Women's Health Newsletters 4/4/04 - 6/13/04
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********** Health Newsletter ***********
April 4, 2004
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Lead can be hazardous to your health
2. Legumes - an alternative to meat
3. Reader submitted Q&A - Fainting upon standing
4. Vulvar vestibulitis and semen allergy
5. Health tip to share - Interstitial cystitis diet
6. Humor is healthy
The next newsletter will be in two weeks.
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1. Lead can be hazardous to your health
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Lead is a metal salt that can accumulate in the
body if the lead containing particles get in your
stomach. It does not come from food but rather
from dust or small particles of lead paint, lead
solder in water pipes (usually installed before
1986), stained glass, curtain weights, foil,
fishing weights, batteries, linoleum, plaster,
leaded gasoline fumes and putty among other
things. A very small amount of lead can cause
medical symptoms.
While lead poisoning can produce paralysis,
seizures, coma and even death, such high levels
are rarely seen today. More commonly symptoms from
lower levels of lead toxicity can be seen
including muscle pains, fatigue, irritability,
difficulty concentrating, tremors, headaches and
stomach upset. These symptoms can be caused by
many other conditions so blood levels of lead are
rarely tested for by doctors. However if there is
any suspicion of exposure to lead containing
substances, testing is indicated.
There are home testing kits that measure heavy
metal concentration in hair or finger nail
samples, since the metals tend to accumulate in
the body but these are just screening tests. If
there are any abnormalities on such a screening
test then blood levels need to be performed.
Children are more susceptible to lead toxicity
because their brain and spinal cord systems are
more actively growing and these are tissues that
lead attacks. But adults can be exposed just as
much and since the body accumulates it, older
individuals can have more of a chronic, low grade
exposure.
Lead can be hazardous to your health
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2. Legumes - an alternative to meat
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Legumes are vegetables such as beans, peas,
lentils, chickpeas, navy beans, black-eyed peas,
peanuts and soy beans (also tofu, soy milk,
tempeh, soy flour). They are higher in protein
than many of the other vegetables but more
importantly, as members of the vegetable family
(and except for peanuts) they are low in fat and
cholesterol compared to meat. Thus they can easily
serve as meat substitutes in your diet.
When shopping for legumes:
shop in ethnic markets for less common and a
greater variety of legumes
look for legumes of a uniform size and condition
so they cook more evenly
choose legumes with a deep, almost glossy color
which indicates they have not been stored
excessively long
purchase legumes from a source with high turnover
usually where they are sold in bulk
Also be sure to store what you bought in a cool,
dry place out of direct light. Rinse the legumes,
remove misshapen beans and soak over night before
cooking.
The only down side of increasing legume intake
would be in people who are allergic to them,
especially to soy or peanuts. You need to know
this prior to increasing them in your diet or if
you seem to have more stomach, breathing or skin
problems after switching to them, then you may
also want to consider that you have a food
allergy. Additionally some people form more gas
when they switch to increased legumes, a food
supplement product such as Beano(R) regularly with
a high percentage legume containing meal may solve
that problem,
Legumes - an alternative to meat
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3. Reader submitted Q&A - Fainting upon standing
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I black out frequently when I go from a low
position, ie. stooping down to get something from
the low shelf in a grocery store, to standing. I
have had this problem my entire life. It is not
related to the amount of food I have had that day,
water, stress, etc. The fainting spells have been
a part of me my entire life... I can remember
fainting in church as a little girl when we would
have to go from kneeling to standing, etc." -
Cathy
One cannot diagnose a specific condition such as
this without examination and medical studies.
There can be multiple causes ranging from heart
rate abnormalities or heart valve disease to brain
or large blood vessel problems among many other
things. However, the fact that you have had this
all of your life might indicate it is not a
serious progressive disease condition but rather
something you were born with or acquired very
early in life. This can include congenital heart
problems or benign brain lesions so you should be
checked out by your physician for these. I assume
you have already done that.
This description of fainting (syncope) when
standing up suddenly allows us to discuss a not
too uncommon condition variously called vasovagal
syncope or neurocardiogenic reaction. Many times
the cause of fainting when rising is just an
exaggerated physiologic response as blood drains
more down toward your feet. Your heart rate is
supposed to go up and blood vessels going to the
brain constrict so you do not lose blood supply to
the brain. However, with a vasovagal response,
almost the opposite takes place. The heart rate
goes down instead of up because of stimulation of
the vagus nerve. Thus the blood supply to the brain
is less and you "pass out" or feel very
lightheaded and dizzy because of it.
Why does the vagus nerve become stimulated when
one goes from sitting to standing? Some think it
is because of holding one's breath and straining
the neck muscles that stimulate the main arteries
in the neck where the vagus nerve inserts (carotid
sinus). Other doctors point out that even if you
slowly rise and do not strain (valsalva), many
individuals still get fainting spells upon rising.
In fact the doctors have a test for this condition
called a tilt-table.
For a tilt table test, the head of the bed on
which a person is lying is raised to about 60
degrees to see if spontaneous dizziness occurs.
The dizziness or even fainting may not start right
away but rather after several minutes to twenty
minutes or more. People who have a positive tilt
test may need to have medical treatment if they
have chronic, recurrent syncope, although there
does not appear to be one clearly superior medical
treatment for vasovagal syncope.
Aside from seeing a good cardiologist or
neurologist, I would suggest at least drinking
plenty of fluids and using ample salt in the diet
to fully expand the vascular system; rise slowly
while slowly exhaling the air from your lungs and
avoid any neck movement when going from stooping,
kneeling or sitting if possible. Breath very
regularly, paced, after rising to prevent any
vagal nerve stimulation. Throw away all of your
tight collared blouses or turtle necks.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Vulvar vestibulitis and semen allergy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Vulvar vestibulitis is an infrequent, but
disabling condition characterized by burning skin
at the entrance to the vagina. It is often made
worse by sexual intercourse although the skin can
be sensitive to almost any touch. When doctors
look at skin biopsies from that area in women who
have this condition, they see an inflammatory
response similar to an allergic reaction rather
than any bacterial or fungal infection. In spite
of this, the cause of vulvar vestibulitis is
unknown.
