Womens Health

Women's Health Newsletters 10/19/03 - 12/28/03



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****** Woman's Health Newsletter *******
              October 19,  2003
Biweekly from BackupMD on the Net

1. Rosacea
2. Deciding on repeat C-section or trial of labor 
3. Reader submitted Q&A - Post op fatigue
4. Lifetime risk for diabetes
5. Health tip to share - Pap smear frequency
6. Humor is healthy
1. Rosacea

Rosacea is an inflammatory skin condition of the 
face which can range from a mild redness in the 
cheeks like blushing, to a constant redness and 
acne-like rash. It can be mistaken for acne, the 
facial rash of lupus erythematosis, an allergic 
reaction to a soap or cosmetic or even a sunburn. 
Blushing more easily can be an early sign of 
rosacea. It can also cause a burning and gritty 
sensation in the eyes if the skin around the eye 
and on the inside of the eyelids is affected. 

This condition is found in adults aged 30-60 and 
in women more often than men. It is not a serious 
life-threatening condition but it significantly 
affects your appearance. The cause is still 
unknown but scientists think it is a combination 
of genetic and environmental factors. Triggers 
that make it worse seem to be sun exposure, 
stress, spicy foods, exercise, cold wind, hot 
foods, and hot baths. Alcohol does not cause this 
although it can make it worse in appearance 
because alcohol dilates blood vessels of the face. 

Self-care includes:

Use sunscreen (SPF of 15 or higher) 

Protect your face from windburn 

Do not touch (irritate) your facial skin too much
Avoid facial products with alcohol 

Apply any moisturizer after the topical antibiotic 
has dried 
Use products labeled noncomedogenic (won't clog 
If wearing makeup, use green-tinted pre-foundation 
creams to counter skin redness 

Treatments for rosacea include topical antibiotics 
as well as antibiotics by mouth. Sometimes 
Accutane(R) (isotretinoin), which is used for 
severe acne, can be used to treat rosacea. Laser 
therapy has also been used to reduce the 
visibility of small blood vessels which accompany 


2. Deciding on repeat C-section or trial of labor  

If you have previously had a Caesarean section and 
become pregnant again, you may need to decide if 
you wish to have a routinely scheduled repeat C-
section for delivery or whether you wish to have a 
trial of labor. Surgery encompasses more risks 
than a vaginal delivery but with a trial of labor, 
there is also the chance (quite small) that the 
previous uterine incision at time of C-section may 
rupture and cause complications for both mother 
and baby. 

Doctors used to say that "once a C-section, always 
a C-section." Then, because of increased surgical 
complications compared with vaginal deliveries, 
they began to recommend a trial of labor because 
about 2/3's of women can deliver vaginally even 
though they had a previous C-section. Recently the 
pendulum has flipped and the risk of uterine 
rupture with a trial of vaginal birth after C-
section (VBAC) has become of greater concern. 

A recent study looked at the risks associated with 
both repeat C-section and VBAC to see if there was 
a way doctors and mothers could best decide which 
choice to make in order to minimize the risks of 
either strategy. Investigators found that if a 
trial of labor has a 50% chance or greater of 
success and if the chance of wanting a future 
pregnancy after cesarean section is 20% or above, 
then a women should choose a trial of labor to 
minimize her risk. This strategy is best because 
the risk of significant problems increases with 
more and more consecutive Caesarean sections. 

Deciding on repeat C-section or trial of labor

3. Reader submitted Q&A - Post op fatigue

"I am a 37 yr. old wife and mother of two sons. I 
had an abdominal hysterectomy 3 1/2 months ago. 
While I only had my uterus removed and do not take 
any medications and I thought my recovery was 
going well, these last 3 weeks have been terrible. 
I'm almost always exhausted, everywhere I sit, I 
drift off to sleep. I'm sweating a lot at night 
and have abdominal pain sometimes. I know that it 
takes a while to heal, but is this normal after a 
hysterectomy to be happening so late in the 
healing process? Also, I am still numb in the 
abdominal area. When does that leave? How can I 
lose this pouch that I now carry? (my tummy that 
is?" - G.P. 

At 3 months post op from a hysterectomy you should 
have recovered pretty much to your preoperative 
energy levels. The abdominal numbness around the 
incision, however, is common and may take as much 
as a year to year and a half to go away as the 
nerves slowly recover from having been cut in the 

The fatigue and sleepiness sound as if they are 
new symptoms and probably not related to the 
surgery unless your ovaries have stopped 
functioning and you are becoming menopausal. If 
that is true, that may explain the hot flashes, 
and sleep disturbances causing daytime sleepiness. 
Age 37 is somewhat early for menopause but you can 
never tell. Sometimes the surgery can shock the 
ovaries and cause a premature menopause. Just ask 
the doctor to run a menopause test (FSH blood 
test) to see if that is the problem. If not, you 
may need to look for another cause. Rarely 
infection/abscess of the ovary can present at 3 
months after hysterectomy but the doctor should be 
able to tell that on exam. I would suggest seeing 
the doctor again because of the pain, sweats and 
hot flashes and ask for the FSH blood test. 

As far as the abdominal pouching goes, the only 
cure is abdominal muscle exercises and dieting. 
The inactivity after surgery leads to increased 
fat depositing in the lower abdomen as well as 
weakness in the abdominal rectus muscles that go 
from the ribs to the pelvic bone in the midline. 
You will have to work hard on that to get rid of 
the tummy! 

4. Lifetime risk for diabetes

How likely is it that you might develop diabetes 
at sometime in your life? Those numbers have not 
readily been available until now. Medical 
scientists from the Center for Disease Control and 
Prevention have calculated the odds of different 
people developing diabetes at sometime in their 
life. This is independent as to whether you have a 
history of diabetes in your family. 

They found that the estimated lifetime risk of 
developing diabetes for individuals "born in 2000 
is 32.8% for males and 38.5% for females. Females 
have higher residual lifetime risks at all ages. 
The highest estimated lifetime risk for diabetes 
is among Hispanics (males, 45.4% and females, 
52.5%)." Anyone who is diagnosed with diabetes has 
a fairly large reduction in their life expectancy. 

