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Women's Health Newsletters 5/4/03- 7/13/03
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****** Woman's Health Newsletter *******
May 4, 2003
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. How common are uterine fibroids
2. Body piercing incidence and risks
3. Reader submitted Q&A - Perimenopause
4. Oral contraceptives and voice quality
5. Health tip to share - Nail splitting
6. Humor is healthy
The next newsletter will be in two weeks.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. How common are uterine fibroids
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Whenever a woman has any pelvic discomfort or
abnormal menstrual bleeding, there is a tendency
for physicians to order immediately order pelvic
ultrasound imaging studies even though the pelvic
exam may be normal. The ultrasound is more
sensitive in finding pelvic anatomical
abnormalities than a physician's standard bimanual
pelvic exam. Often the ultrasound is so sensitive
that it picks up minor abnormal findings that are
not really causing symptoms.
There can be so many "abnormal" but insignificant
findings that these findings are often wrongly
"blamed for the symptoms. This is often true of
cystic areas in the ovaries that are merely normal
ovarian follicles but are labelled as "ovarian
cysts" by the radiologist. Small fibroids (smooth
muscle growths of the uterus) are another common
finding on ultrasound that are often incidental
and not the cause of pain or bleeding which the
doctor is looking for.
If fibroids in the uterus were uncommon, then it
might be more likely that if they are found they
might be causing symptoms. However, fibroids under
2 inches in diameter are very common in the uterus
so it makes sense that many ultrasound studies are
going to find them and mislead both the woman and
the doctor into thinking that they are the cause
of symptoms.
How common are fibroids as detected by pelvic
ultrasound? One recent study using pelvic
ultrasound in asymptomatic women in the U.S. aged
35-49 found that over 50% of women who did not
have a previous diagnosis of fibroids did have
fibroids on ultrasound exam. This study estimated
the cumulative incidence of fibroids by age 50 was
over 80% in black women and over 70% in white
women. Thus the answer is that fibroids are very
common. They are slightly more common and occur
earlier in black women.
The bottom line is to not always blame a fibroid
or let yourself be treated with a medical
procedure for a fibroid just because an ultrasound
report indicates a fibroid is present. Discuss
carefully with the doctor as to whether the
fibroid is likely playing a role in whatever
symptoms you might have.
Incidence of Fibroids
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Body piercing incidence and risks
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Body art that includes tattoos and skin piercings
for rings other than those in ear lobes is quite
common today. One study of college students
indicated that over half of women and almost half
(42%) of men admitted to having various parts of
their bodies pierced. These included lips,
tongues, eyebrows, nose, nipples, navels and
genitalia.
About one in seven students reported that they had
complications such as bleeding, infection and
local trauma. Surprisingly, none of them reported
viral infections such as hepatitis and HIV. About
a quarter of both men and women indicated they had
tattoos but again none reported complications from
them.
Other studies have indicated that both body
piercing and tattooing are risk factors for viral
hepatitis both B and C. The authors of the article
below recommend single use instruments (i.e.
sterilized but disposable) be used if you want to
have a tattoo or body piercing. They also
recommend that people who perform the piercing or
tattooing be vaccinated for hepatitis B.
There is about a 10% incidence of bacterial
infection and another 10% incidence of local
tissue trauma or bleeding with piercings so be
careful when having it done.
Body piercing
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Perimenopause
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Are there specific signs that indicate whether or
not a woman going through perimenopause is
actually entering menopause? Why does breast
tenderness occur at this time and when does it
end?" - Anonymous
Perimenopause is a period of time, usually about
4-5 years, before total cessation of ovarian
function. Because ovarian follicle development
during this time is not quite as normal as it is
earlier with respect to the amount and timing of
estrogen and progesterone secretion, menopause-
type symptoms can occur during this period.
Normal menopause symptoms vary from woman to woman
but generally include hot flashes, night sweats,
sleep difficulties and vaginal dryness.
Additionally, because a perimenopausal woman is
still having menstrual bleeding, the bleeding
pattern can be irregular with either skipping
menses or extra or prolonged, heavy menses.
I am not aware that breast tenderness is a
perimenopausal symptom. Rather it is more likely
to just be an age progression of fibrocystic
breast change. You have to be very careful of any
caffeine intake which makes breast pain worse.
Other than symptoms, the only objective way I know
to suspect perimenopause is to measure FSH
(follicle stimulating hormone) levels. Values of
10-25 IU/ml are very suspicious for perimenopause
unless it is drawn in midcycle while you are
ovulating. Therefore, drawing a blood (serum) FSH
level within about a week of the start of a menses
and finding a value of over 10 IU/ml is a fairly
good indication you are in the perimenopause.
Estrogen levels do not seem to be reliable because
the range of normal is so wide.
Perimenopause ends when the ovaries (and menses)
stop altogether. Average age is about 50 but it
can often be as much as 56-57.
Doctors often prescribe very low dose oral
contraceptive pills during the perimenopause to
even out the natural hormonal fluctuations. These
are only used in women who are non-smokers and
have not had thrombosis problems on the pills.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Oral contraceptives and voice quality
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Not being a singer, I was unaware of the rumor
that high dose birth control pills caused an
instability of the tonal range of the voice. Of
course it had not been studied scientifically
because there were not complaints of this problem
among women patients.
One study done in Israel in 2002 looked at women
taking and not taking birth control pills and
performed acoustic analyses on recordings of vowel
pronunciations over a 40 day period. They found
that the jitter and shimmer values of the pill
group were significantly lower than those of the
natural group although there was no difference in
the F0, amplitude, and harmonic-to-noise ratio.
In their follow-up study reported recently they
concluded that "specifically, amplitude and
frequency variations between successive vocal
cycles were smaller in women using oral
contraceptives in comparison with the control
group (.24 dB versus.37 dB and 0.86% versus 1.27%
for amplitude and frequency variations,
respectively).
