Women's Health Newsletters 3/27/00 - 4/30/00
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***** Woman's Diagnostic Cyber Newsletter *****
March 26, 2000
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
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1. Fifty tips for a fitter you
2. Stopping a period by skipping OCP placebos
3. Reader submitted Q&A-Fibrocystic breasts and HRT
4. What happens during the normal sexual response?
5. Fluoride and bacteria in bottled vs tap water
6. Health tip to share--Elevated BP and cholesterol
7. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Fifty tips for a fitter you
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We all know about diets, exercise and other
healthy habits, but how do we make them palatable?
How can we keep them up beyond the first week or
two. There are no easy answers as you are aware
but there are some tips from Michael A. Woo-Ming,
MD MPH at Personal MD.com
Some of the things he points out that I enjoyed
are:
don't diet - embark on a lifestyle change
find a partner to diet or exercise with
add weight training to your program
don't tell friends you are dieting
eat with your opposite hand (slows eating)
plan for the 3-5 pm binge hours with low fat snack
stretch before any exercise
and 43 other tips
Fifty tips for a fitter you
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2. Stopping a period by skipping OCP placebos
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
While doctors do not encourage manipulating an
oral contraceptive dosing schedule just to avoid
having a menstrual period, there often are times
when it would be convenient for a woman to do so.
An upcoming weeks vacation or holiday occurring in
the week you are supposed to get your menses on
the birth control pill, a wedding, a strenuous out
of town business trip etc., are all reasons a
woman might want to just reschedule her menses if
possible.
It is possible to stop a cycle a week early and
get your menses over before that event or to skip
the placebo pills the last week of a 4 week pill
pack and just start the new pack at the end of
three weeks of active pills. The article below at
Mayo Health discusses doing this. There probably
is no harm in doing this several cycles in a row
because we have experience with women who have
endometriosis who are on a continuous regimen for
6-12 months, but breakthrough, unscheduled
bleeding is a side effect. If you do this
alteration in dosage schedule, do it with your
doctor's knowledge.
Avoid your period for a month
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3. Reader submitted Q&A-Fibrocystic breasts and HRT
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Are there any herbs or natural treatments, other
than less caffeine to help in treatment of
fibrocystic breast disease? And why do the cysts
keep getting harder? Does HRT therapy aggravate
the situation? "
As common as fibrocystic breast disease is, we
still do not know very much about the causes and
treatments. HRT which includes estrogen and
progestin seems to worsen fibrocystic change (FCC)
but it varies by which progestin is actually used.
Medroxy progesterone acetate seems to worsen FCC
but only if it is given with estrogen. By itself,
it does not worsen FCC.
You would think oral contraceptives with both
estrogen and progestins would worsen fibrocystic
conditions but they do not. Perhaps it is the
different progestins.
Treatments for FCC include vitamin E and possibly
vitamin A. But the best treatments if you have
severe disease are the antiestrogen ones such as
tamoxifen. It is better than danazol, a long time
standard treatment.
For a discussion about this, see:
Fibrocystic breast changes around menopause
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. What happens during the normal sexual response?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The University of Toronto Sexual Education and
Peer Counselling Centre has a very practical
summary of the human sexual response that they
have taken from the Kinsey New Report on Sex. They
summarize the different phases of a normal sexual
response such as:
Sexual Arousal
Plateau Phase
Orgasm
Resolution Phase
Multiple Orgasm
There can be abnormalities of any of the phases
although most women who have decreased sexual
libido are not even in a state of readiness for
the first phase of sexual response. These phases
are worth knowing about if there is any concern
about sex response.
The normal sexual response cycle
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5. Fluoride and bacteria in bottled vs tap water
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Bottled water doesn't have that awful chlorine
taste that many municipal water supplies do, but
chlorine is added to lower the amount of bacteria
in the water. The study below looked at bottled
water brands off the store shelves and compared it
to the water from the tap in Cleveland, Ohio. They
checked the bacteria count and the amount of
fluoride.
They found that only 5% of the bottled water fell
in the recommended fluoride range as required by
the state of Ohio whereas all of the municipal
water plants met the requirements.
As far as bacteria counts are concerned, most of
the bottled water specimens had lower bacterial
counts than the tap water but 22.6% had higher
bacterial counts and 10% had over 1000 times the
bacterial counts of tap water.
The bottom line in this study is that bottled
water is not always "better" than tap water. It
pays to know what you are drinking and you may
want to take a sample of your favorite bottled
water to your local public health department and
have them check the bacterial count.
Fluoride and bacteria in bottled vs tap water
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6. Health tip to share - Elevated BP and cholesterol
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I am a 35 year old, who is 5'2" and weighs about
114lbs. I found out 6 months ago I had high blood
pressure (135/96), and a total cholesterol level
of 240."
