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Women's Health Newsletters 2/11/01 - 3/18/01
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****** Woman's Diagnostic Cyber Newsletter *******
February 11, 2001
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Bell's Palsy treatment
2. Considering surgery for snoring?
3. Reader submitted Q&A - ERT and hypertension
4. Herbal teas and pregnancy
5. Leg nerve problems from Taxol(R)
6. Health tip to share - Vulvar pimples
7. Humor is healthy
Spread the word! Send a copy of this newsletter
to someone you know.
Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Bell's Palsy Treatment
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Bell's Palsy is a sudden weakness of the facial
nerve on one side of the face. It results in an
inability to close one eye and to produce facial
expressions such as smiling.
Often there is drooling from the mouth on the
affected side. There may be headaches and pain in
front or in back of the ear. There may be no tears
and a dry eye on that side too.
The cause of the condition is unknown but it has
not changed since being described by Dr. Charles
Bell in 1882. Most likely it is due to a viral
inflammation of the facial nerve and it is a
temporary condition that eventually goes away on
its own. The droopy appearance to the face is
disheartening but not serious.
Symptoms usually last from 1-3 months and most
people do not need treatment. For those who do
have more severe cases, treatments include:
1) anti inflammatory drugs such as steroids
2) anti viral medicines such as acyclovir or
famcyclovir
3) facial muscle massage
The essence of self treatment is to protect the
eye by using artificial tears and/or patching it
to prevent drying damage to the cornea.
Bell's Palsy treatment
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Considering surgery for snoring?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
We have previously discussed sleep apnea which
results in an obstructed airway during sleep. It
is often associated with snoring although not all
snoring results in sleep apnea. Before any surgery
is considered for snoring, you must have a sleep
study to make sure that sleep apnea is not an
additional problem.
Snoring is caused by vibration of the fleshy
tissue in the back of the roof of the mouth called
the soft palate and uvula. The vibration occurs
from airflow from both the nose and mouth
breathing. To reduce snoring, the soft palate and
uvula needs to be made smaller and/or stiffened.
Several different procedures have been used and it
may take more than one surgery. The surgery can
sometimes be quite painful as there are many nerve
endings in that tissue. The best of studies report
about 85% success but there are also reports of
lower success rates.
You should seek out an ears, nose and throat (ENT)
specialist who does a high volume of these
procedures. This is after your work-up for sleep
apnea of course.
For more information about procedures, see this
article at Sleepapnea.org :
Surgery for snoring
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - ERT and hypertension
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Does taking estrogen (alone) elevate blood
pressure in some women? I am 69, have taken
estrogen for 15 (or more) years after a
hysterectomy. Have had hypertension most of that
time controlled with medication. One year ago I
discontinued Ogen after blood pressure was very
high. Since then blood pressure is down and
normal. Any connection? " Elise
While the higher doses of estrogens in birth
control pills are known to raise blood pressure in
some women, neither estrogen replacement (ERT) nor
hormone replacement (HRT) have an adverse effect
on blood pressure. In fact they tend to lower
blood pressure.
This is true also in women who have hypertension,
i.e., newly started HRT or ERT lowers blood
pressure in almost 50% of women with hypertension
either on or off anti hypertensive medication.
There have been studies indicating that
discontinuing anti hypertensive medication and not
taking any estrogens can result in a lowering of
blood pressure after several months. Why this
happens we do not know. For a discussion of how
HRT and ERT affects blood pressure and the
cardiovascular system, see our article at:
Does ERT cause or worsen high blood pressure?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Herbal teas and pregnancy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
As women switch from caffeine containing teas to
herbal teas, the question always comes up as to
what herbal teas are safe during pregnancy and
what ones should be avoided if any. It is a hard
question to answer because there is very little
toxicological testing that has taken place.
A general rule-of-thumb is that teas containing
substances you usually associate as safe foods,
such as orange, lemon, lime, mint, cinnamon,
cloves, are generally safe in pregnancy and breast
feeding. You might want to avoid more unusual ones
such as cohosh, pennyroyal, and mugwort, for
example, because we do not always know that they
are safe.
Special teas that claim they are formulated for
use during pregnancy often contain red raspberry
leaf, strawberry leaf, lemon grass leaf, nettle
leaf, alfalfa, fennel seed, rosehips, and lemon
verbena. These are felt to be safe.
Teas containing the herb, ephedra, should be
avoided.
Herbal teas and pregnancy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Leg nerve problems from Taxol(R)
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
With the high frequency of breast cancer and a
lesser frequency of ovarian cancer, many women end
up receiving the chemotherapeutic agent called
Taxol (R), or paclitaxel. This drug often causes
damage to the nerves, especially the ones to the
legs.
Primarily it affects sensation of the legs but it
also can result in weakness of the muscles also.
Most of the time the numbness and weakness
gradually goes away but it depends upon how
extensive the changes are in the first place.
The nerve damage is dose related. The worse the
damage, the longer it takes to recover. Neurontin
(R) is a newer drug that may be helpful in
treating this. If you develop leg pain or weakness
from Taxol, be sure to see a neurologist for help.
Leg nerve problems from Taxol(r)
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Vulvar pimples
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
After having problems with pimples in my vaginal
area (including inner and outer labia) that were
not ingrown hair-related, my doctor recommended:
(1) using anti-bacterial soap (which I now keep in
my shower) and
(2) immediately blow-drying my genital area after
baths/showers.
I have had exceptional results with NO more
pimples. Hope this helps someone else. " -
Anonymous
If you have discovered ways of coping with a
disease or condition and it works for you, please
share it with us:
Health tip suggestion form
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
7. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Longevity"
A fellow who's just reached his 150th birthday was
giving a press conference to the assembled media.
"Excuse me, sir," one of the reporters said, "but
how did you come to live to 150?
"It's actually quite simple," the old fellow
replied. "I just never argue."
"That's impossible," the reporter responded.
"There must be something else, like diet, or
meditation, or something. Just not arguing won't
keep you alive for 150 years!