In a recent study from New York, investigators
looked at whether or not women with vulvar
vestibulitis had antibodies (immune E globulins)
to semen from men. They compared blood samples
from these women to blood samples from women who
did not have vulvar vestibulitis.
About 31% of the women with vulvar vestibulitis
had antibodies to semen and only 5% of the normal
women had antibodies. Of the women who were
antibody positive, 44% had worsening of symptoms
right after intercourse while 11% of the
immunoglobulin E negative women had post sex
symptoms. Worsening of symptoms after a yeast
infection was present in 31% of women with
positive antibodies and in only 3% of women with
negative antibodies.
Thus in this study, it appears that an allergy to
semen MAY play a role in vulvar vestibulitis. The
authors concluded that "A subset of women with
vulvar vestibulitis syndrome are sensitized to
seminal fluid, and an allergic reaction to seminal
fluid may be associated with the initiation and
persistence of their symptoms." I would guess this
subset to be about 15% of women with vulvar
vestibulitis who are possibly having an allergic
reaction to semen as the primary cause of their
symptoms. In truth, we do not know this for sure
yet and can only guess.
Vulvar vestibulitis and semen allergy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Health tip to share - Interstitial cystitis diet
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"For Interstitial Cystitis I have tried numerous
drugs and procedures from two different urologists
and finally told to learn to live with the pain.
Upon searching the Internet for a better solution,
I came upon a Yahoo group called ICPuzzle. There
I found the help of Amrit Willis and her able co-
moderator, Jeanne Karow, who directed me to a
number of very helpful things to do. The chief of
these being changing my diet to help alkalize my
system. I read The pH Miracle and another book
called Alkalize or Die. After following their
recommendations not only is my IC under complete
control, but the fibromyalgia that I've dealt with
for the past four years is so much better that I
have returned to work! It seems acidosis is the
underlying problem for me with these two
conditions. As long as I maintain a more alkaline
base, I'm good to go! Hope this helps many, many
others like me!" - Lisa
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6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"The Mommy Test"
I was out walking with my then 4 year old
daughter.. She picked up something off the
ground and started to put it in her mouth.
I asked her not to do that.
"Why?" "Because it's been laying outside
and is dirty and probably has germs." At this
point, she looked at me with total admiration
and asked, "Wow! How do you know all this
stuff?"
"Uh," I was thinking quickly, " . . . everyone
knows this stuff. Um, it's on the Mommy test.
You have to know it, or they don't let you be
a Mommy."
"Oh."
We walked along in silence for 2 or 3 minutes,
but she was evidently pondering this new
information.
"I get it!" she beamed. "Then if you flunk, you
have to be the Daddy."
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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
********** Health Newsletter ***********
April 18, 2004
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Survival after initial diagnosis of Alzheimer's
2. Acupuncture for chronic headaches and migraines
3. Reader submitted Q&A - Weight and the joints
4. When to end cancer treatment
5. Health tip to share - Preventing cystitis
6. Humor is healthy
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1. Survival after initial diagnosis of Alzheimer's
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If a loved one is suddenly diagnosed with
Alzheimer's disease, it is important for a
caregiver and relatives to know what to expect.
How long will someone with Alzheimer's live? Are
there risk factors that are associated with a
shorter or longer time to live?
A recent article in the Annals of Internal
Medicine looked at a community based population of
23,000 men and women 60 years of age or older who
were living in the Seattle, Washington area
between 1987-1996. All were felt to be free of
Alzheimer's disease at the time of entry into the
study. The investigators then identified 521
people who were newly diagnosed with Alzheimer's
disease (AD) during the years of the study. They
looked at how long those individuals lived after
the initial diagnosis and what risk factors they
had that affected how long they survived after the
AD diagnosis.
Men lived on the average 4.2 years after the
initial diagnosis of AD and women lived 5.7 years.
This was significantly less than their life
expectancy at the time. Those men and women who
had Parkinson like tremors, gait (walking)
disturbance, history of falls, congestive heart
failure, ischemic heart disease, or diabetes at
baseline tended to die even sooner than the
average. Those who did not have those risk factors
and who did not have as severe "thinking"
(cognitive) problems at the time of diagnosis
lived slightly longer than the averages.
These data can be used to give caregivers of
Alzheimer's patients an idea of what to expect as
far as survival of a loved one with AD. While
there is no way to fully prepare for a relative
with Alzheimer's, knowing what to expect in terms
of survival is one element among many.
Survival after initial diagnosis of Alzheimer's
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2. Acupuncture for chronic headaches and migraines
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Many patients with chronic headaches miss work,
use a moderate amount of pain medication and
overall have reduced health that can influence
other daily activities. Both doctors and patients
look for other non medical treatments to help cope
with frequent headaches, both chronic tension
headaches and migraines. One such treatment is
acupuncture which is commonly prescribed for
chronic headaches in Great Britain, Canada and
China.
Randomized clinical medical trials using
acupuncture for headache treatment have been
conducted in the past and the evidence that
acupuncture is beneficial is not clear. The
results of such trials slightly favor
acupuncture's use but better clinical trials are
felt to be needed.
One such recent randomized trial in England looked
at over 400 patients who were having at least two
headaches a month. They assigned half of the group
to have 3 months of acupuncture treatment
supplemented with whatever medicines they were
already prescribed. The other half was told to
avoid acupuncture and to use only the medicines
they were prescribed during the normal course of
their doctor's visits.