I am not sure if these are meaningful differences
but would have to conclude that low dose birth
control pills would not worsen voice variability
in women who depend upon a consistent voice tone
quality for a living and they may even make the
voice quality more consistent.
Do oral contraceptives improve vocal quality?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Health tip to share - Fingernail splitting
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Regarding the problem with splitting nails in the
April 20 Newsletter, I had this problem and my
doctor said to use "Hard As Hoof" cream. It
stopped my problem within three weeks. I applied
it several times a day and every time I washed my
hands. It strengthened the nails and softened the
cuticles."
"I am a 73 year old male and all ten of my finger
nails were splitting to some degree but the worst
were the thumbs. This product is available in the
handcare products area of most drug or cosmetics
stores." - IR
[editor note - Another name for this cream is
Nail Strengthener by Onyx]
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Birthday/Anniversary Card"
A gentleman entered a stationery store and asked
the clerk for a birthday/anniversary card.
The clerk replied, "We have birthday cards and
we have anniversary cards. Why not take one
of each?"
The man said, "You don't understand. I need
a card that covers BOTH events!
You see,
we're celebrating the fifth anniversary of my
wife's thirty-fourth birthday..."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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****** Woman's Health Newsletter *******
May 18, 2003
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Peanut allergy from skin cream
2. Internet and email use for health care
3. Reader submitted Q&A - Perimenopause Weight gain
4. Acetaminophen for high altitude headaches
5. Health tip to share - Communication with physicians
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Peanut allergy from skin cream
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Peanut allergies can develop at a very early age.
In a child, the allergy can present anywhere from
a mild rash to a life-threatening allergic
response to ingested foods containing any peanut
products. It is estimated that one in 150 adults
has a peanut allergy and children who are thought
to "outgrow" an allergy to peanuts can have it
reemerge as adults.
Other than a family history of peanut allergy or
recurrent, itchy skin rashes (atopy), there are no
known risk factors that can predict who will
develop or manifest these allergies. A recent
study from London looked at almost 50 children
with confirmed peanut allergies and compared them
with a group of control children to see if they
could find any other risk factors to predict it.
They found that a history of use of soy milk or
soy formula as infants, rash over joints and skin
creases and oozing, crusted rash were independent
risk factors for peanut allergy. In addition,
there was a significant independent relation of
peanut allergy with the use of skin preparations
containing peanut oil.
The investigators postulate that use of skin
creams and other products on children that have
peanut oil in them may have caused the allergic
sensitization to peanuts when the creams were
absorbed into the blood stream through damaged
skin. This may or may not be the cause of peanut
allergy but it warrants caution in using any
peanut oil containing skin products in children.
Factors associated with the development of peanut allergy in childhood
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Internet and email use for health care
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Readers of this newsletter are no strangers to
obtaining health information over the Internet.
Nationally, however, it is not clear how many
people use the Internet for health information
that actually alters their utilization of doctor's
visits, lab studies, pharmacy use and
hospitalizations. Surveys indicate many people
look up health information on the net but no one
knows whether it really saves (or even increases)
any medical expenses.
The following article in the Journal of the
American Medical Association (JAMA) reports a
survey conducted in 2002 of over 4700 individuals
21 years of age and older who were self-reported
Internet users. They found very little impact of
the Internet on the utilization of standard health
care facilities. Almost 95% said that Internet use
had no effect on the number of physician visits
they had nor did it have any effect on the number
of medical office telephone contacts. Only about
5% reported use of the Internet to obtain
prescriptions or purchase pharmaceutical products
and about the same amount indicated they had ever
used email to communicate with a physician.
This has been somewhat surprising since physicians
have long been told that almost 80% of office
visits are predominantly for medical information.
I would have thought that the massive volume of
medical and health information on the Net would
perhaps decrease the number of doctor's visits but
maybe it just seems to make individuals better
informed medically without eliminating any
doctor's visits.
At BackupMD we have offered medical educational
consults by email since 1998 but there are many
barriers to utilization of this type of service.
Insurance companies have been slow to reimburse
adequately for such Internet health visits and
many people would still rather take off a quarter
or half day of work for a doctor's visit just so
they do not have out-of pocket expenses.
Physician's trade groups such as state medical
associations and licensure boards prohibit health
visits by email unless it is between an existing
patient and the doctor who has previously
performed a physical exam and established a
doctor-patient relationship by a physical office
visit.
In a way, these are good rules that prevent
quackery medicine from being practiced over the
Internet but the rules also block legitimate
access to 2nd opinions for questions that do not
require a physical exam or additional laboratory
or radiological studies. It really remains to be
seen if the Internet can significantly alter (and
hopefully improve) health care over the long run.
Internet and email use for health care
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Perimenopause Weight gain
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Will eating 2 oranges a day make me gain weight?
How about birth control pills taken for a year for
premenopause? I'm pretty sure one or the other has
made me gain weight." - Susan
Both of them have probably contributed to your
weight gain.
Oranges are rich in vitamin C, beta carotene and
fiber and contain about 60-70 calories per average
size fruit. They will not cause you to gain weight
unless they are in addition to what you normally
eat when you do not gain weight. An extra 130
calories, per day, however, would increase your
weight by one pound every 28 days or about 13
pounds in a year. If you put on more than 13
pounds this year then it is not just from eating
the oranges.
Birth control pills can also increase weight by
stimulating the appetite. They do not cause you to
burn calories slower or slow metabolism but rather
just make you eat more calories especially in
snacks. This effect is thought to be due to the
progestin component of oral contraceptives in that
it may lower your blood sugar making you hungrier.
It can cause carbohydrate cravings which seem to
initially appease the low blood sugar but very
quickly you go back to having low blood sugar (and
snacking again) because the progestin is
associated with insulin resistance. This means
your circulating insulin is elevated slightly
which quickly lowers the blood sugar after the
simple sugar snack.
