Women's Health Newsletters 10/3/99 - 11/7/99
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***** Woman's Diagnostic Cyber Newsletter *****
October 3, 1999
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Arthritis symptoms - Is it rheumatoid?
2. Fatigue limits recovery speed after hysterectomy
3. Reader submitted Q&A - Basic infertility dx
4. Depression and anxiety are a common mix
5. 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. Arthritis symptoms - Is it rheumatoid?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Everyone gets aches and pains in the muscles and
sometimes the joints. Rheumatoid arthritis often
starts as pain in the wrists and knuckles.
Stiffness of those joints in the morning lasting
for an hour or more is a hallmark of rheumatoid
arthritis. Pain and swelling of the joints has to
go on for about 6 weeks before a doctor can
diagnose rheumatoid arthritis versus some of the
other self-limited arthropathies.
Rheumatoid arthritis is an immune disease in which
your body forms proteins that react or destroy
your own normal joint tissue. The joint fluids are
swollen but eventually the joint becomes narrow.
It is different from osteoarthritis, which affects
older individuals and usually causes pain in only
a few joints, infectious arthritis, post
inflammatory arthritis and crystal-induced
arthritis (gout).
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2. Fatigue limits recovery after hysterectomy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Fatigue after surgery to remove the uterus is the
major factor that limits recovery according to a
recent survey presented at the American Society
for Reproductive Medicine. This is the longest
lasting symptom after hysterectomy and women are
not well instructed as to how much of a problem
fatigue can present. While anemia (low blood
count) is a common cause of postoperative fatigue,
many women do not even receive iron therapy after
surgery to help build the blood count back.
These investigators found that on the average,
women were extremely tired for more than 10 weeks
post hysterectomy, compared with just 4.5 weeks of
pain. Over a third of the women (37%) said that
"fatigue interfered with their recovery more than
any other side effect, including pain, sexual
dysfunction and hot flashes."
The take-home message is that if you are going to
have a hysterectomy (or any other major surgery)
be sure to discuss this with your doctor and make
plans for what can be done to minimize this
excessive tiredness. This may mean iron therapy,
adequate hormonal replacement, minimal use of
medications that may compound fatigue, early
exercise of muscle groups not involving your
incision and any treatment for sleep difficulty if
needed.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Basic infertility dx
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"We are a couple married 9 years. We don't have a
child. I had a cyst on the right ovary and it was
removed by open surgery. It seems my tubules are
in a mess. For my husband, a testicular biopsy was
done, and the report shows that there is a
complete maturation arrest of spermatozoa. Could
you please help us to overcome this problem and
inform us what can be done to have a child?
Already we are getting old. My age is 30 and
husband's age is 37. I have normal menstrual
periods without pain (at times I have severe
pain). Otherwise our sexual life is normal and
active.
This couple has both a male and a female factor
that is causing infertility. If her husband has
had a testicular biopsy showing no mature sperm,
there is only a 25% chance that premature forms
of sperm can be aspirated and using advanced
reproductive technologies, growing those sperm to
maturity and then injecting them into an egg,
intracytoplasmic sperm injection (ICSI) or mixing
them with an egg using in vitro fertilization
methods.
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4. Depression and anxiety a common mix
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
When I think of depression, the words "blue funk"
come to mind, a down feeling, don't get out of
bed. But did you know that anxiety symptoms such
as phobias, panic attacks, fears, worry and
agitation occur in as many as 80% of depressed
individuals. The anxiety component can even
produce physical symptoms such as headaches
irritable bowel syndrome and chronic pain in a
depressed individual.
Anxiety mixed with depression tends to occur in
younger individuals and result in a longer
lasting, more severe depression that is less
responsive to many anti-depressant medications.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Serious Operation
-=-=-=-=-=-=-=-=-=-=-=-
After a long and serious operation, Lena ended up
in a coma. Try as they might, the doctors just
couldn't bring her out of it. When her husband
Ralph came into the Intensive Care Unit to see
her, the doctors gave him the bad news.
"We just can't wake her. It doesn't look good I'm
afraid," the doctor told Ralph in a quiet somber
voice.
Ralph looked at Lena and with a soft trembling
voice said, "But doctor, she's so young. She's
only 45."
"37," came the weak reply from Lena.
Contributed by: Raman
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That's it for this time.
Make confident self-help care decisions.
