision has been stepped up. However, the company has refused to allow WSPA, as well as local animal welfare inspectors, to re-visit any of the farms…

Adult horses are not the only ones to suffer in the production of Premarin. For every pregnant mare…a foal is born each year. Most of these young animals are of little value to the farmers. Each year thousands are sold off cheaply and fattened up at giant feed lots before being slaughtered. Many end up on dinner plates in Japan or Europe or are used to make dog food.’

Other organization that are concerned about the treatment of these horses include: PETA (People for the Ethical Treatment of Animals); The Humane Society of the United States; the RSPCA; and the University of Edinburgh’s Department of Veterinary Clinical Studies. Both WSPA and PETA have information packs which are available by post.

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The most common side-effects of surgery are secondary to the small size of the stomach remnant in restrictive procedures, and include vomiting and the feelings of bloating and stomach distension. Malabsorptive procedures can lead to iron and vitamin B12 deficiency, and deficiency of other vitamins. Dumping syndrome is a relatively common occurrence. The complications of the obsolete jejunoileal bypass are potentially catastrophic and include acute hepatic failure, cirrhosis, oxalate nephropathy, chronic renal failure and malabsorption syndrome.

In the Danish Obesity Project and Swedish Obese Subjects (NICE 2002) trials, four deaths were directly attributable to surgical complications.

Perioperative problems included subphrenic abscess (7%), pneumonia (4%), wound infection (4-6%), pulmonary complications (3-6%) and hepatic dysfunction (1.5%).

Gallstones are a common long term side-effect.

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Over fifty per cent of women suffer from hand dermatitis. It also frequently appears in both men and women who work in certain professions. Hairdressers, those who work in the food industry and medical people all have a greater risk of developing the condition.

By far the most common cause of hand dermatitis is having the hands in and out of water, and it is water rather than soaps and detergents that tend to cause this annoying condition. Water causes the surface cells of the skin to swell. When the hands are removed from water, the cells shrink. If this happens repeatedly, the skin eventually begins to crack. Soaps and detergents aggravate the situation because they strip away the skin’s protective outer layer. This causes water within the skin to evaporate more quickly.

Preventing hand dermatitis

The only way to prevent hand dermatitis is to keep your hands away from water. This can easily be done by wearing cotton gloves inside rubber or vinyl gloves whenever you are doing ‘wet’ work. It is a good idea to buy several pairs of cotton and rubber or vinyl gloves and keep them in different parts of the house – if they are handy, you are more likely to use them. It is important to wear cotton gloves inside the rubber or vinyl gloves so that your hands do not perspire excessively. Many people protest that it is difficult to do household chores and other wet work such as washing hair with gloves on. It is really just a matter of getting used to them, however, as surgeons, doctors and dentists use gloves routinely, even when performing very delicate operations. Tighter-fitting rubber gloves can be bought at the supermarket in boxes of fifty.

Harsh soaps and detergents should be avoided. For washing your hands moisturizing, mild soaps such as Aveenobar, Dove or Neutrogena are best. You can also use soap-free liquid cleansers such as Cetaphil or an emulsifying ointment.

Using moisture creams on the hands regularly is essential. These act like glue, trapping water in the skin. They also improve the barrier function of the skin by making it less susceptible to irritation. Good moisture creams for the hands include Neutrogena hand cream, Hydraderm lotion and Aveeno skin lotion.

Treating hand dermatitis

Cortisone-based ointments are nearly always needed to treat established hand dermatitis. They are made more effective by wrapping Gladwrap or wearing plastic gloves over the ointment to enhance penetration. If cracks develop on the hands tincture of benzoin or clear nail polish can be applied. Both these measures clear up cracks very quickly.

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