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********** Health Newsletter ***********
December 12, 2004
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Job burnout and its health effects
2. Preventing kidney complications from diabetes
3. Reader submitted Q&A - What can improve memory?
4. Sleep loss can stimulate your appetite
5. Health tip to share - Coping with hot flashes
6. Humor is healthy
The next newsletter will be in two weeks.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Job burnout and its health effects
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Job burnout is a term used to describe a mental
and physical exhaustion that makes you dread to
return to work after a weekend or vacation. It is
caused by the long-term exposure to demanding
work situations. People at risk for job burnout
are those who:
identify very strongly with work to the exclusion
of their non-working life,
try to meet everyone else's needs and wants,
have monotonous jobs,
or work in the helping professions such as
medicine, nursing, counseling, teaching, or
police work.
How can you recognize if you or a coworker or
friend are in the process of "burning out"?
Symptoms include increasing sarcasm or cynicism
at work, trouble getting started at the beginning
of the work day, irritability and loss of patience
with co-workers, customers or clients, an
alteration of sleep or appetite habits, and
chronic head or body aches--physical symptoms
with vague causes. It is possible, however, that
the above symptoms can also indicate an internal
depression that is caused by non-work related
problems rather than job burnout.
If the feelings are caused by job burnout rather
than an endogenous depression, you can usually
identify a lack of control at work, unclear job
expectations, dysfunctional workplace dynamics, a
mismatch in values between you and your company
or boss, or extremes in job activity from boring
to chaotic. Identifying these conditions helps
explain the problem but does not make it better
unless you adjust to these circumstances or change
jobs. You may want to seek counseling to help you
adjust.
Job burnout and its health effects
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Preventing kidney complications from diabetes
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The major long term complication of diabetes is
that it affects the blood vessels all over the
body causing hypertension, heart disease, skin
conditions and kidney damage eventually leading to
kidney failure. While many individuals with
diabetes eventually die from strokes and heart
attacks, a significant number each year die from
kidney failure.
The American Diabetes Association Resource Guide
for 2004 recommends testing for small amounts of
protein in the urine (microalbuminuria) once a
year. It is an early sign of kidney disease and if
present, a diabetic's medications can be adjusted
and intensified in order to prevent full blown
kidney damage and having to go on an artificial
kidney (kidney dialysis).
A recent study published in the New England
Journal of Medicine looked at trying to prevent
early kidney disease as measured by
microalbuminuria by aggressively treating the
blood pressure with either an ACE inhibitor anti-
hypertensive medication or a calcium channel
blocker or both. These are two commonly used types
of blood pressure medications. The Italian
investigators found that the ACE inhibitor,
trandolapril (Mavik), was over 2 times as
effective as a calcium channel blocker, verapamil
(Calan, Isoptin) in preventing microalbuminuria.
If you have diabetes and are on a blood pressure
medicine also, you might check with your doctor to
consider that the anti-hypertensive medication you
are on is an ACE inhibitor as its mechanism of
action or at least discuss this study with him or
her. Also be sure to check annually for any
microalbuminuria.
Preventing kidney complications from diabetes
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - What can improve memory?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Outside of the Alzheimer's issue, what is good
for memory? Any specific food to eat or to
avoid? Any specific vitamin to eat or to avoid?
Anything outside of Ginkgo Biloba to take?" - LA
Some studies of Ginkgo Biloba herbal supplements
to improve memory have shown positive results
while others have shown negative results, i.e.,
it may or may not help. As I read the medical
literature on this, I do not think the evidence is
enough to make me take any Gingko supplements. Soy
supplements (60 mg of isoflavones) also have some
studies supporting improved memory and some
negative studies. At this time there is not
enough to say conclusively whether soy is
beneficial for memory and cognitive function.
Folic acid (vitamin B9) and vitamin B12 have
sometimes been recommended as supplements for
memory and cognitive function because
deficiencies in these vitamins can produce
impaired mental functioning. However the clinical
trials that have been performed using these
vitamin supplements in normal people and in those
with early Alzheimer's disease have not shown any
benefit. The story is the same for vitamin B6.
Unless you are not eating any green vegetables at
all or have been shown to have a folate, B6 or
B12 deficiency, specific vitamin supplements or
multi B vitamins will probably not enhance any
memory.
Caffeine in small doses (less than 200 mg, two cups
of coffee) improves attention. In this way it may
help memory because many of the facts we forget
are due to lack of complete attention and
repetition the first time we heard it.
An ayurvedic herb used in India for memory
enhancement, Brahmi (Bacopa monniera), has one
report of positive memory enhancement but again,
its too little data to say for sure.
You will not help memory by avoiding any specific
foods or vitamins with the exception of alcohol.
Alcohol in small amounts can produce temporary
memory impairment and over two drinks a day may
also produce some chronic memory impairment. Many
prescription drugs that are used to affect the
brain system or alter mood such as anti-
psychotic, anti-seizure or narcotic pain
medicines, can have a negative effect on memory.
The best prescription to preserve your memory
other than avoiding memory impairing drinks and
drugs is to indulge in memory exercises or mental
aerobics. Do crossword puzzles and word games
every chance you get. Read a lot and tell someone
about the book. Play board games or even a musical
instrument. Dancing, walking or any regular
exercise as well as plenty of sleep helps memory.
