Women's Health Newsletters 11/22/98 - 12/20/98
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***** Woman's Diagnostic Cyber Newsletter *****
December 20, 1998
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This week from Woman's Diagnostic Cyber
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1. Lack of heart disease prevention instructions
2. Infection and agent exposures during pregnancy
3. Pain during sex
4. Hysterectomy statistics
5. Effect of smoking on getting pregnant
6. Humor is healthy
Spread the word! Send a copy of this newsletter
to someone you know.
Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.
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1. Lack of heart disease prevention instructions
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During an office visit, doctors should make it a
point to provide you with preventive care
instructions, especially for prevention of heart
disease, a major killer. The truth is they are
quite a bit less than perfect in this. Ob-Gyns are
worse than internists at remembering to check and
discuss heart disease prevention, but I suspect
that is because women have a lower incidence of
heart disease. On the average, all of the doctors
had low incidence of checking for certain things.
Some of the potential problems were measured in
the study below: blood pressure measurement (50%
of visits), cholesterol testing (5%) and
counseling for exercise (12%), weight (6%),
cholesterol (4%) and smoking (3%). These low
numbers imply that women need to fend for
themselves and look for their own prevention
strategies.
Heart disease prevention instruction
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2. Infection and agent exposures during pregnancy
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Motherisk is an organization based in Toronto at
the Sick Children's Hospital. They focus on birth
defects caused by reproductive toxins, infections,
and drugs. If you have exposure to any of these
during pregnancy, you will want to check out their
Update page. It covers topics such as exposure to
alcohol, nicotine, Prozac and other SSRIs,
Accutane, cocaine, anti-histamines and other
drugs. Infections such as chicken pox, HIV,
toxoplasmosis, CMV and others.
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3. Pain during sex
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Pain during sexual penetration, dyspareunia, can
have many causes. No matter what the cause, the
pain sets up a complex physiological response
which in turn causes vaginal dryness, lack of
vaginal relaxation and dilatation and even muscle
spasms which all make the pain worse each time
sexual relations are attempted. See the discussion
of dyspareunia and vulvar skin problems at:
Pain during sex
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4. Hysterectomy statistics
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Statistics can be very boring when individual
decisions are being made about whether to have a
hysterectomy or whether to remove the ovaries at
the time of hysterectomy. However, we can learn
something from national statistics for the
decisions a woman has to face.
The annual rate of hysterectomy is still falling
slightly, from 7.1 per 1000 in 1980 to 5.5 per
1,000 women in 1988-93.
There is no significant difference in incidence by
race but there is a different frequency of
diagnoses by race. Fibroids (leiomyomata) were the
primary diagnosis for 62% of hysterectomies among
black women, and 29% among white women; whereas
endometriosis and prolapse were twice as frequent
in white women compared to black women.
Hysterectomy rates are still highest in the South
(7 per 1000) and lowest in the Northeast (4 per
1000) in the more recent years.
Over 25% of women in the U.S. will have a
hysterectomy by age 60.
Removal of ovaries with vaginal hysterectomy is
rising probably because of the laparoscopic
assisted vaginal procedures. During 1991-1993, 47%
of vaginal hysterectomies associated with
laparoscopy were accompanied by bilateral
oophorectomy, whereas only 22% of vaginal
hysterectomies performed without laparoscopy were
accompanied by bilateral oophorectomy.
Surveillance for Reproductive Health, US Public
Health Service, 1997 is published at JAMA's
Contraceptive Information Center.
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5. Effect of smoking on getting pregnant
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How much does smoking really effect the ability to
get pregnant (fecundability). We hear the evils of
smoking all the time so we assume it must be bad
for women trying to get pregnant.
It looks like the chance of getting pregnant
within six months for smokers is about 50% that of
nonsmokers.
Smoking and fertility
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6. Humor is healthy
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From: "Joe Lex" [email protected]
Subject: Pied Piper
A tourist wanders into a back-alley antique shop
in San Francisco's Chinatown. Picking through the
objects on display he discovers a detailed, life-
sized bronze sculpture of a rat. The sculpture is
so interesting and unique that he picks it up and
asks the shop owner what it costs.
