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****** Woman's Diagnostic Cyber Newsletter *******
March 10, 2002
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Do something about your fatigue
2. Skin boils - the different types
3. Reader submitted Q&A - Urine odors
4. Chance of developing hypertension in your lifetime
5. Cysts in the liver found on ultrasound
6. Health tip to share - Food cutting boards
7. Humor is healthy
If you change your email address, don't forget to
re subscribe using the new address.
Spread the word! Send a copy of this newsletter
to someone you know.
The next newsletter will be in two weeks.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Do something about your fatigue
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Complaints of being tired all of the time or
having a lack of energy are heard commonly by
physicians. In fact I can assure you that
physicians are frustrated by the lack of an easy
fix for this problem. The causes are often
multiple and almost always the treatment requires
a major lifestyle change on the part of the person
who is so tired. Lifestyle changes such as weight
loss, stress reduction and good fitness and sleep
habits are not something the physician has any
control over. They can only recommend and it is up
to the patient to figure out what changes work
best for them.
There are some medical conditions associated with
fatigue that recurs day in and day out. Anemia
(low red blood cell count), hypothyroidism, and
active infections such as hepatitis, Epstein-Barr
virus and others can be a cause. Cancer and other
chronic medical conditions such as chronic
fatigue syndrome can also be a cause as well as
medication side effects. Usually a blood
chemistry, a complete blood count, a thyroid test
(TSH) and a good physical exam can rule out most
of these causes. Unfortunately only about 1 out of
20 patients complaining of continuous fatigue will
have non-lifestyle, medical problems causing it.
Another one or two have fatigue as a side effect
from medicine(s) they are taking. Anti-
depressants and anti-hypertensives are notorious
for this.
The other 17 out of 20 people have too much
stress, too much weight, too little sleep or are
too far out of good physical shape. When a doctor
communicates that one or more of these problems
may be playing a role as a cause of fatigue, I
would guess that almost a third of women will be
skeptical and just assume the doctor did not
really try very hard to find the cause. Perhaps
another third will take the doctor seriously and
try to make the difficult changes needed to
restore their daily energy. The other third of
women realize how life style contributes to the
problem but either feel helpless to change it or
they try change and become discouraged very early
on.
The doctor's dilemma is the lack of an easy
treatment for stress reduction, weight loss or
sleep disorders. Most physicians never learned how
to instruct and monitor patients for those
problems when they went through medical training.
They only learned to prescribe medicines which may
reduce the symptoms but never really address the
long term solution. On your part, you will
probably not be able to rely on much physician
help if trying to reduce stress, lose weight or
improve sleep. You will need to be your own
detective to learn how to tackle these problems
and get your living habits back on track so you
will feel better on a daily basis.
Do something about your fatigue
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Skin boils - the different types
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Any infection deep in the skin elicits the body's
response to wall off the infected area. This
causes redness, soreness and swelling around the
infection and as pressure from dead material
builds up in the infected compartment, it seeks to
break out to relieve the pressure. The path of
least resistance is to go to the surface of the
skin where it forms a "whitehead" and subsequently
breaks through the skin and drains. Many call this
a skin boil.
Actually there can be different types of deep skin
infections like this. They might be started by
ingrown hairs, a foreign body or just plugged up
skin ducts. When there is only one or a couple of
areas infected, they are usually referred to as
furuncles or carbuncles. This skin abscess is
almost always caused by the Staph. Aureus
bacteria. Once drainage of the pus takes place,
the body can heal the area on its own even without
antibiotics.
Another type of skin boil is one that uniquely
occurs in the skin near the base of your spinal
cord in back. It is called a pilonidal cyst and it
often starts at the top of the crease in the
buttock after sitting for long periods of time.
This boil tends to keep recurring periodically
because its origin is in a deep skin cave-like
crevice that may be present from birth and has a
narrow opening which can easily be plugged off if
the skin around it swells at all. Sometimes a
pilonidal cyst has to be surgically drained
because the skin lining has very small spider-like
projections into deeper skin and those areas can
continually be "plugged off" causing frequently
recurrent abscesses.
Skin abscesses unique to the armpit (axilla) areas
or the groin and perineal areas are often due to a
process called hidradenitis suppurativa. This is a
chronic recurrent infection of sweat glands in
those areas. Because sweat glands are so
extensively present in skin, it is almost
impossible to cure the recurrences by just
surgical drainage or excision.
Finally, the most common type of recurrent skin
boils are due to cystic acne. This occurs mostly
on the face, neck and back. Acne is also an
infection of the sweat glands and hair follicles.
The duct of the gland or hair follicle becomes
plugged up with dead skin cell material and if any
skin bacteria are trapped behind the plugged duct,
they grow into an abscess that needs to drain
through the skin. If acne or any boil is squeezed
so that the infected material breaks through the
cavity deeper into the skin, extensive further
abscess formation can take place with a much wider
area of skin involvement and eventual scarring.
The main treatment of any boil is heat to soften
the skin over the boil and promote drainage
through the skin surface and not deeper into skin
structures. Antibiotics are often not needed at
all; the critical treatment is drainage of the
abscess material.
Skin boils - the different types
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Urine odors
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I find that when I urinate that there is an odor
that lingers in the bathroom. I babysit and the
children have complained that I stink. I have
asked my doctor if possibly it could be some of my
medications. They seem to ignore my statement.
What can I do to correct problem. I don't know if
the odor is from there or my vagina."
"I am 62 and have asthma. Medications include:
aspirin, Allegra(R), Singular(R), Verapamil(),
Hyzar(R), Synthyroid(R), Servent(R), Flovent(R),
Relafen(R), and a breathing machine when needed.
I am always wet or moist in the vaginal area.
I am overweight." - H
I know this is a difficult question for you to
ask, but one that is of concern for many women.
Odor that is evident with urination can have its
origins from basically two sources: bacteria that
produce odorous chemicals as they metabolize and
proliferate and chemical substances that are
excreted in our sweat and urine.