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4. Sleep loss can stimulate your appetite
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
It has been known for quite a while that sleep
deprivation of both animals and humans results in
a stimulated appetite and overeating behavior,
usually with unintended weight gain. Until
recently, the mechanism behind this increase in
appetite was not clear.
A recent study from the University of Chicago and
from Brussels, Belgium looked at young men who
underwent sleep deprivation for two days followed
by two days of extended hours of sleep.
Investigators measured two hormones that affect
hunger and appetite: leptin and ghrelin. They
found evidence that those hormones were
significantly altered by either too little or more
than enough sleep. Too little sleep raised the
appetite stimulating hormone ghrelin.
Leptin, a hormone produced in fat cells,
suppresses the desire to eat. It also stimulates
the burning of calories. Normally the more fat
cells you have, the more leptin is produced which
you would think would lead to weight loss. Many
times it does but in obese individuals, there
somehow develops a resistance to leptin. Thus the
hormone leptin is now being closely studied as a
possible treatment for weight loss. Most obese
individuals are leptin resistant so if we could
understand how that works, we might have a
unusable medical obesity treatment.
Ghrelin is a blood factor that seems to be the
opposite of Leptin; it the only hormone we know of
that stimulates the appetite. Not much is known
about it yet but it may play a role in anorexia
and bulemia. For both leptin and ghrelin, it is
interesting that alteration in the amount of sleep
one gets is enough to change these appetite and
calorie burning regulatory hormones significantly.
Inadequate sleep can change hormone levels that
regulate how full you feel and hunger in a way
that could promote overeating and obesity.
Sleep loss can stimulate your appetite
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Health tip to share - Coping with hot flashes
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"One thing about hot flashes. Mine also instigate
feelings of unaccountable anxiety, so I started
taking 250 mg of chelated magnesium with a multi
vitamin and it has made a dramatic difference. I
can tell when I forget to take it now, it works
that well for me. Hasn't stopped actual flashes
but has helped diminish intensity and frequency
along with removing related anxiety." - anonymous
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Merry Christmas from Mom"
Dear Darling Son and That Person You Married,
Merry Christmas to you, and please don't worry.
I'm just fine considering I can't breathe or eat.
The important thing is that you have a nice
holiday, thousands of miles away from your ailing
mother. I've sent along my last ten dollars in
this card, which I hope you'll spend on my
grandchildren. Lord knows their mother never buys
them anything nice. They look so thin in their
pictures, poor babies.
Thank you so much for the birthday flowers, dear
boy. I put them in the freezer so they'll stay
fresh for my grave. Which reminds me -- we buried
Grandma last week. I know she died years ago, but
I got to yearning for a good funeral so Aunt Berta
and I dug her up and had the services all over
again. I would have invited you, but I know that
woman you live with would have never let you come.
I bet she's never even watched that videotape of
my hemorrhoid surgery, has she?
Well son, it's time for me to crawl off to bed
now. I lost my cane beating off muggers last week,
but don't you worry about me. I'm also getting
used to the cold since they turned my heat off and
am grateful because the frost on my bed numbs the
constant pain.
Now don't you even think about sending any more
money, because I know you need it for those
expensive family vacations you take every year.
Give my love to my darling grand babies and my
regards to whatever-her-name-is --the one with the
black roots in her hair who stole you screaming
from my bosom.
Merry Christmas,.
Love, Mom
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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 ***********
January 9, 2005
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Interstitial Cystitis
2. Selecting an antidepressant
3. Reader submitted Q&A - HDL cholesterol
4. Treating warts yourself
5. Health tip to share - dry skin
6. Humor is healthy
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1. Interstitial Cystitis
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Interstitial cystitis (IC) is a vaguely defined
medical condition of the bladder. It is a term
given to a chronic, relapsing syndrome of bladder
pain associated with a frequent urge to urinate
both during the day and also during the night.
Night time urination frequency (nocturia) of 4 or
more times an evening is very often associated
with IC assuming there is not an active, bacterial
urinary infection. IC remains a diagnosis of
exclusion of other conditions such as recurrent
urinary tract infections, bladder stones or other
anatomical abnormalities of the bladder such as
polyps or cancer.
The incidence of IC is less than 1 in a 1000
adults, mostly affecting women and can be
difficult to recognize when it occurs. On the
average, symptoms of urinary frequency and urgency
and lower abdominal pain over the bladder are
present for about 3 years before a diagnosis is
made. Although IC can affect any age, the average
age of onset of symptoms in women is about 45
years old.
Aside from having to go to the bathroom all of the
time, pain is the symptom that can be the most
disabling. It is variable from just happening
occasionally to constant. While most of the pain
is over the bladder area in the lower abdomen, it
can also be in the urethral area, the low back,
the loin area or even the groin area. As many as
60% of patients with IC also have irritable bowel
syndrome and many have food or drug allergies or
sensitivities. Arthritis is also common.
Different treatments have been used for IC and
some are partially successful. And yet a recent
survey in the UK (below) indicates that most
people with IC have not been tried on many of the
therapies known to lessen symptoms. Treatments
used include:
cimetadine (Tagamet)
antihistamines (hydroxyzine, Vistaril(R), Atarax(R))
pentosan polysulphate (Elmiron(R))
DMSO (dimethyl sulfoxide) instilled into the bladder
anticonvulsants (gabapentin, Neurontin (R))
For symptoms of chronic urinary frequency,
urination 4 or more times at night and bladder
pain, be sure to see a urologist or
urogynecologist to be evaluated for possible
interstitial cystitis.
