Women's Health Newsletters 8/21/05 - 10/30/05
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********** Health Newsletter ***********
September 4, 2005
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Biweekly from BackupMD on the Net
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1. Radiological treatment of fibroids
2. Quality of care and longevity of the elderly
3. Reader submitted Q&A - Bleeding and uterine polyps
4. Cell phone use and auto accidents
5. Health tip to share - Exercise is a treatment for pain
6. Humor is healthy
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1. Radiological treatment of fibroids
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Uterine fibroids are a benign growth of muscle
cells that form small to large lumps in the
uterine wall. When they are small, they do not
cause any problems but if they enlarge beyond the
size of an inch or two, they can cause health
symptoms such as constant bladder pressure,
weightiness or bloating of the lower abdomen,
constant low back pain, abnormal uterine bleeding
problems and occasionally sharp pains in the
pelvis. Fibroids can get as big as volleyballs if
you let them and ones that are the size of
baseballs are more common than most people think.
Up to 25% of all women reaching menopause may have
some fibroids present in the uterus. they tend to
get much smaller after menopause.
When fibroids start producing constant symptoms or
they become as large as a 3 month pregnancy size
or more, then many physicians recommend
hysterectomy if childbearing is completed. If
childbearing is not completed, surgery to remove
individual fibroids (myomectomy) may be performed
if the fibroid(s) is felt to be interfering with
becoming pregnant or carrying a pregnancy.
Recently radiological techniques have improved so
that by catheterizing an artery in the groin,
particles can be injected into the arteries of the
fibroids so that the blood supply is cut off.
Gradually those benign muscle lumps dissolve and
become significantly smaller or go away entirely.
This procedure is called uterine artery
embolization (UAE).
The report below is about a registry for cases of
uterine artery embolization for fibroids and they
report their experience. The major complication
rates are slightly lower than that for hysterectomy
(0.66%), although they are not zero. Postoperatively,
there can be some prolonged pain problems but the
incidence of pain is still much less than having a
large abdominal incision from a hysterectomy.
About 5% of patients having UAE may need
readmission for pain or other problems after
discharge from the hospital but these are not
major complications. Only about 1% required any
surgical intervention for post UAE complications.
This procedure, uterine artery embolization,
should be strongly considered as an alternative to
hysterectomy for symptomatic uterine fibroids.
Radiological treatment of fibroids
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2. Quality of care and longevity of the elderly
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
As we get older, most people develop some sort of
medical problems for which they seek health care
on a regular basis. Individuals over the age of 65
are usually under the regular care of a physician
for one reason or another. A recent study
conducted at two managed health care organizations
in California looked at quality of care indicators
in the health care received by medically high risk
patients 65 years of age or older living in their
communities (not in nursing homes). They looked at
over 200 quality of care measures such as how
often patients received certain tests or
treatments depending upon their health problems.
The premise was that a high quality content of
health care should predict how long people live.
You would think this is a "no brainer" that does
not need to be studied, but the evidence has not
been here-to-for conclusive as far as living
longer goes.
The investigators found that in 372 vulnerable
elderly patients, when care did not meet the
quality standards they were looking at, patients
were more likely to die during the 3 years of
follow-up. Actually the first year and a half the
death rate did not increase much, but in the
second year and a half of the 3 year study the
death rate did increase.
I conclude from this study that quality medical
care not only improves how we live with our
diseases, but that good, medically-proved
decisions are effective in prolonging the life of
high risk elderly individuals. It will be
interesting as they continue the study, to see how
long good medical care can contribute to survival.
The important point is to keep seeking out high
quality medical care and follow that advice.
Quality of care and longevity of the elderly
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3. Reader submitted Q&A - Bleeding and uterine polyps
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I have been taking Ovcon-50(R) continually for 3
years... Last year I started bleeding heavy. I had
2 polyps removed. Two months later I started
bleeding again after the doctor tried different
remedies. He saw a polyp again and I had another D
and C. Now after 4 months I am spotting again...
What is going on? I am 43 years old. How will I
know if I am going thru the change if I am on the
pill continually (due to Polycystic ovarian
syndrome)?" - anonymous.
