Women's Health Newsletters 6/27/04 - 9/5/04
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********** Health Newsletter ***********
June 27, 2004
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
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1. Allergy skin tests for diagnosis
2. Liposuction and fat's health risk
3. Reader submitted Q&A - Frequent UTI's
4. First aid and treatment of minor burns
5. Health tip to share - International Travel
6. Humor is healthy
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1. Allergy skin tests for diagnosis
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Allergy testing, whether it is for contact, food
or inhalational allergies, can be fairly complex.
The most accurate, but not the easiest testing is
to have allergy skin tests performed, usually by
someone who specializes in allergy testing.
Using the skin test method, the allergist usually
puts drops of liquid containing the specific
allergen (such as pollen, mold, wheat, antibiotic
etc.) on the skin. Commonly this is done on the
back. Then a small little lancet or needle is used
to "prick the skin" so that the body's immune
system is exposed to the allergen.
If the body is immune to the substance being
tested, a chemical called histamine is released
around the area of the skin prick and swelling or
a bump takes place within the next day or two.
This means the body is allergic to that substance.
Actually a small amount of a histamine containing
liquid is used as a positive control. If your
immune system is suppressed which makes the
testing inaccurate, then this positive control
will not react. If you are taking an anti-
histamine medication then you cannot have the skin
testing performed. For a negative control, just
sterile water or saline is used in the pin prick
test. Some people have very sensitive skin and
will react to almost everything but it is not a
true allergic reaction.
Skin allergy testing is used because it is very
accurate. Blood tests can also be used but
sometimes they will show positive when the body
does not really react that much to cause symptoms.
Also, many people do not like the reactions they
get especially if they have many allergies.
Blood tests can be used instead of skin prick
testing. They measure immunoglobulins such as IGE,
IGA and IGG which govern immediate, intermediate
and delayed reactions respectively. Most
inhalational allergies tend to be immediate while
most food allergies tend to be intermediate or
delayed, therefore requiring at least two tests
to be absolutely sure about allergic causes.
Still, drawing a blood test or two is some times
easier for many people than having the skin prick
tests. The blood tests are especially recommended
for those who have skin conditions such as
psoriasis or eczema over much of the body which
precludes the skin prick testing. Blood tests may
also be better to test multiple different
substances to narrow down the list before skin
testing.
Allergy skin tests for diagnosis
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2. Liposuction and fat's health risk
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Most people are aware that excess fat, obesity, is
associated with adverse health effects such as
abnormal glucose tolerance and diabetes, increased
cholesterol and heart attacks and high blood
pressure and strokes. Exactly what about being
obese causes this is not exactly known but weight
loss very often corrects or reverses these health
problems.
You might wonder if it is the presence of the
volume of fat cells in the body that causes these
health problems. If so, removing the fat
surgically by a technique such as liposuction
might be expected to improve health by lowering
cholesterol or improving insulin resistance which
is associated with adult onset (Type 2 diabetes).
A recent study by a plastic surgeon, Samuel Klein
MD in St. Louis and his colleagues, looked at 15
very obese women who had on the average 22 pounds
of fat removed from the abdomen by liposuction.
They measured before and after blood studies and
could not find any improvement in the health risk
factors such as cholesterol, blood sugar, insulin
resistance or blood pressure following the
liposuction.
This would suggest that it is not the fat cells
per se that govern the health risks, but rather
the dietary weight loss process itself that
reverses some health problems. The mental model I
use to view this process is simply that excess
substances such as fats, refined sugar and other
substances in food we eat act as toxins to produce
many of these adverse health effects. If we take
in smaller amounts of these, the health problems
can go away; if we continue to take in more than
our body can handle, these conditions develop or
progress. Of course all of this process is also
strongly governed by our genetic make-up in that
some people can handle more of excess toxins and
do ok while others are very sensitive even to
small amounts of these toxins because of the genes
they inherited.
The bottom line is that one can only expect
liposuction to help cosmetically and not
medically. Negative calorie and other toxic intake
balance is needed to improve these health risks
associated with obesity.
Liposuction and fat's health risk
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3. Reader submitted Q&A - Frequent UTI's
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
I am 38 years of age, and I just had a
hysterectomy. I have for the last 2 years have
had several UTI's, and now I have a severe kidney
infection, and I am on cephalexen, I was on Tequin
also, but could not tolerate it, I only drink
water and cranberry juice's, what else can I do?
I am on. Celebrex, Aciphex, Estrace, Synthroid,
Wellbutrin, Lexapro, ultram for my kidney pain." -
Tammy
Since your are taking Estrace(R) (estradiol), it
sounds as if you are menopausal, probably because
of removal of the ovaries at the time of
hysterectomy or because they stopped working after
the surgical shock. The reason this may be
important is that low estrogen after menopause
often contributes to frequent urinary tract
infections or to symptoms such as burning with
urination that are interpreted by you as possible
UTIs. Without estrogen, the skin lining the inside
of the urethra is not as plush so it does not shut
as tight to prevent bacteria from the vagina and
rectum from getting into the bladder. Also, low
estrogen makes the skin around the vaginal opening
very thin and when urine hits it, it may cause a
burning sensation with urination that is
interpreted as a UTI.
If your infection has gone all the way up into the
kidneys (pyleonephritis) then it not only needs to
be treated acutely with antibiotics, but you may
also need to take some prophylactic antibiotics
such as nitrofurantoin (Macrodantin(R)) or sulfa
on a reduced schedule after the kidney infection
has been treated to prevent new urinary tract
infections. Taking cranberry pills or cranberry
juice can help prevent recurrent infections but
sometimes you may require prescribed antibiotics
to prevent the infections.
Topical estrogen cream may also help your symptoms
and you will need to ask your doctor about that.
Your physician can check a blood level of the
estradiol (Estrace(R)) to see if you are absorbing
enough from the stomach. If not, you can take more
with a higher pill dose or use estradiol vaginal
cream to improve that skin.