It is estimated that a man diagnosed with diabetes 
at age 40 will lose 11.6 years of life and a woman 
diagnosed at age 40 will lose 14.3 years of life. 
These premature deaths are due to the 
complications of diabetes as well as the worsening 
effect it has on other conditions such as high 
blood pressure, heart disease, smoking etc. 

The bottom line is that we should make every 
effort we can to prevent diabetes by maintaining a 
healthy diet, lifestyle and weight throughout our 
lives. Also, we should pay more attention to early 
diagnosis of diabetes. Perhaps we have been 
underestimating it as a common health problem. 

Lifetime risk for diabetes

5. Health tip to share - Pap smear frequency
If you have not previously had abnormal Pap smears 
and have had several normal (negative) Pap smears 
recently, it is now recommended that you only need 
to have a Pap test every 3 years. The risk of 
getting invasive cancer of the cervix with this 
strategy is less than 2/100,000 

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

6. Humor is healthy

Now that they are retired, my mother and
father are discussing all aspects of their
future. "What will you do if I die before you
do?" Dad asked Mom.

After some thought, she said that she'd
probably look for a house-sharing situation
with three other single or widowed women
who might be a little younger than herself,
since she is so active for her age.

Then Mom asked Dad, "What will you do if
I die first?"

He replied, "Probably the same thing."

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

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****** Woman's Health Newsletter *******
              November 2,  2003
Biweekly from BackupMD on the Net

1. Colon polyps
2. Psycho social factors and high blood pressure 
3. Reader submitted Q&A - Gastric reflux disease
4. Recurrent yeast infection from skin sources
5. Health tip to share - Endometriosis
6. Humor is healthy
1. Colon polyps

Many people die each year as a result of colon 
cancer and yet it is a very preventable disease. 
Most colon cancer arises in skin tags on the 
inside of the large bowel (colon) called polyps. 
They go through a phase in which they just have 
"glandular" growth before becoming an invasive 
malignant growth. 

When polyps are present, they may bleed so that 
minute amounts of blood are measurable in the 
stool. In this phase they can be detected by 
testing your stool for hidden (occult) blood. 
However if blood is present in the stool, it does 
not necessarily mean cancer or even polyps. It may 
just be due to bleeding from hemorrhoids or even 
blood from red meat like hamburger or steak in 
your diet. If the test for blood in the stool is 
positive even after going without eating red meat 
for several days, then you will need to have a 
diagnostic procedure performed like a colonoscopy 
or flexible sigmoidoscopy. This is an office study 
while you are sedated (but not put asleep) in 
which a telescopic instrument is placed in the 
rectum to visually look for polyps. 

The American Cancer Society recommends yearly 
stool tests to check for microscopic bleeding 
starting at age 40. They also recommend a flexible 
sigmoidoscopy every three to five years for people 
aged 50 or older or even more often if you have a 
history of colon cancer or colon polyps in your 
family. When polyps are found in these early 
stages even before they cause bleeding, they 
usually can easily be removed by biopsy at the 
time of sigmoidoscopy or colonoscopy. It is felt 
that removal of all polyps prevents a person from 
developing most forms of colon cancer. 

Colon polyps

2. Psycho social factors and high blood pressure

The association between a "Type A personality" 
(competitive, aggressive) and high blood pressure 
has been known for a long time. However it is not 
clear whether just plain anxiousness, depression 
or anger/hostility are causes also. 

A recent study looked prospectively at the 
development of hypertension and measured several 
personality traits at the start and end to see if 
they had an effect on development of high blood 
pressure. The investigators examined the role of 
psycho social factors of time urgency/impatience 
(TUI), achievement striving/competitiveness (ASC), 
hostility, depression, and anxiety on the long-
term (5 year) risk of hypertension. 

They found that only two of the factors were 
significantly associated with developing high 
blood pressure: time urgency/impatience and 
hostility. It was surprising that 
Striving/competitiveness was not actually 
predictive of blood pressure elevation. Thus it 
appears that the real elements of a "Type A 
personality" that are associated with high blood 
pressure are impatience and anger. Striving to get 
ahead or competing in the workplace do not cause 
high blood pressure unless you get angry about it 
or impatient with the process. 

Psycho social factors and high blood pressure

3. Reader submitted Q&A - Gastric reflux disease

"I have been suffering form gastroesophageal 
reflux disease (GERD) for the last 5 months. 
Suggested remedy includes change in life style. 
Exactly what changes will minimize the symptoms? I 
am a house wife with 2 children. I recently had a 
laparoscopic hysterectomy done. I have recovered 
well. Is it true that GERD leads to esophageal 
cancer? how can it be prevented?" - C.R. 

When acid secretions from the stomach escape 
upward into the throat (esophagus) where they are 
not supposed to be, they cause chronic ulcerative 
damage to the inside skin lining. Any chronic 
irritation of skin can predispose a person to 
developing cancer in that area. For that reason, 
the acid reflux needs to be treated not only to 
give relief from short term symptoms of heartburn, 
difficulty swallowing and chest discomfort, but 
also to minimize any long term effect (20-30 
years) that might induce an esophageal cancer. 

While sometimes a bacterial infection of the 
stomach called heliobacter pylori can contribute 
to GERD, the predominant causes are habits and 
conditions of our daily life which we should have 
control to change on our own. These are labeled 
lifestyle factors. They include: 

alcohol ingestion
excessive caffeine
eating too fast (10 versus 30 minutes for a meal)
eating too many spicy hot, peppery foods
low fruit and vegetable consumption
excessive nitrite intake (from preserved meats)
lying down too soon after eating
obesity (increases stomach pressure to cause reflux)

Doctors often prescribe proton pump inhibitor 
medications which decrease the production of 
stomach acid as treatment for GERD. These 
prescriptions might include omeprazole 
(Prilosec[R]), lansoprazole (Prevacid [R]), 
rabeprazole (Aciphex[R]), or pantoprazole 
(Protonix[R]). However these meds just provide 
temporary relief and you must change the 
"lifestyle" habits which are contributing to the 
problem; otherwise you will be taking those 
medicines forever. 

