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Women's Health Newsletters 8/6/00 - 9/10/00



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***** Woman's Diagnostic Cyber Newsletter *****
                August 6, 2000
This week from Woman's Diagnostic Cyber

1. Anatomy of a wrinkle
2. Osteoporosis vs arthritis - the differences 
3. Reader submitted Q&A - Pain with PCOS
4. Abdominal exercises after surgery or delivery
5. The warning signs of appendicitis
6. Health tip to share - Lichen sclerosis Rx
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. Anatomy of a wrinkle
Not all skin wrinkles are alike. Some are very 
fine lines due to the breakdown of underlying 
collagen tissue mostly due to aging and sun damage 
over time. They are present all of the time. Other 
wrinkles are deep and due to the underlying 
musculature deeper than the skin. You only see 
them when a person smiles or frowns or tenses 
those muscles. Dr. Audrey Kunin at Dermadoctor.com 
explains the differences and how they are treated 

Sunburns, especially in children or youth, are the 
greatest cause of fine wrinkles later in life. 
Prevention with sunblock and avoiding the sun is 
effective long term medicine that we can give our 

To improve or rejuvenate the skin, several things 
must be done. The thickened skin of aging needs to 
be thinned with exfoliative agents. Underneath the 
skin, moisture retention is important. Compounds 
which help the connective tissue retain moisture 
will make the skin look younger. 

2. Osteoporosis vs arthritis - the differences 
Bone diseases such as osteoporosis and the various 
types of arthritis can sometimes be confusing. 
They all produce pain, but osteoporosis is more of 
a silent disease until so much calcium is lost 
from bone that a woman has spontaneous fractures. 
Bone pain occurs late in osteoporosis but earlier 
in the arthritis conditions. Osteoporosis is 
mostly preventable if we know it is taking place 
whereas most of the arthritis conditions are not 
really preventable with current knowledge. 

The two major types of arthritis are 
osteoarthritis and rheumatoid arthritis. 
Osteoarthritis is a condition of degeneration of 
the cartilage in joints that are chronically 
overused and abused. The abuse of the joint may be 
in one's work, a sport, exercise or just from 
heavy weight. The degeneration of the joints often 
involves knees, hips and smaller joints of the 
hands, as well as the vertebrae of the neck and 
lower spine. Most people who jog or run for 
exercise on a regular basis over many years will 
eventually develop osteoarthritis or the knees. 

If osteoarthritis is from degeneration of joint 
cartilage due to chronic trauma, rheumatoid 
arthritis is an immune disease in which the body 
produces enzymes that attack cartilage. The 
enzymes also cause symptoms other than joint pain, 
stiffness and deformity such as fatigue, fever 
weight loss and anemia. 

For a discussion of these bone problems, see the 
article at the NIH Osteoporosis and Related Bone 
Diseases National Resource Center: 

Osteoporosis vs arthritis

3. Reader submitted Q&A - Pain with PCOS
"Last month I had a vaginal hysterectomy due to 
PCOS (polycystic ovarian syndrome), but the Dr. 
refused to take out the cysts in my ovaries and 
didn't take out the ovaries either. The pain is 
still present and feels like someone is squeezing 
the ovary really hard. I can't stand it and it 
affects both ovaries. Birth control pills didn't 
work. Any suggestions as to what I can do? The Dr. 
is no help. I'm 36 years old and in pretty good 


This is a difficult question because traditional 
polycystic ovarian syndrome (PCOS) is not 
associated with ovarian pain for the most part. It 
is not impossible for the pain to be due to PCOS, 
but most likely the pain is due to multicystic 
ovaries (a different condition of recurrent 
ovarian cysts) or possibly due to other conditions 
such as pelvic congestion, bowel dysfunction or 

After you recover more from the surgery (about 3 
months at least) you and your doctor will need to 
go back and try to see if the correct diagnosis is 
PCOS, or whether it can be something else. You may 
want to look at our article about cysts and pelvic 
pain and PCOS. 

Polycystic Ovarian Syndrome and Pelvic Pain

4. Abdominal exercises after surgery or delivery
"When can I start abdominal exercises to get rid 
of this bulge?" is a common question after surgery 
or delivery. What is not asked or answered often 
enough is what type of exercises are best to 
restore a flat stomach. 

At prevention.com there is a very good article "To 
tighten your tummy in 21 days". They do an 
excellent job of describing how to isolate the 
rectus abdominus muscle by palpation while 
standing and then performing correct abdominal 
crunches that exercise the entire rectus muscle 
(not just the upper part) and at the same time do 
not harm the lower back muscles. If you have never 
had expert instruction in abdominal muscle 
exercises, this is a good place to start. 

As far as performing these exercises after 
delivery or surgery, they are definitely safe and 
the best way to go. It might take more than 3 
weeks to get up to maximum repeats and tone but 
they allow for you to go at your own pace. 

