Women's Health Newsletters 9/19/04 - 11/28/04
- September 19, 2004
- October 3, 2004
- October 17, 2004
- October 31, 2004
- November 14, 2004
- November 28, 2004
********** Health Newsletter *********** September 19, 2004 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Biweekly from BackupMD on the Net ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Physical activity, obesity and diabetes in women 2. Living with celiac disease 3. Reader submitted Q&A - Sea salt and shellfish allergy 4. Irritable bowel syndrome effect on quality of life 5. Health tip to share - Flexibility problems 6. Humor is healthy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Physical activity, obesity and diabetes in women ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ An interesting study was published in the Journal of the American Medical Association (JAMA) which looked at both body mass index (obesity) and amount of daily physical activity and its effect upon diabetes. Both increased weight and low amounts of physical activity are known to be related to diabetes and heart disease events like myocardial infarction. Since obesity and low physical activity often tend to travel together, it is difficult to know which is more important losing weight or increasing physical activity. Doctors always tend to recommend both. The reason this study was so interesting is that it found that overweight/obesity was worse than low physical activity for developing diabetes. The increased risk was as follows: Category Risk Ratio normal-weight inactive 1.15 overweight active 3.68 overweight inactive 4.16 obese active 11.5 obese inactive 11.8 In a companion article in the same issue looking at the relationship between weight, physical fitness and heart attacks in women who had been suspected of having heart ischemia (low blood flow to the heart), authors found that good physical fitness was more protective against heart attacks and was independent of weight. This is the opposite of the effect of physical fitness on diabetes where weight was the more important factor. Physical activity, obesity and diabetes in women ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2. The journey of Parkinson's disease ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ The average age of onset of Parkinson's disease is about 65 years although it sometimes can start earlier as in the case of Muhammad Ali. The course of the disease is often not well communicated to newly diagnosed patients. Sometimes the doctors themselves are not as familiar with the course of the disease so that anyone who is newly diagnosed with Parkinson's disease should seek out a specialist in that treatment. Parkinson's is known as the "shaking palsy" and it can be caused by past head trauma, past neurological infections, arteriosclerosis of certain parts of the brain or just totally be of unknown cause. People will ask if Parkinson's will make them to die earlier. In general it does not shorten life span unless they develop illness from malnutrition or infection because they are unable to care for themselves. The main problem is the eventual worsening of the shaking symptoms such that a person has a difficult problem with any self care. It is a journey that requires someone to help and the most important aspect is knowing what to expect. Sometimes doctors may discuss many of the good treatments for Parkinson's but they fail to mention that there is no cure. All of the treatments are just to control the symptoms as best as possible and prolong the time to which the palsy and movement difficulty makes self care impossible. If you know of anyone with Parkinson's disease, have them or their family check out this article from the British Medical Journal. The journey of Parkinson's disease ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3. Reader submitted Q&A - Sea salt and shellfish allergy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "If I am allergic to fish and shellfish can I still eat Sea Salt? Or can microscopic pieces of fish protein be stuck in the Sea Salt? I am a 44 y/o female with food allergies?" -Laura L. It is fantastic that you understand that your allergy is to the protein from certain fish or shellfish rather than to "iodine" as many people think. People who have these severe allergies may not only react upon eating the shellfish but even upon walking through a large seafood market with fish "particles" in the air. So the question you ask about the sea salt is interesting. I honestly do not know the answer to this from anything in the medical literature. In other words, no one has reported an allergy to sea salt nor have doctors tested and found the absence of allergic reactions to sea salt among those allergic to fish and shellfish. However I did learn something about how salt is manufactured which may help us. Almost all regular salt and sea salt is produced by one of two methods: mining salt deposits on land (originally the salt was probably from sea water) and solar evaporation of sea water. Salt that is advertised as sea salt would usually be from solar evaporation of sea water in which large pools of sea water are exposed to the sun. Then when much of the water is evaporated, the saline suspension is transferred to smaller and smaller containers until eventually you have only salt left. I would guess that most smaller operations of this sort would not pump water into the initial holding tanks with any whole fish in the water. To be a purist, however, you would only want to use sea salt that had been derived from sea water that had been run through a particle filter before the water evaporation process. Some manufacturers also "wash" the salt once or twice. I do not think I would hesitate to use sea salt if I had a shellfish/fish allergy but if I found a brand that I was successfully able to use, I would stick with that brand. It is extremely unlikely that there would be enough fish protein in salt to cause any sort of a reaction in someone allergic to that protein. Does Iodine Allergy Mean a Shellfish Allergy Too? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 4. Irritable bowel syndrome effect on quality of life ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Irritable bowel syndrome (IBS) is a poorly understood condition in which the large bowel undergoes altered muscle function such that one has diarrhea or constipation along with crampy bowel, lower abdominal or pelvic pain and bloating. Often the discomfort worsens or improves with a bowel movement but not always. There is some evidence that individuals who have food allergies, especially with IgG antibodies to specific foods, are a part of the overall population that has IBS. Unfortunately, IBS sufferers have more than abdominal pain and bowel dysfunction; they often have other debilitating symptoms that significantly affect their quality of life. A recent study in Los Angeles examined over 700 people with IBS to look at what factors most affected the physical and mental quality of their daily living activities. Frequent visits to the doctor (more than 5 visits a year), tiring easily, low energy and severe symptoms were the most significant predictors of altered physical quality of life. Feeling tense, feeling nervous, feeling hopeless, difficulty sleeping, tiring easily, low sexual interest, IBS symptom interference with sexual function, and low energy were the predominant predictors of altered mental health status. This