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****** Woman's Diagnostic Cyber Newsletter *******
July 29, 2001
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Smell and taste disorders
2. Uterine embolization for adenomyosis
3. Reader submitted Q&A - Bloody nipple discharge
4. Urinary tract infections
5. Iron deficiency anemia
6. Health tip to share - Stopping smoking
7. Humor is healthy
Spread the word! Send a copy of this newsletter
to someone you know.
Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Smell and taste disorders
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The ability to taste is closely linked with smell.
When either is impaired, appetite goes down and
the immune system can be depressed. Smell is
10,000 times more sensitive than taste and it is
required for distinguishing all flavors. Taste can
only distinguish bitter, sweet, sour and salty.
All other "tastes" are really smells that are
detected in the skin cells lining the nasal and
posterior mouth cavity (nasopharynx).
In younger people, head trauma is a common cause
of loss of taste. It may disturb the nerves that
interpret smells or cause a chronic loss of
nervous system fluid that covers up the skin
lining cells that sense smell. In older adults,
viral infections of the upper respiratory tract
can disturb smell and thus taste. Natural aging
also results in a gradual loss of our sense of
smell at the rate of about 1% a year. Any
degenerative brain disease such as Alzheimer's or
Parkinson disease also can interrupt taste and
smell.
Other causes of loss of smell include:
medications - Amitriptyline (Elavil(R)), alcohol,
nicotine, organic solvents, cocaine and direct
application of zinc sulfate
sinusitis, allergies
gum disease or oral cavity inflammation
radiation therapy to the head and neck
nutritional deficiencies eg, vitamin A, thiamine,
zinc
masses that block the cell smell receptors or
transmission such as nasal polyps or a brain tumor
or sarcoidosis
endocrine disturbances such as hypothyroidism,
hypoadrenalism, diabetes mellitus
intravenous or inhaled drugs (eg, aminoglycosides,
formaldehyde) can contribute to olfactory
dysfunction.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Uterine embolization for adenomyosis
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Uterine artery embolization is being used to treat
uterine fibroids that cause irregular bleeding and
sometimes pelvic pain. Another condition called
adenomyosis often coexists with fibroids and some
investigators believe that most of the time when
pain is associated attributed to fibroids, it
really is the coexistent adenomyosis that causes
the pain. This study looks at women with heavy
bleeding (menorrhagia) and pain who had
embolization performed but in whom only
adenomyosis was found without fibroids.
Those patients with only adenomyosis had improved
bleeding and pain. This retrospective, very small
study suggests, therefore, that uterine artery
embolization may be a possible treatment for
adenomyosis. Most women with adenomyosis have
developed the return of uterine cramps with their
menses after having years of no or minimal cramps.
This may be a promising treatment in the future
for those women.
Keep in mind this is just a preliminary report.
Uterine embolization for adenomyosis
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Bloody nipple discharge
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"For about the last 2 months I have been having a
severe burning, some swelling and a rust colored
discharge from one nipple. That breast is also
very tender. My GYN ordered a mammogram which was
ok, then he ordered a ductogram, which the
radiologist says can't be performed since " my
nipples are too small". My GYN has now
recommended that I see a surgeon. No one has said
yet what this could be. How is it treated? Also,
the radiologist made me feel as if I was a
freak, because he complained so forcefully that my
nipples were too small. Is there such a thing as
too little? What is the appropriate treatment for
this breast and nipple problem?" - Terry
Rust colored nipple discharge implies blood in the
secretions from the gland and ducts of the breast.
Bloody discharge is worrisome for basically two
conditions: intraductal papilloma (about 90% of
bloody nipple discharge) and intraductal or other
types of breast cancer (about 10% of bloody nipple
discharge). Rarely it can indicate other benign or
inflammatory conditions but intraductal papilloma
and cancer are the main two to rule in or rule
out.
Almost always, a rust colored or bloody nipple
discharge come from only one of the breast ducts.
A ductogram is an xray procedure in which a very
small, blunt-ended plastic tube is placed in the
nipple duct that is producing the discharge in
order to inject dye and see if there is a
papilloma in the duct.
I have not heard that size of nipples affects the
ability to perform a ductogram and certainly your
recent radiologist was a clod about making such an
issue about it even if it was the case. It is
possible that there are other radiologists in the
area that have more experience with this and can
perform the procedure for you. Ask the breast
surgeon if there is some other radiologist he or
she has worked with that could be recommended.
The usual contraindications to ductogram are:
history of dye allergies
previous surgery disconnecting the ducts from the
openings on the nipple
severe retraction of the nipple
In either case, whether an intraductal papilloma
is seen or not, you will likely have surgery to
remove the duct that is bleeding to be examined
for possible malignancy or premalignancy (in situ
carcinoma) or to remove the papilloma. You will
need to see the breast surgeon about this and be
sure to ask any questions you have. Write them
down beforehand if you need to so you will not
forget.
Imaging the breast ducts
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4. Urinary tract infections
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Most urinary tract infections (UTIs) are due to a
bowel bacteria called E. coli. This bacteria comes
from the rectum or stool and gets in the opening
of the urethra which leads to the bladder. Other
bacteria as well as sexually transmitted diseases
such as chlamydia or gonorrhea may also cause a
UTI.
If the infection sets up in the urethra, frequency
and burning upon urination results. If the
infection goes higher into the bladder, frequent
urination and even blood in the urine occur. If an
infection then gets higher into the ureter or
kidney, sharp back pain in the loin on the right
and/or left side of the spine is produced.This is
very serious and can cause permanent kidney
damage.
Those at risk for UTIs include people with any
obstruction to urine outflow such as that seen
with kidney or renal stones, those who have birth
defects of the urinary tract, those who have to
wear a catheter for a prolonged time and
individuals with diabetes. Woman are more prone to
UTIs because the urethra opens close to the vagina
and with sex, vaginal bacteria may get into the
the opening which leads to the bladder.