Rick
Frederick R. Jelovsek MD
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***** Woman's Diagnostic Cyber Newsletter *****
October 10, 1999
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Eyecare
2. Women and sex - Science is behind
3. Reader submitted Q&A-Non menopausal hot flashes
4. Treatment of depression during pregnancy
5. A digital health conscience - just what I need
6. 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. Eyecare
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Everything you always wanted to know about the
eyes is included in this extensive article and
listing at the Health 0n the Net Foundation.
Different conditions of visual acuity are covered
as well as how to read an eyeglasses prescription
and the ins and outs of glasses and contacts. If
you are having any problems with your vision or
contact lenses, this section can answer some
questions.
Eye diseases and conditions such as
conjunctivitis, eyelid problems of stys or flaking
eyelashes are among the topics and the topics all
have secondary links to other web sites to expand
upon a given condition.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Women and sex - Science is behind
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Viagra for mens' erectile dysfunction has brought
to light just how little science is behind is
studying sexual desire, libido and arousal in
women. Lack of sexual desire is a very common
problem in women. It is different, but related to,
sexual arousal. In other words, many women will
complain that they just have no desire to be
involved in sex, but if they do get involved, they
can still undergo arousal with their feelings very
easily. Its the "getting started" that is
difficult.
A recent article below from the women's section of
the New York Times points out how little is known
of the physiology. One psychologist, Dr. Sandra
Leiblum said she thinks many sexual complaints in
women are psychological, that women feel pressured
to perform, or that "they feel concerns about how
they look or how they are formed or how they
smell."
Surveys show twice as much lack of sexual desire
in women as men, up to a third of them.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - non menopausal hot flashes
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I am a 32 year old female. Throughout the last
year, I've developed "night sweats". I have them
sporadically about once a month. I know this is a
common occurrence with menopause, but I'm only 32!
I also know that I could be starting menopause
early. However, are there other conditions that
would cause night sweats? Is there a way to
prevent them? Thanks a bunch." J.S.
Hot flashes are not always menopausal. In fact
most hot flashes are often due to other causes and
occur in both men and women. Once a month hot
flashes are not worrisome for menopause or
serious diseases.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Treatment of depression during pregnancy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The safety of anti depressant pharmacologic
therapy during pregnancy has always been a
concern. On the one hand, some medications have
been associated with birth defects such as lithium
or Dilantin. Recently, there have been many new
products developed for depression treatment.
This article from the Journal of the American
Medical Association (JAMA) looks at different
studies in the medical literature to see which
medications appear safe during pregnancy.
There were only four good studies that they found
- mostly concerning tricyclics (Elavil, Pamelor,
Sinequan, Tofranil, Triavil), fluoxetine (Prozac)
and serotonin reuptake inhibitors (Paxil, Prozac,
Zoloft). They concluded that "exposure to these
agents did not increase risk for intrauterine
death or major birth defects. Decreased birth
weights of infants exposed to fluoxetine in the
third trimester were identified in 1 study. The
development of children whose mothers took
tricyclics or fluoxetine during gestation did not
differ from that of controls. Direct drug effects
and withdrawal syndromes occurred in some neonates
whose mothers were treated with antidepressants
near term."
Keep in mind that babies do have withdrawal and
therefore are being affected by these drugs.
Therefore treatments should not be used unless
they are very necessary.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. A digital health conscience - just what I need
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If you have personal goals to:
Lose weight
Stop smoking
Get in shape
Take care of myself
then this site at iVillage's Allhealth.com is for
you. Here they have a program to sign up for a
weekly email on one of the above topics. They even
go further and let you choose whether the tips,
advice and reminders you receive will come from
"Mom", your "friend" Constance, or "Coach" - all
members of the digital conscience team.
Mom encourages you with lots of love and warm
words of wisdom!
Your friend, Constance, is forever by your side!
and Coach, drives you to get off your butt and
work harder!
I would probably choose the coach but I wonder who
most women will choose?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
A doctor was having an affair with his nurse.
Shortly afterward, she told him she was pregnant.
Not wanting his wife to know, he gave the nurse a
sum of money and asked her to go to Italy and have
the baby there.
"But how will I let you know the baby is born?"
she asked.
He replied, "Just send me a postcard and write
'spaghetti' on the back. I'll take care of the
child's expenses."
Not knowing what else to do, the nurse took the
money and flew to Italy.
Six months went by and then one day the doctor's
wife called him at the office and explained,
"Dear, you received a very strange postcard in the
mail today from Europe, and I don't understand
what it means."
The doctor said, "Just wait until
I get home, and I will explain it to you".
Later that evening the doctor came home, read the
postcard, fell to the floor with a heart attack.