The only way to get around the insulin resistance
effect of progestin that some women have is to
avoid all simple carbohydrates using an Atkins
type diet. Taking in predominantly proteins, fats
and complex carbohydrates provides a substrate for
the insulin so you do not get low blood sugar and
stimulate your appetite. Oranges have a very high
simple sugar content (glycemic index) which
aggravates the problem rather than helping it.
The only medical condition that slows metabolism
is hypothyroidism. You may want to have your TSH
checked since women have an increased incidence of
hypothyroidism near the menopause. OTherwise it is
calories-in versus calories-out that governs
weight gain or loss.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Acetaminophen for high altitude headaches
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
At higher altitudes there is a lower amount of
oxygen in the air and many people suffer headaches
know as mountain sickness. Nausea often
accompanies the headaches and each year over 7
million people visit, ski or hike into altitudes
over 6500 feet where acute mountain sickness may
be severe enough to limit activity.
Traditionally ibuprofen (Advil(R)) has been the
main medication used for skiers and hikers to
treat the headaches until the body becomes
accustomed to the lower oxygen levels. This
article reports that acetaminophen (eg.,
Tylenol(R)) is just as effective for the headaches
and it does not aggravate the nausea as ibuprofen
can.
While not an earth-shaking medical discovery, this
reminds us to take precautions and perhaps carry a
small bottle of acetaminophen when visiting Mt
Mitchell in the East or the Rockies in Colorado or
other mountains over 6000 feet. The author also
reminds us that when we are in high altitudes, we
should not continue to ascend if we develop
symptoms such as worsening headaches, shortness of
breath and confusion.
Acetaminophen Fights High-Altitude Headaches
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Health tip to share - Communication with physicians
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Physician and patient communication: Patients
should always have written questions to ask
physicians after any procedure or testing ordered,
and prescriptions. Educate yourself concerning
your health. If you find the physician is not
willing to allow time to talk to you in more
detail, I would suggest that you find another
physician that will. How will you know if other
physicians in a particular area allow more time
for patients? Ask around and explain your
concerns; then most patients have a sound feel for
physicians who are not troubled by patients asking
questions and obtaining information so that you
can be more informed and have a better
understanding about your health." - Kelly
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Effective Communication"
A widow, recently married to a widower, was
accosted by a friend who laughingly remarked, "I
suppose, like all men who have been married
before, your husband sometimes talks about his
first wife?"
"Oh, not any more," the other woman replied.
"What stopped him?" asked the first.
"I started talking about my next husband,"
replied the second woman.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** Woman's Health Newsletter *******
June 1, 2003
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Rectal cancer and hospital treatment
2. Food allergies
3. Reader submitted Q&A - Dark under eye circles
4. Iron supplementation for fatigue
5. Health tip to share - Prevent tennis elbow
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Rectal cancer and hospital treatment
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The rectum is the area of the bowel that extends
from the anus on the outside for a distance of
about 4 inches (10 cm) into the bowel where it
continues as the sigmoid colon. It is the area
responsible for eliminating stool (defecation) and
any gas that collects in the bowel tract. In
women, the rectum lies just below the vagina and
in men just below the prostate gland.
Rectal cancer usually occurs after age 50. It is
often lumped together with colon cancer (from the
bowel tract higher up), but it can present
differently from colon cancer. Rectal cancer may
present more often with bright red rectal bleeding
that is present even when not passing a stool.
While hemorrhoids often produce bright red
bleeding, they do so usually when you have a bowel
movement. Rectal cancer, however, can cause
bleeding in between bowel movements. A narrowing
of the caliber (diameter) of the stool can also be
a sign of rectal cancer. Other symptoms include a
change in bowel movement pattern, lower abdominal
bloating and even bowel obstruction with acute
nausea and vomiting but these symptoms are also
common to colon cancer higher up in the bowel
tract.
Surgery to treat rectal cancer almost always
includes a colostomy in which the colon is cut
away from the rectum and the anus muscles that
control defecation. The colon is then brought
through the abdominal skin so that a bag needs to
be attached to that skin to collect stool. The bag
is needed since there is no muscle control from
the rectum.
One study looked at over 7000 patients with stage
1-3 rectal cancer who had to have a colostomy as
part of their treatment. They found that both the
30 day (postoperative) survival from the surgery
and the 2 year survival from the cancer were
highest in the hospitals that did the highest
volume of surgery for rectal carcinoma. The
highest quartile (25%) surgical volume hospitals
had a 30 day survival of 98.4% versus a 95.2% in
the lowest quartile volume hospitals. The 2 year
survival was 83.7% versus 76.6% in the highest
versus the lowest volume hospitals.
These findings suggest that a high volume of
procedures may be beneficial in obtaining better
operative and longer term cancer survival. This
"volume/experience relationship has also been
found with other surgical procedures and
treatments and should be taken into account when
seeking treatment for major medical problems.
Rectal cancer and hospital treatment
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Food allergies
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Food intolerance and food allergies are NOT the
same. A food allergy that stimulates the immune
system to cause a serious reaction such as:
hives, itching or skin rash
swelling of the lips, face, tongue and throat, or
other parts of the body
wheezing, nasal congestion or trouble breathing
dizziness, lightheadedness or fainting
is much more serious than a food that your body
may be directly sensitive to resulting in nausea,
vomiting, cramping and diarrhea.
Food intolerance may be due to the lack of an
enzyme such as lactose which results in many
people having a problem drinking or eating milk or
milk products without becoming bloated, with
cramping, diarrhea and excess gas. Sometimes food
may contain a toxin from bacteria that causes you
to react adversely. This does not mean that you
cannot ever eat that food again; it just means you
should not eat that food when it is contaminated
again. Mushrooms, rhubarb, and spoiled tuna or
other fish are foods more likely to be come
contaminated with toxins. It can be very difficult
to differentiate an intolerance to the food itself
or to a substance or ingredient used in the
preparation of the food. This is especially true
of foods containing lactose, wheat or sulfites.
