 |
|
Women's Health Newsletters 12/16/01 - 2/24/02
Back to main archive menu
****** Woman's Diagnostic Cyber Newsletter *******
December 16, 2001
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Facts about lung cancer
2. Screening for osteoporosis detects fracture risk
3. Reader submitted Q&A - Ovary, cervix removal at 50
4. Anaphylaxis - a severe allergic reaction
5. Lichen planus - a skin rash of middle age
6. Health tip to share - Rash from perineal deodorant
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.
The next newsletter will be in two weeks.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Facts about lung cancer
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Lung cancer is now the most frequent cancer killer
of women. Even breast cancer does not cause as
many deaths. While lung cancer is decreasing in
incidence in men, it is increasing in women. There
are two main types of lung cancer:
non-small cell lung cancer (80%)
squamous cell carcinoma
adenocarcinoma
large cell carcinoma
small cell lung cancer (20%)
Most lung cancer (87%) is caused by smoking. There
are numerous substances in cigarette smoke, many
of which cause cancer. The longer one smokes, the
greater the risk of cancer. Stopping smoking helps
reverse this trend although it does not go back to
a zero risk.
Another cause of lung cancer which is greatly
under appreciated is radon gas. It is the second
leading cause of lung cancer today. It comes up
from the soil under a home or building. Some
experts have estimated that 1 in 15 houses will
have elevated radon levels. Radon causes about 12%
of all lung cancer cases. Other causes include job
related exposure to substances that may induce
lung cancer such as asbestos, repairing brakes,
coke ovens, uranium, arsenic and certain petroleum
products. Both radon and job-related carcinogen
exposure are additive to smoking, further
increasing the risk for lung cancer.
Early lung cancers do not give any symptoms which
presents a problem in detecting the cancer.
Symptoms do not occur until late in the disease.
When they do occur, symptoms may include:
chronic cough
hoarseness
coughing up blood
weight loss & loss of appetite
shortness of breath
fever without a known reason
wheezing
repeated bouts of bronchitis or pneumonia
chest pain
Doctors no longer order routine yearly screening
chest x-rays but if you have any of the above
symptoms, be sure to talk to your doctor about
having a chest xray. Even non-smokers can
sometimes get lung cancer and if you are a smoker,
it is doubly important to have a chest x-ray
whenever you have the above symptoms that do not
completely resolve within 2-3 weeks.
Prevention of lung cancer includes:
stop smoking
avoid second-hand smoke
check for job-related exposure
check your home for radon
Early detection of this killer disease is very
difficult but any lung symptoms that persist
beyond the 2-3 week cold or flu stage should be a
warning signal to see your doctor for further
evaluation.
Facts about lung cancer
You can get home radon detection kits at:
Radon detection kits
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Screening for osteoporosis detects fracture risk
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Osteoporosis is a condition in which bone has lost
calcium and it becomes fragile. The measurement
most often used to detect the amount of calcium in
bone is the mineral density. The gold standard
technique to measure bone mineral density (BMD) is
a dual photon densitometry scan which measures
total body calcium as well as the lumbar spine and
hip density. It is an expensive test that is not
covered by most insurance plans, especially when a
woman is under the age of 65.
Since many women have to pay for the test on their
own if they wish to have it, smaller scanning
units have been developed in order to make an
osteoporosis screening test that is less
expensive. These units scan the wrist, the fingers
or even the heel of the foot. They are not as
accurate as the larger bone densitometry scanners
and thus have not become very widespread in use.
The correlation between the large scanners and the
peripheral bone scanners is 60%, which seems low,
but most people do not realize that the
correlation between a spine measurement and a hip
measurement in the same woman only has a 60%
correlation using the most accurate equipment
available. In other words, individual bones in the
body have considerable natural variability.
Scientists and insurers continue to argue about
whether the peripheral scanners are precise enough
to be medically useful.
The following study recently published in the
Journal of the American Medical Association (JAMA)
looked at how useful these smaller, peripheral
bone scanners were in detecting women at risk for
bone fracture. They looked at over 200,000
postmenopausal women who did not have suspected
osteoporosis and who underwent peripheral bone
densitometry performed at the heel, finger, or
forearm. Of those whose measured values were in
the osteoporosis range (7% of all the women
screened), the fracture risk in the next 12 months
following screening was increased four times.
Even those women who had slightly low bone
density, osteopenia, but not osteoporosis, had a
1.8 times higher fracture rate in the year
following the study.
At the beginning of the study, 11% of the
postmenopausal women reported having had a
fracture after the age of 45. Fractures of the
wrist occurred in 6.2% and hip fractures occurred
in 1.2%. The new, overall fracture rate in the
year after scanning was about 3%.
The bottom line is that these less expensive scans
are quite useful for screening even if they do not
find all instances of osteoporosis. The cases they
discover can have a more formal diagnosis
performed and treatment begun to prevent a
disabling fracture. If your doctor offers you the
availability of such a scan, you should take
advantage of it to see where in the range of bone
mineral density your measurements lie.
Screening for osteoporosis detects risk for fracture
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Ovary, cervix removal at 50
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Is it possible to keep your ovary and cervix,
following a diagnosis of adenomyosis, I don't mind
the uterus being removed, but I am concerned about
the other organs, if they're healthy."
"I am 50 yrs. of age still have regular monthly
periods, 2 days heavy. I only have one ovary, the
other was removed in my 20's for a large cyst.
Enlarged uterus, 4 to 5 month pregnancy size, no
pain involved, just frequent discharge. I forgot
I also have fibroids." - DYR
It IS possible to have just the fibroids in the
body of the uterus removed and not remove the
ovary or cervix. This would be a subtotal
hysterectomy. You might want to talk to your
doctor about it. Your menstrual periods would stop
and the pelvic pressure from the fibroids should
be cured.
You need to carefully examine your reasons for
wanting to keep the remaining ovary and the
cervix. Both of them can develop cancerous lesions
in the future and if you have them removed, almost
all (about 98%) of those cancers could be
prevented. At age 50 the chance of a future
cancer of the ovary or cervix is about 1-2%.