If you have cut down your intake of fruits and 
acid foods like tomatoes because they worsen your 
symptoms, there is an over-the-counter food 
supplement called Prelief[R] that lowers the acid 
content of foods so that you can eat small amounts 
of them. But remember again, that this is just a 
temporary fix to the problem. 

4. Recurrent yeast infection from skin sources

Many women feel they suffer from Chronic, 
recurrent yeast vaginitis caused by candida yeast 
species. However we know that 50% of the time, 
episodes of suspected yeast vaginitis or vulvitis 
are not really caused by yeast. At least yeast 
cultures are negative when they are checked. The 
other 50% of the time, yeast is the culprit and 
women who have this suffer moderately. 

A recent study looked at how often women who had 
recurrent yeast infections had evidence of yeast 
growth from sites other than the vagina such as 
the mouth, rectum, perianal skin, and urine. They 
postulated that the other sites might be the 
source of the yeast causing a vaginal infection. 
They also looked at habits such as oral sex, 
wearing tight fitting pants or non-cotton 
underwear to see if these made a difference in the 
frequency of culture positive candida infection. 

The investigators confirmed previous studies by 
finding that only 50% of the suspected episodes of 
recurrent yeast vaginitis were culture positive 
for yeast in the vagina. However, of the 50% of 
women who did have positive vaginal yeast 
cultures, yeast could also be cultured from other 
sites a significant percent of the time: 

mouth         17%
rectum        52%
perianal skin 74%
urine         35%

When yeast was cultured from these other sites, 
the species of yeast was often different than the 
typical candida albicans that is most often 
associated with vaginal infection. These findings 
would indicate that the source of yeast 
reinfection may often be from other skin sites and 
that treatment needs to be directed against non 
candida albicans species. 

The investigators also found NO correlation 
between oral sex, tight fitting pants or use of 
non cotton underwear as causes of recurrent yeast 
infection. This is contrary to what many doctors 
have said. 

Recurrent yeast infection from skin sources

5. Health tip to share - Endometriosis

"I have lived with the pain of endometriosis and 
have had two laparotomy surgeries to treat it, the 
second surgery did not relieve my pain.  My gyne 
physician ordered Lupron(R) (for two years), which 
did relieve the pain, but the Lupron(R) caused 
osteoporosis. I stopped taking Lupron one year ago 
and my endometriosis pain came back.  My primary 
care physician recommended that I increase my 
Caltrate(R) dose (calcium carbonate) from 600 
mg/day to 1200 mg/day to treat my osteoporosis. 
Within two months of the increased dose, my 
endometriosis pain is so much less!! We found a 
good treatment by accident!" - KMS 

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

6. Humor is healthy

"Eternal Truths"

Remember, once you get over the hill, you'll begin 
to pick up speed. 

I love cooking with wine. Sometimes I even put it 
in the food. 

If it weren't for STRESS I'd have no energy at 

Whatever hits the fan will not be evenly 

Everyone has a photographic memory. Some just 
don't have any film. 

Dogs have owners. Cats have staff. 

If the shoe fits......buy a pair in every color. 

Never be too open minded, your brains could fall 

If you look like your passport picture, you 
probably need the trip. 

Bills travel through the mail at twice the speed 
of checks. 

Some days are a total waste of makeup. 

Men are from earth. Women are from earth. Deal 
with it. 

A balanced diet is a cookie in each hand. 

Middle age is when broadness of the mind and 
narrowness of the waist change places. 

Opportunities always look bigger going than

Junk is something you've kept for years and throw 
away three weeks before you need it. 

Experience is a wonderful thing. It enables you to 
recognize a mistake when you make it again. 

By the time you can make ends meet, they move the 

Learn from the mistakes of others.  Trust me...you 
can't live long enough to make them all yourself. 

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

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****** Woman's Health Newsletter *******
              November 16,  2003
Biweekly from BackupMD on the Net

1. Laser skin resurfacing
2. Pelvic muscle exercise to reduce incontinence
3. Reader submitted Q&A - Measuring estrogen
4. Uterine artery embolization
5. Health tip to share - Excessive weight and depression
6. Humor is healthy

1. Laser skin resurfacing

You may have heard of dermabrasion or chemical 
peel as methods to treat your skin to remove 
wrinkles, scars and pigmented areas. Recently, 
dermatologists and plastic surgeons have been 
using lasers to vaporize those outer skin layers 
containing the defects you do not want. This is 
called laser skin resurfacing (LSR) or "laser 
peel," A carbon dioxide (CO2) laser is used to 
remove areas of damaged or wrinkled skin, layer by 
layer. The procedure is most commonly used to 
minimize the appearance of fine lines, especially 
around the mouth and the eyes. However, it is also 
effective in treating facial scars due to acne or 
areas of uneven pigmentation. 

Many physicians feel this technique is better than 
the chemical peels or dermabrasion because the 
depth of skin layer can be much better controlled. 
Thus there is less deep skin damage, bleeding and 
quicker recovery. Only recently have studies been 
performed to see how patients tolerate laser 
resurfacing in the long run. 

Investigators followed 27 patients who underwent 
laser resurfacing for acne scarring or skin 
photodamage. They interviewed them at 
postoperative days 1 and 3, within 1 week, at 3 
weeks, 6 weeks, 3 months, and 30 months and asked 
standardized questions. 

They found that on the first postoperative day 37% 
were concerned about the outcome, one in nine 
patients considered it a "terrible" experience. At 
3.7 days after the procedure, 89% would have the 
procedure again. At 3 months post LSR, the 
patients' mean rating of appearance was 2.3 (0-3 
scale), and all 27 (100%) felt that their 
appearance had been improved by LSR. 

Long term after 30 months:

75% would recommend the procedure, 
71% would have LSR again 
88% felt that their appearance was improved, 
final appearance was rated 1.8 (0-3 scale)

Patients undergoing LSR to treat acne scarring 
were as satisfied as patients treated for 

Hopefully this give you an idea of what to expect 
as far as satisfaction from a laser resurfacing 

Laser skin resurfacing

2.  Pelvic muscle exercise to reduce incontinence

Dr. Arnold Kegel in the late 1940's began 
publishing about the benefits of pelvic exercises 
for female urinary incontinence. his particular 
brand of exercises, Kegel's exercises, have come 
to be a standard non surgical treatment to improve 
urinary continence. Actually Dr. Kegel was much 
more successful than we are today in using the 
pelvic muscle exercises to improve this problem. 
Perhaps his success was based upon excellent 
patient compliance in religiously performing the 
isometric muscle contractions several times a day 
for months at a time. 

