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****** Woman's Health Newsletter *******
June 2, 2002
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
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1. Supplements for a healthy heart
2. Body weight and birth control pill failure
3. Reader submitted Q&A - Continuous OCPs for cramps
4. Herbal safety news
5. Health tip to share - NSAID pain meds need more lead time
6. Humor is healthy
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1. Supplements for a healthy heart
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Vitamin and other nutritional supplementation has
been promoted for many reasons but a common use is
to prevent heart disease and cancer. The data for
any benefit of heart disease prevention is
somewhat doubtful. Vitamin E, vitamin C, beta
carotene and coenzyme Q-10 are antioxidants that
have been touted at various times as useful in the
prevention of heart disease. By blocking a
chemical reaction (oxidation) that is necessary
for the arteries to absorb LDL cholesterol (the
"bad" cholesterol), fatty plaques in the arteries
are lessened or prevented - at least so the theory
goes.
Studies using vitamin E have had some success in
showing a lower rate of heart disease but these
were balanced by other scientifically valid
studies showing no heart disease prevention. Right
now there are no recommendations for vitamin E
supplements to be used for heart problem
prevention. Vitamin C, beta carotene and coenzyme-
Q are in the same state. Dietary studies suggested
that people who had higher intake of those
compounds had lower rates of heart disease but
when studies were performed giving supplements to
people, there did not appear to be any reduction
in heart problems.
The only nutritional supplement I know of that has
shown promise in preventing the new occurrence of
heart disease is fish oil -- omega-3 fatty acids
or long-chain n-3 polyunsaturated fatty acids.
When these have been given as dietary supplements
there has been a lower incidence of adverse
cardiac events. They help just minimally thin the
blood, provide some protection from rhythm
abnormalities and lower cholesterol. While the
best source is from cold water fish such as tuna,
salmon or halibut, other foods such as canola oil,
flaxseed, flaxseed oil, walnuts, and leafy green
vegetables all have some omega-3 fatty acids.
Supplements in pill form rather than foods can be
obtained at almost any health food store if
dietary sources are not consistent for you.
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2. Body weight and birth control pill failure
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Other than forgetting to take the birth control
pills (BCPs) or starting them too late in a cycle,
there are not too many things known to reduce
their efficacy. One question has always been,
however, that women who weight more, may require
higher dose oral contraceptives. This is
especially true as the doses of estrogens in pills
have gone from 35 mcg down to 20 mcg.
Other medicines have their doses often calculated
according to how much the patient weighs so it
would make sense that BCPs might need to be
adjusted by weight. The study cited below from
Seattle, Washington looked at over 2800 women and
found that the failure rate, i.e., unintended
pregnancies, from birth control pills overall was
3.8 per 100 women on the pill for one year. This
is consistent with many other studies that the
failure rate of BCPs is about 3%.
They then looked the specific dose (estrogen
component) of the birth control pill each woman
was taking and segmented the failure rate by
weight categories. They found that the women in
the highest weight categories had an over 4 times
increased pregnancy rate on the lowest dose pills
(20 mcg of estrogen) as compared to women in the
lowest weight categories. These results are not
surprising but we have not previously had the data
about the lower dose pills and failure rate.
There are some new contraceptives being marketed
and one of them is a weekly skin patch (Evra(R) by
Ortho-McNeil Pharmaceutical) which delivers 20 mcg
of estrogen. In their literature they note that in
women of 200 pounds weight or more, the failure
rate was slightly higher.
These studies would suggest to me that women who
weigh 200 lbs or more should not use a 20
microgram, low dose birth control pill, but rather
they should consider using a 30 or 35 microgram
pill.
Body weight and birth control pill failure
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3. Reader submitted Q&A - Continuous OCPs for cramps
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"My daughter just turned 17. About 1 1/2 years ago
we put her on the pill to help the incredible pain
she goes through every month with her period. It
helped for about 4 months and that's all. We have
continually asked her Gyn if there is anything
stronger than Vicodin (already prescribed) and
Naproxen (doesn't work either)....all they say is
that they can put her on the pill continuously
without the break, so she just won't get her
period. This CANNOT be healthy! What about all the
OTHER side effects of the pill? It doesn't seem
they are taking those into consideration!" - JG
Your doctor is treating your daughter under the
diagnosis of primary dysmenorrhea or "painful
menses". Intrauterine pressure generated with some
menstrual cramps have been measured as high as 300
mm Hg. A uterine contraction during labor only
gets as high as about 80 mm Hg so you can see that
a bad menstrual cramp can easily be 4 times as
painful as laboring with a baby.
Before we go on to address treatment, however,
endometriosis is often reported in adolescents and
if the pain just seems to persist too strong too
long, you may need to ask your doctor about
diagnostic laparoscopy to see if any endometriosis
is present and also to dilate the cervix at the
same time. While continuous oral contraceptive
pill regimens can treat endometriosis, there are
other therapies that might be used if there was a
certain knowledge (not just guessing) that
endometriosis was present.
As far as pain medicines for dysmenorrhea, the non
steroidal anti inflammatory drugs (NSAIDs) are the
best because they block the formation of
prostaglandin which causes the severe uterine
contractions. They have to be taken on a regular
basis during menses, however, not just when your
daughter can't stand the pain. See our discussion
in this newsletter about NSAIDs.
A common problem with medications that doctors see
is that an adolescent (or even an adult) looking
for instant relief, waits until the pain builds up
and then decides a pain medicine is needed. When
she then takes an NSAID like Aleve(R) (she should
take 2 or 3 at once, not just one like the bottle
says) the onset of blocking the cause of the pain
does not take place for several hours. So by that
time she has concluded the pain medicine does not
work. Instead, she should take two tablets
regularly twice a day as soon as she senses that
the cramps are going to start. The expectations
should not be for total pain relief, but merely to
lower the magnitude to the point where she can
cope with the cramps until the period is over.
Vicodin (R) and other narcotic pain medicines are
not very effective at all for menstrual cramps.