Not much is known about what causes uterine
polyps. Whether or not hormone therapy in general
or the specific type of hormone therapy plays a
role is uncertain. In women who do have
symptomatic uterine polyps, about 30% of the time
there is recurrence or persistence of the polyps.
I suspect you fall in that category. Currently the
standard treatment for uterine (endometrial)
polyps causing bleeding problems is an office or
outpatient surgical procedure called hysteroscopy
and D and C (dilatation and curettage).
Hysteroscopy is looking into the uterus with a
tiny scope so the doctor can see if any polyps are
present before scraping the lining of the uterus
with the D and C part of the procedure. Before the
hysteroscope was used, D and Cs were done blindly
in the hopes that all polyps would be removed just
by a thorough, systematic scraping of the lining.
However when studies were performed of
hysterectomies immediately after D and Cs, we
found that many polyps had been missed. Even with
hysteroscopy it is still possible to "miss"
existing polyps but it is a much lower frequency
than before.
The reason I mention this at all is because there
are still some physicians performing D and Cs
without doing a hysteroscopy immediately
preceding. You did not mention a hysteroscopy with
your D and C although I would guess that 85-90% of
physicians are doing that. You did mention that he
"saw a polyp" so probably he is performing a
hysteroscopy but you might ask your physician if
that was done with both of your D and Cs. If it
was, then your problem is more of recurrence than
of persistence of endometrial polyps. If that is
the case, switching you to a lower estrogen pill
than the Ovcon-50 might help prevent some of the
recurrent polyps. Estrogens are felt to stimulate
the growth of polyps. A 20 microgram pill rather
than a 50 microgram pill should still control your
bleeding if the progestin component is a strong
one (e.g., Loestrin 1/20)
The question about recognizing menopause while you
are taking continuous oral contraceptive pills is
a good one. Normally the hormones in the pills
prevent you from having both perimenopausal
symptoms as well as menopausal symptoms such as
hot flashes, vaginal dryness and sleep
difficulties. The only way to know about menopause
is to periodically stop the oral contraceptives
and see if you get hot flashes. Also, a blood test
for follicle stimulating hormone (FSH) can be
ordered by the doctor and if it is elevated above
30 mIU/ml, then you are in the menopause. Average
age of menopause is about 50-51 years old so you
will probably still be on the continuous oral
contraceptives until the 50's.
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4. Cell phone use and auto accidents
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Most of us have heard by now that cell phone use
while driving a car can be dangerous and lead to
accidents. In one study in the U.S., at any time
of the day up to 5% of people driving cars are
using a hand-held telephone. Most studies looking
at this have been conducted with small numbers of
volunteers. Those studies have found phone use
while driving:
impairs reaction time
affects the variability of lane position and speed
adversely affects following distance and
situational awareness
In a recent Australian study listed below, they
looked at 456 drivers aged 17 years or more who
owned or used mobile phones and had been involved
in motor vehicle accidents resulting in hospital
admissions. The driver's use of mobile phone at
the time of crash and on trips at the same time of
day in the week before the crash were recorded by
interviews with the drivers as well as phone
company's records of phone use.
It turned out that using a mobile phone within 10
minutes of a crash was associated with up to a 4
times increased risk of an accident. Interestingly
enough, the increased risk was still present
whether the driver used a hand held mobile phone
or a hands-free phone. In other words, it is more
the distraction of the attention and thought
process from speaking on the phone than it is the
physical handling of the phone itself that leads
to impaired driving.
Cell phone use and auto accidents
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5. Health tip to share - Exercise is a treatment for pain
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Years ago if you were in pain, the treatment
dictum was "to take it easy". In other words
decrease your physical activity. However, it has
now been shown that exercise is an excellent
treatment for pain. Exercise releases pain numbing
substances (endorphins), strengthens muscles that
make painful joints more stable and less likely to
produce pain, helps you to sleep better, improves
mood, keeps muscles flexible and less likely to be
injured and boosts your energy level. Check with
your doctor to see if exercise is right for your
specific pain problem and if it is, get on an
exercise program to eventually ease the pain. You
will get over the pain quicker with exercise. -
FRJ
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6. Humor is healthy
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"Wedding Advice"
At my granddaughter's wedding, the DJ polled the
guests to see who had been married longest. It
turned out to be my husband and I who had been.
The DJ asked us, "What advice would you give to
the newly-married couple?"