"I began to investigate my cupboards for possible
culprits and eliminated fat free non-dairy
creamer, nutrasweet, and started using extra
virgin olive oil to saute or stir fry. I also
began to walk 2 miles, three times a week."
"In a week off the artificial sweetner and
nutrasweet, my blood pressure dropped to normal.
Within 3 mos., my cholesterol level was 172!"
"I recommend walking and watching foods that are
processed or synthetic.(Also, I stopped having
migraines every day after giving up the artificial
sweetner-now I only experience one menstrually).
The high cholesterol was found after the high
blood pressure was cleared up--both conditions
were found by my OB/GYN during my annual pap,
something my primary physician did not find
despite going to him for obvious symptoms.
Sometimes your OB/GYN can prove very invaluable."
Anglena
If you have discovered ways of coping with a
disease or condition and it works for you,
please share it with us:
Health tip suggestion form
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7. Humor is healthy
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At the Source
-=-=-=-=-=-=-=-
Two storks are sitting in their nest: a father
stork and baby stork. The baby stork is crying and
crying and father stork is trying to calm him.
"Don't worry, son. Your mother will come back.
She's only bringing people babies and making them
happy."
The next night, it's father's turn to do the job.
Mother and son are sitting in the nest, the baby
stork is crying, and mother is saying
"Son, your father will be back as soon as
possible, but now he's bringing joy to new mommies
and daddies."
A few days later, the stork's parents are
desperate: their son is absent from the nest all
night! Shortly before dawn, he returns and the
parents ask him where he's been all night.
The baby stork says, "Nowhere. Just out
frightening college students!"
Contributed by: David L.
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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 *****
April 2, 2000
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This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Olive vs sunflower oil effect on hypertension
2. Sinus and stuffy nose problems
3. Reader submitted Q&A-Non med hypertension Rx
4. How to survive prescribed bed rest in pregnancy
5. Congenital uterine anomalies tutorial
6. Health tip to share - Oil therapy for hair loss
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. Olive oil vs sunflower oil effect on hypertension
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Many women have been made aware that mono-
unsaturated fatty acids such as those in olive
oil, are better for us than fatty acids that are
polyunsaturated, e.g., sunflower oil. We are told
that use of mono-unsaturated fatty acids (MUFA)
instead of polyunsaturated fatty acids (PUFA)
will lower your cholesterol and also your blood
pressure. What may not be appreciated is that
these are two separate effects, i.e., the blood
pressure reduction is a direct effect of the MUFA,
not through the eventual lowering of the
cholesterol.
This study below was a randomized trial in which
men and women who were hypertensive used either
measured amounts of extra-virgin olive oil or
sunflower oil for 6 months and then crossed over
to the other oil for another 6 months. After two
months on each oil, doctors tried to lower the
blood pressure medicines if there had been a drop
in their systolic and diastolic blood pressure.
The net result of this Italian study (possible
bias so take it with a clove of garlic) was that
when the hypertensive men and women were using the
extra virgin olive oil, there was a 48% reduction
in daily drug dosage versus only a 4% reduction in
those using sunflower oil.
Olive oil lessens need for antihypertensive meds
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2. Sinus and stuffy nose problems
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Since so many women have sinus problems of various
sorts, it is a lifelong topic we should learn
about. In addition to the richness of information
material at this ENT site, there is a great set of
3D pictures of the insides of the sinuses and
nose. If you would like a visual picture of what
goes on with infections and allergies involving
the sinuses, be sure to see the illustrations
Peter J. Casano, M.D. has created and organized.
Everything you want to know about sinuses and
noses is at the site below.
Sinusitis Information
You and Your Stuffy Nose
Earaches and Otitis Media
The Common Cold
Antihistamines, Decongestants, and Cold Remedies
The "Flu"...It can be dangerous
Ready to Quit Smoking? Read This
Earwax and what to do about it.
Sore Throats, Causes and Cures
Tonsils and Adenoids
Ears, Altitude, and Airplane Travel
Snoring...Not Funny, Not Hopeless
Sinus Care Center
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3. Reader submitted Q&A-Non med hypertension Rx
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"How does taking calcium supplements affect the
calcium channel blocker I take for high blood
pressure?
I am a 48 yr old Native American woman. I really
want to stop taking blood pressure medicine. I
think the medicine causes as much harm as it does
good. There has to be another way."
While it seems that taking calcium supplements
would work against taking a calcium channel
blocker, physiology does not actually work that
way. In fact in one type of essential
hypertension, calcium supplements themselves lower
blood pressure and at the same time the blood
pressure is very treatable by calcium channel
blockers. The way to look at it as a mental model
is that the extra calcium desensitizes the system
so there is not as much difference in calcium
levels inside and outside of the muscle cell on
the two sides of the calcium channel.
