Women's Health Newsletters 3/25/01 - 4/29/01
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****** Woman's Diagnostic Cyber Newsletter *******
March 25, 2001
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Side effects from anesthesia
2. Vulvar self-exam
3. Reader submitted Q&A - Black skin from rings
4. Elevated prolactin levels
5. Exercise and risk for coronary artery disease
6. Health tip to share - Stress can make you fat
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. Side effects from anesthesia
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
We know that there are differences between men and
women in response to pain medications. Now a
recent study in the British Medical Journal looks
at how men and women differ in respect to recovery
from anesthesia for surgery.
The investigators found that women wake up from
anesthesia quicker than men do by several minutes.
However women had more postoperative side effects
such as nausea, headaches, and backaches. Both men
and women had an equal incidence of sore throat.
Even up to 3 days after surgery, women still had
about twice as much incidence of nausea and
headache.
If you are about to undergo anesthesia for surgery
and you are a person who is easily nauseated, be
sure to ask the anesthesiologist for anti-nausea
medicine before and during the surgery so when you
wake up you will not have much difficulty with
that.
Women's side effects from anesthesia
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Vulvar self-exam
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Have you ever been told you should do a monthly
self-vulvar exam? I'll bet you have not. Many
women never look at the vulva skin because it may
be difficult to do or because they may have mental
inhibitions about looking "down there". It is
important to examine the vulva because skin
lesions and even cancer can be detected early.
Any woman older than 18 years of age should
perform vulvar self-exams. From 18 to age 45 the
most common vulvar lesions are condyloma
accuminata (venereal warts) caused by the human
papilloma virus. If detected early, these can be
treated before they spread and become
uncomfortable. Pigmented lesions in the vulvar
skin may indicate melanoma which is cancerous.
After age 45 it is even more important to do the
exam because cancer of the vulva can be detected
early and be totally cured by just a simple skin
excision (like a mole) in the office. Cancer of
the vulva is more common in the postmenopausal and
elderly woman. If you have a spot that itches or
burns, it goes without saying that it needs to be
examined by your physician but even if it is just
a red or white spot that does not feel any
different, detecting it early can save your life.
To examine your vulva, sit on the bed or a carpet
or even with one leg up on a stool in the shower.
You will need to use a mirror with one hand and
separate the lips of the labia with another.
To see what the anatomy should be, check out the
vulva self-exam at IVF.com
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Black skin from rings
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I think its because my body is acidic that I get
black marks under my gold rings. This doesn't
happen all the time. On occasion I do get a
urinary track problem. My body is highly
sensitive to citrus, but on occasion I can eat a
fresh orange, but not first thing in the morning
on an empty stomach. How do I make my system more
alkaline?" - lmo
Having a black skin reaction to contact with gold
is not a common problem but some women are plagued
with it. This is different than a contact
dermatitis to gold in which you may get an itchy,
red skin rash. With the black skin reaction, some
metal in the ring reacts with sweat or even
cosmetics to turn into a black ink-like stain on
the skin.
I do not think anyone knows for sure whether it is
acid in the sweat, aminoacids excreted from the
food you eat, medications excreted in the sweat or
some other salt or compound that causes the
reaction. It is possible it may be different
causes for different women.
For many years this was thought to be due to the
other non gold metals that were compounded with
the gold such as nickel, or even the metal such as
lead in solder joints of the ring, earrings or
other jewelry. Sometimes this may be the
explanation for a specific piece of jewelry
because it seems to happen more often with less
pure gold jewelry such as 10 karat, but for the
most part it may be a direct reaction with the
gold metal.
No one knows if this reaction has to do with the
acidity of the sweat or, more likely, the salts of
sodium (Na), chloride (Cl) and potassium (K) that
are secreted in sweat. Chloride from swimming
pools is known to discolor gold and it may be that
the reaction of your jewelry is predominantly due
to the chloride in the sweat.
I do not know if alkalinization of the urine and
sweat is the answer. If it is, traditionally
sodium bicarbonate (the bicarbonate found in
antacids) is used. Another method used to decrease
sodium and chloride in the urine and also to raise
the urine pH is to hyperdiurese by drinking large
amounts of water. This dilutes and lessens the
salts.
Before doing any of these things, however, you may
want to get some urine dipsticks at the pharmacy
that measure urinary pH (sweat and urine are very
similar in their components). Test your urine
frequently to see whether it is running acidic or
basic. If you can do this right after you notice a
black skin mark from gold jewelry, it would be
extremely helpful to give a direction in which to
go.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Elevated prolactin levels
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Prolactin is a hormone in the brain (pituitary
gland) that governs the production of milk in the
breast for lactation. It also suppresses ovulation
and women with elevated prolactin levels non
pregnant can have an absence of menses,
infertility and even milky discharge from the
breast.
Prolactin is secreted very close to the area in
the brain where thyroid stimulating hormone (TSH)
is secreted so sometimes it can be elevated when
there is elevation of TSH in the case of
hypothyroidism. A tumor of the pituitary gland is
one of the most serious causes of elevated
prolactin. Sometimes, however, anti-depressant and
other psychotropic medications can cause an
elevated prolactin.
If a prolactin level is higher than 100 ng/ml,
x-ray studies of the brain are recommended such as
an MRI. Often small growths are found called
microadenomas. Those can be followed or treated
medically but sometimes there are larger tumors
that need to be surgically excised.
For a description of the findings and different
causes of hyperprolactinemia, see this article at
mdmultimedia.com
Elevated prolactin levels
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Exercise and risk for coronary artery disease
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Women who are physically active have less coronary
artery disease than women who are sedentary. Does
this mean you have to go to the "club" to exercise
every day or jog several miles?