On the other hand, if you are truly allergic to a
food such as:
cow's milk
eggs
peanuts
Wheat
soybeans
fish
shellfish
tree nuts
even a small amount could give you a serious
health reaction.
If you suspect that any food is causing you a
serious allergic response, be sure to see an
allergist to have it diagnosed thoroughly. Skin
tests for allergies are considered the best way to
diagnose an immune response but sometimes you may
have much less of a reaction by just having a
blood test known as an in-vitro allergen-specific
IgE antibody test. There are home tests using a
drop or two of blood from a finger stick which
check IgE allergic sensitivities.
Food allergies
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Dark under eye circles
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Are there any procedures that will permanently
remove dark, under eye circles which are
hereditary?"
"I developed under eye circles when I went through
puberty (around age 12) I've used concealer to
cover them, but I'm hoping in the modern age of
medicine that there is some type of procedure that
can lighten the skin under the eye. I've seen
those extreme make-overs on TV, but no one has had
my problem. I'm too young for a face-lift (I'm
25) and I've heard that lasers are good for
removing wrinkles only." - MCM
There are several types of conditions causing dark
circles under the eyes:
1) increased pigmentation of the skin due to
genetic background, chronic inflammation from the
sun, treatment with Retin A, allergies, estrogens
or any type of chronic skin irritation in the area
below the eye.
2) increased fine blood vessels just below the
skin either from chronic skin inflammation or from
the lack of fat under the skin so that just the
blood vessels are visable.
3) increased fat deposition in the skin (bags)
causing a bulge below the eye that throws a shadow
which further darkens the skin.
Since you developed the dark circles at age 12,
pubertal estrogen probably caused increased under
eye skin pigmentation to which you were
genetically predisposed, I would suspect that you
fall in the number 1 group above. In this case
there are sometimes depigmentation creams such as
hydroquinone that you can get from the
dermatologist. It is a good option as it can
lighten the skin if that is the problem.
Hydroquinone or Kojic acid is often used in ethnic
and Caucasian patients to lighten the skin before
laser treatments, peels, etc. Lasers are not only
used to remove wrinkles; they can be used to
remove pigment from the skin and both
dermatologists and plastic surgeons may use them.
It is also possible that you may have too much fat
in the under eye skin (bags) or even too little
fat (sunken eyes) allowing the blood vessels to
darken the skin. If this is a contributing factor,
you may need to see a plastic surgeon for suction
of the fat out of the skin, or even for adding fat
cells back to the under eye skin. You probably
would not need a face lift at all at your age but
the eyes may get a long lasting "eyelift" if the
appropriate procedure is performed now.
If you had not said that the problem started as
early in life as it did, I would suggest you also
look for iron deficiency anemia, sleep deprivation
(or even excess), and vitamin and mineral
deficiencies as well since any of them could be a
cause of dark under eye circles.
At your age, I would spend the money at this time
to seek out two different medical opinions. I
would schedule to see a local dermatologist and a
local plastic surgeon to see what they say the
cause is and what treatment they suggest. Do not
accept any treatment until you have seen both of
them for their suggestions.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Iron supplementation for fatigue
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Low blood count or anemia, is most commonly caused
in women by excessive menstrual bleeding. The body
cannot replace blood very fast if body iron stores
are low. This leads to a special type of anemia
called iron deficiency anemia. A low blood count
for reproductive age women is a hematocrit of less
than 37% and a hemoglobin measurement of less than
12 gm%. Fatigue is the main symptom of iron
deficiency anemia.
Fatigue is also a common complaint among women,
even ones who do not have any anemia. From 14-27%
of the population will admit to fatigue as a
symptom at any one time, however only 1-2% of the
population will seek help for this. One European
study found that up to 20% of women had a low
serum ferritin concentration but only 4% of those
women had a true iron deficiency anemia. In other
words their iron levels were on the low side but
their bodies were still able to keep up the blood
counts to normal levels.
Previously there had been no evidence that fatigue
is associated with iron deficiency unless anemia
was present. Some investigators in Switzerland
however looked at a group of over 100 women who
consulted doctors for fatigue but were not anemic
and did not have other conditions that would
explain the fatigue. In other words they had
unexplained fatigue. Over 85% of them had low
serum ferritin levels (less than 50 µg/l). The
investigators gave half of the women iron
supplements and the other half placebo pills. They
found a significant decrease in measurements of
fatigue in the group who received iron
supplements.
This study suggests that when fatigue is a
problem, doctors should check (and you should
request) a serum ferritin level to see if iron
supplementation may be indicated.
Iron supplementation for fatigue
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Health tip to share - Prevent tennis elbow
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The pain of tennis elbow is on or around the bony
prominence felt on the outside of the elbow. Pain
may radiate down the arm. Gripping or extending
the wrist or arm further increases the pain.
The pain is actually caused by tiny tears in the
tendons in your forearms that were produced by
overuse of the muscle in the first place.
Continued muscle overuse can prevent the tears
from healing and produce further pain as the
tendons become inflamed.
In addition to tennis, other activities that can
cause tennis elbow include everything from raking
leaves, weed eating and repetitive hammering to
rowing or even painting.
The best treatment is to simply stop whatever
activity you believe is causing the pain and give
your tendons some time to heal. It may take 3-6
months to totally heal and you may have to
discontinue tennis, yard work, hammering or
whatever until then.
Anti-inflammatory medications such as ibuprofen or
naproxen may help reduce the pain and
inflammation. In time, the pain should subside and
you should be able to return to your normal
activities. If, however, the pain seems to be
staying the same or worsening two to three weeks
after discontinuing the activity, you may want to
consult a doctor.