"Twelve dollars for the rat, sir," says the shop
owner, "and a thousand dollars more for the story
behind it." "You can keep the story, old man," he
replies, "but I'll take the rat."
The transaction complete, the tourist leaves the
store with the bronze rat under his arm. As he
crosses the street in front of the store, two live
rats emerge from a sewer drain and fall into step
behind him. Nervously looking over his shoulder,
he begins to walk faster, but every time he passes
another sewer drain, more rats come out and follow
him. By the time he's walked two blocks, at least
a hundred rats are at his heels, and people begin
to point and shout. He walks even faster, and soon
breaks into a trot as multitudes of rats swarm
from sewers, basements, vacant lots, and abandoned
cars. Rats by the thousands are at his heels, and
as he sees the waterfront at the bottom of the
hill, he panics and starts to run full tilt. No
matter how fast he runs, the rats keep up,
squealing hideously, now not just thousands but
millions, so that by the time he comes rushing up
to the water's edge a trail of rats twelve city
blocks long is behind him. Making a mighty leap,
he jumps up onto a light post, grasping it with
one arm while he hurls the bronze rat into San
Francisco Bay with the other, as far as he can
heave it. Pulling his legs up and clinging to the
light post, he watches in amazement as the
seething tide of rats surges over the breakwater
into the sea, where they drown.
Shaken and mumbling, he makes his way back to the
antique shop.
"Ah, you've come back for the rest of the story,"
says the owner. "No," says the tourist, "I was
wondering if you have a bronze sculpture of a
lawyer."
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We've added a classic book to our store on
What's Happening to my Body Book for Girls
which is a must have for a young girl or teen.
http://st1.yahoo.com/wdxcyberstore/whathaptomyb.html
What's happening to my body
Also added is an excellent 80 page book called:
Woman's Self-Care Guide
from the American Institute of Preventive Medicine.
http://st1.yahoo.com/wdxcyberstore/womselguid.html
Self-Care Guide
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That's it for this time. We will bring you
accurate women's health answers again soon.
Rick
Frederick R. Jelovsek MD
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***** Woman's Diagnostic Cyber Newsletter *****
December 13, 1998
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This week from Woman's Diagnostic Cyber
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2. Review of 12 commonly used medicinal herbs
3. Must I get rid of the cats during pregnancy?
4. Traveler's diarrhea
5. Obesity evaluation and treatment guidelines
6. Humor is healthy
Spread the word! Send a copy of this newsletter
to someone you know.
Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Review of 12 commonly used medicinal herbs
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In the Archives of Family Medicine, you might want
to look at a recent review of commonly used herbs.
They review chamomile, echinacea, feverfew,
garlic, ginger, ginkgo, ginseng, goldenseal, milk
thistle, St John's Wort, saw palmetto, valerian.
You might pay particular attention to feverfew
which can help prevent migraines, ginger which is
effective in extreme morning sickness (hyperemesis
gravidarum), and Siberian ginseng (popular in the
U.S.) which is not really ginseng at all.
Medicinal herb review
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3. Must I get rid of the cats during pregnancy?
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Many women have heard of the serious complications
that toxoplasmosis infection can cause during
pregnancy for the baby. What is the link between
cats and toxoplasmosis? Handling cat litter can be
a problem during pregnancy but that isn't the
major source of exposure and no, you don't need to
get rid of the cats! If you have questions about
this, be sure to read the news article at:
Toxoplasmosis and pregnancy
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4. Traveler's diarrhea
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The Travel Clinic sponsored by Dr. Mark Wise of
Ontario, Canada offers some interesting
information for special travelers such as those
with inflammatory bowel disease, diabetes and most
importantly, pregnancy.
Travel during pregnancy
Also the section on traveler's diarrhea has some
very practical information if you are travelling
to more tropical areas. Be sure to pack Imodium
and ask your doctor for a prescription for Cipro
(ciprofloxin) to take with you just in case.