Paramedics rushed him to the ER. The lead medic
stayed back to comfort the wife. He asked what
trauma had precipitated the cardiac arrest.
So the wife picked up the card and read:
"Spaghetti, Spaghetti, Spaghetti, Spaghetti -
Two with sausage and meatballs, two without."
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That's it for this time.
Get quickly to the medical nitty gritty,
Rick
Frederick R. Jelovsek MD
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***** Woman's Diagnostic Cyber Newsletter *****
October 17, 1999
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Osteoporosis fracture prevention
2. Snoring and sleep apnea
3. Reader submitted Q&A - Pelvic organ prolapse
4. When PMS needs an antidepressant
5. Are supplements needed for vegetarian diets?
6. 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. Osteoporosis fracture prevention
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
A report of a new drug for treatment of women who
ALREADY have osteoporosis is worth knowing about
because it has less side effects than a current
standard treatment drug, Fosamax (alendronate). In
a recent issue of the Journal of the American
Medical Association, authors report a very
significant reduction over three years of use, of
new spinal cord (vertebral) fractures (11% vs 16%)
and non vertebral fractures (5.2% vs 8.4%) using a
drug called Actonel (risedronate). This drug did
not have as high an incidence of gastrointestinal
side effects like Fosamax and reduced non
vertebral fractures more effectively than another
drug for osteoporosis called Evista (raloxifene).
Therefore if these study results hold up, it will
probably replace Fosamax and Evista as the non
estrogen treatment for women who already have
osteoporosis. Keep in mind that estrogen therapy
is still the drug of choice for fracture
prevention with or without existing osteoporosis
as long as a woman does not have problems with it
or is adverse to taking estrogen because of cancer
concerns.
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2. Snoring and sleep apnea
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Sleep apnea, a condition in which a person stops
breathing at night for periods up to 10 seconds
and sometimes as often as 100 times an hour, is
often considered an overweight man's disease. But
many women are probably not diagnosed with this
condition when they should be.
Hallmarks of sleep apnea are daytime sleepiness,
morning headaches and often mood changes with
severe irritability or depression. Before you
decide that you and many others you know have this
condition, you may want to learn about it. This
is especially so if you or your partner is a heavy
snorer. Most snorers do NOT have sleep apnea, but
those with sleep apnea almost always snore, wake
up with a "snort", and if carefully watched while
sleeping, they can be seen to stop breathing for
several seconds on many occasions. The lack of
oxygen at night causes the daytime sleepiness.
High blood pressure, personality change, and night
sweats can also be symptoms.
The only way to correctly diagnose this condition
is by a test in a special sleep laboratory called
polysomnography. While one sleeps, certain
physiological measurements are made of oxygenation
of the blood and other signs. Please keep in mind
that just because you snore does not mean you need
this test done. But if someone tells you that you stop
breathing sometimes, during sleep, be sure to
investigate about this topic at The Sleep Apnea
Information Clearinghouse.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Pelvic organ prolapse
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I am 50 yrs old and have been diagnosed with a
prolapsed uterus, bladder, and rectum. From what I
have read, this will be an increasing problem for
the baby boom generation, as we age. The only
treatment my doctor recommends is hysterectomy
with rectal and bladder repair, which can fail and
lead to other problems. Is any research being done
into more effective ways to correct this problem?
Are uterine resuspensions, using materials other
than the patient's own tendons, a good option for
older women? "
If you are going to undergo surgery for any type
of pelvic organ prolapse, you want to know that
the surgery being performed is the best surgery to
permanently cure your problem. Any hernia surgery
can fail so what questions can you ask to make
sure you are being treated according to the latest
techniques, technology and concepts? This is
discussed in the article below.
The observation that many doctors suggest
hysterectomy at the time of prolapse surgery is
also discussed as why that may be done and whether
hysterectomy needs to be included.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. When PMS needs an antidepressant
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Most doctors do not like to prescribe anti-
depressants for PMS symptoms until a woman has
made as many positive changes in lifestyle habits
as possible. After caffeine discontinuance, sleep
deprivation reversal, switching to a low
carbohydrate diet, adding in regular exercise, and
possibly even using magnesium supplements,
antidepressants have been shown to help.
But which class of antidepressant? This paper in
the Archives of Clinical Psychiatry about a
clinical trial comparing Zoloft (sertraline)
versus Norpramin (desipramine) versus placebo in
189 women with PMS showed that the SSRI (selective
serotonin reuptake inhibitor) class drug
sertraline was much more effective than the
tricyclic drug desipramine in improving symptoms.