The old fellow stared hard at the reporter for
several seconds.
"Hmmm," he finally shrugged, "maybe, you're
right."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** Woman's Diagnostic Cyber Newsletter *******
February 18, 2001
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Boosting your energy naturally
2. Plantar fasciitis heel pain
3. Reader submitted Q&A - ASCUS Pap under age 50
4. Endometrial polyps and hysteroscopy
5. Wine and your health
6. Health tip to share - Thyroid replacement and calcium
7. Humor is healthy
Spread the word! Send a copy of this newsletter
to someone you know.
Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Boosting your energy naturally
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Fatigue, lack of energy. This is probably the
number one complaint physicians hear from
patients. While fatigue can be due to medical
conditions or medications, the most common cause
is due to lifestyle factors and habits.
If lack of energy is one of your complaints ask
yourself these questions before going to the
doctor.
Are you getting 7-8 hours of sleep each night?
Do you get sleepy after meals?
Do you exercise 3 times a week or more?
Are you having more than one caffeine or alcohol
servings per day?
Are you spending time outside each day?
Do you feel positive each day, not angry or
depressed?
Lack of sleep is a big cause for fatigue as well
as irritability. Sleepiness after meals is due to
high insulin levels. It means you are eating too
much and should cut back to smaller meals perhaps
more frequently.
Regular exercise and getting out in the daylight
each day helps keep the biologic clock functioning
correctly. Caffeine and alcohol deplete body water
as well as cortisol levels, your stress hormone.
If you go through each day angry about something,
you also deplete your cortisol and fight or flight
hormones. Depression and fatigue go hand in
hand.
Dr. Andrew Weil has a few energizer tips for you
to pick it up naturally.
Natural energizers
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Plantar fasciitis heel pain
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Pain on the bottom of the foot where the heel and
arch join that is worse in the morning and eases
later in the day is often due to a condition
called plantar fasciitis. This is an inflammation
of a foot tendon that connects to the heel and
runs across the bottom of the foot.
The pain worsens overnight as the tendon contracts
and gets better with use of the foot during the
day as the tendon stretches. The original insult
to the tendon is actually over stretching. The
over stretching injury is what leads to the
inflammation of the tendon.
Causes of over stretching the plantar tendon may
be:
an unusually high arch
a sudden increase in physical activity
excessive weight on the foot, often due to
pregnancy or being overweight
improperly fitting footwear
Treatment for plantar fasciitis is non steroidal
anti-inflammatory medications like ibuprofen or
naproxen and also eliminating the cause. You
should avoid running on hard surfaces and lose
weight if needed. Orthotic appliances and properly
fitting shoes are also needed.
For more explanation, see foot.com :
Heel pain from plantar fasciitis
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - ASCUS Pap under age 50
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
[We had a recent article noting that ASCUS Paps
over the age of 50 had a lower incidence of
progressing to dysplasia - 13% vs 30%]
"Today's newsletter talked about "ASCUS Pap smears
over age 50". Do you have information for woman
under 50 with the same condition? The higher risk
to get dysplasia for woman under 50?"
"I have been experiencing ASCUS on and off for
last 5 years and don't seem to be cured. Dr. told
me that it is more worrisome for younger woman
with this condition because it could develop to
cervix cancer."
"Is there cure for ASCUS or even for dysplasia?"
Anonymous
Women under age 50 have a higher progression of
ASCUS pap smears to dysplasia than do menopausal
women, but the rates vary considerably depending
upon the population studied and the accuracy of
the laboratory used. Most studies (see below) will
quote a lower rate of progression to dysplasia
than the 30% listed in the previous study.
The point is that it is quite rare for the lesion
to progress all the way to an invasive cancer as
long as repeat Pap smears are monitored. Pap
smears that show only ASCUS can be followed for a
long time. Since your Pap has not worsened in 5
years, that is a fairly good sign it is not going
to progress at all.
On the other hand, 5 years is a very long time to
worry about this and undergo the hassle of
frequently repeated Pap smears. It might be time
to ask your physician to treat the cervix with
some method to get it to produce normal cells and
a normal Pap smear. ASCUS changes and even
dysplasia are curable by destroying the cervical
surface cells by freezing, cautery, LEEP, laser
and any procedure that destroys the abnormal cells
and stimulates the body's normal cells to repair
the damaged ones.
To see how different grades of Pap smears
progress, see our previous article at:
Natural progression of an abnormal Pap smear
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Endometrial polyps and hysteroscopy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Some physicians are still not performing a
hysteroscopy (looking into the cavity of the
uterus) at the time of a dilatation and curettage
for abnormal uterine bleeding or postmenopausal
bleeding. The problem with omitting the
hysteroscopy is that anatomical causes of bleeding
such as fibroids or polyps are missed.
This study in the American Journal of Obstetrics
and Gynecology looked at just doing a regular D
and C not using hysteroscopy and then doing an
additional hysteroscopy. They found that the D and
C alone missed quite a few polyps (57%).
Just be sure that if your doctor suggests a D and
C that you ask whether a hysteroscopy will be
performed. It is much more accurate. Also, if you
have an abnormal endometrial biopsy, that should
also be followed up with a hysteroscopy and D and
C because the biopsy can miss abnormal tissue.
Endometiral polyps and hysteroscopy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Wine and your health
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Almost anything ingested to excess is bad for your
health. In moderation, however, many substances
can actually be beneficial, even alcohol in the
form of wine.
Wine lowers total cholesterol and raises the good
HDL cholesterol. It also has anti-cancer agents
that help protect against cancer. The net result
is that it significantly reduces all-cause and
particularly cardiovascular mortality when
compared with individuals who abstain or who drink
alcohol to excess.
Actually the benefit may not be confined to wine.
Studies looking at the relative benefits of wine
versus beer versus plain alcoholic spirits suggest
that moderate consumption of any alcoholic
beverage is associated with lower rates of
cardiovascular disease.