If you keep the cervix, you will need more
frequent Pap smears and occasionally you may have
some bleeding from the cervix if you take estrogen
replacement. Ovaries can sometimes form cysts
after menopause and Pap smears can become abnormal
also. While these are not cancerous changes, the
worry and concern that you would undergo at the
time as well as the extra studies and medical
visits can be more than worth having them removed
at the time of the hysterectomy. I would guess
that the future ovarian or cervical problem that
you might have that needs medical attention is in
the range of 5% or 1 out of 20 chance.
I do not know of negatives from removing the ovary
at age 50 except that you may need to start
estrogen replacement right away rather than in a
few more months or years with natural menopause.
Ovaries due secrete small amounts of testosterone
for a short while after menopause but this too can
be replaced if needed.
The main negative from removing the cervix is that
orgasm with intercourse can change. It is not
noted as less pleasurable but the fine uterine
contractions that are sometimes present with
orgasm either change or go away. A recent patient
of mine was concerned about this and asked for
just a subtotal hysterectomy. Unfortunately
postoperatively she actually complained of a new
pain with intercourse after her subtotal
hysterectomy. I do not know the cause of the pain
but it is reproducible by moving the cervix on
pelvic exam. It may be because of adenomyosis of
the cervix or perhaps the stitches that are
suspending the cervix to keep it from prolapsing
may be putting a stretch on the ligaments that the
woman is not used to. I only relate this to you
as an example that we still do not have all the
answers about how surgery affects each individual
person and there can be other disadvantages to
leaving the cervix in. Truthfully, no one yet
knows whether the chance of painful intercourse is
higher after removal of the cervix with
hysterectomy or higher after a subtotal
hysterectomy.
Most gynecologic surgeons who are old enough to
have performed moderate numbers of both total and
subtotal hysterectomies will tell you that more
women in the years post follow-up regret not
having the ovary or ovaries removed (over age 45)
and not having the cervix removed, than regret
having them removed. I do not think these doctors
are perceiving these complaints erroneously. I
just would not want you to be someone who later
regrets a decision about surgery because of not
investigating the alternatives.
I'm glad you are evaluating the alternatives and
asked!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Anaphylaxis - a severe allergic reaction
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Allergies can cause different reactions in the
body. Skin rashes, pain, bowel upset and
headaches are among those different types of
allergy manifestations that frequently occur. The
most severe reaction, however, is one called
anaphylactic shock. This is a rare but extreme
reaction in which the blood vessels lose their
tone and blood pressure falls very low and the air
tubes to the lungs (bronchi) narrow making
breathing difficult. The reaction is all over the
body, not just in small areas. That is what makes
anaphylactic shock life threatening. With the
entire vascular system collapsing and decreased
oxygen supply, death can take place if treatment
is not begun quickly.
The trigger for such a serious allergic event can
be a medication, an insect sting, a food or even
just skin contact with a substance that previously
sensitized the system. The onset of symptoms can
be within seconds or minutes. Each subsequent
allergic reaction becomes more and more systemic
throughout the entire body. Thus even if you are
unharmed from one episode, the next one may be
lethal and you need to be prepared.
Symptoms include:
swollen throat
difficulty breathing
weak and rapid pulse
dizziness or fainting, shock
hives and large red skin welts
flushing of skin and intense itching
swelling of the lips and tongue
nausea, vomiting or diarrhea
If you think you have ever had a severe allergic
reaction, double check with an allergist to make
sure what the specific allergy is. If the allergy
is to an insect, a food or a contact substance,
ask the allergist for an emergency kit such as
that used for bee stings. It contains a syringe
with epinephrine that can stop the anaphylactic
reaction until you can get to emergency medical
care. Also, be sure to get a medical alert
bracelet to wear.
Anaphylaxis - a severe allergic reaction
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Lichen planus - a skin rash of middle age
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Lichen planus is an itchy skin rash or collection
of bumps that occurs most often between ages 45
and 60. It looks like slightly raised, purplish-
red, irregular polygon-shaped itchy skin lesions.
They commonly occur on the wrists and inside of
the arms, on the legs and ankles and sometimes on
the inside of the mouth. There may be just a few
lesions or large areas that coalesce and form
violet colored patches. A skin biopsy is needed to
confirm the diagnosis.
Lichen planus occurs in only 1% of adults but it
is more common in women. The basic pathology is an
inflammatory reaction but no one knows what causes
the inflammation. The lesions are not contagious
and do not go away with any known antibiotic
treatment. They often last for one or two years
and then go away on their own.
Certain medications can cause a lichen planus
reaction. Drugs such as thiazide diuretics,
antihypertensives including beta blockers, and
even pain meds such as non steroidal anti-
inflammatory drugs (NSAIDs), are among those known
to be associated with these lesions.
Treatment is variable depending upon how extensive
the rash area is. Steroid ointments may be used as
well as ultraviolet light treatment. Sometimes
oral steroids are the treatment of choice and
occasionally the lesions may need to be injected
with steroids.
If you think you might have lesions of lichen
planus, see your doctor or a dermatologist for a
biopsy and treatment.
Lichen planus - a skin rash of middle age
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Rash from perineal deodorant
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"[As far as the health tip] using deodorant as a
cover up for odor "down there" [perineum and
vulva], it does help VERY well. But the problem is
after about a week of using it, the deodorant
made me break out in a rash and to tell you the
truth, I would rather have odor then deal with the
pain I have right now. Just thought I could let
you guys know. I hope i helped!! " - Amanda
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Parrot's Vocabulary"
There's this senior woman who bought a parrot for
company. The problem was the parrot swears like a
sailor, I mean he's a pistol. He can swear for
five minutes straight without repeating himself.
Trouble is, the woman who owns him is a quiet,
conservative type, and this bird's foul mouth is
driving her crazy.
One day, it gets to be too much, so the woman
grabs the bird by the throat, shakes him really
hard, and yells, "QUIT IT!!!" (She used to be a
high school teacher and always wanted to do that!)