The group receiving acupuncture (compared with
controls) had 22% fewer days of headache per year,
used 15% less medicine, had 25% less visits to
their general practitioner and took 15% fewer sick
days from work. The improvement in fewer headaches
persisted even after the end of the 3 months of
treatment. Patients with migraine headaches seemed
to improve slightly more than the patients with
chronic tension headaches.
These are not massive improvements, but
improvements nevertheless. The study led the
authors to conclude that acupuncture can be an
important alternative to just using headache
medicines for control of chronic symptoms and to
decrease time lost from work.
Acupuncture for chronic headaches and migraines
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Weight and the joints
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I am 45 years old and over weight, actually
obese. I have been over weight for approximately
11 years. Before that I was average weight and
had been for my whole life. I have noticed over
the past year or so that I can literally no longer
bend my knees very far. I have trouble getting in
and out of the car as well as walking. This seems
so strange to me. I am sure it has to do with
being over weight but I would like to know what
the cause of this condition is if you know. I
also would like to know if it is reversible. Will
it get better if I lose weight?" - Lori
Limitation of knee joint range of motion which
affects getting in and out of the car as well as
walking probably comes from two sources:
1) pain from the knee joints, knee ligaments or
leg muscles themselves
2) weakness of the leg muscles for the weight they
have to support
What you describe is quite common when a person
continues to gain weight or even has a sudden
increase and then stabilization of body weight.
The difficulty may start fairly soon after the
weight gain when the muscles do not have the
constant strength to lift more weight. However,
movement difficulty may not appear right away with
weight gain but rather later, as the joint
cartilage wears down causing an osteoarthritis of
the major support joints such as the knees and
lower back.
I would guess that you may also have difficulty in
your lower back range of motion and physical
discomfort if weight is the main culprit. If the
back is fine but the knees are the only problem, I
would ask if you ever had a history of knee injury
in the past that may contribute now to the overall
problem because age, obesity and previous injury
are the major risk factors for osteoarthritis.
There have been studies of taking the supplement
glucosamine and/or chondroitin sulfate to help
restore damaged knee cartilage. Thus you may want
to go to your doctor to see if any x-ray studies
are indicated to look for loss of joint space
(damaged knee cartilage) in the knees.
The question you ask about will this knee joint
difficulty reverse if you lose weight is an
interesting one. In general, arthritis damage to
the joints, if indeed that has already taken
place, does not usually reverse. As I mentioned
the only evidence for reversal I know of is to use
glucosamine supplements for up to three years
before you can improve the joint space in the
knees. On the other hand, from studies of massive
weight loss such as that seen with the gastric
bypass surgery for obesity, over 3/4s of those
patients report a significant improvement in how
they feel physically and how they get around after
the weight loss. The muscles were used to moving
around 50-60 pounds more on the average and when
that weight is gone, the relative muscle strength
is greatly improved.
I would have to say that for the most part, weight
loss will improve how you feel getting in and out
of the car. It may not make everything go to the
level of how you felt 11 years ago but more likely
than not you will be happier with how you feel
physically if you can get a large amount (15%) of
your weight reduced.
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4. When to end cancer treatment
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
It is often a medical axiom that, excluding
accidents and trauma, all people will eventually
die from vascular disease (stroke or heart
attacks) or from cancer. Infection as a cause of
death is much less common than it once was due to
our modern day antibiotics. Since many people end
their lives with cancer and since modern medicine
can prolong life to the point it is only
prolonging misery, it is important to have a sense
of when cancer treatment should end.
The goals of a patient with cancer change as
treatment for cure either works or does not.
Initially everyone involved has the goal to cure
the cancer so the body is rid of it absolutely.
When it becomes obvious that the cancer is so far
spread it will not be cured or if it has come back
after an initial curative treatment, then the goal
may shift to just prolonging life as long as
possible by "beating back" as much of the
malignant tissue growth as possible. Finally, the
growth of the cancer may not be able to be kept in
check and the treatment goal becomes to just
provide comfort care as one is in the process of
dying.
With the final goal of comfort care only, curative
treatments are stopped and one must make sure the
side effects of any further medicines are not just
making the process of dying more miserable than it
needs to be. This is a time patients should focus
on family and relationships exclusively and not on
a cure. The popular book "Tuesdays with Morrie"
points out how positive even the process of dying
can be.
The decision to quit seeking a "cure" for the
cancer is not easily reached in the real world.
Doctors may not be sure there is no hope of a cure
left or the cancer patient may not want to give up
that "hope" of a cure even though the physician
indicates he or she believes that cure is
extremely unlikely. The treatment decisions, side
effects and comfort care alternatives need to be
fully discussed with both physicians and
relatives. This needs to be done, if possible,
while the cancer patient can still make rational
decisions.
Once the decision is made to stop seeking a cancer
cure, discussing this with remaining family
members or friends is an important part of the
process. The talking about it itself can provide
comfort to the dying patient. It also allows the
family to know what to expect and how to accept
the inevitable death themselves. It give them more
time to adjust emotionally. Discussing advance
directives with them will help ensure that wishes
after loss of decision making abilities have gone
are carried out. It is best to have someone
appointed to make health care decisions after a
cancer has made one unable to make those him or
herself.
Stopping active cancer treatment does not mean the
cancer patient will die immediately. There often
will be many months left for activities that can
be spiritually uplifting. Final days should be
spent at home as much as possible or in a hospice
if there is less than 6 months of expected life.
Sometimes a nursing home or hospital is the only
choice but it is best to plan this out as much as
possible before that time comes. The following
article at Mayo Clinic .com is quite helpful to
begin one thinking about these end of life
situations.
Ending cancer treatment
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5. Health tip to share - Preventing cystitis
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I never see this simple solution for preventing
cystitis. If a woman doesn't have enough
lubrication during sex, this can lead to this
infection. The minute you feel yourself getting
too "dry" stop and use a lubricant. I finally
figured this out after years of problems. I have
passed this info to other women who said this
worked for them also." - N.J.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Murphy's Laws On Work"
Everything can be filed under 'miscellaneous.'