While UTIs may spontaneously clear with just
drinking an increased amount of fluids to produce
frequent urination and wash the bacteria out, it
is best to treat them with antibiotics. Many
different, inexpensive antibiotics are effective
such as those containing sulfa, amoxicillin or
ampicillin. doxycycline or nitrofurantoin.
Recurrent infections may develop resistance to
some of the antibiotics so testing of urine from a
recurrent infection to see which antibiotics are
effective may be necessary.
Urinary tract infections
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Iron deficiency anemia
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Low levels of iron in the body's stores and
circulation produces a low blood count because
iron is the central molecule needed to build
hemoglobin in our blood cells. Hemoglobin is
essential to carry oxygen in our blood. With
anemia, if it is severe, we literally suffocate
slowly because of lack of oxygen.
Anemia is measured by a low hemoglobin or
hematocrit. For non pregnant women, the hematocrit
should be above 35% and the hemoglobin 12 gm/dl or
above. Levels below this would be considered
anemia; 10-11.9 gm/dl would be a mild anemia with
lower levels being much more serious. There are
other causes of anemia other than iron deficiency
so to diagnose the cause as low iron, red blood
cell indices on a CBC blood count need to show a
mean corpuscular volume (MCV) of less than 82 and
a serum ferritin level should be less than 12
ug/dl.
The body can be low on iron because of:
chronic blood loss such as heavy menstruation or
bleeding from the bowel tract,
lack of enough dietary iron intake
an inability to absorb dietary or supplemental
iron
Bowel bleeding can be detected by a stool guiac
test but poor iron absorption is very difficult to
diagnose. Bowel diseases such as Crohn's disease
or malabsorption or even chronic antacid use may
interfere with iron absorption. Vegetarians are a
risk because much iron comes from red meat.
You may not know you have anemia because your
body's cardiovascular system compensates until the
anemia is severe. Symptoms may include: fatigue,
shortness of breath, headache, lightheadedness,
palpitations, or loss of appetite. With any of
these problems, be sure your physician checks a
blood count looking for anemia.
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6. Health tip to share - Stopping smoking
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"My husband and I have not had a cigarette since
Thanksgiving 1999. Both of us had smoked for over
twenty years. We used herbal cigarettes to help
us through the tough times. Last February my
cousin died and I wanted a cigarette, I had an
herbal instead. I believe that is why we have not
started smoking again. There is a pack of them in
the garage and they have been there for over a
year. I have had maybe two all year. Maybe this
can help someone. We are so glad to be smoke
free!" - Cynthia
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
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7. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Words of Wisdom
Sex is hereditary. If your parents never had it,
chances are you won't either.
When I was born, I was so surprised I couldn't
talk for a year and a half.
I live in my own little world, but it's ok, they
know me here.
I don't have a big ego, I'm way too cool for that.
Every time I walk into a singles bar I can hear
Mom's wise words: "Don't pick that up, you don't
know where it's been."
Nobody is perfect until you fall in love with
them.
Marriage changes passion...suddenly you're in bed
with a relative.
I have learned there is little difference in
husbands, you might as well keep the first.
I love being married. It's so great to find that
one special person you want to annoy for the rest
of your life.
I married my wife for her looks...but not the ones
she's been giving me lately!
Money can't buy happiness, but it sure makes
misery easier to live with.
Regular naps prevent old age.....especially if you
take them while driving.
I think your problem is low self-esteem. It is
very common among losers."
Travel is very educational. I can now say
"Kaopectate" in seven different languages.
Shopping tip: You can get shoes for 85 cents at
bowling alleys.
I am a nobody, nobody is perfect, therefore I am
perfect.
I gave my son a hint. On his room door I put a
sign: CHECKOUT TIME IS 18."
Midlife is when you go to the doctor and you
realize you are now so old, you have to pay
someone to look at you naked.
Middle age is when you choose your cereal for the
fiber, not the toy.
"Everyday I beat my own previous record for number
of consecutive days I've stayed alive."
"I don't do drugs anymore 'cause I find I get the
same effect just by standing up really fast."
"If carrots are so good for the eyes, how come I
see so many dead rabbits on the highway?"
Ever notice that people who spend money on beer,
cigarettes, and lottery tickets are always
complaining about being broke and not feeling
well?
The next time you feel like complaining, remember:
Your garbage disposal probably eats better than
thirty percent of the people in this world.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
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****** Woman's Diagnostic Cyber Newsletter *******
August 5, 2001
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Walking and cognitive function in the elderly
2. Psoriasis presents in different ways
3. Reader submitted Q&A - DepoProvera bleeding
4. ITP - Immune (Idiopathic) Thrombocytopenic Purpura
5. Handsome hands and nails
6. Health tip to share - Herbal cigarettes
7. Humor is healthy
Spread the word! Send a copy of this newsletter
to someone you know.
Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Walking and cognitive function in the elderly
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Physical activity helps maintain mental alertness
especially in the elderly, or so several studies
suggest. What has not been clear is whether the
physical activity prevents mental deterioration
and dementia or if mental deterioration and
dementia cause less physical activity.
This article in the Archives of Internal Medicine
looks at a large sample of almost 6000 women over
65 still living in their community (as opposed to
nursing homes). Their activity and mental status
were measured at the beginning of the study and 6-
8 years later. None of the women were felt to have
cognitive impairment at the start of the study.
After 6-8 years, women who started out at higher
physical activity levels had less mental
impairment then the women who started with lower
activity levels.
The authors concluded that the findings support
"the hypothesis that physical activity prevents
cognitive decline in older community-dwelling
women."
Walking and cognitive function in the elderly
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Psoriasis presents in different ways
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Psoriasis is a chronic skin condition
characterized by thick red skin plaques that are
dry and scaly and often itch. The lesions can
present at the elbows, knees, scalp, lower back,
face, palms, and soles of the feet. However, it
can affect any skin site. One type of psoriasis
(inverse) occurs in the folds of the skin near the
genitals, under the breasts, or in the armpits.
Loose and very dry fingernails can also be a
symptom.
Psoriasis occurs equally in men and women and can
affect any ages of adults. About one third of the
time it is inherited. In 15% of the cases
arthritis symptoms are present in the larger
joints.
