Women's Health Newsletters 1/2/00 - 2/6/00
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***** Woman's Diagnostic Cyber Newsletter *****
January 2, 2000
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
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1. Computer screens and vision
2. Endometriosis case history and discussion
3. Reader submitted Q&A - PCOS and baldness
4. Is a red face rash rosacea?
5. Causes of dark circles under the eyes
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. Computer screens and vision
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Yes, there is such a thing as too much computer
viewing - a computer vision syndrome. People tend
to blink less while looking a computer screens and
as a result the eyes dry out and there is and
increase in discharge.
Computer vision syndrome
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2. Endometriosis case history and discussion
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Endometriosis is a complex disease that can
present with just light menstrual cramps all the
way to extensive pelvic adhesive disease with
ovarian masses that can destroy the ovaries and
cause infertility and even menopause.
The following article in the Journal of the
American Medical Association (JAMA) gives a
clinical case history that is quite typical of a
woman with severe endometriosis. The best part,
however is the discussion and summary of all the
different treatments - Lupron(R), surgery, birth
control pills, and their effect on infertility and
pain. It is hard to find all the different aspects
of endometriosis treatment brought together in one
place like this.
Some of the salient points brought out are:
1) if a woman's menstrual cramps do not respond to
a 3-6 month trial of birth control pills and non
steroidal anti-inflammatory drugs there is about a
50% chance endometriosis will be seen at
laparoscopy
2) 6 months of Lupron(R) therapy is about 70-90%
successful in treating pain.
3) Lupron(R) treatment does not improve fertility
rates compared to no therapy, it only delays
attempting to conceive
4) initial surgical treatment of endometriosis is
generally superior to medical treatment for pain
in patients with more severe disease, but not
necessarily in patients with chronic pelvic pain
and minimal or mild disease
Endometriosis case history/discussion
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - PCOS and baldness
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Could you please give more information on
polycystic ovarian syndrome? I want to become
pregnant but of course I am starting to bald.
Everything I read states I better get treatment
before it really goes bad. Neither my parents nor
any of my 3 older brothers are balding in the
crown area, so may I ask where on what side of
genetics does this come from? My primary MD
answers that it is probably my (testosterone)
level which is 102."
Polycystic ovarian syndrome (PCOS) is a complex of
symptoms including anovulation, excess hair
growth, obesity, and sometimes male pattern
baldness, high blood pressure and diabetes. There
is an increased incidence of PCOS in some families
and the genetics of this condition are discussed
as well as treatments to decrease the testosterone
excess in the article below:
Polycystic ovarian syndrome and baldness
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4. Is a red face rash rosacea?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Rosacea is a skin condition of the face which can
range from a mild redness like blushing, to a
constant redness and acne-like rash. It can be
mistaken for acne, the facial rash of lupus
erythematosis, an allergic reaction to a soap or
cosmetic or even a sunburn. Blushing more easily
can be an early sign of rosacea.
The onset of this skin condition is most often in
the 30-60 age range and in women it tends to be
slightly milder than in men, but still a major
skin condition needing treatment. The cause is
still unknown but the triggers that make it worse
such as sun exposure, stress, spicy foods,
exercise, cold wind, hot foods, and hot baths can
be identified and avoided.
If your face is beginning to look like W.C.
Fields, you may want to look at this article at
Personal MD.com
Rosacea
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5. Causes of dark circles under the eyes
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Part way down the page of the article below from
the Archives of Facial Plastic Surgery is a good
explanation of what causes those dark circles
under the eyes.
Several etiologies are discussed:
1) increased pigmentation of the skin due to
genetic back ground, chronic inflammation from the
sun, allergies, estrogens and any type of chronic
skin irritation in the area below the eye.
2) increased fine blood vessels just below the
skin either from chronic skin inflammation or from
increased fat cell deposition
3) increased fat deposition causing a bulge below
the eye that throws a shadow which further darkens
the skin.
Dark eye circles
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6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Restroom Signs
Friends don't let friends take home ugly men
* Women's restroom, Starboard, Dewey Beach, DE
The best way to a man's heart is to saw his breast
plate open.