Interstitial Cystitis
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Selecting an antidepressant
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
It used to be that psychotherapy by psychologists
or psychiatrists was the recommended treatment for
moderate or severe depression. Health care
financing policies in the last decade have pushed
doctors to almost exclusively use antidepressant
medications with very little professional
counselling. As a result, many patients are placed
on medical therapy for their depression even
though doctors would like to see them undergoing
cognitive-behavioral therapy also. People with
depression are often left to fend for themselves
with overcoming depressive feelings as well as
coping with the side effects of various
antidepressant medications used.
There are many different mechanisms of action of
the drugs currently used by doctors as
antidepressants. For a fairly complete list, see
the article below at MayoClinic.com. Each of the
different types of antidepressant drugs manifest
different therapeutic as well as side effect
profiles.
Side effects of antidepressants are most
pronounced within the first few days of starting a
new medicine. Usually your body adjusts quickly
but if after about two weeks of taking a new
antidepressant you still have some of the
following symptoms, you should talk to your
doctor about switching to a different med.
All antidepressants may cause minor or major side
effects. Most side effects are mild and temporary
and disappear within a few days or a week or so.
In general, the most common are:
nausea
decreased sexual desire or arousal
constipation
bladder problems
dizziness
drowsiness
dry mouth
changes in sleep patterns
restlessness
Many of the drugs also have a warning about the
increase in thoughts of suicide in children and
adolescents who use them. Certain classes of drugs
will cause different side effects, for example.
SSRIs have more sexual dysfunction side effects
than do norepinephrine reuptake inhibitors;
tricyclics seem to produce more dry mouth and
constipation side effects. Some alpha2 receptor
blockers are worse for drowsiness, lightheadedness
and dizziness while others (monoamine oxidase
inhibitors) may cause low blood pressure or cross
react with other antidepressants.
Most people only have to take an antidepressant
for 6-12 months at the most. If you find you are
having problematic symptoms on an antidepressant
or have been on one for a year or more, talk to
your doctor about making a switch in treatment.
Selecting an antidepressant
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - HDL Cholesterol
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"My HDL level of good cholesterol is 72. Is it
good for me? I am a 75 year old woman With total
cholesterol level 295, triglycerides 199 and LDL
194. I can not tolerate statins medication"- E.F.
In women, a good HDL level above 35 mg/dl (or 45
mg/dl if you have a family history of heart
disease), trumps a high total cholesterol level or
a high LDL (bad cholesterol level. Women who have
a good cholesterol level (HDL) generally have a
lower incidence of atherosclerosis. If you already
have heart disease or atherosclerosis, doctors
would be pleased to see your HDL level above 55
mg/dl as a therapeutic goal of any diet or medical
therapy. Your level of 72 is excellent and
probably represents good genes. I would be very
pleased if my HDL level were as good as yours and
I would not take any statin drugs.
Even small increases in HDL cholesterol are
associated with a reduced frequency of heart
attacks. For each 1 mg/dl increase in HDL
cholesterol there is a 2 to 4% reduction in the
risk of coronary heart disease. This does not
absolutely mean you will not get a heart attack or
stroke in the near future, but the odds are quite
favorable that you won't especially if you are
also a nonsmoker and do not have diabetes.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Treating warts yourself
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Most warts of the hands or feet take care of
themselves within a year or two. Your immune
system isolates the virus (a human papilloma
virus) and they go away by themselves. However
warts can be unsightly and uncomfortable for that
amount of time so treatment to get rid of them is
important to know. Many times you can self treat
warts rather than going to a dermatologist or
general practitioner.
The most common self treatment of warts is the use
of salicylic acid. This can be purchased without a
prescription at a pharmacy as a liquid, a patch,
or a gel. Usually you try to first file away dead
wart skin so the salicylic acid can get to the
center and base of the wart. You can use a nail
file, an emery board or a pumice stone for this.
Then you need to soak the wart for about 10 to 15
minutes with water so that the dry skin is
softened to absorb the salicylic acid. Apply the
salicylic acid and repeat this once or twice a day
for about 3 months.
Another home use technique that has been described
as successful is to "cut a piece of duct tape to
match the size of the wart and wear the duct tape
on the wart for six days. Then, remove the duct
tape patch and soak and file the wart. Leave it
uncovered for the night and reapply a duct tape
patch the next morning. Repeat this process for
two months or until the wart is gone."
If these choices make you too squeamish or are too
much bother, you can always go to a physician who
can freeze the wart using liquid nitrogen or
cauterize it using a needle. Then they scrape the
dead skin away just like you would at home. It may
take only 3 or 4 treatments to get rid of the wart
this way.
Treating warts
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Health tip to share - Dry skin
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Moisturizing lotions, creams and gels for dry skin
generally contain lanolin, but the most effective
ingredients are urea (most effective) and
glycerine. Urea containing creams ranging from 4%-
30% are the most effective for decreasing water
loss from the skin. At the 20-30% urea level, hard
calloused skin of the feet can be softened.
Propylene glycol is very drying and should be
avoided in skin preparations for dryness. - FRJ
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Hey Doll . . ."
What's in a name? Apparently, a lot more than you
(or I) ever thought there was. Here's what his pet
name for you *really* means.....
Darling -- Depends on how he says it. If he
stresses the first syllable, then he's probably
done something wrong or wants money.