This study looked at over 39,000 healthy female
health professionals aged 45 years or older and
their exercise levels and incidence of coronary
artery disease. They looked at vigorous activity,
walking less than an hour a week, walking 1-1.5
hours a week and walking 2 hours a week or more
all compared to no exercise at all.
They found that both vigorous activity as well as
walking an hour or more a week was associated with
a 50 percent reduction in the number of adverse
heart events. This positive effect held true
regardless of weight, cholesterol levels, or
smoking.
This study continues to lend credence to the
positive health effects of even a light exercise
such as walking 30 minutes 2 or 3 times a week.
Exercise and risk for coronary artery disease
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Stress can make you fat
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Stress increases cortisol, epinephrine and
norepinephrine, our "fight or flight" hormones.
This is a beneficial reaction if we are facing an
emergency situation but when we have frequent
micro-emergencies each day in a stressful
environment, cortisol is elevated too frequently
and causes fat to deposit around our midsections."
"If stress and weight gain are a one-two punch for
you, concentrate on the stress reduction before
embarking on a diet. You will be more successful
in losing the weight you desire." FRJ
Why Stress Can Make You Fat
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
7. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Kids on Life
-=-=-=-=-=-=-
How Do You Decide Who To Marry?
You got to find somebody who likes the same stuff.
Like, if you like sports, she should like it that
you like sports, and she should keep the chips and
dip coming. - Alan, age 10
How Can A Stranger Tell If Two People Are Married?
You might have to guess, based on whether they
seem to be yelling at the same kids. - Derrick,
age 8
What Do You Think Your Mom And Dad Have In Common?
Both don't want any more kids. - Lori, age 8
What Do Most People Do On A Date?
Dates are for having fun, and people should use
them to get to know each other. Even boys have
something to say if you listen long enough. -
Lynnette, age 8
When Is It OK To Kiss Someone?
When they're rich. - Pam, age 7
Is It Better To Be Single Or Married?
It's better for girls to be single but not for
boys. Boys need someone to clean up after them. -
Anita, age 9
How Would The World Be Different If People Didn't
Get Married?
There sure would be a lot of kids to explain,
wouldn't there? - Kelvin, age 8
How Would You Make A Marriage Work?
Tell your wife that she looks pretty even if she
looks like a truck. - Ricky, age 10
Contributed by: Moodyfan
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** Woman's Diagnostic Cyber Newsletter *******
April 1, 2001
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Health and wellness just for girls
2. Facts about Chlamydia
3. Reader submitted Q&A- Ca-125 cancer screen test
4. How much do you know about anxiety disorders?
5. Screening recommendations for colon cancer
6. Health tip to share - Herbal supplements
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. Health and wellness just for girls
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
iEmily.com is a web site just for teen girls that
informs about health and wellness. It is a place
for teens to learn about their bodies, and their
feelings. to see if what they are thinking about
their hair or weight or sexual concerns are the
same as what other teens have on their mind.
In the sex-body-health section, topics range from
"What You Need to Know About Getting a Pap Smear"
to "Natural Face Mask for Oily Skin". These topics
are written in a very clear, understandable
terminology for the younger woman who has not
already been exposed to medical jargon through
frequent gynecological or obstetrical encounters.
Categories of articles include:
A Healthy You: How to Stay Well
All About Skin and How to Protect It
Caring for Your Hair and Its Problems
Fooling Around: All About Sex
Girl Problems
It Can Happen to Me: Sexually Transmitted Diseases
Itchy and Scratchy:The Lowdown on Vaginal Infections
Living With Injury, Disability, or Illness
Playing It Safe:A Guide to Birth Control
Pregnancy and What to Do If You're Not Ready for
Momhood
Quiz Yourself
Self Care--Naturally!
You Can't Be Too Careful:Skin Safety
Your Changing Body
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Facts about Chlamydia
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Chlamydia is a silent sexually transmitted
disease. Approximately 75% of women who have
infections are asymptomatic and may never seek
help. If it does strike symptomatically, women get
urinary tract infections and/or pelvic
inflammatory disease of the tubes that can lead to
later infertility, chronic pelvic pain or ectopic
(tubal) pregnancies.
Infections are more common in men and women under
the age of 25 but it can occur at anytime. As many
as 10% of teen girls may get chlamydia infections.
Doctors can check you for this by doing a cervical
smear similar to that done for the Pap smear test.
Treatments with specific antibiotics are quite
effective for chlamydia so it is best to have it
picked up before it causes serious infection.
Don't be ashamed to ask the doctor to do a smear
to check for it. It is often done routinely at the
beginning of pregnancy but can be done anytime
you ask.
Condoms can be used to prevent transmission of
chlamydia and should always be used if you do not
have a long term partner. Contrary to the belief
of many, chlamydia does not produce vaginal
discharge, itching, burning or odor.
You may want to review some of the health
statistics about chlamydia at the Center for
Disease Control STD Prevention site:
Some facts about chlamydia
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Ca-125 cancer screen test
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Prior to a complete hysterectomy in 1997, I had
periodic CA 125 tests for Cancer. The test
numbers gradually escalated over the years. No
cancer was found when I had the hysterectomy but I
have not had a CA 125 test since. Should I? My
father died at age 50 of colon cancer and my
mother was diagnosed with breast cancer at 75, at
84, she is a breast cancer survivor. Does the CA
125 only address uterine or ovarian cancer or is
it a more general indicator of the presence of
cancer somewhere in the body?" - DMG
Ca-125 is a blood cancer antigen that measures
almost any disease in the abdominal cavity
(peritoneum). It is primarily used to detect
ovarian cancer since that spreads over the
peritoneal cavity. Unfortunately it can pick up
endometriosis, fibroids, liver disease, colon
inflammatory disease among other conditions. It is
not effective as a screen for uterine cancer.
