Women's Health Newsletters 2/13/00 - 3/27/00
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***** Woman's Diagnostic Cyber Newsletter *****
February 13, 2000
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Cardiac catheterization for diagnosis and therapy
2. Breast pain - different types
3. Reader submitted Q&A - Vaginal opening looseness
4. Breast cancer risk calculator
5. Dealing with cancer chemotherapy effects
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. Cardiac catheterization for diagnosis and therapy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Hopefully you will never have to have a procedure
as complicated and risky as a cardiac
catheterization, but when you do, a thorough
understanding can alleviate some anxiety.
A site called yoursurgery.com has very good
explanations of different procedures such as
cardiac catheterization. They explain the anatomy,
diseases associated with needing the procedure,
historical symptoms and physical findings in
patients having to have this procedure, and an
explanation of the procedure itself often with
multimedia clips of video.
Other procedures in addition to cardiac
catheterization include:
craniotomy
shunt for hydrocephalus
cataract removal
LASIK for vision correction
spinal disk removal
carotid endarterectomy
coronary artery bypass
mastectomy
chest surgery
esophagus surgery
hernia repair
colon removal
gall bladder removal
Cesarean section
aorta aneurysm surgery
prostate surgery
hysterectomy
hip replacement
spinal fusion
arthroscopy
knee replacement
carpal tunnel release
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Breast pain - different types
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Breast pain comes in different types, cyclical,
non cyclical and non breast origin. Cyclical
varies with the menstrual cycle and is thought to
be hormonal in origin. The pain goes away at
sometimes during the menstrual cycle. Progesterone
cream or pills may slightly reduce this cyclical
pain somewhat.
Noncyclical pain is less common than cyclical and
tends to occur in a specific area in the breast.
It is more common in the 40-50 year age range and
is often very difficult to diagnose an exact
cause. Sometimes the pain can last for years.
While a possible cancer must be ruled out, it is
unusual for cancer to present initially with pain.
Chest pain can also present as breast pain.
Inflammation of where the ribs join the breast
bone (costrochondritis) is a common cause.
Suspensory ligament pain from poor bra support is
another cause.
Types of breast pain
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Vaginal opening looseness
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"My doctor has told me that I need to have vaginal
reconstruction due to the problems childbirth
caused me. He is not pushy about it but says it is
my decision whether it would be worth it to have
the surgery. My problems are urinary incontinence,
vaginal dryness because I am "wide open", and
intercourse is not as pleasurable because of my
muscles being so weak and loose. I don't know if
this is recommended or is my problems just
something I have to live with since they are not a
medical necessity? "
Looseness of the vaginal opening after childbirth
can be quite distressing. It can allow increased
amounts of air into the vagina during intercourse
resulting in both dryness and sometimes noise of
the air during sexual relations. Decreased
pleasure due to loss of sensation and tightness
also occurs. More women will have vaginal opening
looseness after childbirth if no episiotomy is
performed but healing over time often returns the
opening to a tighter state so that intercourse
pleasure is not an issue.
In some women, however, the looseness persists and
then what to do for that becomes an issue. See the
discussion at:
Vaginal opening looseness
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Breast cancer risk calculator
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Dr. Steven B. Halls, a radiologist, has created a
breast cancer risk calculator. There have been
several other such risk estimators available but
they all seem to request data a woman is unlikely
to know precisely. This calculator is more robust
and accepts unknown as data elements.
It also gives some helpful explanations of items
like mammographic density and how some formulas
tend to include carcinoma in situ (not an invasive
cancer) and may underestimate risks. There is a
good explanation of how the formulas work.
I like the way the calculator gives you not only
the lifetime risk (up to age 90), but also a
woman's risk of breast cancer over the next 5, 10,
20 and 30 years. You can also test out some other
risk factors that are not usually included in the
formulas but which have been shown to affect risk.
Breast risk calculator
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Dealing with cancer chemotherapy effects
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If you have ever known anyone who has had to have
chemotherapy for treatment of a cancer, you know
what a double whammy the treatment is on top of a
fatiguing disease. What can be done to make the
treatment not worse than the disease?