Dear -- Probably a leftover from his parents.
Expect him to wear woolly cardigans, smoke a pipe
and prefer a mug of Ovaltine to lager.
Sweetheart -- If it's said patronizingly, it's not
so sweet. But when uttered in earnest, it may send
your own sweet heart aflutter.
Babe -- Not to be confused with the film of the
same name. Check for flares or signs that he's a
70s throwback. He's a bit of a medallion man.
Chances are he's got his initials on his chunky
ring. Leave immediately if he tries to sell you a
second-hand car.
Baby doll -- This type of man will probably
require you to wear transparent frilly nighties
even in the dead of winter. He doesn't want you to
grow up, and obviously can't deal with real women.
Princess -- Never trust a man who calls you
princess. You may think you're being treated like
royalty, but beware of Prince Charmings - they may
be secretly plotting your over- throw.
Sexy -- Fine if you're sexy. If you're not, who
cares? He probably thinks you are anyway!!
My girlfriend -- He's honest, open and probably
glad to have you around. The next thing you know
he'll be using your name!
The wife -- If you're married then he probably
thinks he owns you. If you're not, he probably
thinks you act like his wife, in which case, he
thinks he owns you.
My other half -- You complete the set - he's only
half a man without you. But it may make you feel
as though you are losing your identity somewhere.
The missus -- See The Wife.
My partner -- He's right on. Probably likes eating
tofu and hugging trees.
My significant other -- He's even more right on.
Probably thinks it's cruel to eat tofu and that
trees need their own space.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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 ***********
January 23, 2005
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Dry nose
2. How much water/fluid a day is enough?
3. Reader submitted Q&A - Fosamax and blood pressure
4. Folic acid and lower hypertension risk
5. Health tip to share - Shedding pounds
6. Humor is healthy
The next newsletter will be in two weeks.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Dry nose
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Dry nasal passages are common in cold climates
during the winter. Inside heat often reduces the
humidity in the air to very low levels causing
this abnormal dryness. The dried, inside-nose skin
not only becomes dysfunctional for filtering
particles in the iar you breathe but it can also
lead to nose bleeds as the skin loses its natural,
protective secretions. People who have allergies
and sinusitis even have a worse time of it in the
winter months. Individuals who use nasal CPAP
(controlled positive airway pressure) for sleep
apnea have problems with dry nasal passages all
year round.
You might want to know what is safe to put in the
nasal passages to restore moistness, prevent
nosebleeds and just give an overall modicum of
relief during the dry winter months. Some people
have recommended putting Vaseline(R) (petrolatum
jelly) in the nose but while generally safe, it
can produce a lipoid (fat) pneumonia if the
petrolatum is inhaled into the lungs too often.
This is also true if you use mineral oil.
If the dryness is not too severe, use of a
isotonic saline (salt) spray without any medicines
in it is the fastest way to moisten the nasal
passages and even wash out secretions that have
caked to the nose hairs inside. Isotonic means it
is the same salt concentration as is normal in all
of your body's liquids (about 0.9%). Nasal
isotonic saline sprays are available without
prescription at any pharmacy and most food stores.
It can be used as often as you want since no drugs
are involved.
A water-soluble nasal gel (e.g., Entsol(R) Nasal
Gel) or even just a general water soluble gel such
as K-Y Jelly (R) can also be used to moisturize
the nasal passages without any risk of a lipoid
pneumonia. Just use your finger to place a small
amount in each nostril especially before going to
bed and then upon rising or early in the day.
If your nasal dryness is compounded by swelling in
the nasal passages, allergies and even colds, you
can use a hypertonic (about 3%) saline nasal wash
(e.g. Entsol Buffered Hypertonic Nasal Spray)
which will draw fluid out of the swollen skin and
make breathing easier.
Dry nose
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. How much water/fluid a day is enough?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
In the doctor's office, it is not uncommon to see
women who are drinking excessive amounts of water
each day. They have been told by friends and media
that water is healthy and dehydration is bad for
you (which it is). Unfortunately excessive fluid
intake causes you to have to urinate more often.
If a person has any bladder problems such as
urgency, overactive bladder or urinary
incontinence, then those problems are compounded
by the excessive water intake.
How can you tell if you are getting enough fluids?
Basically you need to look at the color of the
urine. If it is totally clear like water, you are
taking in too much fluid. If the urine is
light/pale yellow you are probably at the correct
amount. If the urine is a deep yellow, then you
are somewhat dehydrated and should increase fluid
intake.
The amount of fluid your body needs each day
varies with your physical activity, the
temperature, the humidity and even the altitude at
which you live. You need more water when you
exercise, when its hot, when it is dry and if you
live at higher altitudes. There are some rules-of-
thumb about drinking fluids. The old adage of
eight 8 oz glasses a day (about 2 liters) when
added to a normal amount of water in the daily
food you consume, is about right if your activity,
temperature etc., are normal.
Keep in mind that many glasses, cans or bottles
which your liquid comes in are more than 8 ounces.
Twelve and 16 oz (500ml) containers may be the
rule rather than the exception. You do not
generally need eight 12 oz bottles or even six 16
oz bottles of liquid a day. Sipping all afternoon
on a 32 oz Big Iced Tea will make anyone have to
run to the bathroom quite a bit.
If you are not sure you a taking in enough liquid
or you think you may be drinking too much, just
look at the color of your urine.