This just makes the bird madder and he swears
more than ever.
The woman decides to get tough and locks the bird
in the kitchen cabinet. This really aggravates
the bird and he claws and scratches at the door.
When the woman finally lets the bird out, he lets
loose with a stream of vulgarities that would make
a veteran sailor blush.
At this point the woman gets so angry herself
that she throws the bird into the freezer. For
the first few minutes there is a terrible din.
Kicking and clawing and thrashing and swearing.
Then...silence.
At first, the woman just waits. Concerned that
the bird may be hurt, she opens the freezer door.
The bird calmly climbs onto the woman's
outstretched hand and says, "So sorry about the
trouble I've given you. I'll do my best to
improve my vocabulary from now on."
The woman is astounded! She was hopeful but
really cannot understand the transformation that
has come over her foul parrot.
Then the parrot says,
"By the way... what did the chicken do?"
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** Woman's Diagnostic Cyber Newsletter *******
December 30, 2001
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Attacking mold growth in your home
2. Mother's weight at your birth predicts your adult weight
3. Reader submitted Q&A - Vaginismus - spastic muscles
4. What is pelvic inflammatory disease?
5. Weight Watchers (R) Online
6. Health tip to share - Dry skin in the winter
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.
The next newsletter will be in two weeks.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Attacking mold growth in your home
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Mold spores are a common cause of household and
work allergies. Every home has some mold growth in
it. Rarely, certain types of molds can act almost
like a poison if they are inhaled or produce a
serious anaphylactic shock if the spores are
stirred up. Less severe reactions can be breathing
problems, burning, itching or watery eyes, and
even fatigue or memory loss.
When the mold is on a surface, it does not present
much of a problem. When it or its spores become
dispersed in the air you breathe, that is when
reactions occur. Most of the time when you touch
mold spores, nothing noticeable happens. However,
if you spray chemicals on large areas of mold, you
can cause spores to become airborne and thus
produce a medical reaction when they get in your
eyes nose or lungs. Ventilator ducts and air
filters with their almost constant airflow must
be kept clear of mold.
Proper procedure is to soak mold areas in a
solution of water mixed in a ratio of about one
cup of bleach to a gallon of water. On porous
surfaces such as wood or plasterboard, the
solution should be left on for about 15 minutes.
If an area is extensively covered with mold, there
are professional services that clean up after
flood damage that can restore the area to a
relatively mold-free state.
Look around your home for any areas that have been
flooded, had sewer back-up, had leakage around
pipes. damp areas, ventilators or crawl spaces.
Check any humidifiers and the pipe areas under
sinks. Clean these areas as best you can unless
you are a person who gets severe reaction to mold
spores. In that case, have someone else do the
cleaning.
We have previously mentioned about severe allergic
reactions such as anaphylactic shock in this
newsletter. If you are a person who experiences
these reactions but you are not absolutely certain
about the causative agent, be sure to be tested by
an allergist or your family physician to be sure
what causes your reactions.
Attacking mold growth in your home
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Mother's weight at your birth predicts your adult weight
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Many of us have assumed that a big heavy baby at
birth often means that individual will be a big
person in childhood and adult life. There is some
truth to this, but predictors of adult weight from
measurements at birth have not previously been
carefully examined. A recent study in the British
Medical Journal looks at whether one's birth
weight or one's mother's weight at time of
delivery is more predictive of how much you will
weigh as an adult.
This study looked at all babies (over 10,000)
born in a study period in 1958 and their birth
weights, their mother's weight and body mass index
(BMI) and how much these individuals weighed at
ages 7, 11, 16, 23, and 33 years.
The authors found two strong predictors of adult
weight. Mother's body mass index (BMI) which is
calculated as a function of weight for height, was
more predictive of her offspring's adult weight
than was birth weight alone. Secondly, being
overweight by age 7 was strongly predictive of
being overweight as an adult, especially in male
children.
We still do not know if this is a genetic effect
or an environmental one. Until we do know, it is
best to assume that something about mother's
weight during gestation or at delivery sets an
internal thermostat that strongly governs what
that child is going to weigh as an adult. Perhaps
that is why significant weight change as an adult
is so difficult. It also means that being at ideal
body weight before conception may protect a child
from future adult obesity.
Mother's weight at your birth predicts your adult weight
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Vaginismus - spastic muscles
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Why do I experience pain while having sex? I am
25 years and lost my virginity at 23. I didn't
enjoy the experience as there was pain. Also I
have not had a climax since I started having sex.
My menstrual circle is normal, not heavy not
light." - Jane
I cannot say for sure without an exam, but 9 times
out of 10, the reason for painful intercourse as
you describe above is because of a condition
called vaginismus, an involuntary contraction of
the muscles around the vagina prior to penile
insertion during intercourse. Sometimes it can be
due to other reasons such as a birth anomaly of
the vaginal canal or a vulvar or vaginal lesion
that produces the pain and for that reason you
must have a pelvic exam by a doctor to make sure
there is not another cause.
The medical term for this condition would be
called primary dyspareunia (painful intercourse)
and primary anorgasmia (lack of ever having a
climax). Vaginismus is probably the cause for over
90% of primary dyspareunia. Sometimes painful sex
can develop later in a woman's sexual experience
and vaginismus may only be the cause in those
instances about 20-40% of the time.
When we see women with pain that started with
first intercourse and persists with subsequent
attempts at intercourse, almost always we will see
an involuntary tightening of the vaginal opening
upon attempt to insert a speculum for visual
vaginal exam or at finger insertion for the
bimanual exam to feel the uterus and ovaries. It
is the fear of pain that makes the bulbocavernosus
muscle at the entrance to the vagina and the
pelvic diaphragm muscles just inside the vagina
contract involuntarily. Normally those muscles
should relax and the vaginal opening dilates with
sexual arousal and foreplay. In the case of
vaginismus, those muscles contract instead of
dilate.