At cancerlynx.com there is an excellent brochure
with helpful tips of how to deal with the effects
of cancer chemotherapy. For fighting the fatigue
of the treatment and disease and to conserve all
one's energy, an example of the suggestions
includes:
Bathing
Wash hair in shower, not while leaning over sink.
Sit to dry off.
Use a terry robe instead of drying off with a towel.
Use a shower bench or lawn chair to sit while
showering.
Grooming
Sit.
Don't lean forward unsupported
Rest elbows on counter or dressing table.
Use long-handled combs or brushes to avoid holding
arms overhead.
Dressing
Loose-fitting clothing allows easier breathing.
Organize early to avoid rushing to dress.
Lay out clothes before starting to avoid extra steps.
Shopping
Make a list first.
Organize list by store aisle.
Combine errands to reduce the number of trips.
Use the grocery cart for support.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Feel the need to exercise?
Read this from "Ten Foot Stop", a dive medicine
newsletter.
1) My grandmother started walking five miles a day
when she was 60. She's 97 now & we don't know
where in the world she is.
2) The only reason I would take up jogging is so
that I could hear heavy breathing again.
3) I joined a health club last year, spent about
400 bucks. Haven't lost a pound. Apparently you
have to show up.
4) I have to exercise in the morning before my
brain figures out what I'm doing.
5) I don't exercise at all. If God meant us to
touch our toes, he would have put them further up
our body.
6) I like long walks, especially when they are
taken by people who annoy me.
7) I have flabby thighs, but fortunately my
stomach covers them.
8) The advantage of exercising every day is that
you die healthier.
9) If you are going to try cross-country skiing,
start with a small country.
10) I don't jog. It makes the ice jump right out
of my glass.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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 20, 2000
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Nickel contact dermatitis - earrings, rings
2. Gastritis and other GI problems
3. Reader submitted Q&A - Perineal body odor
4. Hormone replacement synopsis
5. Grieving a loss
6. Humor is healthy
Spread the word! Send a copy of this newsletter
to someone you know.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Nickel contact dermatitis - earrings, rings
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
While less expensive jewelry often has high
percentage of nickel, even expensive jewelry has
some nickel in it and after years of wear can
cause redness and itching on your finger or
earlobes. A contact dermatitis like this can be
treated with hydrocortisone cream but the
challenge is diagnosing that it is indeed a
contact allergic reaction.
There can also be cross reactions of a skin
contact dermatitis to objects that do not contain
nickel but that have similar allergens such as:
Coins
Pool table felt green dye
Machine oils used to cut or grind
Some eye cosmetics
Chromium and cobalt
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Gastritis and other GI problems
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Anytime someone complains of an upset stomach it
gets labelled as a "gastritis". But that diagnosis
which refers to an inflammatory condition of the
stomach lining can only be made by looking inside
the stomach (gastroscopy) or biopsy of the stomach
lining. Sometimes a chronic gastritis may be be
associated with an increased risk of stomach
cancer.
Symptoms of gastritis include: nausea, vomitting,
pain or discomfort in the upper abdomen, loss of
appetite and sometimes vomitting of blood. It is
most often caused by ingesting something that is
toxic to the stomach lining like alcohol, aspirin,
other non steroidal anti-inflammatory drugs, or
even bile. It can also be caused by radiation,
infection with h. pylori bacteria, and other
allergic, vascular or infectious conditions.
Gastritis at Gastro.net
Gastro Net, an Australian site also has excellent
sections on diets and nutrition in various
gastrointestinal conditions such as:
What is a health diet?
Boosting the fibre in your diet
Weight reduction diet
Diest for irritable bowel syndrome
Gastro-oesophageal reflux diet
Lactose free diet
Gluten free diet for coeliac disease
Diet issues in inflammatory bowel disease
Gastrointestinal diets
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Perineal body odor
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"My question is do you have any suggestions for
how women can maintain a "nice flora scent"
throughout the day without using douches
frequently? Sometimes usually by lunch time 12:00
noon, when I go to use the restroom I notice a
mild to moderate urine smell. I do not currently
suffer from a yeast infection, and take
acidophillus on a regular basis to maintain a
healthy urinary tract and decrease the frequency
of yeast infections. I also use a mild soap
without dyes or fragrance such as Dove in my
genital area to keep it clean and free from
irritation."