Oral contraceptive pills (OCPs) can be quite
useful in treating menstrual cramps because they
decrease the amount of menstrual tissue formed and
lower the pain level (amplitude) of the uterine
contractions probably due to their progestin
effect. When given in a continuous fashion, i.e.,
no week of placebo pills to allow an artificial
menstrual period, they can further reduce the
level of pain because most of the time menstrual
periods are blocked completely. There still may be
some irregular spotting with cramps but generally
they are of much lower severity and less
interruptive of everyday activities.
You have concerns about long term side effects or
complications of continuous birth control pills.
It would be helpful to know which concerns you
have in mind because the television and newsprint
media often exaggerate reported studies or experts
comments out of proportion; otherwise they would
have "ho-hum" news. You may need a personal
medical educational consult to answer a specific
concern.
In general, physicians do not have evidence of
significant long term problems from either normal
withdrawal oral contraceptive regimens or
continuous oral contraceptives as used for
endometriosis or severe menstrual cramps. OCPs
are associated with a much lower incidence of
ovarian cancer and endometrial cancer. In fact
they are one of the very few medicines known to
actually prevent any cancers. Cervical cancer is
slightly higher on the pills and breast cancer is
essentially unchanged. As far as cervical cancer
goes, the pills are not thought to have a chemical
effect on it but rather they allow the behavior,
intercourse with multiple partners, that has been
also associated with increased cervical cancer.
Long term use of OCPs are not known to affect
future fertility one way or the other so this
treatment now should not affect her ability to
have a pregnancy in the future.
The main deleterious effect of OCPs is the
formation of blood clots in the veins and
arterial thrombosis. The increased incidence is
real but very small, on the level of two times
increased over not taking the pills - 3 per 10,000
women. The risk can go higher in women who are
over 35 years of age and smoke or who have
hypertension but it is highly unlikely your 17
year old will have a problem with this. The small
increase in risk does have to be weighed against
the possible benefits, however.
All in all, I would be comfortable prescribing the
continuous pill regimen for this purpose. If she
does not have significantly less days of severe
pain after a 3 month course of continuous pills,
then I would strongly consider a diagnostic
laparoscopy to look for endometriosis.
Endometriosis is the one thing that if not
diagnosed early, can cause impaired fertility in
the long run.
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4. Herbal safety news
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Herbal remedies for medical problems or disease
prevention are popular because they are "natural
approaches" to a healthier body. Unfortunately
herbal formulations are not very much regulated
for safety by governments, especially as compared
to prescription medications. As a result, many
unsubstantiated claims are made for various
formulations and manufacturers of these products
may intentionally or by accident adulterate the
herbal mixture with pharmaceutical grade products
or other herbal components that are misidentified.
In the UK, the government has started an on-line
herbal safety news site to let consumers be aware
of problems they have found in various herbal
formulations. That way you can look up ingredients
in any herbal products you are using or even
sometimes the name of the product to see if any
reports have been made that would affect the
safety of taking those supplements.
Problems that have been identified include:
content including plant substances that are known
to produce liver toxicity
contamination with blood thinners such as coumadin
contamination with a benzodiazepine that is a
strong, addicting anti-anxiety drug
illegal adulteration of products with
fenfluramine, a diet substance taken off of the
market for complications
illegal adulteration of products with sildenafil
citrate (Viagra(R))
inclusion in Chinese herbal remedies of plants
containing aristolochic acids which have been
associated with toxic kidney effects and cancer
inclusion of prescription grade steroids in
topical creams
Herbal remedies need to be treated with the same
respect that prescription grade drugs are. After
all, many pharmaceuticals were originally
identified from and manufactured using the
"natural sources" where the active ingredient was
found. These remedies may also have interactions
with other drugs you are taking. Do not take any
herbal preparations in which the ingredients are
not clearly listed in terms you understand.
Finally, you may want to check out this site
periodically if you take a herbal preparation on a
regular basis or if you want to start a new one.
Herbal safety news
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5. Health tip to share - NSAID pain meds need more lead time
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The class of pain medications called non steroidal
anti inflammatory drugs (NSAIDs) work better as
pain meds when the source of the pain is due to
inflammation and swelling. While they reduce
current pain somewhat, their most frequent use is
to prevent future pain. They prevent the formation
of an enzyme used to produce prostaglandin which
is a pain and inflammation producing substance.
They work best with pain due to muscle, ligament
or bone inflammation.
NSAIDs should be taken with the first sign of
pain, but then they should be continued on a
regular basis for several doses or several days
even though the pain has been reduced. In this way
they help prevent recurrence of the pain due to
continued inflammation. A common mistake is to
take something like naproxen (Aleve(R)) or
ibuprofen (MotrinR)) and when they do not reduce
the pain within 15 minutes, a person concludes
they do not work and no further NSAID is taken.
Then the pain persists when in fact taking the
NSAID regularly could have significantly reduced
that future pain.
Over-the-counter NSAIDs include:
aspirin
ibuprofen (Advil(R), Motrin(R), others)
ketoprofen (Actron(R), Orudis(R))
naproxen sodium (Aleve(R))
NSAIDs available only by prescription include:
diclofenac sodium (Voltaren(R))
etodolac (Lodine(R))
fenoprofen (Nalfon(R))
flurbiprofen (Ansaid(R))
indomethacin (Indocin(R))
ketorolac (Torado(R))
nabumetone (Relafen(R))
oxaprozin (Daypro(R))
piroxicam (Feldene(R))
sulindac (Clinoril(R))
If you have a chronic pain that requires these
medications on a regular basis, be sure to check
with your doctor to see which one may be the best
for you. They all have different side effects and
tolerances and if one does not work, another might
still be very effective.
If after a trial of several of these different
NSAIDs you find that your stomach is too irritated
when taking them, there is a different class of
anti-inflammatory drugs called Cox enzyme
inhibitors such as Vioxx(R) or Celebrex(R) that
may work for you. Ask your doctor about them.
