Women's Health Newsletters 5/6/01 - 6/10/01
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****** Woman's Diagnostic Cyber Newsletter *******
May 6, 2001
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This week from Woman's Diagnostic Cyber
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1. Embarrassed by chronic blushing?
2. Clomid for unexplained fertility
3. Reader submitted Q&A - PMS after menopause?
4. What is a cataract?
5. The truth about latex condoms
6. Health tip to share - Carpal tunnel 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.
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1. Embarrassed by chronic blushing?
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Blushing is not the same as hot flashes. Some
women have a problem with chronic blushing almost
all of their adult life. Anything can trigger it;
even a fear of blushing. Mistakes, criticism,
unexpected attention or praise can cause this
reaction which is embarrassing to those who have
it.
Anyone who has social anxiety is at risk for
chronic blushing. While surgery is an option, it
is much better to try biofeedback or even
cognitive therapy with a counselor. With this
method, people learn to change the thought pattern
that results in the sympathetic nerve discharge.
Dietary change and anti-anxiety meds such as
Paxil(R) are also options prior to any surgery.
There is a procedure, however, called thoracic
sympathectomy which can alleviate chronic
blushing. It is now performed with an endoscope
and involves cutting some nerves that control
blushing. This surgery is also used for those
individuals that have extremely sweaty palms all
of the time.
For more information about this procedure, see
this article at PersonalMD.com
Blushing
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2. Clomid for unexplained fertility
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Clomid (clomiphene, Serophene(R)) treatment is
often used for women who do not ovulate. Sometimes
it may be used in cases of unexplained fertility
in women who already ovulate. The theoretical
reason is that some unexplained infertility may be
due to ovulations that are not "adequate" to
produce sufficient hormonal levels to support
implantation of the fertilized egg.
It is believed by some scientific investigators
that Clomid can improve the quality of ovulations
and thus result in a higher pregnancy rate even if
a woman ovulates regularly. Cochrane reviews look
at the scientific trials that have been conducted
using Clomid for this limited purpose and
comparing its use with placebo.
They have found that although the pregnancy rate
is still low in women with unexplained fertility,
those who received Clomid had a 2 - 2.5 times higher
pregnancy rate. They conclude that the cost is low
and therefore Clomid should be tried even in women
who ovulate regularly after all other causes have
been ruled out. Remember, however, there is a 10%
multiple pregnancy rate when using Clomid.
Clomid for unexplained fertility
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3. Reader submitted Q&A - PMS after menopause?
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"I am 60 years old and I had my last period in
1987. Since then my (PMS), or whatever it is, is
so bad it takes at least a week out of my month! I
have a woman obgyn because I thought she would
understand my problem. She doesn't. I have talked
to some other women about it and they have never
heard of having such a bad time after no periods.
I have headaches, backaches, cramps, bad-bad
depression, and even nightmares. Can you help? I'm
on hormones, Wellbutrin(R) and aspirin plus a high
blood pressure med." - mjb
The "whatever it is" is the key to this problem.
Premenstrual Syndrome (PMS) only occurs with
ovulation from the ovary and since you are
postmenopausal, your ovaries are no longer
producing eggs and hormones each cycle. Therefore
we have to look for other hormone sources that are
mimicking PMS symptoms or perhaps look for other
conditions entirely.
You mention that you are taking hormones and I
assume those are estrogen and progestin
replacement. If you are taking the estrogen daily
and the progestin for two weeks or less, i.e.,
cyclically, that would be the easiest explanation
for your cyclical symptoms.
In PMS, investigators attribute the physical and
mood symptoms to either progesterone or an excess
of progesterone over estrogen. With postmenopausal
hormone replacement (HRT), many women have mood
and physical symptoms from the specific progestin
that is used. Provera(R) (medroxyprogesterone
acetate used in PremPro(R) or PremPhase(R)) tends
to produce more physical symptoms such as low back
pain, bloating, and cramps. Another progestin used
in HRT is norethindrone acetate found in
Aygestin(R), Activella(R), and FemHRT(R). It has
been shown to produce more mood symptoms. Women
who had PMS before menopause tend to react more to
these progestins after menopause.
If you are taking your HRT with cyclical
progestins (5-14 days a month), then changing to a
continuous regimen will avoid the cyclical nature
of your symptoms. Unfortunately, it may also
produce some of your symptoms, albeit less severe,
all of the time. In that case you will need to ask
your doctor to switch your HRT to one with a
different progestin such as norgestimate in Ortho-
Prefest(R) or natural micronized progesterone such
as in Prometrium(R).
If you are currently taking your HRT continuously
such that the progestin is taken every day, then
switching progestins may be helpful although it
does not explain why you get your symptoms for
only one week out of a month. You may need to keep
a symptom calendar to make sure when you get
symptoms in relationship to your medications and
activities. That may shed more light on the cause.
Other non hormonal medications can also play a
role. You may be having some side effects from
your medications that just for some reason seem to
occur cyclically rather than constantly. This can
sometimes be due to interactions between
Wellbutrin (bupropion) and beta blockers used for
hypertension. Also, Wellbutrin can cause headaches
and muscle pains on its own.
Finally, the fact that you mention more nightmares
makes me suspect you are having low blood sugar
problems. Progestins can cause that and so can the
Wellbutrin and anti-hypertensives if taken at
night. High insulin and low blood sugar often
produces nightmares. You may want to have your
doctor check you out for diabetes or hypoglycemia.
The nightmares can be lessened with a protein/fat
snack before bed such as a small cup of yogurt or
a piece of cheese. If you are taking any of your
medicines at night (except the aspirin should not
make a difference) then switch them to the morning
or take earlier in the evening.
If you do find the medications are causing the
problems, you may have to be switched to different
medications or even evaluate if the benefit of the
medications outweighs the side effects you may be
having.