There are other non medical ways to lower high
blood pressure. In addition to the standard stop
tobacco and alcohol and exercise more, switching
to olive oil or including fish or fish oil in the
diet helps. Eliminating simple carbohydrates and
replacing them with complex carbohydrates will
also help. Salt restriction does not help as much
as most people think.
For discussion of these approaches and others to
help you conquer hypertension without prescription
medicine, see:
Non medical treatment of hypertension
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4. How to survive prescribed bed rest in pregnancy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
There are certain pregnancy complications for
which doctors will prescribe almost absolute
bed rest. Conditions such as:
pregnancy induced hypertension (PIH)
placenta previa and abruptio placenta
Incompetent cervix
PPROM: Premature pre-term rupture of membranes
multiple gestation (twins, triplets, etc)
are reasons to decrease activity during pregnancy
so as not to go into labor too early.
Any woman who has been prescribed bed rest in
pregnancy will tell you it drives them crazy.
While the first two weeks might seem a rest from
the numerous chores at home, succeeding weeks and
months can be the worst times of your life.
The frequently asked questions (FAQs) on "all you
ever wanted to know about pregnancy bed rest" at
this site by Judy Maloni, PhD, RN, FAAN, are
invaluable to surviving the ordeal should it be
prescribed for you or your family.
I especially like the activity list which helps
the woman and doctor define just what activities
are allowed. This is often a source of confusion.
The explanations about medications you might be
prescribed and the procedures you and the baby may
go though are also extremely informative.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Congenital uterine anomalies tutorial
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Birth defect anomalies of the uterus can be
associated with chronic miscarriage or difficulty
getting pregnant. Sometimes it is not very clear
how much a given anomaly affects the ability to
carry a pregnancy or to conceive.
As you can see it is most important to make an
accurate diagnosis of the specific anomaly before
determining whether and what treatment is needed.
The tutorial below emphasizes the different tools
such as MRI, ultrasound, hysterosalpingogram (dye
injection into the uterus and taking an xray) and
laparoscopy that are used to diagnose the type of
anomaly.
Treatment surgically of a septate, bicornuate,
didelphic, and unicornuate uterus are also
discussed.
Congenital uterine anomalies tutorial
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6. Health tip to share - Oil therapy for hair loss
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
A condition of non scarring, patchy hair loss
called alopecia areata can be treated with some
success with essential oil therapy. Rubbing a
mixture of a base of jojoba or grape seed oil with
essential oils of thyme, rosemary, lavender, and
cedarwood into the scalp on a daily basis lessens
the hair loss. (Keep in mind this has not been
tested for generalized hair loss.) FRJ
Alopecia areata treatment with essential oils
If you have discovered ways of coping with a
disease or condition and it works for you,
please share it with us:
Health tip suggestion form
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7. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
ACTUAL SENTENCES FOUND IN PATIENTS' MEDICAL CHARTS
1. Patient has chest pain if she lies on her left
side for over a year.
2. The patient has been depressed since she began
seeing me in 1993.
3. Discharge status: Alive but without my
permission.
4. The patient refused autopsy.
5. The patient has no previous history of
suicides.
6. Patient had waffles for breakfast and anorexia
for lunch.
7. Between you and me, we ought to be able to get
this lady pregnant.
8. She is numb from her toes down.
9. While in ER, she was examined, x-rated and
sent home.
10. The skin was moist and dry.
11. Occasional, constant infrequent headaches.
12. Rectal examination revealed a normal size
thyroid.
13. She stated that she had been constipated for
most of her life, until she got a divorce.
14. Examination of genitalia reveals that he is
circus sized.
15. The lab test indicated abnormal lover
function.
16. The patient was to have a bowel resection.
However, he took a job as a stock broker instead.
17. Skin: somewhat pale but present.
18. The pelvic exam will be done later on the
floor.
19. Patient was seen in consultation by Dr. Blank,
who felt we should sit on the abdomen and I agree.
20. Patient has two teenage children, but no other
abnormalities.
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That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
***** Woman's Diagnostic Cyber Newsletter *****
April 9, 2000
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Food irradiation - FAQs
2. Estrogen by nasal spray
3. Reader submitted Q&A - Informed consent
4. Fast facts on primary hyperparathyroidism
5. Antibacterial activity in cranberry juice
6. Health tip to share - For excessive bruising
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. Food irradiation - FAQs
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The Centers for Disease Control and Prevention in
Atlanta has put together some information about
food irradiation. Admittedly, they emphasize the
benefits of food irradiation and the safety of it.
