****** Woman's Diagnostic Cyber Newsletter *******
June 17, 2001
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. What is obesity?
2. Recurrent yeast infections - A theory of cause
3. Reader submitted Q&A - HRT and breast cancer
4. Migraines and hormones - What you should know
5. Seniors are also at risk for HIV
6. Health tip to share - Wolff-Parkinson-White Syndrome
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. What is obesity?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The term 'obesity' hits us right in the midsection
-- or elsewhere. It is defined as a body mass
index (BMI) of 30 or higher. In other words, at
various heights for women, the following weights
or higher would be classified as obesity:
height weight lbs
5'0" 153
5'1" 158
5'2" 164
5'3" 169
5'4" 174
5'5" 180
5'6" 186
5'7" 191
5'8" 197
5'9" 203
5'10" 209
5'11" 215
6'0" 221
Unfortunately no other recipe than 'more calories
in than calories out' leads to obesity. Therefore
the primary treatment is a long term 'more
calories spent than are taken in'.
The main conditions known to promote obesity are:
genetics - with one or both obese parents, your
chances increase to 25-30%
medications - tricyclic antidepressants, steroids
including DepoProvera
aging - we all lose muscle mass as we age and our
calorie requirement goes down
hypothyroidism - about 2% of obesity is explained
by low thyroid function.
Inactivity - It is easy with sedentary activity to
expend 500 less calories a day. If eating goes on
the same rate as before this decreased activity, a
weight gain of almost 50 pounds a year is
possible.
For a list of suggestions as to how you might take
off some weight, see this article below at
Mayoclinic.com. Also see our past article on the
health consequences of an elevated BMI.
What is obesity?
Guidelines for Healthy Weight
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Recurrent yeast infections - A theory of cause
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Recurrent yeast infections can be difficult to
treat. One of the big questions that faces
physicians is whether a recurrent yeast infection
represents reinfection after successful treatment
or whether it represents reemergence of the yeast
overgrowth from an infection that was not
completely treated.
The following study tries to answer that question
by looking at the specific strains of yeast that
could be cultured after an infection. Yeast have
many different strains that can be measured by
their DNA configurations and other properties. In
a series of 22 women who had recurrent vaginal
yeast infections the investigators looked at
whether the recurrent infection had a different
strain of yeast than the previously treated one.
They found that the same strain of yeast was
responsible for the initial and recurrent episode
in 17 out of 22 women (77%). The other 5 women had
different strains or a different species of yeast
growing.
This implies that in about 3/4's of the cases,
perhaps we need to have longer courses of
treatment because the yeast does not seem to be
fully eradicated. The other 25 percent of cases
represent a vaginal environment that is simply
just too conductive to growing yeast and the
environment needs to be changed.
For those of you who have recurrent yeast
infections, you might ask you doctor about a
regimen of 100-150 mg of Diflucan once a week.
That has worked well in our practice although it
is not a common way to prescribe for recurrent
yeast. Remember also to change the environment by
taking lactobacillus acidophilus as a separate or
a food supplement.
Recurrent yeast infections
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - HRT and breast cancer
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"What are the risks of cancer when taking Fem-HRT?
I am 48 and my Dr. put me on it a year ago. I go
on it for awhile then read about HRT and quit
taking it for fear of cancer. But it does help
with severe hot flashes."
"My mother and grandmother never took HRT. They
both had strokes. My mom had throat cancer. I
worry about how safe Fem-HRT is." - T J.
This is a question the doctor cannot answer for
you; you have to answer it for yourself. Hormone
replacement therapy (HRT) has been used for
decades and there is a good body of knowledge
about the risks and benefits of it. Fem-HRT(R) is
a fairly new combination of estrogen and progestin
but both components have been used extensively
and there is no reason to think that it will react
or produce differently than other more extensively
studied HRT.
Estrogens have benefits and risks. You know the
short term benefits of the hot flash reduction and
counteraction of vaginal dryness. The long term
benefits are the protection of the new occurrence
of heart disease and osteoporosis. There also
appears to be a 50% reduction of colon cancer and
Alzheimer's disease in women who are on long term
HRT.
Menopause
The main concern most women have is the
possibility of a slightly higher incidence of a
well-differentiated breast cancer. The risk ratio
for developing breast cancer may be 1.3-1.4 to 1.
There are other factors that are more important
for breast cancer risk than taking HRT. The Gail
model is the most commonly associated risk
assessment tool to predict breast cancer risk and
the factors it uses are:
age
race
number of 1st degree relatives with breast cancer
age at first menstrual period
age at first delivery of a child
number of previous breast biopsies
previous history of atypical ductal hyperplasia on
breast biopsy
past history of ductal carcinoma in situ or
lobular carcinoma in situ
These above factors are much more important than
whether you take HRT. If you do have some of these
risk factors, use the Gail model to calculate your
risk. If you are at least 35 yrs of age with a 5-
year predicted breast cancer risk of 1.67% or more,
as calculated by the Gail model, then you would be
considered at high risk and I would not suggest
taking HRT.
Am I at risk for breast cancer?
Risk model software
If you are at high risk or are just concerned
enough that you do not wish to take HRT, then you
might want to consider taking phytoestrogens such
as that found in soy or red clover. It is only
about 50% as effective in preventing hot flashes
and preventing osteoporosis as estrogens but it is
better than not taking anything. Promensil(R)
which is available at health food stores and many
pharmacies is my choice (taking 40 mg of
isoflavones a day).
If you still have hot flashes, you may just need
to manage them conservatively.
The Non Hormonal Treatment of Hot Flashes
To summarize, this is an agonizing question for
all women. Try to read as much as you can and keep
an open mind. Discuss your specific concerns with
your doctor and when your questions seem to be
answered as best they can be, make your choice.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Migraines and hormones - What you should know
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
In women who have migraine headaches, the question
arises as to whether hormones will make the
headaches worse or if a woman who has migraines is
at risk for strokes from hormones. Traditionally
all types or forms of migraine headaches have been
lumped together when assessing for the risk of
ischemic stroke.