Perineal odor can be due to sweating, urine and
vaginal secretions and the interplay of food you
ingest whose oils are secreted in sweat and the
action of bacteria on these secreted compounds. I
have no answer for producing a "nice flora scent"
short of using some type of deodorant coverup. But
that approach can have its problems too.
Perineal odor
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Hormone replacement synopsis
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
For a good review of the current therapeutic
regimens for hormone replacement therapy during
menopause, you may want to look at this article
from the Australian Family Physician online
journal.
It covers not only the usual immediate symptoms
that are relieved and other longer term benefits,
but it also discusses different regimens, cyclic
(with regular withdrawal bleeding), continuous and
low dose oral contraceptives versus different
prescription estrogens and progestins. It also
discusses which regimens might be used in the
different time periods such as right before
menopause, immediate post menopause, postmenopause
2-3 years or more, as well as other indications
such as:
osteopenia/osteoporosis (bone thinning)
urogenital atrophy (vaginal dryness, urethral
irritation
cardiovascular protection
after hysterectomy
HRT side effects
and progestin side effects
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Grieving a loss
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Losing a loved one or having a stillborn baby or
miscarriage are situations that can lead to grief
reactions in your friends. How do you recognize
these and what can you do about them?
Dr. Kirsti A. Dyer has a web site called
journeyofhearts.org that is focused on grief
reactions. She has some great tips on how to help
friends in grief.
Avoid chatting, just listen.
Your friend's silence is ok.
Keep in touch.
Help out with the daily routine things.
Know the signs and symptoms of depression.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Memory and Menopause
Three ladies, recently menopausal, were were
discussing the merits of estrogen and the travails
of short term memory difficulty.
One said, "Sometimes I catch myself with a jar of
mayonnaise in my hand in front of the refrigerator
and can't remember whether I need to put it away,
or start making a sandwich."
The second lady chimed in, "Yes, some times I find
myself on the landing of the stairs and can't
remember whether I was on my way up or on my way
down."
The third one responded, "Well, I'm on estrogen
and I'm glad I don't have a memory problem; knock
on wood," as she rapped her knuckles on the
table, then told them "That must be the door, I'll
get it!"
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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 27, 2000
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Bacterial vaginosis and preterm labor
2. Estrogens do not slow Alzheimer progression
3. Reader submitted Q&A - Urethral dilatation
4. Sexual dysfunction on antidepressants
5. Education for children with diabetes
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. Bacterial vaginosis and preterm labor
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Bacterial vaginosis in pregnancy has been
associated with preterm labor. This is a good
example of an association which may or not be a
cause and effect. If bacterial vaginosis is a
cause of preterm labor, then treating it should
decrease the incidence of premature birth.
This recent New England Journal of Medicine
article looked at over 800 women who had
ASYMPTOMATIC bacterial vaginosis in pregnancy.
They treated half of them with metronidazole
(Flagyl(R)) and the other half placebo. They had
about a 75% cure rate from the treatment but the
incidence of preterm labor was not different in
the treated (12.2%) and the placebo (12.5%)
groups.
Thus it is unlikely that bacterial vaginosis is a
cause of preterm labor although it can be a high
risk marker for preterm labor.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Estrogens do not slow Alzheimer progression
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Estrogen replacement after menopause has been well
shown to be associated with a decreased incidence
of the new occurrence of Alzheimer disease. What
has not been certain is whether there is any role
for estrogen to treat women who already have
Alzheimer disease. Some evidence suggested that it
might, but the study below is a randomized trial
of giving women who already have Alzheimer disease
estrogen or placebo.
The study was reported in the Journal of the
American Medical Association (JAMA) in which 120
women with mild or moderate Alzheimer disease were
given conjugated estrogens 0.625 mg, 1.25 mg or
placebo. Unfortunately the women receiving
estrogen progressively worsened over a year at the
same rate as those receiving placebo.
This study would indicate that estrogens do not
slow the progression of Alzheimer disease once a
woman has it.
Estrogen treatment for Alzheimer progression
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Urethral dilatation
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"My doctor is suggesting that I have urethral
dilatations for recurring bladder infections. I am
getting conflicting information regarding this
procedure. Are they helpful or not?"