A recent study in Hong Kong looked at many 
factors such as age, mode of delivery, menopausal 
status, history of pelvic surgery, duration of 
incontinence, and how well the women adhered 
(compliance) to the muscle exercise regimen. 
Basically they found that almost totally, the best 
predictor of reducing incontinence was the 
compliance rather than any other factor. In other 
words postmenopausal women did as well as 
premenopausal women in reducing urine leakage as 
long as they did their exercises as they were 
supposed to. 

The pelvic muscle training program appears to be 
able to reduce urinary incontinence episodes by 
85%. Although women who had more numerous wetting 
episodes did not become totally dry, those who 
were more compliant with the exercises had a 
greater reduction in leakage episodes. 

This finding is a recurrent theme in the 
literature, i.e., that simple muscle exercises can 
be as effective as surgery if a person is really 
disciplined to carry out the exercises. 

Pelvic muscle exercise to reduce incontinence

3. Reader submitted Q&A - Measuring estrogen

"I am a 70 year old woman and want before starting 
HRT to check my hormone levels. What is better, a 
vaginal smear, blood or urine test? May be 
something else? The doctor recommended 
hysterectomy because of pelvic prolapse." - J. 

Starting hormone replacement therapy at age 70 if 
you have not been taking it before, is somewhat 
late and questionably beneficial. Usually women 
take hormone replacement to prevent hot flashes, 
vaginal dryness and bone thinning. If you have not 
had those problems up until now or if you have 
overcome or survived them, then you should not 
need any replacement therapy. After a hysterectomy 
you can take only estrogen therapy as your hormone 
replacement rather than both estrogen and 
progesterone (HRT), but if you have not taken it 
since menopause in your 50's then the major 
benefits have been lost. To get any of the long 
term benefits of estrogen including the maximum 
protection against rapid bone loss, the therapy 
needs to be started within 5 years of menopause. 

To directly address your question about measuring 
estrogen levels, I would have to say that a blood 
estrogen level (estradiol) is probably the most 
accurate, instantaneous measurement of how much 
estrogen your body is producing. This is true even 
though your ovaries stopped working years ago. 
Estrogen can be made from other body hormones and 
converted to natural estrogen in the skin and fat 

Urine estrogen measurement does not have well 
established norms as to what level a 
postmenopausal women should be at. You can also 
measure salivary estrogens with home hormone test 
kits. The salivary estrogens measure the average 
levels  that were present in your body over the 
last 48 hours. Again the normal ranges for a 
menopausal woman not to have symptoms or to 
prevent osteoporosis are more difficult to come 

Estrogen levels as measured by a maturation index 
of vaginal cells that have been collected like a 
Pap smear, are a very good indication of whether 
any estrogen is actually getting to the lining of 
the vaginal wall. It is more useful when taking 
oral estrogens to see if they are absorbed enough 
to prevent vaginal dryness.It is not a 
particularly good way to measure if the estrogens 
are high enough to prevent hot flashes, for 

4. Uterine artery embolization

Uterine artery embolization (UAE) is a medical x-
ray procedure to block the blood supply to uterine 
fibroids so that they will shrink up and cause 
less symptoms such as pain or abnormal menstrual 
bleeding. It still is in a relatively experimental 
state but UAE has had enough successes that women 
should be aware of it as an alternative to 
surgical treatment of fibroids such as 
hysterectomy or myomectomy (removal of individual 
fibroids without removing the uterus.) 

The procedure of uterine artery embolization is 
carried out by making a small incision in the 
groin and inserting a catheter in the main artery 
to the leg, the femoral artery. The catheter is 
then advanced to the uterine artery under x-ray 
control and a substance called polyvinyl alcohol 
is injected to block the small branches of the 
uterine artery. These in turn cut off the blood 
supply to the fibroids. 

There can be complications of this procedure just 
like any procedure: 

infection requiring hysterectomy
embolization of other organs such as the ovary 
   causing menopause 
loss of ability to have orgasm
failure of the fibroids to be ablated
chronic pain
blood clot in the groin
bleeding from the incision site
bleeding or foul discharge from the vagina
and even death

Of course these are all complications (except 
continued growth or regrowth of the fibroids) that 
one can have from hysterectomy. Since the 
procedure is still somewhat new, we do not have 
good statistics on how often to expect these 
complications compared to hysterectomy or 

Uterine artery embolization

5. Health tip to share - Excessive weight and depression

No one really knows whether depression is a cause 
of overeating and excessive weight or whether the 
excessive weight itself (and body image) causes 
depression. For the most part we just say they are 
associated. But when women have surgical treatment 
of extreme obesity, they have a lower likelihood 
of depression after recovering from the surgery. 
In effect it does not matter whether obesity is a 
cause or effect of depression; losing weight helps 
lessen depression. 

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

6. Humor is healthy

"Another Child"

When Diane found out she was pregnant, she told 
the good news to anyone who would listen. But her 
4-year-old son overheard some of her parents' 
private conversations.  One day when Diane and her 
4-year-old were shopping a woman asked the little 
boy if he was excited about the new baby. 

"Yes!" the 4-year-old said, "and I know what we 
are going to name it, too. If it's a girl we're 
going to call her Christina, and if it's another 
boy we're going to call it quits!" 

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

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****** Woman's Health Newsletter *******
              November 30,  2003
Biweekly from BackupMD on the Net

1. Allergies and allergens
2. Toxoplasmosis infection 
3. Reader submitted Q&A - Breast reduction and lactation
4. Grief and the holidays
5. Health tip to share - Yogurt for yeast infections
6. Humor is healthy
The next newsletter will be in two weeks.

1. Allergies and allergens

Allergies are rising in frequency and it is not 
only allergic asthma and sinusitis/rhinitis that 
are the problems. Allergic skin reactions called 
atopic eczema are becoming more frequent both 
among children and adults. This is characterized 
by redness and peeling of the skin especially on 
the hands but it can be anywhere on the body. 