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"How To Know You're Growing Older"
-Everything hurts and what doesn't hurt, doesn't
work.
-The gleam in your eyes is from the sun hitting
your bifocals.
-You feel like the morning after, and you haven't
been anywhere.
-Your little black book contains only names ending
in M.D.
-You get winded playing chess.
-Your children begin to look middle aged.
-You finally reach the top of the ladder, and find
it leaning against the wrong wall.
-You join a health club and don't go.
-You decide to procrastinate but then never get
around to it.
-Your mind makes contracts your body can't meet.
-You need glasses... to find your teeth.
-A dripping faucet causes an uncontrollable
bladder urge.
-You know all the answers, but nobody asks you the
questions.
-You look forward to a dull evening.
-You walk with your head held high trying to get
use to your bifocals.
-Your favorite part of the newspaper is "25 Years
Ago Today."
-You turn out the light for economic rather than
romantic reasons.
-You sit in a rocking chair and can't make it go.
-Your knees buckle and your belt won't.
-You regret all those mistakes resisting
temptation.
-You stop looking forward to your next birthday.
-After painting the town red, you have to take a
long rest before applying a second coat.
-Dialing long distance wears you out.
-You're startled the first time you are addressed
as "Old Timer."
-You remember today that yesterday was your
wedding anniversary.
-You just can't stand people who are intolerant.
-You burn the midnight oil after 9 p.m..
-Your back goes out more than you do.
-A fortune teller offers to read your face.
-You get exercise acting as a pallbearer for your
friends who exercise.
-You have too much room in the house and not
enough in the medicine cabinet.
-Your sink your teeth into a steak and they stay
there.
-You go to the beauty shop so they can touch up
those gray hairs...on your chin.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** Woman's Health Newsletter *******
June 15, 2003
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Laser resurfacing - one way to treat wrinkles
2. High iron intake and Parkinson's disease risk
3. Reader submitted Q&A - Celiac disease
4. Stool incontinence after delivery
5. Health tip to share - Pedicures
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Laser resurfacing - one way to treat wrinkles
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
As we and our skin age, the tautness that prevents
wrinkles no longer holds our skin smooth. The
tautness is due to fiber-like proteins called
collagen and elastin. We also lose the underlying
layer of fat in the skin and both of these
processes together result in skin wrinkles.
A recent laser procedure called laser resurfacing,
has been used to remove the aged or sun-damaged
outer layers of skin to allow younger skin (with
its new elastin and collagen) to grow in its
place. You may want to know if laser resurfacing
is safe for you.
Destroying the outer layer of skin to promote new
growth underneath is not a recent concept.
Dermatologists have been performing chemical skin
peels and mechanical dermabrasions for years. The
laser, however, is a tool that allows a more
precise skin depth control than the other
techniques. This is mostly an office procedure in
which an area of skin is numbed with a local
anesthetic and the laser is used to evaporate
(burn off) a microscopic layer of the outer skin.
The procedure may take from a few minutes to
several hours depending upon how extensive a skin
area must be treated.
After the procedure, the skin appears red or pink
and a with a little crust of dried secretions. You
can have mild swelling and skin discomfort much
like a sunburn sensation. The skin takes about 1-2
weeks to heal although it may stay red or pink for
up to 6 months. During this time you must avoid
sun exposure.
If you think you might be interested in the
procedure which also can be used to remove scars
and skin pigmentation spots, see the article at
Mayo Clinic.com for more information about its
advantages and the complications and risks
involved.
Laser resurfacing for wrinkles
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. High iron intake and Parkinson disease risk
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Investigators from Seattle, Washington, looking
for dietary associations, collected food frequency
questionnaires from over 250 individuals with
Parkinson disease. They were looking for links
with vitamin B, anti-oxidants and fat intake which
had previously been suspected as associated with
Parkinson disease. They did not find any of those
relationships.
They did, however, find that a higher than average
iron intake and manganese intake, coupled with one
or more multivitamins or iron supplements each day
was about 2 times more likely to be associated
with Parkinson disease than those individuals with
low intake of these substances.
Now it is important for you to know that in
Parkinson disease patients there is an increased
deposition of iron pigments in a certain brain
area that has been know for a long time. But other
investigators have looked for dietary iron
relationships and not found an association. They
have postulated that it is not abnormal iron
intake but rather a metabolic defect in iron
metabolism that results in abnormal brain tissue
deposition.
There are conflicting results about iron and now
manganese and their relationship to Parkinson
disease. This report adds to the conflicting
results. While we do not know the answers, I think
we should be cautioned about taking any
supplements that our bodies are not really
deficient in.
High iron intake related to Parkinson disease risk
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Celiac disease
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Could you please tell me about Celiac Disease.
My GI specialist told me that people with Polish
ancestry could have this disease. I am 56 years
old, Jewish/Polish background. I am currently
having coughing spells every morning. Also, I
have heartburn." - ssc
Celiac disease is a condition of diarrhea, weight
loss and malnutrition among other symptoms that is
caused by a genetic sensitivity to gluten in the
diet that destroys cells that line the bowel
tract. Gluten is found in barley, oat, rye, wheat
and other grains. In people with celiac disease,
gluten sets off an autoimmune reaction that
attacks the body's own gastrointestinal lining
cells.
While not everyone with celiac disease has severe
symptoms of diarrhea, I am not sure that heartburn
and coughing spells result from celiac disease.
Coughing spells are more likely to be due to the
heartburn. On the other hand, your GI specialist
is aware of this and if he/she thinks your
symptoms warrant testing for celiac disease, then
you should go ahead.