I said, "The three most important words in a
marriage are, 'You're probably right.'"
Everyone then looked at my husband. He said,
"She's probably right."
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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 ***********
September 18, 2005
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From BackupMD on the Net
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1. Cancer-related causes of mouth sores
2. Belching, bloating and intestinal gas
3. Reader submitted Q&A - Laparoscopic surgery for prolapse
4. Green onions and a hepatitis outbreak
5. Health tip to share - Shin splints
6. Humor is healthy
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1. Cancer-related causes of mouth sores
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Many cancer chemotherapeutic agents cause mouth
sores which can be painful and distressing. The
sores can be so bad as to interrupt treatment. The
ulcers that form can be on the inside of the
mouth, on the gums and even the tongue and lips.
Even bone marrow and stem cell transplants can
produce ulcers as well as radiation therapy to the
head and neck.
Some people are more susceptible than others to
developing mouth ulcers from cancer treatment.
Younger patients, those with preexisting gum or
dental disease, people who do not brush or floss
regularly and those on certain predisposing
medications such as pain medicines or anti-
depressants.
There are some things that can be done if
chemotherapy is anticipated:
get a dental check-up
take care of your teeth
stop smoking
eat a well-balanced diet for vitamins
drink plenty of water
These above suggestions from Mayo Clinic may help
protect from cancer treatment related ulcers.
Once ulcers occur, the treatments are limited. If
you are taking 5-FU (fluorouracil), swishing ice
chips in your mouth for the first half-hour of
treatment may limit the amount of the drug that
reaches your mouth, reducing the risk of mouth
sores. Mouth wash preparations such as Ulcer ease(R)
can help relieve the pain of the ulcers.
Palifermin (Kepivance) is a prescription medicine
that stimulates the growth of cells on the surface
of the mouth, but it is only approved in people
with leukemia and lymphoma who receive bone marrow
transplants. Low-energy laser therapy may be used
to stimulate cell growth in the mouth but it
requires expensive equipment and specialized
training.
Cancer-related causes of mouth sores
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2. Belching, bloating and intestinal gas
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Belching, bloating and intestinal gas are
certainly normal physiologic functions. When the
amounts become excessive, however. they cam make
one quite uncomfortable as well as embarrassed.
What defines excessive varies substantially from
person to person. When these symptoms become
bothersome, there are some things that can be
done.
Since belching is the body's way of getting rid of
excess air in the stomach, excess air swallowing
needs to be avoided. Chew food carefully and eat
slowly. Avoid carbonated beverages that release
carbon dioxide in the stomach. Both smoking and
chewing gum or candy make you swallow air so these
should be avoided. Poor fitting dentures may also
result in increased stomach air.
Bloating happens when the air remains trapped in
the stomach or goes down into the small intestine.
Most of the time food causes this. Vegetables like
broccoli, any type of beans, cabbage, and salads
are the most common culprits.
Increased bowel gas is still part of the same
problem when the air passes into the large bowel
or when it is produced by incompletely digested
food that is further broken down by colon
bacteria. Stress can make the bowel move
undigested food too quickly from the small
intestine where it is supposed to be totally
digested to the large intestine. Constipation
makes the problem even worse because normally
insoluble fiber is fermented by large bowel
bacteria resulting in even more flatulence.
People who have lactose intolerance or irritable
bowel syndrome (IBS) also have a problem with
excess intestinal gas. It may be important to make
these diagnoses before just assuming the increased
gas problem is to be treated only with diet and
behavior modification.
Over-the counter products such as Mylanta(R) or
Gas-X(R) containing simethicone can break up the
bubbles in gas. While these do not address the
original problem of air swallowing, dietary
intolerances or increased bowel motility due to
stress, they can still reduce symptoms markedly
and are worth a try while correcting the base
problem.
Belching , bloating and intestinal gas
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3. Reader submitted Q&A - Laparoscopic surgery for prolapse
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"What is your opinion of laparoscopic surgery for
pelvic floor displacement where bladder and
ligaments need readjustment (dropped)?" - M.J.