* Women's restroom, Murphy's, Champaign, IL
Don't trust anything that bleeds for 5 days and
doesn't die.
* Men's restroom, Murphy's, Champaign, IL
Beauty is only a light switch away.
* Perkins Library, Duke University, Durham, NC
I've decided that to raise my grades I must lower
my standards.
* Houghton Library, Harvard University, Cambridge, MA
If life is a waste of time, and time is a waste of
life, then let's all get wasted together and have
the time of our lives.
* Armand's Pizza, Washington, DC
Remember, it's not, "How high are you?" it's "Hi,
how are you?"
* Rest stop off Route 81, West Virginia
God made pot. Man made beer. Who do you trust?
* The Irish Times, Washington, DC
No matter how good she looks, some other guy is
sick and tired of putting up with her shit.
* Men's Room, Linda's Bar and Grill, Chapel Hill, NC
To do is to be. - Descartes
To be is to do. - Voltaire
Do be do be do. - Frank Sinatra
* Men's restroom, Greasewood Flats, Scottsdale, AZ
At the feast of ego, everyone leaves hungry.
* Bentley's House of Coffee and Tea, Tucson, AZ
It's hard to make a comeback when you haven't been
anywhere.
* Written in the dust on the back of a bus, Wickenburg, AZ
Make love, not war. -Hell, do both, get married!
* Women's restroom, The Filling Station, Bozeman, MO
God is dead. - Nietzsche
Nietzsche is dead. - God
* The Tombs Restaurant, Washington, DC
If voting could really change things, it would be
illegal.
* Revolution Books, New York, New York.
A Woman's Rule of Thumb: If it has tires or
testicles, you're going to have trouble with it.
* Women's restroom, Dick's Last Resort, Dallas, TX
JESUS SAVES! But wouldn't it be better if he had
invested?
* Men's restroom, American University, Washington, DC
If pro is opposite of con, then what is the
opposite of progress? Congress!
* Men's restroom, House of Representatives, Washington, DC
Express Lane: Five beers or less
* Sign over one of the urinals, Ed Debevic's, Phoenix, AZ
You're too good for him.
* Sign over mirror in Women's restroom, Ed Debevic's,
Beverly Hills,CA.
No wonder you always go home alone.
* Sign over mirror in Men's restroom, Ed Debevic's,
Beverly Hills,CA.
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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 *****
January 9, 2000
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Rheumatology Handbook and "mouse shoulder"
2. Influenza, or is it a cold?
3. Reader submitted Q&A - Postpartum vaginal probs
4. Having children after a cancer treatment
5. Emergency contraception - Plan B
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. Rheumatology Handbook and "mouse shoulder"
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The following rheumatology handbook for patients
written by Dr. B. Pal at the South Manchester
University Hospital in the UK has some great
sections for the diagnosis of:
osteoarthritis
rheumatoid arthritis
polymyalgia rheumatica
temporal arteritis
fibromyalgia
inflammatory arthritis
I also liked the section on work related upper
limb disorders such as epicondylitis of the elbow
(tennis elbow), carpal tunnel syndrome, trigger
finger, and supraspinatus tendonitis (a persistent
upper shoulder blade pain), professional hand
cramp (from writing or typewriting), and a
traumatic inflammation of the tendons of the hand
or forearm or of the associated tendon sheaths in
any occupation entailing manual labor or frequent
repeated movements of the hand or wrist. There are
many muscles and tendons that can become inflamed
as a repetitive strain injury.
I did however, miss his mentioning about "mouse
shoulder", a problem of shoulder pain probably
related to using the computer mouse. Remember to
keep your mouse and pad within your shoulder width
to minimize this. You may even need a shorter
keyboard without a numeric keypad.
Mouse shoulder
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2. Influenza, or is it a cold?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
What is the difference between just a cold and the
flu? In general, you start with cold symptoms but
there is a very rapid progression of symptoms with
a higher fever and severe muscle aches and pains.
Most people cannot get out of bed when they have
the flu.
If you want to brush up on what the diagnosis and
treatment for the flu is, you might visit this
site at Medinfo.co.uk if you missed your flu shot.