Bacteria that cause odor are either on the skin of
the perineum, where it stays moist, and bacteria
in the vagina that are not normally there but that
are causing chemical reactions with the vaginal
secretions. Contrary to what you might think,
urine that smells is almost never due to a
bacterial urinary tract infection but rather it is
due to the chemicals from food metabolism as
previously stated. Your doctor should be able to
perform a vaginal exam to check for bacterial
infection such as an atrophic vaginitis or a
bacterial vaginosis. If either of those are
present, they need to be treated.
A common cause of perineal odor is from skin
bacteria that grow in the moist folds of skin. The
only way to combat this is to frequently keep the
skin folds exposed to air and keep them dry. It is
strains of bacteria that do not need oxygen to
grow (anerobic bacteria) that usually produce the
strongest odor. By "air drying" the skin folds you
introduce oxygen which impedes growth of these
bacteria as well as it removes moisture needed for
their growth. If you are overweight and sweat a
lot, you will have to take breaks in privacy where
you lie down or sit with your legs very wide apart
and with no underwear, until the skin dries out.
Doing this several times a day may significantly
help this problem and certainly you should try to
air dry right after voiding each time.
I am not aware that any of your medicines would
cause a skin odor but it certainly is possible
because most prescription medicines are not
naturally occurring human chemicals. Ampicillin is
a compound that causes an asparagus type smell to
the urine so the question you ask about medicines
causing some of this is a very good one. You will
have to work very closely with your doctor as far
as trying to go without a medicine for 3-4 days to
see if it makes a difference in the odor. I am not
sure I would recommend this until you look more at
skin bacteria in a constantly moist environment as
the main cause.
There are some metabolic diseases such as diabetes
and liver cirrhosis that can be associated with an
increased body acetone or amine odor. Your doctor
should be able to easily check you out for those.
There is also a metabolic condition called
trimethylaminuria in which your body abnormally
secretes an odorous chemical in the sweat and
urine that comes from bowel bacteria breakdown of
food products such as eggs, fish, soy, and liver.
Total elimination of these foods from your diet
for about 2 weeks would be recommended to see if
it makes a difference.
Finally, you did not mention that you noticed the
odor as strongly as the children. As aging takes
place, sometimes our own sense of smell declines
or we become very used to an odor since we live
with it all the time. You will need to be your own
detective about his to see if a decreased sense of
smell on your part can be playing a role in not
recognizing the problem soon enough to prevent a
concentrating odor.
Some additional tips for body odor control:
have a daily aerobic workout before going to work
- this can help dissipate sweat gland compounds
and then bath or shower before work to remove as
much skin bacteria as possible - this will help
daytime odors
avoid seafood, soy, liver and egg yolks as well as
pungent vegetables such as onions, garlic
asparagus etc., for awhile to see if this makes
any difference
minimize stress and any sweating at work if
possible - if you feel you have excessive
sweating, ask your doctor about medications to
help this.
keep the perineal area clean and dry especially in
the skin folds
Perineal odor
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Chance of developing hypertension in your lifetime
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
As a person ages, it is common for their blood
pressure to rise. In fact it used to be taught to
physicians that the systolic pressure (140 in a
140/90 blood pressure measurement) was naturally
100 plus your age when you got to 50 or older.
This is not true, but for many years it was a
rule-of-thumb based upon the premise that most
older individuals developed higher blood
pressures. The lower number in the blood pressure
(diastolic, 90 in the 140/90 measurement) should
not rise as much with age, however.
Stage 1 hypertension is defined as a blood
pressure of 140/90 mm Hg or over and Stage 2
hypertension is a blood pressure of 160/100 or
more. The study below looked at data from the
large Framingham Heart Study. They looked at
individuals who started the study between the ages
of 55 and 65 and had no evidence of hypertension.
After following them to see if their blood
pressure went up as they aged, the authors
calculated that the residual lifetime risk for
developing stage 1 or greater hypertension for
study participants was 90%. It was not more or
less frequent for women than men. Approximately
40% of study participants developed stage 2
hypertension.
While you might think this is just an aging
phenomenon, the encouraging news is that the
frequency of stage 2 hypertension has actually
decreased in recent years. This means it is a
disease process and not just a natural physiologic
progression because some individuals are managing
to prevent the age progression. About 60% of both
men and women received anti-hypertensive
medication at sometime in their life. This
indicates that many people either try to treat the
high blood pressure with only lifestyle
modification or perhaps they or their doctors do
not think the pressure was elevated enough to
begin medical treatment.
Chance of developing hypertension in your lifetime
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Cysts in the liver found on ultrasound
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
With all of our modern medical imaging
technologies such as ultrasound, CAT scans and
MRIs, more and more often we come across an
abnormal x-ray finding that surprises us. An
imaging report such as cysts in the liver is not
uncommon at all. Before such powerful x-ray
techniques ere available, liver cysts were only
discovered when they were quite big and causing
symptoms just from their size alone. Now we know
that liver cysts can often occur on their own, not
produce any symptoms, and be left alone without
any problem.
Many liver cysts are present from birth as the
result of the developmental process when the liver
was being first formed. There may just be one or
two cysts or multiple cysts called a polycystic
liver condition. Sometimes the liver cysts can be
the result of infection by parasites although the
radiologist should have been able to tell that.
Cystic tumors and abscesses are also possible
causes of liver cysts but again, the radiologist
should be able to tell if those are possibilities.
Most of the time the report just indicates simple
cysts(s) of the liver and it is assumed that they
are of the simple cyst, congenital origin and do
not need any treatment.
Occasionally liver cysts can become very large and
cause pain in the right abdomen just below the
ribs or even pain with taking a deep breath. When
these simple cysts become big and cause symptoms,
the most common treatment is surgical. It may
involve use of the laparoscope to remove the top
of the cyst or the surgery could be more major and
require a large abdominal incision.
Cysts in the liver found on ultrasound
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Food cutting boards
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
While experts agree that an ideal type of cutting
board for food preparation would be non porous and
easy to clean, the word is not in on whether
plastic, wood, ceramic or glass are the safest.