Many medical scientists blame the rising incidence 
of atopic eczema on the number of chemical 
products that we have been increasingly exposed to 
over the last 40 years. Soaps, detergents, bubble-
baths, gels, cleaning products and even baby wipes 
containing perfume and alcohol are products 
containing many new chemicals that can potentially 
cause an allergic reaction in our skin. 

House dust mites are also a very common allergen 
that not only causes inhalational problems, but 
also can produce skin eczema reactions. Did you 
know that: 

1 in 3 adults now actively suffer from an allergy 

4 in 10 school children have an allergic condition 

Allergic disease is growing 5% per year 

Over 65% of people reported reacting to chemicals 
and perfumes 

Asthma, rhinitis and eczema often caused by house 
dust mite have increased threefold in the last 20 

There are 28,000 house dust mites in an ounce of 

House dust mite droppings enter the body through 
the nose, linings of the eyes and linings in the 
airways of the lungs 

Sitting on a bed or sofa disturbs the house dust 
mite dropping which then stay airborne for at 
least 30 minutes 

The average bed contains more than 10,000 dust 
mites and over 2 million droppings 

The average pillow doubles in weight in six months 
due to the droppings of the house dust mite 

While you cannot totally avoid exposure to 
chemicals that your skin comes in contact with or 
avoid house dust mites altogether, it is worth the 
effort to try to reduce the quantity of your 
exposure. Just lessen your exposure to different 
chemicals and lower your exposure to house dust 
mites as much as you can. 

Allergies and allergens

2.  Toxoplasmosis infection

Toxoplasmosis is a parasite infection that is 
common, but generally unrecognized because it 
causes very few symptoms. Cats can be carriers of 
this infection as well as raw meat from animals 
such as deer (venison), sheep (lamb) and pigs 
(pork). When cats become infected, their feces 
contain the parasites and can be infective at that 
time. Handling cat litter pans or any contact with 
cat feces itself can cause an infection in humans. 
Eating or handling raw meat as listed above or 
even from the knives, cutting boards or cooking 
utensils that come in contact the meat can be 

The typical infection produces either no symptoms 
at all or flu-like feelings "with swollen lymph 
glands, or muscle aches and pains that last for a 
month or more. Rarely, a person with a 'normal' 
immune system may develop eye damage from 
toxoplasmosis. However, most people who become 
infected with toxoplasmosis do not know it." 

Severe infections tend to occur only in 
individuals with compromised immune systems such 
as those on chemotherapy, HIV positive or having 
had a recent organ transplant. Newborn infants can 
be infected from the mother who has been exposed 
shortly before or during early pregnancy. If the 
baby has a congenital infection, it can have eye 
damage including blindness as well as mental 
retardation. This makes it especially important 
for women who are trying to conceive to avoid 
contact with potential sources of toxoplasmosis. 

Preventative steps include:

Wear gloves when you garden
Wash your hands well after outdoor activities
wash hands before you eat or prepare any food 
Wash any cutting boards, sinks, knives, etc. that 
have touched raw meat.  
Cook all meat to an internal temperature of 160° F 

Diagnosis of toxoplasmosis is by blood tests that 
measure antibodies against the organism. You can 
get those blood tests at most public health 
departments in your community or ask your doctor 
to order the tests if you have any symptoms such 
as lymph node swelling, muscle aches lasting more 
than a few days or any flu-like symptoms that seem 
to last longer than 4-5 days. 

Once your body has been exposed to toxoplasmosis, 
it becomes immune to further symptoms or to being 
contagious to others. Mot of the time no treatment 
is needed unless the infection is severe. 

Toxoplasmosis infection

3. Reader submitted Q&A - Breast reduction and lactation

"How safe is Breast Reduction?  Will I still be 
able to breast feed when I get pregnant and have 

I am a 21 year old, healthy, normal menstruation, 
on no medication.  I am not overweight.  My 
breasts are extremely large.  I do a lot of 
running and due to the large size of my breasts, I 
often return with an extreme backache.  I have 
tried wearing sports bras, but they don't seem to 
alleviate the pain. I am so unhappy with the size 
of my breasts - I sometimes feel very depressed." 

Breast size reduction is called reduction 
mammoplasty and is indicated anytime a woman is 
having physical symptoms because of the breast 
size and weight. Macromastia is distinguished from 
large, normal breasts by the presence of 
persistent, painful symptoms such as upper 
backache or neck pain associated with standing, 
sitting or running. Also there can be physical 
signs such as arm nerve numbness, marked breast 
size differences, shoulder grooving and skin 
breakdown/inflammation underneath the breasts. 

There can be complications from the surgery. These 
include numbness of the breast or nipple, 
persistent pain where the breast skin has been 
sutured, Poor appearance of the skin scars, 
infection, bleeding and even blood clots. Rarely 
(less than 1%), there can be loss of the nipple 
due to blood supply that has been cut off and 
there can be an inability to breast feed. 

While having the surgery does not mean you cannot 
breast feed, women who have the reduction 
mammoplasty tend not to breast feed as often or as 
long as women who have not had the procedure. We 
do not know the reasons for this but one study of 
women who started out breast feeding found: 

                Still any breast feeding at
                1 month   6 month   12 months

with surgery       58%      16%       10%
no surgery         94%      58%       42%

For women with breast reduction surgery, the 
median duration of exclusive and any breast feeding 
was 5 days and 2 months, respectively, and 3 
months and 6 months for controls without the 
breast reduction mammoplasty. The results of this 
study suggest that breast reduction surgery has a 
negative impact on breast feeding continuance 
although there are undoubtedly many different 
reasons for this. 

4. Grief and the holidays

While holidays are usually a time of enjoyment and 
celebration, they can be reminders of loved ones 
who are no longer with you. Sadness or grief over 
a person who has died can easily be brought on by 
celebrations, gatherings, meals, and even recipes 
and songs. This is common for many people as the 
reminders trigger thoughts you had suppressed 
during the rest of the year. However, for most 
people, there is not a dread of the holidays 
because of these reminders. 