Early studies of about 5 years ago comparing
laparoscopic procedures for prolapse and stress
incontinence were only slightly less effective
than "open" procedures resulting in an abdominal
and/or vaginal incision. Studies in the last year
or two, however, show about the same results when
performed by surgeons who have had moderate
experience in these techniques. The advantages of
laparoscopic surgery include small incisions and
less recovery time although you have to be very
cautious about too much post operative activity
too soon. That can tear out some of the results
before total healing occurs.
The best rule-of-thumb to follow when considering
surgery by various techniques is to be willing to
have whatever procedure your surgeon has performed
the most of. There is no substitute for
experience. Extensive experience will almost
universally produce the least complications and
the best success rate.
Personally, I still prefer the "open" procedures
just because that is where my experience lies.
They give a very good success rate with minimal
complications. It usually takes performing in the
range of about 100 procedures to develop a routine
that optimizes the intended results of the
procedure while minimizing any risk. Recovery time
of laparoscopic procedures versus "open"
procedures has been shown to be about 2-3 weeks
less. That's not as much difference as you would
expect.
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4. Green onions and a hepatitis outbreak
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While food poisoning is the worry that most people
have about eating out in restaurants frequently,
one of the more worrisome foodborne diseases is
hepatitis A. This can come not only from kitchen
workers who are infected but also from foods that
are contaminated and improperly washed. You
probably remember the 2003 incident in
Pennsylvania where over 600 people who had eaten
in the same restaurant were infected by hepatitis
A which was subsequently traced to contaminated
green onions from Mexico used in large salsa
batches and other menu items. Three people died
and 124 were hospitalized.
Symptoms of hepatitis A include:
a short, mild, flu-like illness
nausea and vomiting
diarrhea
loss of appetite
weight loss
jaundice (yellow skin and whites of eyes, darker
yellow urine and pale stools)
itchy skin.
A person can be exposed and have no symptoms at
all or develop a severe inflammation of the liver.
He or she can even be a carrier for a short while.
Most hepatitis A symptoms improve after a few
weeks, although some people can feel tired for
months after the infection.
The best treatment is prevention which is carried
out by immunization. Current Center for Disease
Control recommendations for Hepatitis A
immunization are for:
Travelers to areas with increased rates of hepatitis A
Men who have sex with men
Injecting and non-injecting drug users
Persons with clotting-factor disorders (e.g. hemophilia)
Persons with chronic liver disease
Children living in areas with increased rates of
hepatitis A
Actually, I would suggest that everyone be
immunized for hepatitis A (viral hepatitis), not
just high risk people. I think there are too many
possible foodborne exposures for most people who
eat food that someone else has prepped. You can
usually get a vaccination either at your doctor's
office (general practitioner), or at your local
health department.
Green onions and a hepatitis outbreak
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5. Health tip to share - Shin splints
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Shin splints is a condition in which there is a
sharp, searing type of pain along the bone of your
lower leg. It can be caused by inflammation or
injury to the shin muscles.
The Calgary Health Region of Canada offers these
self-care tips:
Rest the affected leg as much as possible.
Substitute non-weight bearing exercises, such as
swimming, for your usual workout until the pain
has gone.
Do daily calf muscle and Achilles tendon stretches
but avoid stretching the shin muscles.
Apply ice to the inflamed area.
Wrap your lower leg with a tensor bandage to
provide support.
Elevate the lower leg above the level of your
heart as often as possible.
The pain from shin splints can last from several
days to a week, but it may become chronic if you
do not allow enough time for the muscles to heal.
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6. Humor is healthy
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"Crossing The River"
Three men were hiking through a forest when they
came upon a large, raging violent river. Needing
to get on the other side, the first man prayed,
"Lord, please give me the strength to cross the
river."
Poof! Lord gave him big arms and strong legs and
he was able to swim across in about 2 hours,
having almost drowned twice.
After witnessing that, the second man prayed,
"Lord, please give me strength and the tools to
cross the river."
Poof! Lord gave him a rowboat and strong arms and
strong legs and he was able to row across in about
an hour after almost capsizing once.
Seeing what happened to the first two men, the
third man prayed, "Lord, please give me the
strength, the tools and the intelligence to cross
this river."
Poof! He was turned into a woman. She checked the
map, hiked one hundred yards up stream and walked
across the bridge.