Some women have other causes for having frequent
urine or kidney infections. Kidney or bladder
stones, bladder polyps or other inflammation of
the bladder can lead to kidney infections. I would
say that if you get another kidney infection after
your estrogen status is corrected, then you may
need to have a kidney X-ray (intravenous pyleogram
IVP) and a cystoscopy (looking into the bladder
with a scope) in order to make sure there are not
stones, polyps or even an early cancer of the
bladder.
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4. First aid and treatment of minor burns
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Certain principles have evolved over recent years
of how to treat burn injuries so that the chance
of infection is minimized and an improved chance
of having a reasonable cosmetic outcome when the
burn is healed. Over 90% of burns are minor and
will heal with minimal treatment.
The main first aid principles for burns are:
1) stop the process causing the burn (eg. flame,
chemical, electrical)
2) cool the burned tissue
3) get pain relief
4) cover the burned area
Immediately after the burning process is
stopped, do not try to remove any adherent
material such as burned nylon clothing, tar or any
other substance. If clothing is not adherent to
the skin it should be removed to prevent further
heat transfer to the skin.
Within less than 20 minutes from the time of the
burn, the skin should be cooled down to prevent
progression of burn damage. You should NOT use
ice; ice can cause blood vessels to constrict to
the extent that it causes further damage to the
skin. Just use tepid tap water (drinkable water).
Immerse or keep applying water over the burn for
at least 20 minutes.
You may need some narcotic pain medicines from
your local physician but if the pain can be
controlled with non steroidal anti inflammatory
drugs NSAIDs (ibuprofen, naproxen), be sure to
take them on a regular basis until most of the
pain is improved. The anti inflammatory action is
needed as much as the pain relief.
While there are special bandage coverings for
burns, the best covering is the polyvinyl chloride
cling wrap (e.g., Saran Wrap(R), Glad Wrap(R)). It
is essentially sterile if you remove the first
inch or two from the roll. The wrap is pliable and
does not adhere to the burned skin surface. Also
you can see through it to assess how the damaged
skin is doing. Topical creams or ointments are
avoided at this time so you can keep an eye on the
burned skin.
Partial thickness burns (some skin remaining, no
fat or muscle tissue exposed) that are less than
about 12 inches in diameter in adults or about 6
inches in diameter in children can be managed
without hospitalization. Full thickness burns of
much more than an inch or so will also require
hospitalization. If there is any doubt about this,
be sure to see an emergency physician.
The cling wrap dressing should be changed every 24
hours for the first two or three days and then
every 3 days. The burn should be washed with just
a mild antibacterial soap (a very small amount)
and water. Antibiotics or antibiotic creams are
not usually necessary. If the burn is more than 2-
3 inches in size, be sure to let the doctor look
at it and monitor the healing process.
Key points in the primary care of burns are:
Initial first aid can influence final cosmetic
outcome
Cooling with tepid tap water is one of the most
important first aid measures
Routine use of antibiotics should be
discouraged
Simple dressings suffice
Aseptic technique should be used for dressing
changes
If in doubt, seek advice from your doctor or a
regional burn unit or plastic surgery department
First aid and treatment of minor burns
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5. Health tip to share - Travel health risks
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About 10% of the population living in the U.S. was
born outside the U.S. This group tends to account
for a high proportion of international travel
because of visiting friends and relatives. They
also account for a high proportion of travel
related illness. It is extremely important for
immigrants and others who travel to have their
health related vaccinations as well as
prophylactic medicines (e.g., for malaria
prevention). They should not assume their health
risk is low just because they were born in a
country. Be sure to look at the
Center for Disease Control (CDC) Traveler's Health
web site if you are taking an
international trip - FRJ
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6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Signs Found In Kitchens"
1. Kitchen closed - - this chick has had it!
2. Martha Stewart doesn't live here!!
3. I'm creative; you can't expect me to be neat
too!
4. So this isn't Home Sweet Home... Adjust!
5. Ring Bell for Maid Service...If no answer do it
yourself!
6. I clean house every other day.... Today is the
other day!
7. If you write in the dust, please don't date it!
8. I would cook dinner but I can't find the can
opener!
9. My house was clean last week, too bad you
missed it!
10. A clean kitchen is the sign of a wasted life.
11. COOK CAN'T TAKE IT ANYMORE!
12. I came, I saw, I decided to order take out.
13. If you don't like my standards of
cooking...lower your standards.
14. A messy kitchen is a happy kitchen, and this
kitchen is delirious.
15. If we are what we eat, then I'm easy, fast,
and cheap.
16. A balanced diet is a cookie in each hand.
17. Thou shalt not weigh more than thy
refrigerator.
18. A clean house is a sign of a misspent life.
19. My next house will have no kitchen --- just
vending machines.
20. I'm the MOMMY, That's why!
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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 ***********
July 11, 2004
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
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1. Carbs, low carbs and confusion
2. Post menopausal use of soy protein - does it help?
3. Reader submitted Q&A - Grapefruit juice and drugs
4. Repeat C-Section vs vaginal birth after C/S
5. Health tip to share - Maca root for breast pain
6. Humor is healthy
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1. Carbs, low carbs and confusion
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Most of the food and restaurant marketers have
joined the low carbohydrate bandwagon and created
several new, but confusing, terms. "Carb-
friendly", "carb-fit", "carb-wise", and "net
carbs" are just a few of these coined terms. Many
uninformed consumers may get the idea that any
carbohydrates are "bad", just as any "fats" are
bad for your nutrition. If someone declares
proteins as bad for your diet, we will have
nothing left but water.
The premise behind low carbohydrate diets is that
the body's insulin blood level will not be raised
as high; high insulin prevents fat in our body
from being burned. Actually low carbohydrate diets
do not produce any greater weight loss in the long
run than do other types of diets such as low fat
or a weight-watchers balanced diet. Some people
may lose more weight initially but it appears that
all diets boil down to calories in versus calories
out and your choice of diet should be whatever one
you can stick to by eating a reduced amount of
calories.