All of them depend upon cleaning in between uses,
especially when meat or poultry is cut on the
board. You need to wash the cutting board after
cutting meat on it before using it for vegetables
or fruits.
If the board cannot be washed in between types of
foods, a chlorine bleach solution, 2 teaspoons
(10ml) of liquid chlorine to a quart of water,
should be used to wash the board or use a
commercial antibacterial cleanser. If you use a
wood board to cut, be sure to make up a bleach
solution to soak the board after every use. - FRJ
Cross contamination from cutting boards
If you have discovered ways of coping with a
disease or condition and it works for you, please
share it with us:
Health tip suggestion form
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
7. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"ER Visit"
I am five feet, three inches tall and pleasingly
plump. After I had a minor accident, my mother
accompanied me to the emergency room. The triage
nurse asked for my height and weight, and I
blurted out, "Five-foot-eight, 125 pounds."
While the nurse pondered over this information, my
mother leaned over to me.
"Sweetheart," she gently chided,
"This is not the Internet."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** Woman's Diagnostic Cyber Newsletter *******
March 24, 2002
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. What is a heart arrhythmia?
2. Pregnancy at an older age
3. Reader submitted Q&A - What estrogens for menopause
4. Low birth weight infants from infertility treatments
5. About prostate cancer
6. Health tip to share - Breast cancer without lumps
7. Humor is healthy
If you change your email address, don't forget to
re subscribe using the new address.
Spread the word! Send a copy of this newsletter
to someone you know.
The next newsletter will be in two weeks.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. What is a heart arrhythmia?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The electrical system that controls our heart rate
is an amazingly precise system. It accommodates
our different emotions and physical activities 24
hours a day, 7 days a week for over 70 years, on
the average, without failure. Sometimes the
conduction system can develop abnormal electrical
activity and when it does, that is known as a
heart arrhythmia.
If you want to understand arrhythmias, you must
understand the normal conduction pathway. Blood
comes into the heart in the right upper chamber
(atrium). It is pumped down to the right lower
chamber (right ventricle) and then out to the
lungs to receive more oxygen. This oxygenated
blood returns from the lungs to the left upper
chamber (left atrium) and then is pumped to the
left lower ventricle for distribution to the rest
of the body. The pacemaker of the heart is located
near the top of the right atrium and is called the
sino-atrial node.
The electrical impulse to trigger the heartbeat
essentially starts at the sino-atrial node in the
right atrium and spreads over the both upper
chambers. As the impulse spreads over to the lower
chambers, it crosses a specialized electrical
conduction tissue called the septum. The tissue
there takes the electrical signal from the top
chamber, slows its progression down slightly, and
then passes it on to specialized fibers that
transmit the impulse across the ventricle chambers
to signal these muscles to contract and pump blood
to the lungs (right) and rest of the body (left).
The slowing down of the first impulses allows the
atria to contact first and then fractions of a
second later, for the ventricles to contract.
Whenever this normal sequence of electrical
conduction is disrupted, an arrhythmia occurs. It
can be due to extra electrical impulses starting
at locations other than the sino-atrial node
(premature atrial or premature ventricular
contractions, atrial tachycardia or ventricular
tachycardia) or it can be due to poor conduction
along the pathway which blocks some or all of the
impulses from initiating a heart muscle
contraction (partial or complete heart block).
Sometimes the tissue that is supposed to slow down
the impulse is abnormal or there is an electrical
pathway around it (Wolf-Parkinson-White syndrome).
There may even be a block of any starting impulses
from the node or a complete block of any impulses
being transmitted to the ventricles.
Some arrhythmias are caused by damage to the
normal heart muscle such as that from a heart
attack. Most abnormal heart rates however are just
due to these abnormal electrical impulses that we
do not understand. Any arrhythmia that alters
normal blood pumping action enough can be life
threatening, although most times a common
arrhythmia such as premature ventricular
contractions (PVCs) gives no problems at all
except an occasional awareness of a "pounding
heart".
Symptoms to look for that may indicate a heart
arrhythmia are:
a pounding heart rate or pulse,
shortness of breath,
dizziness
chest discomfort or pain
Since these same symptoms can be caused by other
conditions, a physician should be consulted to
detect if the heart is likely to be the source of
these symptoms. Sometimes a 24 hour EKG type of
heart monitoring is needed to pick up the abnormal
rhythm if it does not occur all of the time.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Pregnancy at an older age
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
How old is too old for pregnancy? While the ideal
pregnancy outcome is for women who deliver between
ages 15 and 30, many women delay childbearing
until after 30. Pregnancies in the 40's are not
that uncommon either and rarely, there are
pregnancies in the early 50's. Pregnancy at a
later age has some more risks to it but for the
most part they are not excessive risks.
With age comes a higher incidence of uterine
fibroids. These can decrease the chance of
conception but if a woman does become pregnant
with fibroids in the uterus, growth of the baby
must be closely watched. High blood pressure is
more common with advancing maternal age as well.
Perhaps one of the worst daily reminders of being
pregnant after 35 or 40 is just the general bony
and muscular aches and pains that occur more often
during the antepartum course.
The mother over 40 has a much higher rate of
cesarean section due to poor labor, fetal distress
and abnormal presentation problems (the baby is
not directly head first). Even a greater chance of
having a baby with a birth defect is a standard
risk for the older mother. This risk can be
discovered mostly by an amniocentesis procedure
which involves a needle stick to the abdomen of
the mother to draw off fluid from the baby's bag
of waters. So this adds another hassle to the
older mother's pregnancy because it is recommended
for any mom who will be over the age of 35 when
she delivers.
All of these problems add up for the mother who
becomes pregnant after 35 but they are not
surmountable problems and they do not raise the
risk so high that a woman should be talked out of
becoming pregnant if she really wants to.
If you or a woman you know wants a pregnancy but
is afraid her age is a barrier, please suggest
seeing a physician who can explain the magnitude
(or lack of great magnitude) of what she might
face.