The lack of orgasm (climax) follows along from not
going through any of the physiological stages of
the sexual response cycle. The normal progression
would be:
arousal with increased vaginal/vulvar lubrication
excitement with dilatation of the vaginal opening
and inner vagina
plateau phase with further lubrication and
movement of the uterus
orgasm (climax) with fine muscle contractions and
release of blood vessel congestion
resolution with further return to normal of the
blood engorged tissues
Curing the vaginismus problem should cure the lack
of orgasm problem. Unfortunately, the treatment
for vaginismus is not easy and it is very
difficult to do on your own without a trained
therapist or physician. The reason for this
difficulty is that there is a considerable
emotional response on the part of your mind --
fear of pain, apprehension of the future,
depression etc. All of these responses are normal
to this problem but they are at a subconscious
level and you have very little control over
fighting them.
Vaginal dilators are sometimes used to treat this
condition. They start out with small sizes and
gradually increase in diameter. Kegel exercises
are used to gain voluntary control over those
muscles so that a woman with vaginismus can learn
to relax those muscles and allow the vaginal
opening and canal to dilate rather than contract
with spasm and produce painful intercourse.
Vaginismus - the frightened vagina
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. What is pelvic inflammatory disease?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Pelvic inflammatory disease (PID) is a condition
in which bacteria from the vagina and cervix go up
through the uterus to the faloppian tubes and the
ovaries as well as the abdominal cavity. Most of
the time it is due to bacteria that are sexually
transmitted such as gonorrhea and chlamydia but it
can also occur from any bacteria at the time of
gynecologic procedures such as endometrial biopsy,
LEEP, cervical cryotherapy or insertion of an
intrauterine device. Teens when they first start
intercourse are most susceptible to PID although
it can happen at any age.
PID is a common cause of infertility because if
not treated within the first 18-24 hours it
produces adhesions or scarring that either blocks
the faloppian tubes or impairs their movement over
the ovary to gather the egg at ovulation. Chronic
pelvic pain is another long term consequence of
PID. Once scarring is produced, pain from the
scarring cannot be treated with antibiotics.
Symptoms of acute pelvic inflammatory disease
include:
gradual onset of pelvic pain worsening over 12-24
hours
the onset of pain is often within a week of menses
low back pain and pain with intercourse
low grade fever, fatigue
nausea or diarrhea do not occur until after about
18-24 hours of pain
yellowish mucous vaginal discharge may be present
The symptoms become similar to an acute
appendicitis if no antibiotic treatment is begun.
While the symptoms also can present similar to a
gastrointestinal flu, it is characteristic for PID
that nausea and vomiting or diarrhea do not occur
when the pain begins. Rather these GI symptoms
only occur when the pain has been present for some
time.
If you have a pelvic pain like this that slowly
builds up in intensity over 12-24 hours and you
have recently had a gynecologic procedure or
possibly been exposed to a sexually transmitted
disease, be sure to seek medical attention right
away because early antibiotic treatment may
preserve your fertility.
What is pelvic inflammatory disease?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Weight Watchers (R) Online
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
It is that time of the year again and this time
there is no excuse. Weight Watchers now has an
online site that you can go to instead of
attending a local meeting. There is still a
monthly charge ($14.95) plus a joining fee but if
you are serious about dieting, that monthly charge
will more than be made up for by your decreased
monthly food bill if you are really sticking to a
diet.
Weight Watchers(R) now has a point system for food
which sort of combines calories, fat and fiber. It
is not hard to learn and you can look up the point
value of all your foods online. They have also
added a system whereby you can get more points
added to your daily allotment by exercise and you
can also "bank" some points during the week for
that occasional splurge. They still target no more
than a 2 pound loss (one kilo) per week as the
safest rate at which to lose weight.
The web site has many online tools for meal or
recipe planning to help you keep to your program.
Features like:
Food Ideas
Recipe Renovations
Community Recipe Swap
Recipe Search
Food Lists
Eating Out Guide
help make this agonizing task easier.
I have mentioned in previous newsletter articles
that the common feature to all successful weight
loss programs is counting and keeping a record of
the amounts you eat. Whether it is a high protein,
low carbohydrate, special food or other type of
diet, it is more likely to result in significant
weight loss if some sort of calorie counting or
food portion recording is done. Without that
painful step of counting and recording how much
you actually eat, diets tend to be uniformly
unsuccessful for most individuals.
I have joined the ranks of the New Year's dieters
via Weight Watcher's (R) Online just because I
need the discipline of reminding me at each meal
to stick to a program. If you have not looked at
Weight Watchers(R) in a long time, you might find
their new system is just what you need to reduce
your health risk by losing weight.
Weight Watchers (R) Online
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Dry skin in the winter
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Healthy skin has between 10-20% water in it. When
the heat comes on in winter, water evaporates from
the skin and when less than 10%, the skin becomes
dull, rough and flaky. In addition to the use of
skin moisturizers which keep water in, do not
forget to humidify your environment. At home, use
a room humidifier at night. At work, see if you
can put out a pan of water close to the heat. Even
a wet towel will give up water to the air at low
humidity. Be creative. Have some plants with
large saucers for excess water underneath them. An
electric water fountain on your desk might be just
what you need. And don't forget to drink plenty of
water. That helps the skin in winter too.
Dry skin in winter
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
From Joke du Jour
"Let's Have Male & Female Nouns"
Many languages have male and female nouns but
English impersonalizes them. It has often been
suggested that English should have some male and
female nouns and here are a few candidates for
consideration:
SWISS ARMY KNIFE -- male, because even though it
appears useful for a wide variety of work, it
spends most of its time just opening bottles.
KIDNEYS -- female, because they always go to the
bathroom in pairs.
PENLIGHT -- male, because it can be turned on very
easily, but isn't very bright.
TIRE -- male, because it goes bald and often is
over-inflated.
HOT AIR BALLOON: male, because to get it to go
anywhere you have to light a fire under it... and,
of course, there's the hot air part.
SPONGES -- female, because they are soft and
squeezable and retain water.
WEB PAGE -- female, because it is always getting
hit on.