This would seem to indicate that PMS may be more
related to a serotonin problem specifically since
the generalized anti-depressant qualities of
desipramine were not any better than placebo,
i.e., PMS does not respond to just generalized
antidepressant drugs like the tricyclics.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Are supplements needed for vegetarian diets?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Vegetarian diets have been shown to be beneficial
for certain chronic diseases and conditions such
as obesity, coronary artery disease, hypertension,
diabetes mellitus, and some types of cancer. Those
diets can also have some deficiencies in necessary
food elements if they are not well balanced. The
American Dietetic Association has a position paper
written and available about vegetarian diets and
their suggestions.
They address the main two types of vegetarian
diets - the lacto-ovo-vegetarian eating pattern
and the vegan pattern that does not include eggs
or milk products or other animal products. While
iron sources are low in vegetarian diets,
increased vitamin C may enhance iron absorption.
Vitamin B-12 supplements are recommended for vegan
dieters as well as vitamin D supplements if sun
exposure is infrequent. In all types of vegetarian
diets calcium and zinc requirements can be met if
the balance and source of food is closely watched.
Because adequate calcium is difficult to get in a
vegan diet, supplements or calcium enhanced
vegetarian foods should be considered.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
What about those telephone answering menus?
"You have reached the psychiatric hot line--
if you are obsessive-compulsive, please press 1
repeatedly
if you are co-dependent, please ask someone to
press 2
if you have multiple personalities, please press
3, 4, 5, and 6
if you are paranoid-delusional, we know who you
are and what you want. Just stay on the line long
enough for us to trace your call.
if you are schizophrenic, listen carefully, and a
little voice will tell you which number to press
if you are manic-depressive, it doesn't matter
which number you press, no one will answer."
if you have PMS, all the numbers lead to wrong
answers
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time. Accurate answers for
when a symptom or health problem concerns you.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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***** Woman's Diagnostic Cyber Newsletter *****
October 24, 1999
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Panic attacks
2. Why MDs do not always follow clinical guidelines
3. Reader submitted Q&A-Uterus needed postmenopause?
4. Irritable bowel syndrome diagnosis
5. Safe use of medicines - your responsibility
6. 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. Panic attacks
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Panic attacks can affect as much as 5% of the
population. All of a sudden, out of the home, at
home, anywhere, a sudden terror strikes with a
very rapidly beating heart rate, difficulty
breathing, dizziness and even a fear of death.
There may be no obvious reason for these feelings.
If you have ever had an anxiety or panic attack,
you would remember it.
Almost 75% of panic attacks occur in women, mostly
in their 20's-30's but it can be at any age. The
underlying condition is called panic disorder and
it can progress over time so that a woman fears to
leave the house, to go in public places. It can
masquerade as other diseases. The immediate cause
of a panic attack is believing one is trapped and
helpless, by some overwhelming threat.
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2. Why MDs do not always follow clinical guidelines
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Guidelines, algorithms or decision trees, for
diagnosis or treatment of a condition or disease
are often developed by individuals or committees
of experts who analyze the scientific literature
and proclaim a "best" way to manage a medical
problem. Managed health care companies, HMOs and
medical insurance companies like guidelines
because they define a standard method of spending
money for medical care. Non physicians have a much
easier time determining whether a guideline was
followed than determining when a deviation from
that guideline is appropriate medical care.
The question of why such guidelines do not have
100% compliance has not been well examined.
However a recent article in the Journal of the
American Medical Association looked at what the
barriers were to why physicians did not always
follow guidelines. This topic is important to
women to know about because if a doctor is not
aware of the recommended method to diagnose of
treat a condition, that is quite a different
situation for your health than if the doctor is
aware of a guideline but also has strong feelings
that she or he can improve upon the
recommendations and get a better health outcome
because of some additional knowledge.