Pregnancy at an older age
The Complete Guide to Pregnancy After 30
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - What estrogens for menopause
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Two questions this week have a similar thread.
"This is a general question. Is taking Estroven
(R) (sold over the counter at pharmacies) harmful
in anyway? This is a natural soy plus vitamin B6,
E, black cohosh, Kava Kava etc. product. Can
women without menopausal symptoms take this
product?" - Kay
"Aside from contraception, what medical
indications would lead you to prescribe a non-
human hormone (Premarin(R), Provera(R), ...) in
preference to a human estrogen or progesterone?" -
DRW
To the best of my knowledge and from what I could
find in the scientific literature, Estroven (R) is
not harmful if taken at the suggested dose of one
capsule per day. The only thing you have to
remember is that there is only a small amount of
calcium in it (150 mg or about 10% of what is
recommended per day if you are not taking
estrogens in the menopause). So if you are using
it for your total calcium source then it would be
harmful by omission. The isoflavones in it from
the soy content should be helpful with hot flashes
and they may help slow down bone loss after the
menopause also. The black cohosh component is
probably not effective one way or the other but it
is not harmful.
There are several different Estroven(R) products
as you may know. The original formulation for
menopause, one for memory and concentration, one
for bone density, one for mood and one for PMS.
They are all combinations of different herbs and
do not have the same amount of isoflavones (plant
estrogens) in them as the original formulation. I
do not think from their components they are
harmful. The one for mood has St John's Wort in it
and there are always some cautions about taking it
with prescribed mood medications containing
monoamine oxidase inhibitors, but this has not
turned out to be a real problem at the doses used
that I know of.
You can take it even if you are not menopausal.
The estrogenic plant components (isoflavones) are
not very potent at all and since they do not
stimulate the uterine lining to any great degree,
they should not cause a problem at all. They
actually may help some perimenopausal hot flashes.
Like many herbal and plant remedies, the safety
profile for Estroven(R) should be much better than
many prescribed medications. The efficacy is less,
but that is the trade-off people make. Within
prescribed estrogens, the conjugated equine
estrogens (Premarin(R)) have some similarities to
herbal medications in that they are composed of
multiple different estrogenic substances in small
amounts. There are over 10 different estrogenic
compounds in Premarin(R) and over twice as many
other chemicals, some of which have been shown to
have a beneficial effect on the heart and other
systems. The aggregate of these 30+ compounds
are like herbal medicines that are safe because of
such small doses of one or a few components that
might give an adverse effect but a synergistic
beneficial effect among the rest of them to
produce a clinically beneficial effect.
Even when compared to generic conjugated
estrogens, there is a slower, time release
characteristic of the original equine estrogens
(Premarin(R)) than with the synthetic conjugated
estrogens. The main cardioprotective effects of
Premarin may be due to one particular component
that seems even better than pure estradiol
(natural estrogen) as far as its effect at
dilating coronary blood vessels.
Premarin was approved for use in the late 1940's
and we have a much more extensive scientific
experience than we do with the natural estrogens
(estradiol) which were used in large scale studies
mainly in Europe. The studies showing lower colon
cancer incidence and lower Alzheimer's disease
incidence was mainly collected from conjugated
estrogen users and not from women using estradiol.
In fact in animal studies looking at the
protective effect of estrogens on the nervous
system, the conjugated estrogens had a much more
protective effect (3+) than did "natural estrogen"
(estradiol)(1}+.
Natural estrogen and progesterone have had a
history of being quite variably absorbed from the
stomach, thus producing lower levels in some women
than in others. Now that they have been processed
to be "micronized" they absorb in oral form much
better but there still can be more variability
among different woman. For while it looked as if
there was a higher incidence of breast cancer
associated with estrogens in Europe (where they
predominantly use estradiol) than in the U.S.
where conjugated equine estrogens have the largest
share of the market. I could not confirm this with
the scientific studies I found, but I still worry
about it.
So to answer your question about when would I
prescribe any "non-human" hormone other than
natural estradiol and progesterone, my answer is
'when first prescribing hormone replacement in a
woman who has not had it previously'. The first
rule of medicine is to do no harm and the
conjugated equine estrogens still have the best
safety profile and clinical evidence of a long
term benefit in heart, colon cancer and
Alzheimer's. Estradiol is certainly as good in the
bone and hot flash studies as well as for vaginal
and skin atrophy. I do switch to estradiol when
women are having difficulty getting on the right
dose for hot flash and mood problems. It is much
better for measuring blood levels than with use of
conjugated equine estrogens. I also use estradiol
when money is a problem. Generic estradiol (but
not progesterone) is very inexpensive compared to
Premarin(R). I also will use it if a woman just
objects to conjugated estrogens because of what
she has heard and believes.
I would guess that this is not the answer you
expected to hear but having followed this
literature for over 30 years now, my first choice
to prescribe would be conjugated estrogens. with
the other estrogen products being a second choice
under various circumstances. I would guess my
thoughts are the same as the majority of
gynecologists prescribing estrogen replacement and
is the same reason why women seek so many non
prescription hormone replacement treatments. The
popular news media has done women a great
disservice by selective reporting in my opinion.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Low birth weight infants from infertility treatments
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Women who undergo infertility treatments such as
ovulation induction, in vitro fertilization and
other advanced reproductive technologies always
have a higher risk of twin and higher multiple
pregnancies such as triplets, quads etc. Because
multiple pregnancies often result in premature,
low birth weight infants, women undergoing these
treatments are at higher risk of having premature,
low birth weight (below 5 1/2 lbs/2500 kg) babies.
It has not been clear, however if the risk is only
due to multiple pregnancies or whether singleton
pregnancies are also at the same risk for lower
birth weights.
This study below looked at over 42,000 infants
born to women who received infertility treatments.
They compared those children to over 3 million
children born in the U.S. in 1997. The expected
low birthrate rate was about 7.2% in the general
population. In women undergoing infertility
treatment, the low birth rate in singleton
pregnancies was 13.1% which is almost twice as
frequent.