How much water/fluid a day is enough?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Fosamax and blood pressure
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Is there any evidence that long term use of
Fosamax may cause higher blood pressure levels and
may cause a higher risk for heart disease or
stroke?
I am age 66, high blood pressure under control
with diuretics (goes out of control after
ingestion of Fosamax)" - RE
Fosamax(R) (alendronate) is used to lay down extra
calcium in bone in people who have bone thinning
(osteoporosis). It can be taken as a daily dose or
even a long acting weekly dose. Fosamax(R) can
irritate the esophagus to cause heartburn in
people who lie down flat right after taking the
medicine. It can cause a decrease in blood calcium
levels. Most of its side effects are confined to
the gastro intestinal system with things like
heartburn, nausea, abdominal pain etc. I have not
heard of any problem with raising blood pressure
and I could not find an incidence of that when
scanning the medical literature.
This does not mean that in you it is not causing
elevated blood pressure; everyone reacts
individually to a medicine and I am sure something
about the Fosamax may not be agreeing with your
body's blood pressure control. It is a sodium salt
but the sodium level is so small that I would not
think the sodium (salt) in it is the culprit.
It would be important to know what you mean by the
blood pressure "going out of control". The
diastolic blood pressure rising to between 100 and
110 for a hour or so would not be too worrisome.
Diastolic rising above 110 or a systolic blood
pressure in you (age 66) rising above 200 for
anything more than 5 or 10 minutes would indicate
maybe you should consider trying another
osteoporosis medicine to see if it produces less
of a problem.
Also I am not aware of a long term effect of
Fosamax on blood pressure and strokes. Obviously
in you if it is raising your blood pressure for
any length of time after taking it then it could
produce long term, increased risk. Be sure to talk
to your doctor about that. I am assuming you are
not a smoker which can cause both osteoporosis and
cardiovascular and stroke risk. If you are, stop
the cigarettes right away; it produces the
greatest cardiovascular and stroke risk.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Folic acid and lower hypertension risk
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Folic acid (vitamin B9) is a building block of
many of the body's cells. It plays an important
role in the cells that line blood vessels.
Investigators recently looked at the large Nurse's
Health Study of over 150,000 women during the
1990's in which dietary histories were taken and
updated periodically.
They found that young women who had a dietary plus
supplemental folic acid intake of 1000 micrograms
per day (one milligram) had a only a 50% new
incidence of hypertension compared with women
taking only the recommended daily allowance level
of 200 micrograms a day. Women aged 43 and older
also had a reduction (about 20%) in hypertension
when ingesting a gram of folic acid a day.
Sources of folic acid include:
leafy greens such as spinach and turnip greens
broccoli
asparagus
mushrooms
liver
dry beans and peas
fortified cereals and grain products
fortified juices
It is interesting that we recommend only about 200
micrograms a day of folic acid for men and non
pregnant women. Pregnant women should have 400
micrograms a day to prevent certain spinal cord
and brain defects in babies. It seems that this
new hypertension data should be added to what we
know to raise the recommended daily intake of
folic acid.
Too little folic acid can cause diarrhea, anemia,
loss of appetite, weight loss, sore tongue and a
variety of other symptoms.
Folic acid and lower hypertension risk
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Health tip to share - Shedding pounds
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"As we head into the New Year, shedding pounds and
starting an exercise regime is on everyone's mind!
Women balk that they don't have enough time to
exercise but here are some suggestions that work
for me and my co-workers to add at least 20-30
minutes of cardio into your busy work day! It's
easy to break up your workout into 10 minutes
increments!
If you sit all day at work, take a break and walk
around the building or walk around a different
floor for at least 10 minutes.
If you are planning to go out to lunch with
coworkers, weather permitting (or carry an
umbrella!), pick a restaurant close by and walk to
and from the restaurant.
Instead of taking that 3 pm coffee or snack break,
invite a coworker or two to take a 10 minute walk
with you. If you want a more difficult workout,
climb stairs for 10 minutes.
Also, another trick if you work in a building that
has stairs and an elevator, opt to take the stairs
instead of the elevator.
It's easy to break up your day with "small"
workouts...so no complaints that you don't have
enough time! Just think "small" and you'll be able
to get in at least 20-30 minutes of cardio in your
busy work day!!" - Therese
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Shopping"
A man observed a woman in the grocery store with a
three year old girl in her basket. As they passed
the cookie section, the child asked for cookies
and her mother told her "no." The little girl
immediately began to whine and fuss, and the
mother said quietly, "Now Ellen, we just have half
of the aisles left to go through; don't be upset.
It won't be long."
He passed the Mother again in the candy aisle.
Of course, the little girl began to shout for candy.
When she was told she couldn't have any, she
began to cry. The mother said, "There, there, Ellen,
don't cry. Only two more aisles to go, and then we'll
be checking out."
The man again happened to be behind the pair at
the check-out, where the little girl immediately began
to clamor for gum and burst into a terrible tantrum
upon discovering there would be no gum purchased
today.
The mother patiently said, "Ellen, we'll be through this
check out stand in five minutes, and then you can go
home and have a nice nap."
The man followed them out to the parking lot and
stopped the woman to compliment her. "I couldn't
help noticing how patient you were with little Ellen..."
The mother broke in, "My little girl's name is Tammy...