They claim it does not change food such as leaving
radiation behind or causing a change in the
nutrition value. They also say it is very
difficult to test food to know if it has been
irradiated or not because there is so little
change with irradiation. The CDC thinks
irradiation is much safer than the use of ethylene
oxide gas.
If you think about trying to protect the food
supply from bacteria such as such as E. coli
O157:H7, or Salmonella on raw meats or parasites
such as trichina on pork, you can see why
irradiation is used as a tool.
The FAQs include among others:
What is food irradiation?
Which food borne diseases could be prevented with
irradiation?
What is the actual process of irradiation?
How does irradiation affect foods?
How do you measure the amount of irradiation used?
How does irradiation affect disease-causing
microbes?
Which foods can be irradiated?
Which foods have been approved for irradiation in
the United States?
Which foods are being irradiated in the U.S.?
How can I tell if the food has been irradiated?
Food irradiation FAQs
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2. Estrogen by nasal spray
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Most estrogen replacement is accomplished by
pills, skin patch, creams and occasionally
injections. This multicenter European study tested
delivery of estrogen by a nasal spray. It was
compared with an oral estradiol preparation.
The nasal preparation did as well as the pills at
treating hot flashes. Interestingly it was
associated with less bleeding problems and less
breast soreness than the oral preparation.
This nasal preparation of estradiol is not
available for use at the present time but it
implies that some of the side effects of hormone
replacement can be lessened by the route of
administration. The main difference between nasal
or skin administration is that the estradiol does
not first pass through the liver where some of it
is processed before going to the target organ as
it does with oral pills. This first-liver-pass
effect may be the cause of abnormal bleeding
because of uneven blood levels. The lower
incidence of breast pain with the intranasal
estradiol is not explainable unless the liver is
processing some of the estrogen from oral
ingestion to compounds that cause breast pain.
Nasal estradiol spray
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Informed consent
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
" The surgical consent form I have been given does
not spell out any direct risks for hysterectomy,
but rather just gives some generic risks that
might apply to an ingrown toe nail. "
"What are the ACOG guidelines for an 'INFORMED
PATIENT SURGICAL CONSENT' for a hysterectomy,
partial and radical? ".
We get questions periodically like this that are
essentially asking what is the standard of medical
care in a given situation. As you may be aware
these are extremely difficult to answer.
To help in this, we are fortunate to have an
editor with an RN and a legal background (JD). I
have convinced Sandra Jelovsek JD, RN to
participate with us in answering these sticky
questions in order to give women the best
information possible about their health and law
options. Sandy has also agreed to field email
reader submitted questions and write an article
once a week if there are enough questions.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Fast facts on primary hyperparathyroidism
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Primary hyperparathyroidism is a metabolic
disorder in which one of the small parathyroid
glands located by the thyroid gland becomes
overactive and secretes excess parathyroid
hormone. Too much parathyroid hormone results in
excess calcium being released from bone and
eventual osteoporosis.
It is a rare disease but twice as common in women
as men. It is usually picked up in early stages
because of high serum levels of calcium on a
screening blood chemistry. The reason to know
about this condition even though rare, is because
it can produce symptoms similar to fibromyalgia
and chronic fatigue syndrome which are more
common conditions.
The excess calcium in the body produces appetite
loss, thirst, frequent urination, tiredness,
muscle weakness, joint pains, and constipation. If
the blood calcium levels stay too high too long,
symptoms of abdominal pains, nausea and vomitting,
memory loss and depression can result. Kidney
stones and the bone thinning are also
manifestations of hyperparathyroidism.
See these fact sheets at the NationalInstitutess
of Health Osteoporosis and Related Bone Diseases
National Resource Center:
Primary hyperparathyroidsm
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5. Antibacterial activity in cranberry juice
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
There have been previous publications about the
antibacterial activity in cranberry juice which is
sometimes used to help prevent recurrent urinary
tract infections. Originally scientists thought it
was the acidity that killed bacteria. Then the
tannins were thought to inhibit the bacteria
especially E.Coli, a common urinary pathogen.
This recent report in JAMA indicates that it is
not just the acidity (the investigators
neutralized that) but some compounds in cranberry
juice have a wide range of antibacterial activity
against many different bacteria. The cranberry
juice is best used as concentrated as possible.
Does cranberry juice have antibacterial activity?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - For excessive bruising
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"For excessive bruising, I use arnica and ginger
gel. Rub a small amount on bruise each morning.
The bruising dissipates slowly. This worked for me
when I needed to take heparin subcutaneously in my
stomach. In a few days the massive bruising caused
by the shots went away. " - NG
[Editor note for source but not endorsement -
Arnica-Ginger Gel. By Ginger Delivery System,
External Herbals. For Product info contact New
Moon Extracts, Inc. Brattleboro, VT, 1-800-543-
7279.]