study indicates that the quality of life in patients with IBS is primarily related to non gastrointestinal symptoms rather than altered bowel function or pain per se. Whether the IBS condition causes depressive symptoms or whether depression can cause IBS, those symptoms of low energy, hopelessness, anxiety, tenseness and decreased libido are the major reason that patients with IBS feel bad. Perhaps treatment needs to be primarily directed toward the depressive/anxiousness symptoms rather than just the pain or constipation etc. IBS effect on quality of life ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5. Health tip to share - Flexibility problems ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "Many physically challenged women probably have the same difficulty I do putting on their brassiere in the morning. I have discovered that with a front closing bra it works best to turn the bra upside down and backwards in front of you, put your arms through the arm holes.then flip it over your head, pull it down in back and fasten in front. This prevents having the bra twist on you when you put your arms through the arm holes. A back closing bra is easier to put on if you just put your arms through the arm holes and fasten it in back before you put your breasts in. If you have trouble reaching things on the floor or on shelves or in your clothes dryer and you do not have a regular reacher, barbecue tongs are a good temporary solution." Gladys L. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6. Humor is healthy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "Marriage Seminar" While attending a Marriage Seminar dealing with communication, Tom and his wife Grace listened to the instructor, "It is essential that husbands and wives know the things that are important to each other." He addressed the man, "Can you describe your wife's favorite flower?" Tom leaned over, touched his wife's arm gently and whispered, "It's Pillsbury, isn't it?" The rest of the story gets rather ugly, so I'll stop right here. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ That's it for this time. Your BACKUPMD on the Net. Rick Frederick R. Jelovsek MD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
********** Health Newsletter *********** October 3, 2004 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Biweekly from BackupMD on the Net ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Physical therapy for low back pain 2. Healthy lifestyle for the elderly 3. Reader submitted Q&A - Continuous BC Pills 4. Knee injury especially ACL ligament 5. Health tip to share - Heart attack symptoms 6. Humor is healthy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Physical therapy for low back pain ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Low back pain is a common problem and often doctors will refer patients for physical therapy to improve the discomfort of low back pain. Physical therapy consists of exercises, massages, heat and other non surgical modalities. While low back pain sufferers often feel better after such physical therapy, there is question as to whether it really results in any improvement of physical limitations from the pain, i.e., can you perform functions you were previously unable to because of the level of pain. A recent study in the UK looked at over 280 patients with low back pain for at least six weeks with or without leg pain or neurological signs. They excluded patients with serious conditions, including systemic rheumatological disease, gynecological problems, ankylosing spondylitis, tumors, infection, past spinal operations, and treatment for physical problems in the previous month. They gave half of the patients five or more 30 minute physical therapy sessions and to the other half they only gave a one hour assessment and educational (advice) session on how to self treat with exercises. While the group who had the standard physical therapy multiple sessions claimed that they felt better than the advice only group, there was no difference in the disability measures one year after treatment between the two groups. Multiple physical therapy sessions were not an advantage over only one educational instruction session. In other words once you know what to do, that is as good as having multiple visits to the physical therapist. Physical therapy for low back pain ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2. Healthy lifestyle for the elderly ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ While hundreds of articles have looked at the risk of dying by analysis of diet, physical activity, drinking and smoking, they have not always been able to simultaneously control for every factor to see which factors are the most important. A recent study reported in the Journal of the American Medical Association (JAMA) looked at the combined results of two long term European studies that followed a cohort of over 2300 men and women aged 70-90 followed for 10 years or more. They looked at the specific risk factors in all of these elderly people. Low risk factors include: 1) a Mediterranean diet which is low in meats except fish and high in fruits, vegetables and the ratio of mono unsaturated to saturated fat has been shown to be heart healthy. 2) moderate daily physical activity 3) moderate alcohol consumption has also been shown to be good for the heart. 4) non-smoking - smoking of course, is bad for the heart. Since many of these elderly people died during the length of the study, investigators were able to calculate which of these factors would put a person at the lowest risk for dying. They found that individuals who had all 4 low risk factors died at only a 35% rate compared to those who had none or one low risk factor. Number low risk factors Risk ratio Zero/none 1.0 One low risk factor 1.0 Two low risk factors .62 three low risk factors .45 four low risk factors .35 Basically, the more of these low risk factors that apply to you when you are over age 70, the longer you can expect to live. Healthy lifestyle for the elderly ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3. Reader submitted Q&A - Continuous BC Pills ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "I recently skipped my period by not taking the sugar pills in the pack of oral contraceptives. Is it normal to still receive some bleeding by tricking the body into thinking it is not menstruating?"- CW The answer is yes. You can still have some bleeding even though you skip the placebo sugar pills and just start the next pack of pills so that you are taking continuous estrogen and progesterone. Many women will skip menses when taking the continuous pill regimen but approximately 30-40% will have some bleeding ranging from spotting to full menses. Traditional birth control pills have 3 weeks of active hormone and 1 week of inactive pills. Your menses usually starts during the week of no hormones. Even though you are off of the active pills for a week, you are still protected from pregnancy as long as you do not go longer than the 7 days with no hormones. A newer regimen of continuous pills, 3 months of active, hormonal pills, is used by many women to avoid problem menses such as severe cramps, heavy bleeding, and severe PMS symptoms. You can also use it like you did in an abbreviated form over two cycles just to skip a menses because of your other activities. It is not a perfect regimen, however, hence the breakthrough bleeding which you had. There are now pills (Seasonale(R)) that are packaged with 3 months of active pill. Then you are off of them about 4-7 days and resume another continuous pack. About 60% of women will stick with that regimen over time while the others drop out presumably due to problems such as break- through bleeding. DepoProvera(R) the contraceptive shot also functions similar to this. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 4. Knee injury especially ACL ligament ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ With sports or exercise regimens there is always a risk of injury to the knees. A common injury is to tear the ligament which holds the thigh bone (femur) against the shin bone (tibia). This ligament is called the anterior cruciate ligament (ACL) of the knee. It is often injured with a sudden overextension of the knee joint or a twisting motion of the joint. Once torn, the ligament does not heal. While you would think in this day and age that surgical repair of the ligament is easy, it is not. Any knee surgery can potentially cause more long term pain than it cures and the knee joint will still be more subject to injury if you continue with high risk sports activities such as skiing, soccer, football and basketball. Rehabilitation from knee surgery can also put you out of work for a longer time than the non surgical treatment. You will need to decide if it is possible to alter your activities for the rest of your life so as not to put the knee joint at risk whether or not you have surgical treatment of the joint. The non surgical treatment of ACL injury usually involves leg exercises to make the muscles around the knee joint so strong that they keep the joint stable and without pain even with the torn ACL. If the joint cannot be made stable and the cartilage becomes injured then there may be no choice but to have surgery to repair the ligament. Professional athletes also may choose surgical repair so they can continue their livelihood albeit at increased risk for re injury at a later time and even more permanent damage. There is no advantage to having the ligament repaired surgically right away after injury so you should take your time to decide about it. Let the swelling go down. Get started on the leg exercises. Surgery at a later time is always an option. See this article at Mayo Clinic for help in deciding. Knee injury especially ACL ligament ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5. Health tip to share - Heart attack symptoms ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "Heart attack symptoms are often different in men than in women. Men tend to have the traditional chest pain or "crushing pain" with or without radiation of the pain down the left arm. On the other hand, women may be more likely to have more subtle symptoms such as nausea, sweating, lightheadedness, Vomiting, breathlessness, neck, shoulder or abdominal discomfort. They may manifest unusually extreme fatigue or sleep disturbances during the weeks before a heart attack."- FRJ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6. Humor is healthy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "Athena" During a museum tour the guide explains, "Here you can see the beautiful statue of Athena...". "Excuse me, madam," a visitor interjects. "Who is that man behind her? Is he her husband?" "No, Athena wasn't married. . . She was the g~ddess of wisdom." ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ That's it for this time. Your BACKUPMD on the Net. Rick Frederick R. Jelovsek MD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
********** Health Newsletter *********** October 17, 2004 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Biweekly from BackupMD on the Net ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Ask about X-ray risk 2. Gallstones 3. Reader submitted Q&A - Work up for menopause 4. Obesity surgery risks and benefits 5. Health tip to share - Ginger for GI upset 6. Humor is healthy The next newsletter will be in two weeks. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Ask about X-ray risk ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ We are bombarded almost daily about the risk of "this" medicine or "that" dietary habit. Sometimes both the writer of an article or the reader of that article lose perspective on whether a two fold increase in risk means a jump from 1/1000 to 2/1000 or from 25% to 50%. "A risk of death of one in one million is generally ignored, since we face many risks of such magnitude every day, from travelling 100 miles by car or 1000 miles by aeroplane." However when you get up to a risk of 1 in a thousand, it becomes pertinent to you as an individual. Many x-ray (radiological) procedures can induce eventual cancers that can be fatal. Most people forget that radiation exposure causes cancers and doctors tend to minimize these risks or sometimes be totally unaware of the magnitude of these risks. As doctors are ordering more and more radiological studies because of their fear of being sued for missing a condition and patients are more and more demanding of radiological studies to be performed because they are distrustful of the physician's diagnosis, it is very important for both parties to know the risk of the procedure such as its cancer induction risk. For example a CAT scan of the abdomen is probably equivalent to 500 chest xrays and has a risk of inducing a fatal cancer of about 1/2000 people. A thallium scan for the heart has an induced cancer risk of greater than 1/1000. Many fluoroscopic exams have a risk of 1/1000 also. The graph that accompanies the article in the British Medical Journal below is a very good representation of those risks. The point is that those studies may well be worth the cancer risk depending upon circumstances but in any case, both the patient and the doctor should know how much risk is involved. Be sure to ask about this when a bone scan, CAT scan, thyroid, liver, lung or gallbladder scan are recommended. Ask about X-ray risk ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2. Gallstones ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ The gallbladder connects to your intestines and forms bile salts that help digest the food as it passes through. Gallstones are solid deposits of cholesterol or bile salts that form in the gall bladder in some people. Most people who have gallstones never even know about them because they do not cause any symptoms. It is estimated that 1 in 12 people have gallstones but it is more common in women, older individuals and people who are obese. Post menopausal estrogen replacement therapy also predisposes to gallstones. About 20% of people who have gallstones will develop symptoms and have one or more gall bladder attacks if the stones plug up the flow of bile salts needed by the intestines. Typical symptoms of a gall bladder attack are nausea and a moderate to severe pain in the right upper abdomen or in the upper middle abdomen. Other symptoms include chronic indigestion, bloating and rarely, yellow jaundice or gray clay colored stools. Gallstones are diagnosed by ultrasound scans, CAT scans and radionucleotide scans. Your doctor can order one of these if gallbladder disease is suspected. There are some non surgical treatments of gallstones but they do not tend to work as well as surgery. Nowadays, laparoscopic surgery is the procedure of choice for removal of the gall bladder and its stones. Chronic loose stools or diarrhea can be a consequence