"Low-carb" cookies, cakes etc., are not healthy
for you since they usually contain higher fats and
still plenty of calories. "Carb-friendly" beers
are in that same ridiculous category. The concept
of "net carbs" tries to subtract out fiber (which
is good for you) and also glycerin and sugar
alcohols from the total carbohydrates. The "good
carbohydrates" still count as calories, however,
so it may just be fooling you to think the food is
healthier because the "net carbs" calculate out
lower.
Glycemic index is another confusing term. This
refers to the ability of the food to raise the
blood sugar quickly. Low glycemic foods are the
basis for the Sugar Busters Diet. Actually this is
quit a tricky term also because the body's
response depends not only on the glycemic index
but also upon the glycemic load of the food. For
example carrots raise the blood sugar quickly but
the normal number of calories or glycemic load in
a typical serving of carrots is quite low and
therefore not considered bad for you by most
nutritionists.
The following article at MayoClinic.com will be
interesting for you if you find these terms
confusing or even if you put much stock in the
terms at all.
Carbs, low carbs and confusion
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2. Post menopausal use of soy protein - does it help?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Many post menopausal women have switched from
hormone or estrogen replacement therapy to soy-
based food products that have estrogenic-like
plant proteins (usually isoflavones) in them. The
hope is to obtain some of the health benefits of
estrogen without the adverse effects of
prescription medications. Some women take the soy
products merely for help in controlling hot
flashes. There is some evidence that isoflavones
may lessen hot flashes in some women although they
do not do it as well as estrogen.
But what about the other beneficial effects of
estrogen such as that on bone deposition, lowering
lipids and even improving "brain fogging"
(cognitive function)? Do the soy proteins provide
any of those benefits as estrogen does?
Investigators in the Netherlands looked at this in
over 175 women followed for a year. Half were
given a measured soy supplement as a powder and
the other half were given a cow's milk protein
powder as the control group. The investigators
measured cognitive function (verbal and math
skills, memory etc.), bone mineral density of the
spine and hip, and lipid (cholesterol) profiles.
After a year of taking either the soy protein
powder or the milk protein powder, women had
repeat measurements performed. Investigators found
that there was no significant difference in any of
the tests between the soy group and the milk
protein group. Cognitive function, bone mineral
density, or plasma lipids did not differ
significantly between the groups after a year.
While I am not sure that cow's milk protein is
really placebo medication, this study would seem
to indicate that if a woman was not gaining a
benefit of decreased hot flashes by taking soy
protein supplements, then there is no real point
in taking any extra soy supplements at all. The
soy isoflavones do not help the vaginal dryness of
menopause either.
Post menopausal use of soy protein
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3. Reader submitted Q&A - Grapefruit juice and drugs
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
" In the past I have read the grapefruit juice is
not a good thing to drink when taking certain
prescription drugs but do not remember what drugs.
Can you please advise?" - Bonnie
This is a question we receive periodically but the
last time we answered it was back in 2001. There
have been some new developments about the genetics
of the cytochrome P-450 enzyme system that
grapefruit juice affects so it may be worth
reviewing it again.
The bad news is that grapefruit juice CAN alter
the absorption of some medicines. The good news is
that you can get around this interaction and most
of the time do not need to worry about drinking
grapefruit juice or eating grapefruit on your diet
as long as you follow a few simple rules.
There is an enzyme in the bowel and liver called
cytochrome P-450 (CYP) that is very important in
metabolizing food and medicine ingested by mouth.
Cytochrome P450 is a microstructure in our body's
cells that is responsible for creating the enzymes
that process (activate or deactivate) chemicals of
all kinds within our bodies. The enzyme changes
the base food or drug compound by adding small
chemical groups to the molecule. Sometimes these
changed compounds are absorbed from the stomach
more easily; sometimes the change inhibits
absorption. CYP can change the drug to a more
potent form as far as medical action and at other
times it will deactivate it and change it to a
less active compound. In other words, any
substance that stimulates CYP or inhibits CYP can
make ingested substances more active in its
medical effects and side effects or less active,
less potent.
Grapefruit juice is one substance that has been
found to inhibit the CYP enzyme system. It does
this much more than other citrus juices like
orange juice. Grapefruit juice is not the only
compound that inhibits CYP. Even red wine or St
John's Wort, among others, have been shown to
affect this system. There are undoubtedly many
other food and drug substances that have the same
CYP effect but we just do not know about at the
present time. Inhibition of CYP often results in
HIGHER BLOOD LEVELS of a drug because inhibited
drug absorption means that the liver, which often
breaks down the drug, does not get the first
chance to inactivate the drug before it has its
medical effect.
Probably even more important than grapefruit's
affect on the CYP enzyme system is what is your
genetic make up. It has been shown that many
people have genetic variations that affect this
system just as grapefruit does. Approximately half
of all Americans have genetic defects that affect
how they process certain drugs through the CYP
mechanism. There are four different genetic
baseline types of metabolizers, and we all fall
into one of the categories for the variable
pathways in Cytochrome P450.
Genetically you can be:
1) Normal metabolizer - likely to have the desired
effect from a standard dose of the drug
2) Slow (intermediate) metabolizer - do not need
as high a dose of the drug to get the desired
effect
3) Poor metabolizer - likely to have significant
side effects from a standard dose because the drug
accumulates in your system 4) Extensive
metabolizer - your system works at triple speed
and overtime so that you require a higher dose to
have the desired drug effect
These above birth variations are probably much
more important than ingesting grapefruit or any
other substance that affects the system. There are
now home genetic tests you can get to see what
type of metabolizer you are as well as lists of
drugs known to be affected by the CYP system.
DNA Drug Reaction Profiles
Most of the drugs that I could find that have been
tested, are INCREASED in the blood by about 0-50%
if they are taken with a glass of grapefruit
juice. While decreased blood levels can happen
too, almost every agent was actually increased.