The most common form of psoriasis is called plaque
psoriasis but there are several other different
forms that also occur:
Guttate psoriasis--Small, drop-like red lesions
Pustular psoriasis--Blisters of noninfectious pus
Inverse psoriasis--Large, red plaques occur in
skin folds
Erythrodermic psoriasis--Widespread reddening and
scaling of the skin
Psoriasis treatment depends upon the severity of
the lesions. It starts out with topical creams and
then ultraviolet light treatments are used.
Finally, systemic medicines including steroids may
be needed.
For more information about psoriasis, check out
the National Institute of Arthritis and
Musculoskeletal and Skin Diseases at the National
Institutes of Health pages on psoriasis.
Psoriasis FAQs
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - DepoProvera bleeding
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I've been on the DepoProvera for more than 5
years now, and have had constant problems with
bleeding. I constantly have spotting and it is
really interfering in my life. I'm thinking of
going off the injection, but I don't know if it is
wise, I'm scared of picking up weight, and of
having more problems, but I can't carry on with
all the spotting, because it causes infections.
One day there will be nothing and then the next
day I will bleed, it has been going on like this
for more than 3 years now!! please give me
advice!" - C
Prolonged spotting on either DepoProvera or oral
contraceptive pills is almost always due to what
is called atrophic bleeding. In other words, the
lining of the uterus is very thin and bleeds
easily because there is not enough tissue
protecting the cavity from any little rubbing or
irritation of the front wall of the uterus against
the back wall. The progestin effect of DepoProvera
or of birth control pills and the absence or low
dose of estrogen to promote tissue thickening,
both contribute to this easy bleedability.
The treatment, therefore is to slightly increase
the estrogen dose which allows the lining to
become more thickened and resistant to abrasion.
This can be done in several ways:
estradiol 1 mg a day by mouth
estradiol skin patch 0.1 mg/day
or if on birth control pills,
switch to a pill with a slightly higher estrogen
level
Another alternative is to use a recently
introduced birth control shot called Lunelle (R).
It has both estrogen and progestin. It is a
monthly shot rather than every 3 months like
DepoProvera(R), but you may only need to take it
for about 3 months to straighten out the bleeding.
Finally, I would not be concerned about weight
gain if you switch to the birth control pills.
DepoProvera(R) is many times worse at causing
weight gain than are the pills. If that has not
been a problem on Depo then it should not be a
problem with the pills.
Be sure to talk to your doctor about these
options.
Continuous Bleeding on Birth Control
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. ITP - Immune (Idiopathic) Thrombocytopenic Purpura
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
ITP is an autoimmune condition that results in
blood platelets being consumed by the body's
normal defense clearing mechanisms. It results in
a low blood level of platelets, a cell in blood
responsible for stopping bleeding if a blood
vessel injury occurs. When platelets are low,
there can be spontaneous bleeding resulting in
easy bruisability and tiny star-like or pinpoint
hemorrhages on the skin of the legs or inside the
mouth. There may be bleeding from the gums, the
gastrointestinal tract or even hematuria from the
kidneys.
Women are three times more likely to get ITP than
men. It can affect all ages including children. No
one knows the exact cause but in many cases
antibodies are made toward one's own platelets
just as if they were foreign bacteria needing to
be cleared from the body.
ITP is initially suspected if a platelet count is
less than 100,000 per cu/ml. As long as the count
does not get lower than 30,000 per cu/ml there
usually is not much risk of a spontaneous stroke
or internal hemorrhage. Once ITP is suspected,
other causes of low platelets need to be ruled
out. Tests for Lupus should be performed as well
as a bone marrow aspiration to rule out different
types of leukemia or lymphoma. HIV, hepatitis or
cytomegalovirus infection should also be ruled
out. Medications can also cause low platelets and
they may need to be stopped for 2-3 weeks to make
sure they are not the cause.
Treatment often includes steroids to suppress the
body's overactive immune system. Sometimes the
spleen has to be removed because it is the organ
that senses antibodies attached to cells and it
destroys any antibody cell complex. If the
platelet count gets below 30,000, platelet
transfusion may be needed. Different physicians
may have different preferences for treating ITP so
be sure to thoroughly discuss the options with an
experienced physician, usually a hematologist.
ITP - Immune (Idiopathic) Thrombocytopenic Purpura
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Handsome hands and nails
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Our hands and fingernails really take abuse. They
are frequently exposed to hot, cold, cleaning
solutions, prolonged immersion in water, drying
out and scrubbing. If you want your hands to not
look all dry and shrivelled, you need to protect
them.
Wear protective gloves when cleaning in the house
or outside.
Wear warm gloves in the winter.
Use sunscreen on your hands when outside.
Use a moisturizer cream after washing and drying
the hands.
Massage your hands and fingers using a massage
cream when you have a moment to relax.
The fingertips and nails also need special digital
care. Sesame oil can be used to hydrate and soften
the cuticle. If the skin or nails are excessively
dry, put a coat of petroleum jelly (Vaseline (R))
on the hands and cover them overnight with cotton
gloves or during the day while working with rubber
gloves. To improve your nails and hair, take 25g
(about 2 tbs) of unflavored gelatin daily in water
or juice. It will take about a month to see the
results.
For more digital hand and nail tips and
instructions on a good home manicure, see this
article at surgerydoor.co.uk.
Handsome hands and nails
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Herbal cigarettes
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
In our last tip, the writer mentioned about using
herbal cigarettes as an aid to quitting smoking.
There were several inquiries about where such
cigarettes were obtainable. You can not by them on
the Internet because tobacco sales are banned. One
of the wholesale distributors offered the
following suggestions:
Check your yellow pages for a tobacco shop near
you and call them to see if they have any herbal
cigarettes or can get them. Other sources are some
of the large discount stores such as Costco and
Price Club.