Influenza
Also if you missed your flu shot, there is a new
drug out used to treat the flu called zanamivir
(Relenza{R}). It is too early to say how well it
works when used for everyone, but the flu puts you
down for at least 3-5 days so any relief might be
worth a try. If started within 30-36 hours of the
symptoms, there was an average reduction of 1-2.5
days of symptoms.
Zanamivir (Relenza{R}) for the flu
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3. Submitted Q&A - Postpartum vaginal probs
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Does taking a bath increase your chances of
getting an infection, yeast or UTI?
I am 29 years old, always have menstrual periods
on time, although I am 9 weeks post partum. I seem
to get a lot of yeast infections".
Yeast infections are not more common after
delivery than at any other time. Many times it is
the case that atrophic changes in the postpartum
vagina make a woman more likely to acquire an
irritant vulvitis or urethritis that gives
symptoms often indistinguishable from vaginitis or
urinary tract infections.
There are other postpartum vaginal changes such as
painful intercourse, episiotomy discomfort,
vaginal looseness and even uterine or bladder
prolapse. These expectations of possible vaginal
conditions after delivery are discussed at:
Postpartum vaginal conditions
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4. Having children after a cancer treatment
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Many women and men and even some doctors think
that if you have chemotherapy or radiation therapy
for cancer treatment that the eggs undergo genetic
damage and if a woman gets pregnant after therapy
has ended, any child will have a birth defect.
This is FALSE information.
Because the egg cells in the ovary do not
genetically divide until the cycle in which
ovulation occurs, they are not very susceptible to
DNA damage from chemicals or radiation. The cells
can be totally killed if the insult is great but
they are not altered genetically. Therefore the
chemotherapy or radiation can sometimes destroy
the eggs and cause premature menopause, but if the
eggs and ovary survive, then when ovulation
resumes, the eggs are normal. A pregnancy has has
the same 97% chance of having a baby without birth
defects.
This article explains some of that and also
includes a list of which chemotherapy drugs as
treatment for which cancers have the potential to
destroy the eggs and ovary rendering a woman
menopausal and infertile. See the Virtual Hospital
at the University of Iowa Health Care web site:
Your fertility after a cancer treatment
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5. Emergency contraception - Plan B
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The recent release of a new emergency
contraceptive called Plan B(R) provides the
opportunity to remind us about options available
to prevent an unwanted pregnancy if involuntary
(rape) or even voluntary intercourse takes place
without protection against pregnancy. It can also
be used if a condom breaks, is forgotten or if a
diaphragm is not used. This is a progestin only,
set of two pills taken 12 hours apart and started
within 72 hours of the episode of intercourse. If
the 72 hour window is missed, another option would
be an IUCD insertion. Both of these regimens
reduce the chance of pregnancy from about 7-8% to
about 1-2%.
The new progestin only treatment has a lower
incidence of nausea and vomitting side effects so
it looks promising. Discussion about this subject
can be found at this article below from the
Journal of the American Women's Medical
Association.
Emergency contraception - a global overview
You may also want to look at our disease profile
on emergency contraception:
Emergency contraception profile
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6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Preparing for the Yearly Mammogram
Many women are afraid of their first mammogram,
but there is no need to worry. By taking a few
minutes each day for a week preceding the exam and
doing the following practice exercises, you will
be totally prepared for the test, and best of all,
you can do these simple practice exercises right
in your home.
EXERCISE 1:
Open your refrigerator door and insert one breast
between the door and the main box. Have one of
your strongest friends slam the door shut as hard
as possible and lean on the door for good measure.
Hold that position for five seconds. Repeat again
in case the first time wasn't effective enough.
EXERCISE 2:
Visit your garage at 3 AM when the temperature of
the cement floor is just perfect. Take off all
your clothes and lie comfortably on the floor
with one breast wedged under the rear tire of the
car. Ask a friend to slowly back the car up until
your breast is sufficiently flattened and chilled.
Turn over and repeat for the other breast.
EXERCISE 3:
Freeze two metal bookends overnight. Strip to the
waist. Invite a stranger into the room. Press the
bookends against one of your breasts. Smash the
bookends together as hard as you can. Set an
appointment with the stranger to meet next year
and do it again. You are now properly prepared.