SHOE -- male, because it is usually unpolished,
with its tongue hanging out.
COPIER -- female, because once turned off, it
takes a while to warm up. Also, because it is an
effective reproductive device when the right
buttons are pushed. Also, because it can wreak
havoc when the wrong buttons are pushed.
ZIPLOC BAGS -- male, because they hold everything
in, but you can always see right through them.
SUBWAY -- male, because it uses the same old lines
to pick people up.
HOURGLASS -- female, because over time, the weight
shifts to the bottom.
HAMMER -- male, because it hasn't evolved much
over the last 5,000 years, but it's handy to have
around and it's good for killing bugs.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** Woman's Diagnostic Cyber Newsletter *******
January 13, 2003
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. How to avoid injuries from jogging and running
2. What symptoms does prolapse cause?
3. Reader submitted Q&A - Osteoporosis and HRT
4. The effects of body weight on infertility
5. Lifelong management of diabetes
6. Health tip to share - Caffeine calculator
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.
The next newsletter will be in two weeks.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. How to avoid injuries from jogging and running
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Most injuries from jogging or running result in
tearing or bruising muscles and tendons in the
legs and feet. Occasionally tripping and falling
or twisting the foot or ankle is the cause of an
injury but most of the time, the injury is caused
by muscle strain or overuse.Almost exclusively, a
muscle not yet "in shape" or not properly
stretched, is the one that is injured.
The secret to avoiding injuries is to properly
stretch and warm-up the muscles prior to any
running, as well as to slowly increase the level
of exertion that is expected of the muscle. There
are several warm up stretches and exercises
recommended:
wall push-up - straighten one leg back, bend one
at the knee and lean forward with your hands
against a wall. Repetitively push yourself away
from the wall.
hamstring stretch - place a leg forward, straight
at the knee and rest it on a chair or stool. Bend
your body and head toward the leg.
knee clasp - lying down, bring both knees to the
chest and hold for 10 seconds.
bent leg sit-up - lying down with both knees up,
raise your head and body slowly.
straight leg-lifts - lying down, flex one knee to
a right angle and repeatedly lift the other leg
with knee extended to a 30-60 degree angle off of
the floor.
The back and posterior muscles of the legs are the
ones that tighten up the most with running. Those
are the ones that need to be stretched prior to a
repeat session of running or jogging. Sessions
need to slowly increase the level of running. Also
sessions with short episodes of speeding up and
slowing down should precede sessions of long times
of running fast.
Please keep in mind that your shoes may wear out
in their inner support from repeated impact long
before the upper parts look worn. You may need to
change them every 4-8 months if you are running
regularly.
How to avoid injuries from jogging and running
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. What symptoms does prolapse cause?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Vaginal relaxation of the anterior wall (below the
bladder) and the posterior wall (on top of the
rectum) is often called prolapse or cystocele and
rectocele and produces various symptoms of pelvic
pressure. Sometimes there are bladder or bowel
voiding problems. You would think that the more
the tissues sag, the more severe the symptoms
become. In fact, doctors have noticed that some
women seem to have moderate symptoms with only
small amounts of relaxation, while others do not
present to doctors for treatment until the vaginal
walls are actually coming out of the opening of
the vagina.
In the study below, the physicians performed
precise physical measurements during pelvic exam
in 237 women and compared the results to their
symptoms graded by severity. They found that the
symptoms only minimally correlated with the
physical findings. This confirms what doctors have
observed; some women with 2nd degree prolapse
might have just as severe symptoms as others with
4th degree (complete) prolapse. In fact, urinary
incontinence symptoms occurred less with the more
severe instances of prolapse. This is probably
because when the bladder falls enough to start
coming out of the vagina, it kinks the urethra,
the tube from the bladder to the outside. The
kinking blocks urine loss with coughing and
straining so that symptom gets better with more
severe prolapse.
The meaning of the study is that severity of the
symptoms is not predicted by the physical degree
of prolapse alone. Symptoms may be caused by
factors other than just straight stretching of
tissue. Nerve damage that produces numbness,
rectal or urinary unintentional leakage or just
difficulties in voiding urine or passing stool is
very likely a component of the prolapse symptoms.
Nerve damage does not improve with surgery; it may
even become worse after surgery so some symptoms
may not be cured in spite of undergoing a fairly
extensive operation.
What symptoms does prolapse cause?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Osteoporosis and HRT
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I am 56, no periods for 3 years, no significant
menopause problems (hot flashes,etc.), but my
mother has severe osteoporosis. What are the pro
and cons of HRT for me. My bone density test shows
slightly below normal, even though I run, and have
been very athletic all my life. I am Caucasian,
not obese, and have good muscle mass due to my
active lifestyle. I am not on any meds and have no
medical problems." - Sandy
The question you raise is about the use of
postmenopausal estrogen therapy (and progestin)
solely for the purpose of preventing bone mass
loss with aging. Continued bone loss over time
will gradually lead to spontaneous fractures when
the density falls below a critical threshold. It
takes a while for a woman to lose that much bone
density so that the age at which spontaneous
fractures happen will depend upon the original
starting bone density and the rate at which bone
mass is lost.
Women start gradually losing bone density at about
age 40. At menopause, with loss of natural
estrogens, the bone loss accelerates and can
average EACH YEAR as high as 3.5% ("fast losers")
or as low as 1%. The annual rate of loss tends to
be more in the first 5 years after the last menses
and then the rate of loss lessens after that. It
is very important to try to prevent loss in those
initial menopausal years since a larger amount of
bone mass disappears then. Therefore you are not
too late to start.
Several medicines have been shown to either reduce
the rate of loss or in some cases actually cause
an increase in bone density. Estrogens have always
been the most effective. The average dose of .625
mg of conjugated estrogens or 1 mg of estradiol
will result in about a 1-1.5% annual INCREASE in
bone density especially in the first several years
of taking them. Alendronate (Fosamax®) can add
about 1% a year and raloxifene (Evista®) can add
in the range of about 0.5-1% annually.