This is not a reason for a woman to avoid
infertility treatment but it is one of those
factors that should be taken into account. Women
who are just very anxious to start fertility
treatment before having an adequate trial of
attempting pregnancy should consider all of the
risks.
Low birthweight infants from infertility treatments
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. About prostate cancer
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Men have a high frequency cancer just like breast
cancer in women. Prostate cancer is the most
common cancer in men and the second leading cause
of cancer deaths in men. Actually it is a some
what slow growing cancer and may be present in
many men by age 50 and by age 80 one in every two
men may have prostate cancer cells in their body.
Men often die with it but not necessarily because
of it.
The prostate gland is a walnut sized gland that
surrounds the tube from the bladder, through the
penis to the outside. It manufactures semen for
sperm. Symptoms of prostrate cancer often come
from the mass effect of a growth that is enlarging
in the prostate gland and compressing urinary
tract outflow:
difficulty urinating
slow urine stream and dribbling
irregular flow of urine stream
urinary urgency both day and night
painful urination
blood in urine
painful ejaculation during sex
Early in the course of prostate cancer there are
often no symptoms, so to detect it early,
screening exams are needed. The two major screens
are the digital rectal exam done by the doctor
during the physical exam to feel the size and
shape of the prostate gland through the rectal
wall, and a blood test called the prostate
specific antigen (PSA). This antibody test is not
limited to only prostate cancer; any prostate
infection, cancer or even just benign enlargement
can cause an abnormal result. If a man has either
an elevated PSA test or an abnormal finding on the
doctor's rectal exam other imaging studies will be
needed such as ultrasound, MRI, bone scan and then
a biopsy of the gland itself.
Cancer of the prostate can be treated well with
surgery or radiation therapy if it is found early.
Large tumors often need to be shrunk with hormone
therapy such as Lupron (R) or other anti-hormone
medications that block testosterone. The American
Urological Association and the American College of
Radiology recommend annual digital rectal exams
and PSA blood test screening beginning at age 50
and annual PSA screening beginning at age 40 for
African-American men and other men with a positive
family history of prostate cancer.
When you get your annual mammogram test and
physician breast exam, remind any men close to you
that it is their turn to suffer the screening test
that can save their lives.
At home prostate cancer screening test
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Breast cancer without lumps
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Why don't most people know you don't have to have
a lump to have breast cancer? My daughter was
diagnosed with inflammatory breast cancer 4 plus
years ago .. she continues to do amazingly well.
With the proper diagnosis and treatment lives can
be saved. "
"Just knowing there is more than one type of
breast cancer and you don't have to have a lump to
have breast cancer can literally save lives.
Inflammatory breast cancer is too commonly
misdiagnosed as mastitis and after ten days the
patient should have a biopsy. Public Awareness of
inflammatory breast cancer and it's symptoms are
vital not just for the general public but for
physicians, nurses, technicians, etc. " - M. K.
If you have discovered ways of coping with a
disease or condition and it works for you, please
share it with us:
Health tip suggestion form
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
7. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The following list of phrases and their
definitions might help you understand the
mysterious language of science and medicine. When
you hear the news media interview or quote a
physician or scientist and they say... it may
mean....
"It has long been known" ...
I didn't look up the original reference.
"A definite trend is evident" ...
These data are practically meaningless.
"While it has not been possible to provide definite answers to the
questions" ...
An unsuccessful experiment, but I still hope to
get it published.
"Three of the samples were chosen for detailed
study" ...
The other results didn't make any sense.
"Typical results are shown" ...
This is the prettiest graph.
"These results will be in a subsequent report" ...
I might get around to this sometime.
"In my experience" ...
once
"In case after case" ...
twice
"In a series of cases" ...
thrice
"It is believed that" ...
I think.
"It is generally believed that" ...
A couple of others think so, too.
"Correct within an order of magnitude" ...
Wrong.
"According to statistical analysis" ...
Rumor has it.
"A statistically oriented projection of the
significance of these findings" ...
A wild guess.
"A careful analysis of obtainable data" ...
Three pages of notes were obliterated when I
knocked over a can of pop.
"It is clear that much additional work will be
required before a complete understanding of this
phenomenon occurs" ...
I don't understand it.
"After additional study by my colleagues" ...
They don't understand it either.
"Thanks are due to Joe Blotz for assistance with
the experiment and to Cindy Adams for valuable
discussions" ...
Mr. Blotz did the work and Ms. Adams explained to
me what it meant.
"A highly significant area for exploratory study"...
A totally useless topic selected by my committee.
"It is hoped that this study will stimulate
further investigation in this field" ...
I quit.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** Woman's Diagnostic Cyber Newsletter *******
April 7, 2002
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Pulmonary hypertension-High blood pressure of the lung
2. FDA advisory about Kava Kava herb
3. Reader submitted Q&A - Aspirin for heart protection
4. Stress reduction techniques
5. At what age should I get a test for colon cancer?
6. Health tip to share - Coffee and high blood pressure
7. Humor is healthy
If you change your email address, don't forget to
re subscribe using the new address.
Spread the word! Send a copy of this newsletter to
someone you know.
The next newsletter will be in two weeks.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Pulmonary hypertension - High blood pressure of the lung
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Not all hypertension is the same. The body has two
different networks of blood vessels that are under
different resting tone control. Blood is pumped
from the heart to the lungs to receive oxygen and
then back to the heart. From there, blood is
pumped all over the rest of the body. The blood
flow to the lungs is a lower pressure system and
normal systolic ranges are 14-40 mm Hg. This
compares to a systolic pressure of about 80-135 mm
Hg in the rest of the body.
Hypertension is a tightening in the diameter of
blood vessels somewhat like pinching a water hose
and restricting the flow of water from the hose
nozzle. Both types of hypertension make the heart
pump harder and can lead to heart failure over
time. While systemic hypertension is most often
due to atherosclerosis, pulmonary hypertension has
different causes.