And when it was, it was increased about 50%. I
could not find testing that indicated how long
after ingesting grapefruit juice the altered
absorption levels lasted. It is likely that the
effect is short lived, under 60 minutes.
Women will be glad to know that the estrogen
(ethinyl estradiol) in birth control pills is not
decreased by grapefruit juice but rather increased
by 37%. The estrogen often used for menopausal
replacement, 17 beta-estradiol, is also altered
somewhat in its absorption by grapefruit juice.
Estrone (a weaker estradiol metabolite) levels are
increased after taking estradiol with grapefruit
juice but estradiol itself is not increased.
For the most part, the differences in active drug
levels with or without grapefruit juice are not
very great and probably less important than your
genetics or body weight in determining medical
effect. However, with a drug that has a narrow
range between adequate treatment of a medical
problem and toxicity producing side effects, then
this amount of interaction can make a difference.
Chemotherapy agents or blood thinners (e.g.,
Coumadin) would be instances where the different
levels could produce very undesirable side
effects. Anti-depressants and anti-anxiety agents
are another class of drugs that grapefruit juice
could affect. On the other hand, if you were not
seeing a therapeutic effect from a medication,
taking it with grapefruit theoretically might help
(eg. low dose estrogens for hot flashes).
Finally, the wisest course of action with regard
to eating grapefruit or drinking grapefruit juice,
however, would be to follow these simple rules:
Take most medicines at least 30 minutes before or
60 minutes after you ingest the grapefruit. Take
them with water or orange juice if you have to (OJ
has some effect but much less than grapefruit
juice).
If you are having side effects from the drugs you
take, avoid grapefruit for at least 6-8 hours or
altogether and check with the doctor to see if
drug dose adjustment is possible or for genetic
testing for your DNA metabolizer type.
If you are taking any cancer chemotherapy drugs or
blood thinners, check with your doctor about all
substances which may alter their absorption or
blood levels.
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4. Repeat C-Section vs vaginal birth after C/S
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
For about the last 20 years, physicians have been
encouraging women who had a previous Cesarean
birth to attempt vaginal delivery with a
subsequent pregnancy rather than having an
automatic, repeat Cesarean section. In the last 5
years, however, there has been a trend back to
recommending repeat Cesarean section (RCS) rather
than vaginal birth after Cesarean (VBAC) because
of the fear of a small increase in uterine rupture
before delivery. Uterine rupture can result in
hysterectomy, fetal death and even a possibility
of a mother dying.
The following article in the British Medical
Journal looked comprehensively at all of the
medical scientific studies in the literature to
see how high these risks are when considering VBAC
versus RCS. The investigators found the following:
the additional risk of uterine rupture from VBAC
is 0.3% (range 1-5/1000)
the additional risk of a baby dying from VBAC is
about 1.4 per 10,000 trials of labor (range 0-
1/1000)
the additional risk of a hysterectomy was 3.4 per
10,000 trials of labor (range 0-1.2 per 1000)
it would take 370 (213 to 1370) elective caesarean
deliveries (RCS) to be performed to prevent one
symptomatic uterine rupture.
it would take 7142 elective repeat cesareans (RCS)
to prevent one rupture-related perinatal death
it would take 2941 elective repeat cesareans (RCS)
to prevent one rupture-related hysterectomy
The numbers generated by this study are the best
estimates we currently have when describing the
relative risk of VBAC versus Repeat CS although
they do not include the risk of maternal problems
with RCS versus vaginal delivery such as
infection, blood clots, transfusions etc. Those
risks should also be taken into account.
Repeat C-Section vs vaginal birth after C/S
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5. Health tip to share - Maca root for breast pain
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I am 51 years old and have battled fibrocystic
breasts for about 10 years. My new gynecologist
(my old gynecologist died a few years ago)
mercilessly ordered a mammogram last week while my
lumpy breasts were acutely tender and swollen.
Over the years, I have had some success with
vitamin E and evening primrose oil, and totally
abstain from caffeine, but now continue to have
frequent bouts of enlarged lumps and soreness."
"This morning, I tried one dose of Maca 300 mg
(Peruvian maca root), and within a few hours
noticed a decrease in the tenderness. I
hesitantly took another dose of 300 mg eight
hours later resulting in a DRAMATIC diminishment
of the fibrocystic lumps. I need to read more
about how to take this Maca, and I understand that
it shouldn't be taken every day. So far, I have
obtained such relief. Wish that I had known about
this before I had the mammogram." - M.H.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"But I Never Forget A Face!"
An elderly widow and widower were dating for about
five years. The man finally decided to ask her to
marry. She immediately said "yes."
The next morning when he awoke, he couldn't
remember what her answer was! "Was she happy? I
think so, wait, no, she looked at me funny..."
After about an hour of trying to remember to no
avail, he got on the telephone and gave her a
call. Embarrassed, he admitted that he didn't
remember her answer to the marriage proposal.
"Oh", she said, "I'm so glad you called. I
remembered saying 'yes' to someone, but I couldn't
remember who it was."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
********** Health Newsletter ***********
July 25, 2004
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Herbal supplements and flare up of auto immune disease
2. Doctors are often unaware of prescription costs
3. Reader submitted Q&A - Sun sensitivity of meds
4. Hyperpigmented liver skin spots
5. Health tip to share - Resveratrol
6. Humor is healthy
The next newsletter will be in two weeks.
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1. Herbal supplements and autoimmune disease flare up
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Some herbal preparations are used for supposed
immune system stimulation. Echinacea is the best
known one but also some of the algae (Spirulina
platensis) are thought to do the same thing and
are sold as such. People use them to prevent colds
and viral flu thinking that if your immune system
is boosted it will help prevent or ameliorate an
infection. So far none of those benefits have been
proven in controlled human clinical medical trials
and echinacea at least had been shown NOT to be
beneficial for cold prevention.