The test for celiac disease is a blood test that
looks for IgA antibodies against tissue
transglutaminase (tTG) which is found in the bowel
lining. It is important to understand that people
can have a food intolerance to gluten but not
necessarily have celiac disease. If you have a
food allergy test that is positive for glutens,
you should then have a specific test for celiac
disease.
As far as the genetics goes, people of Jewish
background have a higher incidence of celiac
disease. Therefore the bottom line is that even
though your symptoms do not suggest celiac
disease, you should probably have testing because
your GI doctor recommends it.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Stool incontinence after delivery
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
We have previously discussed accidental loss of
stool and gas from the rectum known as anal
incontinence. One of the causes is labor and
delivery. It used to be thought that this was an
uncommon occurrence after delivery. Now with
careful questioning we find that it happens more
often than expected. It can even take place even
though a cesarean section was performed. It can
happen with or without an episiotomy and with a
forceps vaginal delivery or even without it.
Investigators at the University of Oregon gave
questionnaires to postpartum women at their 6 week
postpartum visit. They found that the frequency of
at least one fecal incontinence symptom postpartum
was 38%. Of that group, 24% of women reported
incontinence of gas and 10% incontinence
of stool. Size of baby did not make a difference
nor the number of past babies but women who had
any perineal lacerations had a greater chance of
having incontinence symptoms.
We know from other studies that the incontinence
of stool tends to go away (down to about 1%) at 9
months to a year after delivery. Infrequent but
occasional unintended passage of gas per rectum
can still occur up to 25% of the time but
decreases over time.
It is important for all women who become pregnant
to know that this can happen after delivery. In
fact it can happen with or without an episiotomy
and with or without a cesarean section; although
admittedly it happens much less with a cesarean
section.
Stool incontinence after delivery
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Health tip to share - Pedicures
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
An infection of the legs with boil-like sores
caused by a mycobacterium has been associated with
pedicures. Over 100 patrons of a nail salon in
California acquired this infection in their legs
as a result of exposure to foot baths contaminated
with Mycobacterium fortuitum.
Mycobacterium infection from pedicures
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Romeo and Juliet - Txt Version"
--------- Act 1 ---------
Login:
Romeo : R u awake? Want 2 chat?
Juliet: O Rom. Where4 art thou?
Romeo: Outside yr window.
Juliet: Stalker!
Romeo: Had 2 come. feeling jiggy.
Juliet: B careful. My family h8 u.
Romeo: Tell me about it. What about u?
Juliet: I'm up for marriage if u are..Is that a bit
forward?
Romeo: No. Yes. No. Oh, doesn't matter, 2moro
at 9?
Juliet: Luv U xxxx
Romeo: CU then xxxx
---------- Act 2 ---------
Friar: Do u?
Juliet: I do
Romeo: I do
---------- Act 3 ---------
Juliet: Come bck 2 bed. It's the nightingale
not the lark.
Romeo: OK
Juliet: !!! I ws wrong !!!. It's the lark. U gotta
go. Or die.
Romeo: Damn. I shouldn't hv wasted Tybalt &
gt banished.
Juliet: When CU again?
Romeo: Soon. Promise. Dry sorrow drinks our
blood. Adieu.
Juliet: Miss u big time.
--------- Act 4 ---------
Nurse: Yr mum says u have 2 marry Paris!!
Juliet: No way. Yuk yuk yuk. Anyway, am
married 2 Rom.
--------- Act 5 ---------
Friar: Really? O no. U wl have 2 take potion
that makes u look dead.
Juliet: Gr8.
--------- Act 6 ---------
Romeo: J-why r u not returning my texts?
Romeo: RUOK? Am abroad but phone still
works.
Romeo: TEXT ME!
Batty: Bad news. J dead. Sorry m8.
--------- Act 7 ---------
Romeo: J-wish u wr able 2 read this...am now
poisoning & and climbing in yr grave.
LUV U Ju xxxx
--------- Act 8 ---------
Juliet: R-got yr text! Am alive! Ws faking it!
Where RU? Oh...
Friar: V bad situation.
Juliet: Nightmare. LUVU2. Always. Dagger. Ow!!!
Logout.......!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** Woman's Health Newsletter *******
June 29, 2003
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Bone health in women with breast cancer
2. Laboratory blood tests to predict heart risk
3. Reader submitted Q&A - Vitamin E for cuts/scrapes
4. Major depressive disorder - How common?
5. Health tip to share - Chitosan diet supplement
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Bone health in women with breast cancer
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Women with breast cancer frequently receive
chemotherapy which can cause early menopause if
they have not yet stopped menstruating. If they
are postmenopausal, estrogen replacement therapy,
which is very good for blocking osteoporosis, is
withheld by many physicians. This makes breast
cancer survivors at additional risk for
osteoporotic bone thinning and breakage.
Although this long term risk is well known by
physicians, very few women (5%) are counselled by
their cancer specialists about diet modification
and supplements to maintain bone health.
Additionally, many of the women cut down their
intake of milk and milk products without
compensating by taking additional calcium.
Calcium (1000-1500 mg a day) with or without any
vitamin D supplement can substantially help
prevent osteoporosis. It is important for women
who have been treated for breast cancer be
reminded to at least take calcium supplements. It
is also important at some time around the
diagnosis and treatment phases to have a baseline
bone densitometry performed in order to document
to what degree bone mineral density changes in the
future.
Breast cancer patients "risking bone health"
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Laboratory blood tests to predict heart risk
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The traditional risk factors that predict heart
disease are high blood pressure, high cholesterol,
smoking, diabetes and lack of exercise. However
even the above factors do not identify all
individuals who develop heart disease. Recently,
doctors have found that there are other blood
tests that can be predictive of whether one
develops heart disease or not:
C-reactive protein
Homocysteine
Fibrinogen
Lipoprotein (a)
Not all doctors check for these substances but
some feel it is very useful for you to know if you
have abnormal levels of these above blood
proteins.
