Womens Health

Women's Health Newsletters 3/6/05 - 5/15/05



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********** Health Newsletter ***********
              March 6,  2005
Biweekly from BackupMD on the Net
1. Vitamin D deficiency in the elderly
2. Walking shoes
3. Reader submitted Q&A - Thirsty with dry skin
4. Changes in drug metabolism during pregnancy
5. Health tip to share - Ankle sprains and arthritis
6. Humor is healthy
The next newsletter will be in two weeks.
1. Vitamin D deficiency in the elderly
The building blocks for Vitamin D, which helps 
strengthen both bones and muscles, are 
manufactured in the skin. Under the influence of 
sunlight, as little as 10 minutes a day, the 
building blocks are converted to vitamin D. As we 
age, the skin becomes less efficient at 
manufacturing the building blocks (provitamin 
calcidiol) so that by age 75 there is a marked 
impairment of skin vitamin D synthesis. Sometimes 
the elderly are more confined inside such as in 
nursing homes or by being partially physically 
disabled in their own home. This leads to a 
Vitamin D deficiency much more commonly than has 
been suspected. 
The following review article in the British 
Medical Journal makes several important points: 
"The prevalence of vitamin D deficiency in elderly 
people is much greater than previously realised, 
especially among those who are house bound." 
"Vitamin D deficiency is associated with muscle 
weakness as well as osteomalacia (bone thinning)" 
"Deficiency is also associated with falls and 
fractures among elderly people that are not 
explained by reduced bone density" 
"Supplementation of 800 IU of vitamin D daily is 
needed to have an effect on falls" 
Since vitamin D can be stored in the body, it can 
be taken by shot (100,000 IU of vitamin D every 4 
months) as well as by mouth (800 IU a day). Many 
calcium supplementations have added vitamin D but 
400IU a day is probably not enough. Studies have 
shown that in this dose (800 IU per day), many 
falls can be avoided as well as bone fractures. 
In one of the Women's Health and aging studies, 
the incidence of vitamin D deficiency was 8.3% in 
those aged 65-74, 14.5% at ages 75-84, and 17.4% 
at 85 and over. I would suggest that after the age 
of 65 or even before then if a person is more 
confined inside with little sunlight exposure, 
calcium supplementation with added vitamin D 
should be taken. The exception might be if you 
have a history of calcium based kidney stones; in 
that case see your physician to have the vitamin D 

Vitamin D deficiency in the elderly
2. Walking shoes
You would think that all shoes should be 
classified as walking shoes since that is the most 
common use of any shoe, but that would be wrong. 
There are special features on shoes now that 
making prolonged walking easier on the feet. If 
you do any amount of walking, primarily for 
exercise, you should make sure your shoes are 
built especially for walking. Some of the features 
that are desirable in a walking shoe are: 
a wide toe box to prevent calluses or irritation 
of bunions and hammertoes 

arches that support your particular high, low or 
neutral foot arch 

an ankle collar that cushions the ankle and makes 
a snug fit 

an Achilles notch that keeps pressure at the ankle 
off of the Achilles tendon 

an insole or gel pad that cushions and reduces 
impact energy when your feet hit the ground 

a firm support in the heel of the shoes that 
stabilizes your feet if they tend to roll inward 
as the feet hit the ground 

an upper shoe material that allows your foot to 
When you replace any worn walking shoes or buy new 
shoes for any reason, there are helpful tips: 
take your "walking socks" with you to the store to 
try on the shoes 

make sure the width is not too tight; women with 
wide feet may need men's sizes for more width in 
the heel and ball of the foot. 

there should be at least a half inch between your 
longest toe and the inside of the shoe 

if one foot is longer or wider than the other, buy 
the larger size 

walk in the shoes in the store; they should be 
comfortable immediately 
When it is time to use the shoes, wear loose 
comfortable clothing that breathes. Warm up by 
walking in place until you feel a little warm and 
then do some muscle stretching exercises. Start 
walking slow and easy and then build up to what is 
comfortable. Fifteen minutes may be plenty if you 
are just starting a walking program. Beginners 
should consider starting out at just 15 minutes 
twice a week and build up to about 30 minutes 5 
days a week. This build up is over a 10 week 
You may be interested in this article at Mayo 
Clinic about the ins and outs of walking shoes. 

Walking shoes
3. Reader submitted Q&A - Thirsty with dry skin
"I am having a problem with constant thirst, very 
dry skin, and peeling nails. Is there anything 
other than diabetes that would cause this/these 
I am currently 45 y.o. and am menopausal, no 
menstruation for 11 months, on no meds, and gluten 
sensitive." - MJ 
What has your doctor said about these symptoms? 
Have you had any tests run? I assume you have not 
been putting up with peeling nails without seeking 
medical opinion from someone else. 
Other than being chronically dehydrated due to 
exercise or living in a very warm climate, thirst 
can be knocked off kilter by diabetes mellitus 
(sugar diabetes) or diabetes insipidus which is a 
brain hormone abnormality. 
There can be practical reasons for dry skin such 
low home humidity due to home heating
rubbing alcohol
certain chemicals and cleaning products
Medical conditions associated with newly acquired 
dry skin include: 
contact dermatitis
fungal skin infection
uremia due to kidney failure
vitamin A deficiency
Peeling nails are commonly seen in people who 
repeatedly immerse their hands in water, and in 
women who use nail enamel or acrylics. Rarely, it 
shows up due to nail fungal infections, anemia, 
arterial insufficiency, or metabolic disorders 
like hypothyroidism (low thyroid). Occasionally, 
psoriasis, lichen planus and the use of oral 
retinoids can cause brittleness of the nails. The 
underlying cause appears to be a drying out of the 
nail plate through the use of solvents, such as 
nail enamel. Water exposure expands the nail 
volume, and drying causes it to contract. This 
repeated cycle weakens the nail matrix, leading to 
fractures. What about the water exposure of your 
nails and use of nail cosmetics? 
If you really have not seen a physician yet you 
should. You will probably need blood sugar 
assessment, thyroid studies (TSH) and possibly 
kidney function studies, (BUN serum creatinine, 
urine osmolality).  If all of those studies are 
normal, I would suggest seeing a dermatologist to 
look at your skin and nails to make sure you do 
not have a fungal nail infection or skin condition 
that predisposes you to dryness. 

