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***** Woman's Diagnostic Cyber Newsletter *****
              May 7, 2000
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

1. Gastro esophageal reflux disease - heartburn
2. Ductal in situ breast cancer prognostic factors 
3. Reader submitted Q&A - Prolapse repair without hyst
4. Progesterone IUCDs as rx for heavy menses
5. Erythema multiforme - an allergic skin response
6. Health tip to share - Weight training for PMS
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. Gastro esophageal reflux disease (GERD)- heartburn
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
About 7% of people have heartburn once a day. It 
is a common condition resulting from the reflux of 
stomach contents up into the esophagus. Almost a 
third of people get heartburn at some time, but 
the incidence rises after age 40. 

Besides throat burning, pain on swallowing and 
difficulty swallowing, you can also get lung or 
respiratory symptoms because the acid can reflux 
all the way into the trachea (windpipe). It can 
cause coughing, wheezing, asthma, pneumonia and 
lung stiffening as well as tooth decay, gum 
disease and bad breath. 

Pregnancy and the influence of progesterone can 
make reflux a terrible problem  because the 
hormone relaxes the lower esophageal sphincter, 
allowing acid reflux and the pregnant uterus 
forces the stomach higher toward the diaphragm and 
lung. 

In nonpregnant adults, GERD is often a chronic 
disease. Treatment is by change in diet, 
medications and occasionally in severe cases, 
surgery. 

For a good tutorial from gerd.com, that really 
explains what is happening in reflux disease, see: 

Heartburn, gastroesophageal reflux

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Ductal in situ breast cancer prognostic factors
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Carcinoma in situ is a category of cancer that is 
confined to the skin lining (epithelium) and is 
not invasive. In many tissues such as the vulva, 
skin or cervix, if the abnormal tissue is totally 
excised, carcinoma in situ is cured 99% of the 
time. Breast tissue, however, is a somewhat 
different problem because it is much more 
difficult to make sure that all of the abnormal 
ductal tissue is removed without removing the 
entire breast. And yet the ultimate goal should be 
to preserve the breast if there is less than a 1% 
chance that the cancer has invaded somewhere along 
the duct. 

The article below looks at what are the risk 
factors in which a breast ductal carcinoma in situ 
on excisional biopsy can just be followed without 
removing the breast or just be given radiation 
therapy without having a mastectomy. In 575 
patients in France, recurrence free survival was 
96% after modified radical mastectomy and only 83% 
after breast conserving treatment and 
radiotherapy. Seven year metastasis free survival 
was 99% and 96% after modified radical mastectomy 
and just radiation therapy respectively. 

The study found that recurrence and metastasis 
were more common if the cancer was of a "comedo" 
cell type, if it occurred in many different foci 
rather than being continuous, and if the margins 
of the excisional biopsy were not free of the in 
situ carcinoma. On the other hand, if the margins 
are free of tumor, if the lesion is not multifocal 
and the cell type is not comedo, then a mastectomy 
may not need to be performed. 

Ductal carcinoma insitu of the breast

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Prolapse repair without hyst
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Is a hysterectomy absolutely necessary in order 
to repair a rectocele? Is there some procedure for 
repair without having to also have a total 
hysterectomy? This is after menopause,  age 52,  
difficult birth of a child 24 years ago, now the 
herniated rectum (rectocele) is protruding through 
the vagina ... not all the time...more after being 
tired at the end of a day." 

G.T.

The quick answer is no, hysterectomy is not 
necessary in order to fix a rectocele or cystocele 
or even uterine prolapse. It is not even a 
necessary component in the repair of stress 
urinary incontinence. As to why it is very 
frequently recommended or included in the 
procedures to fix pelvic organ prolapse, you may 
want to read our discussion below. It can be a 
complex decision. We modified and updated our 
article of October 17, 1999 to "Having Prolapse, 
Cystocele and Rectocele Fixed Without 
Hysterectomy" 

Cystocele and rectocele repair without hysterectomy

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Progesterone IUCDs as rx for heavy menses
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If heavy menstrual flow is not due to endometrial 
polyps or fibroids, it often becomes labelled as 
dysfunctional bleeding. Dysfunctional bleeding 
just means we do not know the cause and think that 
most of the time it is due to a dysfunction of 
normal hormonal physiology. Actually there are 
other causes but most of the time treatment is 
hormonal supression of the heavy flow. Frequently 
oral contraceptives or just progesterone tablets 
are used to decrease flow. 

One treatment we often forget about is use of the 
progesterone intrauterine device (Progestasert 
[R]). It has been used to decrease menstrual blood 
loss. Some women do not like the thought of an 
IUCD in their uterus but if oral contraceptives 
and oral progesterone are not tolerated because of 
side effects, the only other alternative short of 
hysterectomy is endometrial ablation. 