These authors found several different barriers to
physician use of a clinical guideline:
Lack of Awareness - did not know at all about a
given guideline
Lack of Familiarity - knew of guideline but not
familiar enough with the details in order to
actively change what they were previously doing
Lack of Agreement - did not agree that the
guideline was the best way to manage a condition
Lack of Self-efficacy - did not have the personal
skills to manage the guideline as it was intended
(for example nutrition counselling may be
efficacious but some doctors did not feel
comfortable with their diet counselling skills
Lack of Outcome Expectancy - even knowing a
guideline was effective (eg. smoking cessation
counselling) but very pessimistic that they would
be effective to change the incidence that much
Inertia of Previous Practice - old habits die hard
External Barriers - lack of resources such as
staff or equipment,inconveniences of
implementation, not easy to use or lack of
consultant support among other things
Unfortunately this study did not determine what
percent of MD non compliance is due to the
different categories of barriers. It is very
likely that the specific barriers vary greatly
depending upon the topic of the guideline.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A-Uterus needed postmenopause?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"What are the advantages of keeping your uterus
over a lifetime? Does the uterus perform any
functions past child-bearing years? Some sources
say the uterus continues to produce needed
hormones during a woman's entire life; that it is
part of the endocrine system; and that the loss of
the uterus decreases sexual enjoyment."
"I am 50 and still having regular periods. In the
1960's my mother had a hysterectomy. Those years
seemed to be the start of an epidemic of
hysterectomies similar to tonsillectomies, which
now are being thought to be often unecessary.
Thanks!".
In essence, this question tries to get at what are
the effects a woman can expect after just a
hysterectomy. This is separate from the concept of
menopause, either natural or surgically induced
due to premenopausal removal of the ovary.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Irritable bowel syndrome diagnosis
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Abdominal cramping, loose stools, increased gas --
these can all be signs of irritable bowel syndrome
(IBS) or "spastic colon". It is difficult to
diagnose this condition because often it is a
diagnosis of exclusion. Ulcerative colitis and
regional enteritis (Crohn's disease) must be
ruled-out. There are no specific blood tests or
xrays that can be done to diagnose IBS so
researchers have come up with a set of symptom
criteria.
Called the Rome criteria, the article below at the
Mayo Health website points out that there must at
least be a three month history of:
Abdominal pain or discomfort relieved with bowel
movements or associated with a change in frequency
or consistency of stool.
In addition to that, at least 25% of the time,
there should also be a history of at least 2 of
the following 4 symptoms:
Altered stool frequency and form (lumpy/hard or
loose/watery).
Altered stool passage (straining, urgency, or
feeling of incomplete evacuation).
Passage of mucus.
Bloating or feeling of abdominal distention.
If these symptoms are present then there is a very
good likelihood of irritable bowel syndrome. Three
times as many women as men get IBS. Often the
symptoms of gastrointestinal upset are worse just
before menses.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Safe use of medicines - your responsibility
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Improper use of prescribed medicines causes more
deaths each year than illicit drugs. You would
like to depend upon your physician and the Federal
Drug Administration to protect you from serious
side effects but the truth is you need to protect
yourself.
You need to know the name and dose of your drugs
and what side effects you may expect. Also, be
sure to ask the doctor or pharmacist what you
should do if one of those side effects occur.
Sometimes a side effect may be confused with the
disease effect for which you are being treated and
if you fail to stop the medicine when you are
having a serious side effect, complications can
occur.
It is also important to know what foods, drinks or
other medicines may interact with your medication.
When you are on multiple medications prescribed
from different physicians it is even more
important to be aware of possible drug-drug
interactions.
I would add one of the most critical pieces of
information to know is "what are the consequences
of not taking a prescribed medicine". The worst
complications I know come from not taking an
antibiotic prescription or a diabetic who
eventually goes blind from not taking their
diabetic medicine as directed on a regular basis.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Your Tattoo"
The doctor noted with astonishment a tattoo of a
bluebird on the shoulder of his high society 70
year old patient, who was in his office for her
annual check up. She told him that she had wanted
one her whole life, so she and her 16 year old
grandson decided that they would birthday tattoos
together.
The doctor inquired why she had not got one
sooner.
"Until now," she replied, "I was afraid of what my
mother would say."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time. We will bring you
accurate women's health answers again soon.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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***** Woman's Diagnostic Cyber Newsletter *****
October 31, 1999
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Ectopic pregnancy - medical or surgical rx?
2. Hair loss - What's normal, what's abnormal?
3. Reader submitted Q&A - Osteoporosis
4. Gestational diabetes
5. Dizziness in the elderly
6. 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.