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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 *****
January 16, 2000
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Gall bladder symptoms
2. Breast cancer diagnosis during pregnancy
3. Reader submitted Q&A - Breast asymmetry
4. Ovulation determination methods
5. Blood clots on OCPs and genetic clotting defects
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. Gall bladder symptoms
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Gall bladder disease is two times more common in
women than men. Both gall stones (cholelithiasis)
and inflammation of the gall bladder sac
(cholecystitis) can give symptoms. The gall
bladder produces bile salts that help digest food,
especially cholesterol. If a stone partially or
completely blocks the duct from the gall bladder
to the intestine, the back up of bile causes
pressure and acute nausea and vomitting.
Most symptoms come from the gall stone blockage
but gradually the stones cause a chronic
inflammation and bacterial infection. This gives
chronic rather than episodic pain. The pain is
usually in the right upper abdomen just below the
ribs. Sometimes it radiates back through the
abdomen to the base of the shoulder blade on the
right.
About 10% of people have gall stones but only 20%
of those with gall stones have symptoms, i.e., 4
out of 5 people have no need to have their gall
bladder removed for stones. If you find out you
have gall stones you may want to look at:
Gallbladder stone and inflammation symptoms
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2. Breast cancer diagnosis during pregnancy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The diagnosis of a breast lump during pregnancy is
very difficult for doctors. There are many
conditions that can produce a lump during
pregnancy and of course everyone is quite nervous
about pursuing a diagnostic work up because of the
pregnancy and also the great vascularity of the
breast during pregnancy with its enlarging
lactation ducts.
Among the different conditions that can produce a
lump during pregnancy are:
abscess
galactocele (milk filled cyst)
fibroadenoma
hemartoma
lactational hyperplasia
lactating adenomas
exaggerated breast enlargement
breast tissue infarct
and breast cancer
Can you perform a mammogram during pregnancy? Will
a needle biopsy cause a milk fistula during
subsequent lactation? How likely is a lumpectomy
to cause a large hematoma (bleeding into the
tissue)? These are very difficult answers and
requires experienced physicians to give you the
best advice.
Breast cancer diagnosis in pregnancy
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3. Reader submitted Q&A - Breast asymmetry
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I am 21 years old and for the past several years
I noticed my left breast was somewhat larger but
nothing to worry about. Now my breast is much
larger and it hangs lower. Do you think this could
somehow catch up with the other breast? ".
If very careful measurements are made, almost no
woman has two breasts of identical shape. Size
differences are also the rule more than an
exception but usually those size differences are
unnoticeable by anyone except the woman herself.
Larger, noticeable size differences are not too
uncommon, however, so this subject can be of great
concern to many women.
Most size and shape differences are either
hereditary or just happenstance growth
differences. Size differences include hyperplasia
(too large), hypoplasia (too small) and
asymmetrical size. Shape differences include
tubular breasts, pseudo ptosis (flattening and
decreased size after pregnancy) and ptosis
(drooping or sagging). All of these conditions are
treatable surgically. Creams and pills cannot
change breast size significantly.
For an explanation and discussion of these
problems, see:
Breast asymmetry
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4. Ovulation determination methods
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
When trying to conceive a pregnancy, one of the
most frustrating parts is being sure of when you
ovulate. If ovulation were precisely predictable
to the hour, that knowledge might help improve a
woman's chances of getting pregnant. Unfortunately
all of the ovulation determination methodologies
work in retrospect, i.e., they do not indicate
ovulation until 24 hours or more after it occurs.
The site at Am-I-Pregnant.com has a very good
section that explains all of the different methods
by which ovulation can be detected. It covers:
menstrual cycle
basal body temperature (BBT)
endometrial biopsy
ovulation predictor kits
serum progesterone
curettage
blood tests
cervical mucous
ultrasound
If you would like to learn more about ovulation
and the methods that detect it, see:
Ovulation determination
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Blood clots on OCPs and clotting defects
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
One concern in using birth control pills is the
possibility of blood clots (venous thrombosis).