Moderate in the case of women means no more than
one glass of wine a day but that one glass on a
regular basis.
Wine and your health
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Thyroid replacement and calcium
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"At age 37 I was diagnosed with hypothyroidism.
This caused many health problems that increased
throughout the years. One of these problems was
waking up as tired as when I went to bed. Years
later it was suggested to me that lack of the
proper kind of calcium may be the problem. I was
taking oyster shell with Vitamin D."
"I made a trip to the health food store and was
handed a bottle of calcium. I still had the same
problem and took the calcium back and was handed
what was said to be the best they had in the
store. It was Calcium and Magnesium Asporatate -
it was in capsule form, citrate calcium with
dandelion root that will provide the vitamin D.
That night I got my first nights sleep in years."
"I have since learned more about thyroid disease
and know that calcium and also iron need to be
taken 4 hours apart from your thyroid hormones
because it can bind the thyroid hormone so less is
absorbed. You need to take the calcium at night
before going to bed and the thyroid hormones early
in the morning. Waiting 1 hours before eating
anything." A.
If you have discovered ways of coping with a
disease or condition and it works for you, please
share it with us:
Health tip suggestion form
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
7. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"PMS Advice"
Every "Hormone Hostage" knows that there are days
in the month when all a man has to do is open his
mouth and he takes his life in his hands. This is
a handy guide as a discussion tool or simply print
it out and give it to your loved one to keep in
his wallet...
DANGEROUS: What's for dinner?
SAFER: Can I help you with dinner?
SAFEST: Where would you like to go for dinner?
DANGEROUS: Are you wearing THAT?
SAFER: Gee, you look good in brown.
SAFEST: Wow! Look at you!
DANGEROUS: What are you so worked up about?
SAFER: Could we be overreacting?
SAFEST: Here's fifty dollars.
DANGEROUS: Should you be eating that?
SAFER: You know, I've got lots of apples left.
SAFEST: Can I get you a glass of wine with that?
DANGEROUS: What did you DO all day?
SAFER: I hope you didn't overdo today.
SAFEST: I've always loved you in that robe.
From: Joke du Jour
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** Woman's Diagnostic Cyber Newsletter *******
February 25, 2001
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Know the signs of heart attack and stroke
2. Cooling coworker conflict
3. Reader submitted Q&A - Restless legs
4. Tubal sterilization reversal
5. Pain meds may be associated with miscarriage
6. Health tip to share - Morning nasal congestion
7. Humor is healthy
Spread the word! Send a copy of this newsletter
to someone you know.
Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Know the signs of heart attack and stroke
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
It is very healthwise to know the common and
uncommon symptoms of a heart attack because
quickly seeking medical care can save your own
life or that of an accompanying relative or
friend. From the American Heart Association we
learn that the most common symptoms of a heart
attack are:
a pressure, fullness, squeezing or pain in the
center of the chest that lasts more than a few
minutes, or goes away and comes back
pain that spreads to the shoulders, neck or arms
chest discomfort with lightheadedness, fainting,
sweating, nausea or shortness of breath
Sometimes there are some less common signs and
symptoms of a heart attack that include:
atypical chest pain, stomach or abdominal pain
nausea or dizziness (without chest pain)
shortness of breath and difficulty breathing
(without chest pain)
unexplained anxiety, weakness or fatigue
palpitations, cold sweat or paleness
They also tell us that signs and symptoms of a
stroke are:
sudden weakness or numbness of face, arm or leg
especially on one side of the body.
sudden confusion, trouble speaking or
understanding.
sudden trouble seeing in one or both eyes.
sudden trouble walking, dizziness, loss of balance
or coordination.
sudden, severe headache with no known cause.
Study these above symptoms and keep them in the
back of your mind. Check out the American Heart
Association web site.
Signs of heart attack and strokes
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Cooling coworker conflict
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Stress not only comes from yourself and relatives
in the home environment but many times originates
at work. Not all workplaces can have a pleasant
and friendly environment.
The secret to coping with stress from
interpersonal interactions at work is to recognize
that you cannot change anyone else's behavior. You
can only change your reaction to someone else,
escape the anxiety provoking situation, or
practice stress reduction techniques.
Escape is not a long term solution but some things
you can do include:
use vacation time (days, not weeks) as getaway
time
distance yourself from the situation when you
feel anger coming on
Stress reduction techniques include:
work off your frustration with exercise
practice relaxation techniques such as deep
breathing or yoga have a life outside the office
The most difficult of stress management is to
change your reaction to the behavior of others.
You must realize that most of others' behavior is
just their method of reducing their own stress
rather than being targeted specifically toward
you. Other tricks to change your own reaction
might be:
don't waste your precious mental energy on every
squabble
tell co-workers what's bothering you using "I"
statements
use no accusation or blame statements
use humor when someone talks about you
Most of all, if you absolutely cannot change your
reaction to coworker's behavior or comments, look
for somewhere else to work.
Cooling coworker conflict
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Restless legs
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I would like some information on restless leg
syndrome and what are some of the things that you
can do to help it."
"I am 31 years old- Had to have a hysterectomy 2
months ago and I am hypothyroidism and currently
take estradiol and Synthroid. After surgery my
physician put me on Elavil to help me sleep and it
gave me restless legs worse than I have ever had -
Please give some suggestions or information."
B.N.
Restless legs syndrome is a sleep disorder
characterized by a creepy, crawly sensation in the
legs just before falling asleep. It can also feel
like pins and needles and can occasionally occur
in the arms also. It is more bothersome at night
although it can occur at any time of rest or
inactivity. During the night, jerky leg movements
may keep your bed partner awake.
This condition is worsened by lack of sleep and
also by menopause. If you had your ovaries
removed, you should make sure you are on high
enough doses of estradiol (about 2 mg per day by
pill or 0.2mg/day by patch) otherwise the lack of
estrogen is worsening, but not causing, your
restless legs syndrome.