of gall bladder removal so surgery is not usually recommended unless you are having symptoms for gall stones. If they diagnose gallstones in you but you are not having symptoms, carefully discuss your treatment options with more than one doctor to see if you really need surgery. Gallstones ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3. Reader submitted Q&A - DX Workup for menopause ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "Could you review the medical testing/work up for the diagnosis of menopause? I never had the typical hot flashes. I am a 44 year old female. Could being on two years of Lupron(R) for endometriosis cause early menopause?" - kms The medical test performed for diagnosis of menopause is a blood serum FSH level (follicle stimulating hormone). If your doctor orders it, a value of more than 30 IU/L is usually accepted as an indication of menopause; a value of under 20 IU/L would indicate that a woman is not yet menopausal. Between 20 and 30 IU/L is indeterminate. it could represent menopause or just perimenopause. There have been cases especially in infertility work-ups with FSH values above 30 IU/L in which women have still have some more ovulations, i.e., they were not totally menopausal. Home tests for menopause usually turn positive at 25 IU/L which splits the difference but as you can see, it can occasionally lead to an incorrect diagnosis. Also it is important to avoid any testing, either at home or at the doctor's office, at about two weeks after bleeding like a menses. That is because there is a midcycle surge in FSH that can often get above 20 IU/L. Many doctors treating endometriosis with Lupron(R) have anecdotal cases of women who had permanent suppression of menses after discontinuing Lupron(R). Sometimes the women are menopausal, sometimes not. However it is not a common side effect of Lupron(R) and there have been no studies that I could find that have objectively looked at this. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 4. Obesity surgery risks and benefits ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Now that there is a national push against obesity as a health problem and insurance companies are starting to cover bariatric surgery (gastric stapling and by-pass surgery) in their policies, we need to look closely at the risks of surgery for obesity. Many people will turn to surgery just because of multiple diet failures. On the other hand, this is serious surgery and people can die from it. A recent study in JAMA (Journal of the American Medical Association) looked at studies in the literature of bariatric surgery to summarize the benefits of the surgery and also the risks. They found: Benefits overall weight loss 61.2% of preoperative weight gastric banding 47.5% gastric bypass 61.6% gastroplasty 68.2% biliopancreatic diversion or duodenal switch 70.1% Diabetes completely resolved in 76.8% of patients Hyperlipidemia improved in 70% of patients Hypertension completely resolved in 61.7% Sleep apnea resolved or improved in 83.6% of patients Risks Death rate gastric banding 0.1% (1/1000) gastric bypass 0.5% (5/1000) biliopancreatic diversion or duodenal switch 1.1% (11/1000) The article did not mention it but patients undergoing any of these surgeries tend to have gastrointestinal symptoms such a nausea or diarrhea the rest of their lives. Sometimes the symptoms are major problems, sometime minor problems, but they persist because of the permanent rearrangement of the stomach and bowel structure. Obesity surgery risks and benefits ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5. Health tip to share - Ginger for GI upset ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "After taking ibuprofen for two months for bursitis in my shoulder, my hands and feet began to swell. I discontinued using it, then, started taking a ginger root capsule 550 mg two or three times a day (sometimes making a tea) for its anti- inflammatory benefits. Prior to taking the ginger, I had abdominal cramping and watery stools after eating head lettuce or milk products. I especially had this problem after eating at restaurants. To my surprise, I could eat anything at any restaurant or buffet while taking even a maintenance dose of one capsule a day without the cramping, etc." - MH ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6. Humor is healthy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "Classes For Men" Classes for men at the learning center for adults -registration must be completed by Nov 5th. Note: due to the complexity and difficulty level of their contents, class size will be limited to 8 participants maximum. Class 1: How to Fill Up the Ice Cube Trays. Step by Step, with Slide Presentation. Meets 4 weeks, Monday and Wednesday for 2 hours beginning at 7:00 PM. Class 2: The Toilet Paper Roll. Does it Change Itself? Round Table Discussion. Meets 2 weeks, Saturday 12:00 for 2 hours. Class 3: Fundamental Differences Between the Laundry Hamper and the Floor. Pictures and Explanatory Graphics. Meets Saturdays at 2:00 PM for 3 weeks. Class 4: After Dinner Dishes. Can They Levitate and Fly Into the Kitchen Sink? Examples on Video. Meets 4 weeks, Tuesday and Thursday for 2 hours beginning at 7:00 PM Class 5: Learning How to Find Things - Starting with looking in the right places instead of turning the house upside down while screaming. Open Forum. Monday at 8:00 PM, 2 hours. Class 6: Health Watch - Bringing her flowers is not harmful to your health. Graphics and Audio Tapes. Three nights; Monday, Wednesday, Friday at 7:00 PM for 2 hours. Class 7: Real Men ask for Directions When Lost. Real Life Testimonials. Tuesdays at 6:00 PM, location to be determined. Class 8: Is it genetically impossible to sit quietly while she parallel parks? Driving Simulations. 4 weeks, Saturday's noon, 2 hours. Class 9: How to be the Ideal Shopping Companion. Relaxation Exercises, Meditation and Breathing Techniques. Meets 4 weeks, Tuesday and Thursday for 2 hours beginning at 7:00 PM. Class 10: How to Fight Cerebral Atrophy - Remembering Birthdays, Anniversaries and Other Important Dates and Calling When You're Going to be Late. Cerebral Shock Therapy Sessions and Full Lobotomies Offered. Three nights; Monday, Wednesday, Friday at 7:00 PM for 2 hours. Class 11: The Stove/Oven - What it is and How it is Used. Live Demonstration. Tuesdays at 6:00 PM, location to be determined. Upon completion of any of the above courses, diplomas will be issued to the survivors. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ That's it for this time. Your BACKUPMD on the Net. Rick Frederick R. Jelovsek MD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
********** Health Newsletter *********** October 31, 2004 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Biweekly from BackupMD on the Net ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Common Cold 2. Daily exercises can help dizziness 3. Reader submitted Q&A - Morning neck stiffness 4. Thyroid Cancer 5. Health tip to share - Shingles 6. Humor is healthy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Common Cold ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ With over a billion colds a year in the U.S. and the average child having 3-8 colds per year, you can see why it is called "common". Symptoms generally include nasal congestion, a runny nose and sneezing. With only those symptoms, you might not be able to tell a cold from allergies. However with a cold, there are often other symptoms such as a sore throat, headache, cough or muscle aches. Colds are caused by over 200 different viruses and as such, antibiotics are not helpful at all. The first 2-3 days are the most contagious so it is best to stay home rather than going to work to spread the germs. If you do have to go out, do not hesitate to wear a surgical type face mask to prevent infecting other people. You can also wear one at home to protect your family. It is not inevitable that all family members must catch the same cold. The nasal drainage collects in the windpipe (trachea) and lungs causing a cough. This means that the best treatment for a cold is a nasal decongestant that dries up the secretions so you do not cough them up as much. You can get a decongestant at a pharmacy or grocery store without a prescription. Don't run to the doctor's office just to be told to take a decongestant and drink plenty of fluids. Even a yellowish or yellow-green nasal discharge does not require antibiotics unless you have a lung problem such asthma or bronchitis. A common cold is usually over all by itself in about a week. Sometimes a cough can persist for another week. If it lasts longer, consider another problem, such as a sinus infection or allergies. You should see the doctor if you start running a fever (for an adult), if the drainage lasts 10 or more days or if the throat really hurts with swallowing for more than 2-3 days. Once you have a cold it is too late to start taking herbs or vitamins thought to prevent colds so save your money at that point. Lay in a supply of surgical masks to have at home. Common Cold ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2. Daily exercises can help dizziness ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Dizziness or loss of balance is very common after the age of 75. While there are various medical causes of dizziness (vertigo), most often there is no obvious explanation for its cause. No matter what the cause of dizziness, physical therapy for balance control is common to all treatments for it. The exercises are very simple for someone without dizziness but very hard for a person who gets light-headed every time they move their head. Physical therapy patients have to turn their head from one side to the other side and to lower or raise the head while keeping eyes open (and either simultaneously focusing or not focusing on an object) or keeping them closed. At first, these movements were are made slowly while sitting, then faster, and finally while standing or walking. After 3 months of performing these exercises, individuals have significant improvement in their symptoms. Daily exercises can help dizziness ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3. Reader submitted Q&A - Morning neck stiffness ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "When I wake up in the mornings my neck is almost stiff and my lower back hurts a little bit. Doctors say I should correct my sleeping position and stop tilting my neck before it becomes a permanent problem which will cause problems with my nerves. THE MAIN PROBLEM IS: I can't control my sleeping position. I wake up many times at night trying to do so, but it's becoming quite irritating and useless. PLEASE TELL ME HOW TO CONTROL MY SLEEPING POSITION." - anonymous The question you ask is almost impossible to answer because no one that I know of has a prescription to control movement during sleep. Neck position, however can sometimes be controlled by special cervical pillows that are shaped slightly different than conventional pillows and also made of new age foam materials that better accommodate the shape of the head and neck to provide more even support. With these special pillows you do not unconsciously contract your neck muscles at night as much when you sleep. There was a recent article in Prevention Magazine that looked a different pillows to see which ones gave their staff more restful sleep with the least neck pain. As I remember, the best pillow they chose was the ObusForme(R) UltraFoam Deluxe Pillow. I have used that and it seems to be quite helpful for morning neck pain. The neck pain itself usually comes from uneven sustained muscle contraction of one or several of the many neck muscles. Pillows that are too high (plump) or too thin can cause uneven muscle contraction of the front muscles if you are laying on your back while sleeping or uneven contraction of the side neck muscles if you are laying on your side. A pillow that keeps your head and neck in an unbent position relative to your shoulders will help alleviate morning neck pain. Sometimes the uneven neck muscle contraction during sleep can come from stress, sleeping disorders, or even daytime muscle stress from work, school or home lifting or positional strain. Even sitting for a long time during the day looking at a computer monitor that is not straight ahead of you can result in uneven night time neck muscle contraction. People who have chronic neck pain (cervical dystonia) usually have weakened neck muscles and exercises to strengthen your neck may also help relieve some of the morning stiffness. Each evening before bed, try about 5 repetitions of the following neck muscle exercises from preventdisease.com : 1. Hold one hand against the side of your head. Use your hand to resist the movement as you try to touch your shoulder with your ear. Hold this posture for a count of 5. Repeat to other side. 2. Hold both hands against your forehead. Try to move head forward, but resist the movement with your hands. Hold this posture for a count of 5. 3. Place both hands behind your head. Try to move head backwards, but resist the movement with your hands. Don't tip chin. Hold this posture for a count of 5. 4. Hold one hand against the side of your head. Use your hand to resist the movement as you try to rotate your head to one side until your chin is lined on top of your shoulder. Hold this posture for a count of 5. Repeat to other side. Also consider acquiring a cervical pillow even though they can be somewhat expensive. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 4. Thyroid Cancer ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Thyroid cancer has been in the news recently but it is not one of the more common malignancies. It is, however, a very curable cancer (greater than 90% cure with surgery) so it is important to know the signs and symptoms of this. Most of the thyroid cancers present as a "lump" in the thyroid gland just below the "Adam's Apple" on the front of the neck. While most lumps in the thyroid are benign nodules (non-cancerous), about 1 in 20 (5%) are malignant. Sometimes a neck lump is not noticed as the first symptom but rather presents other symptoms such as voice hoarseness, difficulty swallowing, trouble breathing, swollen lymph nodes in the neck, or pain in your throat or neck which sometimes spreads up to your ears. Both benign and malignant thyroid nodules can produce these symptoms so just because they are present does not mean you have cancer but it does mean you need to have the nodule evaluated. The diagnosis of whether a thyroid nodule is benign or malignant is either by a fine needle biopsy or sometimes by a surgical biopsy or excision. Prior to that a thyroid scan is usually performed to visualize the entire extent of the nodule. Also a blood test measurement of thyroid function such as the TSH is drawn to determine whether the nodule is over functioning