This is an uncommon but serious complication. The
incidence of venous thrombosis in women is
approximately:
0.4/10000 women not pregnant or on oral contraceptives
1-3/10000 women on combined oral contraceptives
6/10000 pregnant women
As it turns out, many of the women who develop
these clots actually have rare genetic clotting
defects such as:
protein C deficiency
protein S deficiency
antithrombin deficiency
factor V Leiden mutation
prothrombin 20210 A mutation
Women with the above problems have 3 times the
incidence of blood clots in the first 3 months of
starting pills and their risk is increased up to
the first 12 months of starting pills.
While we are not at the point that doctors can
order several hundreds of dollars of lab tests to
screen for these rare disorders before starting
women on the pills, if you have any family history
of clotting or thrombosis problems, you should
mention this to your doctor to see if any testing
is indicated before starting combined oral
contraceptive pills.
Thrombosis and genetic clotting problems
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6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Parents and kids
Whenever your kids are out of control, you can
take comfort from the thought that even God's
omnipotence did not extend to God's kids. After
creating heaven and earth, God created Adam and
Eve. And the first thing he said was:
"Don't".
"Don't what?" Adam replied.
"Don't eat the forbidden fruit." God said.
"Forbidden fruit?
We got forbidden fruit?
Hey, Eve...we got forbidden fruit!"
"No way!"
"Yes way!"
"Don't eat that fruit!" said God.
"Why?"
"Because I am your Father and I said so!" said
God, wondering why he hadn't stopped after making
the elephants.
A few minutes later God saw his kids having an
apple break and was angry.
"Didn't I tell you not to eat the fruit?" the
First Parent asked.
"Uh huh, " Adam replied.
"Then why did you?"
"I dunno" Eve answered.
"She started it!" Adam said.
"Did not!"
"Did too!"
"DID NOT!!"
Having had it with the two of them, God's
punishment was that Adam and Eve should have
children of their own.
Thus, the pattern was set and it has never
changed.
But there is reassurance in this story.
If you have persistently and lovingly tried to
give them wisdom and they haven't taken it, don't
be hard on yourself. If God had trouble handling
children, what makes you think it would be a piece
of cake for you?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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 *****
January 23, 2000
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Excessive sweating - what can be done?
2. Women and epilepsy initiative
3. Reader submitted Q&A - Talc and cancer
4. HerbMed - A reference database of herbs
5. Migraine headaches
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. Excessive sweating - what can be done?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Women who have excessive sweating from the palms,
soles, armpits, or forehead at any slight anxiety
stimulation situation, are made even more anxious
in social or work situations. It can be
embarrassing and a difficult problem to manage.
Dermatologists usually recommend or prescribe
drying agents such as those used in
antiperspirants. If those do not work, anti-
cholinergic medications can be tried. Some of the
superabsorbant powders can also be obtained with
an antifungal component so that if a woman has
problems with sweating under the breasts or
abdominal folds that get yeast skin irritations,
she has a way to prevent that.
Dermatologist Audrey Kunin, M.D. discusses these
and other treatments for excessive sweating
(hyperhidrosis) at Dermadoctor.com
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Women and epilepsy initiative
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Much of the information women have received in the
past about epilepsy is incorrect. An information
sheet about women's issues in epilepsy has been
developed by Galaxo Wellcome in response to an
Epilepsy Foundation survey that identified lack of
information about women's issues as a concern.
This fact sheet cover subjects such as:
Special concerns about epilepsy for teenage girls
Special concerns about seizure medications
Health issues after your baby is born
Menopause and epilepsy
Hormones and epilepsy
Epilepsy and sexual Relations
Birth control for women with epilepsy
Pregnancy and the mother's health
Pregnancy and the developing Child
Parenting concerns for the mother with epilepsy
Women and epilepsy
The Epilepsy Foundation also has a seizure
recognition chart that you will find invaluable if
you are ever faced with knowing someone with
epilepsy. It gives a description of all different
types of seizures:
Seizure recognition chart
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Talc and cancer
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I have read that using talcum powder in the
genital area has been associated with increased
cervical cancer risks. Does this also apply to
cornstarch based powders?"
Talcum powder has been associated with an
increased risk for ovarian cancer as has asbestos.