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~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Ectopic pregnancy - medical or surgical rx?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
An interesting recent article below highlights
some of the present conflicts within our medical
care and insurance payor system. It has to do with
an economic analysis of whether surgery
(lapaoroscopic removal of a tubal pregnancy) is
more or less expensive than the medical therapy of
a tubal (ectopic) pregnancy. At first glance you
might wonder why anyone would prefer to have
surgery rather than to have some shots and blood
tests and several doctors visits. The major
difference in treatment is that with surgical
treatment a woman would undergo anesthesia and
laparoscopic surgery and return to work within 3-4
days after surgery. With medical treatment
encompassing a methotrexate drug injection
(intramuscular), a woman may have continued pain
for up to 7-10 days or more, miss time from work and have
to have 4 or more visits to the doctor for
laboratory tests. When you add up the costs and
time lost from a wage earning job, it turns out
that the medical treatment can be more expensive,
on the average than surgical treatment. At lower
levels of HCG less than 1500 IU/L, the two treatments
are about equal in cost.
It seems that whether or not a woman chooses
surgical treatment or medical treatment depends
upon whether loss of time from work or activity is
more negative than fear of surgery or being put
asleep. Either choice of treatment can be
reasonable. Remember, however, from an insurance
company point of view, medical treatment is always
preferable because they do not bear the cost of
time out of work or other activity. You do!
Therefore a managed care company may try to push
women toward medical therapy when in fact surgical
treatment may be the best choice in your own
situation and value system.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Hair loss - What's normal, what's abnormal
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Ever have clumps of hair come out in your hair
brush? Did you know that normally, women lose 50-
100 hairs a day and the average hair grows for 5
years before it undergoes a resting phase and then
comes out? These and other facts about hair growth
will help you in the self-diagnosis of hair loss
via an article at regrowth.com.
Some hair loss in women occurs about 3-9 months
after a pregnancy because the hormones of
pregnancy forced many hairs into a synchronized
growth phase during pregnancy and a resting phase
after pregnancy. But aside from that instance, 95%
of permanent hair loss is genetic. The follicles
are sensitized and damaged by a male hormone, DHT
or dihydrotestosterone. That hormone can occur in
women also. While much has been written about male
pattern baldness, did you know that there is a
definite female pattern of baldness? The scales
used to measure that (the Ludwig Scale) can also
be viewed at the link below. Patches of hair loss
or extreme thinning are not normal.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Osteoporosis
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I am 51 years old. I have three children, and I
had a total hysterectomy when I was 44. I had been
on Premarin 1.25 mg for the first 5 years, and for
the past two years I have been doing a hormone
implant. My problem is my bone density which keeps
decreasing every year. My mother has osteoporosis,
which she had diagnosed when she was in her
seventies. She also had six children which could
have attributed to this condition.
My bone density test shows that I have
osteoporosis. I have heard of a new kind of
treatment for osteoporosis, but I know nothing
about this product, and how safe it is. Could you
please help me. " [email protected]
There is a new biphosphonate treatment that has
been reported and it seems to have less side
effects (only one study) than alendronate
(Fosamax) which is the standard osteoporosis
treatment in addition to estrogens. Its name is
risedronate but I do not believe it is approved
yet in the U.S. for osteoporosis. It was just
recently approved in Sweden. Probably you should
ask your doctor to start you on alendronate first
to stop further bone loss and then use the new
drug only if you have problems with alendronate.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Gestational Diabetes
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did you have gestational diabetes mellitus (GDM)
during pregnancy? Are you pregnant now? Women who
are over 30 at the time of pregnancy or are
overweight are at a higher risk to develop
gestational diabetes. This can lead to
large birth size
low blood sugar in the baby after birth
jaundice
early birth
If you had GDM in pregnancy there is about a 2%
chance that you actually have diabetes after the
pregnancy is over, and an 8% chance to have
impaired glucose tolerance. Almost 60% of women
with GDM will get diabetes later in life so be
sure to have the doctor keep checking your glucose
tolerance.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Dizziness in the elderly
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Dizziness is not a disease or diagnosis but rather
it is a symptom. It can be the result of
infection, inner ear disease, vascular disease in
the ear or brain or even due to heart rate
abnormalities among others. Many elderly patients
have dizziness but also have vascular disease or
heart rate problems that are just coincidental and
not the cause of the dizziness. Diagnostic work-
ups for dizziness can be quite expensive or
intensive and possibly not yield the actual cause
of the symptom.
The study below looked at elderly patients with
and without dizziness and found that there were
similar rates of diagnostic abnormalities in both
groups, i.e., elderly patients WITHOUT dizziness
tended to have the same abnormalities as patients
WITH dizziness. Therefore it is very unlikely that
the abnormality found is really the cause of the
dizziness. They did complicated diagnostic tests
and found "there were no differences in the
results of blood tests or 12-lead EKGs; 24-hour
ambulatory EKG showed abnormalities in 30 % of
both groups, usually short-lived episodes of
atrial fibrillation. Approximately 80% in both
groups showed two or more abnormalities on
electronystagmography. MRI results showed that
approximately 70% of both groups had facet joint
degeneration in their necks, and 80% had signs of
cerebral atrophy."