Traveler's diarrhea
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5. Obesity evaluation and treatment guidelines
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The American Academy of Clinical Endocrinologists
has a current set (1998) of clinical guidelines for
the evaluation and treatment of obesity.
Especially interesting are the sections on the
scientific basis for obesity including genetic
predisposition, low energy output,
neurotransmitters (affected by Phen fen),
circulating protein (leptin) that sends signals to
the brain about fat stores and many other
influences that contribute to what we weigh.
(This is a PDF file requiring Acrobat Reader (R))
Obesity guidelines
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6. Humor is healthy
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Q: What is a man's view of safe sex?
A: A padded headboard.
If men had a menstrual period, they'd brag about
the size of their tampon and use an empty aluminum
cigar tube filled with angry wasps as an
inexpensive vibrator.
Q. How can we be absolutely certain that Santa
Claus is, in fact, a man?
A. Would a woman wear the same outfit year in and
year out?
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That's it for this time. We will bring you
accurate women's health answers again soon.
Rick
Frederick R. Jelovsek MD
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***** Woman's Diagnostic Cyber Newsletter *****
December 6, 1998
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This week from Woman's Diagnostic Cyber
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1. Hypothyroidism - Clinical dx and rx guidelines
2. Osteoporosis prevention - treatment successes
3. Endometriosis - Does it always cause pain?
4. Induction of labor
6. Humor is healthy
Spread the word! Send a copy of this newsletter
to someone you know.
Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Hypothyroidism - Clinical dx and rx guidelines
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The American Association of Clinical
Endocrinologists (AACE) has developed practice
guidelines for evaluation and treatment of
hyperthyroidism and hypothyroidism. The section on
hypothyroidsm is very useful, not only because
this is a common disease in women, but because it
discusses subclinical hypothyroidism (no major
symptoms but abnormal thyroid studies) and whether
it should be treated or not. Many primary care
physicians do not treat subclinical disease but
the AACE group recommends treatment. The article
also mentions which medications interfere with
thyroid medications and the pros and cons of
generic versus brand name thyroid replacement
medication.
Thyroid disease guidelines
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2. Osteoporosis prevention - treatment successes
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Both men and women lose bone at a rate of 0.3% to
0.5% per year beginning at about age 40. at
menopause, however, women have a faster bone loss
at a rate of 3% to 5% per year for the initial 5
to 7 years after menopause. It is difficult to
know the best treatment for osteoporosis
prevention. The article below discusses different
therapies such as hormone replacement, alendronate
(Fosamax), raloxifene (Evista), and calcium and
vitamin D supplements.
Osteoporosis prevention
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3. Endometriosis - Does it always cause pain?
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If a women has chronic pelvic pain and at
laparoscopy, endometriosis is diagnosed, it means
that the endometriosis is causing the pain -
correct? No, it doesn't. Many times pain can be
present and not due to existing endometriosis. See
the discussion at:
Endometriosis and pain
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4. Induction of labor
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Many women who near their due date want to have
labor induced rather than waiting for spontaneous
labor. This may be due to the convenience of a
relative coming to help with babycare after
delivery, job requirements for husband, living a
distance from a hospital with the fear of delivery
en route, or just plain being very uncomfortable
with pain and achiness or swelling. In some
studies, induction of labor near term is
associated with almost a doubling of the incidence
of cesarean section for failed induction. Since
induction of labor may carry more risks than
spontaneous labor, doctors and patients have sought
criteria as to when and how to induce labor to
make it as safe as possible.
The Maternal Fetal Medicine Committee of the
Society of Obstetricians and Gynaecologists of
Canada (SOGC), produced a position paper on when
labor is safe to be induced, including methods of
induction and criteria that are the most
predictive of induction success. This paper will
help you discuss the topic with your doctor.
(This is in a PDF format requiring Adobe Reader)
Induction of labor
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6. Humor is healthy
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YOU MIGHT BE IN THE HEALTH CARE FIELD IF........
Discussing dismemberment (or rectal exams) over
gourmet meal seems perfectly normal to you.
You believe in serial spraying of Prozac.
You believe that "Shallow Gene Pool" should be a
diagnosis.
