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Ask Dr. Etingin.

Why do I need a prescription for my mammogram? Why can't I just make the appointment myself and take the results to my doctor?

Prescriptions are only needed to comply with insurance companies' regulations that require a doctor to order the test (to establish medical need). You can certainly make a mammogram appointment on your own at most facilities and have the results sent to your doctor. But you will have to pay out of pocket and submit the bill to your insurance company on your own, whereas a mammography facility will send the bill to the company or to Medicare.

In the January 2006 Women's Health Advisor, you reported that glucosamine and chondroitin were found to reduce the pain of osteoarthritis in the knee. I have been taking glucosamine for several years and it seemed to work a little. But I still had pain, so I asked my doctor for a prescription for Celebrex, which really helped me. With all the problems that have been seen with Celebrex, Vioxx, and similar medications, should I try the combination of glucosamine and chondroitin? Would they work as well and which supplements are best?

To help answer your question, we contacted Vijay Vad, MD, a professor of rehabilitation medicine at the Weill Medical College and author of the forthcoming Arthritis Rx: A Cutting Edge Program for a Pain-Free Life (March 2006, Penguin). According to Dr. Vad, glucosamine and chondroitin may have antiinflammatory effects that help relieve knee osteoarthritis pain, although these effects are somewhat different from those of Celebrex or other nonsteroidal antiinflammatory drugs (NSAIDs). "Glucosamine inhibits inflammatory cytokines, including interleukin 1(IL-1). All antiinflammatories inhibit IL-1 to some extent, but glucosamine does not work through the same pathways as NSAIDs. While some research suggests that glucosamine has some cartilage-protective effects, that was shown in just one laboratory study. One study in rabbits showed it slowed the progression of osteoarthritis, but that was injecting glucosamine into the joints," says Dr. Vad. "Chondroitin is essential for structure and function of cartilage, but there are actually data that it is well-absorbed orally. I do think it has a synergistic effect with glucosamine to produce antiinflammatory effects. They can be a first-line therapy for mild to moderate pain. Supplements are not as strictly regulated as drugs, so their purity is not guaranteed. We cannot endorse any supplement, but we have had experience with a few: CosaminDS, used in the large U.S. clinical trial, Zyflamine, and Zingerflex, which also includes ginger. Any glucosamine/chondroitin supplement from a brand-name manufacturer would have consistent quality from batch to batch. You need a total of 1,500 mg a day of glucosamine sulfate and 1,200 mg of chondroitin, taken in three separate doses. The daily dose of ginger is 510 mg. I would avoid prolonged use of Celebrex. Try supplements first. If you still need Celebrex, take it in spurts, 3-4 times a week, in the smallest possible dose."

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Title Annotation:prescription for mammogram
Publication:Women's Health Advisor
Geographic Code:1USA
Date:Feb 1, 2006
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