This question very well illustrates why we have a
paid subscriber service for personal health
questions. Many situations require an iterative
process to make sure all the correct information
is available to give you the best advice on how to
solve a health problem. The process for you to
try some different regimens may take one to
several months or more with revision of what to
try next coming after each different trial failure
or success.
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4. What Is a Cataract?
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A cataract is a clouding of the lens of the eye
most commonly associated with aging. In fact over
half of Americans 65 or older have cataracts. The
clouding is caused by proteins in the lens that
precipitate and clump just like an egg white gets
more solid as heat is applied.
The clouding may not affect vision for a while but
if it spreads throughout the lens it makes visual
images blurry and colors fade. Poor night vision
is a result with worsening halos around
headlights. Double vision and frequent eyeglass
prescription changes indicate a cataract is
progressing.
Diseases such as diabetes or steroid use can cause
cataracts in younger people. Smoking and excessive
sun exposure are very strong risk factors.
Sunglasses with ultraviolet ray protection may
prevent or delay age-related cataract development
if used regularly.
When a cataract gets so bad it prevents driving,
reading or watching TV then it needs to be
treated. Initially an eyeglass prescription change
may be all that is needed. Eventually, however, a
cloudy lens needs to be removed. It can be
replaced with an artificial lens which will
improve vision.
For a primer on what to expect if you develop a
cataract and need to have it treated, see the site
at the National Institute of Health's National Eye
Institute:
What Is a Cataract?
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5. The truth about latex condoms
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Condoms are very effective at preventing both
pregnancy and sexually transmitted diseases such
as HIV and chlamydia when used correctly. In fact
when studying couples in which one partner had HIV
and the other did not, regular and correct condom
use prevented the negative partner from
contracting HIV over the 20 month average follow-
up period.
If the couples did not use the condoms
consistently or they did not use them at all, the
rate of HIV conversion was 10% and 15%. This is
approximately the same efficacy of condoms for
preventing pregnancy, i.e., when used consistently
and correctly, pregnancy rates are very low (about
2%) but when use is not with every episode of
intercourse, pregnancy rates are 12%.
So what constitutes using a condom incorrectly?
not using the condom every time
using brittle, damaged condoms (heat damages)
not withdrawing immediately if breakage is felt
not withdrawing right after ejaculation while
still erect
using oil based lubricants such as vegetable oils,
baby oil, hand lotion or petroleum jelly
You may want to print out this fact sheet from
SIECUS, the Sexuality and Information and
Education Council of the United States, for your
partner just as a gentle nudge.
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6. Health tip to share
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"I had a small booklet that suggested hand
exercises to alleviate carpal tunnel syndrome.
Extend your arms, putting the affected hand(s)
straight out in front of you. Put your palms
straight out, as if pushing something, with hands
completely opened. Then make a fist, bending your
hands down at the wrist. Bring your hands up
again, palms facing out, again as if pushing
something. This does wonders to relieve my carpal
tunnel syndrome. I have severe nerve involvement
to my right hand and minor to my left. I have not
opted for the surgery yet and may not if I can
stave off with these exercises. Water retention
absolutely worsens my carpal tunnel symptoms." -
Kristi
If you have discovered ways of coping with a
disease or condition and it works for you, please
share it with us:
Health tip suggestion form
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7. Humor is healthy
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Golfing Guru
-=-=-=-=-=-=-=-=-
Two women were paired together as partners in a
club tournament and met on the putting green for
the first time.
After introductions, the first golfer asked the
second, "What's your handicap?"
"Oh, I'm a scratch golfer," the other replied.
"Really!" exclaimed the first woman, suitably
impressed that she was paired up with such a
strong player.
"Yes, I write down all my good scores and scratch
out the bad ones!
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That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
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****** Woman's Diagnostic Cyber Newsletter *******
May 13, 2001
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This week from Woman's Diagnostic Cyber
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1. Attacking home allergens
2. All about ovulation - natural and artificial
3. Reader submitted Q&A - Morning muscle pains
4. What are gall stones?
5. Faking illness on the internet
6. Health tip to share -
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. Attacking home allergens
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The air in your home is estimated to be as much as
70 times more polluted than the outside. Even
recently built homes have a moderate amount of
particles and pollutants in the air. There can be
a million dust particles in a cubic inch of air.
On the other hand, opening the windows for fresh
air may not be the answer because of heavy pollen
counts.
So what is the answer if you suffer from allergies
or asthma? There are several steps you can take:
Place all mattresses and pillows in allergen-
impermeable covers.
Wash all bedding weekly in water at least 130
degrees F.
Don't spend much time reclining on upholstered
furniture.
Remove all carpeting in the bedroom.
Clean up surface dust as often as possible,
Avoid aerosols or spray cleaners in the bedroom
and don't clean when someone with allergies or
asthma is present.
If you are allergic and must do the cleaning, wear
a face mask and avoid the use of chemical
cleaners.
Remove stuffed animals, and remove any objects
under the bed that can collect dust.
Clean closets regularly, often removing off-season
clothing.
Maintaining in house humidity at 35-40% is also
critical to minimize the multiplication of dust
mites and at the same time avoiding so much
dryness of the respiratory passages that worsens
respiratory problems significantly.
Attacking home allergens
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2. All about ovulation - natural and artificial
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How the ovary works to ovulate an egg each month
may not be of interest to most women as long as
the process functions normally. However, if you
are trying to conceive, if you are having a
problem with ovarian follicle cysts or polycystic
ovarian disease, or if you are having abnormal
menstrual bleeding after skipping periods, then
you may want to know how the ovulation mechanism
works.
At birth, a woman has all of the follicles she
will ever have. They remain in the resting state
until the start of menses at which time several
follicles will start to develop each month. These
developing follicles look like tiny cysts in the
ovary on ultrasound but usually each month, only
one follicle goes on to develop fully into the egg
that will be ovulated that month.