4. Changes in drug metabolism during pregnancy
How your body metabolizes drugs is mostly 
determined by the cytochrome P450 system. 
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. Scientists have found 
that up to half of all Americans have genetic 
modifications of this system in that they 
metabolize drugs differently from one another. 
People may be:
Normal metabolizer - likely to have the desired 
effect from a standard dose of the drug 

Slow (intermediate) metabolizer - do not need as 
high a dose of the drug to get the desired effect 

Poor metabolizer - likely to have significant side 
effects from a standard dose because the drug 
accumulates in your system 

Extensive metabolizer - your system works at 
triple speed and overtime so that you require a 
higher dose to have the desired drug effect 
So far, no one had really measured whether 
pregnancy changes this system. Recent 
investigators at the University of Minnesota 
looked at the cytochrome P450 system during 
pregnancy to see if pregnancy itself made an 
additional difference in how we metabolize drugs 
through this system. They found that one of the 
enzyme system variants decreased by about 30-60% 
while two other variants increased about 30-50%. 
Right now it is still hard to say which drug will 
cause more or less side effects or therapeutic 
effects in a given pregnant individual, but the 
essence is that every person potentially may 
metabolize a drug differently than someone else 
and this should be taken into account by doctors. 
From your point of view as someone who may be 
prescribed certain drugs, you need to carefully 
understand the side effect profile of any 
medication you are prescribed so you can quickly 
tell if you may be metabolizing a standard drug 
dose differently than the doctor would expect of 
most people. 

Drug metabolism in Pregnancy Changes
5. Health tip to share - Ankle sprains and arthritis
Arthritis of the ankle often occurs within a 
couple of decades after an ankle fracture. 
Arthritis may also occur just from an ankle 
sprain. If the sprain makes the ankle joint 
unstable, there is evidence than a vast majority 
of people will end up with arthritis in the ankle. 
If you have a sports injury or even just an 
around-the-house injury of your ankles, make sure 
you find out what physical therapy is needed to 
build up the muscles to stabilize the ankle joint 
in order to ward off arthritis of that joint in 
later years. This is especially true if you have 
had more than one sprain of the same ankle. - FRJ 
6. Humor is healthy
"Three elderly women"
Three elderly women are sitting in a diner, 
chatting about various things. 
One lady says, "You know, I'm getting really 
forgetful. This morning, I was standing at the top 
of the stairs, and I couldn't remember whether I 
had just come up or was about to go down." 
The second lady says, "You think that's bad?  The 
other day, I was sitting on the edge of my bed, 
and I couldn't remember whether I was going to bed 
or had just woken up!" 
The third lady smiles smugly.  "Well, my memory's 
just as good as it's always been, knock on wood."  
She raps the table.  With a startled look on her 
face, she asks, "Who's there?" 

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

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********** Health Newsletter ***********
              March 20, 2005
Biweekly from BackupMD on the Net

1. Lack of Vitamin E effects on heart disease and cancer
2. Avian influenza (bird flu) 
3. Reader submitted Q&A - Nighttime Incontinence
4. St John's Wort for depression
5. Health tip to share - Thirst and peeling nails
6. Humor is healthy

1. Lack of Vitamin E effects on heart disease and cancer

In experimental studies with animals and in the 
lab, various forms of Vitamin E have been touted 
as useful to prevent heart disease and even cancer 
by its antioxidant properties. Unfortunately there 
continue to be studies that dispute any beneficial 
effects of Vitamin E when taken by human subjects 
as food supplements. The argument in favor of 
Vitamin E notes that most of the studies in humans 
have not been carried out long enough to see the 
benefits or they claim that the "correct form" of 
Vitamin E was not used. 

Now a large study of over 1000 patients with 
diabetes using a daily dose of natural source 
vitamin E (400 IU) or matching placebo has been 
reported. The average length of follow-up is over 
7 years. In this study they found no difference in 
the new occurrence of either heart disease or 
cancer in either group. New cancer incidence was 
11.6% in the vitamin E group vs 12.3% in the 
placebo group. Major cardiac events were 21.5% in 
the vitamin E group and 20.6% in the placebo 
group. There actually was a slightly higher 
incidence of heart failure and hospitalizations 
for heart failure in the vitamin E group. 

This study in diabetics concluded that long term 
vitamin E supplementation does not prevent cancer 
or major cardiovascular events and may actually 
increase the risk for heart failure. I am not sure 
that one can still justify taking Vitamin E 
supplements for the purpose of  trying to prevent 
either heart disease or cancer. 

Vitamin E lack of effects on heart disease and cancer

2.  Avian influenza (bird flu) 
While most viruses are unique to the species that 
they cause disease in, more and more instances are 
occurring of cross species infections. For example 
West Nile virus, SARS, hantavirus and monkey pox 
virus are examples that started in animals and 
then spread to humans to cause serious diseases. 
HIV was originally a monkey infection. Now we are 
concerned with Avian Flu virus (bird influenza). 
It has caused some infections in Southeast Asia, 
originating in about 1997 in Hong Kong. 

Avian flu is like regular flu but worse. It causes 
the usual cough, fever, sore throat and muscle 
aches of regular flu but often it progresses to a 
viral pneumonia or adult respiratory distress 
syndrome which can be life threatening. These are 
the complications that are the common causes of 
flu related deaths. Bird flu is a type A influenza 
that commonly causes influenza pandemics as 
opposed to a type B or C influenza which are 
milder and cause less spread and severe symptoms. 

MayoClinic.com has a good explanation of how 
people get this infection: 

1. Wild birds shed the virus. Infected migratory 
waterfowl, the natural carriers of avian influenza 
viruses, shed the virus in their droppings, saliva 
and nasal secretions. 

2. The virus spreads to domesticated birds. 
Domestic poultry become infected from contact with 
these birds or with contaminated water, feed or 
soil. They may also catch the disease the same way 
humans contract conventional flu by inhaling the 
airborne virus. Bird flu spreads quickly and 
lethally within a flock and is inadvertently 
transported from farm to farm on tractors and 
other equipment, on cages, and on workers' shoes 
and clothing. Heat destroys the virus, but it can 
survive for extended periods in cool temperatures. 