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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 ***********
October 16, 2005
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From BackupMD on the Net
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1. Alcohol use and breast cancer
2. What should your cholesterol be?
3. Reader submitted Q&A - Dermatographism
4. Fingernails - Keep them healthy and strong
5. Health tip to share - Cinnamon tea and bladder
6. Humor is healthy
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1. Alcohol use and breast cancer
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Many studies have shown a relationship between
high alcohol consumption (about 3 or more drinks a
day) and breast cancer. The effect is not a great
one but high alcohol use increases the risk for
breast cancer by about 40%. How exactly alcohol
raises the risk for breast cancer is not clear and
most scientists do not postulate that it is the
alcohol itself that causes cancer but rather
byproducts of alcohol or dietary changes that go
along with higher alcohol consumption.
Folic acid (vitamin B6) that comes mostly from
green leafy vegetables has been shown to be low in
those who consume larger amounts of alcohol and
develop breast cancer. A recent study in Australia
looked at the folic acid and alcohol consumption
in over 22,000 women and analyzed their risk for
breast cancer as correlated with their self
reported alcohol and folic acid consumption. They
found than expected higher incidence of breast
cancer in women who consumed about 3 or more
drinks a day (over 40 grams of 100% alcohol) but
if that person also consumed 400 ugm a day of
folic acid, then they did not have the increased
cancer incidence. In other words, somehow folic
acid was protective of the alcohol relationship
with breast cancer.
This study does not show that woman who drinks
alcohol can take folic acid supplementation to
prevent breast cancer but it does strengthens the
evidence that an adequate dietary intake of folate
may afford some protection against the increased
risk of breast cancer associated with alcohol
consumption.
Alcohol use and breast cancer
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2. What should your cholesterol be?
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As you may have realized, there is a big national,
medical push to have people lower their blood
cholesterol levels presumably to reduce their
incidence of heart attacks and strokes. This is
especially true for people who are at high risk
for heart disease such as having a positive family
history of cardiovascular events at ages less than
50, having diabetes mellitus, smoking, having high
blood pressure or having already had a history of
a heart attack or stroke. Most people, however, do
not fall into this category. Most people who are
not at high risk are fine if their:
Total cholesterol is below 200 mg/dl,
LDL cholesterol is below 160 mg/dl,
HDL cholesterol is above 40 mg/dl,
triglycerides are below 200 mg/dl
If you are normal risk for cardiovascular events,
there is not much of a benefit to lowering
cholesterol below the above levels; however if you
are in a high risk group or have already had a
cardiovascular problem, then studies from statin
therapy trials indicate that lower levels may
reduce your risk. Although I am not sure it is the
cholesterol level itself that predicts risk or
another mechanism of statins such as lowering
platelets, LDL levels below 100 mg/dl and HDL
levels above 60 mg/dl by taking statins will make
your risk even lower.
The following tables from the National Heart,
Lung, and Blood Institute offer general guideline
categories. At home cholesterol
profiles are available.
Total cholesterol
Below 200 mg/dL Desirable
200-239 mg/dL Borderline high
240 mg/dL and above High
LDL cholesterol
Below 100 mg/dL Optimal
100-129 mg/dL Near optimal
130-159 mg/dL Borderline high
160-189 mg/dL High
190 mg/dL and above Very high
HDL cholesterol
Below 40 mg/dL Bad
40-59 mg/dL Better
60 mg/dL and above Best
Triglycerides
Below 150 mg/dL Desirable
150-199 mg/dL Borderline high
200-499 mg/dL High
500 or above Very high
What should your cholesterol be?
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3. Reader submitted Q&A - Dermatographism
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"What can you tell me about dermographism and the
different treatment options. Are there any
dermatologists that specialize more in this area?
I am 43 years old with a mid-life onset of
allergies. I went to my family doctor with very
itchy skin. He told me that I have dermographism
triggered by an allergic reaction. He feels it
will go away as the allergy calms. I called my
derm (I also have controlled rosecea) and the
nurse practioner said she didn't think that was
true, although she did not see me." - Darlene
Dermatographism is a condition in which physical
pressure on the skin, such as lightly writing your
initials on your skin, produces a histamine
response (urticaria) in the skin. The histamine
release in turn causes redness and swelling so
that the initials appear on the skin as big red
wheals. It lasts on the skin for a variable amount
of time. This condition is an allergic response in
skin that has been sensitized by some allergen
although often we do not know what specific
allergen. Most of the time it goes away in about 3
weeks as long as you are not continuously exposed
to that allergen.