If a dominant follicle (egg) does not develop, the
ovaries tend to remain in a polycystic state with
multiple small follicles until an ovulation
finally occurs. If a dominant follicle develops
but does not ovulate, then a follicular cyst
results which can swell up fairly big and produce
pain. Gradually it will go away on its own but
sometimes there is some bleeding inside the cyst
("bruised ovary") which makes it painful and last
fairly long.
If there is something wrong with the follicle
development phase or the ovary is arrested in
follicle development from polycystic ovarian
syndrome, clomiphene (Clomid (R)) may be used to
restart the system. If clomiphene is not enough
and a woman wants to conceive, then stronger
medicines are used to stimulate follicle
development and ovulation.
One company that makes some of these products,
Organon Inc., has a very good tutorial on the
entire process that you may want to read if you
are interested in that aspect of female
reproduction.
All about ovulation
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3. Reader submitted Q&A - Morning muscle pains
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"I woke up the morning before I started my first
period in 11 months with leg muscle pains. I
attributed this to tramping around the city on a
getaway that previous weekend. Each morning the
pains in my muscles have worsened, mainly in my
hamstrings, not in my joints. My range of motion
in my arms has significantly decreased also.
Early morning is the worst and when I am in one
position for a long time; i.e. driving, sitting at
my desk, etc. stair climbing difficult. My
ankles, knees, hips are all okay with movement and
reflexes normal. what could this be?"
"I am 48 and take no medications except vitamins.
I walk every day, am slightly overweight (15 lb)
but otherwise healthy except for stress to the max
with an at risk teenage daughter and elderly
parents." - jls
You have very well described the pain as affecting
the muscles and not the joints. If you are still
within a week or two of your city excursion, the
pain could still be from that if it was quite
strenuous. If not, the only serious condition that
this may represent that I am aware of is
fibromyalgia. It is characterized by increased
muscle pain in the morning that generally affects
many areas of the body. A hallmark feature of the
muscle pain of fibromyalgia is that if you press a
finger on the muscle area that hurts, there is a
significant increase in the level of the pain. If
pressing on the muscle does not seem to aggravate
the pain or it actually feels good to massage the
muscle, then you probably do not have
fibromyalgia.
The other main cause of muscle pain which is worse
in the morning is from overuse of the muscles
themselves. This may be because your muscles are
still not used to the walk that you take each day
or it may be that the stress you have is tensing
the muscles abnormally during each day. At night
you may also be tensing your muscles during sleep
because of the stress or you may have a sleep
problem such as restless legs syndrome (RLS) that
results in abnormal leg activity while you sleep.
These are very difficult conditions to overcome
and you will need to work with your physician if
stress or RLS is a problem.
When the body's salts are out of sync, e.g.,
sodium (Na), potassium (K), calcium (Ca) and
magnesium (Mg), muscle cramps are more common.
Sometimes taking a calcium/magnesium supplement,
potassium rich foods such as bananas or just a
sports drink with salts (e.g., Gatorade), can help
decrease muscle cramps if that is the source of
your pain.
Finally, aging seems to produce more muscle
soreness. I hate to say that or even to attribute
muscle stiffness to that but it happens. Be sure
to see your physician to have the other things
checked out first, especially if this persists and
if you have pain in the muscles with any finger
pressure
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4. What are gallstones?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Gallstones are solid chunks of cholesterol or
calcium salts that precipitate from the gall
bladder secretions called bile. Most people never
know they have them because 80% of the time
the stones do not produce any symptoms. They may
be discovered incidentally on x-ray or ultrasound
imaging for other problems.
The only serious hazard that gallstones present
are the possibility that smaller ones may block
off the common bile duct from the gall bladder and
liver on its way to empty into the intestinal
tract. If that happens, one gets severe pain due
to distension of the gall bladder full of liquid
bile and liver damage and jaundice from bile
backed up into the liver.
If not fully obstructing the duct, lesser symptoms
include heartburn, nausea, bloating or mild pain
in the upper abdomen. Sometimes a woman may have a
more intense pain shortly after a meal lasting for
15 minutes to several hours. This would be called
a gall bladder attack. They may come infrequently
or more regularly but if you are having pain on a
daily basis, it is probably not due to gall
bladder attacks.
Complete blockage of the bile duct does not always
produce severe pain. Sometimes it just produces
symptoms of yellowing skin (jaundice), clay
colored stools, tea or coffee-colored urine or a
high fever with shaking chills. These can indicate
duct obstruction and require surgical
intervention.
Women who are taking estrogen replacement are at
higher risk for gallstones. Maintaining a low fat,
high fiber diet and maintaining your weight in the
ideal range is the only way to help prevent
gallstones.
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5. Faking illness on the internet
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Munchausen syndrome is a condition where a person
fakes an illness or disease mainly to get
attention from with the medical profession or from
their family and friends. Sometimes it is done to
obtain sympathy, act out anger or even to control
the behavior of others. It is not common but it
happens occasionally. Now it is happening on the
internet.
When you discuss a condition with a person in a
chat room or reply to questions and comments on a
message board, you may be communicating with a
person who is just faking the problem. But how
would you know? That person may also be playing
several roles in the chat room or message board.
They have simplified the deception by taking to
the internet rather than attending a hospital
emergency room or doctor's office.
The following article by Marc D. Feldman MD, who
has followed patients with this condition over the
years, gives tips for recognizing this syndrome on
the Net:
"the posts consistently duplicate material in
other posts, in books, or on health-related
websites;
the characteristics of the supposed illness emerge
as exaggerated;
near-fatal bouts of illness alternate with
miraculous recoveries;
claims are fantastic, contradicted by subsequent
posts, or flatly disproved;
there are continual dramatic events in the
person's life, especially when other group members
have become the focus of attention;
there is feigned blitheness about crises (e.g.,
going into septic shock) that will predictably
attract immediate attention;
others apparently posting on behalf of the
individual (e.g., family members, friends) have
identical patterns of writing.
Let us know if you think you have witnessed this
going on in any of the women's health forums/chat
rooms you have visited.