3. Markets provide pathways to humans. Open air 
markets, where eggs and birds are often sold in 
crowded and unsanitary conditions, are hotbeds of 
infection and spread the disease into the wider 

People who come in contact with the birds, their 
meat or their eggs are susceptible to contracting 
bird flu. As usual the solution is cleanliness to 
keep the virus from spreading. 

If you contract the flu and it becomes quite 
severe, the doctor has to send off a specimen for 
testing to the Centers for Disease Control since 
very few local laboratories have the ability to 
test for this influenza virus. 

Avian influenza (bird flu)

3. Reader submitted Q&A - Nighttime Incontinence

"Is there such a thing as nighttime incontinence? 
This has been going on for 2 yrs now, where I 
don't wake up in time to go to the bathroom. No 
particular pattern, it can happen one night and 
not again for a month or 3 mos, but then again it 
can happen 2 or 3 nights in a row. No incontinence 
during the daytime. I am 53, insulin resistant 
diabetes (I take 1 Avandia daily) diagnosed 2 yrs 
ago. I get up every night to go to the bathroom, 
but these occasions where I don't wake up in time 
are very distressing." - DF 

The symptom you are speaking about is medically 
called "nocturnal enuresis." It is not so much 
incontinence as it is a spontaneous voiding in 
which your bladder muscle contracts and the 
urethral muscle (the tube from the bladder to the 
outside) relaxes just as if you had voluntarily 
wanted to pass urine. The difference is that you 
are asleep and have no conscious recall of 
"allowing voiding to take place". This symptom is 
more common in children than adults and is often 
thought to be due to such sound sleeping in 
children that they just do not wake up when their 
bladder tells them it is full. It is estimated, 
however, that up to 2% of adults have this 

Adults who are taking some sort of sedatives, 
anti-depressants, anti-epileptics, narcotic-like 
pain medicines or excess alcohol run the risk of 
sleeping so soundly that this nighttime problem 
happens. I do not think it is a side effect of 
Avandia although sometimes Avandia does cause 
fluid retention. 

Another cause of the new development of nocturnal 
enuresis can be loss of nerve sensation from the 
bladder telling your brain it is full. In this 
situation you have an over distended bladder full 
of urine that just finally gets so full, it fires 
off the bladder contraction muscle (detrusor) and 
relaxes the urethral muscle itself without your 
brain ever knowing about it. Long standing 
diabetes can cause this type of nerve sensation 
loss as well as arthritis of the spine that is 
pressuring nerves. Sometimes multiple sclerosis 
which is a disease of the nerves can cause this 
too but usually there are other symptoms before 
just urinary problems. Men can get a bladder over- 
distention problem from prostate enlargement. 
Sleep apnea usually results in the opposite 
problem, i.e., frequent night time voiding, but 
occasionally it can present as nocturnal enuresis. 
The doctor may want to order a sleep study on you. 

There is an effective treatment available for 
nocturnal enuresis so it is important to see your 
doctor or even a  urologist for this. Identify any 
reasons you might be sleeping "too soundly" and 
eliminate them. Restrict fluids within 2-3 hours 
of bedtime. Your physician may want you to try a 
nasal spray called desmopressin that restricts 
urine production at night. There may also be some 
further testing needed as indicated above. 

4. St John's Wort for depression
Many of the studies indicating that the herb, St 
John's Wort (hypericum extract) is effective for 
treating depression have come from Germany where 
physicians have prescribed herbal medicines for 
decades. There have been some U.S. studies 
indicating effectiveness of St John's Wort in mild 
depression but in general, U.S. physicians do not 
use it much for moderate and severe depression. 

The study below recently reported in the British 
Medical Journal looked at a comparison of St 
John's Wort, 900 mg a day of hypericum extract, 
with 20 mg a day of paroxetine (Paxil). The St 
John's Wort was actually slightly more effective 
than the paroxetine in reducing depression 
symptoms and also it had about half of the side 
effect events that paroxetine had. 

St Johns' Wort can have interactions with certain 
blood pressure medicines and other pharmaceuticals 
so it is not totally benign.  One review of the 
literature study found that St John's wort 
(Hypericum perforatum) lowers blood concentrations 
of cyclosporin, amitriptyline, digoxin, indinavir, 
warfarin, and theophylline. It also can cause 
intermenstrual bleeding, delirium or mild 
serotonin syndrome, respectively, when used along 
with oral contraceptives 
(ethinylestradiol/desogestrel), loperamide or 
selective serotonin-reuptake inhibitors 
(sertaline, paroxetine, nefazodone). 

Except for some of these uncommon side effects, St 
John's Wort is quite low in any adverse reactions 
compared with most prescription medicines. Still, 
it probably is a good idea to seek a physician's 
help before self-prescribing if you suspect 
anything other than a very mild depression. 

St John's Wort for depression

5. Health tip to share - Thirst and peeling nails

"I would like to make a comment in response to the 
person who wrote in about excessive thirst, dry 
skin and peeling nails.  They also mention having 
gluten sensitivity.  This could possibly be a sign 
of celiac sprue.  I have all of the above, plus 
much more.  Just going to the doctor will, in all 
probability, not tell the person that they have 
celiac, unless they specifically request the blood 
test (from a doctor who is knowledgeable about 
celiac).  This is one of the most misdiagnosed 
diseases, and I am finding very few doctors who 
know anything about it. " - HRS 

6. Humor is healthy

"Beware The Ringing In Your Ears"

A man sought medical aid because he had popped 
eyes and a ringing in the ears. 

A doctor looked him over and suggested removal of 
his tonsils.  The operation resulted in no 
improvement, so the patient consulting another 
doctor who suggested removal of his teeth.  The 
teeth were extracted but still the man's eye 
popped and the ringing in his ears continued. 

A third doctor told him bluntly, "You've got six 
months to live." 

In that event, the doomed man decided he'd treat 
himself right while he could.  He bought a flashy 
car, hired a chauffeur, had the best tailor in 
town make him 30 suits. Then he decided that even 
his shirts would be made-to-order. 

"Okay," said the shirt maker, "let's get your 
measurement. Hmm, 34 sleeve, 16 collar--" 

"Fifteen" the man said.

"Sixteen collar," the shirt maker repeated, 
measuring again. 

"But I've always worn a 15 collar," said the man. 

"Look," the shirt maker said, "I'm warning you.  
You keep on wearing a 15 collar and your eyes will 
pop and you'll have ringing in your ears." 