One might ask the opposite question, i.e., if some
herbal products really did stimulate the immune
system, could those products worsen medical
conditions which are autoimmune (the body is
allergic to itself) in origin?
Again, no good clinical trials have been performed
but a recent Archives of Dermatology article
reported three patients that had flare ups of
their autoimmune diseases. Two had flaring of the
skin condition pemphigus vulgaris after ingesting
Echinacea and the alga Spirulina platensis. One
patient had a flare of dermatomyositis after
ingesting a supplement containing the algae
Spirulina platensis and Aphanizomenon flos-aquae.
While it is too early to postulate direct cause
and effect, I would caution individuals with
autoimmune conditions to avoid any supplements
containing algae (Spirulina platensis) as well as
to consider avoiding Echinacea or any other
supplement touted as an immune stimulant.
Herbal supplements and flare up of autoimmune disease
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Doctors are often unaware of prescription costs
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Since about the 1950's, physicians no longer
dispense many or any prescription medicines from
their offices. It has been discouraged by medical
societies who feel there can be a major conflict
of interest if a physician profits from the sale
of something he or she recommends to the patient.
This makes good sense in a way but it has also
caused physicians to lose track of how much
medications cost at the pharmacy.
In this study below from family practitioners in
Iowa, doctors were asked how much they thought
certain medicines cost. They did not need to guess
exactly but just get it within a $10.00 range from
$0.01 to $80.00. They gave estimates for each of
50 medications that they might prescribe.
Of 178 physicians who responded, only 23% guessed
the medicine price within a $10 range correctly.
Over 2/3's of the physician guesses were
underestimated. When the drugs were divided by
whether they were brand names or generic, the
estimates were even worse. Doctors 90% of the time
underestimated brand name drug costs and 90% of
the time they overestimated generic drug costs.
These errors in estimates will result in higher
drug costs overall because the less expensive
drugs (generic) will be used less often than they
should and the more expensive drugs (brand name)
will be prescribed more than they should.
Be sure to ask your doctor about the availability
of generic meds for your prescription.
Doctors are often unaware of prescription costs
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Sun sensitivity
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I am on high blood pressure medication
(Avalide(R)) and was wondering why the warning
label says to stay out of the sun for prolonged
periods of time and to wear a sunscreen? What
would the harmful effects be while taking this
medication?" - Michelle
Avalide(R) is a medication that can change the
sensitivity of your skin to the sun's ultra violet
rays. In other words, you will sunburn quicker
when your blood levels of Avalide (irbesartan) are
high. For this reason, you should Use a sunscreen
and wear protective clothing when exposure to the
sun is unavoidable. The sun exposure time to burn
can be cut almost in half.
Skin will redden or burn from the sun or tanning
lamp easier with any photosensitizing agent. The
list of drugs causing increased photosensitivity
is too long to list here. it includes many
prescription and over-the-counter medications
including hormones, oral contraceptives and even
ibuprofen.
For any specific photosensitizing medication, it
is difficult to estimate by how much your time to
burn in the sun is reduced. Some of the
medications such as Accutane are extremely
sensitizing while others such as ibuprofen are
less so. It is best to use the 50% rule-of-thumb
until you know for sure.
On the other hand, with today's knowledge about
sun damage, you should never be outside in direct
sun for more than about 15 minutes without using
sunscreen that protects against all ultraviolet
rays; unless you like the wrinkled, leathery look.
Using a protectorant with a factor of SPF 30
should be routine if you are on any
photosensitizing medications and even then,
confining time in direct sun to less than an hour
would be wise.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Hyperpigmented liver skin spots
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
When you were young, you probably did not know
that sun exposure was eventually going to cause
"liver" spots on your skin when you age. Its too
late now to prevent them, so what do you do when
they come? Basically you can leave them alone or
bleach them.
Dark skin spots are caused by an excess of a skin
pigment called melanin. Sometimes the cause is
genetic such as in the case of freckles. At other
times skin injury such as that from acne, surgery
or other trauma can cause increased pigmentation.
Big blotchy areas of skin darkening are called
melasma and are often due to pregnancy hormones or
birth control pills along with sun exposure.
Prescription creams used to lighten the skin
contain hydroquinone. This is a skin bleach which
lightens and fades darkened skin patches by
slowing down the production of melanin so those
dark spots gradually fade to match normal skin
coloration. When a doctor writes a prescription
for a skin bleach, it contains about two times the
amount of hydroquinone (4%), the active
ingredient, as over-the-counter skin bleaches
(2%). Of note is that in Canada and via Internet
you may purchase 4% hydroquinone cream without a
prescription.
In more severe cases prescription creams with
tretinoin and a cortisone cream are added. These
are somewhat irritating to sensitive skin and will
take 3-6 months to produce improvement. It is
important to also note that as little as 10
minutes in the sun without UV blockers can reverse
months of using these creams.
Hyperpigmented liver skin spots
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Health tip to share - Resveratrol
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The compound that makes red wine healthy is called
resveratrol. It not only improves cholesterol
profiles but in studies in which it is given to
animals, it prolongs their life span. Resveratrol
is not only found in red wine but also red grapes,
red grape juice and also in grape root
supplements. If you are not a wine drinker or do
not want the calories of grapes or grape juice,
check with your local health food store for grape
root supplement or even just a resveratrol
supplement.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Living In The 00s"
You know you're living in the 00s when:
1. You try to enter your password on the
microwave.
2. You haven't played solitaire with real cards in
years.
3. You have a list of 15 phone numbers to reach
your family of three.
4. You e-mail your mate who works at the desk next
to you.
5. Your reason for not staying in touch with
friends is that they do not have e-mail addresses.
6. When you go home after a long day at work you
still answer the phone in a business manner.
7. When you make phone calls from home, you
accidentally insert a "9" to get an outside line.
8. Your company's welcome sign is attached with
Velcro.
9. Even though you've sat at the same desk for 4
years you have worked for 3 different companies.
10. Your CV is on a disk in your pocket.
11. You learn about your redundancy on the 11
o'clock news.