The biggest question that is not well answered 
with scientific studies but is common experience 
is when to to start these exercises. These are 
personal rules-of-thumb for beginning abdominal 
muscle tightening after you have been examined by 
your doctor to make sure there has not been any 
infection or impairment of wound healing: 

after delivery an uncomplicated delivery 
- 2nd day after
after a transverse incision without muscle cutting 
(most C-Sections and hysterectomy incisions
- 6 weeks 

after midline incision or transverse muscle 
cutting incision (rarely used now) 
- 8 weeks 

add two weeks for every decade of age over 50 
because of slower wound healing with age 

add 6 weeks for any surgery involving repair of 
hernia, pelvic organ prolapse or urinary 

5. The warning signs of appendicitis
Appendicitis strikes most often between the ages 
of 10-30. It can be quite confusing and difficult 
to diagnose. Symptoms often include pain around 
the navel which progresses to pain in the right 
lower abdominal area after about 12 hours. Usually 
there is tenderness to pressing on the abdomen, 
loss of appetite, nausea and even vomitting. 
Sometimes there is a fever but not always. 

High resolution CT (computerized tomography) scans 
are frequently used to diagnose appendicitis and 
if it is suspected by a surgeon, laparoscopy is 
often used to remove the appendix. Sometimes at 
laparoscopy (20-30%) the appendix appears normal. 
It is usually removed anyway because appearances 
can be wrong and the recovery is not too much 

It is not known how to prevent appendicitis 
although countries with high fiber diet have much 
lower incidences. 

Appendicitis warning signs

6. Health tip to share - Lichen sclerosis rx
I have had lichen sclerosis for about a year.  A 
Dr. had me use a cortisone cream on it, but it 
kept getting worse.  I went to  a dermatologist 
and she said that medicine was too strong.  She 
put me on Aclovate ointment, 0.05% and in just 2 
weeks it has cleared up a lot. 


[ed note - In the U.S. this is clobetasol which is 
marketed under the name of Temovate(R) or 

7. Humor is healthy
Some say a computer is a woman -- 

if you do something wrong, it will remember every 
bit of it. 

Some say a computer is a man -- 
if you had just waited one more week, you could 
have gotten a better model for less. 

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

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****** Woman's Diagnostic Cyber Newsletter ******
              August 13, 2000
This week from Woman's Diagnostic Cyber

1. Low back pain - a major cause of disability
2. Test your contraceptive IQ
3. Reader submitted Q&A - Pregnancy test timing
4. Vaginal douche product effect on vaginal bacteria
5. Keeping weight loss with a walking program 
6. Health tip to share - Severe bleeding 
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. Low back pain - a major cause of disability
Many reproductive conditions in women can cause 
low back pain because the same nerves feed the 
pelvic organs that get compressed with spinal cord 
or back muscle problems. A bladder infection, 
prolapse of pelvic organs, uterine fibroids, 
endometriosis and even just an enlarged or 
"tipped" (back) uterus can cause low back pain. 

The most common cause of low back pain, however, 
is injury to the vertebral bodies of the spine, 
the ligaments or muscles of the back. This pain 
can become chronic and far removed from the injury 
making it difficult to tell if your low back pain 
is a musculoskeletal problem or a gynecologic 

Usually the key differentiating symptom is pain 
that worsens with movement of the lower back, the 
lumbosacral spine. This points to a 
musculoskeletal problem if the pain is aggravated 
in going from standing to sitting, sitting to 
standing, or any rotational (twisting) movement of 
the upper body between the waist and shoulders. 
Low back pain from a gynecological or urological 
cause is much more constant, a worsens mainly with 
pressure on the abdomen, vaginal intercourse and 
vigorous exercise. 

If you suspect your low back pain may not be 
pelvic in origin but rather from the lower spine, 
look at this low back pain tutorial from 
R.C.Sechrest MD. It has great illustrations with 
it that explain about causes of pain from the 
lower back as well as how MRI is used in 
diagnosing disk problems. 

2. Test your contraceptive IQ
The Association of Reproductive Health 
Professionals has developed a test-your-knowledge 
section on various methods of contraception. It 
asks about 6 general questions concerning 
prevention of pregnancy and then 10 questions 
about your specific type of contraception or tubal 

You may be contraceptively challenged if you are 
not aware that: 

tubal ligations are not 100% effective
birth control pills do not prevent STDs
it takes about 12-18 months on the average to 
 conceive after stopping DepoProvera injections 
latex condoms should not be used with oil based 

Test your contraceptive IQ

3. Reader submitted Q&A - Pregnancy test timing
"When is the best time to check a pregnancy test 
if you have regular cycles and are trying to get 
pregnant? Is it true the earlier the test turns 
positive the less likely it is to have a 


For many women, a regular menstrual cycle with 
ovulation occurring on the same cycle day is a 
exception rather than a rule. Ovulation can vary 
by several days or even skip months. For women who 
are fairly regular (every 26-32 days), however, 
pregancy testing can start on the first day of a 
"late" menses. 

With today's sensitive home pregnancy tests, you 
can have a positive result anywhere from 2-3 days 
before a missed menses to 4-5 days after a missed 
period. The pregnancy hormone HCG (human chorionic 
gonadotropinn) enters the blood stream after 
implantation occurs. Implantation most often 
occurs on day 8 or 9 after ovulation. If it occurs 
later than that, there is a higher early 
miscarriage rate. 