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
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6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Games For Hospital Waiting Rooms"
Surgery: Operation, Life
Neurology: Concentration, Boggle
Mental Health: Crazy Eights, Solitaire, Outburst
Gastroenterology: Chutes and Ladders, Go Fish,
Poker, Dungeons and Dragons, Lincoln Logs
Administration: Trivial Pursuit, Monopoly
Eating Disorders: Hungry Hungry Hippos
Finance: Trouble
Diabetes Center: Candyland
Plastic Surgery: Mr. Potato Head
Payroll: Payday
Rehab: Twister
Parkinson's Center: Jenga
Travel Clinic: Ants in the Pants
Infectious Disease: Cooties, Risk
Geriatric Medicine: Bingo
Gene Therapy: Barrel of Monkeys
Urology: Upwards
Cardiology: Hearts
Orthopedics: Pinball
Cafeteria: Mousetrap
Pediatrics: Tic Tac Toe
Hospital Patient Relations: Sorry
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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
****** Woman's Health Newsletter *******
June 16, 2002
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. How allergies work
2. Tanning salons associated with increased skin cancer
3. Reader submitted Q&A - Finding a cause for hair loss
4. Compulsive gambling is an illness
5. Health tip to share - Perineal clipping to reduce odor
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. How allergies work
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
When your nose is runny and eyes are itchy you
probably are just interested in relief; not in why
this reaction is happening. Sometimes though, it
is helpful to know the detail of how a medical
condition is produced especially when it is one
that is chronic and going to afflict you the rest
of your life. Allergy is one such condition.
People with allergies have genes that make them
more likely to develop a bodily reaction to
various substances they are exposed to.
The body's immune system is the main protective
mechanism to maintain health. It identifies and
fights off bacteria, viruses, parasites, cancer
cells, food and any foreign protein substance.
Lymphocytes are one type of white cell in your
blood and they are a major component of the immune
system. As soon as a foreign protein enters the
body, the lymphocytes identify the protein,
fingerprint it and determine if it belongs to this
body or not. "Lymphocytes act like traveling
customs agents. Everywhere they go, they are busy
checking the passports of every cell they
encounter. Whenever they discover a cell that
seems threatening, they immediately begin
countermeasures against it. The biochemical
process behind these countermeasures is amazing! "
Allergies result when this immune system is
hypersensitive, overreactive. When the system
misidentifies harmless proteins as serious enemies
and then reacts out of proportion to the threat,
you get symptoms from this major bodily battle.
Those symptoms may be mildly annoying or a major
illness. Usually for your immune system to
overreact like this you must have a genetic
tendency for it.
After the lymphocyte identifies the foreign
protein (antigen) it goes back to a lymph node
where it changes into a different type of white
blood cell (mast cell). The mast cell manufactures
a chemical called an immunoglobulin that is
exactly configured like a laser ray to destroy the
specific protein that the lymphocyte identified in
the first place. Of the different immunoglobulins
(IgA, IgD, IgE, IgG, IgM), Ig E is the class that
forms an allergic reaction. They attach to other
white blood cells in what is called the
sensitizing exposure,
When the protein comes into the body again, at
least 7-10 days after the sensitizing reaction,
the IgE primed mast cells release many chemicals
including histamine that try to destroy the
"invading" protein. Histamine lowers the local
blood pressure and causes itching and swelling .
It can also cause wheezing, an itchy, runny nose,
nausea, vomiting or diarrhea. That is why "anti-
histamine" drugs are used to treat allergies.
Specific allergies can be identified either by a
blood test for IgE or by a scratch test in which
the suspected allergen is "scratched" into the
skin to see if the body reacts to it with redness
and swelling. A problem with specific
identification of allergies, however is what is
called cross-reactivity. Sometimes proteins of
different but similar substances, e.g., shrimp and
crab meat, can both cause an allergic response
even though the body had previously been exposed
to only one of them. Even so, allergen
identification is very important so that you can
avoid the offending allergen in the first place.
Now why is it important to know the mechanism of
action for allergies? If there is a genetic
disposition for your body to form allergic
responses, there is not much you can do - correct?
No. You basically have two practical choices for
self-care. Identify the causative agents so you
absolutely avoid them and treat with anti-
histamines for mild but annoying allergic
reactions. Unfortunately there is only one self
home test for food allergies that I know of,
Food allergy test kit
and none for other plant/mold fungus allergies.
For those tests you will have to have a doctor's
order and have a blood drawn and sent to a special
laboratory. If you are having serious reactions,
see an allergist for allergen identification and
treatment.
One last tip. The gold standard for diagnosing
allergies are the scratch test sets applied in the
allergist's office. Many times, however, you may
not want to suffer the reactions you get during
testing or you may fear causing a new allergy by
sensitizing through your skin to a new substance
you are not already allergic to. The allergy
doctor may prefer the scratch tests because they
are more accurate but you can ask to have the
blood test done instead, with subsequent scratch
testing if needed, to narrow down the specific
allergen from a general group of substances.
How allergies work
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Tanning salons associated with increased skin cancer
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
It should come as no surprise that those who use
tanning salons are at twice the risk of developing
non melanotic skin cancer as those who do not. At
least that is what a recent study suggests.
Repetitive doses of the ultraviolet wavelength of
light can, over time, stimulate the growth of a
skin cancer. The study in the Journal of the
National Cancer Institute (J Natl Cancer Inst 2002
Feb 6;94(3):224-6) even corrected for those who
previously had bad burns and excessive sun
exposure in the past. There still was an increased
risk in those individuals who used indoor tanning
beds.
There are basically three types of skin cancer:
basal cell skin cancer - starts from the bottom of
the outer skin layer, most common form of skin
cancer
squamous cell skin cancer - arises from the middle
layer of skin cells and occurs mostly in areas
exposed to the sun/tanning rays
melanoma - from middle skin layers and contains
very much pigment (dark like a mole) and dangerous
because it spreads easily to other areas of the
body.
Even though this study looked at the non melanoma
types of skin cancer, all types of skin cancer are
known to increase in frequency with repeated sun
exposure, What can you do to avoid this known
risk? Self tanning lotions are safe to use and can
give you that suntanned look. Avoid any burning of
the skin by using 15 SPF sunscreen or higher when
outside.
You also need to know that the indoor tanning
industry representatives claim that newer
equipment is less cancer producing and produces
ultraviolet rays that are not "as harmful".
However there really is no evidence yet that the
newer equipment makes a difference and until that
time it would be safer to assume that any
repetitive ultraviolet light exposure can increase
your risk for skin cancer.