12. Your biggest loss from a system crash was when
you lost all of your best jokes.
13. Your supervisor doesn't have the ability to do
your job.
14. Contractors outnumber permanent staff and are
more likely to get long-service awards.
15. Board members salaries are higher than all the
Third World countries annual budgets combined.
16. Interviewees, despite not having the relevant
knowledge or experience, terminate the interview
when told of the starting salary.
17. Free food left over from meetings is your
staple diet.
18. Your supervisor gets a brand-new state-of-the-
art laptop with all the latest features, while you
have time to go for lunch while yours boots up.
19. Being sick is defined as you can't walk or
you're in hospital.
20. There's no money in the budget for the five
permanent staff your department desperately needs,
but they can afford four full-time management
consultants advising your boss's boss on strategy.
21. Your relatives and family describe your job as
"works with computers."
AND THE CLINCHERS ARE...
22. You read this entire list, and kept nodding
and smiling.
23. As you read this list, you think about
forwarding it to your "friends"
24. It crosses your mind that your jokes group may
have seen this list already, but you don't have
time to check so you forward it anyway.
25. You got this email from a friend that never
talks to you anymore, except to send you jokes
from the net.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
********** Health Newsletter ***********
August 8, 2004
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Smoking cessation and elective surgery
2. Headaches
3. Reader submitted Q&A - Perimenopause
4. Plantar warts
5. Health tip to share - Ayurveda precaution
6. Humor is healthy
The next newsletter will be in two weeks.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Smoking cessation and elective surgery
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Smokers are at increased risk for many health
conditions but most people do not realize that
smokers undergoing elective surgery are at much
higher risks for complications. Lung infections
such as pneumonia are increased and Wound
infection rates go up by a factor of 3-8 times. It
has even been shown by a randomized study that
smoking cessation prior to surgery such as
artificial hip replacement can reduce wound
infection from 27% to zero.
Reducing the amount of smoking does not help; it
needs to be total smoking cessation. And the time
period of smoking cessation before surgery
probably needs to be about 6 weeks although a
significant reduction can be seen with a cessation
period of 4 weeks.
Wound infection can be quite serious. It is not
just a matter of taking antibiotics and opening
the surgical incision to drain pus. Sometimes the
deeper tissue can be disrupted so that with an
abdominal wound, for instance, the bowels can come
through the open incision (evisceration). With
orthopedic surgery, chronic bone infection can set
in which may require additional surgery or a very
long, protracted course of intravenous
antibiotics.
Doctors often forget to tell patients about
stopping smoking so it is up to you to be aware of
this relationship either for yourself or for a
family member or friend who smokes.
Smoking cessation and elective surgery
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Headaches
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Headaches are often treated by others as a non
serious health problem. Chronic headaches is not
looked upon as a serious medical condition and yet
it is one of the most common causes for
absenteeism from work or school. About 4-5% of
individuals have headaches more days than not so
this is a major population problem.
About 80% of headaches are categorized as tension
headaches. Most of these are treated with over-
the-counter pain relievers. They are often
aggravated by caffeine abuse and sleep
deprivation. Another group of headaches which
numbers almost 20% is the category of vascular
headaches. These include migraine and cluster
headaches. They are often misdiagnosed or under
diagnosed. A class of drugs called triptans are
the most commonly used for these although
sometimes the headaches will respond to the
recommended 1st round treatment combination drug
of acetaminophen, aspirin and caffeine (eg
Excedrin Migraine(R)) especially for mild or
moderate vascular headaches.
Women are much more susceptible to migraines while
males get cluster headaches predominantly. A
cluster headache is very severe and usually
centered around one eye. Cluster headaches occur
in a series or bunch, several in a day for 2-4
months before going away.
Headaches
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Perimenopause bleeding
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I was wondering if it is normal for women who are
going through menopause to stain lightly, but
without a stop between periods. I had a period,
which lasted five days, (unusually short for me;
it usually lasts 6 to 7 days.) and about a week
later, I started to have a full period, dark red
blood, and all. It continues to stain very
lightly; but it doesn't go away. I am going to be
48 soon, and this year I have started menopause. I
have not taken anything at all for the regulation
of my periods. How long does this process of
irregularity last ultimately?" - Carole
Menopause is defined as the condition of having
had no menses for one year. It signifies the
inability of the ovary to ovulate eggs having
totally exhausted its supply. In the time period
running up to complete cessation of menses, more
and more of the menstrual cycles are anovulatory.
In other words, an egg is not ovulated each month
and that may go on to cause abnormal bleeding
patterns. This time period is called the
"perimenopause".
I would say from what you describe that you are in
the time period of the perimenopause. You have not
yet become fully menopausal, i.e., stopped
ovulation altogether. The irregular bleeding you
are experiencing is normal for this time period
although women manifest many different specific
abnormal bleeding patterns. The real dilemma for
doctors is that while the abnormal bleeding can be
due to perimenopause hormonal fluctuations,
endometrial cancer, endometrial pre malignancy
(hyperplasia), polyps or fibroids can also cause
these bleeding patterns. Thus when do you assume
the abnormal bleeding is physiologic and hormonal
and when do you assume it could be due to an
anatomical abnormality? Basically if you have 3
abnormal cycles in a row, then the doctor should
consider doing an endometrial biopsy just to make
sure there is not a possible malignancy inside the
uterus.
How long can this pattern last before full
menopause you ask? Basically it can be anywhere
from about 2-8 years but the average is about 4
years. That is about how long you can expect this
to last. The average age of onset of these
abnormal periods is about 47.5 years of age. Only
about 10% of women have an abrupt cessation of
menses at menopause without having any preceding
abnormal menses.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Plantar warts
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Plantar warts are skin growths on the bottom of
the feet caused by a virus. The skin growths can
push up into the sole or toes when you walk
causing a moderate amount of pain. The virus is
usually contracted in shower rooms and up to 10%
of teenagers will have had plantar warts at
sometime.