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
7. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
A fellow is going on a tour of a factory that
produces various latex products.
At the first stop, he is shown the machine that
manufactures baby-bottle nipples. The machine
makes a loud "hiss-pop" noise. "The hiss sound is
the rubber being injected into the mold," explains
the guide. "The popping sound is the needle poking
a hole in the end of the nipple."
Later, the tour reaches the part of the factory
where condoms are manufactured. The machine makes
a noise: "Hiss. Hiss. Hiss. Hiss-pop!"
"Wait a minute!" says the man taking the tour, "I
understand what the 'hiss, hiss,' is, but what's
that 'pop!' every so often?"
"Oh, it's just the same as in the baby-bottle
nipple machine," says the guide. "It pokes a hole
in every fourth condom."
"Well, that can't be good for the condoms!"
"Yeah," says the guide "but it's great for the
baby-bottle nipple business!"
Sue Hunter FF/EMT
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
***** Woman's Diagnostic Cyber Newsletter *****
April 16, 2000
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. The Merck Manual Home Edition on the net
2. Circumcision and genital skin problems
3. Reader submitted Q&A-Bacterial/yeast vaginitis
4. Polycystic ovarian syndrome and anti-insulin rx
5. Endometrial (uterine) cancer links
6. Health tip to share - Flaxseed and constipation
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. The Merck Manual Home Edition on the net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
It is very handy to have a good quality,
understandable medical reference book at home. One
such classic is the Merck Manual, Home Edition.
The original manual was written for physicians to
have a handy synopsis of many different diseases
and conditions. The home edition takes much of
that material and puts it in an easy to read
format that people without a medical background
can understand.
Each chapter does not have the depth of detail an
experienced medical surfer might want about a
specific disease of condition they have or have
researched, but this manual is a great beginning
place to learn a general overview of a topic. Even
physicians who are removed in time from a subject
can find this resource a handy review of a topic
before going on to more depth of detail.
I especially like the explanation for
hypoglycemia. Low blood sugar can cause many
symptoms and be the result of different causes.
The manual has an understandable description of
blood sugar, insulin and the interplay among
different dietary influences and medicines.
Merck Manual of Medical Information
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Circumcision and genital skin problems
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Circumcision in a male, surgical removal of
foreskin covering the head of the glans penis, is
usually performed as a child for either religious,
ritual or conformity reasons. As an elective
procedure in a newborn baby, many question whether
it should be done because there can be rare
complications and it does not reduce medical
problems until later in life.
Male circumcision has been studied and does
significantly reduce the incidence of penile
carcinoma in later life. This study in the
Archives of Dermatology was carried out to see if
there was a relationship between circumcision
status in males and skin diseases and infections
of the penis. They studied males who presented for
genital skin problems (357) and for non - genital
skin problems (305) and looked at how many males
were circumcised in each group.
They found that uncircumcised males were 3 times
more likely to have inflammatory skin conditions
such as:
Zoon balanitis
bowenoid papulosis
nonspecific balanoposthitis
lichen sclerosus
psoriasis
lichen planus
seborrheic eczema
Skin conditions in circumcised and uncircumcised males
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A -Bacterial/yeast vaginitis
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"What oral medication would you recommend for
bacterial and yeast infection?".
It is quite uncommon to have both yeast and
bacterial vaginitis but it can happen. It is still
very important to make a correct diagnosis.
Traditional treatment is usually vaginal gel or
suppositories for yeast infections and oral
metronidazole (Flagyl[R]) for bacterial vaginosis.
Many women may prefer an oral agent like
fluconazole (Diflucan[R]) for yeast infections but
doctors try to reserve it for more recurrent or
systemic infections because resistance yeast
strains are becoming more prevalent (C. glabrata)
and C.albicans strains seem to be requiring higher
and higher doses of fluconazole to eradicate the
yeast.
Other treatments such as lactobacillus, boric acid
and tea tree oil are also discussed.
Oral Treatment of Bacterial and/or Yeast Vaginal Infections
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Polycystic ovarian syndrome and anti-insulin rx
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
In women who have polycystic ovarian syndrome,
many have a condition called insulin-resistance.
In those women with this condition, the current
recommended treatment is with insulin sensitizing
drugs such as would be used in treating a diabetic
woman (Type2 diabetes). This is especially the
case if menses are irregular and there is evidence
of excess hair growth.
Dr Mark Perloe at IVF.com has a good article that
explains how it is the insulin resistance that
causes the hormonal problem (androgen excess)
rather than vice versa. The high insulin levels
decrease sex hormone binding globulin which makes
blood testosterone and androstenedione higher.