Ultraviolet Rays, Tanning Salons, And Risks for Cancer
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Finding a cause for hair loss
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"How can one investigate the cause of hair loss
beyond the expected thinning at the onset of
menopause. I took phentermine for a while but the
hair loss continued after stopping. I did lose 30
pounds in just a few months, but the hair loss
continues. Are there tests for deficiencies or
other possible causes?"
"I am 53 and have been 1 1/2 years without a
period." - E.S.
Hair loss can have many different causes from
local agents such as the chemicals in hair
products, to body wide substances that we ingest
or are deficient in from our diets, to natural
hormonal changes such as pregnancy or menopause,
to disease states that affect the skin and hair as
an organ. Ingested causes can be toxic substances
from our water or food as well as medical
prescription drugs or over-the-counter drugs.
In your case the menopause with its decreased
estrogen levels and the dieting are the most
likely culprits in explaining your hair loss. You
did not mention if you were taking any estrogen
supplements for hormone replacement or vitamin and
mineral supplements while dieting but these would
be important to prevent hair loss if you are not
taking them. As far as I know, the phentermine is
not thought to be a drug that causes hair loss
although there are many drugs that can cause it.
Hair cycle growth goes through different phases.
Agents that cause hair sloughing, called
effluvium, can be active in those different
phases. Anagen phase is the growth phase that a
hair goes through and it generally lasts about 6-
10 years for each individual, randomly growing
hair. Catagen phase is a very short deactivation
phase where the hair follicle prepares to go
inactive. Catagen phase lasts only about 2-3
weeks. Telogen phase is the final resting phase of
a hair follicle and it lasts about 30- 90 days. At
any one time, about 90% of hair is in the anagen
growth phase and about 10% is in the resting
telogen phase. When you brush your hair and it
comes out in the brush, that is removing resting
phase (telogen) hair shafts. After resting, a hair
follicle sloughs its shaft becomes active again,
growing a new hair shaft as long as the follicle
itself has not been damaged.
If a disease or substance affects the growing
(anagen) phase of hair, hair loss is massive and a
person can actually lose most (90%) of her hair.
If the disease or substance affects only the
resting (telogen) phase. only about 10% of hair is
lost (although that seems like a massive amount
also) and the loss only lasts for about 3-4
months. Post partum effluvium and hair loss
associated with menopause is mainly due to the
lower estrogen levels put more hair into the
resting phase all at once and then in 1-3 months
there is a significant hair loss - "gobs of
hair". Hair growth will resume as soon as the
hormones are back to normal level.
From www.keratin.com, we can get some lists of the
different causes of hair shedding or "effluviums".
In addition to withdrawal of estrogen hormone,
telogen effluvium can be caused by:
diet deficiencies, particularly lack of iron
crash dieting
fever
ultra violet (UV) radiation
acute blood loss
hyperthyroidism or hypothyroidism
extreme physical stress such as surgery
emotional stress
severe illness
drugs such as:
cholesterol-lowering drugs, clofibrate,
gemfibrozil
anti-histamines/ulcer drugs, cimetidine,
ranitidine, famotidine
anti-coagulant drugs, dicumarol, heparin,
coumarin, warfarin
anti-convulsant drugs, ethotoin, phenytoin,
mephenytoin, trimethadione, paramethodione,
valproate sodium
anti-thyroid drugs, carbimazole, methimazole,
itraconazole, thiouracil
beta blockers/high blood pressure drugs,
acebutolol, diazoxide, nadolol, atenolol,
pindolol, labetalol, metoprolol, propranolol,
timolol
non steroidal anti-inflammatory drugs, aspirin,
fenoprofen, meclomen, ibuprofen, naproxen,
indomethacine, piroxicam, ketoprofen, sulindac
arthritis drugs, penicillamine, auranofin,
indomethacin, naproxen, methotrexate
tricyclic anti-depressant drugs, amitriptyline,
imipramine, amoxapine, nortriptyline, desipramine,
protriptyline, doxepin, trimpramine
vitamin A and derivative drugs, retinoids,
retinol, acitretin , isotretinoin, etretinate,
miscellaneous drugs, allopurinol, aminodarone, azothioprine, azulfidine, bromocriptine, carbamazepine, choramphenicol, clomiphene, clonidine, colchicine, dixyrazine, ethambutol, ethionamide, etretianate, gentamycin, haloperidol, hydantoin, levodopa, interferon-alpha, methyldopa, methysergide, metapyranone, nifrofurantoin, para-amino-salicylic acid, prazosin, probenecid, pyridostigmine bromide, sulphasalazine, terfenadine
toxic chemicals containing:
monomeric/dimeric chloroprene (rubber
manufacturing), potassium bismuth (cosmetic
formulations with "pearlescence"), lithium salts,
iodine, iron, lead, gold, aluminum, arsenic,
boric acid, borates, mercury, selenium, thallium,
zinc
Many of the same triggers that cause hair loss in
the resting phase can also cause hair loss in the
actively growing anagen phase. Since so many hair
follicles (about 90%) are in the growth phase at
any one time, this can result in massive amounts
of hair falling out at once. Causes of anagen
effluvium include:
genetic hereditary disease
defective hormone production other than estrogens
nutrient deficiencies such as copper, iron, zinc,
biotin, essential fatty acids, or vitamin C
cancer treatments
excessive X rays or X ray therapy
toxic agents such as thallium, arsenic, lead,
bismuth, vitamin A and derivatives
Therefore to get back to your question of how you
can go about determining the cause of the hair
loss, be sure that you are on estrogen replacement
and a multivitamin/mineral supplement as you diet.
If you are already on those and are still having
hair loss, see your doctor and ask for the
following:
1. Check the list of any prescription medicines or
over-the counter medicines that you take on a
regular basis to see if any of them cause hair
loss
2. Check a complete blood count (CBC) and serum
iron looking for anemia or iron deficiency/excess
3. Check a TSH, thyroid function study
4. Check a screen for toxic metals and mineral
deficiencies
There are at home thyroid tests (TSH) and mineral
screens you can order on the internet but of
course insurance does not cover the tests unless
your doctor orders them.
