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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 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~




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***** 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 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~




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***** 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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