The usual treatment is to eliminate all caffeine,
alcohol and exercise within 6-8 hours of bedtime.
Medications usually include agents that increase
the body's dopamine. This is a neurological
condition different from but similar in treatment
to Parkinson's disease.
The Elavil (R) probably does aggravate your
condition and there are much better drugs for
this. You will need to see a sleep specialist or a
neurologist if there is not a sleep specialist
near you. Your doctor should be able to refer you.
For more information about restless legs syndrome,
you may want to see this fact sheet at the RLS
Foundation web site:
About Restless Legs Syndrome
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Tubal sterilization reversal
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Tubal ligation should be considered a permanent
sterilization procedure. Sometimes situations
change, however. A child or a husband may die or
divorce and remarriage may change the
circumstances.
The surgical procedure that reverses tubal
ligation is called a tubal reanastamosis. The ends
where the tubes were previously ligated are
excised to fresh, unscarred, undamaged tubal
tissue. Then the ends of the tube are sewn back
together.
How successful is this procedure? It varies quite
a bit depending upon how much damage to the tube
was done from the original tubal ligation and
where in the tube the ligation was performed. The
most successful reversal rates are 85% if a clip
procedure was performed to a lower success of
about 35-50% if extensive cautery was used for the
original surgery.
Cost of the reversal is also variable and is not
covered by insurance plans. Typical costs may
range in the U.S. from $2500 - $5000.
Tubal ligation reversal
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Pain meds may be associated with miscarriage
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Non steroidal anti inflammatory drugs (NSAIDs) are
not usually recommended in the U.S. to take during
pregnancy. Unfortunately they are commonly taken
in over-the-counter preparations by many non
pregnant women and some pregnant women. Typical
NSAIDs might include aspirin, ibuprofen
(Advil®), or naproxen ( Aleve®,
Anaprox® DS) among others.
Some investigators believe NSAIDs may cause birth
defects or premature deliveries while others
question whether this is true. Large studies
looking at possible adverse pregnancy outcomes
from NSAIDs have not been done.
This study carried out in Denmark looked at almost
1500 women who had taken NSAIDs and compared them
with over 17000 women who had not taken any
medications during pregnancy. They found that
there was a much higher incidence of miscarriages
in women who took the NSAIDs in the weeks before
the event, a risk ratio of almost 7 times higher
than women who did not take NSAIDs. If women took
the NSAIDs 7-9 weeks before the miscarriage they
still had an increased risk ratio of over 2.5
times.
Thus it is important if you are at all trying to
conceive to avoid any NSAID pain pills even before
you conceive.
Pain medications and miscarriages
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Morning nasal congestion
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"When you wake up congested, and you don't have
time for a bath in the morning, try using bath
salts anyway. Juniper or eucalyptus salts work
very well. I sprinkle some on the floor of my
shower (back far enough so they don't get rinsed
away) and the moisture and steam triggers the
effectiveness of the salts. It's extremely
pleasant and effective yet doesn't take alot of
time. It opens you up and gets you going !! Hope
you enjoy it too !!" - Kelli
If you have discovered ways of coping with a
disease or condition and it works for you, please
share it with us:
Health tip suggestion form
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
7. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
SIGNS OF INTEREST
1. Veterinarian's office sign: "All unattended
children will be given a free kitten."
2. In parking lot outside vet's office in
Silverton: "Parking for customers only, others
will be neutered."
3. In a veterinarian's waiting room: "Be back in 5
minutes. Sit! Stay!"
4. Plumber: "We repair what your husband fixed."
5. At a tire shop in Milwaukee: "Invite us to your
next blowout."
6. Door of a plastic surgeon's office: "Hello, can
we help pick your nose?"
7. At a towing company: "We don't charge an arm
and a leg. We want tows."
8. On an electrician's truck: "Let us remove your
shorts."
9. In a non-smoking area: "If we see you smoking,
we will assume you are on fire and take
appropriate action."
10. On Maternity room door: "Push, Push, Push."
11. At an optometrist's office: "If you don't see
what you're looking for you've come to the right
place."
12. On a taxidermist's window: "We really know our
stuff."
13. In a podiatrist's office: "Time wounds all
heels."
14. On a fence: "Salesmen welcome, dog food is
expensive."
15. Outside a muffler shop: "No appointment
necessary, we'll hear you coming."
16. Inside a bowling alley: "Please be quiet, we
need to hear a pin drop."
17. In the front yard of a funeral home: "Drive
carefully, we'll wait."
18. In a counselor's office: "Growing old is
mandatory, growing wise is optional."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** Woman's Diagnostic Cyber Newsletter *******
March 4, 2001
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Recognizing a subdural hematoma
2. The care of menopausal skin changes
3. Reader submitted Q&A - postmenopausal yeast
4. Psychological causes of decreased sexual desire
5. Heart arrhythmias
6. Health tip to share - Using a pessary
7. Humor is healthy
Spread the word! Send a copy of this newsletter
to someone you know.
Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Recognizing a subdural hematoma
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
A fall with a bump on the head, hitting your head
on a cupboard corner, no loss of consciousness but
perhaps seeing stars for a few seconds. Then in
the next week or two or three, a general feeling
of not doing well, having difficulty with normal
daily tasks, mild headaches and tiredness. These
can be signs of bleeding inside the skull putting
pressure on the brain.
The events leading up to and the signs and
symptoms of a subdural hematoma can be subtle. It
happens more often to older people but can occur
at any age. Since the head injury may be nothing
more than a sharp bump on the head without
immediate problems, it is often ignored as a
serious medical problem. If untreated, however,
paralysis can occur as well as permanent memory
damage.
Symptoms of a subdural hematoma include:
Mild to moderate headaches that do not get better
and, in fact, slowly seem to get worse
Desire or need to sleep more
Blurred or decreased vision
Trouble speaking or understanding speech
Loss of balance or fine motor skills
Numbness, weakness or paralysis on one side of the
body
The lesson is if you bump your head, be sure to
have it medically checked out and even followed up
later if you do not feel up to par.