Never delay the ending of a meeting or the
beginning of a cocktail hour.
To err is human, to forgive is not company policy.
Important letters that contain no errors will
develop errors in the mail.
There is never enough time to do it right the
first time, but there is always enough time to do
it over.
If you are good, you will be assigned all the
work. If you are really good, you will get out of
it.
If it wasn't for the last minute, nothing would
get done.
At work, the authority of a person is inversely
proportional to the number of pens that person is
carrying.
No one gets sick on Wednesdays.
The longer the title, the less important the job.
Once a job is fouled up, anything done to improve
it makes it worse.
Success is just a matter of luck, just ask any
failure.
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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
********** Health Newsletter ***********
May 2, 2004
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Premenstrual flare of facial acne
2. Low dose contraceptives and stroke risk
3. Reader submitted Q&A - Hashimoto's thyroiditis
4. Depression during pregnancy
5. Health tip to share - Weight loss
6. Humor is healthy
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1. Premenstrual flare of facial acne
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Many skin conditions such as atopic dermatitis,
lupus erythematosus, infections due to herpes
virus, hives (urticaria) and acne have all been
reported to flare-up or worsen in the last 1-2
weeks of the menstrual cycle. Even women who have
allergies or skin sensitivity to nickel metal on
jewelry are reported to have worse reactions in
the last half of the menstrual cycle. It also
appears that women 35 or older may have worse acne
flaring than younger women.
While not every woman who has acne gets a
premenstrual flare, it has been reported that
about 40-70% of women do have worsening. A recent
study of women with acne actually measured the
number and size of facial acne lesions and
documented that 63% of them had, on the average, a
25% increase in the number of acne lesions in the
two weeks immediately prior to their menses.
The hormonal effect on acne is not totally clear.
Estrogen alone seems to improve acne, probably
because it inactivates some blood testosterone by
protein binding. In the second half of the
menstrual cycle, progesterone and a small amount
of testosterone are also present in addition to
estrogen. It is suspected that it is the
testosterone that is responsible for acne flares
but no one knows for sure how much of a role
progesterone plays.
Birth control pills generally improve acne. For
example studies with taking the birth control pill
equivalent to Ortho Tri-Cyclen(R) show that about
80% of women with acne have significant reduction
in lesions while only about 3-4% have a worsening
of acne or start new lesions. The oral
contraceptives, and probably the patch and vaginal
ring contraceptives, reduce both ovarian and
adrenal gland testosterone production. This is
probably the mechanism by which they improve acne.
Premenstrual flare of facial acne
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Low dose contraceptives and stroke risk
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
There is always concern about the use of hormones
and risks of blood clots (thrombosis). Post
menopausal estrogen use has a very small, but
real, increased risk for strokes. The higher dose
oral contraceptives that used to be marketed also
had a risk of stoke and other thrombosis events.
However, studies about the current lower dose oral
contraceptives tend to support that there is
either no increased stroke risk or a very low
risk.
A recent review of the medical literature by
Toronto physicians and scientists concluded also
that there is either a zero or a very low risk of
strokes from modern low dose birth control pills.
They looked at over 20 large studies of women
taking low dose oral contraceptives compared to
women who did not take them. It is important to
keep in mind that the age-adjusted incidence of
stroke in the reproductive age population is less
than 1.5 per 10,000 people. A doubling of the rate
might sound very serious but the chance of any
individual having a stroke is still extremely
small.
Low dose contraceptives and stroke risk
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Hashimoto's thyroiditis
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I have Hashimoto thyroid disease. Is it common to
have spells where I wake up totally wet and really
hot? I take 5m Synthroid(R) daily in the
mornings. Thank you,"
"Age 56 , hysterectomy at age 36 (endometriosis),
Detrol(R), Synthroid(R), Vioxx(R), Nexium(R),
weigh 140 lbs. have problems with anemia and had
an iron transfusion two years ago." - Wanda
Hashimoto's Thyroiditis is an autoimmune thyroid
disease. The body's own immune system which should
protect you from infection somehow gets
misdirected and actually starts attacking the
thyroid gland. It destroys some of the thyroid
gland function so that you actually become
hypothyroid or low thyroid. That is why you are on
the Synthroid. Hypothyroidism alone would give the
opposite effect of what you describe with the
night sweats; it would make you chill easier, not
be hot. Therefore it would be very uncommon to
have night sweats from Hashimoto's thyroiditis
alone.
More likely causes of what you describe would be
from
1) taking too much thyroid replacement,
2) menopause in which your ovaries have finally
stopped functioning,
3) reaction to one of your other medications or
4) sometimes just unknown reasons.
As far as your thyroid replacement dose goes, I am
not familiar with the "5 m" dose you described. If
it refers to 5 mg (milligrams) then it is an
extremely high thyroid dose. Excess thyroid
replacement can cause symptoms of hyperthyroidism
such as insomnia, irritability, weight loss
without dieting, heat sensitivity, increased
perspiration, thinning of your skin, fine or
brittle hair, muscular weakness, eye changes,
rapid heart beat and hand tremors.
If the Synthroid(R) dose you are on is 5
micrograms, then it is an extremely low dose and
you may not be receiving enough. This is something
you should have checked to make sure you are
taking the right amount. You might begin by asking
your pharmacist what dose you are on and whether
it is a typical dose. If there is any question
about it you should see your doctor again.
If the doctor did not remove the ovaries at the
time of your hysterectomy, then menopause might be
the main cause of your night sweats. The doctor
can check a serum FSH level and if it is elevated,
then the ovaries are no longer working.
I doubt if the Detrol(R) is causing night sweats.
It is more likely to cause constipation, dry mouth
or vision problems. Nexium(R) also does not
usually cause night sweats. Gastrointestinal
disturbances or headaches may result from taking
Nexium(R) but the night sweats are probably due to
something else.