This article below represents a current
neurological opinion about the risk of stroke in
women with migraines and whether or not they take
hormones including oral contraceptives (OCs) or
postmenopausal estrogen replacement (HRT) therapy.
The opinion is based on how the International
Headache Society Task Force assessed the efficacy
of treatment of women with OCs or HRT.
It concludes that women who do not have an aura
with their migraines can take oral contraceptives
safely. If they do have migraines with aura or
have other risk factors for stroke (e.g., previous
stroke or ischemic heart disease) then they are at
risk if they take OCs. They also conclude that
postmenopausal hormone replacement therapy neither
increases nor decreases stroke risk in women with
migraines whether or not they have auras
associated with the headache.
An aura with a migraine is an unusual visual
episode of "seeing stars" or spots in the eyes,
seeing wavy or jagged lines or color patterns. The
visual disturbance usually precedes or coincides
with the headache; rarely it can take place even
without the headache.
Migraines and hormones - What you should know
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Seniors are also at risk for HIV
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"`When we were going together, I always used
condoms,' she said of her second husband, ... who
died seven years ago. `But when we got married I
felt, well, husband and wife, I didn't think he
could've had the (HIV) virus.'"
Doctors forget to counsel seniors about safe sex.
The Center for Disease Control (CDC) says that
AIDs is growing twice as fast among individuals
over 50 years of age as among those under 50
years old. The suspected reason for this is
basically because those under 50 are probably
using more precautions in sexual relationships
than are those older individuals.
There also seems to be a delay in diagnosis of
AIDs in more elderly individuals. This may be
because seniors have more medical conditions that
are difficult to differentiate from the early
symptoms of AIDs. Symptoms such as chronic fever,
sore throat or rashes may not trigger the
investigation for AIDs in seniors as it does in
younger individuals.
With the more frequent use of Viagra and a
refractoriness to using condoms by elderly men,
AIDs may continue to rise in frequency unless
physicians start to remind seniors about using
precautions and seniors themselves begin to
realize it can happen to them.
Seniors are also at risk for HIV
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Wolff-Parkinson-White Syndrome
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I have Wolff-Parkinson-White syndrome and my tip
on how to live with this is by taking my meds and
saying to myself 'it could always be a lot worse'"
:) Deborah
(editor note - Wolff-Parkinson-White syndrome is a
condition in which a rapid heart rate is caused by
abnormal electrical pathways in the heart.)
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Unity Candles
I was escorted to a wedding by my twenty-four-year-old
bachelor son. He appeared unaffected by the ceremony
until the bride and groom lighted a single candle with
their candles and then blew out their own. With that he
brightened and whispered, "I've never seen that done
before."
I whispered back, "You know what it means, don't you?"
His response: "No more old flames?"
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
****** Woman's Diagnostic Cyber Newsletter *******
June 24, 2001
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Bone density testing
2. Weight loss obsession
3. Reader submitted Q&A - Rectocele after hysterectomy
4. Laparoscopic surgery for uterine prolapse
5. Cancer in patients with hidradenitis suppurativa
6. Health tip to share - Breathing for relaxation
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. Bone density testing
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Unfortunately many insurance plans do not pay for
bone mineral density testing unless you already
have a diagnosis of osteoporosis. This makes it
very difficult to get an initial test to diagnose
whether you are at risk or not.
The 'gold standard' test for osteoporosis is dual
energy X-ray absorptiometry (DEXA) scan. It
measures the bone mass in the spine and hips which
are very important for predicting hip fractures
and spinal vertebrae compression fractures. It
also estimates total body bone mass. Unfortunately
a DEXA scan is expensive so other less costly
devices have been developed in order to estimate
bone loss.
These devices are explained in the article at
mayoclinic.com. They are made to measure the heel,
finger or wrist bone density. Those joints or
bones may or may not reflect the bone density in
the critical areas of the hip or the spine, so if
they are used for screening and the results are
abnormal, then the DEXA scan must be performed for
confirmation as to whether there is a problem at
the hips or in the spine.
Results are given in T-scores. Those T-scores
measure how far your measurements are away from
the average measurements of other women your age.
If you have a score of -2.5 or more (eg., -2.6, -
3.0) then that joint is at fracture risk. If the
score is -1.0 or less (eg., -0.5 or +1.5) then you
do not have osteoporosis in that joint.
There is a quite a variability among joints so
while one hip could be bad, the other may be
better than the average woman's. The scan is
repeated after a year's treatment to make sure
bone loss is arrested or even some bone is
restored.
Medicare now pays for screening scans even if you
do not yet have osteoporosis but if you meet the
following conditions:
If you are postmenopausal and at risk of
osteoporosis
If you have a condition called primary
hyperparathyroidism
If you have certain spinal abnormalities that
might indicate a fracture
If you are on long-term corticosteroid therapy,
such as prednisone
Bone density testing
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Weight loss obsession
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
We have written about obesity before as a health
risk and it certainly is. Even when women are not
significantly overweight, many are still obsessive
about dieting to the extent of being willing to
submit their bodies at any cost to the latest and
greatest weight loss plan.
The article below at personalmd.com points out a
survey where, if given a choice between losing 20
lbs permanently or living to 90 years of age, over
half of the women chose the weight loss. Thus it
is not for health reasons that most women
desperately want to lose weight. This trait has
made women very susceptible to the marketing
efforts of any company trying to sell a painless
weight loss solution.
With the last fen-phen diet debacle, women
literally lost their lives trying to diet. It is
this obsession with weight loss that makes women
especially prone to unproven or poorly tested diet
regimens. A woman needs to know the extent to
which she is targeted by companies trying to make
money. The companies hype the need for weight loss
and quickly offer to sell you the solution.