Does the progesterone IUCD work? This review from 
the Cochrane Library Review of clinical trials 
concludes that it does decrease blood loss better 
than oral progesterone but not as much as 
endometrial ablation. There is more breakthrough 
bleeding with the IUCD and less amenorrhea than 
with ablation, but apparently the satisfaction 
level is the same with the IUCD as with 
endometrial ablation. 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Erythema multiforme - an allergic skin response
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Have you ever seen a skin rash that almost looks 
like a target was painted on the skin? Erythema 
multiforme is a skin reaction that almost always 
is an allergic response to a medication, chemical 
or other condition. You can recognize it as a red 
circular area with pale but otherwise normal skin 
on the inside of the circle. The lesions are not 
always circular but often are and your first 
response might be to think of a ringworm 
infection. 

Systemic symptoms besides the skin rash can 
include itching, joint aches, an all over poor 
feeling, and fever. 

Medications that produce this rash are almost 
always sulfa, penecillins, barbituates or Dilantin 
[R]. Infections that can cause this are herpes 
simplex virus and mycoplasma. 

Treatment is directed at the underlying condition 
which may mean discontinuing certain medications, 
taking antibiotics or anti virals, and using anti-
histamines and occasionally steroids if the skin 
condition blisters and worsens. 

For pictures and more info, see this library page 
at Healthcentral.com: 

Erythema multiforme skin reaction

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Weight training for PMS
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Here's the tip of the week for women experiencing 
extreme fatigue, irritability, and a feeling of " 
I just do not want to get out of bed today" during 
PMS/Perimenopause. 

I have discovered that lifting weights gives me an 
incredible amount of energy plus an added bonus of 
feeling really good about myself.  I joined a gym 
that offers a class called "bodypump" using 
barbells (just like the big muscle guys!) with an 
hour of intense work out that will make your body 
sing, your brain happy and glad that you did, 
indeed, get out of bed!!  

Happy bodypumping!  M.L.T.

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 TOP TEN THINGS ONLY WOMEN UNDERSTAND

10. Cats' facial expressions.

9. The need for the same style of shoes in 
different  colors. 
8. Why bean sprouts aren't just weeds.
7. Fat clothes.
6. Taking a car trip without trying to beat your 
best time. 
5. The difference between beige, ecru, cream, off-
white, and eggshell. 
4. Cutting your bangs to make them grow.
3. Eyelash curlers.
2. The inaccuracy of every bathroom scale ever made.

AND,.... the Number One thing only women understand:

1. OTHER WOMEN 
 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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 *****
               May 14, 2000
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

1. Lyme disease - What to look for
2. Depression is a risk factor for heart disease 
3. Reader submitted Q&A - Possible adenomyosis
4. Osteoporosis prevention and treatment
5. Resuming intercourse after cancer therapy
6. Health tip to share - Vitamin C for heavy menses
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. Lyme disease - What to look for
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
With spring and summer coming and outdoor 
activities on the rise, we have to keep our eye 
out for us and our children to make sure that deer 
ticks do not get a bite on us. They can spread 
Lyme disease caused by a bacterium spirochete. 
Initially the skin is infected but it spreads to 
the joints and nervous system. 

The first symptom is an expanding rash that gets 
quite big; 5-6 inches is not uncommon. It radiates 
from the tick bite and starts about 1-2 weeks 
after the bite and may last 3-5 weeks. The rash 
coincides with a fever, chills, fatigue and joint 
aches. This can progress to more severe joint 
pains, a stiff, aching neck, and a tingling or 
numbness in the extremities or a facial palsy can 
occur. 

Early treatment with antibiotics can prevent 
permanent neurological sequelae. Also, the tick 
does not transmit the spirochete until after it 
has been attached for 24 hours. Therefore a once a 
day tick check is necessary for those spending 
time outdoors. The disease can occur in any state 
although the Northeast, the upper midwest and 
California report more cases. 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Depression is a risk factor for heart disease
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
According to a study in the Archives of Internal 
Medicine, both men and women who have depression 
have about a two-fold increased risk of coronary 
heart disease events such as heart attacks or 
angina. Depressed men actually had an increased 
risk of fatal heart attacks while women did not. 

I'm not sure what to make of this information 
except that depression has manifestations beyond 
that of the mind and mood. 

Depression as a risk for heart attack

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Possible adenomyosis
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I am  46 and  every  month before I start my 
period,  I have really painful cramps. They are so 
painful that I can barely function. What could be 
the cause of this?" 