in its thyroid hormone secretion or not. Sometimes a CT scan or MRI scan needs to be performed to determine if the cancer has spread to the lymph nodes or the windpipe (trachea). While the predominant manner of treating thyroid cancer is surgical excision, sometimes radiation therapy must be used and sometimes medical chemotherapy such as that with radioactive iodine must be given. Thyroid Cancer ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5. Health tip to share - Shingles ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "I would like very much to share a health tip on shingles/herpes. Exercise is very important to prevent breakouts. It took me 10 years to realize what a difference this would make in controlling breakouts. Since I started to workout at the gym 3-4 days a week, I have not experienced a breakout in 6 months. Usually I have a breakout every 2 months. I also take a multivitamin. This really works for me. I hope I can help someone with sharing this info." - Mellissa ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6. Humor is healthy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "Signs" At a Santa Fe gas station: "We will sell gasoline to anyone in a glass container." In a New York restaurant: "Customers who consider our waitresses uncivil ought to see the manager." On the wall of a Baltimore estate: "Trespassers will be prosecuted to the full extent of the law. --Sisters of Mercy" On a long-established New Mexico dry cleaners: "38 years on the same spot." In a Los Angeles dance hall: "Good clean dancing every night but Sunday." In a Florida maternity ward: "No children allowed." In a New York drugstore: "We dispense with accuracy." In the offices of a loan company: "Ask about our plans for owning your home." In a New York medical building: "Mental Health Prevention Center" On a New York convalescent home: "For the sick and tired of the Episcopal Church." On a Maine shop: "Our motto is to give our customers the lowest possible prices, and workmanship." At a number of military bases: "Restricted to unauthorized personnel." On a display of "I love you only" Valentine cards: "Now available in multi-packs." In the window of a Kentucky appliance store: "Don't kill your wife. Let our washing machine do the dirty work." In a funeral parlor: "Ask about our layaway plan." In a clothing store: "Wonderful bargains for men with 16 and 17 necks." In a Tacoma, Washington men's clothing store: "15 men's wool suits, $10. They won't last an hour!" On a shopping mall marquee: "Archery Tournament -- Ears pierced" Outside a country shop: "We buy junk and sell antiques." In the window of an Oregon store: "Why go elsewhere and be cheated when you can come here?" In a Maine restaurant: "Open 7 days a week and weekends." On a radiator repair garage: "Best place to take a leak." In the vestry of a New England church: "Will the last person to leave please see that the perpetual light is extinguished." In a Pennsylvania cemetery: "Persons are prohibited from picking flowers from any but their own graves." On a roller coaster: "Watch your head." On the grounds of a public school: "No trespassing without permission." On a Tennessee highway: "When this sign is under water, this road is impassable." Similarly, in front of a New Hampshire car wash: "If you can't read this, it's time to wash your car." And apparently, somewhere in England in an open field otherwise untouched by human presence, there is a sign that says, "Do not throw stones at this sign." ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ That's it for this time. Your BACKUPMD on the Net. Rick Frederick R. Jelovsek MD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
********** Health Newsletter *********** November 14, 2004 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Biweekly from BackupMD on the Net ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Will exercise with sore muscles hurt you? 2. Which calcium supplements for bone density? 3. Reader submitted Q&A - Rosacea 4. Dry mouth 5. Health tip to share - Gingivitis 6. Humor is healthy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Will exercise with sore muscles hurt you? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Muscle soreness after any physical activity or exercise workout is common unless the muscles have been working at that level for at least two weeks. The more out-of-shape the muscles are, the later the soreness sets in. It is not uncommon to be sore the day after rather than the day of, any unusual muscle workout. The question becomes "Is it safe to push the muscles with more exercise when they are already sore?" There is no absolute answer to this because it depends upon whether there is just generalized muscle fiber swelling due to the unaccustomed exercise or whether there is tearing (usually microscopic) of the muscle fibers. You have no way of knowing except by the degree of pain when you resume exercise. If light warm-up exercises seem to make the pain somewhat less, you are probably good to go ahead with a workout no greater than what you did the previous day. If the pain seems to be made worse or if it localizes to a specific muscle rather than being generalized then it is best not to try to "exercise through the pain". Rather you should confine your workout to muscles that are not sore or try a light activity like walking and wait another day before exercising the very sore muscles. If you are really going for muscle strengthening rather than just the aerobic work-out, it is more important not to stress the same muscles each day. Usually a muscle group needs a day of rest in between so that if you exercise, for example, your abdominal muscles on Monday, wait until Wednesday to exercise them specifically again. This gives the muscle time to adapt rather than to be "broken down". Will exercise with sore muscles hurt you? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2. Which calcium supplements for bone density? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Calcium is a basic mineral needed for many bodily functions other than strong bones. Heart rhythm, nerve conduction and hormone secretion are among those physiological functions that need calcium. Calcium mostly comes from our diet, especially meat and dairy products but often it is not enough. Supplements containing calcium come in different forms with different side effects and efficacy. Look on the supplement bottle label for "purified" or for the USP (United States Pharmacopeia) symbol. This will help protect against contaminants. Most experts recommend to avoid calcium from unrefined oyster shell, bone meal or dolomite, since these in the past have contained high lead levels or other toxic metals. Different forms of calcium include: calcium carbonate (Caltrate(R), TUMS(R), Coral calcium) calcium phosphate (Solaray(R)) calcium citrate (Citracal(R) or Solgar(R)) calcium gluconate (Solgar(R)) calcium lactate (Twinlab(R)) While the daily calcium requirements are calculated at 1000-1200 mg a day, remember that some calcium always comes from your diet. A milk product serving, eg., milk cheese, yogurt, cottage cheese etc. contains about 300 mg of calcium. On the other hand, you must look at the supplement to see how much "elemental" calcium is released from that supplement because only the elemental calcium counts toward your daily requirement. For example a 500 mg tablet of calcium carbonate may only provide 200 mg of elemental