The moral of the story is not to be so gullible
for every new diet pill. To lose that gullibility,
a woman has to give up the obsession for weight
loss and just focus on lifelong healthy eating
habits. Don't let the marketers con you.
Women's weight loss obsession
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Rectocele after hysterectomy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Is it normal or usual to develop a rectocele
after a vaginal hysterectomy? Is surgery the only
way to repair/reverse the condition?"
"I am 56 and have had 4 children delivered
vaginally; menopause 2 years prior to surgery;
otherwise healthy." - J.A.E.
It is not normal to develop a rectocele right
after hysterectomy but it also is not unusual. The
most common reason for it to occur within a few
months is that the rectocele was not recognized
prior to surgery and thus was not repaired at the
time of the vaginal hysterectomy. It may not have
been symptomatic (difficulty with defecation) for
you before the hysterectomy because the uterus and
cervix which had dropped down somewhat could have
been preventing the rectum from protruding very
much and causing symptoms.
Another reason for rectocele occurrence closely
related to vaginal hysterectomy is lack of support
of the vaginal vault from the surgery itself. If
the ligaments from the sacral bone that are
primary support of the uterus and vagina are not
well attached to end of the vagina, or if with
coughing or straining after surgery those sutures
are broken or pull out of the tissue, then the end
of the vagina becomes unsupported. The vaginal
end (like the end of a sock), which is now the
superior portion of support of the rectovaginal
wall, will drop down with straining and allow the
posterior vaginal wall (rectocele) to protrude
from the vagina.
Finally, with any vaginal surgery and repair, the
weak points are reinforced and made stronger. Any
subsequent intraabdominal straining attacks the
weakest areas which then may quickly develop
herniation. Water behind a storm dyke will always
find the weakest area to break through and that
can happen in the pelvis. There may not have been
any recognizable weakness at the time of surgery
but as soon as the weakest areas were supported,
the rectocele quickly developed in an unrepaired
weak spot. This can happen especially where you
had an episiotomy or vaginal tearing with any of
your 4 vaginal deliveries. That weakness was never
evident until you became menopausal and the mesh
of blood vessels around the vagina (which gave
additional support) has shrunk and gone away.
If you have a rectocele now (you did not mention
if you did and how soon it developed), then the
main consideration is what other pelvic support
defects are still present. You do not want to have
a rectocele surgically repaired and then a few
years later find out you need bladder support
surgery and or vaginal vault suspension. Be sure
that your doctor is well versed with these
different support defects.
Remember that the main reason gynecologic surgeons
are able to remove the uterus vaginally is because
of pelvic support weakness. A woman who has not
delivered children vaginally will usually have to
have an abdominal hysterectomy or a laparoscopic
assisted hysterectomy and is much less likely to
develop these support problems because they did
not have weakening of the tissue in the first
place.
Muscle exercises such as Kegel's do not usually
help a rectocele. They can help stress
incontinence and anterior wall bladder support but
not posterior wall rectal support. A pessary, a
silicone object placed in the vagina, can give
support to the rectal wall and can be effective in
relieving some symptoms, but most women of your
age do not choose to use them for long term
treatment. Unless your health is bad, you will
probably want to have surgical repair so you can
remain physically active for several decades.
Cystocele, rectocele and pelvic support surgery
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Laparoscopic surgery for uterine prolapse
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Many women ask if uterine prolapse can be fixed
without having a hysterectomy. While vaginal
hysterectomy has been the most common treatment,
uterine prolapse can be treated with a
hysteropexy, or a suspension of the uterus.
In recent years, suspension of the uterus
(hysteropexy) has been performed via laparoscopy
so it can be done with only several small
incisions. It is not as effective as removing the
uterus but up until now we have not had good
statistics to know how successful it is.
The article below followed 43 women prospectively
for a year after a laparoscopic hysteropexy. They
found that approximately 80% of the procedures
were successful at preventing symptoms. Two women
even conceived after hysteropexy and delivered by
Cesarean section.
As long as a woman understands that this surgery
is not always successful, it is a very good
procedure to fix uterine prolapse. Symptoms of
early uterine prolapse, before the uterus/cervix
is actually protruding out of the vagina at rest,
are pelvic pressure, sometimes low back pain and
pain or discomfort with sexual intercourse when
the uterus is hit during the thrusting of sex.
If you think you may be having symptoms of
prolapse, discuss this with your doctor.
Laparoscopic surgery for uterine prolapse
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Cancer in patients with hidradenitis suppurativa
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Hidradenitis suppurativa is an infectious
condition of the sweat glands of the skin that
causes lumps and bacterial abscesses which may
drain pus. It is like having several to quite a
few boils on the skin very close together. It is
very difficult to treat.
The most common areas affected are the armpits
(axillae) and the vulva although anywhere with
sweat glands can be affected. A big question when
it affects the vulva is whether or not there is a
higher incidence of vulvar cancer in women with
hidradenitis of the vulva.
The following Swedish study looked at over 2100
people with hidradenitis of all skin locations and
determined how many of them had non melanoma skin
cancer. They did not just look at cancer of the
vulva but rather all skin cancers except the
malignant melanomas.
They found that those with hidradenitis had a 50%
increased risk for any type of cancer and had 4
times increased incidence of skin cancer.
Women with hidradenitis of the vulva (or any skin
location) need to be examined frequently for
possible cancer.
Cancer Among Patients With Hidradenitis Suppurativa
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Breathing for relaxation
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
A helpful technique for relaxing from the stress
of everyday life when you only have 5 minutes is
"tummy breathing". To do it, let your stomach just
below your ribs move out a little as you breathe
in, and then go back down when you breathe out.
Don't let your chest move when you breathe. Do
this softly and gently until it feels like you are
breathing into your stomach a little, maybe 5-10
breaths. Once you get used to it. Use this
technique to relax for about 5 minutes at a time.