While a rising CA-125 is worrisome, many times it
turns out to be nothing identifiable or a benign
condition. In fact if the CA-125 is elevated, a
pelvic ultrasound is next performed. If it is
normal, usually no further diagnostic tests are
performed except for a follow-up ultrasound.
Now that you have had both the uterus and ovaries
removed, there is no point in having a CA-125 test
done any more. It would be best to concentrate on
detecting early breast cancer (mammograms) and
colon cancer (stool testing for occult blood or
colonoscopy.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. How much do you know about anxiety disorders?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Anxiety and stress are a fact of life. Sometimes
they get out of hand and significantly cripple a
person's everyday activities. When anxiety becomes
overbearing it may be classified into one of
several mental health problems:
Panic Disorder,
Obsessive-Compulsive Disorder,
Post-Traumatic Stress Disorder,
Phobias,
Generalized Anxiety Disorder,
These problems can be coexistent with other
problems such as drug or alcohol abuse, eating
disorders, depression and other anxiety disorders.
For a description of these disorders, see the
Facts About Anxiety Disorders at the National
Institute of Mental Health.
How much do you know about anxiety disorders?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Screening recommendations for colon cancer
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Screening for colon cancer is not well agreed
upon. Most people are at average risk except if
you have a family history of colorectal cancer,
hereditary nonpolyposis colorectal cancer,
familial adenomatous polyposis or ulcerative
colitis.
The screening tests used for colon cancer are:
testing stool for occult blood,
flexible sigmoidoscopy,
colonoscopy, and
double contrast barium enema.
Occult blood testing is very safe and inexpensive
but returns a lot of false positive tests. The
other tests are more expensive and have many more
risks. Additionally, many people fear the pain and
discomfort of the scopes and enemas.
Current recommendations for women at average risk
are ONE of the following regimens at age 50 or
over:
1. Fecal occult blood testing annually.
2. Flexible sigmoidoscopy every five years.
3. Fecal occult blood testing annually and
flexible sigmoidoscopy every five years.
4. Double-contrast barium enema every five to 10
years.
5. Colonoscopy every 10 years.
Each different screening strategy has it
advantages and disadvantages. If you choose to use
the screening for occult blood, then you must
abstain from red meat, Vitamin C, turnips, NSAIDs
such as Alleve(R), aspirin or Advil(R) for two
days before the test. If the test shows positive,
a colonoscopy must be performed.
Screening recommendations for colon cancer
Home tests for occult blood are available:
Colocare for occult blood
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Herbal supplements
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Most herbal supplements are quite safe but there
are some that should be discontinued before
surgery. There have been no scientific trials but
there have been some anecdotally reported
postoperative bleeding problems in patients taking
gingko biloba, garlic extract, feverfew, ginger,
and ginseng. This is not a negative report about
these herbs for they can be quite useful. Just
remember that it may be safer to discontinue the
above herbal supplements about a week before
any surgical procedure. Your doctor may not be
aware of this. - FRJ
Herbal supplements and postoperative bleeding
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
7. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Hearing Aid
-=-=-=-=-=-=-=-
A man goes to his doctor and says, "I don't think
my wife's hearing is as good as it used to be.
What should I do?"
The doctor replies, "Try this test to find out for
sure. When your wife is in the kitchen doing
dishes, stand fifteen feet behind her and ask her
a question, if she doesn't respond keep moving
closer asking the question until she hears you."
The man goes home and sees his wife preparing
dinner. He stands fifteen feet behind her and
says, "What's for dinner, honey?"
He gets no response, so he moves to ten feet
behind her and asks again.
Still no response, so he moves to five feet.
Again, no answer.
Finally he stands directly behind her and says,
"Honey, what's for dinner?"
She replies, "For the fourth time, I SAID
CHICKEN!"
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** Woman's Diagnostic Cyber Newsletter *******
April 8, 2001
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Women smokers at higher bladder cancer risk than men
2. Foot-And-Mouth: Anatomy of an epidemic
3. Reader submitted Q&A - Cervix remaining after TAH
4. Rectal and anal pain - proctalgia fugax
5. High heel shoes and arthritis of the knees
6. Health tip to share - Growth hormone releaser
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.Women smokers at higher bladder cancer risk than men
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Lung cancer is the best known malignancy caused by
smoking but bladder cancer has also been
associated with smoking. With lung cancer, it has
been shown that women who smoke the same number of
cigarettes as a man actually have a higher chance
of getting lung cancer. This study looked at
whether women also have a higher chance, cigarette
per cigarette, of getting bladder cancer than men.
In studying over 1500 subjects and comparing them
with non-smoking control subjects they found an
overall 2.5 times increased risk ratio for bladder
cancer among both men and women. There was no
variation by the use of filtered versus non
filtered cigarettes, low-tar versus higher tar
cigarettes, or the pattern of inhalation.
Women, however, had a higher risk than men who
smoked the same number of cigarettes. They also had
a higher blood level of the substance produced by
arylamine exposure which is thought to be the
inducing agent for bladder cancer.
More reasons not to smoke.
Women smokers at higher bladder cancer risk than men
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Foot-And-Mouth: Anatomy of an epidemic
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Foot and mouth disease ALMOST NEVER affects
humans. It is a highly contagious disease caused
by the picorna virus. It can infect cattle, pigs,
sheep and goats as well as several wild animals
(deer, water buffaloes, bears, antelopes, llamas,
camels, giraffes, elephants, rats, hedgehogs).
There is a similarly named condition, hand-foot-
and-mouth disease, in humans which is caused by
other enteroviruses, i.e. Coxsackie virus and
enterovirus 71. It is not at all part of this
recent concern over foot and mouth disease in
animals. In spite of that, it might be helpful to
know a little about what is going on with the
attempts to contain this recent epidemic that can
affect our meat supply.