Most of the time they are not helpful and are not
being performed in women by urologists as much as
they used to. Some urologists still do them for
urethral syndrome and urethral stricture. These
conditions and alternatives you might consider are
discussed at:
Urethral dilatation for chronic UTIs
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Sexual dysfunction on antidepressants
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Many antidepressants cause sexual dysfunction such
as loss of sexual desire, lack of arousal etc.
Fluoxetine (Prozac(R)) is notorious for causing
loss of sexual desire. One study looked at giving
women who were on Prozac and who had reported a
deterioration of sexual function one of three
therapies: buspirone (Buspar), amantadine, or
placebo.
After 8 weeks of treatment, all three groups had a
significant improvement in sexual function. Yes
even the placebo group had the same improvement.
This study suggests that there is a significant
placebo effect in the study of this problem and
any further trials have to be shown to be superior
to placebo.
Perhaps the major determinant in deterioration of
sexual function on antidepressants is the
expectation of such a deterioration and any
attention that gives hope for improvement will
actually give improvement. The bottom line is to
be very wary of studies having to do with sexual
dysfunction because there are so many different
influences on this problem that any given study
may not account for.
Sexual dysfunction on anti-depressants
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Education for children with diabetes
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
A child with insulin dependent diabetes will have
trouble understanding why they need to give
themselves an injection. If they are not educated
as to why they must take control of their disease,
there will be bouts of hyperglycemia and
hypoglycemia and episodes of hospitalization.
If your child or a friend's child has diabetes,
they are not alone. Over 800,000 Americans have
diabetes with 30,000 new cases a year. However,
children are very reluctant to let other children
know they have a chronic disease. This is best
handled by the child being able to explain all
about diabetes and how it is not contagious.
Check out the site Aequilibrium, a compliance
counselling web site by Bayer:
Children with insulin dependent diabetes
Other topics at Aequilibrium include:
Aging and Alzheimers
Hypertension in African Americans
Hemophilia
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
To control perineal odor, use baby wipes. Carry a
few in a plastic bag when going to work. LUV's
extra thick are good for bad days; wipes are also
good when you have to go to the hospital. I tell
patients to bring them.
Our thanks for this tip to: Rose Rubio
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The room was full of pregnant women and their
partners, and the Lamaze class was in full swing.
The instructor was teaching the women how to
breathe properly, along with informing the men how
to give the necessary assurances at this stage of
the plan.
The teacher then announced,
"Ladies, exercise is good for you. Walking is
especially beneficial. And, gentlemen, it wouldn't
hurt you to take the time to go walking with your
partner!"
The room really got quiet. Finally, a man in the
middle of the group raised his hand.
"Yes?" replied the teacher.
"Is it all right if she carries a golf bag while
we walk?"
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
***** Woman's Diagnostic Cyber Newsletter *****
March 5, 2000
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. How common are thyroid abnormalities?
2. A guide for cancer survivors
3. Reader submitted Q&A - Cyclic pelvic pain
4. Diet meds (orlistat) and long term obesity
5. Progesterone cream not effective on endometrium
6. Health tip to share - Cold sore treatment
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. How common are thyroid abnormalities?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Thyroid disease may be more common than we think.
This study in Colorado, USA screened over 25000
individuals at a State Health Fair using blood
measurements of TSH (thyroid stimulating hormone).
They found that 9.5% of the population had
laboratory values consistent with hypothyroidism
and 2.2% had values indicating hyperthyroidism.
This may be an overestimate of thyroid disease in
the population because the fair participants were
volunteers and may have self-selected, however it
is still a high incidence. It reminds us to be
sure to liberally test for thyroid abnormalities
if there are any suggestive symptoms. In women,
menstrual abnormalities are common with
hypothyroidism.
Prevalence of abnormal thyroid function
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. A guide for cancer survivors
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Survivors of cancer treatment have both physical
and emotional concerns. While there are
differences in concerns about pain, physical
problems and sexuality depending upon the specific
type of cancer a woman has, there are also many
common concerns that survivors of all different
types of cancer have.