TSH at Home Test
Mineral Check Home Mineral Analysis
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Compulsive gambling is an illness
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Most people place wagers or bets at sometime in
their lives but they don't get carried away. There
is quite a difference between buying 1 or 2
tickets on the state lottery and spending 5-10% or
more of your take home wages on bets in the hopes
of "striking it rich". At some point the
compulsive gambler loses control of the betting
process and risks financial ruin to support an
addiction to placing bets.
Almost 3% of adults in the U.S. are considered
compulsive or "problem" gamblers. From the Mayo
Clinic web site we get the following signs and
symptoms of gambling addiction:
You take time from work and family life to gamble.
You secretly gamble.
You feel remorse after gambling and repeatedly vow
to quit. You may even quit for a while and then
start again.
You don't plan to gamble. You just "end up"
gambling. And you gamble until your last dollar is
gone.
You gamble with money you need to pay bills or
solve financial problems. You lie, steal, borrow
or sell things to get gambling money.
When you lose, you gamble to win back your losses.
When you win, you gamble to win more. You dream of
the "big win" and what it will buy.
You gamble when you feel "down" or when you feel
like celebrating.
Many physicians feel that a behavior addiction
like compulsive gambling is a disease due to
imbalances of certain chemicals in the brain. At
least the condition which psychiatrists would
classify as an impulse-control disorder, responds
to many of the psychotropic drugs used for such
conditions. Psychotherapy and referral to
organizations such as the 12 step program of
Gamblers Anonymous are also mainstays of treatment
for this condition.
If you know of anyone who seems to be preoccupied
with gambling, help them seek medical attention
for this.
What Is Compulsive Gambling?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Health tip to share - Perineal clipping to reduce odor
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"One thing that I have figured out that helps
eliminate odors caused by sweating in the vaginal
area is to simply keep the hair closely trimmed as
close to the skin as possible to combat an over
abundance of bacteria growth between the hair
where heat and sweat are trapped. It does not get
rid of the problem, but is sure helps." -
Jennifer
[editor note - If you suffer from vulvar burning
and itching or irritant vulvitis, shaving the hair
is not a good idea since it protects the skin from
irritation.]
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Learn Life From A Dog"
1. Never pass up the opportunity to go for a joy
ride.
2. Allow the experience of fresh air and the wind
in your face to be pure ecstasy.
3. When loved ones come home, always run to greet
them.
4. When it's in your best interest, always
practice obedience.
5. Enjoy it when someone wants to rub your tummy.
6. Take naps and always stretch before rising.
7. Run, romp, and play daily.
8. Eat with gusto and enthusiasm.
9. Be loyal.
10. Never pretend to be something you're not.
11. If what you want lies buried, dig until you
find it.
12. When someone is having a bad day, be silent,
sit close by and nuzzle them gently.
13. Delight in the simple joy of a long walk.
14. Thrive on attention and let people touch you.
15. Avoid biting when a simple growl will do.
16. On hot days, drink lots of water and lie under
a shady tree.
17. When you are happy, dance around and wag your
entire body.
18. No matter how often you are criticized, don't
buy into the guilt thing and pout. Run right back
and make friends.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** Woman's Health Newsletter *******
June 30, 2002
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Continuous BCPs to reduce unwanted symptoms
2. Panic disorder - What is it and can it be treated?
3. Reader submitted Q&A - Uterine lining thickness
4. Psoriasis - a common chronic condition
5. Health tip to share - How much water to drink?
6. Humor is healthy
The next newsletter will be in two weeks.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Continuous BCPs to reduce unwanted symptoms
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
For almost 40 years, the most frequent method of
taking oral contraceptive pills has been the
standard 21 days of active hormonal pills and 7
days of taking "placebo" pills or being off of
the active pills. This allows the menses to take
place but still prevents pregnancy. We have
discussed alterations of this pill regimen to
treat endometriosis or to minimize menstrual
problems but there has not been extensive
experience in reporting how well this regimen
works.
The following study describes the experience of
one Ob-Gyn, Dr. Patricia Sulak, in using an
altered regimen over the years 1993-2000. The most
common regimen used was to take the pills
continuously for 12 weeks (4 pill cycles of active
pills) and then being off for one week before
repeating the regimen. The regimen was varied
however, from commonly 9 weeks of active pills to
over a years worth of active pills before taking a
7 day break and having a menses.
The purpose in using this extended regimen was to
reduce symptoms of symptoms of headache in 35%,
painful menstrual cramps in 21%, heavy or
prolonged menses in 19%, and premenstrual symptoms
in 13%. The remaining 12% of patients used the
regimen because of convenience, endometriosis, and
other reasons such as menstrual-associated acne.
About 90% of the women who were counseled on this
continuous regimen chose to use it. The ones who
did not use it did so because they did not feel
their symptoms were bad enough or they just felt
better having a monthly menses. Of the women who
started this extended regimen, 21% discontinued
birth control pills altogether and 14% returned to
a standard monthly regimen. The rest continued on
with the extended regimen.
Basically this report indicates that this is an
acceptable alternative form of taking oral
contraceptive pills to minimize any menstrual-
related symptoms.
Taking birth control pills without withdrawal
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Panic disorder - What is it and can it be treated?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Panic disorder affects over 1% of the population
at sometime in their lives. There may be a family
inheritance factor involved and women are twice as
frequent as men to have panic disorder. The
"attack" is not just a stressed feeling but an
overwhelming fear that comes on without any
warning whatsoever. The sense of fear induces a
strong bodily reaction because of an outpouring of
epinephrine and norepinephrine. Reactions include:
racing heartbeat
difficulty breathing, feeling as though you 'can't
get enough air'
terror that is almost paralyzing
dizziness, lightheadedness or nausea
trembling, sweating, shaking
choking, chest pains
hot flashes, or sudden chills
tingling in fingers or toes ('pins and needles')
fear that you're going to go crazy or are about to
die
It is amazing how symptoms like these can just
arise out of the blue with no immediate events
preceding them or an event that would not
ordinarily evoke such a strong reaction. The
reaction itself only lasts several minutes but
repeated attacks can occur for several hours.
Probably many people experience one or two such
panic attacks at sometime in their lives. What
makes it a disorder needing treatment, is when you
live in fear of a possible future panic attack.