C-reactive protein is produced in the liver and is
an inflammatory marker. Elevation can be due to
many immune or inflammatory conditions, so it is
important to not use it alone as a test for
cardiovascular disease. In women with normal
cholesterol, elevated levels predict as much as a
7 times increased risk.
Homocysteine is an amino acid building block of
foods. Sometimes an excess of homocysteine in the
blood can predict heart problems and strokes even
in the absence of other risk factors. The doctor
may want to know these levels especially if you
are a smoker but do not have any other typical
risk factors.
Fibrinogen is a blood protein that is involved in
the blood clotting process. Smoking, estrogen and
heredity can elevate fibrinogen. Doctors would
want you to stop smoking, alter your lifestyle and
to alter some of your medications in order to
lower blood fibrinogen.
Lipoprotein (a) is a blood fat. It is a low
density cholesterol molecule that is attached to
another blood protein. It is often elevated
genetically. Those who have relatives who
developed or died from heart disease before the
age of 50 should be tested to see if their blood
levels are elevated.
While none of these blood test should be
considered more important than the traditional
risk factors, they may be indicators that provide
more motivation for changing lifestyle and habits.
They can then be used to monitor how well those
changes are reducing risk.
Lab tests to predict heart risk
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Vitamin E for cuts/scrapes
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I use the fluid inside a vitamin E capsule to
heal wounds and it speeds up the healing
wonderfully. I wonder if it is safe to use it for
all the cuts and scrapes my little granddaughters
get. Since they are 10 years old and under I
wonder if it is too strong for their systems." -
DMG
For many years there have been rumors and home
remedies advocating topical vitamin E to promote
wound healing. Only recently have scientific
studies actually been conducted testing topical
vitamin E gels and ointments versus placebos.
Unfortunately the studies have not only shown that
topical vitamin E is no more effective than
placebo at wound healing, but also that there is a
skin hypersensitivity reaction to vitamin E
products in about 15-30% of patients. Thus, I
would not advise using the vitamin E capsules on
fresh cuts and scrapes.
There is some evidence that once a thickened scar
or keloid scar has formed that vitamin E gels may
promote a better appearance (thinning of the
scar). This is different though than any positive
effect on original wound healing.
Now, you may ask why your experience (and others)
has been positive on wound healing using topical
vitamin E in oil. The primary factor that has been
shown to promote healthy (small) scar healing is
keeping the scar moist (skin hydration). If the
skin is kept clean and moist for several weeks,
scars are minimal. By placing the vitamin E
capsule oil on the wound you have created that
moisture barrier which is really what is
responsible for promoting quick wound healing.
Scab formation is actually undesirable.
You may have noticed all of the "healing" and
"scar preventing" bandages that are available
commercially. These are based upon keeping a
moisture barrier on the skin over the scar. In
fact if you undergo surgery and have any tendency
for thick scar formation, talk your doctor into
using one of the transparent gel-like skin
bandages that are left on for at least a week.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Major depressive disorder
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
While depression can be experienced by anyone
occasionally, most of the time it is not prolonged
more than a few days. When it lasts longer than
two weeks and takes place most of the day nearly
every day, it is abnormal. Depression is often
accompanied by extreme fatigue, loss of pleasure
in any activity, irritable mood and even
unintended weight loss or weight gain.
Major depressive disorder alters one's family or
work role so that normal daily activities cannot
take place. It can lead to serious impairment in a
life. How frequent is this condition? A recent
national survey was conducted on over 9000 adults
to find out how common major depressive disorder
(MDD)is in the general population.
The prevalence of MDD for a lifetime was 16%,
i.e., 1 out of each 6 people have at sometime in
their lives experienced a major depression. For
any 12 month period, 6-7% of adults experienced
MDD. The average duration of an episode was 16
weeks and almost 60% of those with MDD for a 12
month period had severe or very severe role
impairment. Only half of the people with MDD
received any treatment at all but less than half
of that group had adequate depression treatment.
Major depression appears to be common and even
though more depression sufferers are receiving
treatment, quite a few still are not.
Major depressive disorder - How common is it?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Health tip to share - Chitosan diet supplement
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Chitosan is a dietary supplement that has been
advocated as promoting weight loss. While some
fats bind to chitosan in the intestine, the number
of calories in those fats are insignificant. It
also decreases your absorption of fat soluble
vitamins A, D, E and K by a small amount. Since
you can not lose weight with chitosan alone
without dieting, it is not a supplement for a
weight loss diet you should take. Chitosan is made
from a starch (chitin) found in the shells of
shrimp, crab and other shellfish.
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Occasionally, people use the term "anal-retentive"
to refer to obsessive-compulsive personality
traits (like Jack Nicholson in "As Good As It
Gets"). We all have some of those traits about a
few things in our lives. Being obsessive can be
healthy but here's how to know if it is getting
out of hand.
"You may be anal-retentive if..."
1. you eat the M&Ms in color order.
2. you fold your dirty clothes before putting them
in the hamper.
3. you have to have all boxes in the kitchen
facing the same way and in order by size.
4. you have all your canned goods organized by
type, flavor, and use and they're all facing the
front.
5. all your books, CDs, and movies have to be
alphabetical order.
6. you require no less than 230 threads per inch
on your sheets. ...and they are tucked so tightly
that you really could bounce a quarter on them.
7. you alphabetize your spices.
8. you organize your closet by color, season, and
fabric.
9. you flame every person who sent you email
because the emails weren't spelled correctly or
grammatically correct.
10. you remove the tires to wash inside the wheel-
wells of your vehicle.
11. you collect the little postcards in magazine
issues... ..for recycling.
12. every e-mail reply that you send has been
through a grammar checker... ..and you correct the
original message.