You think unspeakable evil will befall you if
anyone says "Boy it sure is quiet around here."
When you are out in public you compliment complete
strangers on their veins.
You have ever wanted to hold a seminar entitled
"Suicide.....getting it right the first time".
You have ever restrained someone and it was not a
sexual experience.
You commonly utter the phrase "What changed
tonight at 2 AM that made this an emergency AFTER
6 MONTHS?!"
You think putting a Valium salt lick in the ER
waiting room is a novel idea.
When you mention vegetables, you are not thinking
of a food group.
You have been exposed to so many Xrays, you don't
bother with birth control.
You have heard "Why, I don't know how that got
stuck in there" too many times.
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That's it for this time. We will bring you
accurate women's health answers again soon.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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***** Woman's Diagnostic Cyber Newsletter *****
November 29, 1998
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This week from Woman's Diagnostic Cyber
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1. Alternatives for tampons and pads
2. Smoking causes odors in breast milk
3. Involuntary weight loss
4. Breast cancer prevention by diet is criticized
5. Parkinson's Disease - What are the features?
6. Humor is healthy
Spread the word! Send a copy of this newsletter
to someone you know.
Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Alternatives for tampons and pads
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
There is an interesting article on alternatives to
the normal pads and tampons available at most
stores. The article is at a site called Myria.com
which is a magazine site for motherhood. They
discuss glad rags, cotton tampons and other non-
disposable products.
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2. Smoking causes odors in breast milk
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Children whose mothers smoke have an increased
chance of smoking during teen years. It has been
postulated that there is an odor or taste in the
breast milk of smoking mothers that possibly
addicts or at least causes early learning. The
study below tests that hypothesis, i.e., that
smoking transmits an odorous substance to breast
milk. The reason this study is important is that
it may explain many ingestion preferences.
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3. Involuntary weight loss
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It is hard to believe that some people lose weight
when they are not really trying. That can be a
complaint or symptom of up to 8% of visits to
primary care doctors. If you have a relative or
friend who is losing weight, you may interested in
some of the different causes. This is discussed
at:
Involuntary weight loss
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4. Breast cancer book attacked
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The American Council on Science and Health has
issued a press release criticizing the best
selling book on preventing breast cancer by diet.
They say it is misleading, unscientific, and
speculative advice that Dr. Arnot offers to women
who wish to reduce their risk of breast cancer,
and to women who wish to maximize their chances of
survival once they have been diagnosed with the
disease.
Breast Cancer Book Attacked
Their 17 page article entitled "The Breast Cancer
Prevention Diet by Dr. Bob Arnot: Unscientific and
Deceptive - A Disservice to American Women" is
published on their web site:
Book does disservice to women
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5. Parkinson's disease - What are the features?
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You may have an older relative or friend who is
developing a tremor, slowing down or having
difficulty with balance. Over 15% of adults 65-74
years of age and over 50% of adults over 85 have
Parkinson symptoms and yet it is a frequently
misdiagnosed disease. The following article in the
Journal of the American Medical Association is
quite technical medical jargon but it might make a
good reference if you have occasion to wonder
about Parkinson's Disease in a friend.
Parkinsonian features versus Parkinsonian Disease
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6. Humor is healthy
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Subject: Logic
Sherlock Holmes and Dr. Watson went on a camping
trip. As they lay down for the night, Holmes said
"Watson, look up at the sky and tell me what you
see."
"I see millions and millions of stars," replied
Watson.
"And what does that tell you?" Holmes asked.
Watson said, "Well, astronomically, it tells me
that there are millions of galaxies and
potentially billions of planets. Theologically, it
tells me that God is great and that we are small.
Meteorologically, it tells me that we will have a
beautiful day tomorrow. What does it tell you,
Holmes?
Holmes replied, "Watson, you idiot,
somebody stole our tent."
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That's it for this time. We will bring you
accurate women's health answers again soon.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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***** Woman's Diagnostic Cyber Newsletter *****
November 22, 1998
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
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1. Pregnancy and laser photorefractive keratectomy
2. Basal body temps give clue to endometriosis
3. Ultrasound diagnosis of birth defects
4. What is ideal body weight?
5. Death from sepsis is less for women than men
6. Humor is healthy
Spread the word! Send a copy of this newsletter
to someone you know.
Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Pregnancy and laser photorefractive keratectomy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The Archives of Opthalmology reports an instance
of how pregnancy changes the results of the
eye surgery to correct near-sightedness
(photorefractive keratectomy procedure by Eximer
laser) that everyone seems to be getting now. The
reason you need to know is that it is possible
that there is also a variance in the correction
the opthalmologist gets based on whether a woman
is taking birth control pills or not, i.e., vision
acuity could change if you had the procedure while
on pills and then discontinued them or vice versa.
We will need to keep a lookout for more studies or
reports about this. Meanwhile, if you decide to
have this procedure performed, especially to
correct myopia (near-sightedness) be sure to tell
the doctor if you are on pills or if you are
trying to get pregnant.
The report entitled "Pregnancy-Associated
Overcorrection Following Myopic Excimer Laser
Photorefractive Keratectomy" is at:
Pregnancy associated eye changes with laser eye surgery
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2. Basal body temps give clue to endometriosis
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The Endometriosis Pavillion at Ob Gyn.net has a
few new things. There are some unique articles on
diagnosis of endometriosis by means other than
laparoscopy. One article about the response of
basal body temperature in adolescent women with
endometriosis is interesting. Basically it says
that if the basal body temperature stays somewhat
elevated the first one or two days of the menses
(it is supposed to drop with the onset of the
menstrual period), this is more common in women
with endometriosis. That makes sense because in
some cases of endometriosis there is retrograde
menstrual flow which could elicit a low grade
inflammatory response.
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3. Ultrasound diagnosis of birth defects
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Does having a "normal" ultrasound scan during
pregnancy mean your baby will not have any
anomalies? It helps, but it is not a certainty. To
see an example of how reliable ultrasound is in
picking up structural anomalies before birth, look
at the news at:
Ultrasound scans to screen for birth defects
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4. What is ideal body weight?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
From the Healthcalc Network, there are some useful
materials on health and nutrition. One article is
a clear explanation about how ideal body weight is
calculated and what it means to be over or under.
What is ideal weight?
There are also some useful calculation tools for:
target heart rate, energy expenditure, BMI,
walking test, nutrition and basic aerobic
exercise.
Healthcalc tools
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5. Death from sepsis is less for women than men
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Women with sepsis (blood-borne bacterial
infection) following serious surgical procedures,
survive better than men. In an article in the
Achives of Surgery, men and women who developed a
blood-borne infection after surgery were studied.
This is a serious complication that often causes
death. Men had a 70% mortality and women a 26%
mortality rate with sepsis. It looks like the
presence of estrogens helps change tissue factors
that are toxins with bacterial sepsis.
Gender differences in sepsis survival
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6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
A frog goes into a bank and approaches the teller.
He can see from her nameplate that the teller's
name is Patricia Whack. So he says, "Ms. Whack,
I'd like to get a loan to buy a boat and go on a
long vacation."
Patti looks at the frog in disbelief and asks how
much he wants to borrow. The frog says $30,000.
The teller asks his name and the frog says that
his name is Kermit Jagger and that it's OK, he
knows the bank manager.
Patti explains that $30,000 is a substantial
amount of money and that he will need to secure
some collateral against the loan. She asks if he
has anything he can use as collateral.
The frog says, "Sure. I have this." And he
produces a tiny pink porcelain elephant, about
half an inch tall. It's bright pink and perfectly
formed.
Very confused, Patti explains that she'll have to
consult with the manager; and disappears into a
back office. She finds the manager and reports:
"There's a frog called Kermit Jagger out there who
claims to know you, and he wants to borrow
$30,000. And he wants to use this as collateral."
She holds up the tiny pink elephant. "I mean, what
the heck is this?"
So the bank manager looks back at her and says:
"It's a knick knack, Patti Whack. Give the frog a
loan. His old man's a Rolling Stone!"
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time. We will bring you
accurate women's health answers again soon.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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