Usually this takes four or more attacks to really
condition you to fear additional attacks.
Caffeine, exercise and certain medications can act
as triggers for the attacks. Often a person will
develop a phobia based on something that has
triggered an attack in the past.
Panic attacks can be treated but it takes a
therapy combination to really escape the fears of
a future attack. Psychologic counseling is needed
to understand what is going on. Medications can
help significantly as well as avoidance of any
panic triggers. If you think panic disorder may be
a problem, be sure to seek professional help to
diagnose and treat this.
Whether or not you think you may suffer from panic
disorder, you are invited to take a survey to help
determine background knowledge of this problem. In
an effort to increase understanding on panic
disorder and perimenopause in women, one of our
readers, Pamela Balentine, a Ph.D. candidate, is
conducting an Internet based research project and
is seeking women between the ages of 40 to 60 to
participate by taking the Perimenopause Panic
Disorder Survey at:
Perimenopause Panic Disorder Survey
Answers to questions about panic disorder
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Uterine lining thickness
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Had sonogram few days past and it showed the
lining to be 0.86 cm (8.6mm) so now the Dr. wants
to do a biopsy. He says lining should not be over
0.8 (8 mm). Please explain where/what is problem."
I am 58 and on HRT for 2 years, but had a full
period 6 months ago and 4 months ago. I get
spotting occasionally, sometimes bright blood,
sometimes very dark. Started periods at age 10. No
Meds, only vitamins. My Pap 6 months ago was
normal." - anonymous
The endometrial (lining on the inside of the
uterus) thickness on pelvic ultrasound measurement
is an often misunderstood indicator in making
medical decisions about possible uterine
(endometrial) cancer or other pathology. It was
originally developed as a decision factor in women
who are postmenopausal and also having bleeding.
As you may know, uterine bleeding after a woman
has permanently stopped her menses can be a sign
of cancer.
Our medical rule-of-thumb is that any woman who
has postmenopausal bleeding should have a tissue
biopsy of the endometrium or full dilatation and
curettage (D&C) in order to make sure there is no
uterine cancer present or any precancerous tissue
inside the uterus. This is different than cancer
of the cervix, the opening to the uterus (womb)
which is screened for by Pap smear. About 5% of
women with postmenopausal bleeding will have
cancerous or precancerous tissue changes. The
cause of the bleeding in the other 90% is hormone
therapy side effects, a very thin (atrophic)
lining that bleeds easily or simply unknown.
Since over 95% of women with postmenopausal
bleeding have no serious cause of the problem,
pelvic ultrasound measurement of the uterine
lining was investigated to see if its measured
thickness could predict whether a woman was likely
to have an abnormal tissue endometrial biopsy or
D&C. Basically the studies found out that women
who have less than 5 mm endometrial thickness very
rarely turn out to have uterine cancer; at least
much less than 1% of the time.
Therefore, if the doctor ordered an ultrasound for
a woman with abnormal or irregular postmenopausal
bleeding or spotting, and the endometrial
thickness is 4 mm or less, then a somewhat painful
biopsy or D&C can be avoided. If the thickness is
5 mm or more, then the recommendation is still to
go ahead and do a biopsy or D&C. With all of this
being said, there is one recent study that
suggests ultrasound measurements would miss about
4% of endometrial cancers which, if true, means
that we still always need to do a biopsy anyway.
The 8 mm measurement is a different rule. It
actually comes from studies that show the normal
endometrial thickness in asymptomatic postmenopausal
women rarely exceeds 8 mm in size. This means
that if a postmenopausal woman DID NOT have any
bleeding but was found on routine scan to have a
lining 8 mm or more, then she should have an
endometrial biopsy performed. In your case, since
you are having abnormal bleeding, an value of 5 mm
or more would result in the recommended
endometrial tissue sampling.
None of these endometrial thickness rules apply to
women who are premenopausal. Premenopausal women
can have an endometrial thickness up to 20-24 mm.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Psoriasis - a common chronic condition
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Psoriasis is a dull red skin rash with scaly
raised patches or plaques. The scales have a
silver sheen but they usually are not itchy. The
rash characteristically appears first on the
elbows, knees and scalp. From there, it can go to
involve the fingers and toes. This is an inherited
skin condition but it usually needs a trigger such
as a medication, trauma, hormone changes or some
major physiologic event to start it up.
Since the disease is chronic, it really never goes
away. Medications can help the flare-ups, however.
About one fourth of the women who get psoriasis
also develop arthritis, psoriatic arthritis. The
mainstay treatments are ultraviolet lights,
steroid creams and tar creams and shampoos.
Occasionally, anti-cancer drugs like methotrexate
are used to treat psoriasis especially if
arthritis is present.
Since the rashes are present in exposed skin areas
that others can see, it is a disfiguring disease
and can cause psychological or emotional
reactions. That is where the term "the heartbreak
of psoriasis" came from. It is not just a benign
skin rash. In many, the lesions can cover the body
from head to toe. About 75% of people with
psoriasis feel that the disease has a moderate to
severe impact on their daily lives. The number of
people with psoriasis who have contemplated
suicide at sometime in their lives may be as high
as 25%.
Psoriasis
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Health tip to share - How much water to drink?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Water intake, in addition to the natural water
content of food you eat each day, varies depending
upon your exercise level and diet. The average
woman needs about 9 cups (8 oz.) of water a day.
The average diet provides about 3-4 cups of water
a day. Therefore the daily water requirement for a
woman who is not dieting and who is not sweating
from exercise each day, is about 5-6 cups of
liquids to keep from becoming dehydrated. This
would be about four 12 oz glasses or three 16 oz
drinks each day. If you drink 8 ounces of liquid
with each meal, that means you would only need
another 3 cups of liquid a day. Any exercise would
require more water and if your urine is becoming a
strong yellow color then you need more fluid.
Actually many women take in too much fluid in a
day and have urinary frequency and urgency
problems because of it." - FRJ
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Thoughts for the day
1. There's always a lot to be thankful for if you
take time to look for it. For example I am sitting
here thinking how nice it is that wrinkles don't
hurt.