Recognizing a subdural hematoma
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. The care of menopausal skin changes
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Our skin does not last forever and at the time of
menopause it seems to have more problems all of a
sudden. Loss of estrogen causes a decrease in
sebum production. If you were still a teenager
this might be a good side effect but when
menopausal, it leads to dryer skin that shows
wrinkles easier.
The male type androgen hormones become more
prominent in some women at the time of menopause
or at least are not as well counterbalanced by
estrogen. this can result in unwanted hair growth
or even loss or thinning of hair on the head or
body.
Skin tags or growths called seborrheic keratoses
seem to come faster right after menopause and
removal of these by a dermatologist may be needed.
Graying of hair is an aging problem and not caused
by menopause per se, but all of this seems to
happen at the same time.
You may want to see how a woman dermatologist
handles these problems after her own menopause to
see if you can get some tips for menopausal skin
management.
The care of menopausal skin changes
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Postmenopausal yeast infections
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I had a complete hysterectomy 4 months ago and
have been feeling great. Except I keep developing
monthly what seems to be a yeast infection (but
without much discharge). It is REALLY aggravating
and painful. I see my gyn who prescribes
Diflucan(R) (the last time she prescribed 5 to
me). My husband has also been treated with the
same. Yet, every month here it comes again!
Could this be related to my hormones? I am using
the Climara(R) patch and have NOT experienced any
other problems. Thank you." - Arlene
Chronic yeast infections are actually uncommon
after the menopause. Most frequently, symptoms like
you describe are an irritant vulvitis which is a
secondary bacterial or yeast skin inflammation of
the vulva. It is not from yeast (candida) from the
inside of the vagina. It can be secondary to
pads, topical chemicals from soaps, creams or
powders, urine leakage, just washing with soap too
frequently or too low an estrogen dose.
There are a couple of exceptions to this. If you
develop diabetes, a yeast vulvovaginitis can be
common after menopause. The other situation is one
that dermatologists caution us about and that is
the situation in which a woman has yeast organisms
on her feet which contaminate underwear as it is
put on. the yeast cells seed the vulvar area and
if there is any skin irritation, a yeast vulvitis
can ensue. There are not good scientific studies
that indicate how much of a problem this is but it
is good to keep in mind if you continue to have a
recurrent yeast vulvovaginitis at any age. A
shampoo such as Nizoral(R) used on the feet may
help this.
If you are under age 50 and had a surgical
menopause, the estradiol dose in even the largest
strength Climara(R) patch may be too low for you.
Be sure to have your blood sugar checked and also
a vaginal culture to confirm the yeast is from the
vagina. If the blood sugar and culture are
negative, then you are having an irritant vulvitis
which is a different problem. You may want to
discuss raising your estrogen dose, using a
topical vaginal estrogen such as an Estring(R) and
using good skin care practices to prevent vulvar
skin breakdown.
See our patient instruction sheet at:
Instructions for chronic vulvar pain management
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Psychological causes of decreased sexual desire
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
With the exception of sudden hormonal decreases
around the time of surgical or natural menopause,
the most frequent causes of decreased sexual
desire are psychological conditions or
circumstances that suppress desire. To make things
worse, when a woman is having those conditions or
feelings, it is very difficult for her to see the
cause and effect.
AT Newshe.com from the Female Sexual Medicine
Center at UCLA Medical Center, some of the
identified psychological causes are:
depression
dysthymia
stress
sexual or emotional abuse
drug or alcohol abuse
sexual addiction
body esteem or self image problems
relationship problems
If you suspect some of these conditions may be
affecting your sexual desire, it is important not
to wait too long before seeking help from a
trained sex therapist professional. Do not wait
until your relationship is totally falling apart
before seeking help.
For a brief discussion about how the above
psychological conditions may contribute to libido
problems, see:
Psychological causes of decreased sexual desire
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Heart arrhythmias
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The normal heart rate at rest is 60-100 beats a
minute. When a person feels her own heart beating
that is called palpitations. Some women are more
aware of their heart beat while others only feel
palpitations when the beat is faster than normal
or irregular. Either fast heart beats or irregular
heart beats should be be investigated to see if
they represent heart arrhythmias.
Many heart arrhythmias are benign and not
worrisome while others can be life threatening.
The causes of arrhythmias can be unknown or they
may be due to coronary heart disease, previous
heart attacks with heart muscle damage, or heart
valve problems.
The EKG may miss arrhythmias that occur
irregularly so a 24 or 48 hour continuous EKG
monitor is needed to diagnose the exact type of
heartbeat irregularity. This often quantitates the
most common arrhythmia, ventricular ectopic beats
or premature ventricular contractions (PVCs). PVCs
are generally benign but may be worsened by
certain medicines, caffeine and alcohol.
For a list of some of the other arrhythmias and
their treatments, see:
Abnormal heart rhythms
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Using a pessary
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"It has been over a year now since I had the
information from the Woman's Diagnostic Cyber
network about a pessary and got one."
"I went for my yearly checkup and all my tests
were in normal range. I keep the pessary
immaculately clean, I douche two times a week and
clean it daily. I keep my weight down and work out
daily. All these factors play a important role in
everyday health and play a factor in not having to
have surgery for something that may be avoided."
"I encourage you women to try a pessary (if you
have prolapse, cystocele or rectocele). After all,
once surgery has removed everything, what is there
to try, Try this first, what do you have to lose,
Trust me, you have your health in your own hands."
- C.S.
If you have discovered ways of coping with a
disease or condition and it works for you, please
share it with us:
Health tip suggestion form
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
7. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Women and Mirrors..."
Age 3: Looks at herself and sees a Princess!
Age 8: Looks at herself and sees herself as
Cinderella / Sleeping Beauty.
Age 15: Looks at herself and sees herself as
Cinderella / Sleeping Beauty / Cheerleader; or if
she is PMSing, sees Fat / Pimples / UGLY ("Mom, I
can't go to school looking like this!").