Drugs like fenfluramine (part of the Phen-fen for
dieting) or cocaine can cause the lung vessels to
constrict. Emphysema is a common cause for
pulmonary hypertension and chronic liver disease
(cirrhosis), AIDS, sickle cell anemia, and
connective tissue diseases such as scleroderma and
lupus are other conditions that can cause this.
About 10% of the time there is a genetic
disposition to pulmonary hypertension. Sometimes
we just do not know what causes high blood pressure
of these blood vessels going to the lung - we call
that primary pulmonary hypertension. If we do know
the cause it is called secondary pulmonary
hypertension.
Symptoms of pulmonary hypertension are mainly
those of heart failure:
shortness of breath
difficulty breathing with exercise
dizziness
racing pulse of increased heart rate
swelling of the legs or feet
a bluish color to your lips and skin
Thus, this is a situation where you can have
problems of heart failure even though your regular
blood pressure measured in the arm has always
been normal. Be sure to see your physician if you
are at all concerned about the above symptoms.
Pulmonary hypertension
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. FDA advisory about Kava Kava herb
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
You may have heard about the warning issued by the
FDA about the herbal supplement, Kava kava. This
herb has traditionally been used to promote
relaxation and induce sleep or to relieve stress
and anxiety. Apparently there have been instances
of liver toxicity associated with using it. Those
instances are rare but they have caused deaths.
There have been about 25 reports internationally
of liver toxicity, some even requiring liver
transplants. There has only been one episode
reported in the U.S. but the FDA has still given a
warning just in case this turns out to be a real
complication. Some other countries have taken
action ranging from consumer warnings about the
risks of kava use to removing kava-containing
products from being sold at retail.
Although this seems to be a rare occurrence, any
woman with liver disease such as past hepatitis,
cirrhosis or taking prescription drugs known to
have liver toxicity would be best to avoid taking
kava until we know more. Also anyone with any
adverse effects thought to associated with taking
kava kava should report these events to the FDA
at:
FDA Medwatch
FDA advisory about Kava Kava herb
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Aspirin for heart protection
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Should women take one baby aspirin daily?"
"I am 50; complete hysterectomy 1 year ago; take
Celebrex(R) daily; have mitral valve prolapse - no
treatment. My doctor prescribed that I take one
baby aspirin daily, which I do, but I am beginning
to feel uncomfortable about it. I have read that
it increases the chance of stroke through
bleeding, and the dose has not been proven to be
beneficial to women." - ST
Aspirin is a platelet inhibitor, the blood
component that causes clotting if there is blood
vessel injury. It has been used after heart
attacks and strokes to prevent consequences of the
attack or to prevent a second heart attack or
stroke. It has also been used to prevent new heart
attacks in men who have never had a previous
heart problem. There are some pros and cons about
aspirin's use in this manner.
Your reading has been right on target and the
answers are not yet clear. Almost all of the
studies have been carried out with men as the
subjects and proven beneficial in those men, ages
45 - 70 who are at low risk for coronary events.
The studies show a reduction of about 20 - 30% in
the rate of non-death producing heart attacks. In
other words, taking aspirin does not prevent
deaths but it will reduce the number of total
attacks. For men who already had high blood
pressure, this treatment did not have a positive
or negative effect.
As to the dose of aspirin used in the studies,
anywhere from 50 mg to more than a full aspirin
tablet (325 mg) have been used. So the lowest
effective dose is not yet clear and we know that
as you increase aspirin ingested, the bleeding
problems may also increase. This makes us worry
about possible brain attacks (strokes) from any of
the doses, but especially the higher doses. That
is why doctors have settled on the lower 80 mg
aspirin dose or what has been called a "baby
aspirin".
The overall incidence of strokes in men at low
risk did not go down as the heart attacks went
down. It was expected that the incidence of blood
clot (thrombotic) strokes would go down if heart
attacks went down because the mechanisms of
clotting should be similar but there were some
more bleeding (hemorrhagic) strokes that offset
the thrombotic strokes so the overall incidence
did not go down. That is where you heard that
hemorrhagic strokes increased on aspirin but you
really can't go by that because one merely
balanced the other. I believe the consensus now is
that the baby aspirin reduces non-fatal heart
attacks by about 25% and does not increase or
decrease the overall incidence of strokes in men
who are at low risk for heart problems.
Women tend to be about 10 years later than men in
starting their heart attacks so it has been
recommended as a cardiac event preventative in
women over age 50 who are not already at high risk
for heart problems. The truth is we will not know
if it works in women until completion of the
Women's Health Study in 2004 which is testing low
dose aspirin and vitamin E for cardiac protection
in a randomized, controlled trial.
Before you decide whether or not to continue
taking the baby aspirin a day (or every other
day as the Women's Health Study is doing), keep in
mind that while aspirin may reduce the cardiac
events by about 25%, a Mediterranean diet
consisting of olive oil, pasta, fruits,
vegetables, fish, and wine, is also associated
with a low rate of cardiovascular events (over 35%
reduction). There are probably many healthy
habits that can reduce your risk for heart attacks
just as much as an aspirin can.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Stress reduction techniques
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Stress and anxiety can cause medical problems if
left unchecked. It is essential to learn how to
reduce stress for your own long term health.
There are basically two ways to attack stress. One
way is to identify exactly what is the trigger
that causes stress and change your thought process
to minimize your own emotional reactions to the
trigger. This is extremely difficult to do on your
own because it takes a constant effort and insight
as to what your emotional thought process really
is.
The second stress attack method is to use anti-stress
techniques to relax your mind and the body's
physiological response to that stress. This is
very successful as a stress buster and anyone can
do it. While stress relaxation only treats the
symptoms and not the cure, it is a very useful
tool in our everyday lives.
The preface to any relaxation technique is to
reduce your mental load "to do" list. Most of us
get aggravated by overloading ourselves with tasks
and errands. Make a written list for the day and
then eliminate those tasks you don't absolutely
have to do. Just put the essentials on the list.
Secondly, you need to create a good ambience for
stress relaxation. Quiet spaces, soft music,
outdoor light or cozy corners help set the stage.