Menopause is the most likely explanation for what
you describe but there can be other causes of
night sweats so you should consult with your
doctor about them.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Depression during pregnancy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
While pregnancy is a time of joy for many women,
sometimes it brings overwhelming feelings of
unexpected or unwelcome responsibility. This can
result in clinical depression rather than an
exciting positive outlook. The prevalence of
depression during pregnancy has not been well
established so investigators from Toronto, Canada
looked at different studies in the medical
literature. These studies used various written
tests as well as structured interviews by trained
investigators to discover how often pregnancy was
associated with depression and when in pregnancy
it was likely to manifest. The studies identified
and tested over 19,000 women in various stages of
pregnancy.
The occurence of depression was 7.4% during the
first 3 months of pregnancy, 12.8% during the
second 3 months of pregnancy and 12.0% during the
final 3 months of pregnancy. These are quite
substantial numbers of women and have
ramifications for treatment.
With the tendency to treat most depression
symptoms with medications rather than counselling,
this means that many infants will have been
exposed to anti-depression medications, usually
SSRIs (selective serotonin reuptake inhibitors).
Although we currently consider the SSRIs probably
safe to take during pregnancy, whenever there are
millions of pregnant women on a drug, we worry
about possible unknown effects on the unborn
fetus. I still think that pregnant women should
strive to take the least amount of medications
during pregnancy as possible.
Depression during pregnancy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Health tip to share - Weight loss
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Diet programs can be discouraging when you realize
that most dietary weight loss is regained within a
couple of years. However Weight Watchers
International Program is more successful than
others. They report a 75% maintenance of weight
loss over two years and about 50% maintenance of
weight loss over 5 years. Year in and year out,
this is the most successful diet program available
and the long term results, while not perfect, are
well worth trying for. - FRJ
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Martha's Way Vs My Way"
Martha's way #1: Brush some beaten egg white over
pie crust before baking to yield a beautiful
glossy finish.
My way: The Mrs. Smith frozen pie directions do
not include brushing egg whites over the crust and
so I don't do it.
Martha's way #2: Place a slice of apple in
hardened brown sugar to soften it.
My Way: Brown sugar is supposed to be "soft?"
Martha's way #3: When boiling corn on the cob, add
a pinch of sugar to help bring out the corn's
natural sweetness.
My Way: The only kind of corn I buy comes in a
can.
Martha's way #4: To determine whether an egg is
fresh, immerse it in a pan of cool, salted water.
If it sinks, it is fresh, but if it rises to the
surface, throw it away.
My way: Eat, cook, or use the egg anyway. If you
feel bad later, you will know it wasn't fresh.
Martha's way #5: Cure for headaches: Take a lime,
cut it in half and rub it on your forehead. The
throbbing will go away.
Martha, dear, the only reason this works is
because you can't rub a lime on your forehead
without getting lime juice in your eye, and then
the problem isn't the headache anymore, it is
because you are now blind.
Martha's way #6: Don't throw out all that leftover
wine. Freeze into ice cubes for future use in
casseroles and sauces.
My way: Leftover wine?
Martha's way #7: If you have a problem opening
jars: Try using latex dishwashing gloves. They
give a non slip grip that makes opening jars easy.
My way: Go ask the very cute neighbor to do it.
Martha's way #8: Potatoes will take food stains
off your fingers. Just slice and rub raw potato on
the stains and rinse with water.
My way: Mashed potatoes will now be replacing the
antibacterial soap in the handy dispenser next to
my sink.
Martha's way #9: Now look what you can do with
Alka Seltzer. * Clean a toilet. Drop in two Alka-
Seltzer tablets, wait twenty minutes, brush and
flush. The citric acid and effervescent action
clean vitreous china.
*Clean a vase. To remove a stain from the bottom
of a glass vase or cruet, fill with water and drop
in two Alka-Seltzer tablets.
*Polish jewelry. Drop two Alka-Seltzer tablets
into a glass of water and immerse the jewelry for
two minutes.
*Clean a thermos bottle. Fill the bottle with
water, drop in four Alka-Seltzer tablets, and let
soak for an hour (or longer, if necessary).
My way: Put your jewelry, vases, and thermos in
the toilet. Add some Alka-Seltzer and you have
solved a whole bunch of problems at once.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
********** Health Newsletter ***********
May 16, 2004
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Infections from household pets
2. Men's reaction to erectile dysfunction and Viagra(R)
3. Reader submitted Q&A - Calcifications on mammogram
4. Lactose intolerance is different than food allergy
5. Health tip to share - Natural and herbal
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Infections from household pets
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
While household pets may be beneficial to your
health by reducing stress and blood pressure, they
can also carry infectious diseases that you should
be aware of. Most adults will not have life
threatening symptoms from an infection contracted
from a pet. However, household members who may be
at serious life threatening risk would be anyone
under 5 years of age, the unborn child of a
pregnant woman and anyone whose immune system
might be compromised such as having HIV,
hepatitis, on chemotherapy or having had a kidney
transplant.
Dogs and cats can transmit diseases especially if
they spend much time outdoors where they may be
exposed to live wild animals or their carcasses,
birds and reptiles or the insects that infest
them. Some of the concerns for infections from
different possible pets include:
Dogs - rabies, roundworms (toxocariasis parasites)
Cats - rabies (from bites by raccoons, bats,
cattle, rabbits, skunks, foxes), cat scratch
disease, toxoplasmosis, Q fever
Rabbits - tularemia, rabies
Birds (including parrots, macaws, cockatiels and
parakeets) - psittacosis, cryptococcosis
Fish - mycobacteria
Frogs, lizards, snakes - salmonella
While the human symptoms for these varied
infections are diverse, many of them include
unexplained fever, muscle and joint aches,
headaches and fatigue; Watch for these if you have
pets. Some of the infections also produce lymph
node swelling or ulcerative skin lesions. If you
do have pets or intend on adding a pet to your
household, make sure you know what infections and
symptoms to look for. The following article at
Mayoclinic may be helpful.