2. If you can't be kind, at least have the decency
to be vague.
3. Don't assume people are intentionally trying to
hurt you when stupidity is probably the best
explanation.
4. The real art of conversation is not only to say
the right thing at the right time, but also to
leave unsaid the wrong thing at the tempting
moment.
5. The older you get, the tougher it is to lose
weight, because by then your body and your fat are
really good friends.
6. The easiest way to find something lost around
the house is to buy a replacement.
7. He who hesitates is probably right.
8. If you think there is good in everybody, you
haven't met everybody.
9. If you can smile when things go wrong, you have
someone in mind to blame.
10. The sole purpose of a child's middle name is
so he can tell when he's really in trouble.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** Woman's Health Newsletter *******
July 14, 2002
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Black raspberries as antioxidants
2. Knee replacement to relieve pain
3. Reader submitted Q&A - Urine overflow
4. Estrogen and progestin HRT 5 year outcomes
5. Health tip to share - Frequent UTIs
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Black raspberries as antioxidants
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
All types of berries - strawberries, blueberries,
blackberries, and raspberries, etc - contain a
good supply of antioxidants. These antioxidants
have a preventative effect on both heart disease
and cancer. Vitamins C and E are some of the best
known antioxidants and black raspberries, which
are different from blackberries, have the very
highest levels of vitamin C.
In a recent animal study, black raspberries were
fed to a strain of rats who had been injected with
a cancer causing agent. The object of the study
was to see if rats, who ate equivalent diets
without the black raspberries, developed more
cancer than those who ate black raspberries as
about 5% of their daily diet. As it turned out,
the animals on the black raspberry diet had 80%
fewer cancers. These results were even 40% better
than when the test was done with strawberries and
blueberries.
This is an animal study and not a human study and
none of us can eat as many black raspberries as
needed to replicate these results, but the lesson
here is to include varied, fresh unprocessed foods
in our diet to remain as healthy as possible. At
about 3/4-1 calorie a berry, fresh berries,
especially black raspberries, can play a role in
anyones diet. Also, it is extremely likely but not
absolutely proven that the fresh food is better
for you than taking a supplement, eg. vitamin C.
Black raspberries also have in them acrocyanins
(the black pigment), phenols, such as ellagic,
coumaric and ferulic acid; calcium; as well as
vitamins A, C, E and folic acid. All of these
substances are known chemopreventive agents.
Black Raspberries a Potentially Powerful Preventive Agent
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Knee replacement to relieve pain
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Chronic knee pain is a difficult health burden to
bear. It can sideline you from any physical
exercise at all. Arthritis roughens the smooth
surfaces of the knee joint cartilage and is the
dominant cause of chronic knee pain.
Osteoarthritis is the most frequent form of
cartilage destruction although rheumatoid
arthritis and traumatic arthritis from a previous
knee injury can also be the etiology.
Normally the thigh bone (femur) glides smoothly
over the shin bone (tibia) when you bend at the
knee. The joint can even slide and rotate over the
lubricated plastic-like cushion of cartilage. When
the cushion becomes pitted or broken, the unusual
friction causes pain.
If the knee joint is painful due to arthritis,
normal treatment includes physical therapy and
strengthening of the muscles around the joint,
anti-inflammatory pain medicines and the long term
use of glucosamine and/or chondroitin sulfate.
This nutrient supplement has been shown to thicken
the knee cartilage over a year or more of taking
it.
When the normal treatment fails to relieve or
significantly lessen the pain, your life may be
affected enough to consider total replacement of
the knee joint. If so, you may want to look at
what is involved in joint replacement. It involves
about 5 days in the hospital and a recovery time
of about 3 months. Then you should be able to
resume walking, dancing, swimming, golfing and
cycling. There are some activities you will have
to give up for the rest of your life, however:
jogging, jumping, lifting over 40 pounds, or any
activities that result in twisting or crawling.
Even a new knee joint made out of synthetic
materials cannot stand these types of abuses.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Urine overflow
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Can you explain what "bladder overflow" is. Plus
how it is treated and if it is dangerous."
"I am 65 years old. Have not had a menstrual
period since I was 50 years old. Had a
hysterectomy, but not for any ailment. Had bladder
surgery. Gyn felt it was safer to perform
hysterectomy."
"I am in very good health except for sudden
bladder overflow. Have urine bag and catheter
until the bladder shrinks back to size." - Sue
Overflow urine incontinence is due to a bladder
that has been over stretched and lost its ability
to contract and fully empty all of the urine when
you decide to void. The overstretching weakens the
bladder detrusor muscle and voiding only occurs
when the bladder reaches the limit of its
stretching (about a quart of urine). the amount
voided is only a small amount (less than a cup)
compared to the total amount of urine inside.
There are basically two causes of bladder over
stretching:
obstructed outflow of urine from the bladder due
to urethral narrowing
loss of nerve supply to the bladder detrusor
muscle due to medical disease or medications
I do not know which of the causes of an
overstretched bladder you have but if you had
recent bladder repair surgery, that can sometimes
(about 2-5% of the time) obstruct the urethra, the
outflow tube from the bladder. If the obstruction
is due to surgery, it often will improve within 3-
6 months after the operation and you will just
need to self-cath or use the Foley catheter until
then. If the obstruction persists beyond 3-6
months, you may need a second surgery to relieve
the tightening of the urethra.
The other main cause of overflow urine leakage is
due to a very weak bladder muscle. This can be
caused by a medical condition such as diabetes
which deadens the nerves to the bladder. There are
some other less common neurological and spinal
cord diseases and surgical causes that can produce
this but your doctor would likely be aware if
those applied in your case.
Medications can also cause the bladder to be weak.
In fact most of the medicines we prescribe for
overactive bladder or urine urgency intentionally
cause the bladder to relax and get bigger. Certain
anti-depressant medications can cause this as well
as any medicine that has an "atropine-like"
mechanism of action. Medicines used for irritable
bowel syndrome would fall in this category for
example.