Carolyn

While there are several possibilities causing this 
pain including endometriosis, the most likely 
cause is an entity called adenomyosis. It is a 
condition like endometriosis only instead of the 
growing, sloughing tissue occurring in the 
abdominal cavity and on the outside of the 
ovaries, tubes and uterus, this tissue is found in 
islands deep into the muscle of the uterus. 

It causes pain and abnormal menstrual bleeding. 
The diagnosis is difficult and treatment of it 
medically or surgically short of hysterectomy is 
not often offered to women. 

For a discussion of this topic, see:

Adenomyosis - an internal endometriosis

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Osteoporosis prevention and treatment
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The following article from the electronic Medical 
Journal of Australia presents a great summary of 
the current medical concepts for osteoporosis 
prevention. 

Estrogen therapy is first choice for osteoporosis 
prevention 

First choice for fracture treatment is alendronate 
(Fosamax[R]) and secondly raloxifene (Evista [R]). 

Housebound or institutionalized elderly women 
should have Vitamin D supplementation. 

Calcium supplements should be used with all the 
regimens and have a better bone-sparing effect 
when taken at night. 

"Natural" therapies such as soy may have some 
effect in preventing bone loss in animals but 
there is not yet any evidence they have a 
significant effect in humans. 

Osteoporosis review

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Resuming intercourse after cancer therapy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
After abstaining from vaginal intercourse for 
months or years, vaginal dryness and loss of 
elasticity takes place. Cancer patients who 
undergo radiation treatments, chemotherapy and 
either become menopausal or have to discontinue 
their estrogen replacement therapy, are especially 
hard hit by these drying vaginal changes. 

Resuming vaginal intercourse under these 
circumstances is not just a matter of using a 
little lubricant or restarting estrogen therapy. 
It is a multistep process. These "Seven Steps to 
Reentering Sexuality After Cancer are described at 
veryprivate.com. 

Avoiding the application of more chemicals that 
worsen the dryness and discomfort, and the gradual 
reacquaintence of the vaginal tissue with touch 
and penetration are the key components to 
eventually resuming intercourse. Remember that it 
is a very gradual process, not quick. It takes 
patience. 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Vitamin C for heavy menses
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Since Vitamin C speeds up blood clotting times, I 
tried taking Vit C while menstruating.  I found 
that taking it decreased my heavy menstrual flow 
to a tolerable amount. The difference was very 
noticeable. I took 500 mg a day in two 250 mg 
doses (one in the morning and one at night). 

Since this is anecdotal, it would be fun to be 
able to hear the results of other people trying 
out these remedies." 

Dorothy G.


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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
HUSBAND AND WIFE

A woman accompanied her husband to the doctor's 
office. After his checkup, the doctor called the 
wife into his office alone. 

He said, "Your husband is suffering from a very 
severe disease, combined with horrible stress. If 
you don't do the following, your husband will 
surely die: Each morning, fix him a healthy 
breakfast. Be pleasant, and make sure he is in a 
good mood. For lunch make him a nutritious meal. 
For dinner prepare an especially nice meal for 
him. Don't burden him with chores, as he probably 
had a hard day. Don't discuss your problems with 
him, it will only make his stress worse. And, most 
importantly, make love with your husband several 
times a week and satisfy his every whim. If you 
can do this for the next 10 months to a year, I 
think your husband will regain his health 
completely." 

On the way home, the husband asked his wife."What 
did the doctor say?" 

"You're going to die," she replied.
 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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 *****
                May 21, 2000
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

1. Some causes of memory loss are reversible
2. Avoiding mistakes in a fitness routine
3. Reader submitted Q&A - Getting lab reports
4. Risk factors for advanced stage cervical cancer
5. Improving endometrial ablation success
6. Health tip to share - Hot flashes and Soy
7. Humor is healthy

We are honored that Health Scout.com, a web site 
that rates medical web sites as stars or stinkers 
gave our Woman's Diagnostic Cyber their highest 
4 star rating! 

Health Scout

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. Some causes of memory loss are reversible
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Most memory losses are just a matter of being too 
busy to let a thought or fact "settle in". But we 
make jokes about getting Alzheimer's disease. 
Sometimes we seriously worry that a pre senile 
dementia may be occurring. A parent starts 
forgetting more and more and we attribute it to 
age. 

What would be a real mistake would be to assume 
that someone having memory loss has Alzheimer's or 
a senile memory loss when in fact they had a 
reversible cause of forgetting. Reversible causes 
of memory loss include: 

hypertension (uncontrolled)
diabetes (uncontrolled)
depression
medication side effects
severe hypothyroidism
Vitamin B-12 (pernicious anemia)

There are also causes of permanent memory loss 
other than Alzheimer's or dementia. Small strokes 
can be one cause or congestive heart failure. If 
you have any questions about a possible loss of 
memory, be sure to see your physician. Take a look 
at this article about memory loss at Mayo Health. 