Apparently any particulate matter placed on the
perineum chronically can migrate up the genital
tract. Tubal ligation and hysterectomy which block
this path from outside to inside lower the risk
for ovarian cancer. Also anything that blocks
ovarian ovulation for a long period of time such
as oral contraceptive use, frequent pregnancy or
breast feeding will also lower this risk.
The cause and effect of talcum powder is not known
for sure but it would be wise to try not to
chronically use any powder on the perineum.
Perineal powder and pads can cause problems
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. HerbMed - A reference database of herbs
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The quality of information about herbal therapy
has great variability on the net. It is always
helpful to find a source on herbs that has
comprehensive data about activity, mechanism of
action, warnings, preparations available, and
mixtures thought to have a synergistic effect.
The database is much better at allowing you to
look up all of the scientific data on a specific
herb than at allowing you to look at a condition
and find out what is the best herbal treatment,
but this is still a very valuable resource that
you will want to bookmark.
A recent woman patient swore by using a tea of
echinacea root and Goldenseal after the onset of a
cold. She felt the cold went away in 2 days after
that. While I could not find the exact answer to
their efficacy after the onset of a cold, I found
that there has been a randomized, prospective
study using echinacea to try to prevent colds. It
does not seem to prevent them.
HerbMed - a herbal database
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Migraine headaches
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The AMA has a relatively new health consumer
section with some good background on common health
problems. One of them covers the diagnosis and
treatment of migraine headaches. These disabling
headaches can last from several hours to several
days. They tend to run in families.
Caution signs to look for that may indicate a
headache is NOT a migraine, include:
headache began after age of 50 years
headache is of sudden onset
accelerating pattern of headaches
new-onset headache in someone who has cancer or HIV
headache accompanied by fever, stiff neck, or rash
If a woman has mild to moderate migraines and has
never been given treatment that includes a
compound pill with aspirin, caffeine and
butabarbital, a short acting sedative, this is
something that should be tried. Drugs used for
moderate to severe migraines include:
Ergot Alkaloids
Triptans (Selective Serotonin Agonists)
Isometheptene/Acetaminophen/Sedative Combination
One other section that is quite helpful is on
"Important Information About Drugs That Prevent
Migraine". There are some good drug selections that
can decrease the frequency of occurrence.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Women Talk More than Men
A husband, proving to his wife that women talk
more than men, showed her a study which indicated
that men use on the average only 15,000 words a
day, where as women use 30,000 words a day.
"See dear. I told you women are always rattling
on"
She thought about this for awhile and then told
her husband
"If women use twice as many words as men, it must
be because they have to repeat everything they
say."
"What dear?"
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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 *****
January 30, 2000
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Age-related eye (macular) degeneration
2. St John's Wort for depression
3. Reader submitted Q&A - Cervical Cancer in Situ
4. Sexual functioning after hysterectomy
5. Treating menstrual cramps the natural way
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. Age-related eye (macular) degeneration
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
A common reason for loss of vision in women over
60 is called age-related macular degenderation
(AMD). In this condition the cells of the retina
undergo degeneration for reasons we do not totally
understand. It may be related to arteriosclerosis.
It does not usually cause blindness but the center
of one's vision becomes blurry.
It is more common in women but also it is lower in
incidence in women who have taken hormone
replacement therapy. There are two forms, dry and
wet AMD. Most of the people who get AMD have the
"dry" form. Vision can be lost slowly. Only 10%
have the "wet" form of AMD but in it, vision can
be lost quickly.
There is no pain with this condition, only the
slow loss of vision. It is important to have
regular eye check-ups. This patient information
sheet from the National Eye Institute will help
explain this condition.
Age-related macular degeneration
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. St John's Wort for depression
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
St John's Wort, an herbal preparation, has been
used for treatment of insomnia and depression for
many years in Germany where it still significantly
outsells a medication like Prozac (R). In the last
few years St John's Wort sales have mushroomed in
the U.S. There has still been some question as to
how effective it really is.
This article in the Annals of Internal Medicine is
a review of articles in the medical literature
about the efficacy of St John's Wort. They
concluded that it is more effective than placebo
with a 23% to 55% higher response rate, but ranged
from 6% to 18% lower compared with tricyclic
antidepressants such as Elavil(R). It also had a
good safety profile.