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

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********** Health Newsletter ***********
              April 3,  2005
Biweekly from BackupMD on the Net

1. Tension-type headache
2. Earwax removal 
3. Reader submitted Q&A -
4. Urinary tract infection and E.coli bacteria
5. Health tip to share - Little sleep and weight gain
6. Humor is healthy

1. Tension-type headache

The most common headache is one known as tension-
type headache. it can go by other names such as 
muscle contraction headache, psychogenic headache, 
depressive headache, essential headache or 
ordinary headache. It is not usually a sign of a 
serious disease but it certainly can affect daily 
living activities. It produces a pain on both 
sides of the head, not just the right or left half 
of the head, and it is likened to having a tight 
band around the head. It may also cause pain in 
the back of your neck at the base of your skull. 

For many years doctors thought that tension 
headaches were from involuntary tightening of the 
head and neck muscles. Subsequent studies have 
shown that is not true, muscle tension in not 
increased. A substance called nitric oxide may be 
a cause of headaches as well as other brain 

There are two classes of tension-type headaches, 
episodic and chronic. Episodic headaches occur 
less that 15 times a month and usually last from 
minutes to hours. Chronic headaches occur more 
than 15 times a month and often can be almost 
constant throughout the day. 

Triggers for tension-type headaches can be stress 
or anxiety, lack of sleep, poor eating habits, 
high blood pressure and even overuse of headache 
medications. Hormone changes and prescription 
medications can also be responsible. Chronic teeth 
grinding (bruxism) or past history of head or neck 
trauma can also play a role. The list of 
associated causes is almost endless. 

Treatment is mostly over-the-counter analgesics. 
These should be supplemented with rest, relaxation 
techniques, exercise, ice packs and any other 
method that seems to abate the headache. 
Prescription sedatives and narcotic analgesics are 
not used as a first line treatment because of 
their addicting qualities as well as propensity to 
just make the headaches more frequent as chronic 
use takes place. 

If the headaches seem to continue for more than a 
couple of months, you may need to institute 
preventative measures such as exercise, yoga, 
relaxation techniques and then talk to your doctor 
about some of the non-prescription analgesics or 
the non-narcotic prescription medications that can 
help prevent tension-type headaches such as 
propanolol, SSRI's or antidepressants. 

Tension-type headache

2. Earwax removal

Earwax buildup causing hearing loss has been with 
mankind forever. It can be embarassing to go to 
the doctor just to have ear wax removed so you can 
hear again. Many people learn to treat the problem 
themselves but Q-tips are not always the answer. 
They can often ram the wax deeper into the ear 
canal and make hearing worse. 

If you use something liquid to irrigate the ear 
canals, what should you use? Are there special 
solutions that are any better than just water 
alone? How successful is home ear irrigation? The 
article below looked at randomized trials of 
different liquids and oils for irrigation, with or 
without using a syringe or bulb of some sort to 
spray the liquid in the canal under gentle force. 

Just using saline poured in the ear (without a 
syringe) was as effective as other gentle 
cleansing compounds that were tested. It worked 
about 20% of the time. 

Both corn oil and olive oil were about 60-70% 
successful when used with a syringe to irrigate 
the canal but actually this was not much different 
that using saline or any of the other water-based 
irrigations. Syringing was, however, more 
effective than just pouring the liquid in the ear 
canal without any irrigation pressure. 

One study showed that about 0.5% (1 in 240) people 
who used syringe irrigation on a regular basis 
developed chronic ringing (tinnitus) in the ears 
so it is not without a small amount of hazard. 

Earwax removal

3. Reader submitted Q&A - Little sleep and weight gain

"I have read a lot recently about sleep 
deprivation and weight gain.  I was always very 
skinny.  About my second year into working double 
shifts, I gained weight at a rapid pace even 
though my food intake actually got healthier and I 
did not eat more.  Eventually it capped off.  I 
went from 110 to 160.  I have been doing this time 
of work schedule for almost 10 years. 

Due to work being slow, my hours have decreased.  
Will I return to the way I was since my sleep will 
go from 4 hrs back to about 6-7 a night?  My one 
day off, I had pretty much just slept the day 
away.  I know you can not catch up on sleep, but 
at least I don't feel as strange anymore.  I never 
adapted to the little sleep even after a decade. I 
am 36 years old." - anonymous 

Overweight individuals get less sleep than normal 
weight people. It is almost proportionally less 
sleep as is the number of pounds overweight. These 
statistics may be misleading, however, because 
obese people have more sleep disturbances than 
normal weight people. Sleep apnea, snoring, 
restless legs syndrome and other conditions that 
limit sleep are more common among the overweight. 
Thus it is not certain which comes first, the loss 
of sleep or the weight gain. 

Some studies have looked at shift changes and what 
happens with weight gain. In one study going from 
an 8-hour work day to a 12 hour work day, men had 
increased fatigue and weight gain but the weight 
gain averaged only about 2 pounds over a year. 

In another study of hospital workers, late shift 
employees put on about 9-10 pounds compared to 
day-shift workers. They also had more naps but 
skipped more meals (and yet gained more weight). A 
study of nurses on night shift showed that they 
actually slept more hours than the day shift 
nurses. When satisfaction with shift work was 
looked at, workers who could get along with much 
less average sleep than normal (5-6 hours per 
night) had much higher satisfaction ratings than 
those who needed more sleep each night. 
Dissatisfied workers actually had more hours of 
sleep each night but they were not rested; it was 
as if they constitutionally needed more sleep. 

As you can see, the data does not support a 50 
pound weight gain from having to work the night 
shift but it is very possible that you are one of 
the people who constitutionally needs 8 hours of 
uninterrupted sleep each night and you may begin 
to undergo spontaneous weight loss to some extent 
when you switch back to day shift. You would have 
to do this on a consistent schedule. 

I hope you do lose weight as your work and sleep 
schedule get more straightened out. You may not 
lose the full 50 pounds back to your original 110 
pounds, but even a 10-15 pound loss will make you 
feel much better and healthier. 