For a discussion of the timing of ovulation, 
conception and implantation, see: 

When to test for pregnancy

4. Vaginal douche product effect on vaginal bacteria
Douching has been linked with actually causing 
more bacterial vaginal infections than it cures so 
it is not recommended on a regular basis. And yet 
physicians are aware that it can be useful in 
certain recurrent infection situations. 

This study tested 7 commercially available douche 
products against normal vaginal lactobacilli (the 
bacteria you do not wish to kill off) and 
bacterial strains causing bacterial vaginosis such 
as Gardnerella, Mobiluncus, Mycoplasma, 
Peptostreptococcus, and Ureaplasma, as well as 
group B Streptococcus, and Candida yeast species. 

They found that the 4 products containing 
antiseptics had inhibitory effects against all 
normal and abnormal bacteria and yeasts with only 
a minute of contact time. On the other hand, the 
vinegar containing douche products were effective 
inhibitors of the "bad" bacteria and did not seem 
to inhibit the "good" lactobacillus at all. 

This data seems to imply that vinegar douches 
may not be harmful and in fact may be beneficial 
for treatment of the OCCASIONAL vaginal discharge. 

Vaginal douche effects on vaginal bacteria

5. Keeping weight loss with a walking program
Keeping weight off after a diet program is just as 
tough as losing it in the first place. Most diet 
programs show return to prediet weight (or more) 
within 2 years in over 80% of people. 

Exercise as part of a weight reduction program is 
also questionable, believe it or not, as to 
whether it helps to keep off the weight after the 
intense diet phase is finished and maintenance 
diet phase begun. 

This study of over 200 women who underwent a 12 
week diet program with an average loss of about 28 
lbs and then were randomized to a maintenance 
period of 40 weeks. One third had no exercise 
program, one third had a walking program of 2-3 
hours a week and one third had a walking program 
of 4-6 hours. then all groups were observed with 
no further intervention for 2 years. 

During the maintenance period the women under 
going exercise maintained their weight loss while 
the control group gained 4.4 lbs (2.0 kg). During 
the two year observation period, the control group 
gained back 21 lbs (9.7 kg), the group who had 
exercised 2-3 hours per week regained 13 lbs (5.9) 
kg and the group exercising 4-6 hours a week 
gained 20 lbs (9.2 kg) almost as much as the 
control group. 

The authors postulate that the higher duration of 
exercise group was not able to maintain their 
program as well as the 2-3 hour per week walking 
group and thus "backslid" more. Thus exercise 
helps keep off weight, but only if it becomes a 
regular habit. 

Walking program after diet program to keep it off

6. Health tip to share - Severe bleeding
"Due to months of severe bleeding I was faced with 
the option of a hysterectomy or a lesser known 
option called an 'endometrial ablation.' After 
some research on the net and speaking with my 
primary care physician, I opted for the ablation 
procedure. It's been 2 months and knock on 
wood...no bleeding, no period. I would highly 
recommend exploring this option if a hysterectomy 
is suggested. 1 week recovery at the very most! 


Editor Note - Last week's explanation about the 
treatment of lichen sclerosis was unclear due to 
my editor's note. The usual U.S. treatment is 
clobetasol 0.05% a high potency steroid. The  
point of the health tip was a better response from 
a low potency steroid, Aclovate Ointment 
(aclometasone), 0.05%. Different people have 
different skin sensitivities to steroid ointments. 

7. Humor is healthy

Mid-life is when you go to the doctor and you 
realize you are now so old, you have to pay 
someone to look at you naked. 

The good news about mid-life is that the glass is 
still half-full...of course, the bad news is that 
it won't be long before your teeth are floating in 

Mid-life women no longer have upper arms, we have 
wingspans...we are no longer women in sleeveless 
shirts, we are flying squirrels in drag. 

Mid-life has hit you when you stand naked in front 
of a mirror and can see your rear end without 
turning around. 

Mid-life brings the wisdom that life throws you 
curves...and that you're now sitting on your 
biggest ones. 

Mid-life is when you want to grab every firm young 
lovely in a tube top and scream, "Listen, honey, 
even the Roman Empire fell, and those things will 

Mid-life is when you start to repeat yourself... 
and your chins follow suit. 

You become more reflective in mid-life.  You start 
pondering the "big" questions -- what is life, why 
am I here...how much Healthy Choice ice cream can 
I eat before it's no longer a healthy choice? 

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

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***** Woman's Diagnostic Cyber Newsletter *****
                August 20, 2000
This week from Woman's Diagnostic Cyber

1. Heat Stroke, Dehydration and Prevention 
2. Treatment of hemorrhoids
3. Reader submitted Q&A - Weight gain on OCPs
4. Reflex sympathetic dystrophy - chronic pain
5. G6PD genetic enzyme deficiency
6. Health tip to share - Dizziness and vertigo
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. Heat Stroke, Dehydration and Prevention 
It is very easy at this time of year to become 
involved in a strenuous activity outdoors in a hot 
sun. You might think you are in good shape for a 
hike, yard work or even a game of tennis or golf. 
You may even have a quart of water handy to 
prevent dehydration from sweating. As the water is 
finished and you get thirstier, you still push on. 