Therefore if you are over 65 or have a relative
over 65 years old with dizziness, don't waste your
time with complicated diagnostic studies UNLESS
your doctor finds other abnormalities on physical
exam that may indicate a serious disease.
Conversely, do not be disappointed if your doctor
does not do a "full court diagnostic press" for
dizziness if there are no other symptoms. You may
want to go straight to treatment of the symptom.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The Nun
-=-=-=-=-=-=-=-
A cabbie picks up a nun. She gets into the cab,
and the cab driver won't stop staring at her. She
asks him why is he staring and he replies,
"I have a question to ask you but I don't want to
offend you."
She answers, "My dear son, you cannot offend me.
When you're as old as I am and have been a nun as
long as I have, you get a chance to see and hear
just about everything. I'm sure that there's
nothing you could say or ask that I would find
offensive."
"Well, I've always had a fantasy to have a nun
kiss me."
She responds, "Well, let's see what we can do
about that: #1, you have to be single and #2 you
must be Catholic."
The cab driver is very excited and says, "Yes, I
am single and I'm Catholic too!"
The nun says "OK, pull into the next alley."
He does and the nun fulfills his fantasy. But when
they get back on the road, the cab driver starts
crying.
"My dear child," said the nun, "why are you
crying?"
"Forgive me sister, but I have sinned. I lied, I
must confess, I'm married and I'm Jewish."
The nun says, "That's OK.
My name is Bruce and I'm on my way to a Halloween
party.
Contributed by: Andrea and the Halloween Archives!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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 *****
November 7, 1999
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Foot health care network
2. Chronic pelvic pain
3. Reader submitted Q&A -Vulvar sweat gland cysts
4. Newly acquired herpes infections
5. Acute appendicitis at any age
6. 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. Foot health care network
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Have you ever had heel pain that wouldn't seem to
go away? And you have no idea whether it might be
due to shoe heels that are too low, overactivity
with increased foot impact, an Achilles tendonitis
from running, a plantar fasciitis from having flat
feet and overpronation, or a heel spur calcium
deposit. I knew that poorly fitting shoes could be
a culprit in causing foot pain, but I did not
realize how, as we age, the fat pad on the bottom
of the foot can get thinner and lead not only to
heel pain problems but pain almost anywhere on the
foot. These and many other foot problems have some
helpful fact and diagnosis sheets at
foothealthnetwork.com. Each condition includes a
definition, causes, treatment and prevention.
Other topics include:
AIDS & Your Feet
Arch Pain / Arch Strain
Arthritis
Bunions (Bunionettes)
Calluses
Claw Toes
Corns
The Diabetic Foot
Hammer Toes
Mallet Toes
Metatarsalgia
Mortons Neuroma
Mortons Toe
Neuropathy
Overlapping Toes
Over Pronation (Flat Feet)
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Chronic pelvic pain
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Pelvic pain is a frequent cause for visits to the
gyn physician, perhaps up to 20%. It accounts for
about a fifth of all diagnostic laparoscopies.
Doctors have a primary goal to determine if there
is a serious cause for the pain such as cancer,
endometriosis, infection and other continually
damaging diseases. There can be many causes and
most of them can only be "ruled out" rather than
just precisely pin-pointing the certain cause.
Clues as to cause come from physical exam, pelvic
exam, ultrasound, CAT scans, laboratory studies
and sometimes from investigations of the bowel and
bladder.
Chronic pain can also lead to emotional upset,
depression or anxiety which in turn worsens the
pain because it lowers your coping skills. In
other words a woman with any chronic pain may
perceive the pain as being at higher and higher
levels because her pain threshold goes lower and
lower due to the emotional upset from the pain in
the first place.
You need to help the doctor out in figuring out
the cause. Be sure to note exactly what seems to
bring on the pain, is there anything that eases
the pain, how long does it last and to what degree
is it affecting your daily activities and coping
skills.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Vulvar sweat gland cysts
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"For the last 6 months I have been having problems
with sweat gland cysts on my vaginal area. I have
had 2 removed and now have a third on that needs
removing, what caused these and is there anything
that can be done to prevent them? My doctor says
no! Thank you ".