Munchausen by Internet: Faking Illness Online
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6. Health tip to share - Get checked for glaucoma
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Don't forget that your eyes need to be
periodically checked to make sure the fluid
pressure of the eyeball is not too high. Glaucoma
is an increased eye pressure condition that can
silently lead to blindness if not discovered
early.
Recommended screening frequency at your eye doctor
or with a personal physician who checks the
pressure in your eyes, is:
every 3-5 years after age 38,
every 1-2 years after age 64
every 1-2 years if you are at high risk due to:
diabetes,
African ancestry,
family history of glaucoma,
high blood pressure,
near-sightedness,
history of cortisone use or eye surgery
Glaucoma - get tested
If you have discovered ways of coping with a
disease or condition and it works for you, please
share it with us:
Health tip suggestion form
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7. Humor is healthy
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"He Loves Me, He Loves Me Not..."
Susan and Jane are old friends. They have both
been married to their husbands for a long time,
Jane is upset because she thinks her husband
doesn't find her attractive anymore.
"As I get older he doesn't bother to look at me!"
Jane cries.
"I'm so sorry for you, as I get older my husband
says I get more beautiful every day." replies
Susan.
"Yes, but your husband is an antique dealer!"
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That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
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Back to top
****** Woman's Diagnostic Cyber Newsletter *******
May 20, 2001
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Lipid lowering recommendations
2. Moles or not?
3. Reader submitted Q&A - FSH to measure menopause
4. Withdrawal Symptoms from Paxil(R)
5. Pain in the tailbone
6. Health tip to share - Pulse pressure as a sign
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. Lipid lowering recommendations
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
By now, many of you have heard that there are some
new, medical expert panel recommendations for
goals of maintaining low cholesterol levels.
Specifically, low density lipoprotein levels
(LDL), the "bad cholesterol", is the target of the
outcome goals. The different categories of risk
and what the goal should be for diet, exercise and
lipid lowering drugs called "statins", can be
somewhat confusing.
Risk factors include:
smoking
age over 55
family history of heart disease in first degree
female relatives under age 65 or in first degree
male relatives under age 55
blood pressure over 140/90 on anti-hypertensive
meds
a high density lipoprotein (HDL) level of less
than 40 mg/dl
Risk categories are:
0-1 of above risk factors - LDL goal less than 160
mg/dl
2+ risk factors - LDL goal less than 130 mg/dl
current coronary heart disease or diabetes - LDL
goal less than 100 mg/ml
The main new recommendations from this recent
report are:
1. Diabetes should be treated as a severe risk
factor as much as already having coronary artery
disease even if a person has no yet had a heart
attack or angina. The goal in this highest risk
category is to maintain LDL cholesterol levels at
under 100mg/dl
2. The category of two or more risk factors uses
the Framingham Heart Study risk assessment scoring
system to further divide that group into a higher
risk category that needs more aggressive
cholesterol lowering goals of an LDL of less than
130 mg/dl
3. The identification of a metabolic syndrome that
is associated with insulin resistance and requires
more intensive LDL lowering. This is defined as
any 3 of the following in women:
waist circumference of more than 35 inches (88 cm)
triglycerides greater than 150 mg/dl
HDL level less than 50 mg/dl
fasting glucose greater than 110 mg/dl
blood pressure greater than 135/85
The new recommendations are not different at all
for those who are at low risk, i.e., have 0-1 risk
factors, which is the majority of women. Statin
drugs are not really recommended for those low
risk women unless you have extremely high LDL
levels over 190 mg/dl.
You may want to see these recent recommendations
as well as our past article on cholesterol and
lipid disorders.
National Cholesterol Education Program (NCEP)
Cholesterol and Lipid Disorders
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Moles or not?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Moles are pigmented skin lesions that are either
flat or raised. The medical term for them is nevi.
For the most part they are benign skin lesions
that people have on their skin for many years;
sometimes all of their lives. More moles appear as
you age. The only worrisome concept about moles is
that they can change from a benign growth into a
skin cancer called malignant melanoma.
Malignant melanoma is a very aggressive cancer so
recognizing a mole that has recently changed is
critical to successful treatment. It is much
different than a basal cell cancer of the skin
which doesn't seem to spread very quickly at all.
The warning signs of a mole becoming malignant can
be remembered by the pneumonic of the ABCDs
Asymmetry - One half does not match the other half.
Border irregularity - the edges are irregular,
blurred or may have finger-like projections.
Color - There are various shades of color within
the same mole.
Diameter - any mole greater than 6mm (the size of
a pencil eraser) bears evaluation by a
dermatologist.
This article below at Dermadoctor.com points out a
very key ingredient in watching out for malignant
melanoma. Most people are amazed that a mole they
have had for years and years all of a sudden
changes in shape or size or forms irregular
borders. Dr Kunin says that all of her patients
that develop melanoma declare "but I have ALWAYS
had that mole; it could not be skin cancer!"
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - FSH to measure menopause
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"How do I know if my condition is menopause or
something else? I am 45 years old, take no
medications other than a multivitamin, vitamin E
and calcium supplement. I have not had a period
in 3 months. Over the past year or so, my periods
have been very irregular, and I had what I thought
were probably hot flashes a few times. Before
this, my periods were regular and every 21 days.
Sometimes it feels as though I am about to start,
with lower abdominal pressure and some back pains.
However, I have not even had these symptoms in
over a month." - S.F.
Follicle stimulating hormone (FSH), a blood test,
is the only way to know for sure about menopause.
When the ovaries quit functioning for good, the
FSH levels become high. It depends upon which lab
measures the FSH because they all have somewhat
different normal ranges. A value of over 40 IU/L
is confirmatory of menopause. However some labs
feel that any value over 25 IU/L represents
menopause.
Values between 10-25 IU/L indicate an ovarian
resistance that comes with approaching menopause
(perimenopause). Unfortunately this range can also
indicate midcycle ovulation in a normally
ovulating woman. Therefore if you had a lab
measurement in this range and an episode of
bleeding within two weeks, you would not know for
sure if you were menopausal or just had a sporadic
ovulation.