This United Press International article is a good
review of how widespread the problem is and how
viruses can be spread in meat and other products.
Foot-And-Mouth: Anatomy of an epidemic
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Cervix remaining after TAH
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
I am entering my 5th week after a total abdominal
hysterectomy (removal of the uterus and cervix).
In the 3rd week, I returned to the doctor's office
for an emergency appointment due to severe sharp
pains in my lower left side which extended to the
pelvic area. I am also experiencing a lot of
pressure at the end of urination, as well as a
loss of appetite, insomnia, night sweats and
extremely cold feet and hands during the day. The
doctor ordered a urinalysis to determine if I had
a urinary tract infection (the test was negative).
During the visit the doctor conducted a vaginal
examination, at which time she stated that it
"looked like my cervix was still there and she was
sure that it was removed." She then read the
pathology report and stated that the cervix was
removed, however, she still saw it during the
exam. She mentioned that "maybe they didn't get
it all." She also stated that the pain I was
having was "nerve degeneration" and was normal
after the surgery and suggested that I take
Motrin. She wanted to prescribe sleeping pills
for the insomnia but I refused, at which time she
told me take Benadryl.
Although I am concerned about the pain I am having
as well as the other symptoms described above, I
am more concerned about the comment regarding my
cervix. Am I at any risk if indeed parts of the
cervix was not removed and if so, what risks?
Also, is it unusual for only parts of the cervix
to be removed during a hysterectomy? In addition,
what could be causing the other symptoms I am
experiencing? I have my 6 week follow-up
appointment next week and would like suggestions
on what questions I should ask the doctor
regarding my symptoms and concerns. - Anonymous
The most common types of abdominal hysterectomy
are total (body of the uterus and cervix) and
subtotal (just the body of the uterus). Doctors
who recommend leaving the cervix feel that orgasm
during sexual response is better preserved as well
as future support of the end of the vagina. The
downside is that the junction of skin between the
glandular lining of the cervix and the flat skin
lining of the vagina is not removed and this is
where dysplasia and cancer can occur. Also the
glandular tissue remaining in the endocervix can
occasionally bleed or become infected (cervicitis).
Doctors who remove the entire cervix feel that the
need for future Pap smears and potential for
cancer of the cervix is almost totally prevented
in the future and that good support of the end of
the vagina can be accomplished surgically with the
correct technique. Orgasm may be slightly changed
but is not noted to be less pleasurable by most
women undergoing the procedure.
Sometimes, when doing a total hysterectomy (this
has nothing to do with the ovaries), in an effort
to make sure the vagina is not shortened and to
prevent injury to the bladder, a small amount of
the tip of the cervix is left. This would be like
removing the entire nose and nostrils but leaving
a small amount of the firm but moveable tip of the
nose. When looking straight on, it looks like the
entire cervix may still be present but in fact
only a slight external surface is still present.
It happens to all surgeons unintentionally
sometimes and some surgeons actually try to leave
this tissue intentionally. Almost always the
squamocolumnar junction is removed which gets rid
of the need for future Paps (or decreases the
frequency). It also means the vagina has not been
shortened at all which can happen sometimes.
When this happens to me either intentionally or
unintentionally, I look with a colposcope at about
3 months after the surgery to make sure there is
no endocervical tissue present. You might ask your
doctor about doing that.
As far as your other symptoms of night sweats and
insomnia, you did not mention if the ovaries were
removed or not and how old you are. These could be
symptoms of low estrogens. The pain you are having
needs to be evaluated by your surgeon. It sounds as
if your post operative exam was not by the same
person who did the surgery.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Rectal and anal pain - proctalgia fugax
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Proctalgia fugax is an uncommon but very painful
condition in which the muscle of the anal
sphincter undergoes an unexpected cramp just like
a "charlie horse" cramp of the calf muscle. The
cramp may last up to 20 minutes before going away.
It is closely related to, and sometimes
indistinguishable from, pain in the other pelvic
floor muscles such as levator ani syndrome and
pelvic floor dyssynergia.
There are no special tests to diagnose this
condition, just the history of the periodic
recurrence of a severe pain in the anal area. GI
studies should be performed in order to rule out
any higher rectal or colon conditions such as
cancer or inflammatory bowel disease. There is no
surgical treatment that keeps this pain from
recurring.
Just as massage is the most common treatment for
calf muscle cramps, so is pressing on the anal
area. This can be done with the fingers or by
straddling the edge of a bath tub. Heat from a hot
bath may help. There has been one report of
proctalgia fugax which responded to 0.3 percent
nitroglycerin ointment. In patients with severe,
prolonged attacks, salbutamol inhalation
(Serevent(R) for asthma) has been shown to shorten
the duration of severe pain. and clonidine has
decreased the frequency of attacks.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. High heel shoes and arthritis of the knees
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
High heel shoes have always been known to cause
feet problems but now even the chunky lower heels
are thought to cause knee problems. The wide heels
are not as uncomfortable as high heels and thus
are worn longer.
Investigators in Lancet medical journal report
that either narrow or wide 3 inch heels put
additional pressure on the inside of the knee by
as much as 26% more than normal barefoot walking.
Previous studies found that narrow high heels were
associated with knee osteoarthritis. This study
confirmed that even wide heels are likely to cause
the same osteoarthritis that narrow heels do.