Several hours after finishing a strenuous 
activity, symptoms of fatigue, exhaustion, nausea, 
lightheadedness and even heat cramps can signal a 
condition of heat exhaustion.  The fact that it 
can come several hours after finishing the 
activity and even happen after replacing some of 
the fluids, may make it hard to recognize. Lack of 
replacing the salts lost in sweating is the main 
culprit in heat exhaustion. 

Even worse than heat exhaustion is heat stroke. 
Heat stroke is a more extreme condition and is a 
life threatening condition. Symptoms include 
disorientation, combativeness and hallucinations. 
The body has lost its heat control mechanism and a 
person with heat stroke needs hospitalization. 

To learn about prevention of this serious and 
unsuspected condition, see: 

Heat stroke and dehydration prevention

2. Treatment of hemorrhoids
Hemorrhoids are not a serious condition, but they 
can really be a PAIN! They are enlarged, swollen 
veins like a varicose vein of the rectum or anus. 
They can be inside the anus (internal hemorrhoids) 
or outside (external) and present as rectal pain, 
bright red bleeding with bowel movements, and 
sometimes as an itchy lump by the rectum if the 
hemorrhoid is external. 

Factors which contribute to hemorrhoids are:"poor 
bowel habits", constipation, diarrhea, pregnancy, 
obesity, and especially frequent straining when 
having a bowel movement." 

Treatment of hemorrhoids is at first conservative 
keep area clean and dry 
avoid straining at stool 
increased dietary fiber 
hot sitz baths several times a day 

When conservative measures have failed to clear up 
the hemorrhoids, there are other surgical 
treatments such as: 

ligation (banding)
infrared photocoagulation
surgical excision

For more information about treatment and 
prevention of hemorrhoids, check see the site at Jackson 

3. Reader submitted Q&A - Weight gain on OCPs 
"I have been taking birth control pills for about 
six months now. I am thrilled at the idea of not 
becoming pregnant, however, my problem is 
tremendous weight gain as a result of water 
retention. I have experienced no increased 
appetite, however my breasts are a full cup size 
larger and I feel that I have an added layer onto 
my body that makes me very uncomfortable. Is there 
anything that can be done about this problem?" 


Weight gain from pills can be from fluid retention 
or simply by eating more. It is surprising that 
almost all recent studies show there is not a net 
weight gain or weight loss with the pills. If 10% 
of women gain weight when starting a pill, 10% 
lose weight  thus off setting the ones who gained. 
When compared to placebos, as many women gain 
weight on the placebos as do on the pills. 

Because of this doctors will often tell you that 
the pills do not cause weight gain. More likely, 
the pills do cause weight gain and weight loss. 
The estrogen level seems to be associated with 
fluid retention and the progestin component may be 
associated with insulin resistance in a smaller 
subset of women and these women have the larger 
weight gain. 

For an explanation and to see what you may be able 
to do, see our article at: 

Weight gain and birth control pills

4. Reflex sympathetic dystrophy - chronic pain
Reflex Sympathetic Dystrophy Syndrome (RSD) is 
also known as Complex Regional Pain Syndrome 
(CRPS). It is a mouthful and a poorly understood 
dysfunction of the sympathetic nerves that can 
cause chronic pain. Even a small injury to the 
skin, muscles or bone of anywhere on the body can 
trigger this abnormal nerve response with pain 
that is out of proportion to the injury. 

It is important to know about this entity because: 

it is more common in women than men
if undiagnosed and untreated it can spread to 
large regional areas of the body 

Symptoms in addition to more pain than the injury 
would suggest may include: 

Abnormal nerve function, burning, tingling, deep 
muscle pain 
Swelling, edema often stopping at a line on the 
Joint stiffness, muscle cramps or jerking. 
Changes in skin (shiny, dry), hair growth or 
wasting of muscles  
For a discussion of this unusual condition and to 
learn about reflex sympathetic dystrophy, see this 
clinical practice guidelines paper at the Reflex 
Sympathetic Dystrophy Syndrome Association Of 
America web site: 

Reflex sympathetic dystrophy

5. G6PD genetic enzyme deficiency
The congenital absence of an essential enzyme, 
glucose-6-phosphate-dehydrogenase (G6PD) is one of 
the most common genetic enzymes deficiencies in 
the world today. It makes the red blood cells very 
sensitive to certain infections and especially 
drugs. These can cause breaking up of the red 
blood cells (hemolysis) and thus a major anemia 
without any evidence of bleeding or losing blood. 

The only genetic advantage of having this enzyme 
deficiency is that is makes a person more 
resistant to malaria, so it is more commonly found 
among people living near the equator. An allergy 
to fava beans is almost diagnostic of this 

As far as inheritance goes, it is what is called 
an X-linked recessive. In other words a man who 
inherits the gene from his parents will always 
have the disease because he only has one X 
chromosome. A woman has to inherit the enzyme 
deficiency from both parents and if she is 
positive then it is likely her brothers and 
sisters are all positive. Any of her sons will be 
positive although her daughters will not be 
positive unless her husband  also has the disease. 
If her daughter is not affected but is a carrier 
of the gene (one X chromosome affected, half of 
the daughter's sons will have the condition. 