Once the androgens are elevated, they produce
abnormalities of the ovulatory system. Therefore,
the best treatment is directed at lowering insulin
levels with drugs like metformin (Glucophage[R]).
Besides improving excess hair growth (hirsutism),
this treatment also improves obesity, blood
pressure, triglyceride levels, and reestablishes
normal ovulatory cycles almost 90% of the time.
It is possible that the standard of care for PCOS
with insulin resistance is evolving to have a
trial of metformin therapy before trying to induce
ovulation with Clomid[R] in a woman who desires
pregnancy.
Treatment with Insulin Lowering Medications
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Endometrial (uterine) cancer links
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Cancerlinksusa.com has put together quality links
governing all phases of cancer including not only
diagnosis, treatment and prognosis, but also
support groups, clinical trials, risk factors and
prevention, suggested reading, general information
and FAQs.
The page of links on endometrial cancer also
includes references to articles on the prognostic
significance of hormone receptors in endometrial
cancer (estrogen receptor positive have a much
better prognosis) and tamoxifen and endometrial
cancer.
Endometrial cancer links
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Flaxseed and constipation
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
I read in the Prevention Magazine that flaxseed
oil tablets can help prevent constipation. I went
to the health food store and found some. They
worked!
Mary
[editor note-- raw flaxseeds can also be used for
constipation. Both the oil and the raw seeds are
rich in phytoestrogens.]
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 Masked Man
The couple left the gynecologist's office with the
wife in tears. They were just told that she could
never become pregnant. They would never have the
family they both desired so fervently.
Suddenly, a masked man appeared before them.
"I think I can help you," he said, handing them a
card.
"Why are you masked?" the husband asked.
"Because the government has declared our
activities illegal. Go to the address on this
card. The doctor will take a scrapping from one of
your mouths and culture it. In less than a year,
we will have your baby for you."
"This is the answer to our prayers!" the wife
exclaimed. Then she turned to thank the stranger
but he was gone.
"Who was that masked man?" she asked her husband.
He answered, ... "That was the Clone Arranger"
By Stan Kegel
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
***** Woman's Diagnostic Cyber Newsletter *****
April 23, 2000
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Family Meds pharmacy treatment suggestions
2. Gall bladder disease and high vitamin C levels
3. Reader submitted Q&A - Evista and soy
4. Cancer of the ovary background
5. Understanding panic disorder
6. Health tip to share - Don't fear psych drugs
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. Family Meds pharmacy treatment suggestions
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
There are now more than several online pharmacies
competing for your business but most of them look
alike. The online pharmacy at familymeds.com,
however, has much more health information that you
may find useful. They also make their own
recommendations in each of the treatment
categories. This is very helpful, especially when
confronted with the many options available (and
confusing) in today's pharmacy.
For each of over 300 different diseases and
conditions, they provide short infobits about:
leading causes
symptoms of note
over-the-counter choices
natural choices
prescription choices
other treatments
It was interesting for many conditions, to see
all of the prescription, non prescription and
natural choices listed close together. While we
need to be aware that many of the "other
treatments" and "natural choices" are also
pharmacy products they are trying to sell, there
still is a wealth of information that pharmacists
have about treating medical conditions and
everyday problems. They get to see what treatments
seem to be successful with the least side effects
and what people actually purchase on a repeat
basis because they work. Many of their
recommendations look quite reasonable.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Gall bladder disease and high vitamin C levels
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
You may have already heard about vitamin C and
gallbladder disease. Here's the scoop from the
Archives of Internal Medicine.
In over 7000 women and 6000 men surveyed, the
incidence of a history of gall bladder disease was
higher in women than men (11% vs 4%). Of the
remaining men and women without a history of gall
bladder disease, asymptomatic gallstones on
ultrasound were found in 8% of women and 6% of
men. They then looked at serum vitamin C levels
(ascorbic acid) and found that in women, but not
in men, the higher the blood level of vitamin C,
the lower the incidence of symptomatic gall
bladder disease and asymptomatic gallstones.
This study is important on several counts. First
of all, it does not necessarily mean that taking
vitamin C will prevent gallbladder disease in
women, but there is a good likelihood it may. The
second item is that women have more gallbladder
disease then men. That is probably due to
estrogens. We have known for years of the higher
gallbladder problems in women taking birth control
pills and estrogen replacement.
Vitamin C supplements for all women, but
especially those taking oral contraceptives or
hormone replacement therapy, would seem to be a
wise strategy for the possible prevention of gall
bladder disease.
Gall bladder disease and vitamin C levels
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Evista and soy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Do you have information regarding interactions
between the hormone Evista, and use of soy or
other non-pharmaceutical products for relief of
hot flashes during menopause?"