Infections from household pets
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Men's reaction to erectile dysfunction and Viagra(R)
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Erectile dysfunction can affect men of any age
although the common consumer view is that it only
affects men over retirement age. With the advent
of potentially successful treatment drugs such as
Viagra(R) (sildenafil), the commercial media has
made expectations for cure very high.
Unfortunately not all men with erectile
dysfunction have successful treatment. The
dysfunction affects not only the men but their
partners as well.
A recent study in the UK looked at a comparison of
20 men who had a successful response to sildenafil
versus 20 men who did not. The age ranges were 22-
72 years with a median age of 51.8 years. The
investigators conducted interviews with the men to
determine the impact that erectile dysfunction had
on their self esteem and relationships, as well as
exploring their expectations of sildenafil as a
treatment and the impact its success or failure
had on how they felt.
As far as age goes, the investigators found
sildenafil to be more successful under age 45 and
less successful over age 65. The feelings of the
men with erectile dysfunction before treatment
included:
severe depression - 12%
emasculation - 30%
letting partner down - 22%
felt partner would "go elsewhere" - 15%
inability to discuss with partner - 37%
After treatment, investigators also found a
rebound negative effect in the men who did not
have a curative response from the sildenafil. In
other words their expectations were raised by the
media hype of the drug and when it did not work
for them, the new blow to their self esteem was
even more severe than the original feelings.
Even though there is now a treatment for erectile
dysfunction, the disease and its treatment has a
significant impact on both men and their women
partners.
Men's reaction to erectile dysfunction and Viagra(R)
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Calcifications on mammogram
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Can calcifications in the breast be serious?"
"I will be undergoing a breast biopsy in the very
near future because my mammogram showed some
calcifications (clustered) in the left breast. I
used Activella(R) - a progesterone-estrogen
combination hormone about 9 months for hot flashes
after going into menopause. Could there be any
relation to these calcifications showing up now.?"
- Sue
To take the last part of the question first, there
is no relationship between the nine months of HRT
and the calcifications as far as I can tell.
Neither estrogen alone, nor estrogen plus
progestin is known to cause calcium deposition in
breast tissue. It does help calcium deposition in
the bone where calcium is supposed to go but not
in other soft tissues such as muscle and fat. Even
postulating the small increase (1%) in breast
cancers from HRT after 5 years of taking it would
not explain the calcium now.
On the other hand, calcifications on mammogram can
sometimes be associated with breast cancer and
that is why your doctor recommends a biopsy. There
are radiological classifications of the type of
calcium deposits and also for the pattern of
distribution of deposits.
Calcification types include: round or oval
(punctate), indistinct shape (amorphous), granular
(pleomorphic), round, round with lucent center,
and fine, linear branching (casting). Of these
types or shapes, only the last one, the linear
branching (casting) shape is more likely to be
associated with malignant breast changes rather
than benign.
Distribution in the tissue of the calcifications
no matter what shape they are, include: linear (in
a line), clustered (grouped in a small area),
segmental (following the pattern of a duct and its
branching), regional, and diffuse (generalized
throughout the entire breast. The most worrisome
pattern for malignancy is the segmental pattern.
Clustered pattern, such as on your report, used to
connote suspicion for malignancy. By the more
recent radiological definition used since 1993, it
just means confined to a small area and is not
more or less likely to be associated with a breast
cancer. It is often associated with benign breast
disease. However, you must have a biopsy to
determine if there is a small cancer present that
cannot yet be felt by exam or just benign changes.
While it would not be good to have a biopsy return
as a malignancy, it sounds as if this area is
small and if malignant, perhaps it has been
detected very early while it is completely
curable. I hope all goes well with the biopsy and
it comes back benign.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Lactose intolerance is different than food allergy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
In order for our body to digest milk and milk
products such as cheese, cottage cheese, cream
cheese, and yogurt, it needs an enzyme which is
produced in the small bowel called lactase. this
enzyme is needed to break milk sugar down into
simple sugars so the body can absorb them. If a
person has a low level of lactase in the small
intestine, they often develop nausea, bloating,
abdominal pain, gas and diarrhea about 30-120
minutes after consuming cows milk or milk
products.
This is not an allergy in which the immune system
has produced an antibody to milk or one of its
components, but rather it is just a chemical
defect. The defect can be congenital (inherited)
or can just develop after childhood when our
bodies shut down from the high-milk-only diet we
are fed as infants. Also, surgery or trauma to the
bowel as well as some chronic diseases such as
Crohn's disease, celiac disease, or irritable
bowel syndrome can cause your small intestine to
decrease its lactase production thus producing
lactose intolerance.
The diagnosis of lactose intolerance is usually
made by a test in the doctor's office in which you
drink a liquid high in lactose. Blood is then
drawn a couple of times and the blood sugar
measured. If the lactase enzyme is working, your
blood sugar will rise; if it is not working, the
blood sugar stays level.
Treatment is not necessarily only to avoid milk
products. Some cheeses, for example, have low
levels of lactose and will not significantly
bother a lactose intolerant adult. Similarly
yogurt may already have had its lactose levels
fermented to low amounts so it does not produce
symptoms. Lactase enzyme tablets or liquids are
also available to take with your meals to help
lactose metabolism.
The biggest problem is finding and avoiding
"hidden" lactose in foods such as cereal, instant
soups, salad dressings, milk chocolate and baking
mixes. Before putting these items in your grocery
cart, check their labels. Look for ingredients
such as whey, milk solids, nonfat dry milk powder,
malted milk, buttermilk and dry milk solids. If
you have a severe lactose intolerance, be sure to
take your calcium supplements.