Wearing heels once in awhile is probably not very
damaging in the long run whereas frequent heel use
heel use may cause permanent osteoarthritis of the
knee.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Growth hormone releaser GHR-15
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Several readers have asked about GHR 15 (Growth
Hormone Releaser) herbal supplement which is
heavily advertised as an anti-aging, increased
libido and energy booster. Its premise is to
release your own body's growth hormone which is a
master hormone that somewhat influences the
positive effects of several of the other hormones
(ACTH, cortisol, prolactin). Growth hormone
declines with age and studies giving growth
hormone injections have shown a very beneficial
effect with increasing energy and improving muscle
mass and decreasing fat mass.
I could not find any scientific studies showing
this this GHR-15 or any similar formulation actually
releases your own growth hormone. In theory it
should because it has sheep derived pituitary
extract in it (presumably containing sheep growth
hormone releasing factor) but it is uncertain whether
that extract is inactivated and unabsorbed by oral
administration.
I am not concerned about most of the components
except for the bovine pituitary extract which is
derived from the brain of sheep and thus carries a
very small but still possible risk of bovine
spongiform encephalopathy (mad cow disease).
Personally I would wait until the synthetic growth
hormone releasers are available. FRJ
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
7. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
A man in Florida, in his 80s, calls his son in New
York one November day.
The father says to the son, "I hate to tell you,
but we've got some troubles here in the house.
Your mother and I can't stand each other anymore,
and we're getting a divorce. I've had it! I want
to live out the rest of my years in peace. I'm
telling you now, so you and your sister shouldn't
go into shock later when I move out."
He hangs up, and the son immediately calls his
sister in the Hampton and tells her the news.
The sister says, "I'll handle this."
She calls Florida and says to her father, "Don't
do ANYTHING till we get there! We'll be there
Wednesday night."
The father agrees, "All right."
He hangs up the phone and hollers to his wife,
"Okay, they're coming for Thanksgiving. Now, what
are we going to tell them for Christmas?"
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** Woman's Diagnostic Cyber Newsletter *******
April 15, 2001
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Dietary fat's bad rep is exaggerated
2. Breast implants and connective tissue diseases
3. Reader submitted Q&A - Prolonged nausea after TAH
4. Environmental chemical exposure levels
5. Good grief, bad grief - am I losing my mind?
6. Health tip to share - Swimming and water exercises
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. Dietary fat's bad rep is exaggerated
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Our percentage of food fat consumption as a nation
has dropped over the last 30 years from 40% to 34%
today. And yet in spite of that drop, the rate of
obesity has risen from 14% to 22%. Why is that?
Perhaps the main problem is that we really have
not decreased total calorie consumption along with
our low fat diets. Many have switched to
carbohydrate-rich foods that stimulate insulin.
High insulin levels actually cause hunger and may
promote excessive eating.
An article in Science journal actually goes
farther and suggests that there is very little
hard evidence that decreasing dietary fat will
make us live longer. Can you believe that? Low fat
evangelists may argue that there are just not
enough long term trials of people on sustained low
fat diets. But if you think about the decades of
research and hundreds of millions of dollars that
have tried unsuccessfully to prove low fat
prolongs life, then you may agree that perhaps fat
has received a bad rap.
Dietary Fat's Bad Characteristics Exaggerated
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Breast implants and connective tissue diseases
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
You may remember that due to allegations that
silicone breast implants caused connective tissue
diseases (e.g., systemic lupus erythematosis,
rheumatoid arthritis), in 1992 the FDA restricted
silicone gel-filled breast implants until further
studies could be done. Subsequent studies have
failed to show a relationship between the implants
and such diseases.
This Danish study looked at 2761 women with breast
implants and 8807 control subjects. They found
there was no difference in the incidence of
connective tissue diseases or cancer in those who
had cosmetic surgery with silicone implants and
those who had cosmetic surgery without any
implants. Then the implant and the control group
were compared to the general Danish population
rates of connective tissue diseases. Both of those
groups had higher rates of connective tissue
diseases than the general population.
This means that the implants were NOT associated
with increased rates of connective tissue diseases
but women who undergo any form of cosmetic surgery
probably have higher rates. This is not to say
that women with breast implants do not have a
higher rate of local breast problems such as
implant rupture, thickened capsule formation and
other localized reactions. They do. It happens in
over 30% of women with the implants. But the
evidence continues that the implants do not cause
systemic connective tissue disease problems.
Connective tissue diseases following breast implants
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Prolonged nausea after TAH
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
I was reading about the woman who had total
abdominal hysterectomy surgery who had some of the
same symptoms that I had. I also had a TAH
Surgery where my uterus, cervix, appendix,
ovaries, tubes, and a very large fibroid were
removed. My question is that since coming home
from the hospital 6 weeks ago, I have lost 17 lbs.
and I only weigh 103 lbs. My normal weight is 120
lbs, I am 5'4 and have a medium build. It seems
that I have a poor appetite and get full after a
few bites of food.If I try to eat all my portions
and get very full, I sometimes vomit up all the
food I just ate. I also experience some nausea
every day along with a lot of burping. I want to
gain back my weight but it seems like I can't eat
enough to gain it back. Frequent small meals have
not helped with weight gain. Is this normal after
surgery? My tests are normal and the post op
exams are normal. My doctor doesn't know what is
wrong and keeps telling me to continue to eat
small meals. Any comments?
Most of the time, nausea after gynecological
surgery subsides in the first week, or possibly
two. Occasionally it persists for a long time and
then we need to know if something is wrong or is
it just the body's response to the insult of
surgery and all of the perioperative bowel preps,
anesthesia, antibiotics, and other medications.
Nausea and loss of appetite can persist after two
weeks and when this happens, we honestly just do
not know why it takes so long for the bowel
function to return to normal. I suspect that
antibiotics during and possibly after surgery are
the main culprits that disturb the normal bacteria
of the gastrointestinal tract. Taking capsules
with live Acidophilus cultures may help this.