Age 20: Looks at herself and sees "too fat/too
thin, too short/too tall, too straight/too curly"
--but decides she's going out anyway.
Age 30: Looks at herself and sees "too fat/too
thin, too short/too tall, too straight/too curly"
--but decides she doesn't have time to fix it, so
she's going out anyway.
Age 40: Looks at herself and sees "too fat/too
thin, too short/too tall, too straight/too curly"
--but says, "At least I'm me," and goes out
anyway.
Age 50: Looks at herself and sees "I am" and goes
wherever she wants to go....the hell with the
\\\doctors.
Age 60: Looks at herself and reminds herself of
all the people who can't even see themselves in
the mirror anymore. Out she goes unafraid of the
world, seeks new experiences.
Age 70: Looks at herself and sees wisdom, laughter
and ability. Goes out and enjoys life..... and
enjoys being her.
Age 80: Doesn't bother to look. Just puts on a
purple hat and goes out to have fun with the
world.
Maybe we should all grab that purple hat a little
earlier!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** Woman's Diagnostic Cyber Newsletter *******
March 11, 2001
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Comparison prescription shopping on the Net
2. Enough oxygen when flying?
3. Reader submitted Q&A - OCD, depression and menses
4. ERT, Leiden and risk of thrombosis/heart attack
5. Effectiveness of an Internet weight loss program
6. Health tip to share - Perineal odor
7. Humor is healthy
Spread the word! Send a copy of this newsletter
to someone you know.
Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Comparison prescription shopping on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Comparison shopping web sites like mySimon.com are
quite helpful when you know exactly what product
you want and you want to find the least expensive
source that you can on the Net. Now there are
comparison shopping sites for pharmaceutical
prescription medications, herbs and vitamins and
other beauty and personal health care products.
Destinationrx.com is one such site that spiders
pharmacies that are verified by the National
Association of Boards of Pharmacy. You can go to
the site and search on a specific brand or a
generic product. You can also search by a medical
condition to see what different medications are
used to treat something like hypertension for
example. Also there is a section to search by
insurance companies to see if a specific product
is covered by your plan.
For example if you were taking Premarin 0.625 mg
as estrogen replacement and you wanted to compare
to estradiol 1 mg, you might find the price
difference is substantial (about $47.00 vs
$12.00 for 90 tablets). While not all physicians
would admit these are equivalent medicines, for
many women the difference would not be noted.
Prescription shopping on the Net - Premarin 0.625 (90)
Prescription shopping on the Net - Estradiol 1 mg (90)
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Enough oxygen when flying?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Airplanes have plenty of oxygen in the cabin but
because the air pressure is lower, equivalent to
being on an 8000 foot mountain, less oxygen
reaches the blood. Originally the standards were
set by testing healthy military men and this
pressure was felt to be quite adequate. With an
increase (although still quite unusual) of
fainting and heart attacks on airplanes, cabin
pressure levels are being questioned.
More and more people with medical conditions are
flying and anyone with heart problems or
respiratory problems should be wary. It doesn't
mean you should not fly but be aware of any
increased headaches or fatigue with flying. This
can be a sign of low oxygen tension in the blood.
For a discussion of this, see:
Enough oxygen when flying?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - OCD, depression and menses
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I have been treated for OCD (obsessive compulsive
disorder) and depression for the past 3-4 years
with much success until recently. I began having
'breakthrough' episodes that really seemed to
coincide with my menstrual cycle. My symptoms
would worsen around the time of ovulation and
lessen with the beginning of my period. I also
have PCOS and insulin resistance and am being
treated accordingly for those. My question is:
what is the correlation between my female hormones
and this OCD/depression?" - K.
There is a correlation between depressive symptoms
and menses as well as obsessive compulsive
disorder (OCD) and menses. Both have worsening
symptoms in the week or two before menses, i.e.,
in the 2 weeks after ovulation. The symptoms are
often twice as bad on objective scales. It is very
possible that with your polycystic ovarian
syndrome you were not ovulating at all or at least
regularly. Therefore you did not have ovulation
and symptoms did not noticeably worsen before
menses.
Now with treatment for insulin resistance, we know
that ovulation occurs more frequently in PCOS
patients. Therefore if you have just noticed the
relationship of OCD and depression symptoms since
treatment for insulin resistance, there is a good
explanation for it.
We know from PMS studies that depression worsens
before menses. In fact about 5% of women with PMS
actually just have depression that worsens
premenstrual. The literature also has studies that
indicate worsening of OCD before menses,
especially in those women who have eating
disorders and who are chronic hair pullers
(trichotillomania).
For a discussion of premenstrual syndrome symptoms
and disorders often confused with PMS, see our
article at:
PMS vs. Premenstrual Dysphoric Disorder (PMDD)
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. ERT, Leiden and risk of thrombosis/heart attack
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Postmenopausal estrogen replacement has a very low
risk for blood clots or vascular occlusion leading
to heart attacks. The risk is about 4 per 10,000
women compared to about 1 or 2/10,000 women not
taking ERT. The risk goes up, however if you
already have coronary artery disease to about 3-
4/1000 women. There is a subgroup of women,
however, who are at much higher risk for
thrombosis if they use estrogen replacement.
Certain women have a genetic risk for developing
blood clots, pregnancy vascular complications and
strokes or clots to other body areas. These
genetic variants go under the weird names of
factor V Leiden, prothrombin 20210, methylene
tetrahydrofolate reductase (MTHFR677) and factor V
HR2 haplotype. By far the most common is factor V
Leiden deficiency. Women who have anticardiolipin
antibodies have a higher incidence of this.
Only about 6% of the Caucasian population and 3%
of the African-American population have these
genetic changes. In the study below,
postmenopausal women who had previously had a
heart attack (myocardial infarction) were followed
for 3 years and analyzed for hypertension and
factor V Leiden and prothrombin 20210 GA variants.