I'm Ellen."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
********** Health Newsletter ***********
February 6, 2005
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Chronic pain without physical cause
2. Excess weight and birth control efficacy
3. Reader submitted Q&A - Weight loss programs
4. Depo-Provera and bone density thinning
5. Health tip to share - Foot pain and aspartame
6. Humor is healthy
The next newsletter will be in two weeks.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Chronic pain without physical cause
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
There are many pain syndromes for which the exact
cause is unknown or for which treatment is not
good at relieving the pain. After a while it does
not matter what label your pain-causing disease
has; just the existence of chronic pain makes it
its own disease regardless of whether your doctor
calls it fibromyalgia, chronic fatigue syndrome,
irritable bowel syndrome, interstitial cystitis or
vulvodynia.
Chronic pain takes over your life and makes you
focus on it day in and day out. Your pain
threshold can lower, making you more sensitive to
even small amounts of pain. Your mind is connected
with the nerves producing the pain and any stress
can magnify the pain intensity. Depression, as it
develops, may actually be a pain coping behavior.
Once a chronic pain cycle sets in place, the
treatment regimen is different than that commonly
used for the original disease. The treatment may
include pain medicines but more likely it includes
central nervous system medications which alter
your brain's perception of the pain.
Antidepressant meds such as amitriptyline
(Amitril, Elavil) and nortriptyline (Aventyl,
Pamelor) can bolster the chemical processes in
your spinal cord and brain that normally suppress
pain. If your doctor prescribes these, it is with
the realization that your chronic pain situation
needs a multimodal approach to changing how your
brain processes pain signal inputs from the
peripheral nerves.
Physical activity such as increased aerobic
exercise also plays an important role. It not only
distracts your brain from processing (or obsessing
about) pain signals but it also produces
endorphins, your body's natural pain killers. It
is not a quick fix for the doctor to recommend
increased exercise instead of a pill but it is an
effective strategy that you should listen to if
you want to be able to cope better with the
chronic pain.
Chronic pain without physical cause
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Excess weight and birth control efficacy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Sometimes the dose in milligrams for a medicine is
calculated by how much a person weighs. For other
medicines it is presumably a one-dose-fits-all.
This may work for conditions in which the benefit
of the medicine is not an all or none success
rate. A medicine like birth control pills,
however, has a definite end point, prevention of
pregnancy, so it may be more important to increase
the dose as weight increases.
Over several decades, the original high dose of
estrogen in birth control pills has been
periodically lowered. Originally the most commonly
prescribed pills had over 100 micrograms of
estrogen in them. Now estrogen doses in oral
contraceptives range from a low of 20 micrograms
to a high of about 35 micrograms. This has been
beneficial in reducing side effects and
complications but there is evidence that women who
weigh more than 200 lbs may have a higher
pregnancy rate on these lower doses of oral
contraceptives.
A recent study indicated that 5 percent of
overweight women taking the pill became pregnant
each year versus 3 percent of normal weight women.
While even 3% is a high pregnancy rate, most other
studies show that is what actually happens in a
large study group, i.e., not everyone takes their
pills as regularly as they should and some get
pregnant. Among consistent birth control pill
users in this study, the risk of pregnancy was 70
percent higher in women weighing more than 165
pounds and nearly double in women weighing more
than 190 pounds. Currently only the birth control
patch, Ortho Evra(R), has warnings about an
increased pregnancy rate for women who are
overweight.
Keep in mind that there is no evidence yet that if
an overweight woman increases the dose of a birth
control pill can she reduce her pregnancy rate to
that of normal weight women. Increasing the dose
may just promote more complications rather than
protecting better against pregnancy. On the other
hand, it probably does not make sense for an
overweight woman to be on the lowest (20
micrograms) oral contraceptive. Any woman over 200
lbs should probably take a 30 or 35 microgram of
estrogen pill.
Rather than changing doses of pills, it may be
more beneficial for overweight women to make a
double effort not to start pills late or miss
pills. The most susceptible time to become
pregnant is to start a cycle late after being off
of the active pills for more than 7 days. This is
much more likely to result in pregnancy than by
missing a pill or two in the middle of taking the
active pills.
Excess weight and birth control efficacy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Weight loss programs
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I want to enroll in a weight loss program. Which
one do you suggest? I have 25-30 pounds to lose
from now to August 1st. I'm 50 years old and it
is getting harder for me to lose weight. I'm
doing great health wise but somewhat depressed
about my weight. My height is 5-2' and my weight
is 180." A.H.
Which weight loss program? That's a great
question. There certainly are so many to choose
from: Atkin's, South Beach, Sugarbuster's, Weight
watcher's, Jenny Craig, etc. Are any of those
programs better than any other? It really depends
somewhat on what you can tolerate. Some people
cannot stomach high protein and high fat diets
while others love it.
There have been several principles established
about weight loss programs by well controlled
randomized medical trials:
1. Low carbohydrate diets result in quicker weight
loss but not a greater amount of weight loss over
a year's time.
2. Diets in which there is some sort of calorie
counting or points that represent energy
consumption are much more successful than any
program that seems to allow you unlimited amounts
of any food category.
3. Regular daily exercise (but not excessive
workouts) together with dieting results in more
weight loss than just dieting alone.
You would think that more principles than the
above have been discovered about dieting but these
are the only major ones I am familiar with. There
are no herbs or prescription pills that help over
the long run.