You will hear some vehement warnings that herbal
cigarettes are just as dangerous as tobacco
cigarettes and that is true. Anything that is
burned will produce tars and byproducts that can
be cancer producing in the long run. The herbal
cigarettes, however, do not contain nicotine which
is one of the strongly addicting substances that
keep one smoking. Therefore an herbal cigarette is
a good aid to those who are quitting or have quit
tobacco cigarettes and who may have a lapse and
want a smoke. The non nicotine (herbal) cigarette
should be less likely to cause a relapse to
resuming tobacco cigarettes. While there are
several "addictive" aspects to cigarette smoking,
I believe that people who condemn herbal
cigarettes miss the point of the powerful role
that nicotine plays in continuing the habit and
how people trying to quit should be able to use
any devices that help them succeed. 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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
7. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Of Teenagers And Cats"
For all of you with teenagers or who have had
teenagers, you may want to know why they really
have a lot in common with cats:
1. Neither teenagers nor cats turn their heads
when you call them by name.
2. No matter what you do for them, it is not
enough. Indeed, all humane efforts are barely
adequate to compensate for the privilege of
waiting on them hand and foot.
3. You rarely see a cat walking outside of the
house with an adult human being, and it can be
safely said that no teenager in his or her right
mind wants to be seen in public with his or her
parents.
4. Even if you tell jokes as well as Jay Leno,
neither your cat nor your teen will ever crack a
smile.
5. No cat or teenager shares your taste in music.
6. Cats and teenagers can lie on the living-room
sofa for hours on end without moving, barely
breathing.
7. Cats have nine lives. Teenagers carry on as if
they did.
8. Cats and teenagers yawn in exactly the same
manner, communicating that ultimate human ecstasy
-- a sense of complete and utter boredom.
9. Cats and teenagers do not improve anyone's
furniture.
10. Cats that are free to roam outside sometimes
have been known to return in the middle of the
night to deposit a dead animal in your bedroom.
Teenagers are not above that sort of behavior.
Thus, if you must raise teenagers, the best
sources of advice are not other parents, but
veterinarians. It is also a good idea to keep a
guidebook on cats at hand at all times. And
remember, above all else, put out the food and do
not make any sudden moves in their direction. When
they make up their minds, they will finally come
to you for some affection and comfort, and it will
be a triumphant moment for all concerned.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** Woman's Diagnostic Cyber Newsletter *******
August 12, 2001
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Depression during pregnancy
2. Grinding your teeth
3. Reader submitted Q&A -Perianal boil-like cysts
4. Abdominal wall pain
5. Ulcerative colitis
6. Health tip to share - Cranberry Juice reduces UTIs
7. Humor is healthy
Spread the word! Send a copy of this newsletter
to someone you know.
Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Depression during pregnancy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Most are familiar with the significant problem
that postpartum depression can cause. Sometimes
there can even be a psychosis resulting in harm to
the child or children. There has been significant
media attention to postpartum depression recently
to the detriment of discussing how much of a
problem depression DURING pregnancy can be.
A recently reported study in the British Medical
Journal looked at the incidence of depression all
during pregnancy as well as in the postpartum
period. They administered standardized depression
tests to over 13,000 women at 18 weeks pregnancy,
32 weeks pregnancy, 8 weeks postpartum and 8
months postpartum. At each point in time they
calculated what percent of women measured as being
depressed by the test that was given.
They found the incidence of depression to be:
18 weeks preg 13.9%
32 weeks preg 15.2%
8 weeks postpartum 10.2%
8 months postpartum 8.8%
They concluded that depression really starts
during pregnancy and we should be more aware of
it. It actually seemed to increase somewhat during
pregnancy and the incidences postpartum were not
higher as expected. It turns out that depression
during pregnancy is more common than postnatal
depression, at least as measured at 8 weeks after
delivery.
The peak incidence of postpartum blues is actually
at 5 days postpartum so this study might be
criticized for its timing of when the test was
given. It does bring attention, however, to
depression occurring during pregnancy in
significant numbers. We should turn our attention
toward picking that up early and trying to
intervene to prevent it worsening after delivery.
Depression during pregnancy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Grinding your teeth - bruxism
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Some people grind their teeth at night. This is
called bruxism and the grinding noise can be quite
loud. While a habit like this sounds benign, it
can result in the tips of the teeth being worn
down, flattened and even cracked. Sometimes the
enamel is worn off the teeth and the inside of the
tooth becomes exposed.
A dentist can pick up these changes with an exam
and fit you with a mouthpiece that may protect the
teeth. However the teeth are not the only victims
of bruxism. The tensing of the jaw muscles and
chewing motion while you sleep may produce:
chronic facial pain
a dull morning headache
earache
chewed tissue on the inside of the mouth
tempomandibular joint (TMJ) disorder
While the cause of bruxism can be an abnormal
alignment of the upper and lower teeth
(malocclusion), the more common causes are
anxiety, stress, anger or frustration. Bruxism is
more than a grinding of the teeth problem; it
frequently represents a mental stress or strain
that needs to be identified and addressed. Tobacco
and alcohol can make bruxism worse.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Perianal boil-like cysts
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I am a 24 year old African American woman. At the
age of puberty I developed a constant perianal
odor that would not go away. I have also
experienced boil-like cysts in my perianal area as
well as in my armpits, and the back of my thighs.
This too, is a common nuisance that the women in
my family experience. I have seen many doctors and
specialists but as of yet I have found no
diagnosis of my condition. Upon sharing this
information with close family members,I found that
several other women in my family have experienced
this condition. My Dermatologist told me that this
is a medical condition and that there is really no
known cause or cure. I did however inadvertently
find something that helps. I began taking a
medication called Bupropion (Wellbutrin & Zyban)
for a quit smoking aid and an anti-depressant. I
found that several weeks later, the abnormal odor
had diminished almost entirely. When I shared this
with my Dermatologist she told me that certain
anti-depressant drugs have been proven to help
clear up symptoms of chronic skin disease and
conditions (although they are not cures), however
she had no explanation of why this occurs."
"Here is my question. Do you have any idea what
could cause a condition such as this? I have come
to believe that whatever it is, it is hereditary.