(From respire.net)
Relax with tummy breathing
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Vacation Term Translation"
In case any of you are still thinking about
picking a vacation spot, be aware of the following
advertising lingo...
Old world charm ....................
No bath
Tropical ...........................
Rainy
Majestic setting ...................
A long way from town
Options galore .....................
Nothing is included in the itinerary
Secluded hideaway ..................
Impossible to find or get to
Pre-registered rooms ...............
Already occupied
Explore on your own ................
Pay for it yourself
Knowledgeable trip hosts ...........
They've flown in an airplane before
No extra fees ......................
No extras
Nominal fee ........................
Outrageous charge
Standard............................
Sub-standard
Deluxe .............................
Standard
Superior ...........................
One free shower cap
All the amenities ..................
Two free shower caps
Plush ..............................
Top and bottom sheets
Gentle breezes .....................
Occasional Gale-force winds
Light and airy .....................
No air conditioning
Picturesque ........................
Theme park nearby
Open bar ...........................
Free ice cubes
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
****** Woman's Diagnostic Cyber Newsletter *******
July 1, 2001
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Knee injury to anterior cruciate ligament
2. What is dysplasia?
3. Reader submitted Q&A-Constant menstrual bleeding
4. Endometrial hyperplasia rate of progression
5. Condom effectiveness in preventing herpes
6. Health tip to share - No BHT for herpes
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. Knee injury to anterior cruciate ligament
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Injury to the anterior cruciate ligament (ACL) of
the knee is a somewhat frequent sports injury. You
do not need to be a competitive athlete to injure
it, however. It can be injured from a slip-and-
fall, a sudden twisting motion, a hyper extension
injury in which the foot slips forward and the
knee goes backward or even the opposite in which
the knee goes suddenly forward while the foot goes
backward. Characteristically one hears a loud
"pop" sound when the ligament tears.
Women get torn ACL ligaments much more frequently
than men. In fact a recent study suggests that
women may tear the ligament more often at mid
menstrual cycle during ovulation than at other
times. No one is sure of why there is a gender
difference in frequency of a torn ACL.
The ligament is does not heal after it is torn.
All that can be done is to strengthen the muscles
surrounding the knee to keep the joint stable so
the main calf/shin bone (tibia) does not move
excessively across the main thigh bone (femur).
You can wear a knee brace to aid in stability of
the joint during any fitness activities. You may
need to alter your usual sports and leisure or
daily living activities so that the joint is not
reinjured. It may take years before the pain
finally leaves completely if you do not keep
reinjuring the knee.
Non surgical treatment with physical therapy, a
brace and altering daily activity is usually the
first choice of treatment but surgery can also be
an option. The ligament cannot be repaired but it
can be replaced. Since surgery can have
complications of permanent pain or continued joint
instability, it should not be undertaken lightly.
For a discussion of the pros and cons of surgical
versus non surgical treatment of a torn ACL, see
this article at Mayoclinic.com
ACL injuries. What is best for me?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. What is dysplasia?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Dysplasia is an abnormal growth of the skin cells
of the cervix, vagina or vulva. The nucleus of the
cell enlarges and the whole cell becomes more
active. Dysplasia is not cancer but it is felt
that dysplasia cells are on a growth pattern in
which they can turn into a cancer over time. When
the cells get to a point where they are so active
they are reproducing faster than they are dying
off, the extra cells grow into normal tissue and
become an invasive cancer.
No one knows for sure what causes these cells to
become so actively growing but it is strongly
suspected that certain strains of human papilloma
virus (HPV) cause or promote these changes. The
Pap smear picks up these nuclear activity changes
but in early phases it can not always distinguish
between inflammatory or irritation changes. These
Paps are classified as atypical squamous cells of
undetermined significance (ASCUS) or mild
dysplasia.
Much work is going on with HPV typing of abnormal
Pap smears (The Digene Hybrid Capture(R) HPV test)
to try to tell if the particular strain of HPV
that is associated with the abnormal Pap is one of
the "high risk" strains of HPV known to be
associated with cancer. In theory if the HPV is a
high risk type, doctors might need to be more
aggressive in treating the tissue involved rather
than waiting for the Pap smear to get worse before
treating. Conversely, if the virus associated with
an abnormal Pap is a low risk (for cancer) type,
then screening with repeat smears can be put off
longer. In practice, it becomes very expensive to
do both tests and the long term outcome is not
much different.
Some studies have even suggested that HPV typing
smears may be cost effective in replacing Pap
smears for the detection of moderate and severe
dysplasia to prevent cancers of the cervix. We are
not at that point yet but this test bears
watching.
Dysplasia 101
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Constant menstrual bleeding
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I have had nearly constant menstrual-type
bleeding for the last two years. I have been
diagnosed in the past with uterine cysts and
cervical dysplasia. Even though I am very
concerned about the bleeding, my gynecologist is
not. Should I get a second opinion?"
"I am 39, and have had regular periods from age 14
through 36. After the birth of my child (at 36),
periods have been very long (15-20 days) or I have
intermittent bleeding all month. I had one
laparoscopy after a "mass" was found, but nothing
was removed (it had disappeared)." - Gyl
Two years of constant bleeding is about 22 months
too long. If your doctor has not performed any
investigation into the cause of the bleeding then
you should definitely seek a second opinion.
You did not mention being on any hormone therapy
so at age 39, the most likely cause of this type
of bleeding is either polyps in the uterus or
fibroids. Some type of diagnostic testing needs to
be performed such as an ultrasound or saline
sonohysterogram or even going straight to a
hysteroscopy and D&C.