Based upon the above, I would recommend trying
Weight Watcher's which can be done over the
internet if you like rather than having to attend
weekly meetings in your local area. For your
points for each meal that you are allowed, if you
wish to use them in more protein and fat and only
little carbohydrate, that is up to you. It may get
you started with weight loss more quickly than
not. You can record your point count that you eat
each day online. This program works if you stick
to it. For any program, do not set your goals any
higher than about 2 pounds (one kg) a week except
for that initial week when you may lose more in
water weight.
You should be able to lose your 30 pounds in 4
months. That would allow you to reach your goal by
August even with a week or two of slipping here or
there. Maintenance is actually the more difficult
task; even more difficult than losing weight in
the first place.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Depo-Provera and bone density thinning
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Depo-Provera is contraceptive by shot that many
women choose to use to prevent pregnancy. It is
very effective in blocking ovulation from the
ovary but as a result, it also blocks most of the
estrogen production of the ovary also. Birth
control pills have estrogen in them but the Depo-
Provera shot does not.
The lower estrogen levels have been associated
with bone thinning, osteoporosis, in women using
this contraceptive. In fact in the study below,
women lost about 5% of their total body bone
mineral density in two years when just taking
Depo-Provera shots every 3 months as it is usually
prescribed to most women. I do not think that
doctor's have realized that the bone loss is this
great with Depo-Provera. This rate is higher than
it is at menopause even.
The concept of adding some estrogen to take
together with the Depo-Provera in order to prevent
bone loss is not new, however we have not had good
scientific studies showing whether it is effective
or not. In this recent study from Case Western
Reserve University in Cleveland, OH, investigators
gave women who were using DepoProvera, a monthly
injection of estrogen (estradiol cypionate). The
other half of the group using DepoProvera did not
get any estrogen injections. At the end of two
years, the group receiving estrogen injections
increased their total body bone density by 4.7%
while the group using DepoProvera alone lost 5.1%.
This is a significant change and indicates that
women using DepoProvera for contraception should
receive some type of supplemental estrogen.
If you are using DepoProvera for contraception,
ask your doctor about using some estrogen
supplementation.
Depo-Provera and bone density thinning
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Health tip to share - Foot pain and aspartame
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"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 x-rayed them
and told me I had arthritis on my big toes.
Doctor prescribed me Ultram(R) and it did help
quite a bit. I decided one day I was not going to
use aspartame, the artificial sweetener, 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 has done
this and got same results." - DCH
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Over The Hill?"
Women are the easiest to tell when they hit 40.
You just count the rings under their eyes.
For men, you're middle aged if your crowd
considers you sexy just because you still have
hair.
Men and women know they've reached middle age when
they notice kids are getting noisier and the
latest music is getting worse.
Anybody who can remember when "boobs" meant "the
dumb kids" surely qualifies for middle age.
Ain't it hell though to reach your "September
Years" and discover that you blew the best of July
and August.
And ain't it funny how when you're 50, suddenly 60
doesn't sound all that old anymore.
I'd love to know what part of the body whoever
said "Life begins at forty" was referring to --
seems to me that every damn thing else is starting
to wear out then.
Middle age is usually reckoned at between 40 - 60.
It's easy to tell when you hit there though,
regardless of age, by the way it hits you back.
You younger people out there -- wait until the
first time your kids or Grandkids reveal that they
are studying in "history class" events you lived
through.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
********** Health Newsletter ***********
February 20, 2005
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Screening for abdominal aortic aneurysm
2. Zinc deficiencies
3. Reader submitted Q&A - Menstrual cramps and OCPs
4. Home firearm injuries related to gun/ammo storage
5. Health tip to share - Aloe Vera for dry skin
6. Humor is healthy
The next newsletter will be in two weeks.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Screening for abdominal aortic aneurysm
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The very large artery leading from the heart down
to your legs is the abdominal aorta. Rarely,
especially as one ages, the aorta can have a
hernia of the arterial wall that creates an
aneurysm, a ballooning out. That ballooning out is
a weak point that can rupture spontaneously with
almost certain sudden death. You may have heard
that the presence of an aneurysm can be easily
diagnosed by ultrasound, a painless, non invasive
imaging study. A current medical question being
posed is whether individuals over the age of 50
should have screening ultrasounds to see if they
have abdominal aortic aneurysms.
The problem is that aneurysms are a rare
occurence. The incidence is perhaps 2/10000
individuals. You can see that you would have to do
quite a few ultrasounds (about 5000) to pick up
one case of an abdominal aortic aneurysm. If you
could identify people who are at higher risk for
an aneurysm then it might be worth screening.
A recent U.S. Preventive Services Task Force
committee looked at all of the available medical
evidence for screening for abdominal aortic
aneurysms by ultrasound. They found that men over
the age of 65 would benefit from a one time
ultrasound. Women have such a low incidence of
aneurysms that screening them with ultrasound
would not at all be cost effective. Also, it
appears that with new Medicare rules, a one time
screening for both men and women has been
authorized to be paid for by Medicare.
Screening for abdominal aortic aneurysm
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Zinc deficiencies
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Everyone needs zinc, but young children, teen
girls and older adults are especially vulnerable
to mild zinc deficiency. Vegetarians who limit
zinc-rich foods, like meat, poultry, fish and
seafood, may need up to 50% more zinc. Zinc
deficiency is one of the biggest contributors to
disease in developing countries because of low
protein intake. It can cause stunting of growth
and an increased death rate due to infection.