In some cases dermatographism continues as a
chronic urticarial response. At that point, where
it seems not to go away after a month or so,
treatment with a combination of an antihistamine
and an H2 antagonist, e.g. chlorpheniramine
(Aller-Chlor®, Chlor-Trimeton® Allergy,
Teldrin®) and cimetidine (Tagamet®), appears to
be effective. You should see your dermatologist or
family doctor to get that.
I do not know that any dermatologists specialize
in that area. You may need to see an allergist for
some skin testing if this is a chronic problem.
You will also have to be your own detective to try
to see if there is anything new in your
environment that you may be allergic to. Skin
lotions, soaps, any chemicals applied to the skin,
exposure to toxic chemicals, food allergies,
dietary supplements, new medicines, sun exposure
etc., can all be culprits in producing this.
Sometimes you may never find out the allergic
stimulant and just have to manage it as best you
can.
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4. Fingernails - Keep them healthy and strong
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Weak or brittle fingernails, fingernail fungus or
infection of the skin around the fingernail are
problems that can plague you for a long time and
the fixes are not always obvious. Sometimes the
more you care for your fingernails the more
problems you have because of the strong chemicals
used in polish, polish remover, or infections from
manicurists who do not sterilize their equipment
after each use.
Some of the following tips are given from Mayo
Clinic for strengthening brittle nails so they do
not split or break and become infected or
unsightly:
1. Keep fingernails short
2. Trim brittle nails after a bath or a 15-minute
hand-soak in bath oil.
3. Apply a moisturizer each time you wash your
hands.
4. If the nails are brittle, moisturize nails and
cuticles at bedtime.
5. You may apply a nail hardener, but avoid
products containing toluene, sulfonamide or
formaldehyde which can inflame the surrounding
skin.
6. Don't use nail polish remover more than twice a
month and use a non-acetone remover
7. Repair nail splits or tears with nail glue or
clear polish.
If you develop an infection of the skin around the
nail, frequently soak the nail in a mild
antibacterial soap about three times a day. You
may apply an antibacterial ointment on the skin
like Neosporin(R) after the soaking. Use gloves
when washing dirty dishes or any outside work like
gardening. You do not want to get any foreign
bacteria or fungus invading the skin around the
nail.
Fungus infections of the fingernails are much less
common than of the toenails but they can happen.
Be sure to see your doctor or podiatrist for anti-
fungal treatment. Topical treatment like Tineacide(R)
is less effective than taken oral anti-fungal
medicines but sometimes if diligently used, it can
work.
Be sure to take care of your nails. Nail problems
often reflect other conditions that need to be
addressed.
Fingernails - Keep them healthy and strong
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Health tip to share - Cinnamon tea and bladder
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"After reading about the many benefits of
cinnamon, I began drinking my own version of
cinnamon tea: heat a mug almost filled with
water heated in the microwave, then add and stir
one-quarter teaspoon of ground cinnamon. I then
add a little hazelnut-flavored coffee creamer.
It tastes wonderful.
About a week after daily drinking this tea, it
seemed that my trivial and sometimes annoying
cystitis problems vanished. I had forgotten that
the cinnamon also has some anti-microbial
properties, and seems, for now, to be helping me."
- Maggie
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6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Dear Tech Support:
Last year I upgraded from Boyfriend 5.0 to Husband
1.0 and noticed a distinct slowdown in the overall
performance, particularly in the flower and
jewelry applications, which operated flawlessly
under Boyfriend 5.0.
In addition, Husband 1.0 uninstalled many other
valuable programs,such as Romance 9.5 and Personal
Attention 6.5, and then installed undesirable
programs such as NFL 5.0, NHL 4.3, MLB 3.0, and
NBA 3.6.
Conversation 8.0 no longer runs, and Housecleaning
2.6 simply crashes the system. I've tried running
Nagging 5.3 to fix these problems, to no avail.
What can I do?