This would indicate its usefulness for mild
depression, but it is still better to have a
formal diagnosis of depression than to self-treat.
St John's Wort for depression
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Cervical Cancer in Situ
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I was recently diagnosed with carcinoma in situ
or severe dysplasia of the cervix, I had a LEEP
procedure and recently had a normal pap test. I
was wondering if I am at increased risk for this
to happen again and if it comes back does it start
as minor and progress to severe?"
LEEP treatment of the cervix is an electrical wire
excision of the abnormal tissue on the face of the
cervix. It cures severe dysplasia/carcinoma in
situ about 75% of the time. If it were to be left
untreated for 5-20 years, it would probably go on
to an invasive cancer about 50% of the time.
See a discussion of this topic at:
Carcinoma In situ of the Cervix Expectations
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Sexual functioning after hysterectomy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
A very frequent concern of women undergoing
hysterectomy is whether or not sexual functioning
will change. We have mentioned in the past the
lack of good studies about this topic and how
inaccurate retrospective studies can be due to a
bias in recall of past events.
The study below published in the Journal of the
American Medical Association interviewed over 1100
women who had hysterectomies. They obtained
histories of sexual functioning one month prior to
hysterectomy and at 6, 12 and 24 months after the
surgery. They found some differences in
functioning before and after surgery that are
interesting:
30d before hyst 12 months after hyst
intercourse/mo 2.3 3.1
painful sex 41% 18%
orgasm 63% 72%
strong orgasms 45% 58%
no vaginal dryness 37% 47%
decreased libido 10% 6%
Overall, sexual functioning is improved after
hysterectomy but please remember that these
hysterectomies were being performed for many
reasons such as pain, bleeding and prolapse.
Sexual functioning after hysterectomy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Treating menstrual cramps the natural way
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Menstrual cramps may range from mild lower
abdominal discomfort to fairly severe cramps with
low back and leg pain to nausea and diarrhea. It
is important to learn non prescription ways of
lessening those cramps.
This primer below from the The University of
Chicago Primary Care Group, covers the different
ways nutrition, exercise, temperature and touch
can be used to cope with severe menstrual cramps
(dysmenorrhea). Calcium and magnesium supplements
often help as well as some herbal teas although
the herbal teas mentioned have not been rigorously
tested.
Exercise and heat are often forgotten treatments
of menstural cramps and even orgasm can improve
cramps in some women. Substances such as
endorphins produced by exercise can be a potent
pain reliever.
Menstrual cramps
There also are non-prescription medicines such as
ibuprofen and naproxen that are available over-
the-counter and have been shown in randomized
studies to be effective in reducing menstrual
cramps.
Non-prescription treatment of menstrual cramps
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Trust in a doctor
The patient shook his doctor's hand in gratitude
and said, "Since we are the best of friends, I
would not want to insult you by offering payment.
But I would like for you to know that I had
mentioned you in my will."
"That is very kind of you," said the doctor
emotionally, and then added, "May I see that
prescription I just gave you? I'd like to make a
little change..."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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 *****
February 6, 2000
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Heart disease is slightly different in women
2. Female sexual arousal disorder
3. Reader submitted Q&A - Bleeding on HRT
4. Unusual endometriosis presentations
5. Ankle sprain
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. Heart disease is slightly different in women
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Women develop coronary artery disease about 10
years later than men but it is still a major
killer of women. Did you know that a 50 year old
woman has a 31% lifetime chance of dying from
heart disease and a 3% chance of dying from breast
cancer?
Many of the risk factors for coronary artery
disease are the same in women as in men, however
there are some differences. Women are less
sensitive to total cholesterol and LDL levels than
men but if their HDL (high density lipoprotein)
levels are low their risk is greater. Diabetes is
a stronger risk factor in women than men. Women
have a higher occurrence of chest pain not from
heart disease so the diagnosis is more difficult.
Also women may have more atherosclerotic changes
in the small vessels which are harder to pick up
on imaging studies.
Most importantly, "Women are more likely to have
neck and shoulder pain, abdominal pain, nausea,
vomiting, fatigue, and shortness of breath in
addition to chest pain. Silent heart attacks are
more common in women." For these reasons there may
be a delay in diagnosis in women.