If the anticipation of grief precedes the holiday 
by weeks or months of if the loss of the loved one 
is recent producing raw hurt feelings, then you 
have to adopt some methods of coping with the 
problem so it does not ruin the holiday for 
others. Coping depends upon whether you are alone 
with those grief feelings or whether you will be 
in the presence of others who share or know of 
your grief. 

If you are alone with your grief, you may need to 
"cancel" the holidays by embarking upon a trip 
away from home or participate in a new event that 
that is unlikely to have the same reminder 
triggers. Volunteerism is another activity that 
does not necessarily avoid the holiday but it puts 
you in a different setting that may help you avoid 
severe pain and sadness. Volunteering for work in 
shelters, prisons, libraries, hospitals or many 
other places can serve as a healthy distraction 
from the grief and pain in your own life. 

If you are not alone in your feelings but are 
going to be in the presence of others who can 
understand how you feel, it may be best to talk 
about your feelings for a little bit just to let 
it not "bottle up". You may want to change some of 
the family traditions to new ones. Sometimes you 
may have to have an escape plan if it becomes too 
intense. The important thing to remember is that 
the grief feelings should get better over time. 

The second holiday after losing a loved one can be 
worse than the first one when you had more 
emotional support and were with the logistics of 
settling an estate. After that, each holiday 
should gradually become less painful. If it does 
not, then you seek professional help. 

5. Health tip to share - Yogurt for yeast infections

"After having several recurrent yeast infections 
and not getting much (or any) relief from oral 
medications or over-the-counter creams, I decided 
to take matters into my own hands and did a little 
research. I found a site that suggested eating 8 
ounces of yogurt everyday to combat this. I 
started doing that and it really worked for me. 
Since then, I have not had a single yeast 
infection. It couldn't hurt to try, if nothing 
else, you will be getting added calcium in your 
diet!" - Doris 

[editor note - Many yogurt brands and some milk 
brands now have lactobacillus acidophillus 
cultures in them. These are the protective 
bacteria for the gastrointestinal tract and 
genital tract. You can also get lactobacillus 
acidophilus in the health food stores in pill form 
if you want to avoid the added calories - FRJ] 

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

6. Humor is healthy

"Dreaded Old Age"

I have always dreaded old age. I cannot imagine
anything worse than being old. How awful it must
be to have nothing to do all day long but stare at
the walls or watch TV? So last week, when the
President suggested we all celebrate Senior Citizen
Week by cheering up a senior citizen, I decided to do
just that. I would call on my new neighbor, an elderly
retired gentleman, recently widowed, and who, I
presumed, had moved in with his married daughter
because he was too old to take care of himself. I baked
a batch of cookies, and, without bothering to call (some
old people cannot hear the phone), I went off to brighten
this old guy's day.

When I rang the doorbell this "old guy" came to 
the door dressed in tennis shorts and a polo 
shirt, looking about as ancient and decrepit as 
Donny Osmond. 

"I'm sorry I can't invite you in," he said when I 
introduced myself, "but I'm due at the Racquet 
Club at two. I'm playing in the semifinals today." 

"Oh that's all right," I said. "I baked you some 

"Great!" he interrupted, snatching the box. "Just 
what I need for bridge club tomorrow! Thanks so 

I continued, "...and just thought we'd visit a 
while. But that's okay! I'll just trot across the 
street and call on Granny Grady." 

"Don't bother," he said. "Gran's not home; I know. 
I just called to remind her of our date to go 
dancing tonight. She may be at the beauty shop. 
She mentioned at breakfast (at which house?) that 
she had an appointment for a tint job." 

So I went home and called my Mother's cousin (age 
83); she was in the hospital ... ... working in 
the gift shop. . .... 

I called my aunt (age 74); 
she was on vacation in China. . 

I called my husband's uncle (age 79). 
I forgot; ...... he was on his honeymoon. .... 

I still dread old age, now more than ever. 
I just don't think I'm up to it. 

Author Unknown

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

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****** Woman's Health Newsletter *******
              December 14,  2003
Biweekly from BackupMD on the Net

1. Sick building syndrome
2. Dyslexia
3. Reader submitted Q&A - Cholesterol levels
4. Obesity and insulin resistance
5. Health tip to share - Cinnamon
6. Humor is healthy
The next newsletter will be in two weeks.

1. Sick building syndrome

Most of us are familiar with situations in which 
people working in a specific building or area 
within a building develop health symptoms which 
they attribute to air contaminants or other 
environmental factors. When the symptoms are 
diagnosed as recognized diseases or as due to 
identifiable airborne contaminants, this is called 
"building related illness". 

When the symptoms or complaints are vague and no 
specific causes such as molds, viruses, bacteria 
or airborne toxins can be identified, this is 
called "sick building syndrome". 

For example, in "sick building syndrome" symptoms 
might include headaches; eye, nose, or throat 
irritation; dry cough; dry or itchy skin; 
dizziness and nausea; difficulty in concentrating; 
fatigue; and sensitivity to odors. These are 
symptoms that are difficult to pin down as to what 
specifically is causing this. Typically, those who 
have symptoms report relief as soon as they leave 
the building. 

With building related illnesses, symptoms are more 
likely to include complaints such as cough, chest 
tightness, fever, chills and muscle aches. 
Recovery time after leaving the building may be 
more prolonged. 

Contributing factors to sick building syndrome are 
thought to be primarily inadequate ventilation, or 
chemical or biological air contaminants from 
indoor or outdoor sources. Those contaminants can 
be things like smoke, carbon monoxide, nitrogen 
dioxide, and volatile fumes from things like 
adhesives, carpeting, upholstery, manufactured 
wood products, copy machines, pesticides, and 
cleaning agents. They can also be biological 
contaminants such as bacteria, molds, pollen, and 
viruses that breed in stagnant water that has 
accumulated in ducts, humidifiers and drain pans, 
or where water has collected on ceiling tiles, 
carpeting, or insulation. 

If you suspect a problem in a building 
environment, you should first report it to the 
owner of the building or your employer if it is a 
place of work. If the problem does not seem to be 
easily solved, and in most cases the cause is not 
easily identified, either your employer or you can 
write to the National Institute of Occupational 
Safety and Health (NIOSH) to ask for their help in 
investigation. They have the authority following a 
written request from employees, authorized 
representative of employees, or employers, to 
determine whether any substance normally found in 
the place of employment has potentially toxic 
effects in such concentrations as used or found. 