Signed,
Desperate
Dear Desperate:
First, keep in mind that Boyfriend 5.0 is an
Entertainment Package,while Husband 1.0 is an
Operating System. Try to enter the command:
"C:/ITHOUGHTYOULOVEDME" to download Tears 6.2,
which should automatically install Guilt 3.0. If
that application works as designed, Husband 1.0
should then automatically run the applications
Jewelry 2.0 and Flowers 3.5.
Remember, though, that overuse of the above
application can cause Husband 1.0 to default to
Grumpy Silence 2.5, Happy Hour 7.0, or Beer
6.1.Beer 6.1 is a very bad program that will
create Snoring Loudly 10.8. Whatever you do: DO
NOT install Mother-in- Law 1.0 or reinstall
another Boyfriend program. These are not supported
applications and will crash Husband 1.0. In
summary, Husband 1.0 is a great program, but it
does have limited memory and cannot learn new
applications quickly.
You might consider buying additional software to
improve memory and performance. I personally
recommend Hot Food 3.0 and Lingerie 7.7.
Good Luck,
Tech Support
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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********** Health Newsletter ***********
November 13, 2005
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
From BackupMD on the Net
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1. Chronic caffeine consumption and hypertension
2. What is the risk of dying from obesity surgery?
3. Reader submitted Q&A - Gout
4. Cold sores
5. Health tip to share - Ear pain from flying
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Chronic caffeine consumption and hypertension
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When you have a drink containing caffeine, your
blood pressure goes up. Acutely like this,
caffeine can cause a very temporary hypertension.
The question is whether or not habitual caffeine
consumption can cause chronic hypertension for
which you need to be treated for the long term.
Recently, a group of investigators from Harvard
Medical School looked at the ongoing Nurse's
Health Study of over 150,000 nurses since 1990.
They looked at chronic coffee consumption as well
as caffeine from other sources such as cola drinks
to see if women who did not have high blood
pressure problems at the start of the study but
who had a high consumption of these caffeine
containing drinks, developed high blood pressure
more often than women who did not have a high
caffeine intake. They did not find a linear
increase in high blood pressure among women who
were habitual coffee drinkers, but they did find
that the more regular and diet colas that a nurse
drank, the more likely she was to develop high
blood pressure. The effect was present whether the
drink was diet or regular cola.
The authors feel that the role of cola beverages
in causing hypertension should be studied.
Chronic caffeine consumption and hypertension
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. What is the risk of dying from obesity surgery?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Stomach bypass or banding surgery for obese
patients to lose weight can be risky surgery.
There is a higher surgical death rate overall than
with most other elective surgeries. Known as
bariatric surgery, these types of stomach
operations have an overall death rate in the range
of almost 5% within a year of the operation.
Remember that people who undergo this type of
surgery are already at a higher risk for death
just because of the obesity and associated medical
problems.
A recent study using a Medicare database looked at
how the post-bariatric surgical death rate varied
by gender and age. They looked at the 30 day, 90
day and 1 year mortality. Basically, investigators
found out that men had higher 1 year death rates
compared to women (7.5% vs 3.7%) and that the
death rate went up with age. Individuals 65 years
or older when they had the surgery had an 11.1%
one year death rate vs 3.9% for all those under
age 65. Therefore age is quite a risk factor when
undergoing obesity surgery.
Keep in mind that those who successfully undergo
bariatric surgery have significant benefits of
reduced mortality from the weight loss that takes
place.
What is the risk of dying from obesity surgery?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Gout
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I had an attack of gout (according to the doctor)
but my uric acid level is fine. I am a 55 year old
woman. What can I do to prevent other attacks?" -
Rita
There are 2 different types of crystals which can
end up being deposited in the joints and producing
an arthritis. The most common type is uric acid
crystal deposit called gout. The other type of
crystal is calcium pyrophosphate dihydrate which
produces "pseudogout" or a calcific
periarthritis/tendinitis.
Regular gout is the most common type of crystal-
induced arthritis and while most people with gout
have elevated blood levels of uric acid, not all
do. In fact if measured during an acute attack,
almost half of the people have normal uric acid
levels. Therefore one possibility is that you may
have regular gout with normal blood levels of uric
acid. If this is the case, the goal is still to
reduce your uric acid blood levels even more in
order to prevent gout attacks.