It is very important to know about this condtion 
because many medicines we routinely use can cause 
a severe anemia and even heart failure due to the 
anemia. Drugs and medications that will cause 
hemolysis in a G6PD deficient individual include 
among others: 

sulfa antibiotics
several antihypertensives
certain antimalarial drugs
vitamin C
vitamin K

6. Health tip to share - dizziness and vertigo
For vertigo when standing, and when walking, not 
seated or lying down, and not that which some have 
when first standing up from a seated or lying 
position, get an x-ray of your neck from the side 
to see whether or not your cervical spine is 
positioned in the natural curve that it's supposed 
to be.  If C-4, 5 and 6 are not curved properly 
[i.e., too straight], they could be pinching the 
nerves to your inner ear and be the cause of your 
problem.  It was for me.  Changing to a new 
chiropractor who found and corrected it after 20 
months of trying about everything in the book was 
what did it!  Have at least neurological and ENT 
causes ruled out first, tho'.  There was 
absolutely no nausea ever with this form of 


7. Humor is healthy
An elderly woman went into the doctor's office.  
When the doctor asked why she was there, she 
replied, "I'd like to have some birth control 

Taken aback, the doctor thought for a minute and 
then said, "Excuse me, Mrs. Smith, but you're 75 
years old.  What possible use could you have for 
birth control pills?" 

The woman responded, "They help me sleep better."  

The doctor thought some more and continued, "How 
in the world do birth control pills help you to 

The woman said, "I put them in my granddaughter's 
orange juice and I sleep much better! 

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

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****** Woman's Diagnostic Cyber Newsletter ******
                August 27, 2000
This week from Woman's Diagnostic Cyber

1. Never too old for a mammogram
2. Irritable bowel syndrome diagnosis 
3. Reader submitted Q&A - Premenstrual symptoms
4. Ovarian cancer tutorial
5. Men's health resources and links
6. Health tip to share - Bleeding from fibroids
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. Never too old for a mammogram
Did you know that a woman's chance of having a 
breast cancer is: 

by age 30. . . 1 out of 2,212
by age 40. . . 1 out of 235
by age 50. . . 1 out of 54
by age 60. . . 1 out of 23
by age 70. . . 1 out of 14
by age 80. . . 1 out of 10

Can you see why it would be a mistake for an older 
woman to skip her annual mammogram? Women worry 
about breast cancer in their forties but it gets 
you in the 60's-80's. 

The Breast Cancer Resource Center at the American 
Cancer Society has an excellent section on 
mammography. They provide a good description of 
the standard mammogram procedure and what it looks 
for. Current recommendations include a yearly 
mammogram over the age of 40 for all women. 

They also give you tips for when you have your 
mammogram such as to avoid scheduling the study in 
the week before your menses, to avoid using 
deodorants or creams immediately before the study, 
and to bring a list of the dates and results of 
other studies and procedures you have had done. 

Another helpful section is the description of 
additional studies that might be suggested to you 
such as ultrasound, ductogram, or image-guided 
biopsy which may need to be performed if the 
screening mammogram has any suspicious or 
uncertain areas. 

2. Irritable bowel syndrome diagnosis
Irritable bowel syndrome (IBS) can masquerade as 
primarily pelvic pain in the ovary region, 
especially on the left side, but most of the time 
there is an obvious relationship of the pain to 
eating meals or having bowel movements. Pain may 
worsen or get better with bowel movements but the 
relationship is clear. 

Pain is not always present with IBS. It can be 
just mild symptoms of abdominal bloating or pelvic 
fullness. Sometimes the major symptoms are just a 
change in bowel habits with alternating diarrhea 
and constipation. If women take laxatives for the 
constipation and antispasmodics for the diarrhea, 
it can really become a confusing symptom picture. 

While symptoms of abdominal pain, bloating, and 
altered bowel habits are common to many 
gastrointestinal conditions, there are some 
important ones which strongly suggest IBS: 

A long history of symptoms but not worsening over time 
The absence of diarrhea at night 
The absence of general findings such as fever, 
weight loss, appetite loss, or anemia 
Bowel movements primarily in the morning 
Increased symptoms during periods of increased stress 
A feeling of incomplete evacuation 
Relief of discomfort with evacuation 
The absence of blood in the stool 

For more on IBS, see this clinical guideline at 

Irritable bowel syndrome

3. Reader submitted Q&A - Premenstrual symptoms
"Is it common after the birth of a baby (first 
year not right after) to experience severe 
moodiness, depression, and anger during or right 
before a period?" 

"I am 30 and have no previous medical problems." 


It is not common but it can happen. As far as we 
can tell, neither pregnancy nor labor and delivery 
causes the onset of these symptoms. While many 
women believe that abnormal hormone fluctuations 
cause premenstrual syndrome, there is no evidence 
that either estrogen, progesterone or gonadotropin 
(LH and FSH) levels are different in women with 
and without PMS. 