Finishing the main cancer treatment can be more
frightening than full of the relief you think
would occur. Leaving the medical support team and
being on your own is anxiety provoking. And what
about taking care of your general health in the
areas other than the cancer area? You cannot
forget those other health habits and checkups.
Perhaps returning to work and the way other
coworkers view a survivors ability is a major
concern requiring adjustment. Up to 25% of cancer
survivors returning to their place of employment
face significant bias both from employers and
coworkers.
Even if you have never had cancer, reading this
Cancer Survivor's Guide from the National
Institutes of Health National Cancer Institute can
help you understand what others go through with a
cancer diagnosis and treatment.
Facing forward
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Cyclic pelvic pain
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I have lower right abdominal pain 3 days each
month, 7-10 days before my period. I have had an
internal ultrasound which was negative. Any ideas
what might be causing this? Also the pain mostly
happens at around 1:30-2:30 in the a.m."
We can sometimes get a hint of what causes pelvic
pain depending upon when in the menstrual cycle
the pain occurs and for how long. At 7-10 days
before menses we think of the corpus luteum which
is enlarging on an ovary. At time of menses, pain
makes us think of blockage to menstrual outflow as
well as endometriosis and adenomyosis.
There can also be other causes and atypical pain
presentations so you may want to look at our
article at:
Cyclic abdominal and pelvic pain
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Diet meds (orlistat) and long term obesity
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
A recently introduced drug called orlistat (trade
name Xenical(R)) is being used as an adjunct to
diet by many weight loss centers and diet
programs. This drug blocks or inhibits
gastrointestinal (GI) enzymes called lipases.
These are involved in the absorption of
triglycerides, a form of fat in food, from the GI
tract. Orlistat is minimally absorbed but has a
tendency to cause loose bowel movements because
the fat just passes through rather than being
absorbed.
This study looked at use of orlistat by primary
care physicians over a one year period along with
diet. Two doses, 60 mg and 120 mg three times a
day were compared with placebo. Over the year,
obese patients taking orlistat 60 mg and 120 mg
lost 7 and 8 kg (15.4 and 17.6 pounds) compared
with 4.1 kg (9 lbs) for those taking placebo. At
the end of two years, 24% of those taking placebo
maintained a 5% weight loss compared with about
34% of the orlistat groups.
Thus this seems to be an effective weight loss
medication when combined with diet.
Use of orlistat for weight loss
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Progesterone cream not effective on endometrium
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Many women are using micronized progesterone cream
as part of their hormonal replacement therapy.
Among other reasons for this is the fact that oral
progestins, and even oral micronized progesterone,
results in more adverse mood side effects. The
cream tends not to cause those adverse effects.
One of the questions that has not been answered is
whether the progesterone absorbed through the skin
is enough to block the effect of estrogen on the
endometrium so a woman with a uterus is not at
risk for endometrial cancer.
The study below looked at 3 different doses of the
progesterone skin cream using a daily dose of 16
mg, 32 mg, or 64 mg, and none of them produced
high enough blood levels or endometrial levels to
change the endometrial response.
This means that women who are on estrogens and
still have a uterus cannot use the progesterone
cream to totally replace the oral progesterone
pills which protect a woman from developing
endometrial cancer.
Progesterone cream's effect on endometrium
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Cold sore treatment
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
For a cold sore of the mouth, get one of the
styptic pencils from the drug store. The ones used
if you cut yourself shaving. Touch the pencil to
the sore. It burns and then tastes salty but it
really numbs the cold sore and it is no longer
painful.
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Heaven Life
An 85 year old couple, having been married almost
60 years, died in a car crash. They had been in
good health the last ten years mainly due to the
wife's interest in health food, and exercise.
When they reached the pearly gates, St. Peter took
them to their mansion which was decked out with a
beautiful kitchen and master bath suite and
Jacuzzi.
As they "oohed and aahed" the old man asked Peter
how much all this was going to cost.
"It's free," Peter replied, "this is Heaven."
Next they went out back to survey the championship
golf course that the home backed up to. They
would have golfing privileges everyday and each
week the course changed to a new one representing
the great golf courses on earth.
The old man asked, "what are the green fees?".