The World Health Organization (WHO) has looked at
the feasibility of giving zinc supplements to
individuals in developing countries because it can
reduce infant morbidities as well as prevent
complications for diarrheal disease. But zinc
deficiencies tend to run along with iron
deficiency as well as deficiencies in vitamins
such as A and C. Therefore it probably is a better
strategy not to take just a separate supplement of
zinc alone, but rather to include zinc along with
other micronutrient supplements.
Most non-vegetarians in developed countries do not
need to take zinc supplements unless they are
anemic or have depressed immune systems. Others
should benefit from taking just a general mineral
supplement that comes in many of the multivitamins
available today.
There are home tests available (e.g. Mineral
Check) for determining if one is low nutritionally
in any of the standard minerals.
Zinc deficiencies
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Menstrual cramps and OCPs
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Which birth control pill is better in helping
with menstrual cramps? I am 20 yrs old, very
painful cramps which sometimes cause vomiting.
Currently on Ortho Tri-cyclen Lo®. Helps some." -
smf
Menstrual cramps are smooth muscle contractions of
the uterus of fairly high amplitude. They start
when tissue lining the uterus (endometrium) is
being sloughed at the time of the menses. The
purpose of the cramps is to expel that tissue and
blood from the uterus. If the amount of tissue is
great, or the uterine muscle (myometrium) is
hypersensitive to the substances (prostaglandins)
in the sloughing tissue that cause contractions,
then cramps become very painful.
Progesterone and its synthetic look-a likes called
progestins which are used in birth control pills,
work by two methods to reduce cramps. The more
potent the progestin in a pill, the less
endometrial tissue is produced each month and the
less sensitive to contractions the uterine muscle
becomes. Therefore you want a birth control pill
that has a relatively high progestin potency. You
may also benefit from taking an anti-prostaglandin
medication such as ibuprofen while on your menses.
Higher progestin potency pills would include:
Yasmin®, Desogen®, Ortho-Cept®, Mircette®,
Loestrin® 1.5/30, Demulen® 1/35, Zovia® 1/35E,
Demulen® 1/50, Zovia® 1/50E. You can see a list of
the different potency pills at:
/ncontr13.htm
Another alternative is to use a pill such as
Seasonale® which is not so high potency progestin
but it blocks menses for 3 months at a time
because you take the active pills continuously for
3 months before taking any placebo pills which
allow your menses to come on.
Women who have had pregnancies tend to have less
severe menstrual cramps but if they do have severe
cramps, a progesterone intrauterine contraceptive
device (Mirena® IUCD) often works very well to
reduce the severity of those cramps.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Home firearm injuries related to gun/ammo storage
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
People in households that have guns in them have
much higher chance of having a firearm injury than
people living in households without firearms.
However, many people have guns in their homes and
may have them just for the feeling of safety or
for hunting or practicing shooting skills.
Injuries in the home occur from accidents,
suicides and domestic disputes.
Recently, medical investigators at the University
of Washington in Seattle looked at the risk of
youth suicide and unintentional firearm injuries
and how it varied according to how guns and
ammunition were stored in the home. They looked at
whether the guns were locked up, whether the
ammunition was locked up either together with the
guns or separate from the guns. Specific outcomes
were:
(1) whether the subject firearm was stored in a
locked location or with an extrinsic lock;
(2) whether the firearm was stored unloaded;
(3) whether the firearm was stored both unloaded
in a locked location;
(4) whether the ammunition for the firearm was
stored separately; and
(5) whether the ammunition was stored in a locked
location.
They then corollated children and teens under age
20 that had been admitted for firearm injuries
with a control group of children/teens whose
household had at least 1 firearm and children
living or visiting in the home. They found that
"the 4 practices of keeping a gun locked,
unloaded, storing ammunition locked, and in a
separate location are each associated with a
protective effect and suggest a feasible strategy
to reduce these types of injuries in homes with
children and teenagers where guns are stored."
If you keep guns and ammunition in your home and
have children under the age of 20, you will
definitely want to review this article.
Home firearm injuries
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Health tip to share - Aloe Vera for dry skin
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Most people know that the leaves from the aloe
Vera plant work wonders for burns but I recently
discovered that the gel from the aloe Vera plant
works well for dry skin. I am going through early
stages of menopause and my skin is very dry. I
apply aloe Vera on my skin before going to bed as
a night moisturizer and it works wonders!!!" - CW
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"The Birthday Wish"
A man asked his wife what she'd like for her
birthday.
"I'd love to be six again,"she replied.
On the morning of her birthday, he arose early,
got up, made her a nice Big bowl of Lucky Charms
and then took her off to the local theme park.
What a day! He put her on every ride in the park:
the Death Slide, the Wall of Fear, the Screaming
Monster Roller Coaster, everything there was. Five
hours later she staggered out of the theme park.
Her head was reeling and her stomach felt upside
down.
Right away, they journeyed to a McDonald's where
her loving husband ordered her a Happy Meal with
extra fries and a refreshing chocolate shake. Then
it was off to a movie to see the latest
blockbuster, a hot-dog, popcorn, a soda pop, and
her favorite candy, M&Ms. What a fabulous
adventure!
Finally she wobbled home with her husband and
collapsed into bed exhausted. He leaned over his
precious wife with a big smile and lovingly asked,
"Well, dear, what was it like being six again?"
Her eyes slowly opened and her expression suddenly
changed. "You idiot, I meant my dress size!"
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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