For a discussion of causes and various treatments, 
see our article at: 

Onset and Cause of Premenstrual Syndrome

4. Ovarian cancer tutorial
Ovarian cancer is always a frightful topic. There 
are no symptoms with early cancers (stage 1 and 2) 
when treatment is likely to produce a very good 
survival. It is a silent disease and tumors grow 
from the ovaries along the surface of 
intraabdominal organs like the bowel. 

Since tumor growth is on the outside surface of 
the bowel, it will not be detected by xrays of the 
upper GI series, barium enemas or even the scope 
procedures such as sigmoidoscopy or colonoscopy 
because all of those studies examine the inside of 
the bowel, not the outside. 

Until the fluid that gets secreted from extensive 
tumor builds up (ascites) or the tumor actually 
causes bowel obstruction, a woman may be unaware 
she has the disease. 

Borderline tumors are another strange category of 
ovarian cancer. These are very slow growing 
cancers that are treated surgically and if they 
recur, they do so after 10-15 years rather than 
within two years like most ovarian malignancies. 

To learn more about ovarian cancer, see the 
listing at the web site of William M. Rich, M.D., 
a gynecologic oncologist in Fresno, California. 

Ovarian cancer tutorial

5. Men's health resources and links
Men are not often known to be the guardians of 
health for their families. In recognition of that, 
we need to periodically look at some of those 
health and medical conditions more commonly 
affecting men so that you are aware of resources 
to turn to. 

Beyond just impotence, balding and AIDs, there are 
numerous resources on the net for topics that men 
may want to read. The Healthfinder gateway to 
reliable consumer health and human services 
information developed by the U.S. Department of 
Health and Human Services has a section devoted to 
men's health.  

You can find content and links to topics like:

heart disease
prostrate problems
urology resources
occupational health
low back pain
dancing the work and family tightrope 
depression in men before and after the birth of a child  
fathering skills and issues
developing your fitness program 
exercising proper care while working out 
breast cancer links for men
conditions men get too
hair replacement - what works, what doesn't

6. Health tip to share - Bleeding from fibroids
"Severe bleeding from fibroids kept me sidelined 
for weeks at a time.  My doctor recommended a 
hysterectomy.  After research, I asked about a 
uterine arterial embolization. My first period 
after the procedure was normal as was the second.  
I finally feel normal again.  Women should 
definitely explore this option!!!!  I felt fine 
one day after this non invasive procedure.  I don't 
know why ANY woman would chose a hysterectomy if 
she had this as an option."     


7. Humor is healthy

"Stress Reduction Technique"

Sit quietly and inhale deeply and slowly through 
your nose. 

Exhale slowly.

Picture yourself near a stream.

Birds are softly chirping in the crisp cool 
mountain air. 

Nothing can bother you here.

No one knows this secret place.

The soothing sound of a gentle waterfall fills the 
air with a cascade of serenity. 

The water is clear.

You breathe deeply.

You can easily make out the face of the person 
whose head you're holding under the water. 


It's the person who caused you all this stress in 
the first place. 

What a pleasant surprise.

You let them up ... just for a quick breath ... 
then ploop! ... 

Back under they go.

You allow yourself to take as many deep breaths as 
you want. 

There now ... feeling better?

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

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****** Woman's Diagnostic Cyber Newsletter ******
             September 3, 2000
This week from Woman's Diagnostic Cyber

1. Headache - what causes the pain?
2. Should teens be vaccinated for hepatitis A? 
3. Reader submitted Q&A - Fibroids and HRT
4. Gynecologic cancer risk
5. Birth control pills and carbohydrate metabolism
6. Health tip to share - Recurrent yeast vaginitis
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. Headache - what causes the pain?

Headache pain can come from the skin, muscles and 
blood vessels of the head and scalp, but it does 
not come from the skull bone or even the brain 
inside. The brain and skull do not have many nerve 
fibers. For the most part, headaches represent 
muscle pain or blood vessel pain. 

When you get a very severe headache, much worse 
than you have had before, you may wonder when it 
is time to see a doctor. At PersonalMD.com there 
is a list of headaches that require prompt medical 

headache associated with fever
severe sudden headache
headache associated with convulsions
headache accompanied by confusion or loss of 
headache associated with pain in the eye or ear
headache following a blow on the head
recurring headache in children
persistent headache in someone who was previously 
  headache free 
headache, which interferes with normal living   

MRI studies or CAT scans are used to diagnose 
unusual anatomic causes of headaches such as 
tumors, abscesses or areas of the brain damaged. 
Most of the time these studies are negative and 
the cause is just blood vessels that are 
hypersensitive to many conditions or head muscles 
that chronically contract due to stress. 

For a good review of headaches, see:

Headache - where does the pain come from?