Lactose intolerance is different than food allergy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Health tip to share - Herbal preparations
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Remember that the term "natural" or "herbal" does
not necessarily mean safe. Calcium from natural
crushed rock may contain arsenic. When evaluating
an herbal preparation be sure the label contains
information on the product's scientific name,
plant parts used, name and address of the
manufacturer, batch and lot number, and dates of
manufacture and expiration." - FRJ
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Oneliners"
Part of being sane, is being a little bit crazy.
Life is like a camel: you can make it do anything
except back up.
She was only a whisky maker, but he loved her
still.
I know it's just a diet, but my body thinks it's
famine.
Punctual people have nothing better to do.
It's too bad that stupidity isn't painful.
The best way to make a long story short is to stop
listening.
I had plastic surgery last week. My wife cut up my
credit cards.
This house is protected by killer dust bunnies.
A TV can insult your intelligence, but nothing
rubs it in like a computer.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
********** Health Newsletter ***********
May 30, 2004
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Lipid lowering meds in women - ? as effective
2. Osteoporosis fracture incidence and HRT
3. Reader submitted Q&A - Spironolactone and Crohn's
4. Low carbohydrate diets
5. Health tip to share - Slippery elm for constipation
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Lipid lowering meds in women - ? as effective
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Most of the medical clinical trials of statin
drugs for lowering cholesterol, have had a much
larger proportion of men than women included in
the study. Recently investigators looked back at
many of the cholesterol lowering studies to see if
they had the same benefits in women as in men.
In women who did not have current cardiovascular
disease, the statin drugs used in the studies did
NOT lower the overall incidence of cardiovascular
disease death rate or non fatal myocardial
infarction. This is different than the studies
show for men. Since many women are being placed on
statin drugs such as:
lovastatin (Mevacor, Altocor)
fluvastatin (Lescol)
atorvastatin (Lipitor)
pravastatin (Pravachol)
simvastatin (Zocor)
we need to be careful that the risks of the drugs
do not outweigh the benefits.
We have known for a long time that in women, the
HDL (high density lipoprotein good cholesterol)
level is more important than the total cholesterol
level. If a woman is in the normal ranges for HDL
levels then it is unlikely, in my opinion, that a
woman will benefit from statin cholesterol
lowering drugs even if the total cholesterol is
above what doctors like to see.
Statin drugs can have side effects of nausea,
diarrhea, constipation and muscle aching as well
as the rare occurrence of serious muscle necrosis
(auto-dissolving). Therefore a woman should
carefully question if the physician recommends
statin drugs, or at least be aware of what her HDL
level is and if it is normal or too low.
Lipid lowering meds in women - ? as effective
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Osteoporosis fracture incidence and HRT
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
We sometimes forget that the reason many women
were taking hormone replacement in the past was to
decrease the incidence of bone fractures from
falls. Osteoporosis, bone thinning due to very low
calcium, and osteopenia (low bone calcium but not
at the spontaneous fracture level) are very real
conditions that many women over 50 years of age
are subject to. In general, women 50-70 years of
age taking hormone replacement have about 40% less
fractures than women of the same age who do not.
A recent British study found the same results and
also found that after stopping hormone replacement
for one year, a woman was no longer protected from
fractures compared to women who were still taking
any hormones. Also, older women, 60's, 70's, had a
higher absolute reduction in fractures if they
were taking hormone replacement. Thus there is
some reason to continue on the therapy for longer
than 5 years after menopause with respect to
osteoporosis protection.
Many women have decided not to take hormone
replacement therapy due to the small (1-2) per
thousand increase in stroke incidence. However I
have observed that these same women are not taking
medications to help prevent bone loss or actively
engaging in exercise or physical activity that
would help prevent osteoporosis. I suspect we
will see in the next 10 years a higher incidence
of fractures and deaths from fractures in older
women.
It is very important for the menopausal woman who
chooses not to take estrogen or estrogen and
progestin replacement therapy to discuss with her
physician about preventing bone thinning and
subsequent fractures using other medicines or life
style changes.
Osteoporosis fracture incidence and HRT
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Spironolactone and Crohn's
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I am currently taking the medication
spironolactone and read where it is a synthetic
steroid. Could this drug have the same effect as
prednisone as far as my Crohn's Disease is
concerned? The reason I ask this is because I
received Remicade approximately three years ago
and stopped taking prednisone. At the same time, I
began taking spironolactone for hair loss. I have
been in "remission" since then and wondered if the
spironolactone was responsible in some way. I also
take probiotics, mercaptapurine, and Pentasa
daily. I have never in my 20 years of living with
Crohn's been without symptoms (or prednisone)
until 3 years ago." - LAB
Spironolactone is a synthetic, steroid-like drug
that actually works the opposite of one of the
body's normal hormones, aldosterone. Aldosterone
is secreted by the adrenal glands that sit above
the kidneys and it causes retention of sodium salt
and fluid to maintain a good healthy blood
pressure. Spironolactone is an antagonist of
aldosterone and works to lower blood pressure in
people who have hypertension. Thus it causes salt
and water excretion like a diuretic. In people who
have normal blood pressure, it does not cause too
low blood pressure.
Spironolactone also has an effect to stimulate sex
hormone binding proteins in the blood. These
binding proteins in turn bind any excess
testosterone (male hormone) in the blood thus
lowering the blood testosterone levels. If your
hair loss is due to excess testosterone that
produces male pattern baldness, then
spironolactone will help reverse that.
There is no evidence that I know of that
spironolactone produces a prednisone-like effect.
In fact it would probably produce the opposite
effect if anything. I would guess that your
Crohn's disease improvement is more likely to due
to the past Remicade treatment than it would be to
be due to spironolactone treatment. That being
said, there is still a lot we do not know about
medicines and diseases so I do not think you
should test out the hypothesis by stopping the
spironolactone just to see if the Crohn's disease
worsens.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Low carbohydrate diets - short term and long term
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
With more new diet studies coming out about low
carbohydrate diets, it should be official now --
people lose weight quicker on low carb diets than
on low fat diets and it is easier for most people
to stick to the low carb diets. However after time
passes (such as one year), the final weight loss
is not different on a low carb diet versus a low
fat diet.