See our article below for an explanation of what
is involved in diagnosing and treating this
prolonged bleeding:
Constant Menstrual Bleeding at Age 39
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Endometrial hyperplasia rate of progression
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Hyperplasia of the lining of the uterus
(endometrium) is not the same as dysplasia of the
cervix. It is not associated with HPV or any other
virus as far as we know. However, it sometimes can
be considered a premalignant lesion just like
dysplasia. This is especially true if the
hyperplasia has areas in it microscopically that
the pathologist considers "atypical". Then there
is chance that this tissue, if left alone for a
time, could go on to form an invasive cancer of
the uterus (endometrium).
When a woman has abnormal uterine bleeding,
especially after the age of 35 or 40, and the
doctor performs and endometrial biopsy or D&C and
the tissue returns with hyperplasia, then there
may be a concern about this being a premalignant
lesion. One question we are commonly asked is
"what is the rate that these hyperplasias can go
on to turn into a cancer of the uterus?". There is
not good data to say precisely how worrisome this
is.
A recent Japanese study looked at 77 women with
endometrial hyperplasia and followed them 3 years
without any surgery other than doing a total
curettage every 12 months for 3 years. They looked
at how often the lesion progressed to cancer and
how often it just regressed to normal on its own.
They classified the hyperplasias into 4 grades:
simple hyperplasia without atypia (SH)
complex hyperplasia without atypia (CH)
simple hyperplasia with atypia (SHA)
complex hyperplasia with atypia (CHA)
They had the following findings for progression to
cancer and regression to normal:
Progression Regression
to Cancer to normal
SH 0% 79%
CH 0% 94%
SHA 0% 100%
CHA 9% 55%
Older studies indicate that any hyperplasia with
atypia can progress to cancer although complex
hyperplasia with atypia does so more often (up to
20%). The bottom line is that any endometrial
hyperplasia with atypia can go on to become
cancerous and should be monitored closely, but
the others can be followed with just periodic D&C
(not just endometrial biopsy) rather than having
to have a hysterectomy.
Endometrial hyperplasia progression
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Condom effectiveness in preventing herpes
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Herpes virus, type 2 (HSV-2), that infects the
vulva in women and penile skin in men, is for the
most part a sexually transmitted disease (STD). It
is estimated that over 22% of the adult population
has been infected with HSV-2. While condom use is
recommended to prevent transmission of any STD, we
are not sure how well condoms work to prevent
this. Women may get the active lesions on the
vulvar area where a condom will not be protective.
This study below in the Journal of the American
Medical Association (JAMA) looked at couples in
which one person was infected with HSV-2 while the
other one was not, as measured by blood
antibodies. They followed 528 couples over about
30 months and measured whether the HSV-2 free
partner contracted herpes or not. The methods they
used to try to reduce transmission were
encouragement of everytime condom use and
decreasing the frequency of sexual intercourse
when one's partner had an active herpes lesion.
They found:
Only 10% of the women and 2% of the men newly
contracted HSV-2
The rate of infection transmission with these
methods was approximately 1/1000 sex acts.
Younger partners and partners that were positive
for both HSV-1 (cold sore herpes) and HSV-2
had slightly higher transmission rates.
Condom use less than 25% of sexual acts was not
protective for women at all.
Therefore, while not perfect, condom use can
significantly reduce the transmission of HSV-2.
Condom effectiveness in preventing herpes transmission
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - No BHT for herpes
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
There has been a resurgence in interest in using
butylated hydroxytoluene (BHT) as a treatment for
genital herpes ulcers due to the resurrection of
some old articles in the Web. This is based on
studies about 15 years ago and topical BHT was
shown not to be significantly effective. Oral BHT
has also been used but it has liver toxicity and a
small margin of safety in comparison with lethal
doses in animals. For that reason it is NOT
recommended.
You would be better off using L-lysine (1000 mg
three times a day) which has been shown to reduce
herpes outbreaks. - FRJ
Herpes and topical BHT
L-Lysine for recurrent herpes
If you have discovered ways of coping with a
disease or condition and it works for you, please
share it with us:
/healthtip.htm
Health tip suggestion form
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
7. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Mother was having a hard time getting her son to
go to school in the morning.
"Nobody in school likes me," he complained. "The
teachers don't like me, the kids don't like me,
the superintendent wants to transfer me, the bus
drivers hate me, the school board wants me to drop
out, and the custodians have it in for me. I don't
want to go to school."
"But you have to go to school," said his mother
sternly.
"You're healthy, you have a lot to learn, you have
something to offer others, you are a leader. And
besides,
you are 45 years old and you are the 'Principal'."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
****** Woman's Diagnostic Cyber Newsletter *******
July 8, 2001
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Postmenopausal ERT use reduces cataracts
2. Marijuana chemicals for chemotherapy nausea
3. Reader submitted Q&A - It hurts during sex
4. How risky is vaginal birth after Caesarean (VBAC)
5. Cholesterol Challenge - low cost testing
6. Health tip to share - Diet and blood pressure
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. Postmenopausal ERT use reduces cataracts
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Estrogen replacement (ERT) during menopause has
previously been associated with a reduced
incidence of an eye disease called macular
degeneration that can lead to blindness, However,
there have not been consistent findings on whether
ERT reduces clouding of the lens of the eye which
results in cataracts and extremely poor vision if
not blindness.
This study in the Archives of Internal Medicine
looked at surviving members of the original
subjects of the Framingham Heart Study who also
participated in the Framingham Eye Study (1986-
1989). It included 529 women aged 66 to 93 years
and looked at their estrogen use versus how much
clouding of the eye lens they experienced. It also
looked at whether they had undergone surgical
versus natural menopause.
Basically the study found that estrogen use of 10
years or more resulted in a 60% reduction of
nuclear lens opacities. Also, women who underwent
natural menopause had a lower incidence of
opacities than women who had surgical menopause.
Their main conclusion was that "reduction in the
risk of lens opacities may be an additional
benefit of postmenopausal estrogen use."