2. Should teens be vaccinated for hepatitis A?
Hepatitis is caused by viral infections of various 
virus types A-G. Most of the types are contagious 
by blood contact such as abrasions during sex, 
contaminated needles or blood transfusions. 
Hepatitis A, however can be passed by contaminated 
produce, water or other foods, kissing, eating 
utensils etc. In other words, it is much easier to 
catch and epidemic outbreaks have been reported. 

Western states tend to have a higher incidence and 
it has been suggested that adolescents in those 
states be vaccinated against hepatitis A. The 
following article in the Archives of Pediatrics 
and Adolescent Medicine does a cost effectiveness 
analysis and concludes that Hepatitis A 
vaccination is worthwhile for adolescents in those 

If you have a teen going off to school this fall, 
you may want to consider going to your local 
health department where the teen can get an 
inexpensive vaccination. They will also vaccinate 
against hepatitis B.  

Adolescent Hepatitis A Vaccination 

3. Reader submitted Q&A - Fibroids and HRT
"If you have been on ERT and have a fibroid, what 
will happen if you stop the ERT?  Will you begin 
to bleed, will the fibroid shrink?" 


Fibroids are known to be hormonally sensitive. 
they go away after menopause and do not grow until 
after menses starts in adolescence. Birth control 
pills can make fibroids grow rapidly. 

Hormonal replacement therapy during menopause or 
even in the perimenopause may cause fibroids to 
resume growing. It appears that the progesterone 
or progestin component makes the fibroids grow the 
most. Some estrogens, ethinyl estradiol and 
natural estradiol make fibroids grow more than 
weaker estrogens such as conjugated estrogen or 

It is possible that raloxifene may cause fibroids 
to shrink even in the presence of added estrogen. 
For a discussion of these relationships, see our 
article at: 

Fibroids and estrogen replacement therapy

4. Gynecologic cancer risk
The Woman's Cancer Network has developed a risk 
assessment questionnaire for how likely it is that 
a  woman might develop cancer of the breast, 
ovary, uterus and cervix. The questionnaire takes 
about 5- 10 minutes to complete and they do not 
ask your name. 

The printout tells if you are at low, average or 
high risk of developing a female genital cancer 
and gives suggestions as to what you can do to 
lower that risk, if anything. 

This risk assessment tool is very good to put your 
cancer risk into perspective so you worry (or not 
worry) about the correct risk. 

5. Birth control pills and carbohydrate metabolism
When oral contraceptives first came out, it was 
said that they altered carbohydrate metabolism, 
i.e., they made a diabetic have higher blood 
sugars and a normal woman have glucose tolerance 
test values more like a pre diabetic. As pills 
became lower and lower in dose and the progestins 
in pills became more "progesterone-like" and less 
androgenic (male hormone-like), glucose tolerance 
became less and less abnormal. 

There still has been some controversy, however, as 
to whether pill hormones make some women more 
insulin resistant and therefore more prone to 
gaining weight due to abnormal glucose metabolism. 
This epidemiological study looked at different 
measures of abnormal glucose metabolism such as 
fasting glucose, hemoglobin A1c, fasting insulin, 
and found that women taking the current lower dose 
birth control pills (mostly 35 mcgm of estrogen) 
did not have significantly different values for 
these carbohydrate measurements. 

This study in the American Journal of Obstetrics 
and Gynecology of over 4000 women thus supports 
that, on the average, birth control pills do not 
aggravate a tendency toward diabetes nor do they 
seem to cause a pre diabetic state. 

Oral contraceptive use and glucose metabolism

6. Health tip to share - Recurrent yeast vulvitis
"I suffered from frequent yeast infections for 
years and used every prescription and non 
prescription treatment that my doctor or I could 
find. They were mostly successful in treating each 
infection, but did nothing to prevent the next one 
from happening. A chance conversation with a gyne 
nurse ended yeast infections for me, 100%. She 
asked me if I used "Dove" soap. I did. She asked 
me if I used 'Always' pads. I did. I stopped using 
both and the infections have stopped entirely." 


7. Humor is healthy
With Great Deliberation
Mrs. Smith was called to serve for jury duty, but 
asked to be excused because she didn't believe in 
capital punishment and didn't want her personal 
thoughts to prevent the trial from running its 
proper course. 
But the public defender liked her thoughtfulness 
and quiet calm, and tried to convince her that she 
was appropriate to serve on the jury. 
"Madam," he explained, "this is not a murder 
trial! It's a simple civil lawsuit. A wife is 
bringing this case against her husband because he 
gambled away the $12,000 he had promised to use to 
remodel the kitchen for her birthday." 
"Well, okay," agreed Mrs. Smith, "I'll serve. 

I guess I could be wrong about capital punishment 
after all." 

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

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***** Woman's Diagnostic Cyber Newsletter *****
                September 10, 2000
This week from Woman's Diagnostic Cyber

1. Pain and its effect on sexual response
2. Fallopian tube cancer and cancer support
3. Reader submitted Q&A - Breast cyst on mammogram
4. Self-injury -- A quick basic guide
5. Diet information links
6. Health tip to share - Yogurt for vulvar pain
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. Pain and its effect on sexual response
Any type of pelvic pain, but especially vulvar 
pain at the entrance to the vagina, alters a 
woman's desire, arousal, and response for sexual 
intercourse. Sometimes the pain cannot be cured or 
even lessened. How then does a woman cope with the 
pain and its effect on sex? 