Reversible memory loss

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Avoiding mistakes in a fitness routine
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
A steady fitness routine almost guarantees good 
health and a good mind set. But sometimes we let 
stress follow us there and don't warm up like we 
should or we rush and skip certain parts of the 
routine we may not consider as important. We may 
even rush through some of the exercises or even 
worse, not perform them correctly. 

All of these mistakes can have consequences we 
fail to think of. The muscles need their full 
range of motion in order to improve. Too rapid a 
set of repetitions may inhibit good muscle 
development or even lead to burnout. 

You may want to look at these fitness routine 
mistakes at PersonalMD.com and read about their 
consequences or look at some of the other fitness 
mistakes such as: 

wasting time
over training
not eating right
not taking enough fluids
not getting enough sleep

Avoiding mistakes in a fitness routine

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Getting lab reports
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Health Law Article

"My mother recently had an outpatient CT scan to 
evaluate abdominal pain which she has had for 
about 4 months. We were told it would be a few 
days before receiving the results. I did not want 
to wait that long and the next day I called the 
radiology clinic. I was told they could not give 
the report to me and that it was sent to the 
doctor who ordered the scan and I would have to 
get the report from him. I called the doctor's 
office and the nurse told me the doctor was not in 
the office that day and that she could not give 
the results to me without the doctor's permission. 
I asked for the results by the end of the day and 
the nurse called the doctor and then called me 
back saying that everything looked normal as far 
as she could tell from the report but that the 
doctor had not seen the report. It was two days 
later before the doctor called with the report. I 
know there are laws that say hospitals have to 
give medical records but what about doctors or 
outpatient clinics? " 

anonymous 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Risk factors for advanced stage cervical cancer
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Having regular Pap smears has significantly 
decreased the incidence of advanced (late stage) 
cervical cancer that doctors see. It even has 
made a larger impact in decreasing early cancer 
seen because treatment of dysplasia (a possible 
pre cancerous change) is very common place. 

When a gynecologist sees a patient with cervical 
cancer nowadays, it is almost always of an 
advanced stage in a woman who has not had a Pap 
smear or exam in about 10 years or more. The 
following article in the Archives of Family 
Medicine looked at what are the factors associated 
with advanced stage cervical cancer. 

They found, of course, that advanced age was a 
strong predictor. That is, older women are the 
ones more likely to have advanced cervical cancer. 
You would expect some of this because it takes 
several years for cancer to get worse and spread, 
but it is also true because more elderly women 
tend not to continue having annual pelvic exams. 

Another factor was health finances - if a woman 
was indigent she had a 60% increase of having 
advanced cancer. If she had commercial or HMO 
health insurance, the risk is reduced by 46%. 
Being unmarried also was a factor that increases 
risk. One can only postulate why. 

Surprisingly, race, education level, income level, 
smoking status, other medical conditions, and 
urban residence were not associated with stage at 
diagnosis. 
 

Cervical cancer risk factors

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Improving endometrial ablation success
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Endometrial ablation is a procedure used to 
decrease heavy menstrual bleeding without doing a 
hysterectomy. It does not allow further 
childbearing but it can prevent having to undergo 
a major surgical procedure. 

It is only about 65% successful in preventing the 
need for further medical or surgical therapy for 
the heavy bleeding. This study looked at factors 
associated with the success of endometrial 
ablation in 120 women who were pretreated with 
either danazol (Danocrine [R], 800 mg/day orally) 
or leuprolide (Lupron [R], 3.75 mg in one 
intramuscular injection each month). 

If there were no endometrial polyps or fibroids, 
the ablation was more successful. Also women under 
age 40 pretreated with danocrine had a better success 
rate. This is new information so if you are 
considering having an endometrial ablation, 
encourage your doctor to give you danocrine prior 
to the ablation. It makes the endometrial lining 
thinner and more atrophic. There is less of it 
present so maybe the ablation will miss less 
tissue. 


Endometrial ablation success

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
My sister is a 51 1/2 year old nurse.  She was 
struggling with hot flashes due to menopause.  She 
started taking an Amway product containing black 
cohosh and soy and within 5 days, the hot flashes 
ceased. She's been taking this product for almost 
a year now and has never had a hot flash yet. 