A second possibility is that the crystals causing
your arthritis are the calcium pyrophosphate
dihydrate crystals seen in pseudogout. The only
way to know for sure is for the doctor to put a
needle into an affected joint (usually the big
toe) that has been numbed up with a local
anesthetic, and draw off some fluid for crystal
analysis. You should probably have this done. If
uric acid crystals are found then prevention of
further attacks is helped by lowering your uric
acid levels. If the calcium pyrophosphate
dihydrate crystals are found then lowering uric
acid levels will not help.
Gout - to lower blood uric acid levels:
1) avoid alcohol
2) avoid weight gain and lose weight if possible
3) drink plenty of fluids to dilute uric acid in the blood stream
4) limit animal protein and avoid high purine
foods such as red meats, liver, tongue, peas,
beans, shellfish, clams, mussels, mackerel,
anchovies
5) use drugs as the doctor prescribes such as
anti-inflammatorily, allopurinol (Zyloprim(R),
Aloprim(R)), probenecid (Benemid) and steroids.
Pseudogout -
1) always keep well hydrated; dehydration leads to
crystal deposit
2) use the anti-arthritis pain medicines and
steroids prescribed by your doctor
3) be checked for other conditions such as
overactive parathyroid gland
(hyperparathyroidism), too much iron in the body
(hemochromatosis), hypophosphatasia, an inherited
metabolic bone disease, low blood levels of
magnesium (hypomagnesemia), Wilson's disease, an
inherited disease in which too much copper
accumulates in the body, osteoarthritis, diabetes
You will need to work closely with your doctor on
these things or seek out an arthritis specialist.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Cold sores
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Cold sores or fever blisters are breakouts of red
spots that turn into ulcers on the outside of the
lips as well as sometimes on the inside of the
lips or at the corners of the mouth. They are
different from "canker sores" that occur more on
the gums, inside of the cheeks and mouth away from
the lips or under the tongue. Canker sores may run
in families, but they aren't contagious. Doctors
don't know what causes canker sores, but they may
be triggered by stress, poor nutrition, food
allergies and menstrual periods.
Cold sores ARE infectious and are caused by the
herpes simplex virus which is closely related in
type to the herpes virus that causes genital
sores. Initially pain or tingling occurs for 1 or
2 days at the skin site where the ulcer is going
to break out. Then small, painful, fluid-filled
blisters appear on a raised red area of your skin.
More blister/ulcers may beak out for several days
and they last about 10-14 days. You are most
contagious when the blisters are breaking open and
need to be careful not to spread the virus to
others by touching the area, kissing, sharing
eating utensils, cups, glasses, towels etc. The
person exposed to the virus may not have a
breakout for up to 3 weeks after coming in contact
with the virus.
After an initial breakout, the virus lays dormant
in the nerve cells of the skin and you may get a
recurrence of the cold sore any time your immune
system is stressed such as at time of menses, high
anxiety, fever or even exposure to the sun. Some
people go on to have fairly regular recurrences of
sores that break out. Medicine (antivirals) does
not help shorten the symptoms of an acute breakout
by much, but may help reduce the frequency of
recurrent episodes.
If you do get cold sores, be sure to avoid contact
with high risk individuals such as infants, people
with aids or cancer or those who have had organ
transplants. They can become seriously ill with a
herpes infection. If you seem to get recurrences,
contact your doctor for possible antiviral
therapy.
Cold sores
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Health tip to share - Ear pain from flying
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I had severe ear pain when flying for years. At
one point I had tubes implanted in my ears to
relieve the extreme pain. After one of the tubes
dislodged, my ear doctor suggested that I use
Afrin(R) and Sudafed plus "EARPLANES" (a
specialized pressure adjusting set of earplugs).
At first I thought it was an ear doctor joke but I
tried it and now recommend to everyone. I have
been pain free for five years, have lessened the
amount of Afrin(R) and Sudafed(R) I use, and can
fly without fear of extreme pain. For those who
think the $5 is too much, the pain isn't that
bad." - Anonymous
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"How To Start Your Day With A Positive Outlook"
1. Open a new file in your PC.
2. Name it "HOUSEWORK"
3. Send it to the RECYCLE BIN
4. Empty the RECYCLE BIN
5. Your PC will ask you, "Are you sure you want to
delete Housework permanently?"
6. Answer calmly, "Yes," and press the mouse
button firmly....
7. Feeling better now???
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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