Sweat gland cysts can be one of many different
vulvar problems so it is impossible to say what
the treatment might be. Except for a few vulvar
lesions that can be identified visually with fair
certainty, most cysts of the vulva need to be
biopsied in order to know for certain what they
are. While a doctor can "guess" that a vulvar
lesion is likely to originate from a sweat gland,
if you have not had a biopsy, you may want to
suggest that to the doctor. Epidermoid cysts can
often be mistaken for sweat gland cysts and two
sweat gland diseases, Fox-Fordyce disease and
hidradenitis suppurativa are almost impossible to
be distinguished unless a biopsy is done.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Newly acquired herpes infections
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
In spite of the many information sheets spread
across the Web about herpes infections, there is
still a lot that is not well known about how
herpes spreads.
There are two main strains of herpes simplex virus
(HSV), type 1 and type 2. Type 1 usually causes
cold-sore type of lesions in the mouth or lips but
sometimes, it can also cause genital herpes sores
on the vulva, in the vagina or on the cervix. Type
2 is usually the virus associated with genital
herpes but we really do not know how often it is
passed on and causes symptoms (versus being
asymptomatic) and even how often it is correctly
diagnosed.
A recent study in the New England Journal of
Medicine followed 2393 men and women who were
initially negative by blood titers for any HSV-2
exposure. Of those people, 1508 were seropositive
for HSV-1 past exposure. The authors found that
new HSV-1 and HSV-2 infections occurred in 1.6 and
5.1 cases per 100 person-years, respectively. In
other words, each year, 5% of sexually active
individuals were newly exposed to genital herpes
(HSV-2). Of the new HSV-2 infections, 37% had
symptoms of infection, usually painful genital
sores. Of those who has symptoms, 82% were
correctly diagnosed at presentation, 18% were not.
Of those patients who did not have symptoms of
HSV-2 when their blood indicated they had been
exposed, 15% of those individuals actually had
lesions even though they were not aware of them.
Women were more likely than men to acquired HSV-2
and were more likely to have symptoms.
In a question that is commonly asked - "does
having previously had HSV-1 infection protect
against getting HSV-2 infection" - this study
found that "previous HSV-1 infection did not
reduce the rate of HSV-2 infection, but it did
increase the likelihood of asymptomatic
seroconversion". That is HSV-1 did not protect
against HSV-2 but it made it more likely (risk
ratio of 2.6) that a person would not have
symptoms from the infection.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Acute appendicitis
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
While acute appendicitis occurs more commonly in
the age range of 10 to 30, it can occur at any
age. There is a lifetime incidence of 7% for an
acute infection in this bowel appendage. There are
a few new twists in the diagnosis of appendicitis.
It used to be almost exclusively a diagnosis based
on history and physical exam. Now a CAT scan, an
appendiceal computed tomographic scan is about 90-
100% accurate in picking up an inflamed appendix.
Unruptured, the mortality rate from acute
appendicitis is less than 1% but if it ruptures,
death may occur as high as 5%. Mortality is higher
in older patients so the questions becomes, if you
are having other abdominal surgery (hysterectomy,
ovary removal) should you have your appendix
removed incidentally to the other surgery. This
article does not answer that question but the fact
that CAT scan is quite accurate now, it is
probably less necessary to remove the appendix
incidentally.
I especially liked the table listing the
differential diagnosis of acute appendicitis. It
includes not only other bowel problems. but also
gyn problems such as ectopic pregnancy, ovarian
cyst rupture or torsion, endometriosis, and PID.
Lung problems, urinary problems and other systemic
problems are also included in the differential
diagnosis.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Wedding Vows"
During the wedding rehearsal, the groom approached
the pastor with an unusual offer.
"Look, I'll give you $100 if you'll change the
wedding vows. When you get to me and the part
where I'm to promise to 'love, honor and obey' and
'forsaking all others, be faithful to her
forever,' I'd appreciate it if you'd just leave
that part out."
He passed the minister a $100 bill and walked away
satisfied.
It is now the day of the wedding, and the bride
and groom have moved to that part of the ceremony
where the vows are exchanged. When it comes time
for the groom's vows, the pastor looks the young
man in the eye and says:
"Will you promise to prostrate yourself before
her, obey her every command and wish, serve her
breakfast in bed every morning of your life and
swear eternally before G-d and your lovely wife
that you will not ever even look at another woman,
as long as you both shall live?"
The groom gulped and looked around, and said in a
tiny voice, "Yes."
At the reception, the groom leaned toward the
pastor and hissed, "I thought we had a deal."
The pastor put the $100 bill into his hand and
whispered back, "She made me a much better offer."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time. Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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