Rose

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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Thoughts on Cats

"There is no snooze button on a cat who wants 
breakfast." 
  - Anonymous

"Thousands of years ago, cats were worshipped as 
gods. Cats have never forgotten this." 
  - Anonymous

"Cats are smarter than dogs. You can't get eight 
cats to pull a sled through snow." 
  - Jeff Valdez

"In a cat's eye, all things belong to cats." 
   - English proverb

"As every cat owner knows, nobody owns a cat."
  - Ellen Perry Berkeley

"One cat just leads to another."
  - Ernest Hemingway

"Dogs come when they're called; cats take a 
message and get back to you later." 
  - Mary Bly

"Cats are rather delicate creatures and they are 
subject to a good many ailments, but I never heard 
of one who suffered from insomnia." 
  - Joseph Wood Krutch

"People that hate cats, will come back as mice in 
their next life." 
  - Faith Resnick

"There are many intelligent species in the 
universe. They are all owned by cats." 
  - Anonymous

"I have studied many philosophers and many cats. 
The wisdom of cats is infinitely superior." 
  - Hippolyte Taine

"Some people say that cats are sneaky, evil, and 
cruel. True, and they have many other fine 
qualities as well." 
   - Missy Dizick

"You will always be lucky if you know how to
make friends with strange cats."
  - Colonial American proverb

"Cats seem to go on the principle that it never 
does any harm to ask for what you want." 
   - Joseph Wood Krutch

"Cats aren't clean, they're just covered with cat 
spit." 
   - John S. Nichols

"Do not meddle in the affairs of cats, for they are
subtle and will pee on your computer."
   - Bruce Graham

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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 *****
                 May 28, 2000
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

1. Treating allergies the natural way
2. Lost libido and what to do about it 
3. Reader submitted Q&A - ASCUS Pap smears
4. Spontaneous change in urinary incontinence symptoms
5. USP Drug information on Medline 
6. Health tip to share - Low fat, vegan diet and cramps
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. Treating allergies the natural way
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
You can throw antihistamines at this season of 
allergies, but did you ever stop to think there 
might be another way? This health newsletter at 
VitaCost.com emphasizes the use of vitamins and 
other natural supplements to help ease the 
symptoms of hay fever or food allergies. 

A first effort must include avoiding the known 
allergens as much as possible as well as staying 
in a very clean environment that includes allergy 
filters and anti allergenic pillows, pillow cases and 
mattress coverings. Pets need to stay out of the 
bedroom and humidifiers can make things worse by 
spreading mold. 

As far as supplements go, they discuss vitamins A, 
C and E as well as cofactors needed for the immune 
system such as selenium, zinc, quercetin, 
grapeseed extract, DHA from fish oil and green 
tea. 

Controlling Allergy Naturally

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Lost libido and what to do about it
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Generation A, men and women whose life begins at 
50, have a place to congregate at generationA.com. 
One of the topics that you might expect to be 
discussed is decreased libido. 

In this article below by Charlotte Slopak, Ph.D., 
there is a good review of some of the material 
from a book, I'm Not in the Mood, by Julia 
Reichman, M.D. Statistics show about 40% of women 
lose sexual desire during menopause and about 25% 
have intercourse rarely. 

Low testosterone levels can sometimes play a role 
although there certainly are many other factors 
that can contribute to these feelings. Take glance 
at: 

Decreased libido

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - ASCUS Pap smears
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I have been having pap smears repeated every 3 
months for about 9 months now per my gyn because 
of an abnormal smear. He said it's a category 2, 
not cancer but to keep an eye on this. Can this 
turn into a pre-cancer? He mentioned squamous 
cellular changes. What does all this mean? " 

"Should I get a second opinion?" 

Becky D. 

How should an abnormal Pap smear be followed? The 
different recommendations doctors give for 
abnormal Pap follow up are almost as confusing as 
the different categories of abnormality. In fact 
these Pap classifications have changed several 
times throughout the last several decades and 
physicians may even mix and match these 
classifications when they try to explain them to 
you. 

Some physicians and some patients are more likely 
to want to treat mildly abnormal smears than are 
other physicians and patients. Treatment can 
depend upon whether an abnormality produces 
excessive anxiety. 

For the most part, Pap smears classified as ASCUS 
(atypical cells of undetermined significance) are 
followed without treatment every 4 months. 
Sometimes Paps with suspected dysplasia such as 
LGSIL (low grade squamous intraepithelial 
neoplasia) are also followed the same way. 

For a discussion of the different classes of Paps 
and what they mean, see our article at: 

ASCUS Pap smears

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Spontaneous change in urinary incontinence symptoms
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The following article from the British Medical 
Journal is quite interesting. It is a study in 
which they looked at 2860 women ages 40-60 and 
followed them for one year. They determined how 
many women had urinary incontinence symptoms at 
the beginning of the year (28.5%) and how many of 
those women had regression of those symptoms to 
less than once a week by the end of a year (28% of 
those original 28.5% of women). 