This paper at the University of Michigan entitled 
"Helpful strategies to deal with pain and sex" is 
a valuable resource for any woman experiencing 
this problem. It gives hints on dealing with the 
medical establishment to communicate about the 
problem and get help. In addition to reminding you 
to avoid any sex that hurts (yes, some women need 
to be told that), it gives suggestions about 
expanding your sexual repertoire to include that 
which does not hurt, to experiment with sexually 
stimulating activity that does not involve 
penetration, and to change away from outcome 
(orgasm) oriented sex. 

Pain and sexual response

2. Fallopian tube cancer and cancer support
Cancer of the fallopian tube is quite rare. While 
found in only about 1% of gynecologic cancers, 
even 90% of that time a malignancy of the tube is 
from another site (metastatic); it does not 
originate in the tube. 

Symptoms of fallopian tube cancer are very similar 
to uterine cancer. Vaginal bleeding is the 
hallmark sign. Sometimes there is discharge, 
abdominal pain and pelvic pressure. The only 
symptomatic difference from endometrial cancer is 
that it sometimes give a very colicky abdominal 
pain followed by a thin, very watery discharge. 

Further diagnosis is by surgery, as is treatment 
depending upon the extension and cell type. 

Eyeontheprize.org is more than an information 
source for women with gynecologic cancer. It 
functions as a support resource for women who have 
cancer. It includes sections on: 

What to expect from the different cancer treatments
What to expect for cancer follow-up
Working with the medical system 
Follow-up tests 
Life after cancer
Surgical menopause 
Loss of fertility 
Emotional impact 
Talking with family and friends 

Fallopian tube cancer

3. Reader submitted Q&A - Breast cyst on mammogram
"I just had a mammo, and had to go back for 
another one and an ultrasound, they found a 1/2 
inch cyst with a smaller one next to it. My Gyno 
is leaving it up to me to see a surgeon, What are 
your thoughts on this?" 

"I am 42 white female, I also have cysts on my 
ovaries, fibroid on my uterus and just had the 
Leep procedure done to get rid of bad cells on my 
cervix. My periods are regular, but I do clot a 
lot and bleed heavily."   


The quick answer is to go ahead and have the cyst 
aspirated. That is the easiest way to confirm that 
the mass is a benign process and that you do not 
need surgery to excise the cyst. 

Cysts in the breast and fibrocystic breast disease 
are different but related entities. To see a 
discussion of breast cysts, see our article at: 

Breast cyst on mammogram

4. Self-injury -- A quick basic guide
Yes, there are people, more often women, who 
intentionally harm their own  bodies. They may cut 
their skin with knives, razor blades, pins, glass 
or any sharp object. It may include biting 
yourself, scratching your skin until it bleeds, 
hitting your body, burning yourself or even head 

This condition doesn't refer to the once every 5 
years of scratching yourself raw while being 
anxious. This is a repetitive self-inflicted 
violence. It is not part of the self-harm 
condition if a woman is doing it for:  

sexual pleasure 
body decoration 
spiritual enlightenment via ritual 
fitting in or being cool 

See this primer about self-injury at Palace.net if 
you know anyone who might have this problem. 

5. Diet information links
Web sites that are primarily link collections and 
without original material can be frustrating 
especially if the links are out of date. On the 
other hand, there is so much diet and nutrition 
web material that you can get lost quickly without 
ever coming across the type of information you 
wanted. You may want facts about fat or calorie 
content of food or just some tools to tell how 
much fat or calories are appropriate for someone 
of your size. What about diet pills. fad diets, 
cancer fighting foods? 

Thedietchannel.com has coordinated over 600 links 
about all you ever wanted to know about dieting. 
You will have to sort through them to find what 
you want but the choice is appetizing. Take a 

Diet information links

6. Health tip to share - Yogurt for vulvar pain
"I have found that using plain yogurt on my vagina 
externally helps if I have painful dryness or feel 
a yeast infection may be coming on. It doesn't 
sound great but I lie in bed on a towel and smear 
it on, wait like 15-20 min then shower. I seem to 
always feel so much better after this. Sometimes 
you can do this twice a day if there is an 
infection, its very relieving. The live active 
cultures help replace the good yeast! (I think ;) 


7. Humor is healthy
The Love Potion

A very lovely young lady smote a young man. 

Unfortunately, she did not return the feeling. 

In desperation he went and visited a group of 
witches searching for a love potion. They informed 
him that they no longer provided such an item. It 
was highly unethical to administer a potion to 
someone without her permission. 

They did have an alternate solution. They sold him 
a bottle of small white pellets. He was to bury 
one in her yard every night at midnight for a 

He returned to the witches six weeks later excited 
and thankful. He and the young lady were to wed in 
a month. That was a great idea they had, but why 
did it work?

The witch told him, ... with a little cackle here 
and there...

"Nothin' says lovin' like something from a coven, 
and pills buried say it best." 

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

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