They found not only that women who have
hypertension have a higher risk of heart attacks
but those who had hypertension and the genetic
variation AND took estrogen replacement were at an
11-fold risk for non-fatal heart attacks.
These findings have been confirmed in other
studies and the net result of this is that if you
have had a history of blood clots, stroke, other
vascular thromboses or pregnancy abruption
problems, then you should consider asking your
doctor to check you or refer you to be tested for,
factor V Leiden factor deficiency. This test is a
cDNA-PCR test of the prothrombin gene (about
$150). If you are positive, you should avoid
taking hormonal replacement therapy.
ERT and risk of thrombosis and heart attack
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Effectiveness of an Internet weight loss program
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
There are several resources on the Internet for
weight loss and quite a large amount of
educational, informational articles. Some net
programs include more than just articles and chat
areas. They include active email assignments, form
submissions, email reminders and other
encouragements to continue sticking to a diet.
One recent study looked at 91 hospital employees
who were overweight. Half of the group were given
organized links to informative resources on the
Internet to read about weight loss. The other half
received additional behavioral procedures,
including a set of "24 weekly behavioral lessons
via e-mail, weekly online submission of self-
monitoring diaries with individualized therapist
feedback via e-mail, and an online bulletin
board".
In the group receiving active, behavioral
intervention, the average weight loss at 6 months
was 4.1 kg (9 lbs.) while in the group having
primarily educational links, the weight loss at 6
months was 3.3 kg (7.25 lbs). The difference is
not much but remember that many drug studies of
appetite suppressants do not show much more
difference on the average.
Effectiveness of an Internet weight loss program
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Perineal odor
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Ladies, I know this is tedious, but I know that
odors are also very disturbing. I usually bring a
washcloth and clean myself 2-3 times a day,
usually after I use the bathroom, in addition to
showering in the evening. This will help a lot.
If you don't like the washcloth, use baby wipes,
or even the tissue that is in the bathrooms, just
bring your soap, and wash. Actually, this makes
me feel so much better and more confident about
myself." - Anonymous
If you have discovered ways of coping with a
disease or condition and it works for you, please
share it with us:
Health tip suggestion form
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
7. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
GREAT TRUTHS ABOUT LIFE THAT LITTLE CHILDREN HAVE
LEARNED
1) No matter how hard you try, you can't baptize
cats.
2) When your Mom is mad at your Dad, don't let her
brush your hair.
3) If your sister hits you, don't hit her back.
They always catch the second person.
4) Never ask your 3-year old brother to hold a
tomato.
5) You can't trust dogs to watch your food.
6) Reading what people write on desks can teach
you a lot.
7) Don't sneeze when someone is cutting your hair.
8) Puppies still have bad breath, even after
eating a tic-tac.
9) Never hold a Dust-Buster and a cat at the same
time.
10) School lunches stick to the wall.
11) You can't hide a piece of broccoli in a glass
of milk.
12) Don't wear polka-dot underwear under white
shorts.
13) The best place to be when you're sad is
Grandpa's lap.
GREAT TRUTHS ABOUT LIFE THAT ADULTS HAVE LEARNED:
1) Raising teenagers is like nailing Jell-O to a
tree.
2) There is always a lot to be thankful for, if
you take the time to look. For example, I'm
sitting here thinking how nice it is that wrinkles
don't hurt.
3) One reason to smile is that every seven minutes
of every day, someone in an aerobics class pulls a
hamstring.
4) Car sickness is the feeling you get when the
monthly payment is due.
5) The best way to keep kids at home is to make a
pleasant atmosphere, and let the air out of their
tires.
6) Families are like fudge . . . mostly sweet,
with a few nuts.
7) Today's mighty oak is just yesterday's nut that
held its ground.
8) Laughing helps. It's like jogging on the
inside.
9) Middle age is when you choose your cereal for
the fiber, not the toy.
10) My mind not only wanders; sometimes it leaves
completely.
11) If you can remain calm, you just don't have
all the facts.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** Woman's Diagnostic Cyber Newsletter *******
March 18, 2001
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Toenail trouble: Causes and cures
2. Recurrence of dysplasia after LEEP
3. Reader submitted Q&A - Delaying menses with OCPs
4. Acidophilus and other probiotics
5. Quitting smoking support group web site
6. Health tip to share - Support garment for prolapse
7. Humor is healthy
Spread the word! Send a copy of this newsletter
to someone you know.
Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Toenail trouble: Causes and cures
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Foot care is often a neglected task and can result
in pain and infection that limits our activity.
Toenails can especially bear the brunt of neglect
and end up with a fungal infection, discoloration,
pain or even active bacterial infection of the
surrounding skin.
The most common problems include ingrown toenail,
black toe (or runner's toe), fungus toenail
infection and occasionally a bone spur under the
nail (subungual exostosis). Exercise or athletic
involvement are common causes of problems although
ill-fitting shoes in the toebox area are also
common culprits of toe problems.
Ingrown toenails produce infection in the skin and
even antibiotics will not cure this until the
ingrown toenail is removed. Black toe comes from
bruising of the toe (usually the large toe) with
blood under the nail. It arises from tight shoes
or the sudden starting and stopping movements that
jam the toe against the end of the shoe. If there
is not much pain it is best to leave the toenail
alone. Pain indicates pressure from the blood
under the nail and you may need to have a hole
drilled in the nail to relieve the pressure.
Fungus of the toenails, onychomycosis, can be very
difficult to get rid of once it sets up. While
natural treatments such as tea tree oil and thyme
oil applications can be tried, the quickest and
most effective treatment is medication such as
difluconazole (Diflucan[R]) or itraconazole
(Sporonox[R]). By quick we mean 6-12 months.
Removal of the nail can get rid of the fungus also
as long as the conditions that cause the fungus
(hot, sweaty feet, poor fitting shoes, poor foot
care) are reversed.
A bone spur under the nail can only be diagnosed
by xray. Pain is produced by pushing straight down
on the nail rather than at the sides. Removal of
the spur is the definitive treatment.