Estrogen levels below 50 pg/ml also may indicate
menopause. Just like FSH, low estrogen levels can
indicate conditions other than menopause such as a
suppression of menses by a stress induced
(hypothalamic) anovulation.
In order to clarify whether you are menopausal or
not with one blood draw and one visit to the
doctor, drawing blood tests for both FSH and
estradiol almost always solves the problem:
Condition FSH Estradiol
menopause over 40 IU/L under 50 pg/ml
stress induced
anovulation under 10 IU/L under 50 pg/ml
perimenopause 10-40 IU/L under 100 pg/ml
ovulation 10-25 IU/L over 100 pg/ml
In any cases, if estrogen (estradiol) levels are
under 50 pg/ml, an estrogen supplement will make
you feel better. In the perimenopause very low
dose birth control pills (1/20) or low dose
estrogen patches (0.0375 - .05 mg/day) for this
supplementation. You can confirm the low estrogen
levels by some of the home salivary estrogen
tests, but there is no home test for FSH.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Withdrawal Symptoms from Paxil(R)
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The selective serotonin reuptake inhibitor (SSRIs)
class of drugs has helped make great strides in
the treatment of anxiety and depression and other
mental health conditions. Drugs such as Paxil
(paroxetine), Zoloft (sertraline), and Prozac
(fluoxetine) are heavily prescribed and used and
of benefit to daily functioning.
What happens though, when you decide to stop the
medications either because you do not believe they
are working or perhaps because you are feeling
better or the cause of your anxiety has gone away?
Can you just stop them or do you need to taper
off?
Most people have just been in the habit of
stopping the medications all at once because they
and their doctors may be unaware of side effects
with discontinuance. As it turns out there are
definite antidepressant discontinuation symptoms
although not everyone suffers from them.
Withdrawal starts within 1-2 days after stopping
the medication. Symptoms peak about day 5 and
usually resolve within 2-3 weeks. These include
dizziness, headache, nausea, and flu-like symptoms
as well as anxiety, confusion, irritability,
excessive dreaming and insomnia.
In one randomized clinical trial, Paxil was found
to produce the worst withdrawal symptoms and
Prozac the least, with Zoloft in between. It has
even been reported that in patients switched from
one medication to another, e.g., Paxil to another
drug, that the symptoms from withdrawal have been
misinterpreted as side effects to the new drug.
The bottom line is to be aware that the SSRI
drugs, especially Paxil, must be tapered gradually
(over 2-3 weeks) when being discontinued or even
when being switched to a different drug.
Withdrawal from Paxil
Comparison of withdrawal side effects
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Pain in the tailbone
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The tail bone at the end of the spine is called
the coccyx. Sometimes if it becomes injured and
does not heal properly, it can produce a chronic
pain. People who have this coccydynia pain are
unable to sit comfortably at all. Standing or
lying on their side are the only tolerable
positions. Sometimes even walking can make the
coccyx move slightly and cause pain. Leg numbness
is NOT a part of this problem. If leg numbness is
present, there may be some involvement of the
sacrum bone or the lumbosacral spinal cord and
this will require an MRI to investigate it.
While a fall or some sort of trauma is the most
common cause of tail bone pain, labor and delivery
of a child can also break the attachment of the
coccyx to the sacrum bone. Usually it heals back
in place but a woman needs to be careful not to
keep moving it out of place and thereby developing
chronic pain.
Diagnosis is made by history and physical exam and
x-ray of the coccyx and sacrum. Treatment is
almost always conservative in an attempt to allow
self-healing.
A donut type of cushion or pillow is the only way
to sit comfortably and keep pressure of the
coccyx, to keep it from moving so it can heal in a
fixed position. These donut cushions or pillows
can usually be obtained at a medical supply shop
or by mail order from special catalogs. This is
the best way to get the coccyx to heal non-
operatively.
Anti-inflammatory drugs are very useful to help
with the pain while the coccyx is healing. Heat
and ultrasound treatments may also be used to help
any topical ointments be absorbed through the
skin. Sometimes injection of the joint with
steroids is used for pain relief until healing can
take place. Rarely, if all of these non surgical
treatments fail to relieve the pain of coccydynia,
then surgical removal of the coccyx may be the
last resort.
For more background on this unusual but painful
condition , look at spinesolver.com.
Coccydynia a pain in the tailbone
A coccyx pillow can be obtained at internet stores
and may also aid women with hemorrhoids who sit
for hours at work and the pillow can be turned
around for those who have bad vulvodynia:
Tush-Cush Tailbone Pillow
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Pulse pressure as a sign
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Pulse pressure is the measure of the difference
between your systolic blood pressure minus your
diastolic blood pressure. In other words if your
blood pressure is 130/80 then the pulse pressure
is 50. A blood pressure of 170/90 has a pulse
pressure of 80. As you get older, the pulse
pressure can be more predictive of the potential
for heart attacks and strokes than the blood
pressure itself.
If you are over the age of 60, pulse pressures of
over 60 (e.g., 160/90) are more predictive of
atherosclerosis. Under age 50, the diastolic
pressure (the lower reading) is most predictive of
future heart problems. You may want to discuss
this with your doctor.
Pulse pressure
If you have discovered ways of coping with a
disease or condition and it works for you, please
share it with us:
Health tip suggestion form
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
7. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"You Know You Are Getting Older When....."
1. You and your teeth don't sleep together.
2. Your try to straighten out the wrinkles in your
socks and discover you aren't wearing any.
3. At the breakfast table you hear snap, crackle,
pop and you're not eating cereal.
4. Your back goes out, but you stay home.
5. When you wake up looking like your driver's
license picture.
6. It takes two tries to get up from the couch.
7. When your idea of a night out is sitting on the
patio.