13 you're on a "calorie-counting" diet and you
count the calories in the hot sauce on your "Big
Beef Burrito Supreme"
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** Woman's Health Newsletter *******
July 13, 2003
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Smoking cessation and nicotine patches
2. Spontaneous miscarriage without D and C
3. Reader submitted Q&A - Mastoiditis
4. Maintaining independence as you age
5. Health tip to share - Missing breakfast
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Smoking cessation and nicotine patches
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Any long term habit such as overeating or smoking
is difficult to break. We look for pharmacological
help to assist us to stop the unhealthy habit
rather than just relying on will power (choice)
alone. Nicotine patches were supposed to help
people stop smoking but recent evidence indicates
they are not very effective.
Investigators in Great Britain followed up on over
1500 men and women who had participated in a
nicotine patch smoking cessation randomized trial
in 1991-1992. They contacted them in 1999-2000 to
see how many had stopped smoking for a long time.
In the original study, 11.2% of the nicotine patch
group and 7.7% of the placebo group had stopped
smoking for at least one year. When they
rechecked at 8 years, only about half of those who
had stopped smoking were still abstinent (5% of
the original study). More importantly, the
nicotine patch group had a slightly higher rate of
resuming smoking so that the completely abstinent
rate at 8 years was less than 1% difference.
Basically this would indicate that nicotine
patches may have a slight initial supportive
effect but that in the long run they are not
superior to just quitting on your own. Diet pills
show the same results so we should not be
surprised.
Smoking cessation and nicotine patches
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Spontaneous miscarriage without D and C
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
It used to be the rule-of-thumb that miscarriages
were always treated with a D and C or dilatation
of the cervix and curettage (scraping) of the
contents of the uterus. This was to primarily
prevent heavy bleeding and moderate blood loss
with spontaneous miscarriage. There has been a
recent trend toward just letting the miscarriage
take place itself without medical interference.
In a study conducted in Scandinavia of over 250
women who sought help for symptoms of miscarriage
within the 1st 14 weeks of pregnancy and who were
not having excessive bleeding at the time,
investigators found that 83% completed the
miscarriage spontaneously without D&C within one
week of onset of symptoms. They had an average of
3.2 days of absenteeism from their daily duties
and did not have excessive blood loss that lowered
their blood count.
This data shows most miscarriages can be managed
without surgical intervention and the time to
resolve the miscarriage is not excessive, i.e., up
to a week.
Spontaneous miscarriage without D and C
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Mastoiditis
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"What are the symptoms, diagnosis, and treatment
of mastoiditis. I am age-70, blocked left
Eustachian tube (3 yrs.), Water in right ear
(bubbles seen from exterior on examination,
vertigo, (three treatments wearing collar and
sleeping sitting up), and have problems hearing and
distinguishing vocal sounds. Noises are very
disturbing." - Kay
Mastoiditis is an infection of the mastoid bone of
the skull, the bone just behind the ear. It
usually starts from a middle ear infection (acute
otitis media). The infection spreads from the ear
to the mastoid bone and the bone becomes filled
with infection. It used to a leading cause of
death among children before the days of
antibiotics. Antibiotics have reduced mastoiditis
from 50% after ear infections down to 0.4%.
Symptoms include:
ear pain
fever
redness of the ear or behind the ear
headache
ear drainage
Examination by a doctor can usually diagnose
mastoiditis but also an MRI or CAT scan xrays
may indicate an abnormality in the mastoid
bone consistent with infection. Bacterial culture
of ear drainage may indicate what specific
bacteria is causing the mastoiditis.
If the mastoiditis remains untreated, brain
abscess or infection can spread throughout the
body and hearing loss and destruction of the
mastoid bone can result.
Once infection is in the mastoid bone, antibiotics
do not clear it up very quickly and there may be
recurrences. It is difficult to get good
antibiotic blood levels to bone tissue because of
the relative lack of blood supply to any bone
tissue. The bone may have to be partially removed
which is quite a major operation. Also a chronic
otitis media may need to be drained by incising
the eardrum (myringotomy) in order to allow
drainage of bacterial infection.
This is a serious problem and you may have
symptoms of mastoiditis so I hope you are seeking
medical help. You may need to ask for referral to
an ear, nose and throat (ENT) specialist.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Maintaining independence as you age
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Most people do not necessarily want to live
longer, they want to live better." They want to
get around, do what they want to do and manage
their own affairs. Most adults take their
independence for granted. It is only when you
become older that you realize there may come a
time when you cannot drive, cannot even walk
around easily and are unable to manage affairs
such as paying bills or even fixing yourself a
simple meal.
Before the time comes when your independence is
threatened, planning is in order. The major
problems you want to prevent are:
Avoid falls - make sure your eyesight is fully
corrected, lighting is very good, slippery scatter
rugs are removed.
Avoid muscle weakness and joint stiffness -
exercise regularly, maintain good eating habits
and a healthy weight.
Plan for a day when you may need daily living
assistance either in your home or in some other
care facility.
Take care of any chronic medical conditions - take
medicines you absolutely need but no extra
medications for any minor but tolerable symptoms.
The most common barriers to independence that I
see in the elderly are crippling arthritis and
cataracts. Non impact exercise and possibly
glucosamine/chondroitin supplements may help
prevent some worsening of arthritis and
ultraviolet sunglass eye protection with outside
activities may help prevent cataracts.
Maintaining your independence
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Health tip to share - Skipping breakfast
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Those who skip breakfast are 4.5 times more likely
to be overweight. On the other hand, individuals
who are "nibblers" and have 4 or more meals a day
are much more likely to be thin. - FRJ
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Romancing Your Wife"
Joe had asked Bob to help him out with the deck
after work, so Bob just went straight over to
Joe's place. When they got to the door, Joe went
straight to his wife, gave her a hug and told her
how beautiful she was and how much he had missed
her at work. When it was time for supper, he
complimented his wife on her cooking, kissed her
and told her how much he loved her.
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