Peter's reply, "This is heaven, you play for free."
Next they went to the club house and saw the
lavish buffet lunch with the cuisines of the world
laid out.
"How much to eat?" asked the old man.
"Don't you understand yet? This is heaven, it is
free!" Peter replied with some exasperation.
"Well, where are the low fat and low cholesterol
tables?" the old man asked timidly.
Peter lectured, "That's the best part...you can
eat as much as you like of whatever you like and
you never get fat and you never get sick. This is
Heaven."
With that the old man went into a fit of anger,
throwing down his hat and stomping on it, and
shrieking wildly.
Peter and the man's wife both tried to calm him
down, asking him what was wrong. The old man
looked at his wife and said,
"This is all your fault. If it weren't for your
blasted bran muffins, I could have been here ten
years ago!"
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
***** Woman's Diagnostic Cyber Newsletter *****
March 12, 2000
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Multiple chemical sensitivity disorder
2. Herb - drug interactions
3. Reader submitted Q&A - Irregular menses
4. Bid for your own elective surgery
5. Breast cancer growth - A tutorial
6. Health tip to share - Lysine to prevent cold sores
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.
In last week's article about progesterone cream
not being effective to block estrogen's cancer
effect in women with a uterus, please remember
that the authors were testing doses that are
generally available over-the-counter, not
prescription doses.
Prescription doses of progesterone cream to apply
externally on the skin are much higher (100 - 400
mg per dose) and likely will be protective against
endometrial cancer. Scientific studies have not
been done to confirm this, so be sure to discuss use
of progesterone cream with your doctor. There may
still be some risk compared to taking the
progesterone orally.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Multiple chemical sensitivity disorder
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This syndrome is somewhat like chronic fatigue
syndrome or chronic fibromyalgia syndrome in that
it is not a well defined entity but one that has
multiple symptoms in many different organ
symptoms. It often begins as an acute or chronic
exposure to a chemical toxicant. Symptoms include
difficulty breathing, sleeping and/or
concentrating, memory loss, migraines, nausea,
abdominal pain, chronic fatigue, aching joints and
muscles, and irritated eyes, nose, ears, throat
and/or skin.
There may also be some overlap or a relationship
of multiple chemical sensitivity disorder to Sick
Building syndrome and Gulf War syndrome.
Treatment is basically just to avoid exposure to
chemical triggers. Research is still going on in
this area. To see fact sheets and other
information resources about this, visit:
Multiple chemical sensitivity disorder
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Herb - drug interactions
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Just as prescription medications can interact and
cause adverse health effects, so can health food
store herbal preparations and some prescription
meds. A common interaction is to potentiate
anticoagulant therapy so that something like
gingko biloba, ginseng or feverfew can cause or
worsen bleeding from aspirin, clopidogrel
(Plavix), dipyridamole (Persantine), ticlopodine
(Ticlid), or warfarin (Coumadin).
Ephedra is used in weight loss and asthma. It can
be toxic and cause heart attack, seizure or death
when used with certain decongestants or even
stimulants such as excessive caffeine. Kava can
produce deep sedation and even coma when used with
alprazolam (Xanex (R)) and St John's Wort can
interact with Zoloft (R).
This article at Mayohealth.org is worth reading if
you are taking any herbal preparations on a
regular basis.
Herb-drug medication interactions
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Irregular menses
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"What daily hormone supplement do you recommend to
improve an irregular menstrual cycle?"
It depends upon what type of menstrual
irregularity we are talking about. Also it depends
upon whether the goals of treatment are to
regulate the cycle for predictability or in an
attempt to conceive a pregnancy.
There are several different patterns of irregular
menses. Sometimes periods vary from 3-6 weeks from
the start of one to the start of another but
rarely are menses skipped. Two other irregular
menses patterns are characterized by skipping
periods. In one type estrogens are low because of
no egg (follicle) development and in the other
type, estrogens tend to be high because of
arrested follicle development. Polycystic ovarian
syndrome would fall under this category.
