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
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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.
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1. Vitamin D deficiency in the elderly
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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
measured.
Vitamin D deficiency in the elderly
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2. Walking shoes
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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
breathe
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
period.
You may be interested in this article at Mayo
Clinic about the ins and outs of walking shoes.
Walking shoes
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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
problems?
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
as:
low home humidity due to home heating
rubbing alcohol
certain chemicals and cleaning products
Medical conditions associated with newly acquired
dry skin include:
psoriasis
eczema
contact dermatitis
fungal skin infection
heatstroke/sunstroke
hypothyroidism
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.
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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
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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
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6. Humor is healthy
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"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?"
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That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
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Back to top
********** Health Newsletter ***********
March 20, 2005
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Biweekly from BackupMD on the Net
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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
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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
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2. Avian influenza (bird flu)
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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
community.
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)
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3. Reader submitted Q&A - Nighttime Incontinence
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"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
problem.
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.
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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
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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
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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."
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That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
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Back to top
********** Health Newsletter ***********
April 3, 2005
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Biweekly from BackupMD on the Net
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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
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1. Tension-type headache
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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
chemicals.
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
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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
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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
(Cipro(R)).
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
reinfection.
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
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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
nutrition.
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
surgery.
Satan chuckled and created HMOs....
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
********** 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
protection.
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
term.
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
themselves.
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
activities
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
beneficial.
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
Clinic.
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
frightening.
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
best.
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...
(Signed)
A Relieved Menopausal Wife
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
********** 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
fibroadenomas
fibromas
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
ones.
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
cancer.
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
Fever
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
Wheeze
Cough
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
tissue.
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
men...
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
married.
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
money.
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
cowards.
The men who are somewhat handsome, somewhat nice
and have some money and thank, heaven, are
heterosexual, are shy and NEVER MAKE THE FIRST
MOVE!
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.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
********** 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
or sign up
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