8. When happy hour is a nap.
9. When you're on vacation, and your ENERGY runs
out before your money does.
10. When you say something to your kids that your
mother said to you, and you always hated it.
11. When all you want for your birthday is to not
be reminded of your age.
12. When you step off a curb and look down one
more time to make sure the street is still there.
13. Your idea of weight lifting is standing up.
14. It takes longer to rest than it did to get
tired.
15. Your memory is shorter and your complaining
lasts longer.
16. Your address book has mostly names that start
with Dr.
17. You sit in a rocking chair and can't get it
going.
18. The pharmacist has become your new best
friend.
19. Getting "lucky" means you found your car in
the parking lot.
20. The twinkle in your eye is merely a reflection
from the sun on your bifocals.
21. It takes twice as long - to look half as good.
22. Everything hurts, and what doesn't hurt -
doesn't work.
23. You look for your glasses for half an hour,
and they were on your head the whole time.
24. You sink your teeth into a steak - and they
stay there.
25. You give up all your bad habits and still
don't feel good.
26. You have more patience, but it is actually
that you just don't care anymore.
27. You finally get your head together and your
body starts falling apart.
28. You wonder how you could be over the hill when
you don't even remember being on top of it.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** Woman's Diagnostic Cyber Newsletter *******
May 27, 2001
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Elements of good treatment for hypertension
2. A monthly injectable contraceptive
3. Reader submitted Q&A - Disability from pelvic pain
4. Causes of leg pain.
5. Is there a male menopause?
6. Health tip to share - Acidity of cola products
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. Elements of good treatment for hypertension
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Hypertension has many different treatments, most
of which are very effective in reducing blood
pressure. The main purpose of treating
hypertension is to reduce or eliminate the long
term consequences of heart attacks, strokes or
other vascular complications. High blood pressure
is also a very highly studied entity. Many
different medications have been used and
scientifically evaluated.
The question arises as the whether all of the
different types of antihypertensives are equally
effective in preventing hypertensive complications.
Analysis of all of the scientific trials where a
given medication is compared with a placebo
blindly should be able to show a trend of which
types of antihypertensive medications are the most
effective. A recent study published in the British
Medical Journal looked at this specifically.
After reviewing over 1500 studies, the authors
concluded:
1. For the initial treatment for hypertension, a
single blood pressure drug may work but sometimes
a combination of two or more different drugs may
be needed to control the blood pressure.
2. Anti-hypertensive treatment definitely works.
It decreases risks of fatal and non-fatal stroke,
cardiac events, and death and it may improve
the quality of life because of less serious
complacations.
3. Thiazide diuretics (e.g., hydrochlorthiazide
(Diuril(R)), chlorthalidone) seem to be the best
first line agents for reducing rates of stroke and
death.
4. Angiotensin converting enzyme (ACE) inhibitors
(Accupril(R), Altace(R), Captopril(R),
Lotensin(R), Monopril(R), Vasotec(R)), some beta
blockers, and some long acting calcium channel
blockers are effective alternatives as first line
treatment.
5. Short acting alpha antagonists (doxazosin
(Cardura(R)) should be avoided as a first line
agent.
6. Short acting calcium channel blockers should be
avoided (felodipine or isradipine) because of
higher side effect rates.
In most cases, doctors feel that by controlling
and lowering an elevated blood pressure, that will
result in the best long term result. But the
absolute blood pressure and serious outcome events
of heart attacks or strokes do not always go hand
in hand. We need to keep focused that the goal
is to prevent these serious complications.
Therefore it is interesting that the evidence
shows that simple (and inexpensive diuretics -
water pills) are still considered the first line
drugs to treat high blood pressure. Also, if they
are taken alone and or in combination with other
antihypertensive medications, they still show the
best or equivalent success at the long term
prevention of serious consequences from
hypertension.
My impression is that in recent years, many women
get started on other more expensive drugs first
and if they do, diuretics may never be added as a
combination drug. Remember that diuretics do not
tend to affect sexual functioning as do some of
the other antihypertensive medications. Since
they are also very effective, inexpensive and
have low side effects, you may want to inquire
with your physician if you are hypertensive but
not taking a diuretic.
What are the elements of good treatment for hypertension?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. A monthly injectable contraceptive
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Occasionally we get questions about what new
contraceptives are available. You might want to
know about this one called Lunelle(R) which is a
monthly shot that still results in monthly
menses. It is not for everyone but it may have a
place for you.
The shot is comprised of microcrystals of estrogen
and progesterone and should be taken every 28-30
days and not greater than 33 days apart. The blood
levels of estrogen and progesterone rise and fall
in a somewhat different pattern than when you
normally ovulate, but the pattern is closer to
natural than with birth control pills or with
DepoProvera injections.
The main comparison points to the other frequently
used injectable contraceptive, Depo Provera(R),
are:
Lunelle(R) DepoProvera(R)
monthly injection every 3 months injection
monthly menses often no menses at all
low break thru bleeding frequent spotting
less vaginal dryness more vaginal dryness
? any appetite effect frequent appetite increase
reliable protection reliable protection
This monthly injectable contraceptive may be for
the woman who has difficulty remembering to take
pills on a daily basis but who can remember to get
a monthly shot. It may also be better than
DepoProvera(R) for a woman who has had frequent
spotting or moderate appetite increase on
DepoProvera. It may play a role in perimenopausal
therapy in women having some hot flashes or
irregular bleeding but who are not yet fully
menopausal (and do not smoke).
Ask your doctor about it if you think you might be
interested.