For a discussion of these types of irregular
patterns and what you can do about them with non
prescription or prescription treatments, see:
Hormonal treatment of irregular menses
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Bid for your own elective surgery
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
It was bound to happen. A California firm has
created a reverse auction in which you can bid on
what you are willing to pay for any of several
elective procedures; ones not covered by most
insurance plans such as:
Cosmetic Surgery
Botox injection
Breast Enlargement
Breast Lift
Breast Reconstruction
Breast Reduction
More... facelifts, eyelids etc.
Podiatric Surgery
Bunion Surgery
Vision Surgery
LASIK Surgery
Cosmetic Dentistry
Bonding And Veneers
Implants
Porcelain Crowns
Teeth Whitening
I suspect that most of the bidders are currently
California or West Coast physicians but I do not
know since they do not list the locales on the
site. Maybe I'll have to just go ahead and make a
bid to find out. The procedure to fix a bunion by
a podiatrist looked like it had a fair number of
requests and bids.
Check out Medicineonline.com
Bid for elective surgery
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Breast cancer growth - A tutorial
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
It can be difficult to understand why some cancers
seem to come on quickly while others are quite
slow growing. This tutorial about breast cancer
growth helps explain the concept of cell doubling
time. It takes about 23 doubling times to go from
one cancer cell to become a mass large enough to
be seen on mammogram. It takes about 30 doubling
times to become large enough to be felt as a lump,
about one billion cells. Doubling times may be as
short as 10 days or as long as several years.
This means that a breast cancer with a cell
doubling time of 2 months can show up on xray in 4
years while one with a doubling time of 2 years
will show up in 46 years.
For more information about other breast cancer
risk factors, see the article at Whispers Magazine
by Dr. William Wolberg.
Breast cancer tutorial
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Lysine to prevent cold sores
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Stress, illness, and exposure to the sun will
bring out cold sores. My first symptom is a
burning or tingling on my lip (it's always the
same location). At this first sign, I take 2000 mg
of Lysine for 3 days, and it keeps the cold sore
from coming out. I've been "cold sore" free for 5
years now, so it must have some affect on the
virus cell! This doesn't help once the cold sore
erupts.
Our thanks to SH for this tip!
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
A woman was out golfing one day when she hit her
ball into the woods. She went into the woods to
look for it and found a frog in a trap. The frog
said to her,
"If you release me from this trap, I will grant
you 3 wishes."
The woman freed the frog and the frog said,
"Thank you, but I failed to mention that there was
a condition to your wishes-that whatever you wish
for, your husband will get 10 times more or
better!"
The woman said, "That would be okay," and
for her first wish, she wanted to be the most
beautiful woman in the world.
The frog warned her, "You do realize that this
wish will also make your husband the most handsome
man in the world, an Adonis, that women will flock
to."
The woman replied, "That will be okay because I
will be the most beautiful woman and he will only
have eyes for me."
So, KAZAM - she's the most beautiful woman in the
world! For her second wish, she wanted to be the
richest woman in the world.
The frog said, "That will make your husband the
richest man in the world and he will be ten times
richer than you." The woman said, "That will be
okay because what is mine is his and what is his
is mine."
So, KAZAM she's the richest woman in the world!
The frog then inquired about her third wish, and
she answered,
"I'd like a mild heart attack."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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 *****
March 19, 2000
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Why receding gums are of concern
2. Glucosamine and chondroitin for osteoarthritis
3. Reader submitted Q&A - Hysterectomy and
chronic fatigue and fibromyalgia syndromes
4. Silicone implants unrelated to connective diseases
5. Genetically altered food squabble
6. Health tip to share - Pecans and cholesterol
7. Humor is healthy
We need some more Health tips to share!
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. Why receding gums are of concern
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
As many as 3 out of 4 adults have some form of
receding gum disease. This is caused by the plaque
build-up under the gums which irritates and
eventually destroys the overlying gum. Once the
soft gum tissue is gone, big pockets develop
between the teeth where more and more bacteria can
accumulate.
At first the gum tissue left is inflamed and
reddened and called "gingivitis". Later this
inflammation extends to the bone around the teeth.
The bone infection, periodontitis, is the major
culprit in causing tooth loss and accounts for 70%
of all tooth loss in adults over age 40.
Regular brushing and flossing on a daily basis
help prevent this as well as periodic professional
teeth cleaning.