Immediate techniques to handle stress might
include:
distraction
relaxed breathing
counting to 10
muscle isometrics
facial massage
visualization
laughing or crying
End of the day relaxation activities might
include:
warm bath
warm drink
sit in the sun
drawing
music
Finally, remember to get enough sleep and
exercise. Finding a daily 30 minutes for some
physical activity is difficult due to anxiety and
overloading your daily tasks but if you have no
time for exercise, that is the time you need it
the most. You may want to look at this site that
has some practical tips.
Stress reduction techniques
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. At what age should I get a test for colon cancer?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Current screening recommendations are divided into
those for women and men at low or average risk for
colon cancer versus different recommendations for
those at higher risk. Most people are at average
risk if you do not have a family history of colon
or rectal cancer, hereditary non polyposis
colorectal cancer, familial adenomatous polyposis
or ulcerative colitis.
While there are different recommendations from
different agencies and organizations, the essence
of them are that all low to average risk women
and men aged 50 or older should be screened for
colorectal cancer with yearly fecal, occult blood
testing (FOBT), a flexible sigmoidoscopy every
five years, or both.
Fecal occult blood testing involves a smear on a
piece of special paper of a stool specimen from
the glove after a rectal exam by the doctor or
nurse. This is then tested by adding a drop of a
special dye. A color change indicates blood in the
stool. Another FOBT method is to drop a dye
impregnated piece of paper in the toilet after a
bowel movement and to look for a color change that
would indicate blood in the stool. These at home
tests are available on the internet or at some
drugstores.
The flexible sigmoidoscopy test requires you to
have a bowel prep in which you take laxative
agents to clean out the stool in your colon and
rectum. Then in the doctor's office or sometimes
in the outpatient hospital surgical suite, you are
given sedation (but not put asleep) and a cord-
like, well-lubricated scope is placed into the
rectum and threaded up the colon to visualize any
polyps or cancer areas.
You are at high risk for colon or rectal cancer if
you have one or more parents, brothers, sisters or
children (first degree relatives) with a history of
colon cancer. If that relative was diagnosed with
cancer at age 55 or greater, then you should have
the sigmoidoscopy every 5 years, FOBT testing
annually or both, STARTING at age 40. If that
relative was under age 55 when diagnosed, or if
you have two first degree relatives with
colorectal cancer, you need to have the complete
colon exam every 5 years starting at age 40 or
starting 10 years before the age at which the
youngest relative was diagnosed with colon cancer.
Those are some helpful guidelines for preventative
medicine and screening for colon and rectal
cancer. But what if you get symptoms? Which
conditions warrant immediate testing for colon
cancer? The following circumstances should alert
you to see your doctor for further testing.
unexplained iron deficiency anemia
any rectal bleeding of undetermined cause
sudden narrowing of the caliber of bowel movements
anyone with long-standing (> 8 years) chronic
ulcerative colitis or Crohn's Colitis
Colorado guidelines for colon cancer screening
Recommendations for different at risk groups
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Health tip to share - Coffee and high blood pressure
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Coffee drinking can raise the blood pressure
slightly but on the average, it does so by less
than 1 mm systolic and 1 mm diastolic. Drinking
less than 5 cups of regular coffee per day does
not cause long term hypertension. Caffeine in any
amount, however, worsens fibrocystic breast
disease, PMS and just plain stress.
Coffee and hypertension
If you have discovered ways of coping with a
disease or condition and it works for you, please
share it with us:
Health tip suggestion form
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
7. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Inner Strength
If you can start the day without caffeine or pep
pills,
If you can be cheerful, ignoring aches and pains,
If you can resist complaining and boring people
with your troubles,
If you can eat the same food everyday and be
grateful for it,
If you can understand when loved ones are too busy
to give you time,
If you can overlook when people take things out on
you when, through no fault of yours, something
goes wrong,
If you can take criticism and blame without
resentment,
If you can face the world without lies and deceit,
If you can conquer tension without medical help,
If you can relax without liquor,
If you can sleep without the aid of drugs,
THEN YOU ARE PROBABLY THE FAMILY DOG.
Back to top
****** Woman's Diagnostic Cyber Newsletter *******
April 21, 2002
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Body piercing and tattoos
2. Diabetes dangers in women
3. Reader submitted Q&A - Rectal pain
4. Postpartum Depression
5. Dementia treatment to improve quality of life
6. Health tip to share - Pill identifier
7. Humor is healthy
Spread the word! Send a copy of this newsletter
to someone you know.
The next newsletter will be in two weeks.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Body piercing and tattoos
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Rings through body parts or dye injected in
various areas of skin are assaults on our
protective barriers that can become infected,
bleed, or even tear. Besides bacterial infection,
those who get tattoos are at risk for hepatitis C.
In fact women with tattoos have a 6 times
increased incidence of hepatitis C. The Red Cross
will not allow someone recently tattooed to donate
blood within a year of the tattoo procedure.
Other infections include HIV, tuberculosis and
tetanus. These can originate from instruments and
needles that are not sterilized. Piercing guns for
earrings and body rings are notorious for
introducing skin infection since they are not easy
to sterilize. Also you have to watch out for rings
and posts that are allergenic. Many irritative
metals promote infection. Only use stainless steel
(300 series), gold, niobium, titanium or platinum
that has been sterilized in the autoclave.
Some women will pierce their tongue, nipples or
genitals with the intent of increasing sexual
pleasure for themselves and their partners. The
problem is that bacteria from the other person
gets in the pierced holes and commonly leads to a
chronic infection that causes pain and permanent
scarring.
If you are going to get a tattoo or have a body
part pierced, be sure to check out the cleanliness
of the establishment. The person who does the
piercing or tattoo art should wear gloves.
Instruments should be soaked in disinfectants or
processed in a sterilizer machine (autoclave).
They should be willing to discuss health and
safety issues as well as the training they have
had.