Sick building syndrome

2. Dyslexia

Dyslexia is the most common learning disability in 
children. It results from a difficulty in the 
brain's ability to translate written images or 
letters into their meaning in the brain.  These 
children have normal vision and intelligence but 
the inability to recognize the meaning of letters 
or words creates moderate reading and writing 
difficulties. It can also affect math abilities. 

Signs of possible dyslexia in a pre-schooler may 
be starting to talk late, difficulty in adding new 
words to the vocabulary or difficulty in rhyming. 
By first or second grade the difficulty in reading 
and writing becomes more apparent and the child 
usually falls behind the expected level of 
accomplishment for his/her age. The hallmark is 
the inability to recognize written words on a 
printed page. 

While there is no single test to diagnose 
dyslexia, the child may need to be referred to a 
specialist who administers educational tests 
focusing on reading and writing skills. Most 
schools are aware of who those specialists are 
even though there may not be one in your immediate 

If the dyslexia is mild, you may be able to help 
the child at home by reading to him or her often 
and helping the child pronounce letters and spell 
out words. If the dyslexia is more severe, the 
child will need special help in school with 
individual or small group sessions and may even 
need to train for a vocation that does not rely as 
much on reading and writing skills. 


3. Reader submitted Q&A - Cholesterol levels
"Three months ago I was told by doctor and shown 
my medical report checked on cholesterol is as 
high as 215 mg/dl. This cholesterol check was done 
on the spot without fasting a night before. I was 
told to go back for review two months later with a 
fast a night before - I believe this is a more 
thorough and detailed check. During these two 
weeks I was having my jogging and swimming daily 
and took instant oats every morning as breakfast 
with controlling of my diets." 

"Report shows after two weeks:

Total cholesterol drop to 203 mg/dl (5.21mmol/L);
Triglycerides:  51 mg/dl (0.58 mmol/L);
HDL: 80 mg/dl (2.06 mmol/L);
LDL: 113 mg/dl (2.89 mmol/L);
Total Cholesterol / HDL Ratio: 2.5"

"From the above report, do you think my 
cholesterol is still high? Please explain my 
situation in respect of my cholesterol standard. 
And if I am pregnant during this period (during 
the two months) will the above results been 
affected? Such like why my HDL is so high?" 

"Why is it the total of the three elements (HDL. 
LDL. And Triglycerides) do not equal to 203 mg/dl 
as showed in my medical report? What is the right 
way to calculate the total cholesterol?" - ML 

Actually your blood cholesterol values look very 
good to me. It is true that the National 
Cholesterol Education Program wants you to have a 
total cholesterol value lower than 200 but your 
value is only slightly above that (203) and it is 
above that primarily because of a high value of 
the good cholesterol (HDL value of 80). The HDL 
value is the single most important cholesterol 
level for women. As long as their value is above 
45 mg/dl, women are at lower risk for 
arteriosclerotic changes. 

I do not know why your HDL/good cholesterol level 
is high but that is certainly they way you want it 
to be. Estrogens, wine/alcohol and a healthy diet 
are known to raise HDL levels  as well as 
medications including nicotinic acid and some of 
the statin drugs. Pregnancy usually raises 
cholesterol levels but it is mostly because of the 
HDL levels that are increased due to high estrogen 
levels. If you were pregnant when these above 
values were drawn, you would still have good 
cholesterol levels in my opinion. 

The HDL and LDL levels do not add up to the total 
cholesterol because there is a another component 
called VLDL (very low density lipoproteins that 
should add in there to make up the difference. 
They are not generally thought to be good or bad. 

4. Obesity and insulin resistance

Insulin resistance is a condition often considered 
to be a precursor to diabetes. With increasing 
resistance of the body to normal, circulating 
insulin levels, blood sugars become higher and 
higher. The insulin secretion works overtime to 
keep up with the higher glucose levels and when it 
finally lowers the glucose level, it depresses the 
glucose too low resulting in hypoglycemic hunger. 
The hunger in turn makes you eat more and become 
obese. Since being overweight is common and 
insulin resistance is more common in overweight 
individuals and is associated with an increased 
risk for type 2 diabetes mellitus and 
cardiovascular disease, it follows that we need 
some screening tests to determine which overweight 
people are insulin resistant. 

A recent study from Stanford, California looked at 
what metabolic markers could be used to identify 
overweight individuals who are insulin resistant. 
They found that there are three measurements that 
are fairly equivalent in helping to identify 
overweight individuals who may be insulin 
resistant. Those measurements are: 

plasma triglyceride level (fasting) greater than 
130 mg/dL (1.47 mmol/L) 

triglyceride-high-density lipoprotein cholesterol 
ratio of 3 or more (1.8 in SI units) 

fasting insulin level of greater than 15uU/ml (109 

You can get the first two measurements from a 
lipid profile test. These are available for home 
testing. The fasting insulin level would need to 
be ordered by your doctor. If any of the above 
values are abnormal, it is very important to your 
health to begin a weight reduction diet. You may 
prevent the early onset of diabetes or heart 
disease or both. 

Obesity and insulin resistance

5. Health tip to share - Cinnamon

"I skipped a period one month then had one the 
next month, and 17 days later started another 
period of heavy bleeding with lots of clots, this 
lasted over 3 weeks, I used cinnamon 1/4 tsp in 
eggnog, on toast and drank cinnamon tea, the 
bleeding stopped in two days." -    fm 

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

6. Humor is healthy

"The Rules of Chocolate"

If you've got melted chocolate all over your 
hands, you're eating it too slowly. 

Chocolate covered raisins, cherries, orange slices 
and strawberries all count as fruit, so eat as 
many as you want. 

The problem: How to get 2 pounds of chocolate home 
from the store in hot car. The solution: Eat it in 
the parking lot. 

Diet tip: Eat a chocolate bar before each meal. 
It'll take the edge off your appetite and you'll 
eat less. 

A nice box of chocolates can provide your total 
daily intake of calories in one place. Isn't that 

If you can't eat all your chocolate, it will keep 
in the freezer. But if you can't eat all your 
chocolate, what's wrong with you? 