Check this article at runningnetwork.com for tips
on toenail care.
Toenail trouble: Causes and cures
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Recurrence of dysplasia after LEEP
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Women who undergo treatment of the cervix to get
rid of moderate or severe dysplasia are counselled
that treatment is not 100% successful. The main
reasons for this are two:
1) Not all of the tissue that has undergone
dysplastic change is removed by the LEEP
procedure, cryosurgery or cervical conization,
i.e., there is residual dysplasia.
2) Other cells which are infected by virus such as
HPV but which have not yet undergone dysplastic
change are still left behind because there is no
way of identifying those infected, but not yet
dysplastic cells.
The net result is that some women have recurrent
dysplasia even after standard treatment. This
study looked at the long term cure rate for
dysplasia after having a LEEP (loop electrical
excision procedure) in 184 women.
The overall, long term recurrence rate for
dysplasia after LEEP was only 9.2% at 6 months
but went as high as 31% with an average follow-up
of 2 years. In women who had high grade dysplasia
(moderate or severe dysplasia) and had all of the
dysplasia removed at LEEP (negative margins), the
recurrence rate was 26%; while if they had
remaining dysplasia, the recurrence rate was 55%.
You would think that with remaining dysplasia the
recurrence rate would be 100% but many times
dysplasia goes away on its own given time. As our
bodies mount an immune response the virus and its
changes are stopped.
The bottom line is that a LEEP is about 70%
effective in the long term for curing moderate or
severe dysplasia. If all of the dysplastic skin
changes are removed it is 75% effective but only
about 50% effective if there is still dysplasia
remaining behind after the procedure.
Recurrence of dysplasia after LEEP
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Delaying menses with OCPs
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Can you tell me how to use my birth control pills
to prolong getting a period? I have a vacation
coming up and my menstrual is scheduled to occur
right in the middle of it." Anonymous.
While birth control pills are normally taken with
21 active hormonal pills followed by 7 placebo or
iron pills, there are other ways of taking the
pills to control the timing of when you get your
menses.
Menses usually starts after no active hormone
pills for 3 or 4 days. That is why if you miss
more than two birth control pills, a menstrual
period often starts prematurely. Then it is best
to let it proceed and just start a new pack 7 days
after the first missed pill.
You could start your menses earlier than usual by
just discontinuing the active pills and starting a
new pack 7 days later. Ovulation rarely takes
place in less than 10 days after stopping a pill
so this should not lead to pregnancy unless you
forget to restart them at the correct time.
Rather than having your menses earlier and
starting a new cycle, you could start a new pack
right after the 21 days of active pills and then
your menses would be delayed by 3 weeks.
We know from women who take pills continuously for
endometriosis that eventually you may have
breakthrough spotting or bleeding if you continue
on active pills but that still should not affect
getting pregnant.
Be sure to see our instructions on birth control
pills for other questions about taking pills.
Instructions for birth control pill use
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Acidophilus and other probiotics
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Probiotics refer to bacteria and yeasts that help
rather than harm the body. Lactobacillus
acidophilus is one of the best known of these
helpful bacteria that colonize the mouth, the
gastrointestinal tract and the vagina in women. It
helps digestive function and keeps down harmful
bacteria by competing with them for limited
resources.
Antibiotics often disturb the balances of these
natural organisms. The result can be bad mouth
odor, diarrhea, yeast or bacterial vaginal
infections. Normally you do not need daily doses
of these probiotics but when vaginitis is a
problem or traveller's diarrhea greets you, then
taking some of these probiotics can be a natural
way of overcoming the disease-disturbed balance.
Milk and dairy products now have live cultures of
some of these bacteria added. Other sources
include supplements which are widely available in
powder, liquid, capsule, or tablet form at natural
health food stores and pharmacies. The organisms
in these preparations must be alive, however, not
dried up on the shelf. Therefore be cautious of
your source.
Conditions that may benefit from probiotics
include:
irritable bowel syndrome
chronic vaginitis
ulcerative colitis
diarrhea
You may also want to take some along with, and
after taking, prescribed antibiotics. For more
information about these natural organisms, check
out thenaturalpharmacist.com.
Acidophilus and other probiotics
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Quitting smoking support group web site
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Stopping smoking can be a painful experience
because it is an addiction that makes us lose our
voluntary control over choice of action.
Quitnet.org is based at the Boston University
School of Public Health and provides scientific
for the support of smokers trying to quit.
Their quitting guides are well-organized, concise
and very informative. They explain all about
addiction both physiologically and psychologically
as well as the phases that a quitter goes through.
The different prescription medicines that are
available are also explained and categorized and
appropriate warnings and side effects listed.
Informational sources available include:
Quitting Guides - help you plan your quit.
Quitting Calendar - details the day-to-day steps
to quit smoking.
National Directory - connects you to local
smoking cessation programs.
Pharmaceutical Guide - helps you sort out your
options to end your addiction.
Daily Tobacco News
The site also provides personal tools that a
smoker can use to aid in quitting:
Peer to peer support - means you are not alone
Quitting Tools - track your progress and
recommend strategies to stop smoking.
Quit Date Wizard - helps you set a Quit Date.
Q-Gadget - tracks lifetime and money saved.
Quit Tips and Anniversary Emails - provide long-
term support.
Personal Profile - puts you in control of what's
public, what's private.
Expert Counselors make sure you have the latest
information.
Support for smoking cessation
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Support garment for prolapse
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I saw your newsletter with a tip about wearing a
pessary for prolapse."
"I have a prolapsed uterus. While there are women
who can wear a pessary there are many women that
can't wear a pessary for various reasons such as
infection, slipping etc. I was in this predicament
until found a great new support garment for women
with prolapse. It's working wonders for me. It's
called the V-brace and it's available at
www.fembrace.com"
"I wanted to pass this tip along as I know there
are many women like me who can't have surgery and
who can't wear a pessary." - Elise
If you have discovere
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