Any bacteria infection or STD has already been
ruled out. It is not a matter of feminine hygiene
either. Another interesting thing is that when I
began using ultra sensitive under arm deodorants
on my external vaginal area, I noticed that the
strong unpleasant smell would disappear
completely, but I would still retain a normal
women scent. I believe this rules out a discharge
of any sort. If you know of any thing that could
help explain this I would be grateful." -
anonymous
While it is very difficult to diagnose cystic-like
skin lesions in the perineal and perianal area
without seeing them, there is a condition that is
very similar to what you are describing. It is
called "hidradenitis suppurativa" This is an
inflammatory condition of the sweat glands and
hair follicles in the genital area as well as the
armpit area (axilla). These boil-like lesions can
be come infected and cause significant pain and
disfiguration. The odor comes from the sweat gland
secretions that are mixed with skin bacteria. When
you use an anti-perspirant (as opposed to just a
deodorant), that decreases the sweat gland
secretions.
I am not sure about the Bupropion effect except it
is known that smoking seems to aggravate the
hidradenitis. If you were stopping smoking when
you used the medicine, it is more likely that the
smoking cessation was responsible for the
decreased odor rather than the drug itself.
There are other conditions of the vulvar, perianal
and axillary sweat gland cysts other than
hidradenitis suppurativa, although it is the most
common to produce symptoms as you describe. Fox-
Fordyce disease is similar and often needs a
biopsy to distinguish it from hidradenitis. There
are some sexually transmitted diseases that can
cause similar symptoms but those would be acquired
at a time later than puberty so it is doubtful
that is what is going on.
Hidradenitis suppurtiva is difficult to treat.
Acute and chronic antibiotics are used. Retin A
topical cream and Accutane used to treat acne
sometimes give a response. Perhaps that is why
hidradenitis suppurativa is also called "acne
inversa". Radiation has been used but the most
successful treatment is surgical excision. The
main problem with surgery is complications of
scarring. As you can imagine the wide areas of
tissue that need to be excised. It is a last
resort treatment.
Your dermatologist probably knew the name of your
condition but did not mention it to you. You may
want to follow up for some antibiotic treatment at
least.
Vulvar Sweat Gland Cysts
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Abdominal wall pain
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
When someone complains of abdominal or pelvic
pain, doctors and relatives alike all assume that
the source of the pain is from some internal
abdominal organ such as the gall bladder, the
stomach, the small or large bowel, the appendix,
the ovaries, the tubes or the uterus. We forget
that occasionally the source of the pain can be
from the muscles, nerves and skin of the abdominal
wall itself.
Pain that originates inside the abdomen usually
has a relationship to bodily functions such as
eating, bowel movements, urination or the
menstrual cycle. Abdominal wall pain is not so
related. It is more constant or it may vary only
with physical movement of the muscles and
overlying skin.
One of the hints that pain might be from the
abdominal wall is when a person tenses the
abdominal muscles and the pain worsens (positive
Carnett's sign). Other hints include:
the pain does not vary by eating, bowel movements,
urination, or menstrual cycle
the pain varies significantly upon changing
positions such as standing to sitting, sitting to
standing, lying to standing etc.
there are "trigger points" on the skin that when
touched even lightly produce a wider spread pain.
Since many doctors do not always consider the
abdominal wall as the main cause of chronic pain,
it may be up to you to figure out if your pain
comes from outside the abdominal cavity rather
than inside it. Try tensing of the muscles to see
if the pain worsens. Use a q-tip or light finger
touch to see if there are any skin areas that are
quit painful and the pain broadens in area when
touched.
If so, bring it up with the doctor. Sometimes
injections of local anesthetic in the abdominal
wall at the "trigger point" can significantly
relieve the pain. Even if it is not permanent
relief, it helps establish the diagnosis. If your
doctor is not familiar with trigger point
injections, ask if there is a pain specialist
(usually an anesthesiologist with special
training) that you can be referred to.
Abdominal wall pain
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Ulcerative colitis
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Ulcerative colitis (UC) is exactly what it sounds
like. It is an inflammatory condition of the
bowel wall that produces ulcers in the lining of
the large colon and rectum. Sometimes the small
bowel can also be affected. The ulcers cause
bleeding, pain and hyperstimulation of the bowel
resulting in diarrhea.
Because of its symptoms of diarrhea, ulcerative
colitis can be confused with irritable bowel
syndrome (IBS) which is quite common in women. IBS
does not have blood in the stool, however, nor
does it cause fever or weight loss as ulcerative
colitis often does. UC is different than Crohn's
disease which causes ulcers in the small intestine
but it has a similar process causing ulcers in the
bowel wall.
Diagnosis of UC is by colonoscopy (looking with a
flexible telescope up the rectum and large colon)
or by a barium enema x-ray study (dye placed up the
rectum and colon). While it is uncomfortable to
have these studies it is very important to have an
accurate diagnosis because it raises the risk for
colon cancer. It is a long term disease with no
known cure other than surgical removal of the
affected bowel.
Most people do not have severe cases requiring
surgery. They can be treated medically with sulfa-
type antibiotics and occasionally steroids to
reduce inflammation. Other medicines such as
immune suppressing agents are also used. About 5%
of people with UC develop cancer of the colon.
Anyone with longstanding ulcerative colitis needs
to have a colonoscopy frequently (every 1-2 years)
to screen for premalignant or malignant changes.
For more information about ulcerative colitis, see
this article at The National Digestive Diseases
Information Clearinghouse of the National
Institutes of Health.
Ulcerative colitis
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Cranberry Juice reduces UTIs
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I read several scientific articles that described
evidence that drinking cranberry juice resulted in
lower bacteria levels in the bladder and fewer
urinary tract infections. I had a nasty allergic
reaction to one of the medications that I took to
combat the problem of frequent UTIs, so reading
this article was timely. What I find is that
drinking a large glass daily of the low calorie,
artificially sweetened version of cranberry juice,
has indeed helped me in prevention of UTIs. This
has been a recurrent problem for me for about 30
years, and I am delighted to find a solution that
does not involve taking a lot of medication. I
think this does not help much after you have a
UTI, but drinking cranberry juice on a regular
basis does seem to work for prevention. There are
also cranberry juice concentrate pills and liquid
available from nutrition stores such as GNC." -
anonymous
If you have discovered ways of coping with a
disease or condition and it works for you, please
share it with us:
Health tip suggestion form
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
7. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Arthritis With Complications?"