Lunelle injectable contraceptive
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Disability due to pelvic pain
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Are chronic pelvic adhesions considered a
disability under the "Americans with Disabilities
Act?" Is it legal to terminate someone for
excessive absenteeism with this diagnosis? "
"I was diagnosed with this chronic disease in
1998. Through the years I have been in pain on and
off and was taken out on short-term disability for
this disease. I returned back to work for three
days and then started having unbearable pain when
walking and sitting. I called in sick on the 4th
day of work and went to my doctor who prescribed
new medication and advised in writing that I stay
home for one week. I was called at home and
terminated by my manager. This disease is
sometimes very debilitating. How can they fire me
for this when if the disease was diabetes or
lupus, termination would never have happened." -
Anonymous
Chronic pain of any type can play havoc with a
job. Employers are often intolerant of missing
work due to illness or doctor's appointments but
certainly the extent of their intolerance varies
with their company's policies and your immediate
supervisor's own personality. You may wonder to
what degree an employee has the right to expect
sick leave without being fired for taking it too
often.
As it turns out, employers may have to make some
accomodations to help a disabled employee
continuing working under the Americans with
Disabilities Act, 42 U.S.C. §§ 12101-12771. On the
other hand, if you cannot perform the work because
of the problem, you do not qualify for any
protection under the act.
For a discussion of disability from chronic pelvic
pain in the workplace and its role in retaining a
job, see our health law article at:
Job Termination Due to Pelvic Pain
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Causes of leg pain.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Leg pain is a common complaint among both women
and men. It may occur after sitting in a fixed
position for awhile or also commonly at night
during sleep. The most frequent cause is previous
muscle exertion that the legs are not used to.
Also loss of salts such as sodium (Na), potassium
(K) and calcium (Ca) can be associated with leg
pains as we discussed in the newsletter not too
long ago.
Morning leg pains
There are many other causes of leg pains that you
should be also be aware of. The pain may arise
from arterial or venous problems of the blood
vessels to the legs. Varicose veins are common and
if you press on the vein directly and it hurts, a
varicose vein is likely to be the source of the
pain. Deeper veins can also be the source of the
pain. In this case the pain feels as if it is deep
in the muscle of the back of the calf or thigh.
This may represent a thrombophlebitis and in many
cases is associated with swelling of the leg. It
usually affects only one leg rather than both at a
time. It is a serious problem because it may
result in blood clots to the lung.
Joint pain or bone pain is different than muscle
pain as far as the etiology. If joint movement
reliably reproduces the pain then arthritis is
likely and you should see your physican for that.
Pain that seems to be deep in the bone may
represent infection of the bone especially if
there has been previous trauma in that area.
Other less common causes of leg pain might include
nerve damage, fractures or past trauma to the
bones, or side effects to drugs. Narrowing of the
arteries is a serious cause of leg pain and if
exercise immediately produces leg pain, see
your physician right away. The medical term for
this is claudication and it can be a complication
of diabetes or severe atherosclerosis.
For a list of leg pain possiblities see this
article at Adam.com
Causes of leg pain
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Is there a male menopause?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
In a woman's natural menopause, there is a gradual
decline in many hormones such as growth hormone,
testosterone, and DHEA with a more abrupt
lowering of estrogen at the time of ovarian
failure. Men have the same gradual lowering of
all hormones without any abrupt change at about
age 50 like women but if you look at age 60, you
would not see any real difference in the overall
decline of hormones in men versus women compared
to their own earlier values in their 30's for
example.
Many people, including physicians feel, that such a
condition like male menopause does not exist.
Others believe that the decline in testosterone
in men is significant at sometime between 45 and
60 label it as "andropause. They say the symptoms
of male menopause "will sound familiar to any
woman who already has undergone the change:
irritability, mood swings, depression, anxiety,
palpitations, memory loss. About one in 10 men
even suffer hot flashes." Loss of muscle mass and
a decreased need to shave on a daily basis are
also warning signs.
Testosterone levels in males spike more than women
so several blood levels need to be drawn and an
average is taken to see if they are low. The
treatment for this is testosterone supplementation
usually by shot, skin patch or skin gel.
Unfortunately testosterone supplementation in men
carries some of the same consequences as in women,
especially if the replacement levels are too high.
Baldness (hair loss), acne, elevation of
cholesterol, increase in blood pressure and fluid
retention are all side effects that men (and
women) can develop or have worsen when taking
testosterone replacement therapy (TRT).
Therefore any replacement should be administered
under a physician's guidance and the benefits and
risks need to be carefully weighed in an
individual's case.
For information about this, see the article at
PersonalMD.com
Is there a male menopause?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Acidity of cola products
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Some women have questioned whether the caffeine in
Coke or cola products is bad for your stomach.
Actually the caffeine is not the problem; acid is.
Coke has a pH acid measurement of 2.5 which is
extremely acidic (neutral is 7.0). Actually Coke
syrup has been reported as quite soothing to the
stomach. It is the carbon dioxide gas that is
dissolved and turns into carbolic acid that is the
main gastrointestinal irritant. Women with
gastroesophageal reflux disorder (GERD) would be
well advised to avoid most carbonated beverages.
If you have discovered ways of coping with a
disease or condition and it works for you, please
share it with us:
Health tip suggestion form
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
7. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Stress Kit
-=-=-=-=-=-
An old one with a new face:
As a new bride, Aunt Edna moved into the small
home on her husband's ranch. She put a shoe box
on a shelf in her closet and asked her husband
NEVER to touch it.
For fifty years Uncle Jack left the box alone
until Aunt Edna was old and dying. One day when he
was putting their affairs in order, he found the
box again and thought it might hold something
important. Opening it, he found two doilies and
$82,500 in cash.
He took the box to her and asked about the
contents.
"My mother gave me that box the day we married,"
she explained. "She told me to make a doily to
help ease my frustrations every time I got mad at
you."
Uncle Jack was very touched that in 50 years she'd
only been mad at him twice.
"What's the $82,500 for?" he asked.
"Oh, that's the money I made selling the rest of
the doilies."