4. Urinary tract infection and E.coli bacteria

Sulfa-based antibiotics are often the treatment of 
choice for an uncomplicated urinary tract 
infection (cystitis). However the most common 
urinary bacterial pathogen is E.coli, a common 
bowel bacteria, and it is becoming more and more 
resistant to sulfa antibiotics. Common substitutes 
for sulfa antibiotics (Bactrim(R), Septra(R)) that 
are used to treat cystitis are amoxicillin-
clavulanate (Augmentin(R)) and ciprofloxin 

A recent study from Seattle, Washington looked at 
treating over 300 women with cystitis with 
Augmentin(R) or Cipro(R). They gave the 
antibiotics for 3 days after obtaining urine 
bacterial cultures. They also did vaginal cultures 
for E. coli. 

Initial cure rates (2 weeks) were 76% for women 
treated with amoxicillin-clavulanate compared with 
95% of women treated with ciprofloxacin. But the 
long term (4 month) cure rate was only 58% for  
women treated with amoxicillin-clavulanate 
compared with 77% for those treated with 
ciprofloxin. This was due to the fact that in the 
first two weeks, amoxicillin-clavulanate was 
inferior to ciprofloxin in its ability to 
eradicate vaginal E coli, thus facilitating early 

Not only does this this study show that 
ciprofloxin is more effective than amoxicillin-
clavulanate for cystitis but also that the major 
reason for failure of any antibiotics is the 
presence E.coli in the vagina that are antibiotic 
resistant. More important than a urine culture at 
2 weeks to test for cure of a UTI would be a 
vaginal culture for E. coli because that is where 
the recurrent infection is commonly coming from. 

Urinary tract infection and E.coli bacteria

5. Health tip to share

"I have had problems with my feet, very sensitive, 
hurt if walked too long, in general I was very 
concerned with my feet. One doctor xrayed them and 
told me I had arthritis on my big toes.  Doctor 
prescribed me ultram and it did help quite a bit. 
I decided one day I was not going to use Aspartame 
in my food or drinks any more.  All of the sudden 
my feet don't hurt anymore and I quit my medicine.  
I don't know for sure if the quitting of Aspartame 
did it or not.  But maybe someone else would have 
done the same and got same results." - DCH 

6. Humor is healthy

"The Fatitudes"

In the beginning, G~d covered the earth with 
broccoli, cauliflower and spinach, with green and 
yellow and red vegetables of all kinds, so Man and 
Woman would live long and healthy lives. 

Then, using God's bountiful gifts, Satan created 
Ben and Jerry's and Krispy Kreme. And Satan said: 
"You want hot fudge with that?" And Man said: 
"Yes!" And Woman said: "I'll have one, too...with 
sprinkles." And they gained 10 pounds. 

And G~d created the healthful yogurt that Woman 
might keep the figure that Man found so fair. 

And Satan brought forth white flour from the 
wheat, and sugar from the cane, and combined them. 
And Woman went from size 2 to size 14. 

So G~d said: "Try my fresh green garden salad." 

And Satan presented crumbled Bleu Cheese dressing 
and garlic toast on the side. And Man and Woman 
unfastened their belts following the repast. 

G~d then said: "I have sent you heart-healthy 
vegetables and olive oil in which to cook them." 

And Satan brought forth deep-fried coconut shrimp, 
butter-dipped lobster chunks, and chicken-fried 
steak so big it needed its own platter. And Man's 
cholesterol went through the roof. 
Then G~d brought forth the potato, naturally low 
in fat and brimming with potassium and good 

Then Satan peeled off the healthful skin, sliced 
the starchy center into chips and deep-fried them 
in animal fats, adding copious quantities of salt. 
And Man packed on more pounds. 

G~d then brought forth running shoes so that his 
children might lose those extra pounds. 

And Satan introduced cable TV with remote control 
so Man would not have to toil changing the 
channels. And Man and Woman laughed and cried 
before the flickering light and started wearing 
stretchy lycra jogging suits. 

G~d then gave lean beef so that Man might consume 
fewer calories and still satisfy his appetite. 

And Satan created McDonald's and the 99-cent 
double cheeseburger. Then Satan said: "You want 
fries with that?" And Man replied: "Yes! And super 
size 'em! 

And Satan said: " It is good." And Man and Woman 
went into cardiac arrest. 

G~d sighed...and created quadruple by-pass 

Satan chuckled and created HMOs....

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

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********** Health Newsletter ***********
              April 17,  2005
Biweekly from BackupMD on the Net

1. Noise induced hearing loss
2. Mental health - what's normal what's not
3. Reader submitted Q&A - Cluster headache
4. Aspirin for women does not prevent heart attacks
5. Health tip to share - Fibromyalgia and diet
6. Humor is healthy
The next newsletter will be in two weeks.

1. Noise induced hearing loss
As we age, many individuals undergo some degree of 
hearing loss.  As many as 40% of adults over age 
65 have difficulty hearing  and 30% of people over 
age 85 are deaf in at least one ear. Age related 
hearing loss may occur because of blood vessel 
atherosclerosis or arthritis of the small bones of 
the ear (otosclerosis) but most commonly it is 
just a lifetime accumulation of events such as 
past trauma, drug effects, noise injury or ear 
infections that injure the nerve cells and 
hairs of the inner ear. 

Many times, however, the above causes can produce 
hearing loss at a younger age if the insult is 
great enough. Noise related hearing loss falls 
into this category. In fact over one-third of all 
people with hearing loss have all or some part of 
their loss attributable to noise injury. Noise 
injury hearing loss tends to produce difficulty 
hearing all pitches of sound from low to high 
while purely age related hearing loss is more 
associated with high pitched sounds. 

Any sound over about 80-90 decibels (dB) can 
produce hearing injury over time. City traffic 
noise is about 80 decibels so noises louder than 
that should make you seek hearing protection if 
you are exposed on a regular basis. If you are 
constantly around or personally use power tools 
such as wood working, manufacturing machinery, 
lawn mowers, weed eaters, chain saws, or leaf 
blowers for example, you need to have ear 

Even less frequent but louder sounds such as guns 
firing, explosions, hammering or other 
construction noises, snowmobiles, motorcycles or 
go-carts will cause hearing loss by injury to the 
ear nerve cells. Exposure to sudden or continuous 
loud noise may cause only a temporary hearing 
loss. If the hearing recovers, it usually take 
place 16 to 48 hours after exposure to loud noise. 
If you get an immediate hearing loss from a sudden 
loud noise it may be accompanied by tinnitus, a 
ringing, buzzing, or roaring in the ears or head. 
Sometimes the tinnitus subsides over time but at 
other times it can be present constantly or 
occasionally throughout a lifetime. 