The middle-aged man was shuffling along, bent over
at the waist, as his wife helped him into the
doctor's waiting room.
A woman in the office viewed the scene in
sympathy. "Arthritis with complications?" she
asked.
The wife shook her head, "Noooo....Do-it-
yourself," she explained, "with concrete blocks."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** Woman's Diagnostic Cyber Newsletter *******
August 19, 2001
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Vitamin deficiencies causing anemia
2. Preventing injuries in exercise and sports
3. Reader submitted Q&A - Endometrial ablation
4. Chlamydia symptoms
5. What is a luteal phase defect?
6. Health tip to share - Vitamin C and gall bladder
7. Humor is healthy
Spread the word! Send a copy of this newsletter
to someone you know.
Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Vitamin deficiencies causing anemia
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The most common form of anemia (low blood count)
is due to low iron. Iron is an essential component
of hemoglobin, a molecule that carries oxygen.
There are some vitamins that are essential to
building blood cells too. Vitamin B-12
(cobalamin), Vitamin B-9 (folic acid) and Vitamin
C are needed. Deficiencies in any one of these
vitamins can produce an anemia just like an iron
deficiency one.
These anemias are caused either by a diet
deficient in the vitamin, or failure to absorb the
vitamin from the stomach. When vitamin B-12 cannot
be absorbed in the stomach, it results in
pernicious anemia. Folic acid may not be absorbed
when Crohn's disease or high alcohol intake is
present. Certain medicines such as anti-seizure
drugs or anti-tuberculosis increase the need for
folic acid as do the conditions of pregnancy and
women on hemodialysis for kidney failure.
Vitamin deficiencies such as those found with B12
and folic acid take months or even years to
develop. In addition to the normal symptoms of any
anemia such as fatigue, dizziness, shortness of
breath with mild exertion, and numbing of the
hands and feet, there are some unique symptoms
with vitamin B-12 deficiency:
Yellowing or darkening of the skin
Sore mouth or tongue
Yellow-blue colorblindness
Mental confusion or forgetfulness
While vitamin B-12 and folic acid are needed to
build blood cells, vitamin C is required to help
absorb iron and folic acid. Vitamin C comes from
fruits, folic acid from fruits and greens, and
vitamin B12 from eggs, meats and milk. Thus the
need for a "well-balanced" diet.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Preventing injuries in exercise and sports
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Different age groups have different physical and
personality characteristics so rules of fitness
and accident prevention are different for children
than they are for say adolescents or adults.
Children are much more flexible with their bodies
and not as strong muscularly so they are not as
prone to muscle strains and sprains. They do not
have to warm up as much as adults do but they also
cannot stand repetitive overuse of the muscles.
Children also have shorter attention spans so
their interest must be kept up or mind wandering
can lead to inadvertent mishaps. Game-playing
sports and fitness routines work well with
children.
Adolescents are less flexible than children, but
muscularly they are stronger. They are also in the
period of rapid growth spurts which can cause pain
that is confused with injuries. The tendinous
areas of the knee, the heel and the back are often
susceptible to these growth spurts and pain in
these areas can be a normal response to exercise.
Adolescents need stretching exercises before
workouts and need low level, muscle strengthening
works outs as well as balancing exercises. They
should avoid heavy weight training with strong
resistances. Keep in mind however that the biggest
problem is the different rates of body maturation
so it is more important to adjust the fitness
routine to the teens body development than it is
to follow one specific course or the other.
Adults lose flexibility and develop muscle
weakness. They need more stretching exercises to
warm up with and more muscle strengthening
routines. Stiffness due to loss of elasticity
makes adults more prone to muscle injury. Routines
need to be more gradual and more frequent.
Footware equipment is more critical to prevent
injury as is overall movement technique. Adults
are susceptible to injuries from moving only part
of their body rather than all of it when
participating in an exercise or sport. They should
even consider exercise or sports "lessons" for
activities they did not master at younger ages.
For additional tips on preventing injuries, see
this article at surgerydoor.co.uk
Preventing injuries in exercise and sports
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Endometrial ablation
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I'd like some information on endometrial ablation
as I am scheduled to get one done soon."
"I have been having very heavy long periods for
about 3 years now on birth control pills. I have
a small fibroid and have had two pelvic
ultrasounds and also a transvaginal ultrasound.
My doctor says this is "mechanical" meaning that
every month the fibroid will keep causing my heavy
periods until its removed. Right now I am on
Aygestin(R) to control the bleeding while I have
my period until I get the surgery done."
"Please give me any information and risks you have
on endometrial ablations and the success rate and
chances of my periods becoming lighter or
nonexistent." - DS
Endometrial ablation is a procedure usually
performed in out patient surgery during which you
are put under general anesthesia and a
hysteroscopy is performed to look inside the
uterine cavity. If the cavity is normal without
any impingement by a fibroid or any congenital
anomaly, then the skin lining the uterine cavity
is heated (thermal), cauterized (roller ball,
laser), frozen (cryo), or skinned (resectoscope).
If there are uterine (endometrial) polyps present,
those are removed before treatment. Endometrial
ablation should not be performed by the thermal
balloon method if the cavity is not smooth. Many
times there is no further treatment given if the
bleeding is thought to be due to the polyp and the
polyp is completely removed.
If your fibroid is impinging upon the cavity (deep
intramural) or if one is polypoid hanging out in
the cavity (submucosal), it may be shaved off.
Then the ablation is performed or not performed,
depending upon whether the fibroid(s) is suspected
of causing the heavy bleeding. In other words, if
any anatomical cause is found that explains the
heavy bleeding you are having. and it is removed,
then you may not have to have the ablation done.