Ultimately the warts go away as the body's immune
system fights off the virus. It may take months to
a year or more but eventually they disappear. They
need treatment if they become too painful and
interfere with normal activities.
Salicylic acid patches from the local pharmacy can
be used to soften the warts and a pumice stone can
be used to rub away some of the protruding skin.
You must keep the feet very clean and dry so that
the warts do not spread. If the salicylic acid
patches do not work, you might want to see a
dermatologist. The dermatologist may freeze the
warts with liquid nitrogen and then scrape the
excess tissue off as the skin cells die from being
frozen.
Plantar warts
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Health tip to share - Ayurveda precaution
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Most lead poisoning among U.S. adults results from
occupational exposure, but it can also occur from
use of traditional or folk remedies. Ayurveda is a
traditional form of medicine practiced in India
and other South Asian countries. Ayurvedic
medications can contain herbs, minerals, metals,
or animal products and are made in standardized
and nonstandardized formulations. During 2000-
2003, a total of 12 cases of lead poisoning among
adults in five states associated with ayurvedic
medications or remedies were reported to the
Center for Disease Control.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Best Excuses If You Get Caught Sleeping In Your
Cubicle..."
1. "They told me at the blood bank this might
happen."
2. "This is just a 15-minute power nap like they
raved about in that time-management course you
sent me to."
3. "I was working smarter-not harder."
4. "Whew! I musta left the top off the liquid
paper."
5. "Oh, I wasn't sleeping! I was meditating on our
mission statement and envisioning a new paradigm!"
6. "This is one of the seven habits of highly
effective people!"
7. "I was testing the keyboard for drool-
resistance."
8. "I was trying to remember where that difficult
"Z" Key was, and now it is indelibly imprinted on
my brain, or at least my forehead."
9. "I'm in the management training program."
10. "I'm actually doing a "Stress Level
Elimination Exercise Plan" (SLEEP) I learned at
the last mandatory seminar you made me attend."
11. "This is in exchange for the six hours last
night when I dreamed about work!"
12. "I was doing a highly specific Yoga exercise
to relieve work-related stress. Do you
discriminate against people who practice Yoga?"
13. "Darn! Why did you interrupt me? I had almost
figured out a solution to our biggest problem."
14. "Uh, hey, whaddaya expect... the coffee
machine is broken..."
15. "Someone must've put decaf in the wrong pot."
16. "Boy, that cold medicine I took last night
just won't wear off!"
17. "Ah, the unique and unpredictable circadian
rhythms of the workaholic!"
18. "I wasn't sleeping. I was trying to pick up my
contact lens without my hands."
19. "The mailman flipped out and pulled a gun so I
was playing dead to avoid getting shot."
20. "Geez, I thought you (the boss) were gone for
the day."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
******** Health Newsletter ***********
August 22, 2004
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Fear of social situations
2. Listeriosis bacterial exposure
3. Reader submitted Q&A - Heartburn in pregnancy
4. Depression in teenagers
5. Health tip to share - Plantar Warts
6. Humor is healthy
The next newsletter will be in two weeks.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Fear of social situations
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Meeting someone new or having to give a short
speech can produce anxiety or "butterflies" in
almost anyone, That is normal. Some people,
however, fear social situations so much that they
avoid jobs, activities or events even though they
would find those things enjoyable were it not for
having to expose oneself to others who might be
critical. This avoidance becomes so severe that it
is called a phobia. "Social phobia can severely
limit dating, academic achievement and career
choice."
For those with social phobia, sometimes called
social anxiety disorder, common, everyday
experiences can be a source of extreme stress:
Using a public restroom or telephone
Returning items to a store
Interacting with strangers or with people of the
opposite sex
Writing in front of others
Making eye contact
Entering a room in which people are already seated
Ordering food in a restaurant
Being introduced to strangers
The treatment for this problem is both counselling
as well as anti-anxiety medications. The important
point is to recognize that this is a behavioral
condition that needs treatment. It often starts
during childhood or adolescence and will persist
most of one's adult life unless some cognitive
counselling takes place. Medications can improve
the symptoms but only counselling and rarely, a
self-help approach will permanently lessen or
abate the symptoms. You or someone you know with
this problem should not suffer in private.
For self-help suggestions, see this article at
Mayo Clinic's web site.
Fear of social situations
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Listeriosis bacterial exposure
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Listeriosis is a very serious, food borne public
health infection which is probably under
recognized by the general population. Symptoms can
be mild or severe including headache, stiff neck,
confusion, loss of balance, or even convulsions.
Many times, especially in pregnancy, it presents as
only mild flu-like symptoms. A listeria infection
can cause stillbirths, however so it is very
serious for the unborn baby.
Anyone who has a suppressed immune system such as
the elderly, newborns, someone on steroids, those
with HIV, cancer or who are on chemotherapy are at
more risk for the serious consequences of the
disease. About 2500 people annually become
infected and about 20% of those people die from
the infection or its complications.
Listeria comes from contaminated soil and water
and can be present on vegetables, meat or
unpasteurized milk and cheeses. Animals can carry
the bacterium without appearing ill and can
contaminate foods of animal origin such as meats
and dairy products. The listeria bacterium has
been found in a variety of raw foods, such as
uncooked meats and vegetables, as well as in
processed foods that become contaminated after
processing, such as soft cheeses and cold cuts at
the deli counter.
Some of the known foods to avoid to prevent
listeriosis are:
"Do not eat hot dogs, luncheon meats, or deli
meats, unless they are reheated until steaming
hot.
Avoid getting fluid from hot dog packages on other
foods, utensils, and food preparation surfaces,
and wash hands after handling hot dogs, luncheon
meats, and deli meats.
Do not eat soft cheeses such as feta, Brie, and
Camembert, blue-veined cheeses, or Mexican-style
cheeses such as queso blanco, queso fresco, and
Panela, unless they have labels that clearly state
they are made from pasteurized milk.