Phytoestrogens such as the ipriflavone found in
red clover (Promensil®) or soy phytoestrogens may
add a small amount of bone density but for the
most part they just keep a woman from losing bone
mass. Calcium supplements alone (1000-1200 mg/day)
are very helpful but they do not increase mass by
themselves; they do slow down the rate of loss.
Calcium supplementation is recommended with all of
the other medicines.
If estrogen is the best therapy to make up some of
your lower than average bone density, the question
becomes what dose is the best. For many years it
was felt that .625 mg of conjugated estrogens or 1
mg of estradiol was the lowest dose effective for
osteoporosis prevention. Recently doses as low as
0.3 mg of conjugated estrogen with 2.5 mg of
medroxyprogesterone acetate (Provera®) have been
shown to increase lumbar spine bone density. The
positive effects of estrogen on lowering total
cholesterol and raising HDL (good cholesterol) are
still present at the lower doses but not quite as
potent as at the higher doses. For women concerned
about the effect of estrogens on breast cancer,
these lower doses might be the best regimen.
Don't forget to take the supplemental calcium.
Almost all of the osteoporosis prevention studies
included calcium supplements and we actually do
not know how effective some of the above therapies
might have been without them. Right now you would
need two separate prescriptions (pills) for HRT at
the lower doses. Companies are working on new
pills that include both the estrogen and progestin
at the lower doses of 0.3/1.5 and 0.45/1.5
conjugated estrogen/medroxyprogesterone
combinations. They should become available not too
long from now.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. The effects of body weight on infertility
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Women who are underweight as well as women who are
overweight may have reduced fertility. A lower
than normal range body mass index (BMI) can be
associated with lack of ovulation often designated
as "hypothalamic anovulation". This form of egg
production difficulty is not as treatable with
Clomid as is anovulation due to overweight or
polycystic ovarian syndrome (PCOS). Being
overweight is often associated with PCOS but it
can affect ovulation even if PCOS is not present.
Weight's effect on fertility is almost always
restricted to its effect on blocking ovulation
from the ovary each month or at least making it
more difficult. Women who are overweight and
undergo in-vitro fertilization (IVF) also have a
lower pregnancy success rate than normal weight
women because it is harder to induce ovulation.
Once an equal number of eggs are obtained in an
IVF cycle, the clinical pregnancy rate and the
miscarriage rate do not vary by mother's weight.
The best feature about excess weight and fertility
is that even a small amount of weight loss (5%)
can restore ovulation in many (60%) women. This
also applies to IVF success, i.e., if a woman
loses weight prior to IVF there is a higher
success rate in overweight women. Women who have
insulin resistance and take an insulin enhancer
like metformin may resume ovulation just because
of the weight loss and not necessarily due the
direct effects of the metformin.
Weight can also adversely affect pregnancy so that
is a double reason for a woman trying to conceive
to lose weight. Excess weight can cause high blood
pressure in pregnancy, diabetes, and more frequent
urinary tract infections and Cesarean sections.
Miscarriages also tend to be increased in women
who are overweight. It is not clear whether there
are just more blighted ova/chemical pregnancies
or whether later miscarriages are also increased.
The former may have to do with ovulation problems
affecting the quality of the follicle.
The effects of body weight on infertility
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Lifelong management of diabetes
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Before the discovery of insulin and other
diabetic medications, those who suffered from
diabetes face an early death. With modern
medicines, diabetics live much longer but still
face chronic disease complications from the
diabetes such as:
kidney disease/failure
visual problems/blindness
more frequent infections
high blood pressure
vascular insufficiency
skin ulcers
Any of these conditions can lead to early death so
it is very important to take all steps possible to
prevent these problems if possible, or at least
detect them in the earliest stages to begin
additional preventive treatment. Doctors and
nurses can tell you what to do but it is up to the
diabetic person themselves to take the time to
carry out the preventative measures.
Once diabetes is diagnosed, a woman should put all
of the following on her highest health priority:
1) frequent blood pressure checks
2) annual ophthalmologic eye exam - to detect
glaucoma, retinal vascular or detachment problems
3) annual blood testing for kidney disease
(microhemoglobinuria), hemoglobin A1c
4) every 6 months dental visit for teeth cleaning
and gum check
5) flu shots annually, all vaccinations including
pneumovax (to prevent pneumonia) and their
recommended boosters as per schedules.
6) daily foot and skin care
The recommendation for daily foot and skin care
needs some explanation. Diabetes is the most
common cause of foot and leg amputation because of
the vascular disease it produces. The smallest
blood vessels which are furthest away from the
heart get narrowed and the feet and toes lose
normal blood supply. This makes them more
susceptible to infections, ulcers and fungus.
Diabetics also have dry skin which is more easily
injured.
Examine the feet for cracks, blisters, redness and
dry skin. Wash your feet and dry thoroughly
between the toes without rubbing. Make sure shoes
and socks fit well without areas that put abnormal
pressure on any part of the foot. Don't use
chemicals on the feet and have calluses, corns,
bunions or warts taken care of by a podiatrist
rather than trying to treat these yourself.
Lifelong management of diabetes
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Caffeine calculator
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
For those of you who try to watch your caffeine
intake by drinking decaffeinated coffee (it still
has some caffeine), tea, and soft drinks, you may
want to know how much caffeine you are really
getting. Here is a handy calculator. It includes
chocolate too. Actually it would take 5 oz of dark
chocolate to equal a small cup of coffee but milk
chocolate has much less.
Caffeine calculator
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Water Pills"
A woman goes to the doctor and tells him that she
hasn't been feeling well. The doctor examines her,
checks her urine and blood, leaves the room and
comes back with three different bottles of pills.
The doctor says, "Take the green pill with a big
glass of water when you get up.
Take the blue pill with a big glass of water after
lunch.
Then just before going to bed, take the red pill
with another big glass of water."
Startled to be put on so much medicine the woman
stammers, "My goodness, doc, exactly what's my
problem?"
The doctor says,
"You're not drinking enough water."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** Woman's Diagnostic Cyber Newsletter *******
January 27, 2002
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Should seniors take multi vitamins?