Sometimes you have just been eating different
foods than you normally did and the stomach is
sensitive to these.
You may have discontinued smoking or caffeine or a
medication you were on which increased bowel
motility and now the bowel is quite lazy and
produces an intermittent illeus (lack of bowel
muscle movement). Just being at home all day if
you were used to going out of the house for work
or leisure can lead to swallowing more saliva and
air which causes increased gas and nausea. Be sure
to try to restart all of your presurgical eating
and activity habits now that you are six weeks
out.
There are, however, conditions or complications of
surgery that your doctor should look for. A
chronic infection at the appendiceal stump can
cause these problems as can adhesions affecting
the bowel. A CAT scan may be needed to detect an
abscess; adhesions can only be suspected but not
confirmed short of repeat surgery. Injury at the
time of surgery to the bladder or ureter can also
cause this prolonged bowel problem. A kidney xray
(IVP) may be needed to see injury although a CAT
scan may also pick this up.
In summary I would say to use the Acidophilus
capsules, closely examine any food or medication
changes that have taken place and try to resume
your normal activities. If there is no explanation
there or if the nausea and loss of appetite
persists or seems to worsen, ask your doctor about
the possibility of further studies to look at the
gastrointestinal tract and kidneys.
Hysterectomy and Postoperative Problems
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Environmental chemical exposure levels
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
One of the difficulties in evaluating our exposure
to toxic or harmful chemicals in the environment
is that there has not been good data on what are
the background levels of exposure in the
population. In other words what is normal. For
many of the known toxic metals such as lead or
mercury we do know what levels are common in
people without health problems but for more
uncommon but suspected toxins such as pesticides
(organophosphates) or byproducts of plastics
manufacturing (phthalates), good information about
"normal levels" has been lacking.
Recently, the National Center for Environmental
Health has begun a project to provide an ongoing
assessment of the U.S. population's exposure to
environmental chemicals using biomonitoring. They
have issued a report on the background levels of
27 environmental chemicals measured in 12
different geographical locations across the U.S.
The report covers chemicals such as metals (e.g.,
lead, mercury, and uranium), cotinine (a marker of
tobacco smoke exposure), organophosphate pesticide
metabolites, and phthalate metabolites. They
intend to update the data each year with new
measurements.
This recent report mainly sets "normal range
levels" for compounds but it also concluded that
lead levels in children have fallen in the last
decade and exposure to 2nd hand smoke (cotinine)
has fallen by over 75% in the U.S. over the last
decade.
It is very difficult right now to be screened in a
doctor's office for such a wide range of chemicals
although if there is suspected exposure to one or
two specific chemicals, those tests can be ordered
and sent off to special labs. There are some home
test kits that analyze levels of certain minerals
and metals using hair samples( e.g., Mineral Check
http://www.wdxcyberstore.com/minchechommi.html)
but there are no home tests measuring the
organophosphate pesticide metabolites, or
phthalate metabolites from plastic manufacture.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Good grief, bad grief - am I losing my mind?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Losing a child through stillbirth, neonatal death,
congenital anomalies, SIDS, any child's death or
even an early miscarriage can lead to a
devastating human emotional experience. It is
normal to fear you are losing your mind during
this time.
Symptoms of grief in this situation may include:
tightness in the throat or chest
rapid breathing
an empty stomach feeling
extreme appetite change (none or excessive)
difficulty concentrating
restlessness
headaches
impatience
extreme fatigue
excessive guilt or anger
sensing your (dead) child's presence
ambivalence toward surviving children
The best treatment for grief is to know that these
symptoms are normal. Even though they seem
irrational and out of place they are the same
feelings that other women have in this situation.
Support groups of other women who have had similar
experiences are invaluable. These women have been
through it and know that you are not going crazy;
you are reacting to the intense grief that
accompanies death of a child.
Am I losing my mind
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Swimming and water exercises
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Swimming has always been good conditioning
exercise but you can use water for other
exercises, especially if you are not yet in good
physical shape for this spring and summer.
Running in the water increases your heart rate
just as swimming does. Many people who cannot run
on land because of back, hip, knee or foot pain
can run in the water without a problem. Because of
the water's buoyancy, the jarring impact on your
bones is much less. In chest-high water, begin by
running with your hands on your head, and as you
become more fit, paddle with your arms.
Other suggestions from Health Fitness Tips:
Kick with a kick board or holding on to the side
of the pool to tone legs, buttocks and stomach.
Treading water improves arm and leg strength.
Bobbing up and down in the water improves
breathing and muscle tone
Leg lifts also condition legs, buttocks and
stomach. On your back but holding on to the side
of the pool, lift each leg 10 times in front of
you, behind you and to each side
Even though the water helps prevent you from
overheating, remember to cool down after even
water exercise, whatever your level of ability.
A swim a day
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
7. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"New BMW"
A perimenopausal woman just splurged and bought a
new BMW. She was out on the interstate for a nice
evening drive.
The top was down, the breeze was blowing through
her thinning hair, cooling off all of her hot
flashes. She decided to open the sports car up. As
the needle jumped up to 80 mph, she suddenly saw
flashing red and blue lights behind her.
"There's no way they can catch a Beemer," She
thought to herself and opened her up further. The
needle hit 90, 100....
Then the reality of the situation hit her. "What
in heck am I doing?" she thought and pulled over.
The cop came up to her, took her license without a
word and examined it and the car.
"It's been a long day, this is the end of my
shift, and it's Friday the 13th. I don't feel like
more paperwork, so if you can give me an excuse
for your driving that I haven't heard before, you
can go."
She thought for a second and says,
"Last week my husband ran off with one of your
female cops. I was afraid you were trying to give
him back!"