Contributed by: Robert
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** Woman's Diagnostic Cyber Newsletter *******
June 3, 2001
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Red yeast rice lowers cholesterol like a statin
2. Natural products for sexual dysfunction
3. Reader submitted Q&A - Finding the best treatment
4. The many causes of urinary incontinence
5. Piriformis syndrome causing hip and leg pain
6. Health tip to share - CocaCola acidity
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. Red yeast rice lowers cholesterol like a statin
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Red yeast rice is a Chinese traditional product
called Hong Qu. It is made by the fermentation
of a special yeast over rice. It is an
interesting nutritional supplement because the
yeast converts some of the rice into byproducts
that are the same as statins, the prescribed
medicines used to lower blood cholesterol.
The statins found in this product are quite
similar to cholesterol lowering medications such
as Mevacor(R) and Pravachol(R). In fact one
clinical trial using Red Yeast Rice found
approximately a 20% lowering effect of total
cholesterol and LDL cholesterol. The dose used
was 2.4 grams a day of a proprietary Red Yeast
Rice.
Because prescription grade statins have side
effects, it is prudent to assume that Red Yeast
Rice could also have some of those side effects.
Liver toxicity is a theoretical worry. In
practice, however, the side effects seem to be
quite low. There may be about a 1-2% problem with
GI upset and about 1% severe dizziness, Still, it
is wise to let your physician know you are taking
something like this.
Red yeast rice and cholesterol
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Natural products for sexual dysfunction
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Everyone looks for natural products that may help
with a minor symptom or ailment and this is true
especially for conditions that modern medicine
does not seem to do a good job with. Sexual
dysfunction and decreased libido is one area that
is often the subject of looking for relief from
natural products.
As it turns out, there are some successful natural
therapies for certain sexual problems. For example
anti-depressant associated sexual dysfunction has
been improved using Gingko biloba extract. One
study using 120 mg of Gingko biloba extract twice
a day found a positive effect in improving the
ability to become sexually aroused in men and
women using paroxetine (Paxil(R)) and sertraline
(Zoloft(R)).
Ginseng and yohimbine may also help anti-
depressant associated sexual dysfunction but they
seem to have a much higher incidence of side
effects including hypertension. Using them would
best be under a physician's monitoring or at least
a regular check of blood pressure.
Damiana is another herb that has been used to
stimulate sexual desire. It does have some
progesterone receptor activity but has not been
well enough studied to recommend for or against
its use.
For a discussion of these and other natural
products and their effect upon sexual dysfunction,
see this article:
Natural products for sexual dysfunction
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Finding the best treatment
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"My daughter has lupus and we are searching for
the BEST treatment we can for her. She has not
been in remission in the three years since her
diagnosis."
"My question is: How does one go about finding the
premier hospital for looking at best practices
known for a particular disease and applying them
to an individual patient?" - T. J.
This question is very difficult as you may
surmise. The main problem is that there is no
definition of premier quality medical care and for
most medical conditions there is not universal
agreement as to the "gold standard" of care.
The first approach you use should involve asking
and working with your personal physician to find a
provider to give you a second opinion. While some
physicians may react to a perceived lack of trust,
almost all of them will comply with your request
if you are just polite and persistent.
The internet has given us tools to search for the
latest medical research as well as to find out the
names and membership of medical specialty
societies, associations and organizations. Support
groups which include those who have suffered and
been treated for these conditions at various
locations around the country, can also be a source
of advice. Using multiple sources to cross
reference a list of possible resources for second
opinions, you can search out nationally known
physicians that may provide the answers you are
seeking.
For a discussion of how you might go about this
task, see our article at:
Finding the best medical treatment
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. The many causes of urinary incontinence
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The most common types of urinary incontinence are
stress incontinence, urge incontinence and a
mixture of the two (mixed incontinence). Stress
incontinence is mostly associated with an
anatomical problem in which the bladder neck moves
freely and "drops" with any increase in
intraabdominal pressure such as that associated
with coughing, sneezing or laughing.
Urge incontinence is due to an abnormal frequency
or intensity of bladder contractions. Usually we
can control when the bladder detrusor (emptying)
muscle contracts but with urge incontinence, the
muscle just functions at seemingly random times.
The force of the emptying muscle overcomes our
ability to hold the urine in by voluntary
contraction of the urethral sphincter muscle. The
end result is leakage of urine before we can make
it to the bathroom.
As we age and as we acquire certain medical
diseases, urge incontinence is more and more
common. Loss of estrogen to the urethral lining
makes it harder to hold urine. Prolapse of any
type seems to stimulate the bladder to want to
contract. Stroke, heart failure, constipation,
obesity, chronic lung disease, diabetes mellitus,
multiple sclerosis and Parkinson’s disease all can
cause or worsen urge incontinence.
If there are not major nervous system or spinal
cord conditions such as stroke or spinal cord
trauma, urge incontinence is often treatable by
bladder retraining (timed voiding), medications,
and other non surgical approaches.
For a discussion of the types of urinary
incontinence and their diagnosis and treatment,
see this article in Clinical Geriatrics at:
The many causes of urinary incontinence
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Piriformis syndrome causing hip and leg pain
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The piriformis muscles on the right and the left,
run from the broad part of the tailbone (sacrum)
to the outer part of the hip bone on each side.
The muscle helps rotate the whole leg out or in.
The large nerve that goes down the leg, the
sciatic nerve, lies under this muscle between it
and the pelvic bones. If the piriformis muscle
becomes contracted or goes into spasm, it not only
produces buttock pain on the side the muscle is
affected, but also pain that shoots down the leg
(sciatica).
So what are the causes of this muscle spasm or
contraction? It can occur from just sitting in a
fixed or unusual position, overuse of the buttock
(gluteus) muscles, or abnormal walking, posture or
sitting habits. Just driving on a long trip with
one of your legs externally rotated (knee away
from the body) can cause this.
Stretching and strengthening the muscle are the
primary and best treatments for piriformis
syndrome. From About.com-Sports Medicine, we get
the following instructions to stretch the RIGHT
piriformis muscle:
"lay on your back, bend your knees and cross your
right leg over your left so your right ankle rests
on your left knee in a figure four position. Bring
your left l
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