2. Recurrent miscarriage and antiphospholipid syndrome
3. Reader submitted Q&A - Grapefruit juice and drugs
4. Wild yam cream does not have a hormonal effect
5. Too much vitamin A associated with hip fractures
6. Health tip to share - Aspirin for heart disease
7. Humor is healthy
If you change your email address, don't forget to
re subscribe using the new address.
Spread the word! Send a copy of this newsletter
to someone you know.
The next newsletter will be in two weeks.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Should seniors take multi vitamins?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
While it is easy for a health provider to just say
"take a vitamin", the answer is not so straight
forward. There can actually be a risk of taking
too much of a given vitamin when what you take by
pill is added to fortified cereal and other food
products and your normal diet. In fact most people
do not need to take an added multi vitamin. While
their diets are not perfect, they are reasonable
and the vitamins and minerals present absorb well
from the food.
Seniors, especially those over 65, do not absorb
certain vitamins and nutrients as efficiently as
younger persons. These would include vitamins B-6,
B-12, D and zinc. Vitamin B-12 is important in
preventing anemia, high blood pressure and
cardiovascular disease. Vitamin D is needed to
absorb calcium which seniors lose almost
constantly from their bone mass. Vitamin B-6 can
lower blood homocysteine which is felt to be a
risk factor for heart attack and improve the
immune system. It is used by the body for protein
metabolism and hormone manufacture also. On the
other hand, excessive vitamin B-6 can produce
nerve toxicity. Zinc is needed for enzymes that
affect digestion and wound healing.
Elderly seniors may have even more severe nutrient
problems because of aging changes which diminish
taste and smell and produce denture problems. Poor
appetite and diet can also be due to factors like
eating alone or having depression. Other chronic
diseases accompany age and can cause loss or
impede absorption of vitamins. The vitamins that
are water soluble (thiamin (B-1), riboflavin (B-
2), niacin (B-3), pantothenic acid (B-5),
pyridoxine (B-6), folic acid (B-9) and cobalamin
(B-12). vitamin C, choline, and biotin) especially
have to be supplemented if diet or absorption are
factors.
Because of the increased chance of having low
levels of multiple vitamins, a general multi
vitamin supplement should strongly be considered
for those over 65 and any seniors with impaired
diets or diseases affecting gastrointestinal
absorption of micronutrients. Additionally, there
may even need to be supplements of certain
vitamins beyond the amount found in multi
vitamins. Extra vitamin D and calcium supplements
are commonly needed for seniors in addition to a
multi vitamin.
There are some vitamins and minerals that have
narrow safe vs. toxic levels. For example seniors
age 50-70 are often recommended to take 400 IU per
day of vitamin D and those over 70 to take 600 IU
per day. The lowest no-observed adverse effect
level (NOAEL) is 800 IU and the lowest level at
which adverse effects have been observed (LOAEL)
is 2000 IU per day. For vitamin A, the recommended
daily allowance is 2600 IU, but many vitamins have
5000 IU (a previous recommended daily allowance by
the Food and Nutrition Board but lowered by the
recent Council for Responsible Nutrition) and some
people take supplements of 10,000 IU in addition
to a daily vitamin with 5000 IU. The NOAEL level
is 10,000 IU and the LOAEL is 21,600 IU. As you
can see the margin of safety is not very good when
you add in the amount contained in a daily diet.
Vitamin A is a fat soluble vitamin than can
accumulate in the body; too much can produce
permanent liver damage.
Be sure to ask your doctor about safe vitamin
levels and, more importantly, try to look at the
ingredient listings on foods you commonly eat on a
regular basis for what amounts of vitamins and
nutrients have already been. Only you, not your
doctor, can calculate if you may be getting too
much or not enough of the various micronutrients.
Should seniors take multi vitamins?
Vitamin Intake - How Much is Too Much?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Recurrent miscarriage and antiphospholipid syndrome
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Women who have had one or more miscarriages often
hear about taking aspirin to prevent pregnancy
loss. Actually that therapy has been used for
women with 3 or more consecutive miscarriages (or
sometimes only 2) and with a diagnosis of what is
called antiphospholipid antibody syndrome. This is
a condition detectable by having lupus
anticoagulant (LA) and/or anticardiolipin
antibodies (aCL) in blood serum. These are tests
which need to be ordered by a physician.
The study below looked at randomized clinical
trials that have been conducted and reported in
the medical literature in women with recurrent
miscarriage and antiphospholipid syndrome. They
found that 3 trials using aspirin alone DID NOT
SHOW ANY BENEFIT. Two trials evaluated aspirin
plus injectable heparin, a potent blood thinner,
versus just aspirin alone. These studies did show
a benefit in improving subsequent pregnancy
outcome but from the other aspirin alone studies,
we can surmise that it is probably just the
heparin that helps. One study looked at
prednisone, a strong steroid medication, plus
aspirin and it actually increased the rate of
premature delivery with no reduction in
miscarriages.
The take-home message from this review is that
women should NOT self-medicate with aspirin in an
attempt to prevent a miscarriage. It does not
work. Aspirin can affect platelet-mediated blood
clotting in the body so there is always the
possibility of harm from taking it.. Also, if a
woman has had 3 miscarriages in a row then testing
for antiphospholipid syndrome should be started
with your physician because there is a treatment
that helps.
Recurrent miscarriage and antiphospholipid syndrome
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Grapefruit juice and drugs
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I have heard that when dieting, grapefruit juice
blocks some of the medications people take. Should
I avoid grapefruit juice on my diet if I take
birth control pills?" - Anonymous
The bad news is that grapefruit juice CAN alter
the absorption of some medicines. The good news is
that you can get around this interaction and most
of the time do not need to worry about drinking
grapefruit juice or eating grapefruit on your diet
as long as you follow a few simple rules.
There is an enzyme in the bowel and liver called
cytochrome P-450 (CYP) that is very important in
metabolizing food and medicine ingested by mouth.
The enzyme changes the base food or drug compound
by adding small chemical groups to the molecule.