"Have a nice weekend," said the officer.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** Woman's Diagnostic Cyber Newsletter *******
April 22, 2001
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Access to your medical records
2. Vulvodynia: Diagnosis and treatment
3. Reader submitted Q&A - Bladder falling down
4. Stomach cancer risk factors
5. Medical contraindications to air travel
6. Health tip to share - Boric acid for yeast
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. Access to your medical records
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Have you ever been frustrated when trying to get a
copy of a report from your doctor or even a copy
of your entire medical record? You certainly are
not alone if you have found obstacles to a timely
release of your medical record.
Many people are not aware that the records belong
to the health care institution or the specific
doctor and not to the patient. In spite of this,
many state and some federal laws have established
that patients have a right to their own medical
record. The only exception to that is when the
record contains information which the physician
feels is harmful for the patient to see. This
usually applies to psychiatric records so it
rarely gets invoked for general medical
conditions.
Most of the time, the delay in getting your
records stems from two causes:
1) A long standing office inefficiency in copying
and transferring records because it is the lowest
task on an office's priority.
2) A physician's reluctance to OK release of the
records because of the perception that you, the
patient, do not trust what is being said by the
physician. This usually only results in "foot
dragging" rather than outright refusal.
These are not good excuses but they are the
realities. Just be persistent. The article below
contains some helpful suggestions if you run into
either this delay in obtaining records or in an
outright refusal on the part of a doctor's office
to give you records or reports.
Your medical records
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Vulvodynia: Diagnosis and treatment
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
We have had some recent questions about vulvodynia
so it may be time to review this difficult and
uncertain subject. Vulvodynia refers not to a
specific disease, but rather to a symptom - vulvar
pain. In this case the pain is chronic and either
recurrent or almost constant.
The following article is as concise as I have seen
this problem discussed. It notes that there are 4
main subcategories of vulvodynia:
vulvar dermatoses
cyclic vulvovaginitis
vulvar vestibulitis syndrome
dysesthetic vulvodynia
Again, these four subcategories are not diseases
themselves but rather clusters of different
diseases or descriptive syndromes whose etiology
is unknown.
Vulvar dermatoses often require a biopsy for
diagnosis. Sometimes a dermatologist is the person
to see for this rather than a gynecologist
especially if the vulva seems to have a chronic
redness.
Cyclic vulvovaginitis is frequently due to a
recurrent yeast infection but it can also be
bacterial in origin. In this instance, secretions
from the vagina are the skin irritants and if use
of a tampon eases the burning, it is very likely
that cyclic vulvovaginitis is the major factor.
The remaining two subcategories, vulvar
vestibulitis and dysesthetic vulvodynia are
totally unknown as to their etiology. Vulvar
vestibulitis shows inflammation of the vestibular
gland on biopsy but what causes the inflammation
is unknown. HPV virus was postulated as a possible
cause but current concepts are that HPV is not the
cause.
Dysethetic vulvodynia tends to be found in
postmenopausal women and is postulated to be an
inflammation of the nerves similar to a herpetic
vulvitis. There are no histological changes on
biopsy so it is really just the existence of
vulvar pain in the absence of inflammation on
biopsy.
Vulvodynia diagnosis and treatment
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Bladder falling down
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"What is the best way to treat a dropped bladder
beside surgery? If surgery is the only option,
which one for this problem has the best success
rate?"
"I am a 51 yr. old, white female, 5' 3-1/2",
weighting 190 lbs. I had a complete hysterectomy
in 1998 due to fibroid tumors and a uterine
prolapse. At that time something was done to my
bladder for it was pulled down by my uterus. "
"I have urine leakage really bad, when I exercise.
I have to wear a pad during the day in case of
leakage, if I don't my panties get wet and I have
to change them three to four times during the day.
I AM MISERABLE! HELP!" - I.M.
A dropped bladder can represent several different
conditions such as a cystocele, descent of the
bladder neck (urethrocele) or vaginal vault
prolapse. You may have any one, two or three of
the above conditions so without an exam it is
difficult to give a precise answer to your
question.
In general the non-surgical treatments are muscle
strengthening exercises such as Kegel's, use of
vaginal weighted cones, pelvic floor muscle
stimulation (microelectrical or magnetic), and
artificial support devices such as a pessary.
After age 50 and especially if you have had
previous bladder support surgery at the time of
your hysterectomy, the non surgical treatments are
less likely to be successful in the long term.
While the exercises may not be curative, they are
always beneficial even if you end up having
surgery so I would encourage those.
Since you have symptoms of stress urinary
incontinence, it is very likely that you have a
dropping of the bladder neck. There are several
procedures that are very effective to repair this
and it depends upon the skill of your doctor with
what procedure works best for him or her. The
vaginal procedures would include transvaginal
tape, a sling with bone anchors, a fascial sling
procedure and abdominal procedures would include a
bladder suspension such as a Burch or MMK
procedure. These can be done open incision or some
physicians can do these laparoscopically.
If the bladder is also falling down and causing
pressure and difficulty starting to void and to
completely empty the urine, surgical repair can be
performed vaginally or abdominally with a
paravaginal repair.
The biggest risk with this surgery for future
failure is if the physician does not recognize
whether or not the end of the vagina is also
prolapsing again like the uterus did. If it is
moving more than an inch with intraabdominal
straining (vaginal vault prolapse), then it needs
to be fixed as well along with the other support
defects. If it is not, you will have recurrence of
relaxation problems within a few years. This vault
support is done the easiest by an abdominal
incision although some surgeons are skilled in a
vaginal vault suspension that does not
significantly shorten the vagina.