Thermal balloon ablation is one of the more common
methods used for destroying the lining of the
uterus. The procedure takes totally about 15-20
minutes. You will have some heavy bleeding and
cramps about 1-3 weeks after the procedure as the
cauterized tissue sloughs. After that bleeding
tends to be much less. The more thoroughly the
tissue is destroyed, the less bleeding you will
have in the future.
Rates of complete amenorrhea (no bleeding at all
again) are only about 15-35% depending upon the
type of ablation done and how completely the
tissue is destroyed. Another 35-55% have bleeding
reduced each month enough so that they are happy
they had it done. About 30% of women having the
procedure do not have enough improvement that they
are happy with it. That group usually goes on to
have a hysterectomy later.
You should know by the 3rd or 4th month after the
procedure how good the results are going to be.
Long term bleeding patterns after ablation have
not yet been well categorized. In general it is
better for the woman in her 40's rather than one
in the early 30's because heavy bleeding patterns
tend to recur over the long run and the sooner a
woman undergoes menopause, the less the likelihood
of heavy bleeding returning. There are not good
numbers on this exact frequency.
The ablation procedure is best reserved for the
woman whose main problem is heavy bleeding but
less than 7 days duration and who is not
intolerant of prolonged (greater than 7 days)
bleeding but light/spotting in amount.
Interview on endometrial ablation
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Chlamydia symptoms
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Chlamydia infection is a sexually transmitted
disease that is often called the silent epidemic.
Up to 70% of women and 25% of men have absolutely
no symptoms of infection. In fact we often get
questions from women who have been married for
several years and all of a sudden have a positive
test for chlamydia at a routine new obstetric
work-up, or just a regular screening culture
performed during an office gyn visit. They ask if
this means their husband has been unfaithful to
them or is it possible they could have had the
infection all along from sexual relations prior to
their marriage.
The truth is, both explanations are possible. This
is because chlamydia can remain in the cervix for
so long without producing symptoms that would make
a woman seek treatment. There are no scientific
studies I could find that have examined how long
it can be carried without symptoms but I have seen
instances that are very likely for 3 years or
more. I would guess it could be quite a bit longer
and there is no reason to say it couldn't take
place for 10 years or more. Most people receive an
antibiotic occasionally which probably clears the
chlamydia infection up without knowing it.
When symptoms do occur, they may be one or more of
the following:
bleeding after intercourse or in between periods
burning on urination or frequent urgency
an unusual yellowish vaginal discharge
a low grade fever
acute pelvic pain building up over 12-24 hours
Men can also be asymptomatic carriers of chlamydia
but when they have symptoms, they usually present
like a urinary tract infection with burning on
urination, frequent urination or a pus-like
discharge from the end of the penis.
Do not be afraid to ask the doctor to perform a
cervical smear for chlamydia at the time of doing
a pap smear or at anytime you think you may have
some of the above symptoms. The test is quite
accurate for chlamydia and doctors do not mind
doing that test at all.
Actually doctors tend to not do the test as often
as they should. Some women become quite offended
if a doctor suggests a test for an STD like
chlamydia. and yet study after study shows that
women with extra bleeding during the month and
women having urinary tract symptoms and vaginitis
symptoms will have a fairly high incidence of a
positive test for chlamydia or gonorrhea.
Wouldn't it be better to know for sure you were
negative?
Chlamydia symptoms
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. What is a luteal phase defect?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Many women who are trying to conceive become more
and more involved with self-diagnosing why they do
not conceive as each cycle goes by without
becoming pregnant. This is a normal reaction to
any medical problem, but the desire to become
pregnant can be so strong that a woman will
subject herself to any treatment that she hopes
will improve her chances.
Luteal phase defect is one such condition whose
treatment becomes convoluted with the overwhelming
desire to do something, rather than nothing, even
if the treatment is not effective. While
physicians recognize that such a condition as
luteal phase defect exists, its treatment is
unproven.
If a menstrual cycle is less than 28 days or a day
21-22 luteal phase progesterone is below 10 or 14
ng/ml or a BBT does not show 12 days or more of
temp elevation, many women are led to believe that
they should take progesterone supplements under
the premise that they have a luteal phase defect.
This concept can be wrong on two accounts. First
of all. any one cycle can be abnormal and have a
short luteal phase or a low progesterone level but
it is not a regular pattern. A woman needs to have
at least two menstrual cycles with either biopsies
that show out of phase endometrium or progesterone
levels on day 7-8 after proven ovulation of less
than 10 ng/ml in order to conclude that luteal
phase defect might play a role in their conception
difficulties.
Secondly, it is unlikely that any progesterone
supplementation either by shot or by vaginal
suppositories improves the ability to get
pregnant. Only one randomized controlled study has
looked at this that I could find. It found no
significant improvement in pregnancy rates. Non
randomized studies have had the same outcome with
most showing no benefit and some occasionally
showing a difference. This kind of evidence would
suggest that progesterone supplementation for
luteal defects is probably not beneficial.
Clomid is another treatment used for luteal
defects and although it improves luteal
progesterone levels, the few studies done do not
show an improved pregnancy rate in the case of
"luteal phase defects".
Well if it doesn't hurt, why not use it on the
chance it might help? Some reasons might be:
1) Progesterone sometimes delays menses even
though pregnancy does not occur thus delaying the
next attempt at conceiving.
2) We do not know if there are subtle, long term
effects of taking progesterone in early pregnancy
because it has not had large scale, long term
studies.
3) There is an unnecessary expense involved and
4) it produces false hope.
The intent of this is not to discourage women who
are trying to conceive and may have evidence of
luteal phase defects. Women need to understand
that when no clear evidence for a treatment
exists, accepting an experimental treatment
involves risks. Also, shopping around for a
physician who will give you some treatment rather
than none also involves risks.
Luteal defect criteria
Effect of treatment on pregnancy rate
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Vitamin C and gall bladder
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Women who have higher serum vitamin C levels have
a lower incidence of gallstones. From animal
studies we know that vitamin C supplementation
can prevent cholesterol gall stones. It is very
likely that a vitamin C supplement can help
prevent some development of gall stones in women.