Hearing loss is like skin sun damage. When we are 
young we tend to ignore the long term damaging 
effects of noise or sunburn. When we finally end 
up with hearing loss or wrinkles/skin cancers, we 
regret not having used protection all along. As 
adults who are responsible for children, we need 
to educate them about the risks which are not 
usually immediate but rather delayed and long 

To prevent noise related hearing loss, the 
National Institute on Deafness and other Hearing 
Disorders recommends: 

1. Know which noises can cause damage (those above 
90 decibels). 

2. Wear earplugs or other hearing protective 
devices when involved in a loud activity (special 
earplugs and earmuffs are available at hardware 
stores and sporting good stores). 

3. Be alert to hazardous noise in the environment. 

4. Protect children who are too young to protect 

5. Make family, friends, and colleagues aware of 
the hazards of noise. 

Noise induced hearing loss

2. Mental health - what's normal what's not 

It can be difficult to distinguish between normal 
daily stress that keeps us alert and on our toes 
versus such severe anxiety that needs medical 
treatment so that our decision-making in daily 
life is not impaired. It can be difficult to 
distinguish normal grief from a major depressive 
reaction requiring counseling and/or anti-
depressant medication. When does situational 
anxiety become a full blown panic disorder that 
requires treatment in order to preserve daily 
living activity? 

In other words, how do we distinguish between 
those events that may produce a change in our 
mental health versus the time when one has a 
mental illness that must be treated? The answer 
is, it is "very tricky". Even medical scientists 
and mental health experts have trouble always 
agreeing. The line between normal and abnormal is 
often blurred mainly because there is a huge range 
of what's normal. 

Well if the doctors have difficulty telling when 
mental illness begins, how can you be expected to 
recognize the difference in yourself or your 
family or friends? To generalize about this, 
doctors look to see if there is any functional 
impairment in what would normally be considered 
daily living activities of a person due to how 
that person feels and thinks. For example, 

allowing dishes to go unwashed for days
stopping bathing
washing hands almost constantly
avoid any socializing 
losing interest in hobbies or previously fun 
yelling at your family more often
having negative thoughts that you cannot stop or 
  put out of your mind 
inability to sleep 
sleeping almost all of the time 

all would be examples that normal daily living 
activities are being significantly affected or 
altered. When this happens, treatment by a 
qualified mental health professional can often be 

Many people have normal eccentricities that do not 
represent mental illness so you should mainly look 
for daily living alterations that are harmful to 
that person or others. The is not x-ray or blood 
test for mental illness so just keep your eye out 
for some of the above behaviors or other behaviors 
that you consider detrimental. You may be 
interested in this recent article from Mayo 

Mental health - what's normal what's not

3. Reader submitted Q&A - Cluster headache

"Is it possible that Imitrex would help a cluster 
headache? I get really bad headaches and thought 
they were either sinus or migraine; but while in 
the neurologist office with Mom read some of the 
wall literature and the symptoms I experience 
seemed to fit the cluster type---eyes watering, 
very nasal and feeling like someone had my nose in 
a vice grip and were twisting it causing pain 
everywhere else, head, eyes, ears, neck.  I had 
tried treating them with an over-the-counter 
decongestant or sinus medication first and if that 
didn't work after the allotted time, took the 
Imitrex.  Trouble is it usually takes 6 hours or 
more to get rid of the thing and then one still 
doesn't feel quite right for the rest of the day." 
- B 

Cluster headaches often have sudden onset and 
start behind one eye or the temple or forehead. 
The eye and nose on that one side can become red, 
swollen and runny. The eyelid may be droopy. While 
a cluster headache is one sided, in up to 20% of 
people it can occur on the other side but it does 
not occur on both sides at once. The headaches 
cause extreme restlessness and can be quite 

The cause of cluster headaches is unknown but they 
are not related to other diseases and do not tend 
to run in families although occasionally (1 in 
20), sufferers will have a relative who has 
cluster headaches. Men have these much more often 
than women. 

A cluster headache can last a few minutes or 
several hours, but it usually lasts for 30 to 45 
minutes. Cluster headaches typically occur at the 
same time each day for several weeks, until the 
"cluster period" is over. Cluster periods usually 
last 4 to 8 weeks and may occur every few months. 
At other times, no cluster headaches will occur. 

The diagnosis is made by your doctor based upon 
symptoms and when they occur. There is no 
diagnostic test or x-ray to make the diagnosis. If 
you think you may have cluster headaches you 
should keep a very precise calendar record of 
when, how long and how severe the headaches are. 
Do this over a couple of weeks and take it to your 
personal physician or neurologist. Also keep track 
of possible triggers such as alcohol, smoking, 
naps, or exposure to volatile or strong smelling 
substances right before the headache. 

It sounds as if you are trying to diagnose 
yourself. I would recommend having the doctor make 
the diagnosis so you can follow standard treatment 
regimens. These treatment regimens are usually 
composed of two phases; prevention and active 
treatment once you have the headache. 

Methysergide, lithium and verapamil are used for 
prevention but need to be monitored by your 
doctor. Imitrex(R) (Sumatriptan) injections (but 
not by nasal spray) may used for treating an acute 
cluster headache as well as oxygen administered by 
nose. It may take up to 20 minutes for the 
headache to abate. 

Judging from what you describe, it does not sound 
as if you are having cluster headaches but if you 
are, they are not responding to Imitrex(R) like 
they should.  If this is true, it is all the more 
important to make sure the doctor agrees that you 
have cluster headaches so he/she can treat you 
with both a preventative medication and also with 
something for an acute headache. 

4. Aspirin for women does not prevent heart attacks

The original studies of taking a baby aspirin 
daily to prevent heart attacks was performed in 
men, not women. Recently, the New England Journal 
of Medicine reported a study in over 39,000 
healthy women, 45 years of age or older. They 
received 100 mg of aspirin every other day or 
placebo. They were then monitored for 10 years for 
a first major cardiovascular event (i.e., nonfatal 
myocardial infarction, nonfatal stroke, or death 
from cardiovascular causes). 