ERT Use, Type of Menopause, and Lens Opacities
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Marijuana chemicals for chemotherapy nausea
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
You may or may not have been following the recent
push to have marijuana or its chemical components
legalized for certain medical uses. The main
indication cited is to treat the severe nausea and
vomiting that some cancer chemotherapy treatments
cause.
A review article in the British Medical Journal
looked at all of the high quality scientific
studies that investigated how effective the
chemical components of marijuana, called
cannabinoids, are at reducing nausea and vomiting
from chemotherapy compared to traditional
prescription medications. Non of the studies
looked at just smoking marijuana but rather all of
them looked at either natural or synthetic
extracts of the chemicals in marijuana that are
know to be the active agents for nausea. Those
extracts were given either orally or by
intramuscular injection.
The summation of the 30 randomized studies was
that these components of marijuana were slightly
more effective than traditional medications,
patients more often preferred the cannabinoids as
treatment, but they also had a higher
discontinuance rate because of adverse effects.
The cannabinoids produced more beneficial side
effects such as a "high", sedation, and /or
euphoria, but they also produced more harmful side
effects such as dizziness, feeling awful or
depression, hallucinations, paranoia and
hypotension.
The authors felt that despite some advantages of
the cannabinoids for treatment of cancer
chemotherapy induced nausea and vomiting, the
potentially serious side effects were likely to
limit their widespread use if such treatments were
made legal and widespread.
Cannabinoids for chemotherapy induced nausea and vomiting
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - It hurts during sex
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I feel pain when having intercourse, I also feel
pain, just before and during orgasm, can you
please tell me what is causing this. Sometimes it
is so sore that I lose the desire to have sex.
Sometimes it is also difficult for me to reach
orgasm, please let me know if you can help me."
"I am 21 years old, and I also suffer from
constant bleeding, I've been on the Depo for
nearly 5 or 6 years and I still have spotting all
the time, the doctors can't help me". C.
In order to help you, we first need to determine
the original cause of the pain and to what degree
you are having an involuntary reaction to fear of
having pain each time you have sex. If we can then
make sure the original cause of the pain is
treated as best as possible, what remains is the
body's reaction to the fear of pain which in turn
causes vaginal muscle spasms that cause a
secondary pain. This fear of pain may be conscious
or subconscious but is also decreases the ability
to have orgasm.
It is important to know if the pain started
originally at the opening of the vagina (vulva,
introitus), the inside of the vagina or only deep
inside the pelvis when thrusting moves the pelvic
contents such as the cervix, uterus or ovaries. It
should be easy for you to tell if the entrance to
the vagina (introitus) was the original painful
part. It would have hurt just with touching the
area with your fingers or a pad rubbing against
it.
Vaginal pain is a little harder to tell. The pain
would be present mostly upon your partner entering
the vagina and with the movement back and forth
without deep penetration. You probably have some
degree of this pain now even though you may not
have had it originally. This is because the
vaginal muscles now involuntarily contract because
of fear of being hurt and the contraction makes
the vagina and opening smaller instead of larger
which is the normal response. Since you are on
DepoProvera (R) which is known to cause vaginal
dryness, this could have been or can still be your
main problem.
Deep pelvic pain is much worse when you are having
intercourse and you are on the "top" position.
This results in the deepest penile penetration and
often moves the pelvic organs. Any pathology such
as endometriosis, an ovarian cyst or uterine
abnormalities can be painful with deep
penetration. If that is your original pain problem
then a pelvic exam and possibly a pelvic
ultrasound will help clarify the cause.
Possible causes of painful sex (dyspareunia)
Vulvar entrance
congenital abnormalities of the hymen
post traumatic scarring of the entrance
episiotomy scarring or delivery lacerations
post laser treatment of condyloma
vulvar hypersensitivity or allergic reactions
periorificial (irritant) dermatitis
cyclic/recurrent yeast vulvovaginitis
cyclic/recurrent bacterial vulvovaginitis
vulvar vestibulitis
dysesthetic vulvodynia
vulvar dermatoses
Vaginal
lack of estrogen
breast feeding
menopausal estrogen deficiency
use of DepoProvera (R)
use of progestin only birth control or
ovarian suppression
vaginismus (involuntary pelvic muscle
contraction)
vaginal foreign body
Deep
endometriosis
adenomyosis
interstitial cystitis
ovarian neoplasm
ovary adhered to uterus/vaginal apex
prolapse of fallopian tube
pelvic adhesions
uterine prolapse/descensus
uterine retroversion
posterior uterine fibroid
other uterine neoplasms
As you can see the list of possibilities is
extensive and treatment must be directed toward
the initial cause. Once the initial cause of pain
has been treated, any secondary vaginismus due to
a learned fear of pain must be treated. This is a
slow process and will involve your partner's help
in getting the pelvic muscles to relax rather than
contract. You will need you doctor's help or that
of a professional sex therapist for instructions
on manual massage of the vaginal muscles to induce
relaxation.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. How risky is vaginal birth after Cesarean (VBAC)
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Prior to the decade of the 1990's, doctors felt
that once a woman had a Cesarean section for
delivery of her child, she should always have a
Cesarean section for subsequent deliveries. The
main concern was that surgery on a uterus can
weaken it and with the high intrauterine pressures
of labor, the old surgical scar might rupture
where it previously had been sewn back up. Uterine
rupture carries not only the increased risk of
hemorrhage, infection, injury to bladder and
possible need for hysterectomy, but also the baby
can die if the placental blood supply is disrupted
by the rupture before an emergency C-section can
be performed.
Data in the 70's and 80's seemed to indicate that
the rate of uterine rupture for a normal C-section
incision (called low transverse) was about 1% or
less. It was shown through prospective
experimental studies that about 2/3's to 3/4 of
women who had a previous C-section could
successfully deliver vaginally even after they had
had a previous C-section birth. This is called
vaginal birth after Cesarean or VBAC. The 1% risk
of rupture was felt to be acceptable risk in order
to reduce the surgical morbidity of the 65-75% of
women who were saved a repeat C-section.