"I am 53, and have been taking Evista®
(raloxifene) for almost four months as hormone
replacement therapy; I also take vitamin
supplements and 1200 mg of calcium daily. I have
been suffering from hot flashes numerous times
daily and at night." - Anonymous
Evista [R] (raloxifene) is an anti-estrogen used
to help prevent osteoporosis. It tends to make hot
flashes and vaginal dryness worse than even just
menopause alone. Women who take it have symptoms
similar to women with breast cancer on tamoxifen
therapy. It is natural to ask if some of the hot
flashes can be lessened by taking soy or other
phytoestrogens.
There is not much written about this in the
medical literature. One study mentioned in the
article below suggests that adding soy will not be
harmful but it will not really reduce hot
flashes. Adding estrogens may help but the
combination of estrogens and anti-estrogens has
not been adequately studied yet.
Evista (raloxifene) and soy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Cancer of the ovary background
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
CancerNet from the National Institute has very
good overviews of many different cancers. For
ovarian cancer they cover:
Statistics
Treating Ovarian Cancer
Clinical Trials
Genetics, Causes, Risk Factors, Prevention of Ovarian Cancer
Complementary and Alternative Medicine
Testing for Ovarian Cancer
Coping with Ovarian Cancer
Support and Resources
Cancer Literature
In the section on screening for ovarian cancer you
will find explanations of CA-125 cancer antigen
test, vaginal ultrasound and Pap smears. Also you
may be interested in some of the screening trials
for cancer detection going on.
Cancer of the ovary
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Understanding panic disorder
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Every once in a long while, a person might have an
episode of panic or anxiety in which there is a
rapid heart beat, sweating, choking, dizziness,
or fear of losing control or even fear of dying.
But does this mean a panic disorder requiring
treatment?
At the Panic Disorder Institute, you can see the
possible symptoms that make up the official
diagnosis of panic disorder. Also, you can see
that the diagnosis requires that "your panic
attacks be unexpected and recur every two weeks or
that a single attack be followed by one month or
more of persistent concern about future attacks,
worry about the attacks causing physical illness
or going crazy, or significant behavioral changes
related to the attacks."
If panic disorder persists, it may evolve into an
agoraphobia, which is a fear of being unable to
escape or get help if there is an attack. A women
with this will not go out in crowds, to the mall
or hardly any places outside of the home.
One in 75 people have this problem. It can also
have medical consequences such as:
2 times increased risk of hypertension
4.5 times increased risk of heart attack
12 times increased risk of stroke
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Don't fear psych drugs
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"If you suffer from Panic Attacks, Anxiety,
Depression or any similar disorder, do not fret,
there is help at hand - go and see your doctor
about anti-depressant pills - or your psychiatrist
- don't be afraid, or embarrassed. There are that
many people that suffer from them. It can be
controlled - I have been there and it is the worst
experience of my life. I am one of the weakest
people around - but I needed to get help. It is a
hard struggle but if you can talk to somebody else
that has had them it is so much better."
Tracey
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 group of senior citizens were exchanging notes
about their ailments.
"My arm is so weak I can hardly hold this coffee
cup."
"Yes, I know. My cataracts are so bad I can't see
to pour the coffee."
"I can't turn my head because of the arthritis in
my neck."
"My blood pressure pills make me dizzy."
"I guess that's the price we pay for getting old."
"Well, it's not all bad. We should be thankful
that we can still drive!"
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
***** Woman's Diagnostic Cyber Newsletter *****
April 30, 2000
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Embarrassing medical problems website
2. Guidelines for vulvar skin care
3. Reader submitted Q&A - BCP drug interactions
4. Amenorrhea - When menstruation stops
5. Ménière's disease - dizziness and ear ringing
6. Health tip to share- Casein causing skin allergy
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. Embarrassing medical problems website
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Some people are too embarrassed about certain
health problems to even bring them up with a
physician. Physicians will also admit that there
are many health conditions that are not serious
but present significant problems for the person
with that condition as well as their family and
friends, and they don't really know the answers
for those questions.
Dr. Margaret Stearn, a British physician wrote a
book and created a web site about many of these
embarrassing problems that patients in a
genitourinary clinic she attended were asking.
Some of the topics include:
bad breath, belly button discharges, blushing and
flushing, breast size and shape, nipples, anal
itching, condom use, dandruff, memory problems,
excessive shyness, snoring, stammering, sweaty arm
pits, sweaty feet, sweaty hands, no
sexual interest, wind
Embarrassing medical problems
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Guidelines for vulvar skin care
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
On several occasions we have highlighted irritant
vulvitis which is often mistaken for a candida
yeast vulvovaginitis. This is a condition in which
the skin of the vulva becomes irritated or
hypersensitive so that any substance or material
that comes in contact with it makes the problems
worse. There can be a secondary candida yeast
infection but the treatment is to discontinue all
of the skin irritants.