They found there was no significant reduction in 
risk of the major cardiovascular events. There was 
no reduction of risk of heart attack (myocardial 
infarction) nor reduction in death from 
cardiovascular disease. When looking at the 
subgroups, the aspirin may have reduced some 
instances of strokes but when everything was added 
together, they could not conclude that aspirin was 
beneficial. In fact there was a higher incidence 
of gastrointestinal bleeding requiring blood 
transfusion in the women who had aspirin. 

From this study, I would conclude that the healthy 
woman who wants to prevent serious cardiovascular 
events should NOT use aspirin for that purpose. 

Aspirin for women to prevent heart attacks

5. Health tip to share - Fibromyalgia and diet

"I'm 50 years old and have suffered Fibromyalgia 
for the past 10 years.  I started on a vegetable 
diet and felt almost 100% better.  I'm able to 
sleep through the night just by changing my diet.  
Eat NO sugars, breads or red meats." -A.H. 

6. Humor is healthy

"A letter to the Tide Company"

Dear  Tide:

I'm writing to say what an excellent product you 
have! I've used it  since the beginning of my 
married life, when my Mom told me it was the  

Now that I am older  and going through menopause, 
I find it even better! In fact, about a month ago,  
I spilled some red wine on my new white blouse.  
My unfeeling and uncaring  husband started to 
berate me about how clumsy I was and generally 
started  becoming a pain in the neck. One thing 
led to another and I ended up with a lot of his 
blood on my white blouse. 

I tried to get  the stain out by using a bargain 
detergent, but it just wouldn't come out. After  a 
quick trip to the supermarket, I purchased a 
bottle of liquid Tide with bleach alternative, and 
to my surprise and satisfaction, all of the stains 
came  out! In fact, the stains came out so well, 
that when the detectives came by  yesterday, they 
told me that the DNA tests on my blouse were 
negative and then  my attorney called and said 
that I would no longer be considered a suspect in 
the disappearance of my husband. What a relief! 

I thank you, once again, for having such a great 
product. Well, gotta go. I have to write a letter 
to the Hefty bag people... 

A  Relieved Menopausal Wife

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

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********** Health Newsletter ***********
              May 1, 2005
Biweekly from BackupMD on the Net

1. Do mammograms pose any risk?
2. Blood mercury levels and performance
3. Reader submitted Q&A - Recurrent breast lumps
4. Facts about sarcoidosis
5. Health tip to share - Cluster H.A. and low carbs
6. Humor is healthy

1. Do mammograms pose any risk?

There are definite benefits from screening 
mammography. Among 50-69 year old women, screening 
mammography reduces the risk of death from breast 
cancer by about 25%. But mammograms are not risk 
free. While many people think the only risks are 
from radiation exposure which can cause new 
cancers, that is a minimal risk and not generally 
considered a problem. The main risk from having a 
screening mammogram is over detection of an 
abnormal result so that unnecessary biopsies and 
treatment are performed. 

In an Australian study, for every 1000 women 
screened over 10 years, up to one quarter 
(251/1000 - depending upon age) receive an 
abnormal result and are recalled. Of these 251 
women, about 187 will just require extra mammogram 
xrays and the other 64 will have at least one 
breast biopsy. Only as many as 26 women will have 
a positive biopsy showing invasive cancer and 
about up to 6 will have a premalignant (ductal 
carcinoma in situ - DCIS). The other 32 women will 
have biopsies that do not show any cancer. 

What is most interesting is that of 1000 women who 
do not have any screening mammograms for 10 years, 
only 20 breast cancers will be detected. This 
discrepancy of 12 breast cancers or DCIS per 1000 
screened women and non screened women is called 
the over detection due to screening mammography. 
Some of these 12 extra cancers may be because 
mammography can pick up cancers earlier in their 
development. The other extra cancers may not ever 
grow to clinical detection size or a woman may die 
from some other problem before the breast cancer 
becomes a problem. 

The net result is that mammograms are beneficial 
in preventing some deaths from breast cancer but 
because of over detection, their benefit is not as 
high as one would suspect. There are about 0.5, 2, 
3, and 2 fewer deaths from breast cancer that 
occur "over 10 years among 1000 women aged 40, 50, 
60, and 70 years respectively who choose to be 
screened compared with women who decline screening 
at these times." 

Does any of this mean you should or should not 
have screening mammograms? Doctors recommend 
screening mammography because of the above 
benefits even though the benefits (about 2-3 
deaths per 1000 women over 10 years) are not as 
high as one would think. On the other hand, women 
have to realize that there can be a "down-side" to 
screening mammography in that many women may have 
to undergo biopsies that are unnecessary and also 
to suffer the complications from those biopsies 
even though they did not end up having a cancer. 

Do mammograms pose any risk?

2.  Blood mercury levels and performance

Mercury levels are commonly measured in hair 
samples or in blood. Hair samples represent longer 
term exposure to mercury and are less reliable to 
predict whether the current blood level is at a 
toxic amount. It is, however, a less expensive 
screening test. Blood levels are more accurate but 
also more expensive and not available as a home 
screening test as are hair levels. 

The US Environmental Protection Agency's 
recommended maximum blood level of mercury without 
any adverse effects is 5.8 µg/L. Most women 
average only about 1.0 µg/ml and children normally 
have even lower levels of 0.5 µg/L on the average. 

In a recent study of Baltimore residents aged 50-
74, investigators found the median blood mercury 
level of these older adults was 2.1 µg/L (range, 
0-16 µg/L). After adjustment for other attributes 
that might affect the levels, increasing blood 
mercury was associated with worse performance on a 
test of visual memory. However, increasing blood 
mercury levels were also associated with better 
performance on finger tapping, a test of manual 
dexterity. The authors concluded that was not 
strong evidence that blood mercury levels are 
associated with worse neurobehavioral performance 
in this population of older urban adults. 

I do not think that we should conclude that 
mercury is not harmful. Rather the above study 
just illustrates that the cognitive decline 
associated with aging is not probably very often 
due to a toxic metal such as mercury. Furthermore 
doctors rarely check for toxic metal exposure and 
considering  that up to 8% of women in the U.S. 
have levels above the EPA's recommended level, it 
is something that should be checked more often. Do 
not be afraid to request such a test from your 
physician or get one of the home screening tests. 

Blood mercury levels and performance

3. Reader submitted Q&A - Recurrent breast lumps

"I developed 2 lumps in my breast (same breast) 
and had both removed in '98. The lumps came back 
after three months and have had mammograms every 
six months for three years and once a year since.  
What is the cause?  I limit caffeine.  Watch my 
diet and beverages.  The lumps were fat and at 
last year's exam my radiologist said the lumps 
were from hormones.  What do you think? 