I think your best course is to have the physician
who did the original surgery refer you to someone
whom they know is skilled in this type of
secondary repair. Members of the Society of
Gynecologic Surgeons (http://www.sgsonline.org)
specialize in these problems.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Stomach cancer risk factors
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Stomach cancer is not as common in the U.S. as
some other countries. In fact its incidence has
been declining since the 1930's. The reason for
the decrease compared to the incidence in Asia,
South and Central America and Central Europe is
postulated to be due to increased use of
refrigeration for food storage and decreased use
of salted and smoked foods.
Helicobacter pylori infection is a major risk
factor as is smoking and alcohol use. A diet high
in smoked or salted products also raises the risk.
Stomach cancer is often a disease of the 60's and
70's but since there are different types, it can
occur at any age. Depending upon where in the
stomach the cancer occurs, symptoms may vary:
lack of appetite
unintended weight loss
abdominal pain
vague discomfort in the abdomen above the navel
abdominal fullness after eating only a small meal
heartburn, indigestion, or ulcer-type symptoms
nausea and or vomiting, with or without blood
swelling of the abdomen due to fluid (ascites)
As you can see these symptoms are not unique for
stomach cancer. Many of these can occur with
viruses, ulcers, gastric reflux and even stress
and depression. Anyone over 50 with these symptoms
should see a physician for possible evaluation
with xrays or endoscopy.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Medical contraindications to air travel
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Doctors are often asked if it is safe to travel by
air with a certain medical condition. Air pressure
and oxygen levels are lower in an airplane so it
makes sense that certain conditions that lower
oxygen levels in tissues may put one at more risk
with flying.
The International Transport Association (IATA) has
come up with a list of conditions that would be
either absolute or relative contraindications to
flying.
After an uncomplicated heart attack (myocardial
infarction), passengers should not fly for at
least 7 days.
Angina, if stable with infrequent attacks, is not
usually a problem.
10 days after uncomplicated surgery for coronary
artery bypass grafting should be safe.
After a coronary angioplasty one should wait 3-5
days before travelling
Individuals with asthma and chronic lung disease
(including chronic obstructive pulmonary disease
and pulmonary fibrosis) are usually able to travel
safely if the condition is stable without recent
deterioration.
A rule-of thumb to use is if a passenger can walk
50 yards (meters) or walk up one flight of stairs
without getting moderately short of breath then it
is generally safe to fly.
Travelling with other conditions such as anemia
(hemoglobin less than 7.5 grams), recent stroke
and diabetes are also covered by this article at
PersonalMD.com
Medical contraindications to air travel
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Boric acid for yeast
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Occasionally we see references to the use of boric
acid for chronic recurrent yeast infections.
Several scientific papers have demonstrated their
efficacy. Unfortunately commercial products with
boric acid for vaginal use are almost impossible
to find.
If you are absolutely sure your problem is
recurrent yeast vaginitis you can ask your doctor
to prescribe them or go directly to a compounding
pharmacist to make them up. Gelatin capsules are
used and the dose is 300 mg once a day
intravaginally for 14 days and then use on days 1-
5 of the menses for the 5 months following the
first treatment as per a recent article, (Am J
Obstet Gynecol 2001 Mar;184(4):598-602.) (Note -
this is somewhat a lower dose than was recommended
in the past for boric acid). FRJ
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
7. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
LIFE'S A TEST - AND YOU'RE GRADED ON A CURVE
At age 4, success is...not peeing in your pants.
At age 12, success is...having friends.
At age 16, success is...having a driver's license.
At age 20, success is...having sex.
At age 35, success is...having money.
At age 50, success is...having money.
At age 60, success is...having sex.
At age 70, success is...having a driver's license.
At age 75, success is...having friends.
At age 80, success is...not peeing in your pants.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** Woman's Diagnostic Cyber Newsletter *******
April 29, 2001
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. About Sjogren's syndrome
2. Cancer news service for Rx breakthroughs
3. Reader submitted Q&A - Rate of food digestion
4. HRT and ovarian cancer risk
5. Carpal Tunnel Syndrome
6. Health tip to share - Yogurt for preventing yeast
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. About Sjogren's syndrome
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Sjogren's syndrome is an autoimmune condition that
affects several million women each year. While it
can occur at any age, it typically presents in
women in their late 40's. The major symptoms are
dry eyes and dry mouth but other associated
symptoms can make a woman think she is just
menopausal.
The disease can affect many internal organs such as
the liver or kidneys and it may produce a profound
fatigue and joint pains. It is basically the dry
eyes and mouth that differentiate it in early
phases from chronic fatigue syndrome or
fibromyalgia although sometimes medicines can cause
those symptoms also. Symptoms may go on for two
years or more before diagnosis or there may be
mistaken diagnoses of lupus, multiple sclerosis, or
even rheumatoid arthritis before the correct
diagnosis is made.
Once you or the physician starts thinking about
possible Sjogren's syndrome there are several tests
available, which can help, make the diagnosis. The
basic challenge is to think of Sjogren's in the
first place.
If you want to learn more about Sjogren's syndrome,
visit Sjogren's Syndrome foundation at sjogrens.org
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Cancer news service for Rx breakthroughs
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If you or a friend are diagnosed with cancer it
totally changes and consumes your daily life. Part
of that consumption is the fight to beat the
cancerous cells in your body - to get totally
cured. Some early stage cancers have well
established treatments that you do not want to
deviate from. However the more advanced stages of
cancer or recurrence of cancer are a different
matter.
With any poorly treated or not frequently cured
condition, there is a continual search on the part
of medical science for a better treatment. With
highly funded problems such as cancer there are new
reports about possible curative therapy almost
every day from somewhere in the world.
Robertsreview.com scans about 2500 news sources
each day looking for cancer news. They categorize
the news for over 30 different cancers. That way if
you want to follow the latest news about a given
type of cancer treatment, you can bookmark that
cancer page.
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