At the University of Iowa Clinics, you can find a
great instruction sheet on how to avoid this
irritation. There are suggestions for detergents
free of dyes, enzymes and perfumes. This also
applies to soaps used on the skin. Clothing needs
to be all cotton and any drying off needs to be a
gentle patting dry, not a rubbing. They also
suggest not to shave the vulvar area at all.
There is a well advised caution that lubricated
condoms, contraceptive jellies, creams, or
sponges may cause itching and burning and
aggravate any existing vulvar irritation.
Guidelines for vulvar skin care
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - BCP drug interactions
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Do weight-loss pills (xenedrine) effect birth
control pills, or cause breakthough bleeding?".
T.B.
Any woman using oral contraceptives for birth
control should be concerned if taking certain
medicines or having certain medical conditions may
decrease the contraceptive action of the pill.
For many years, women may have heard that some
antibiotics might decrease the effectiveness of
birth control pills. As best we can tell, this is
a theoretical interaction but is not a practical
problem. We do not know for sure about diet pills
but it is unlikely that they increase the pill
failure rate and break through bleeding has not
been reported excessively on diet pills.
Anti-epileptic drugs, however, are one drug
interaction that is likely to increase the chance
of pregnancy while taking oral contraceptives.
Women with epilepsy on medication for it should
probably take higher dose oral contraceptives in
order to be assured of protection. For
a discussion, see:
Drugs affecting birth control pills
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Amenorrhea - When menstruation stops
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
When menses stops, it is not always caused by
pregnancy or menopause. In fact most of the time,
the cause of amenorrhea has to do with the lack of
ovulation from the ovary. There are many factors
that can affect the hormones that control
ovulation.
Causes of anovulation, and thus amenorrhea may
range from rare pituitary tumors, to polycystic
ovarian disease, medications, stress, chronic
illness, malnutrition and obesity among other
things.
You might think "why worry about this? No menses
is good!" At Mayo Health Oasis there are some good
explanations and visuals about hormones and
ovulation control. It is worth becoming educated
about this because amenorrhea that occurs before
menopause can make a woman at risk for:
infertility
osteoporosis
heart disease
endometrial cancer
Also included are symptoms to watch for and how
to prevent amenorrhea.
Amenorrhea - When menstruation stops
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Ménière's disease - dizziness and ear ringing
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Dizziness is a common symptom. It is not usually
due to an inner ear problem but when it is, it
can be quite frequent and annoying. Attacks of
dizziness and loss of balance come on quickly and
peak in intensity within minutes and may last more
than an hour with the unsteadiness lasting even
longer. Attacks may come in a series over weeks or
months or even have periods of no attacks for
awhile. If the dizziness or vertigo (spinning
sensation) gets bad, it may be accompanied by
nausea, vomiting and sweating. This disease is
more common after the age of 20 but peaks in the
40-50 age range.
Untreated, symptoms may regress over years. There
are actually many different treatments that have
been used and different ones work for different
people. Dietary change, medicines and several
different surgeries may be used so this is a
condition you would want to work very closely with
your doctor about.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Casein causing skin allergy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Eczema was my biggest nightmare for 3 years. I was
given cycle upon cycle of prednisone with only
temporary relief. I now have "prednisone eyes". I
still buy triamcinolone by the pound, but that and
some antihistamines is all I need, since I decided
to try the dietary route and give up all milk
products, (especially, or including) Casein.
BINGO! It's not an easy thing to avoid, but
considering the alternatives, it's well worth the
denial of some very wonderful foods.
I wondered why tuna sometimes bothered my skin,
read the label, casein is used in the canning
process, products like Bumblebee, Chicken of the
Sea have it. Starkist does not. This change in my
life has made my skin tolerable. I work in a
hospital, and OSHA requires us to be constantly
washing our hands. They are always a mess. They
provide latex-free and cornstarch-free gloves for
me. I will probably always have some form of
dermatitis going on, but before, my eczema was
total body, and very red in patches. I could not
work for 9 months because clothing hurt me.
The dietary route for a cure for skin eczema
should not be overlooked.
K.R.
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 man is diagnosed with prostate cancer and the
doctor says he wants to put the man on hormone
therapy.
"Okay," the man says, "what does it do?"
"It reduces the testosterone which feeds the
prostate."
"Okay," the man says. "Are the any side effects?"
"Some loss of sex drive. Possibly some hot
flashes. And an inexplicable urge to ask
directions when lost."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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