Do not eat refrigerated pates or meat spreads.
Canned or shelf-stable pates and meat spreads may
be eaten.
Do not eat refrigerated smoked seafood, unless it
is contained in a cooked dish, such as a
casserole. Refrigerated smoked seafood, such as
salmon, trout, whitefish, cod, tuna or mackerel,
is most often labeled as "nova-style," "lox,"
"kippered," "smoked," or "jerky." The fish is
found in the refrigerator section or sold at deli
counters of grocery stores and delicatessens.
Canned or shelf-stable smoked seafood may be
eaten."
Diagnosis is only by taking a blood culture for
the specific bacteria, listeria monocytogenes when
the symptoms are present. Therefore you or the
doctor has to be highly suspicious in order to
receive the correct diagnostic test. Treatment is
with regular antibiotics such as penicillin.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Heartburn in late pregnancy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"How do I battle (and win) against acid reflux and
nausea during late pregnancy? I am in my 34th week
and at my wits end." - Mary Kay
Toward the end of pregnancy, the stomach gets
highly compressed toward the chest because the
baby is taking up most of the room in the
abdominal cavity. This makes the stomach capacity
small and the hormones of pregnancy relax the
muscles at the top of the stomach so ingested food
and acid liquid regurgitates or refluxes into the
lower throat (esophagus) to produce the burning
sensation of heartburn.
This gastric reflux is much worse when lying down
so it is important to always lie down with your
head still somewhat elevated. A couple of pillows
under your head and/or some bricks placed under
the feet of the bed at the head can help produce
an incline that lessens reflux at night. Of
course avoid eating or drinking anything within
about an hour of going to bed.
When eating or drinking, avoid high acid foods
such as citrus juices, coffee, colas, tomato based
products etc. Also try to separate your liquids
and solids, i.e., don't eat solid food and then
drink liquids at the same time. Just eat solids,
wait a while, and then have your liquids. And keep
the amounts very low because the stomach fills so
quickly. It is better to eat and drink small
amounts more frequently than large amounts at
normal meal times.
Liquid antacids without much sodium are used to
neutralize the stomach contents so if reflux
occurs it does not burn as much. A popular over-
the-counter antacid is the butterscotch-flavored
Gaviscon(R).
Histamine blocking (H2) medications such as
cimetidine (Tagamet(R)), famotidine (Pepcid(R)),
nizatidine (Axid(R)), and ranitidine (Zantac(R))
which block the secretion of stomach acid, are not
recommended during pregnancy or lactation but to
date the evidence shows no adverse effects on the
baby when H2 blockers are taking during pregnancy.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Depression in teenagers
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Teenagers seem to be more prone to major
depression than adults or a least so it seems. In
adult depression treatment, many insurance
companies have decided it is much less expensive
for them to pay for anti-depressant medications
such as SSRIs than it is to pay for counselling
with a psychiatrist or psychologist. Since either
medication only or counselling only are about 60%
effective, it makes sense to see if the
combination of medication and counselling could
significantly improve the success rate of treating
major depression.
A recent U.S. multicenter study examined over 400
teens ages 12-17 with major depression. They were
divided into 4 groups, placebo, fluoxetine
(Prozac(R)) only, CBT only, and CBT plus
fluoxetine. Response rates were:
35% - placebo
43% - CBT alone
61% - fluoxetine alone
71% - fluoxetine plus CBT
There had been a question as to whether Prozac
caused an increased incidence of suicidal thinking
in teens. In this study, clinically significant
suicidal thinking, which was present initially in
29% of the teens at the study beginning, improved
significantly in all 4 treatment groups. It did
not improve as much in the Prozac alone and Prozac
plus CBT group so as such, CBT was more protective
against suicidal thinking than Prozac. In other
words, Prozac did not cause suicidal thinking but
it did not reduce it as much as counselling (CBT).
Depression in teenagers
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Health tip to share - Plantar warts
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"In your recent Health Newsletter, you offered
information on treating planters warts. Planters
warts can be effectively treated with duct tape.
Yes, that manly tool - duct tape!
Cover the wart for 6 days with duct tape. Remove
the tape and soak the foot. Gently scrape the
wart with a finger nail file and re-cover it with
new tape the next day. It does take a few months
but it really works. This is how I treated my
son's warts without using acid or liquid
nitrogen." - DLW
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Things Women Want to Hear, but Never Do"
Wow, I just don't know what to do with this money
we won in the lottery, so why don't you take it to
the mall and see if you can find something to buy
with it.
Hey, how about inviting your mother to spend the
summer with us.
Oh, go ahead and eat that third piece of chocolate
cream pie. If it's one thing I hate it's skinny
women.
What luck, they had a special rental rate at the
video store on romance movies.
You know, that Pam Anderson just doesn't seem to
have the brain power that I find so attractive in
a woman.
What a break, I won a prize on the radio station....
tickets to either the super bowl or the opening of the
New York Ballet. I got first choice so pack your bags
for New York, we get to go to the ballet!!!
Who wants to play golf when I can get to see how
good the lawn looks when it's freshly mowed.
Shoot, there's nothing on TV but football games.
Let's go furniture shopping.
Man I tell you, nothing feels better than getting all
spruced up in a suit and tie.
I'm getting a little tired of steak on the grill. How
about a nice quiche?
You know, I think I'd really prefer the four-door sedan
to that impractical Corvette.
Golly I think we're lost. Let me find a gas station to ask
for directions.
My golf clubs are only 30 years old. Why don't you use
the money my parents gave us to get something nice
for the house.
If the guys call and want me to go to that new
sports club with them, tell them I'm busy. I
really want to get the living room painted
tonight.
Sports cars are just such stupid little toys for
men who have never really grown up.
If you're looking for me later, I'll be over there
looking at the home decorating magazines.
You know, we really don't visit your relatives
enough.
Why don't you relax this weekend. I'll take care
of the cooking and housework.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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