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Graduate Nurses vs Experienced Nurses"
A Graduate Nurse throws up when the patient does.
An experienced nurse calls housekeeping when a
patient throws up.
A Graduate Nurse wears so many pins on their name
badge you can't read it.
An experienced nurse doesn't wear a name badge for
liability reasons.
A Graduate Nurse charts too much.
An experienced nurse doesn't chart enough.
A Graduate Nurse loves to run to codes.
An experienced nurse makes graduate nurses run
to codes.
A Graduate Nurse wants everyone to know they are
a nurse.
An experienced nurse doesn't want anyone to know
they are a nurse.
A Graduate Nurse keeps detailed notes on a pad.
An experienced nurse writes on the back of their
hand, paper scraps, napkins, etc.
A Graduate Nurse will spend all day trying to
reorient a patient.
An experienced nurse will chart the patient is
disoriented and restrain them.
A Graduate Nurse can hear a beeping I-med at 50
yards.
An experienced nurse can't hear any alarms at any
distance.
A Graduate Nurse loves to hear abnormal heart and
breath sounds.
An experienced nurse doesn't want to know about
them unless the patient is symptomatic.
A Graduate Nurse spends 2 hours giving a patient a
bath.
An experienced nurse lets the CNA give the patient
a bath.
A Graduate Nurse thinks people respect Nurses.
An experienced nurse knows everybody blames
everything on the nurse.
A Graduate Nurse looks for blood on a bandage
hoping they will get to change it.
An experienced nurse knows a little blood never
hurt anybody.
A Graduate Nurse looks for a chance "to work with
the family"
An experienced nurse avoids the family.
A Graduate Nurse expects meds and supplies to be
delivered on time.
An experienced nurse expects them to never be
delivered at all.
A Graduate Nurse will spend days bladder training
an incontinent patient.
An experienced nurse will insert a Foley catheter.
A Graduate Nurse always answers their phone.
An experienced nurse checks their caller ID before
answering the phone.
A Graduate Nurse thinks psych patients are
interesting.
An experienced nurse thinks psych patients are
crazy.
A Graduate Nurse carries reference books in their
bag.
An experienced nurse carries magazines, lunch, and
some "cough syrup" in their bag.
A Graduate Nurse doesn't find this funny.
An experienced nurse does.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** Woman's Diagnostic Cyber Newsletter *******
August 26, 2001
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Vioxx, Celebrex and cardiovascular events
2. Yellow and pink, eye growths
3. Reader submitted Q&A - Tubal ligation clips
4. IUCD is not associated with infertility
5. Cryptosporidium parasite in swimming pools
6. Health tip to share - Perineal odor
7. Humor is healthy
Spread the word! Send a copy of this newsletter
to someone you know.
Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Vioxx, Celebrex and cardiovascular events
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Be cautious about Media Medicine!
The drugs Vioxx(R) (rofecoxib) and Celebrex(R)
(celecoxib) are relatively new anti-inflammatory
drugs used for arthritis and other forms of
chronic inflammatory pain. Their major benefit is
longer action (once a day dose) and less
gastrointestinal upset compared to traditional non
steroidal anti-inflammatories (NSAIDs) such as
aspirin, ibuprofen (Advil(R)) and naproxen
(Alleve(R)). However, aspirin is known to reduce
adverse thrombotic cardiovascular events such as
heart attacks and the other NSAIDs may also cause
a reduction.
This recent Journal of American Medical
Association study "reanalyzed" studies in the
literature that tested Vioxx(R) against naproxen
and Celebrex(R) against ibuprofen. The Vioxx study
show an increased relative risk for cardiovascular
events (risk ratio 2.38) but the Celebrex study
did not. If naproxen happens to be more effective
than ibuprofen in preventing heart attacks like
aspirin does, that would explain the total
difference, i.e., not causing increased heart
attacks but rather not preventing them as well as
the naproxen. Neither ibuprofen nor naproxen have
been tested in randomized studies to see if or how
much they prevent heart attacks. Just the rate of
GI upset being lower with naproxen than ibuprofen,
so that people on ibuprofen skip more doses, could
make this difference true.
This JAMA study went on to compare the Vioxx(R)
and Celebrex(R) cardiovascular events with the
placebo groups of a different collection of
aspirin studies. They looked as far as the annual
rate of myocardial infarctions (0.74% per year
versus 0.52% in placebos) and concluded that
these new Cox inhibitor drugs of Vioxx(R) and
Celebrex(R) raise the risk of heart attacks.
I would suggest to you that this is an example of
a dense scientific fog that should not be reported
by the media until further studies show more
definite differences. Even if it is a true
difference, the rate of heart attacks of .74% a
year versus .52% a year among individuals with
arthritis is not a clinically meaningful
difference. In my opinion, if you have to take
long term anti-inflammatory medicine for arthritis
or a chronic inflammatory disease, the benefits of
the once-a-day dose of a medicine with low GI side
effects outweighs the currently known risks
including cardiovascular ones.
Cardiovascular Events and Selective COX-2 Inhibitors
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Yellow and pink eye growths
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The inside of the upper and lower eyelids as well
as the white part of the eyeball (sclera) and lens
have very thin membranes that cover them called
the conjunctiva. This membrane is invisible
unless it becomes inflamed (red eye) or develops
growths in it. The two most common benign growths
in this tissue are pinguecula and pterygium (what
a mouthful).
Pinguecula in the more common of the growths and
occurs in adults and increases with age. Commonly
it will present as small, raised yellow spots on
the conjunctiva. The spots of tissue can also be
gray, white or colorless. They are more commonly
on the nasal side of the lens but can be on either
side. These spots are caused by a chronic,
irritant eye exposure of some sort. It can be due
to toxic vapors, saltwater spray or even sun
exposure. Heat, dryness, wind, dust, smoke, and
other irritants make the spots worse. Treatment is
to remove the irritant source and keep the
conjunctiva moist. Sometimes pinguecula may need
to be removed surgically.