Also, they determined that the new occurrence of 
urinary incontinence (both urge and stress 
incontinence) was 10%  within that year. 

None of the women in the study had any medical 
interventions performed during the year of the 
study, thus this is a natural history study that 
shows what the normal course of symptoms can be. 
It shows that incontinence symptoms can get better 
on their own. Therefore women should be cautious 
about major medical or surgical procedures for 
urinary incontinence until some time passes and it 
is obvious the symptoms are not going to improve 
on their own. 

Lower urinary tract symptoms - a longitudinal study

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. USP Drug information on Medline 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Medline, the service from the National Library of 
Medicine that has all of the scientific Medical 
Journal abstracts now offers drug information on 
over 9000 prescription and over-the-counter drugs. 
This resource is worth knowing about because it is 
considered quite an authoritative database. The 
drug information is assembled by the US 
Pharmacopeia. 

Medline Drug Information

Take a look at the information on a drug like 
Lupron [R] (systemic luprolide) or even just oral 
contraceptives. It is information you are not 
likely to see in other sources. 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Low fat, vegan diet and cramps
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
A low fat (10%), vegetarian diet decreases the 
number of days of menstrual cramps with a 
menstrual cycle by about 25%. 

[Editor]

We encourage you to share your health tips.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
7. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Doctor Joke

How many gynecologists does it take to change a 
light bulb? 

"Why don't we just take out the socket? You're not 
using it any more, and it'll only cause you more 
problems later on!" 
 
Jim Sylvester

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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 *****
              June 4, 2000
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

1. Food recipes for disease conditions
2. Anabolic steroid abuse and its consequences 
3. Reader submitted Q&A - MD refusal of well-baby care
4. Tampons and asbestos and dioxin rumors
5. Free resources for women on cancer chemotherapy
6. Health tip to share - Relieving eye strain
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 recipes for disease conditions
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
WholehealthMD.com has a place called a Healing 
Kitchen. You can choose from many diseases and 
conditions and they will print out a set of 
recipes that have foods containing high levels of 
vitamins and nutrients that have been shown to 
help that condition. 

For example if you would click on the drop down 
menu and choose PMS, there is a display of recipes 
high in calcium, magnesium and vitamin B6, Vitamin 
E and zinc.  The first three mentioned have all 
been shown to improve PMS in randomized trials. 
Vitamin E and zinc have weaker evidence but are 
likely to benefit PMS. 

The best part is the recipes. They list the 
following recipes, among others, that are high in 
the above nutrients and therefore should help PMS: 

California Pizza 
Chicken with Spinach & Cheese 
Golden Vegetable Risotto 
Lasagna Arrabbiata 
Pasta with Spinach & Tuna 
Taosenos Cornmeal Casserole 
Turkey Sausage Pizza 
Sauteed Greens with Garlic & Herbs 
Homemade Granola 
Kale & White Bean Pasta with Almonds 
Spinach & Paneer over Brown Rice 
Pasta with Sardines & Fennel 
Chicken & Winter Squash Tagine 
Stir-Fried Pork & Tofu 
Spicy Kale & Potato Soup 
Sicilian-Style Toasted Quinoa 
Baby Bok Choy with Shiitake Mushrooms 
Pork Mole 
Thai Green Chicken Curry 
Basmati Rice, Chick-Peas & Toasted Almonds 
Tangerine & Avocado Salad 
  
Wow. I'm ready to open a restaurant to tackle 
medical diseases! 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Anabolic steroid abuse and its consequences 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Some women, and many men, take steroid supplements 
such as testosterone or DHEA or androstenedione 
(street name Andro). If taken in small hormone 
replacement doses there are usually no 
complications and minimal side effects. Some 
people get carried away with the doses especially 
if they are trying to build muscle as part of a 
bodybuilding program. About 2-3% of teenagers 
report anabolic steroid use. 

Another category that may abuse these steroids 
have a behavioral syndrome called muscle 
dysmorphia. In this condition a woman might think 
she was fat and flabby even though others would 
disagree. Also women who have been raped may be 
more likely to use anabolic steroids. 

There can be moderate health consequences in women 
from using too high doses of these hormones: 

increased hair growth and clitoral enlargement
acne increase
male pattern baldness
liver damage
heart attacks
tendon rupture

You may want to read about this at Behavioral 
Health Online: 

Anabolic steroid abuse FAQs

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - MD refusal of well-baby care
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Is it against the law for a doctor to refuse to 
attend to a baby for well-baby checks because the 
parents refused to have the child vaccinated?" 