calcium (40% is absorbed). Calcium citrate is better absorbed (about 60%) because it is more acidic. Calcium lactate 740 mg may only provide 100 mg of elemental calcium, however for a specific person the calcium lactate form may be better tolerated in the gastrointestinal tract than calcium carbonate. Both calcium citrate and calcium phosphate are less constipating and produce less "gas" than calcium carbonate but they may be more expensive forms of calcium. You will have to find the right form of calcium for you depending upon cost and side effects. There is such a thing as too much calcium. Some people who tend to form kidney stones will need to watch out. No one should really take in more than 2500 mg of calcium a day. Calcium supplements for bone density ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3. Reader submitted Q&A - Rosacea ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "Is there any hope of a cure for rosacea in the future? I am a 43 year old male who has had rosacea for 11 years." - SD To the best of my knowledge there is not a cure for rosacea on the near horizon but I would not rule it out forever. The rosacea classic symptoms are patchy flushing (redness) and inflammation, particularly on the cheeks, nose, forehead, and around the mouth. Rosacea typically appears between the ages of 30 and 50 and affects more women than men. Rosacea is a disorder of the blood vessels that causes them to swell, leading to flushing. There is a genetic predisposition combined with certain environmental factors that may irritate the skin. There can be Clogging of the sebaceous gland openings with skin mites called Demodex folliculorum, which live in facial-hair follicles. Acne, psoriasis, eczema and atopic dermatitis may look similar to rosacea so it is important to have this diagnosed by a dermatologist and not just guess that a reddened face rash is always rosacea. For people with rosacea, stimulants such as coffee, tea, alcohol, cigarettes, and excessive sugar from sweets and soda are vascular dilators and should be avoided. Diet sodas containing aspartame and or NutraSweet cause excessive redness in approximately 30% of rosacea sufferers and should be avoided. Many rosacea sufferers may have food allergies or triggers that perhaps do not cause the rosacea but will aggravate the symptoms by causing blood vessel dilatation. Topical skin cleansers, topical antibiotics or even laser therapy may be recommended by dermatologists. The treatment can be complex and be different for different people so it is beneficial if you can find a dermatologist who will work with you to try those different treatments that have been shown to improve rosacea. Certain brands of cosmetics can be useful to cover up the redness and these are used even by men. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 4. Dry mouth ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ You would not think that having a dry mouth is much of a health problem but it can be. It can lead to increased tooth decay, it can cause difficulty in tasting, swallowing or speaking. It can lead to sores of the mouth or it can be a sign of adverse medication reaction or disease conditions. Dry mouth (xerostomia) is due to not having enough saliva (spit) from the glands of the mouth. Causes of dry mouth include: medicine side effects - there are many medicines that cause the salivary glands to make less saliva. Anti-hypertensives and anti-depression medicines often cause this diseases - Sjögren's Syndrome, HIV/AIDS, diabetes, and Parkinson's disease can all cause dry mouth. radiation therapy - from cancer treatment, radiation can damage the salivary glands chemotherapy - drugs used to treat cancer can make saliva thicker, causing the mouth to feel dry. nerve damage - head or neck injury can damage the nerves that tell salivary glands to make saliva Treatment for dry mouth may include stopping or substituting any medications thought to block salivary gland secretion. Sometimes an artificial saliva may need to be used. Dry mouth ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5. Health tip to share - Gingivitis ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "My dentist told me if I didn't start flossing I would get gingivitis, (my gums were very red and sore - I hated to floss), and have to be seen every 3 months. I started using Listerine(R) or an alcohol based mouth wash every day morning and night. It went away and I have had no problems since. My dentist was amazed." - DS ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6. Humor is healthy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "Faux HMO memo to all Hospital Staff" MEMO To: All Hospital Staff From: Administration/Groundskeeping Subject: New Cost Cutting Measures Effective immediately, this hospital will no longer provide security. Each charge nurse will be issued a .38 caliber revolver and 12 rounds of ammunition. An additional 12 rounds will be stored in pharmacy. In addition to routine nursing duties, Charge Nurses will rotate the patrolling of the hospital grounds. A bicycle and helmet will be provided for patrolling the parking areas. In light of the similarity of monitoring equipment, ICU will now take over the security surveillance duties. The ward clerk will be responsible for watching cardiac monitors and security monitors as well as regular duties. Food service will be discontinued. Patients wishing to be fed will need to let their families know to bring something or may make arrangements with Subway or Pizza Hut to deliver. Coin-operated telephones will be available in patient rooms for this purpose as well as for other calls the patient may wish to make. Housekeeping and Physical Therapy will be combined. Mops will be issued to those patients who are ambulatory, thus providing range of motion exercises as well as a clean environment. Families and ambulatory patients may also sign up to clean the rooms of non-ambulatory patients for special discounts on their final bill. Time cards will be provided. As you can see on the "from" line above, hospital administration is assuming the grounds keeping duties. If an administrator cannot be reached by calling his/her office, it is suggested that you walk outside and listen for the sound of a lawn mower, weed-whacker, etc. Maintenance is being eliminated. The hospital has subscribed to the Time-Life "How to..." series of maintenance books. These can be checked out from administration, and a toolbox will be standard equipment on all nursing units. We will be receiving the series at a rate of one volume every other month. We already have the volume on "Basic Wiring," but if a non-electrical problem occurs, please try to handle it as best you can until the appropriate volume arrives. Cutbacks in phlebotomy staff will be accommodated by only performing blood-related tests on patients who are already bleeding. Physicians will be informed that they may order no more than two X-rays per patient stay. This is due to the turnaround time required by Photomat. Two prints will be provided for the price of one, and physicians are being advised to clip coupons from the Sunday paper if they want extra sets. Photomat will also honor competitors coupons for one-hour processing in emergency situations, so if you come across any extra coupons please clip out and send these to ER. In view of the hot summer temperatures, the Utilities Dept. has been asked to install individual meters in each patient room, office, etc., so that electrical consumption can be monitored and appropriately billed. Fans will be available for sale or lease in the hospital gift shop. In addition to the current recycling programs, a bin for collection of unused fruit and bread will soon be provided on each floor. Families, patients, and the few remaining employees are asked to contribute discarded produce. Pharmacy will utilize this for antibiotic production. These will be available for purchase and, coincidentally, will soon be the only antibiotics on our HMO's formulary. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ That's it for this time. Your BACKUPMD on the Net. Rick Frederick R. Jelovsek MD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
********** Health Newsletter *********** November 28, 2004 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Biweekly from BackupMD on the Net ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Hair removal 101 2. Over-the-counter wrinkle creams - do they work? 3. Reader submitted Q&A - Baker's cyst of knee 4. Exposure to solvents may affect your baby 5. Health tip to share - Cinnamon vs sugar 6. Humor is healthy The next newsletter will be in two weeks. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Hair removal 101 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ There are many different ways of removing unwanted hair. Some methods are cheap (shaving) while others can be quite expensive (laser removal). Some of the methods result in permanent hair removal while with others, the hairs eventually grow back. Almost all of the hair removal techniques can produce skin irritation, redness, increased pigmentation, acne and swelling. With some techniques, adverse skin changes are worse than others. Permanent hair removal techniques include laser, electrolysis and prescription chemical treatments such as eflornithine (Vaniqa(R)). Laser hair removal is expensive but there is not usually as much skin reaction as with electrolysis or eflornithine. The downside of laser is that occasionally there can be some increased skin pigmentation causing dark blotches. The prescription cream, eflornithine, stops hair growth and is approved for treating facial hair growth in women. Electrolysis is effective but it should be done by someone who is trained in it, not just using a home kit which seems to result in more scarring an increased pigmentation. Waxing, tweezing and sugaring can remove hair for 2-8 weeks and they tend to be more painful techniques of hair removal. Sugaring involves making a sugar paste which is applied to the hair and when it dries, it is peeled off taking much of the hair with it. It is not quite as effective as waxing but there may be less skin burning with it. Keep in mind that all of these methods of hair removal should only be used after you have had a hormone assessment to make sure there is not an excess of male hormone testosterone in the blood. If there is, medicines should be taken to reduce the level otherwise all of the hair removal efforts will be for naught. Hair removal 101 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2. Over-the-counter wrinkle creams - do they work? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Advertising for wrinkle creams that you can purchase without a prescription, always makes the product sound too good to be true. "Just rub this cream on and watch the wrinkles disappear!" But do they really work? Are the ingredients in them known to reduce wrinkles? The web site at MayoClinic.com has a good review of those ingredients that are effective, possibly effective and possibly ineffective. Vitamin A and hydroxy acids are the two main ingredients known to improve wrinkles. Retinol is a vitamin A derivative used in OTC anti-wrinkle creams. It is an antioxidant that is not quite as strong as the prescription cream tretinoin, but it produces less skin redness and irritation. Hydroxyacids cause the outer layer of old dead skin to shed leaving new skin underneath that is more smooth and evenly pigmented. Possibly effective ingredients include: Alpha-lipoic acid (ALA) Coenzyme Q-10 Copper peptides Growth factors such as kinetin Soy isoflavones (phytoestrogens) Tea extracts Vitamin C Vitamin E Most of these are strong antioxidants which help repair and prevent sun skin damage. They have been shown in animal trials to reduce wrinkles. Some of them have been shown in medical human trials to be effective against wrinkles but the evidence is not overwhelming yet. The biggest problem with over- the-counter creams is that the levels of these active ingredients may not be high enough to be effective. This is especially true with vitamin C in which very high levels are needed to have a beneficial effect. If you are interested in the specific products which contain these ingredients, be sure to visit the Mayo Clinic site below. Over-the-counter wrinkle creams - do they work? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3. Reader submitted Q&A - Baker's cyst of knee ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "Can you tell me what a bakers cyst is?" - Betty A Baker's cyst is a swelling of the posterior knee capsule. It is a fluid reaction to arthritis or trauma such as a torn meniscus of the knee joint. The fluid fills the knee joint and pushes out at the weakest part of the joint capsule, usually at the back of the knee. It causes a dull aching pain that is made worse with walking or standing. On rare occasions the cyst can rupture. Usually, however, a Baker's cyst will not cause long-term harm and long-term disability is very rare. Most cases improve with time or arthroscopic surgery. The cyst can be diagnosed on physical exam by feeling it behind the knee joint. MRI (magnetic resonance imaging) can also be used not only to diagnose the Baker's cyst but also to see if there are any tears in the cartilage (meniscus) of the knee. Treatment of a Baker's cyst of the knee is usually non surgical at first. Rest and elevation of the leg usually give some immediate relief. The key is to eliminate inflammation of the joint. Avoid those activities that worsen the pain and swelling such as "squatting, kneeling, heavy lifting, climbing, and even running." Use anti-inflammatory medicines such as naproxen or ibuprofen. A knee brace may be helpful to reduce pain. Sometimes heat from a heating pad can also ease the discomfort and promote healing. The next step is to strengthen the quadriceps muscle and knee cap tendon. Strengthening exercises help keep the knee joint from unnecessary movement and more pain. If the cyst does not regress spontaneously in several months or if it just produces continuous severe pain, one should consult with an orthopedic surgeon for possible arthroscopic surgery. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 4. Exposure to solvents may affect your baby ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Many women have jobs in manufacturing and industrial plants in which they are exposed to organic solvent chemicals such as benzene, carbon tetrachloride, carbon disulfide, chloroform, toluene, phenol and others. They are found in jobs involving painting and plastic adhesives, nail salons, dry-cleaning operations, and medical laboratories among others. Solvents are easily inhaled producing a chronic exposure rather than a limited one such as if you just spill a solvent on your ski
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