The most surprising finding with these diet
studies is how you can eat more fats (but less
simple carbohydrates) and your triglyceride levels
get lower and HDL (high density lipoprotein levels
rise to "good "levels. It does not make sense that
the diets with higher fats would actually improve
cholesterol levels more than low fat diets, but it
does. This sort of throws suspicion on any diet
recommendations that professionals or non
professionals give without a scientific study to
back it up.
Low carbohydrate diets - short term and long term
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Health tip to share - Slippery elm for constipation
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I have had chronic constipation as long as I can
remember. I also suffer from endometriosis, and
bowel problems are a normal side effect of that.
I have researched, and tried many different things
to alleviate the constipation. I was told by
another women who suffers from both about Slippery
Elm Bark powder. After two days, I had regular
movements, and am not nearly as nauseated. It
needs to be taken daily. I notice it is more
effective if taken at night. It even helps an
upset stomach. You can mix it into tea, or milk
and drink it. Just make sure it is the powder
form, I've been told that the other forms don't
work as well. " - Anon
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"How To Ask A Man To Do Something"
Always remember these important rules when asking
a man to do something:
1. Make sure the man is conscious.
2. Crash the hard drive on his computer and line
the bird cage with the sports section.
3. Be brief! Limit your nagging harangue to two,
three hours, max.
4. Reward him for cooperative behavior. Offer to
cook him something that doesn't have a peel-back
cover.
5. Punish him when he refuses to cooperate.
Microwave his remote on high power for 55 minutes.
Rotate 1/4 turn, and microwave again for another
35 minutes.
6. Use "would you" or "will you" instead of "you'd
better" or "do as I say and no one will get hurt."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
********** Health Newsletter ***********
June 13, 2004
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Your periodic health check-up
2. Practical tips for Alzheimer's care givers
3. Reader submitted Q&A - Postmenopausal vaginitis
4. Diabetes and heart disease risk
5. Health tip to share - Pool exercise
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Your periodic health check-up
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
It is not that we are unaware of the benefits of
screening for high cholesterol, high blood
pressure, colon and other cancers; its just that
we do not always take the time to have an annual
physical exam or a battery of screening tests
done. About 70% of women have their mammograms as
often as recommended by current guidelines but
compliance about other screenings is much less.
Men are worse than women and comply way less than
50% of the time on their recommended screenings.
Screening for high cholesterol is especially low
in younger adults as well as children or teens.
Did you know that "starting at age 20, everyone
should have their cholesterol checked at least
every 5 years? Children and teens who have
relatives with a history of early heart disease or
a family history of individuals with a total
cholesterol above 240 mg/dL should be screened
sooner than age 20.
Also there is still misinformation about certain
screening tests. Even among women who know about
having a regular Pap smear test for detection of
cervical cancer or premalignant cervical
dysplasia, as many as one in seven women think
that ovarian cancer, endometrial (uterine) cancer
or even sexually transmitted disease is detected
by the Pap test. They are not!
Screening for colon and rectal cancer after age 50
has a slightly different problem in that many
people may be hesitant to have a colonoscopy
because of exaggerated fears that it is
embarrassing and uncomfortable. Actually, you are
almost always sedated with intravenous medicine to
the point you are hardly aware it is being done.
Most people who have had it do not really think it
is a big deal.
Current recommendations for colorectal cancer
screening are:
Beginning at age 50, both men and women should
follow ONE of these five testing schedules:
yearly fecal occult blood test
flexible sigmoidoscopy every 5 years
yearly fecal occult blood test plus flexible
sigmoidoscopy every 5 years
double-contrast barium enema every 5 years
colonoscopy every 10 years
Be sure to take the time for a periodic health
screening visit. Every time you have a birthday,
make a reminder to yourself to take care of your
health to ensure future birthdays.
Your periodic health check-up
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Practical tips for Alzheimer's care givers
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Taking care of someone with Alzheimer's disease
(AD) is a task no one can imagine until they have
done it. To say it is very difficult is an
understatement. It takes immense patience and
dedication to a loved one. One in 10 individuals
over age 65 has AD and half of individuals over
age 85 develop it. Mayo Clinic has some practical
tips for AD care givers that are worth book marking
in case you ever find yourself in that situation.
Independence of performing daily living tasks such
as bathing, shaving, dressing, driving and eating
meals declines fairly quickly after the diagnosis
of AD is made. Therefore the first step is to
assess what degree of independence is possible and
to frequently (sometimes even daily) reassess if
that amount of independence is still feasible. Try
to:
Involve your loved one in tasks as much as
possible. Give choices of clothes or meals but
make the choices limited.
Reassess needed assistance daily. "For example,
can your husband shave by himself if you set out
his supplies? Or can he shave by himself if you
turn on an electric razor and put it in his hand?
Or does he need you to provide assistance with the
entire task?"
Strive for balance between rest and activity.
Minimize activity later in the day when your loved
one is more likely to be tired.
Alzheimer's disease impairs judgment and problem-
solving skills so it is important to create a safe
environment at home. Remove clutter such as
electrical cords, throw rugs and small pieces of
furniture. Put locks on medicine cabinets,
cleaning closets and storage areas of any
dangerous weapons, tools or toxic substances i.e.,
child proof the house! Make sure you have working
fire and smoke alarms as well as a fire
extinguisher and first aid kit. Keep your hot
water heater at 120 deg F or less and eliminate
electrical appliances from the bathroom. You may
need to put a slidebolt or deadbolt lock requiring
a key on every door that leads to the outside or
down stairs. Car keys may need to be locked up.
Most importantly, an AD care giver needs to change
his or her expectations. Tasks take much longer to
do with AD. Trying to hurry it up does not often
work. If someone with
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