No, its not against the law but the doctor has to 
give you notice of ending the doctor-patient 
relationship with enough lead time to arrange 
other care. 

You might want to check your state laws about 
vaccinations too because many schools, day care 
centers etc., have laws about children needing to 
be vaccinated. 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Tampons and asbestos and dioxin rumors
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Every so often an internet email appears that 
warns about how women are being exposed to 
asbestos and dioxin in tampons. We have mentioned 
this before but it does bear repeating. 

The FDA has tested tampons and there are no 
asbestos fibers in them. Dioxins are sometimes 
found in wood products that have been bleached but 
the FDA has determined that dioxin levels in 
tampons are "are at or below the detectable limit. 
No risk to health would be expected from these 
trace amounts." 

If you have concerns, you may want to look at
articles from the FDA.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Free resources for women on cancer chemotherapy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Smith Kline Beecham Oncology, makers of an ovarian 
cancer chemotherapy drug called topotecan 
(Hycamtin[R]) have made available some videos, 
books and booklets for women who may have to take 
chemotherapy. 

These materials are meant as supplements and are 
not intended to take the place of treatment or 
discussions with physicians, counselors, family or 
friends. They are meant to educate you about the 
complexities of the disease, its treatments and 
the ongoing symptoms. 

You can order the following patient information 
materials free of charge as well as get more 
information about each of these materials. 

Holding on to the Light (Booklet)
Courage & Commitment (Booklet)
Solving the Puzzle of Fatigue: A Program for 
  Coping with Fatigue (Kit) 
Waiting for Spring (Video)
Myths & Facts about Ovarian Cancer: What You Need 
  to Know (Booklet) 
My Journey: A Personal Journal for Women Living 
  with Cancer (Journal) 
What to Eat When You Don't Feel Like Eating (Book)
Health Journeys for People Undergoing Chemotherapy 
(Audiocassette) 
Understanding Chemotherapy (Booklet)
Affirmations for Getting Well Again (Video)
So Many Questions (Video)
Resource Guide for Patients (Booklet) 

Free booklets and videos for ovarian cancer chemo

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Relieving eye strain
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Close eyes, place ring finger directly below 
eyebrows, near bridge of nose. Slowly increase 
pressure for 5 seconds, gently release, repeat 2-3 
times. 

From Visiting Nurse Services in Westchester

Eye strain

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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
An expectant mother was being rushed to the 
hospital, but didn't quite make it. She gave birth 
to her baby on the hospital lawn. Later, the 
father received a bill, listing "Delivery Room 
Fee: $675." 

He wrote the hospital and reminded them the baby 
was born on the front lawn. A week passed, and a 
corrected bill arrived: "Greens Fee:  $200." 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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 *****
              June 11, 2000
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

1. Latex allergy
2. What is the diagnostic work-up for hypertension? 
3. Reader submitted Q&A - Recurrent yeast infections
4. Cervical infections and inflammations
5. Dandruff - what is it, what to do?
6. Health tip to share-Relaxation for panic disorder
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. Latex allergy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Latex allergy is most often manifest by itchy 
hands. Latex can produce a contact allergy, and 
irritant dermatitis just like a poison ivy rash. 
More severe reactions can be runny nose, sneezing, 
itchy eyes, scratchy throat, and asthma. Sometimes 
the reaction is not until 24-48 hours after the 
exposure, so the connection between the cause and 
the effect may be lost.  Many household sources of 
latex can be found such as: carpeting, racquet 
handles, shoe soles, expandable fabric 
(waistbands), dishwashing gloves, hot water 
bottles, and even condoms and diaphragms. 

Treatment is avoidance of latex of course. But 
also there needs to be a knowledge of which of 
many products in the home and workplace can have 
latex as a component. 

This site at the Center for Disease Control, 
National Institute of Occupational Safety and 
Health may help explain what to do if you suspect 
a latex allergy. 

Latex allergy

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. What is the diagnostic work-up for hypertension?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
When hypertension is diagnosed (blood pressure of 
140 over 90 or higher), it is most frequently 
classified in a category called essential 
hypertension. That means that we do not know the 
cause of it other than the blood vessels are just 
constantly under an increased tension or 
hypertonus. There are other types and causes of 
hypertension that although much less frequently 
occurring, may be amenable to different successful 
treatments. 

Causes may include kidney disease, anomalies of 
the kidney arteries or the large aortic artery, 
and tumors or hyperfunctioning of the adrenal 
gland such as pheochromocytoma, Cushing's 
syndrome, and primary hyperaldosteronism. While 
none of these are as common as essential 
hypertension,  a woman needs to know what extent 
of a diagnostic work-up should take place before 
assuming there is no known cause beyond the 
category of essential. 