Finally, when you have had enough of body art
display and want it removed, see this article at
Mayoclinic.com for tips on removing the tattoo
with excision, laser surgery. dermabrasion or
salabrasion.
Body piercing and tattoos: More than skin deep
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Diabetes dangers in women
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Both patients and doctors have a tendency to
treat diabetes lightly. After all, it is quite
uncommon for someone to die in insulin shock or a
high blood sugar crisis. To most people without
diabetes the condition seems to be only
associated with complications in the later years
of life.
But did you know that women have diabetes more
frequently than men and they are at greater risk
for diabetes-associated heart disease and
blindness than men are? Not all women with
diabetes develop heart disease but almost half do.
And women with heart disease die from heart
attacks more frequently than men do. Whether this
is because the degree of heart disease is
underdiagnosed in women or because they just have
an inherently increased cardiovascular reaction to
the diabetes compared to men is unknown at
present.
A major effect of early diabetes is to reduce
sexual functioning in both men and women. In men,
the diabetes effects sexual functioning through
the vascular and local nerve systems making it
more difficult for men to have an erection.
Diabetes has a different effect on women's
sexuality though. For them, sexual health becomes
impaired more by depression and frustration with
diabetes treatment than it does by effect on the
local vascular and nerve system of the genital
tract. Feeling unhealthy, afraid or unattractive
causes more sexual dysfunction from diabetes in
women more than it does in men.
The answer to this potential health problem is
early detection and aggressive early treatment
including weight reduction along with medications
to improve sugar tolerance. If you have ever been
diagnosed with gestational diabetes (sugar
intolerance during pregnancy) or polycystic
ovarian syndrome, it is especially important to
maintain your ideal body weight and frequently
check for diabetes or pre-diabetes through special
tests from your physician.
Diabetes dangers in women
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Rectal pain
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Do you have any information on the disease called
Levator Ani syndrome? How can it best be treated?
Are there any natural supplements that could help
treat it? Is there a web site on the disease?" -
E. T.
Levator syndrome is a condition in which there are
muscle spasms in the rectum that produce pain. The
episodes of spasm may last several seconds or
many minutes at a time. In severe cases the pain
can last for hours. The pain is unrelated to
having a bowel movement and it is more likely to
be associated with sitting or just occur randomly.
This problem also goes under other names such as
proctalgia fugax or coccydynia.
The pain can easily radiate to front of the pelvis
where the bladder is, the perineum, buttocks and
even the legs. Thus it can mimic back, pelvic and
urologic disease so sometimes the presentation is
not as straight forward as it seems. To diagnose
this condition. the doctor needs to perform a
vaginal and a rectal exam to put pressure on the
various muscles of the pelvic floor to see where
the pain is originating from. To see if the tail
bone (coccyx is a major source of the pain, an
injection of local anesthetic and steroid into the
joint of the coccyx and the sacrum may need to be
performed. Almost instant pain relief from this
injection would confirm that the coccyx is the
main source of pain.
No one knows the cause of the muscle spasms. In
some cases it has even been proposed that the
muscles in spasm are the lower colon and not the
anal sphincter muscle. In that case this would be
a variant of irritable bowel syndrome. Others
believe that prolonged sitting on a soft seat that
puts pressure on the tail bone (coccyx) can be a
major cause of this problem.
Treatment is mostly symptomatic for this benign,
but painful condition. Heat from a sitz bath or a
mild analgesic pain medicine is used. Sometimes
muscle relaxants such as Valium (R) or Xanex (R)
are needed. Anal sphincter massage can also be
used to reduce the spasm and physical therapy,
involving a mild electrical stimulation to the
muscles can be helpful, in decreasing recurrences
of these spasms.
I do not know of any natural products that have
been tested on levator ani syndrome. It would make
sense, however, to try calcium and magnesium
supplements which sometimes help muscle spasms in
general. Peppermint is thought to help bowel
spasms in general and might also be worth a try.
It should not be harmful for this at least.
Finally, I could not find a web site that is
dedicated primarily to levator syndrome. It is
not a common problem so there is not a big
collection of experience that I know of. The best
course is probably to find a gastroenterologist, a
colon and rectal surgeon or a urogynecologist who
will work with you on trying various approaches to
this unusual problem.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Postpartum Depression
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
There is a very good reason to know about
postpartum mood illness even though you may never
have a future pregnancy yourself. It is not to
diagnose your own health that this knowledge is
important; it is to help relatives or friends.
When postpartum depression strikes, a woman is
unable to lift herself out of the depths of
sadness, lack of energy, or guilt feelings. While
she may think she can fight it on her own, she
can't. Control over actions and thoughts is lost
and she needs someone to look out for her until
significant time passes.
Probably 60-80% of women have some degree of
"postpartum blues" over the several weeks
following delivery of the baby. For most women
this period passes without significant long term
effects or permanent harm to the mother or baby,
but it does not mean that it is not a painful
period to experience. Both our culture and
physicians seem to be unconcerned about postpartum
blues. Everyone seems to focus only on the
extreme case in which there is a full blown
postpartum psychosis that results in a mother
harming herself or her child.
Actually there is a category between mild "blues"
that last for several weeks or so and a full
psychotic loss of reality. Let us call this
"postpartum depressive illness" or "chronic
depressive disorder", realizing it is but a part
of the collection of postpartum depression that
also includes "blues" as well as "psychosis". It
is still poorly defined but is characterized by
"despondency, tearfulness, feelings of inadequacy,
guilt, anxiety, irritability and fatigue."
This postpartum depressive illness category
probably comprises about 5-20% of women after
delivery but it is the group that you can help the
most just by recognizing that it exists. These
women rarely seek help on their own. While over
90% of them realize something is greatly wrong,
less than 20% report it to a health care provider.
To understand it, you may want to read this book
by Marie Osmond:
Behind the Smile: My Journey Out of Postpartum Depression
What you can do to help is to ask questions of the
new mother each time you see her:
What is her energy level?
Has she worried about harming herself or the baby?
Does she feel hopelessness?
If any of these are yes, she needs to see a
professional right away.