Recently some physicians have questioned whether
this uterine rupture rate is acceptable at all so
studies are trying to look at the comparisons in
women who have routine, scheduled repeat Cesarean
sections versus those who attempt VBAC. VBAC has
a generally lower chance of maternal complications
but the one serious complication of uterine
rupture is potentially catastrophic for baby and
very serious for mother.
This study recently reported in the New England
Journal of Medicine is not the first such study to
look at large numbers of deliveries to determine
how often uterine rupture occurs but it also
includes different complication rates in the
subgroups of women. They found:
Group Rate of uterine rupture
Repeat C/S, no labor .16% (1.6/1000)
Previous C/S spontaneous .52% (5.2/1000)
labor
Previous C/S induced .77% (7.7/1000)
labor (not using
prostaglandin)
Previous C/S induced 2.45% (24.5/1000)
labor using prostaglandin
An obvious conclusion is not to induce labor
using prostaglandin for women who wish to
attempt VBAC. Also, the study shows if the uterus
ruptures, there is a 5.5% chance that the baby
would die.
When you use these numbers to calculate the
difference for a mom between choosing repeat C-
section versus choosing VBAC, we see that with
VBAC there will be a 3.6/1000 (.36%) higher rate
of uterine rupture and the chance of the baby
dying is about .2/1000 or 1/5000 women who choose
VBAC. This is a very small number but it does
represent an increase in risk.
These are numbers that a woman needs to know when
deciding about attempting a vaginal delivery
versus a scheduled repeat C-section.
Risk of uterine rupture with VBAC
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Cholesterol Challenge - low cost testing
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Occasionally we receive press release
announcements that we think are worth passing
along:
BIOSAFE Medical Technologies, Inc. announced that
it will use its new Cholesterol Test System to
make FREE cholesterol testing available to all
Americans. The BIOSAFE test utilizes a small
blood sample (three drops) placed on a special
card and collected through a simple nick of a
finger. The card is then mailed to BIOSAFE's CLIA
Certified Laboratory for testing. The
quantitative results, which meet the College of
American Pathologists (CAP) guidelines, are then
mailed back to you. The BIOSAFE system eliminates
the need for a trip to the doctor for a standard
blood draw from the arm.
The collection kit will be sent free of charge
directly to the home without the need for a visit
to a doctor or clinic. Recipients of free kits
will be asked to pay shipping and handling of
$6.95 and will be given the opportunity to upgrade
the free test to a full Cholesterol Panel, which
includes Total Cholesterol, HDL (good
cholesterol), LDL (bad cholesterol), and
Triglycerides for an additional $9.95 - a $39.95
value.
This FREE Cholesterol Test offer is limited to one
test per person, is subject to change without
notice, and is NOT available in New York or where
prohibited by law. Participants should allow 4-6
weeks for delivery. For more information or to
get your free kit, call 1-800-200-TEST (8378).
eBioSafe.com
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Diet and blood pressure
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I am 53 yrs old and have had my blood pressure
monitored since I was 20, because it fluctuates
around 140/90, being lower most of the time. Six
months ago I was introduced to hacres.com where I
learned about the Hallelujah Diet. I began eating
85% raw fruits and veggies and 15% cooked food,
limiting or eliminating white flour, sugar, salt,
dairy and meat except for cold water fish. This
week my physician announced that my blood pressure
was 118/82 and asked me where I learned how to eat
this way. I shared the web site with her. She
said she would look it up and share the info with
other patients."
"I also am losing the extra weight I have carried
all of my adult life and most of my childhood.
It's so simple, but effective!! - Rebecca R.
The Hallelujah Diet
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If Men Got Pregnant...
Maternity leave would last for two years...with
full pay.
There'd be a cure for stretch marks.
Natural childbirth would become obsolete.
Morning sickness would rank as the nation's number
one health problem.
All methods of birth control would be improved 100
percent effectiveness.
Children would be kept in the hospital until they
were toilet trained.
Men would be EAGER to talk about commitment.
They wouldn't think twins were quite so cute.
Fathers would demand that their SONS be home from
dates by 10:00pm.
Men could use THEIR briefcases as diaper bags.
They'd have to stop saying, "I'm afraid I'll drop
him."
Paternity suits would be a line of clothes.
They'd stay in bed for the entire nine months.
Menus at most restaurants would list ice cream and
pickles as an entree.
Women would rule the world!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
****** Woman's Diagnostic Cyber Newsletter *******
July 15, 2001
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Overweight, diabetes and exercise
2. Vestibular pain versus generalized vulvar pain
3. Reader submitted Q&A - Endometrial stripe
4. Calcium robbers
5. Insect bites this summer
6. Health tip to share - Hyland's for bladder
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. Overweight, diabetes and exercise
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Which comes first, becoming overweight or the
adult onset diabetes? Papers from the Nurses
Health Study suggest that the weight gain, lack of
exercise, and eating of high glycemic foods
(simple sugars,carbohydrates) come first and cause
the adult onset diabetes. Women who are at low
risk for adult onset diabetes (type 2) had a body
mass index under 25; performed moderate physical
activity for at least a half hour daily; were non
smokers, ate foods "high in cereal fiber and
polyunsaturated fat and low in transfat and
glycemic load; and consumed an average of at least
a half a drink of an alcoholic beverage daily."
Another interesting characteristic studied is
people's inability to accurately recall what they
have eaten. Its not that a person consciously lies
about their food intake, rather they just do not
register all of the unscheduled food (snacks,
stress eating) or perhaps report what they think
the interviewer wants to hear. The more obese a
woman was, the greater chance of under- reporting
of caloric intake.