A chest x-ray, EKG and laboratory blood studies 
comprise the basic work-up. The chest xray and EKG 
look for heat enlargement which high blood 
pressure can cause over time, and heart 
abnormalities. A urinalysis looks for kidney 
damage as does the blood test for creatinine. A 
blood count looks for anemia. Serum potassium 
looks for aldosteronism and blood glucose looks 
for diabetes. 

Hypertension diagnosis 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Recurrent yeast infections
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"How do you get rid of recurrences of yeast 
infections? This is a constant thing every month. 
I need help.  I don't have sugar. I have been 
tested for that as well as thyroid. I am 39 years 
old and  I have been to several doctors and so far 
I haven't been able to shake this infection 
completely. What other doctor should I go to 
besides a Gyn physician? ". 

Many women are plagued with recurrent yeast 
infections. Some of those women have a recurrent 
irritant vulvitis rather than yeast vaginitis so 
it is important to confirm the diagnosis with 
yeast cultures. 

There are risk factors for this such as oral 
contraceptive use, diabetes or carbohydrate 
intolerance, antibiotic or steroid use. Many 
times, however, the stimulating events are not 
obvious. 

Dermatologists will often treat a vulvar 
dermatitis as well as gynecologists.

Lifestyle habits, bodily care regimens and 
prophylactic medical treatments to prevent 
recurrence are discussed: 

Chronic Recurrent Yeast Vaginitis - What Can Be Done?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Cervical infections and inflammations
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Most of the concern with diseases of the cervix 
have to do with abnormal Pap smears and the 
possibility that changes of cervical dysplasia may 
go on to become an invasive cervical cancer. We 
often forget about or treat lightly infectious 
conditions of the cervix because they tend to 
cause less symptoms and sometimes just clear up 
their own without treatment. 

The following tutorial about infectious and 
inflammatory conditions of the cervix from the 
Health Sciences Center at the University of 
Virginia School of Medicine make interesting 
reading if you have ever had an abnormal Pap with 
inflammatory changes or if the doctor has 
mentioned any cervicitis or other cervical 
changes. They list: 

noninfectious (nonspecific) cervicitis 
chlamydia trachomatis cervicitis 
herpes simplex virus (HSV) cervicitis 
human papilloma virus (HPV) Infection 
 
They point out that nabothian cysts (plugged 
mucous glands) can develop from the cervical cells 
trying to heal over that nonspecific inflammation 
in a process called metaplasia. Another 
interesting point is that herpes cervicitis 
produces a watery discharge. 

Cervical infections

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Dandruff - what is it, what to do?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Dandruff is basically dead skin that is being shed 
from the scalp. That happens all of the time for 
everyone, but in some people, the production rate 
of skin cell turnover increases. 

A small yeast organism, Pityrosporum ovale, has 
been shown to be associated with dandruff. The 
question is whether it is a primary cause or 
whether it just grows well where there is dead 
skin. No one knows for sure. 

The treatment can range anywhere from just washing 
the hair twice a week with a shampoo formulated 
for dry scalps, to using a selenium based, anti 
dandruff shampoo, to using a shampoo with anti 
yeast agents in it such as ketoconazole (Nizoral 
[R]). 

If there is any flaking around the eyebrows, nose 
or in back of the ears, or you have a red, itchy 
scalp, it is time to see a dermatologist or your 
general physician. 

Dandruff

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Relaxation for panic disorder
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I suffer with panic disorder.  I have learned to 
listen to my body.  When I notice my heart rate 
beginning to raise or the thoughts start to come 
into my mind, or general felling that something is 
wrong, I have learned that the best thing to do is 
concentrate on lowering my heart rate.  Sort of 
mind over body.  I have warned my family and 
friends that I feel the attack about to happen.  
They keep a close eye on me without me knowing 
that they are doing it.  Most of the time I can 
stop it if I catch it early enough.  Deep 
breathing, concentration, and basic relaxing 
techniques. seem to be the best help." 

Tracie


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

Short ones

"Doctors automatically know what's wrong with you. 
They have a sick sense."  -- from a kid, age 10 

"Doctor, Is it true that taking an aspirin every 
day prevents heart attacks?" 

"Yes, to prevent a heart attack take one aspirin 
every day. Take it out for a jog, take it to the 
gym, take it for a bike ride,,,,," 

"Doc, I can't stop singing "The Green Green Grass 
of Home." 
"That sounds like Tom Jones syndrome." 
"Is it common?" 
"It's not unusual." 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time. 
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~




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