Treatment of bladder overflow due to muscle
weakness includes discontinuing any medicines that
may worsen it and a program of timed double
voiding. This is a regimen in which you void a
second time less than a minute after voiding the
first time in order to more thoroughly empty the
urine from the bladder. This starts out every hour
during the day for a week and progresses each week
to every 90 minutes, 120 minutes, 150 minutes and
180 minutes (3 hours). Each time schedule is held
for a week. You should not exceed 3 hours without
voiding. This double timed voiding regimen is
probably what the doctor will put you on after the
catheter is removed.
Overflow urine leakage is a serious and somewhat
difficult problem to treat so you will have to
work closely with your doctor to get over it. The
doctor may want you to see a urologist or
urogynecology specialist if it does not seem the
problem is improving with treatment.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Estrogen and progestin HRT 5 year outcomes
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
You may have heard of the Women's Health
Initiative study which was stopped after and
average of 5 years follow-up because of excess
adverse events in the women who were using hormone
replacement therapy (Prempro). I think it is
helpful to look at the benefits and risks that the
study found
The study looked at over 16000 postmenopausal
women aged 50-79 who had a uterus and were
candidates for hormone replacement therapy (HRT)
with estrogen and progestin. Half of the women
took HRT and half had placebo. The main outcomes
they looked for were cardiac problems and strokes
but they also looked at new cancers that occurred
even though those cancer probably had started
before the study was ever begun.
They found more of the following events for each
10,000 women years of HRT use:
7 more coronary heart disease events,
8 more strokes,
8 more pulmonary emboli,
and 8 more invasive breast cancers
There were some benefits and they found the
following LESS events for each 10,000 women years
of HRT use:
6 fewer colorectal cancers
and 5 fewer hip fractures.
There were no differences in the number of deaths
in either group.
Well what can we conclude about these results?
They actually are not much different than other
previous studies, i.e., there is a very small
increase in the risk of breast cancer with HRT.
Almost one extra woman will develop breast cancer
for each 100 women using HRT for 10 years. This
low incidence is offset by less women on HRT who
develop colorectal cancer and hip fractures which
are as serious as cancers since they can often
result in death.
An increase in heart disease and serious vascular
problems (2.3 more per 100 women using HRT for 10
years) over the first 5 years of HRT use is where
the main disadvantage is. Even though these women
did not have heart disease at the start of the
study, this is similar to the HERs study which
demonstrated an increase in vascular problems
early in the study and a lowering later in the
study. If estrogen has a preventative effect on
the future development of heart disease, it is a
long term effect and in the short run there
appears to be a small adverse effect.
Although most studies that have looked at long
term HRT use conclude that the overall death rate
is less with HRT therapy than without it, this
study will not be able to confirm or refute that
since it was stopped early. Also a woman needs to
keep in mind that this study does not apply to
those who are taking only estrogen therapy i.e.,
probably having had a previous hysterectomy. There
is some suspicion that the progestin component of
HRT (medroxyprogesterone acetate) may be the cause
of cardiovascular problems.
Overall the study results are not a reason for
women to discontinue HRT but you certainly should
talk over the pros and cons which might apply to
your own specific health history and that of your
close blood relatives.
Risks and benefits of estrogen plus progestin in
healthy postmenopausal women
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Health tip to share - Frequent UTIs
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I suffer from frequent bladder/urinary tract
infections. I remember my first one at 7 years
old. Over the years I have seen many doctors about
it and basically all I get is antibiotics when I
have an infection. I have now found a way to keep
the problem under control and get rid of it
naturally if I do get an infection."
"CranActin(cranberry extract pills) is known for
discouraging bacteria from clinging to the walls
of the urethra and thus is flushed out much easier
when voiding. I take one cap in the morning, two
at about 2 pm and another in the evening with a
big glass of water. If I do wind up with an
infection (usually just in the urethra) I double
up on them and the pain is usually gone in one or
two days."
"I really have been to many doctors(specialists).
Have had laparoscopies, bladder biopsy,
cystoscopy." - Debbie
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Hearing Problem"
A concerned husband went to a doctor to talk about
his wife. He says to the doctor, "Doctor, I think
my wife is deaf because she never hears me the
first time and always asks me to repeat things."
"Well," the doctor replied, "go home and tonight
stand about 15 feet from her and say something to
her. If she doesn't reply move about 5 feet close
and say it again. Keep doing this so that we'll
get an idea about the severity of her deafness."
Sure enough, the husband goes home and does
exactly as instructed. He starts off about 15 feet
from his wife in the kitchen as she is chopping
some vegetables and says, "Honey, what's for
dinner?" He hears no response. He moves about 5
feet closer and asks again. No reply. He moves 5
feet closer. Still no reply. He gets fed up and
moves right behind her, about an inch away, and
asks again, "Honey, what's for dinner?"
She replies,
"For the fourth time, vegetable stew!"
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** Woman's Health Newsletter *******
July 28, 2002
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Aloe vera and its healing properties
2. Women and testosterone
3. Reader submitted Q&A - Polyps on gyn exam
4. Persistence in taking cholesterol lowering drugs?
5. Health tip to share - Cranberry juice
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Aloe vera and its healing properties
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Even though the cactus-like plant, aloe vera, has
been used for generations to promote healing of
wounds and relieve skin burning, we still do not
know much about how it works. The active
ingredients are probably in the gooey gel from
inside the leaves because that is why you break
open the leaf to get the thin, sticky gel and rub
it on a skin cut, sore or burn. Wounds that take 3
weeks to heal will often completely heal in 2
weeks. It may be used as a skin soap on patients
undergoing radiation therapy to delay or prevent
some of the redness from the xray therapy.
Patients with psoriasis also seem to benefit from
it and aloe has also been shown to be helpful for
constipation when used by mouth.
Some investigators believe the healing properties
are from the vitamins and other chemicals in the
goo, while others believe the goo is simply acting
as a moisturizer and barrier that promotes more
rapid healing. Recent investigators found that the
gel-like substance contains "pectin", the
substance one uses to make jelly. The aloe vera
pectin is made of different carbohydrates than the
pectin used in cooking but it is similar in its
"gooey ness" properties.
With any plant product, a skin allergic response
can develop or photosensitivity take place. With
photosensitivity, the skin appears normal at first
but as soon as sun shines on the skin, a redness
quickly develops. So be careful.
Aloe vera and its healing properties