Receding gums
A quick quiz from the California Dental
Association will tell you if it is likely you may
already have some gum disease.
Gum disease: a quiz
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2.Glucosamine and chondroitin for osteoarthritis
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Glucosamine and chondroitin sulfate have been
promoted as home remedies for osteoarthritis.
Actually I heard first about this from the
veterinarians who were using it to treat arthritis
and hip dysplasia in dogs. At the time they were
uncertain as to how effective it was and medical
physicians still have quite a skepticism about
their use in people with osteoarthritis.
This review of the literature in the Journal of
the American Medical Association (JAMA) looks at
human studies to see if it is really helpful. It
concluded that there was a moderate to large
benefit of these compounds in the literature even
though many of the studies were somewhat biased
and not of the best quality.
These compounds are extracted from animal products
and have been shown to be safe during their
widespread use in Europe over the last decade.
They are absorbed from the stomach and GI tract and
help new synthesis of joint cartilage.
Doses used in the studies ranged about 800-1200 mg
chondroitin sulfate once a day or glucosamine
sulfate 1500 mg a day (not both meds). It takes
about two months to reach noticeable improvement.
Glucosamine and chondroitin for osteoarthritis
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Hysterectomy and
chronic fatigue and fibromyalgia syndromes
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"A lot of the members of [hysterectomy support
groups] are complaining about joint pain, and FMS,
either before and/or after their hysterectomy. I
also noted when I was on an endo support group
that there was a lot of fibromyalgia and CFS
amongst the members. Is there a connection? "
These two syndromes have fatigue, muscle and
joint pains, headaches and other symptoms in
common. They can both produce pelvic pain.
Fibromyalgia syndrome is associated with menstrual
abnormalities including both skipping menses as
well as more frequent bleeding.
There may be some hormonal abnormalities
associated with these conditions such as lower
adrenal cortisol or DHEA but it is not clear that
it not just because they are both stressful
diseases. For a discussion of these two syndromes
and how they may be related to hysterectomy, see:
Hysterectomy and CFS and FMS
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Silicone implants unrelated to connective diseases
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
In spite of the fact that there has been massive
litigation over the possibility that silicone
breast implants may cause some autoimmune
connective tissue diseases, the medical evidence
has been lacking to prove this.
This meta-analysis of 20 studies in the medical
literature that have investigated this subject was
recently reported in the New England Journal of
Medicine. The authors found no increased risk
ratios of:
rheumatoid arthritis
systemic lupus erythematosus
scleroderma or systemic sclerosis
Sjogren's syndrome
in women who had silicone-gel-filled breast
implants or any other type of breast implant.
They concluded that "from a public health
perspective, breast implants appear to have a
minimal effect on the number of women in whom
connective-tissue diseases develop, and the
elimination of implants would not be likely to
reduce the incidence of connective-tissue
diseases."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Genetically altered food squabble
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
You may have already made up your mind about seeds
that have been genetically altered in order to
make them disease and insect resistant in crop
production. People are concerned that the genetic
alterations may also have the potential to cause
human disease because this is an area that we are
not very familiar with.
Without any studies this was mainly a theoretical
argument and concern but in the late fall of 1999,
one study came out claiming that experimental rats
fed genetically modified potatoes ended up having
some cellular changes in their stomachs and
intestines (we do not know that these changes are
of concern but the fact that there were any
demonstrable changes is of concern).
For an understandable, scientific discussion of
these findings, you may want to visit the
"WHYFILES" at the University of Wisconsin. This is
a subject that bears following.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Pecans and cholesterol
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
About two ounces of pecan nuts a day lowers serum
cholesterol by about 10% - FRJ
Pecans lower cholesterol
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I had the strangest dream last night," a woman
was telling her psychiatrist.
"I saw my mother, but when she turned around to
look at me, I noticed that she had your face. And
you can imagine, I found this very disturbing, and
in fact I woke up immediately, and couldn't get
back to sleep.
I just lay there in bed waiting for morning to
come, and then I got up, drank a Coke, and came
right over here for my appointment. I thought you
could help me explain the meaning of this strange
dream."
The psychiatrist was silent for a full minute
before responding,
"A Coke? You call that a breakfast!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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