Coronary artery disease in women
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Female sexual arousal disorder
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Arousal disorder is a persistent or recurrent
inability to attain sufficient sexual excitement
so that it causes personal distress. It may be
manifest by lack of desire, inability to have
orgasm, or problems with lack of vaginal
lubrication leading to intercourse avoidance.
There can be many non psychological causes such a
medications (anti-depressants, anti-
hypertensives), diabetes, spinal cord injuries and
decreases in vaginal/clitoral blood flow due to
menopause and low estrogens.
It is very likely that this web site below is
mainly an advertisement for "Viagra for women" or
an investigational medical device to increase
blood flow to the vagina, but it does bring
attention to an under-investigated problem in
women.
Female sexual arousal disorder
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Bleeding on HRT
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Is it normal for a woman on Natural Hormone
Replacement (from a compounding pharmacy) to
experience a period after 2 and one-half months on
the NHR? I have not had a "real" period for 2
years. Can hormones initiate ovulation AGAIN?? "
It does not matter what type of hormone
replacement therapy women are on. Most women who
still have a uterus will have some sort of
bleeding within the first three months of starting
HRT. Even after a year of use, one in 4 or 5 women
will still have some bleeding.
Ovulations are rare on HRT but they can happen
especially in younger women who undergo menopause
prematurely and women within the first few months
of turning menopausal.
For a discussion of doses to try to start on HRT
or to minimize bleeding, see:
Bleeding on natural hormone replacement therapy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Unusual endometriosis presentations
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Most of the time endometriosis presents with
severe menstrual cramps and other pelvic pain.
Because of the nature of the symptoms,
gynecologists see most women with endometriosis
when they have difficulties. Sometimes, however,
endometriosis presents in unusual ways and to
learn about those, we have to look at episodes
that present to different specialties. The study
below looked at presentations to general surgeons
that ended up being endometriosis. Out of 9
patients, none had had a previous diagnosis of
endometriosis. Only two were suspected
preoperatively to have it, albeit in unusual
places.
These presentations included swelling in a lower
abdominal scar, swelling in the groin (inguinal
canal), a lump in the navel, rectal bleeding,
recurrent abdominal pain, symptoms mimicking an
ovarian tumor and one presenting like a ruptured
appendix (pelvic peritonitis).
Unusual endometriosis presentations
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Ankle sprain
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
How can you tell if an ankle is just sprained or
broken? It is difficult for even an orthopedic
surgeon. Normally a sprain is a torn or stretched
ligament on the outside of the ankle. The ankle is
almost always swollen and discolored, so much so
that a break is often suspected. Unfortunately
even tests for joint instability cannot always
tell if it is just a sprain or a fracture. Since a
fracture may need surgery (internal fixation) an
X-ray almost always is necessary. Then if it is
negative, which it almost always is, treatment can
be started.
Ice, ibuprofen or naproxen, elevation and
eventually physical therapy are the standard
treatments. Dr Zeman also adds that the treatment
cannot stop there. The main treatment is then
prevention which means taping, wrapping or a brace
with any high risk exercise or athletic activity.
This is needed so that recurrent sprains and
arthritis are not the end result.
Ankle sprain
You may also want to look at hip replacement, shin
splints, tennis elbow, knee problems, carpal
tunnel and heel pain at the main page for Sports
Medicine and Orthopedic Surgery.
Sports Medicine and Orthopedic Surgery
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Jake was dying.
His wife, Becky, was maintaining a candlelight
vigil by his side. She held his fragile hand,
tears running down her face. Her praying roused
him from his slumber. He looked up and his pale
lips began to move slightly.
"My darling Becky," he whispered.
"Hush, my love," she said. "Rest. Shhh. don't
talk."
He was insistent. "Becky," he said in his tired
voice. "I.......I have something I must confess
to you."
"There's nothing to confess," replied the weeping
Becky........"Everything's all right, go to
sleep."
"No, no. I must die in peace, Becky. I.....I
slept with your Sister, your best friend, her best
friend, and your Mother!"
"I know..." Becky whispered softly,
"That's why I poisoned you."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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