I am 46 years old, still menstrual, had an aunt 
(father's sister) who had breast cancer, and 
survived.  Taking no meds and always take the 
stairs and walk the dog." -  mary 

Recurrent benign breast lumps usually fall into 
several categories: 

fibrocystic condition

Fibrocystic condition varies quite a bit during 
the month as far as size and tenderness but 
usually it does not form discrete lumps that you 
can find in the same place time after time. I 
doubt if this is what you are experiencing. 
Fibrocystic change is however worsened by large 
amounts of caffeine intake whereas fibroadenomas 
and fibromas are not. 

The "adenoma" part of fibroadenoma refers to 
breast glandular tissue. While some people believe 
the glandular component is caused by hormones, 
most evidence does not support hormones as a 
cause. However, once you have  glandular adenosis, 
the hormones may stimulate growth of that 
glandular component. 

Fatty tissue breast lumps are called lipomas but 
for the most part I do not think they are 
recurrent. If the breast lumps you have had are 
really lipomas, it may be possible that you have 
just had new lipomas that came up in slightly 
different places after the removal of the first 

The rule-of-thumb with discrete breast lumps is to 
remove them surgically. Even though you may think 
they are just a recurrence of a benign lump, you 
cannot be sure. They tend to obscure any breast 
cancers that arise near the lumps until the cancer 
has become quite big. This happens because either 
you or the doctor assumed the lump that was felt 
was benign. Even if you have a discrete lump that 
has been stable in size on mammograms for three 
years, I would suggest having it surgically 
removed. That way it will not hide a new small 

Finally, be sure to find out what the diagnosis is 
officially. If it is not a discrete mass but 
rather it is called fibrocystic change, then 
removing it surgically would not be recommended. 

4. Facts about sarcoidosis

Sarcoidosis is an inflammatory condition of the 
body although we do not know what agent causes the 
inflammation. The inflammation is different than 
producing the usual red, swollen tissues. In 
sarcoidosis, tiny hard lumps form called 
granulomas. The granulomas may bunch together to 
form larger masses of tissue. Lung, lymph nodes 
and skin are common places that these granulomas 
form although they can also occur in the eyes, 
liver, spleen, salivary glands and muscles. 

Symptoms produced by sarcoidosis include:

 Uneasiness, feeling sick ("malaise")
 Tiredness, fatigue, weakness
 Loss of appetite or weight
 Sweating at night during sleep
 Lymph Node enlargement
 Red eye
 Sensitivity to light (photophobia)
 Eye dryness
 Seeing black spots (called floaters)
 Blurred vision
 Shortness of breath
 Chest pain
 Irregular heartbeat (palpitations)
 Joint stiffness

The diagnosis is usually suspected by physical 
exam or by xray evidence of masses but it is 
confirmed only by biopsy of the granulomatous 

Treatment is only given to control symptoms or to 
improve the function of organs affected by the 
disease. Treatment may or may not affect the long-
term outcome of the disease. In fact, One study 
found that 5-10 years after diagnosis, there was 
no difference in recovery between people who had 
received a short course of treatment and those who 
had not. 

About 60% of the time no treatment is given 
because the symptoms are tolerable and not severe. 
Sometimes, however, steroids are needed to inhibit 
the inflammatory granulomas from growing or even 
cancer chemotherapeutic agents such as 
Plaquenil(R) (hydroxychloroquine), Cytoxan(R) 
(cyclophosphamide), methotrexate or Immuran 
(azathioprine). Even though sarcoidosis is a not a 
cancer, sometimes it has to be treated as if it 
is. Since it can affect almost every organ of the 
body, it is a serious medical condition. 

The odds of recovering from sarcoidosis is good. 
Most often, it goes away spontaneously within a 
few years. About 75 percent of all patients have 
only the acute form of sarcoidosis and, for about 
half of them, the disease leaves no significant 
residual problems. Sometimes, however, sarcoidosis 
can remain active for years and cause organ 
damage. It may significantly reduce a person's 
physical activity. About 25 percent of all 
patients have this chronic form of the disease. 

5. Health tip to share - Cluster H.A. and low carbs

"In response to the woman who had cluster 
headaches.  For years I got regular bad headaches 
mostly behind my right eye.  Had watering eye and 
nose.  I woke up with them.  Often had to take 
Fiorinal(R) to get rid of them.  I went on a low 
carb eating plan and realized 4 or 5 months later 
that I rarely got headaches.  With a blood test I 
have found I have a number of food allergies that 
cause sinus problems, etc.  I believe either 
cutting out sugar or possibly wheat has virtually 
eliminated my headaches.  Hope this helps someone.  
Have been eating low carb for 2 years and had only 
half dozen headaches, rather than multiple per 
month." - Nancy 

6. Humor is healthy

"Understanding Men"

Men claim women control them because women 
understand men, while men know nothing about 
women.  Let's see if women really understand 

The nice men are ugly. 

The handsome men are not nice.

The handsome and nice men are gay.

The handsome, nice and heterosexual men are 

The men who are not so handsome, but are nice men, 
have no money. 

The men who are not so handsome, but are nice men 
with money think we are only after their money. 

The handsome men without money are after our 

The handsome men, who are not so nice and somewhat 
heterosexual, don't think we are beautiful enough. 

The men who think we are beautiful, that are 
heterosexual, somewhat nice and have money, are 

The men who are somewhat handsome, somewhat nice 
and have some money and thank, heaven, are 
heterosexual, are shy and NEVER MAKE THE FIRST 

The men who never make the first move, 
automatically lose interest in us when we take
the initiative.

Now... Who On Earth Understands Men?

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

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********** Health Newsletter ***********
              May 15,  2005
Biweekly from BackupMD on the Net

1. Direct to consumer drug advertising
2. Alendronate for osteopenia prevention not cost effective
3. Reader submitted Q&A - GI reflux meds
4. The 5 top cholesterol lowering foods
5. Health tip to share - Constipation
6. Humor is healthy
The next newsletter will be in two weeks.

1. Direct to consumer drug advertising

Now that pharmaceutical companies are advertising 
prescription drugs directly on TV, c
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