If calories are an issue, store your chocolate on 
top of the fridge. Calories are afraid of heights, 
and they will jump out of the chocolate to protect 

If you eat equal amounts of dark chocolate and 
white chocolate, is that a balanced diet? Don't 
they actually counteract each other? 

Money talks. Chocolate sings.

Chocolate has many preservatives. Preservatives 
make you look younger. 

Q. Why is there no such organization as Chocoholics
A. Because no one wants to quit.

If not for chocolate, there would be no need for 
control top pantyhose. An entire garment industry 
would be devastated. 

Put "eat chocolate" at the top of your list of 
things to do today. That way, at least you'll get 
one thing done. 

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

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****** Woman's Health Newsletter *******
              December 28,  2003
Biweekly from BackupMD on the Net

1. Flu FAQs
2. Echinacea not effective for kids colds 
3. Reader submitted Q&A - Psoriasis
4. Polycystic ovarian syndrome 
5. Health tip to share - Urinary frequency and milk
6. Humor is healthy

1. Flu FAQs

The particular strain of flu that is most active 
is called the Fujian strain. Even though this year 
there is a mismatch between the vaccine flu strain 
(not the Fujian strain) and the most commonly 
occurring Fujian strain of flu virus, there is 
still some cross protection against contracting 
flu. Also, the Fujian strain only accounts for 
about 70-80% of the episodes of flu. The other 20-
30% are covered by the flu vaccine. 

People who are recommended to receive the flu-shot 

Children age 6 months to 23 months 
People over the age of 65 
Anybody with a chronic medical condition 
Women in the second or third trimester of pregnancy

Those people who are the next highest priority for 
vaccination are: 

Anybody who shares a home with an 
immunocompromised person 

Health care workers 

There is a flu immunization that is administered 
through a nasal spray rather than a shot. It is 
called Flu-Mist. It contains a live virus so that 
sometimes the nasal immunization produces more 
symptoms, such as a runny nose, sore throat, 
headache, or cough, than the shot vaccination. It 
is not recommended for those with a chronic 
medical condition or who are on immunosupressive 

This year's flu strain seems to be hitting 
children unusually hard. Children who have not 
been vaccinated before are recommended to have two 
doses of the flu shot since they often do not 
develop a high enough antibody level the first 
time. After a child is vaccinated for one season, 
he or she only needs to get one dose a year in 
succeeding years. 

What should you do if you are not immunized 
against the flu this year and are either exposed 
to someone who has the flu or start developing flu 
signs such as fever, muscle aches or extreme 
fatigue? If you are in a high risk group such as 
those mentioned above, then see your doctor who 
may decide to try to lessen your symptoms by using 
one of the antiviral medications such as 
Flumadine, Tamiflu, and others. If you are not in 
a high risk group you may just as well try to ride 
it out without any medication. Watch out for any 
post-flu problems, however. If you do not recover 
within 5-7 days after symptoms start or you 
develop a persistent fever or productive cough, 
see your doctor. A post-flu pneumonia can be a 
serious problem. 

2.  Echinacea not effective for kids colds 

Echinacea is used as a herbal preparation from the 
Purple Cone flower that grows in North America. It 
has been touted as useful to prevent and treat 
upper respiratory tract infections such as colds. 
The evidence has not been very good that it 
actually works to prevent colds but there is some 
indication that perhaps it can shorten the 
duration of cold symptoms. 

A recent study from the University of Washington 
reported in the Journal of the American Medical 
Association (JAMA) administered echinacea to 
children between the ages of 2-11 each time they 
developed any cold symptoms. Half of the children 
received a placebo while the other half were given 
an echinacea supplement. The investigators 
measured the duration and severity of symptoms as 
well as the number of days of fever or time to 
peak severity of symptoms. 

Less than 20% of children made it through the 4 
month study period without developing any colds. 
The remainder of the children developed one or 
more colds and received either placebo or 
echinacea. Of the children who developed colds, 
the median duration was 9 days of symptoms in that 
4 month period. 

The investigators found no difference in the 
length or severity of upper respiratory tract 
symptoms between the children who received 
echinacea and those who did not. Also, there was 
no difference in the rate of adverse events 
reported in the 2 treatment groups; however, a 
rash occurred during 7.1% of the colds treated 
with echinacea and only 2.7% of those treated with 
placebo. Therefore in view of the ineffectiveness 
of echinacea in shortening cold symptom duration 
in children and the increased rate of skin rashes, 
it does not seem wise to use it for that purpose. 

Echinacea for use with colds

3. Reader submitted Q&A - Psoriasis
"Despite a great diet and following advice of many 
sources, I still have psoriasis and it is 
spreading from knuckles to elbows, etc.  Where 
does it come from?  What can I do?" - AAC 

The cause of psoriasis is still a mystery. We do 
not know where it "comes from". We know that 
psoriasis involves an immune reaction in which 
white blood cells called T cells are put into 
action in large quantities by some unknown 
stimulus. These T cells are supposed to help the 
body fight infection but in this case their 
massive numbers just cause inflammation of the 
skin and a high turnover of skin cells which 
produces the flaky, reddened lesion of psoriasis. 

Conditions that may cause flare ups of psoriasis 
include infections, stress, and climate changes 
that dry the skin. Sometimes certain medicines 
such as lithium for depression or beta-blockers 
prescribed for high blood pressure, may trigger an 
outbreak or worsen the disease. Any toxin (eg. 
metals such as mercury) or allergy to foods or 
herbal supplements that produce eczema (atopic 
dermatitis) will worsen or flare psoriasis. 

You sound like you have done the things 
recommended by doctors for the psoriasis and most 
of the doctors will probably tell you that there 
is nothing else you can do such as dietary change 
or skin exposure change to lessen psoriasis 
flares. I think, however, that if I had psoriasis,  
I would be sure I did not have any food allergies 
or exposure to heavy metals or toxins by using 
some of the home test kits that check for these 
things. Then if any of them were positive, I would 
seek medical confirmation of those allergies or 
exposures and take action to avoid eating or 
contact with substances that might be producing a 
skin reaction of any type. 

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