Overweight Pivotal Cause of Most Diabetes
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Vestibular pain versus generalized vulvar pain
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Vulvodynia, vulvar burning, vulvar vestibulitis,
and vulvar dysesthesia are all confusing terms
even for physicians. Pain and the word component,
"dynia", mean the same thing. Therefore vulvodynia
and vulvar pain are identical terms. The entire
vulva is different than the vestibule of the
vulva. The vestibule is a small area of the vulva
just in front of the hymen but not extending to
the dry skin of the labial lips.
For an anatomy view that shows the entire vulva
and the smaller area called the vestibule, see:
Vulvar and vestibule anatomy
So if someone labels pain as vestibulodynia, that
would mean the pain is confined to the vestibule.
The condition called vulvar vestibulitis is
confined to the vestibule area and produces pain
or burning. Therefore it would labeled as
producing vestibulodynia. The doctor checks with a
Q-tip on pelvic exam touching the area of the
vestibule and then other areas of the vulva. If
the pain in only in the vestibule, that makes the
diagnosis of vulvar vestibulitis. If the pain is
anywhere else on the vulva, some other condition
is causing it.
Vulvar dysesthesia is a term also used to describe
vulvar pain that is beyond the vestibule and for
which no obvious cause such as recurrent
vaginitis, irritant vulvitis, or vulvar skin
conditions are known.
For a review of vuvlar pain, see this article at
OBGManagement.com:
Vestibulodynia: tracing and treating vulvar pain
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Endometrial stripe
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"What does endometrial stripe mean? My doctor
ordered a pelvic ultrasound. The nurse called and
said it showed an endometrial stripe but she
didn't know what that meant and I needed to see a
obgyn?" - Anonymous
On pelvic ultrasound, one of the views is of the
uterus showing it as if it were cut down the
middle. This shows the anterior (toward the
abdominal wall) and posterior (toward the back)
thickness of the uterine cavity. In this view it
just looks like a double line. Doctors measure the
thickness of that double line to get an idea of
how much skin lining (endometrium) there is in the
uterus.
Normally a woman who is in the first week of her
menses will have a thin lining. A post menopausal
woman will also have a thin stripe. In the second
two weeks of a normal menstrual cycle, the stripe
will become thicker until just before menses
starts. After menopause, a thickened endometrium
can mean a cancer of the endometrium or a
hyperplasia that can become cancerous.
If the endometrial stripe is not straight but
rather like a wavy or indented line, that may
indicate endometrial polyps or a fibroid of the
uterus impinging upon the uterine cavity. If the
line is straight and you are premenopausal,
endometrial thickness has no meaning at all. Many
radiologists have been confused about this and
report linings at the upper range of normal as
thickened. Your doctor has no choice but to refer
you to an ObGyn for follow-up but it may be
unnecessary.
If you are postmenopausal, the thickness of the
lining may be significant. Originally, the stripe
was looked at in women with postmenopausal
bleeding and if the stripe was thin (less than 5
mm) an endometrial biopsy could be avoided. The
converse, a thickened stripe does not indicate any
concern if there is no abnormal bleeding.
You did not give us enough information about the
circumstances surrounding why you had an
ultrasound in the first place or age or menopausal
status so it is difficult to precisely say whether
this ultrasound finding is of significance or not.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Calcium robbers
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Experts recommend 1000-1200 mg/day of calcium but
most women only ingest about half of that. If you
do not ingest enough calcium, your body takes it
from your bones. Even if you are getting enough
dietary calcium, you do not want to do anything
that will rob it from your body.
There are some commonly known calcium robbers.
They are:
low levels of vitamin D - needed for absorption
from the GI tract.
salt - too much lets calcium be lost through the
kidneys
certain medications - water pills (diuretics),
steroids, anti-seizure medications, immuno-
suppressive medications, non-steroidal anti-
inflammatory drugs (NSAIDs like ibuprofen,
naproxen), asthma medications with steroids
excessive lifestyles - cigarette use, too much
alcohol (more than 2 drinks a day)
sedentary lifestyle - lack of weight bearing
exercise such as walking, running, weight
lifting, fitness workouts
Too much caffeine or too many sodas can also
inhibit calcium absorption. So in general, it is a
good idea to take some additional calcium in the
form of pill supplements or food supplements where
calcium and vitamin D have been added.
Are You Bad to Your Bones?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Insect bites this summer
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Bug bites are a fact of summer. Most are not
serious but some can be. Do you know how to take
care of insect bites when they happen to you?
For most bites, you need to gently scrape off the
stinger if there is one, using a edge such as a
credit card. Wash with a disinfectant and then
apply a baking soda paste. If you tend to react
with a large reddened skin area to a bite or swell
in reaction to a bite, be sure to take an
antihistamine such as Benedryl(R), Tylenol Severe
Allergy (R) or chlorpheniramine maleate (Chlor-
Trimeton (R), Teldrin (R).
Most women who have serious reactions to bug bites
know the emergency measures they must take to
avoid shock but if you have a severe reaction such
as difficulty breathing or swelling of the throat,
contact emergency services or 911.
Two potentially serious bites to the non allergic
are ticks which may carry Lyme disease and the
brown recluse spider and the black widow spider.
Lyme disease is carried by deer ticks and is
spread to humans after a tick has been attached
tot he skin for 24-48 hours. If you are in a tick
infested area and routinely check your skin each
day for ticks, you can prevent Lyme disease which
causes joint pains, a rash and fever. If you find
a tick, gently remove it with tweezers without
squeezing it and save it in a plastic bag in case
you develop any symptoms.
Spider bites can be quite serious if they are due
to a black widow or a brown recluse spider. They
only rarely can cause death but they can make you
very sick with severe pain in the bite area and
nausea and vomiting. The important part is to try
to identify the spider so if symptoms worsen you
can be treated.
For images of what a black widow or brown recluse
spider looks like, see this article at
Mayoclinic.com
Insect bites
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Hyland's for bladder
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I had my first bladder infection when I was about
29. Bladder and then kidney infections became a
regular occurrence every few months for about the
next six years. They bec