Sometimes these changed compounds are absorbed
from the stomach more easily; sometimes the change
inhibits absorption. CYP can change the drug to a
more potent form as far as medical action and at
other times it will deactivate it and change it to
a less active compound. In other words, any
substance that stimulates CYP or inhibits CYP can
make ingested substances more active in its
medical effects and side effects or less active,
less potent.
Grapefruit juice is one substance that has been
found to inhibit the CYP enzyme system. It does
this much more than other citrus juices like
orange juice. Grapefruit juice is not the only
compound that inhibits CYP. Even red wine or St
John's Wort, among others, have been shown to
affect this system. There are undoubtedly many
other food and drug substances that have the same
effect that we just do not know about at the
present time. Inhibition of CYP often results in
HIGHER BLOOD LEVELS of a drug because inhibited
drug absorption means that the liver, which often
breaks down the drug, does not get the first
chance to inactivate the drug before it has its
medical effect.
Most of the drugs that I could find that have been
tested, are INCREASED in the blood by about 0- 50%
if they are taken with a glass of grapefruit
juice. While decreased blood levels can happen
too, almost every agent was actually increased and
when it was, it was at about the 50% level. I
could not find testing that showed how long after
ingesting grapefruit juice the altered absorption
levels lasted. It is likely that the effect is
short lived under 60 minutes.
Women will be glad to know that the estrogen
(ethinyl estradiol) in birth control pills is not
decreased by grapefruit juice but rather increased
by 37%. The estrogen often used for menopausal
replacement, 17 beta-estradiol, is also altered
somewhat in its absorption by grapefruit juice.
Estrone (a weaker estradiol metabolite) levels are
increased after taking estradiol with grapefruit
juice but estradiol itself is not increased.
For the most part, the differences in active drug
levels with or without grapefruit juice are not
very great and probably less important than your
body weight in determining medical effect.
However, with a drug that has a narrow range
between adequate treatment of a medical problem
and toxicity producing side effects, then this
amount of interaction can make a difference.
Chemotherapy agents would be one instance where
the different levels could produce very
undesirable side effects. Anti-depressants and
anti-anxiety agents are another class of drugs
that grapefruit juice could affect. On the other
hand, if you were not seeing a therapeutic effect
from a medication, taking it with grapefruit
theoretically might help (eg. low dose estrogens
for hot flashes).
The wisest course of action with regard to eating
grapefruit or drinking grapefruit juice, however,
would be to follow these simple rules:
Take most medicines at least 30 minutes before or
60 minutes after you ingest the grapefruit. Take
them with water or orange juice if you have to (OJ
has some effect but much less than grapefruit
juice).
If you are having side effects from the drugs you
take, avoid grapefruit for at least 6-8 hours or
altogether and check with the doctor to see if
drug dose adjustment is possible.
If you are taking any cancer chemotherapy drugs,
check with your doctor about all substances which
may alter their absorption or blood levels.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Wild yam cream does not have a hormonal effect
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Since wild yam extract contains a plant steroid
which can be a chemical precursor to manufacture
estrogen and progestin hormones, it has often been
used in a cream form to rub on the skin to
alleviate symptoms of perimenopause and menopause.
The theory behind this is that maybe the plant
steroid (diosgenin) would either act as a steroid
or stimulate steroid manufacture in people and
improve some of the symptoms such as hot flashes.
Wild yam extract has also been used in
progesterone creams to make people think the
progesterone cream is an all natural product.
The study below from Australia looked at whether
the use of a wild yam extract cream versus placebo
cream affected the number of hot flashes, or other
menopause symptoms or whether it changed any
hormone levels. They found in comparing wild yam
extract cream with placebo that "after 3 months of
treatment, no significant side-effects were
reported with either active treatment or placebo,
and there were no changes in weight, systolic or
diastolic blood pressure, or levels of total serum
cholesterol, triglycerides, high-density
lipoprotein (HDL) cholesterol, FSH, glucose,
estradiol, or serum or salivary progesterone."
They concluded that there was no beneficial effect
for menopausal symptoms from wild yam extract
cream and no influence on any of the reproductive
hormones either. They also found there was no harm
to using it.
Wild yam cream does not have a hormonal effect
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Too much vitamin A associated with hip fractures
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
In animal studies, one of the toxic effects of
vitamin A is that it causes bone problems such as
fractures. The study below looked at the effect of
non-toxic doses of vitamin A from supplements and
fortified food sources among over 72,000
postmenopausal women followed for 18 years in the
Nurses Health Study.
The study looked at the incidence of hip fractures
among women who were taking over 3000 mcg/day of
vitamin A (the recommended daily allowance is 800
mcg/day). In both the women who were taking
vitamin A supplements and those who were not on
supplements but were taking more than 3000 mcg/day
from food they were eating, there was an increased
risk of hip fracture. The overall increase in risk
was about 50%.
Epidemiological studies that try to correlate
certain food intake with diseases are always
subject to many sources of error because they did
not check for the effect of other factors that
might have caused the same disease or condition.
This study claimed that they did correct for many
possible confounding factors so their results may
have merit. I think we have to accept that there
is a possibility that vitamin A can have adverse
effects above the recommended daily requirement.
The significance of this study is to remind us
again that just because a little of something is
good for us, twice as much may not be better. I do
not have trouble with the vitamin A levels in most
multi vitamins, usually about 800-1600 mcg (2500
IU - 5000 IU). However, anyone taking supplemental
vitamin A or vitamins advertised as "mega"
vitamins needs to calculate their total daily dose
between the supplements and their normal food
intake to make sure they are not placing
themselves at an unknown risk.
Too much vitamin A associated with hip fractures
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Aspirin for heart attack prevention
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
After age 40 or 50, you only need to take one baby
aspirin a day (80 mg) to help prevent heart
attacks. A regular aspirin (325 mg) is actually
not better and may cause blood clotting problems.
- FRJ
Baby Aspirin Recommended for 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
~~~~~~~~~~~~~~~~~~~~
|
|
