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****** Woman's Health Newsletter *******
August 25, 2002
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Exercise helps fibromyalgia
2. Measuring blood pressure at home
3. Reader submitted Q&A - Surgery to lose weight
4. Eye strain and your computer screen
5. Health tip to share - Smoke-free workplaces
6. Humor is healthy
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1. Exercise helps fibromyalgia
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Muscle aches and pains are common complaints and
affect as many as 1 in 7 or 8 people at any given
time. Fibromyalgia is the extreme end of the
spectrum in which there is constant muscle pain
with multiple points of touch tenderness all over
the body. It can affect as many as 1% of the
population and is a chronic disease about which
not much is known. Pain medicines and non
steroidal anti-inflammatory drugs (NSAIDs) are
commonly prescribed but like most treatments for
this, they are ineffective.
A person who is having constant muscle pain tends
to be physically inactive for fear of worsening
muscle soreness. Using this principle to design an
aerobic cardiovascular exercise program, a group
of investigators in London conducted a study to
see if exercise improved or worsened the pain of
fibromyalgia.
There were 69 men and women in the active exercise
group and they were compared to 67 in the control
group who were just taught muscle relaxation. The
exercise group started out with as little as 6
minutes of exercise twice during an hour session
on a daily basis. The sessions built up to two 25
minute exercise periods over the 12 weeks of the
study. The investigators then looked at how each
group did at the end of the 12 weeks.
At 3 months, the exercise group reported moderate
or significant improvement in 35% of people
compared to only 18% of the control group
undergoing relaxation therapy. More importantly,
the muscle point tenderness count which is used to
diagnose fibromyalgia went down enough so that 45%
of the study group no longer qualified to be
labeled as having fibromyalgia. The results
persisted out to 12 months.
While the above improvement rates do not seem very
high, for a medical condition that is still
unexplained and has no successful treatments,
these results are encouraging.
Exercise helps fibromyalgia
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Measuring blood pressure at home
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
There can be quite a large difference between the
blood pressure recorded at the doctor's office and
one that you have taken yourself or had someone
else take at home for you. The difference is not
because the doctors or the doctor's nurses are
more accurate reading the systolic (upper number)
and diastolic (lower number) blood pressure. The
difference is real and is called the "white coat
effect" because most people's pressure goes up
when visiting the doctor.
This study below from Southampton England measured
ambulatory blood pressure taken at home or
anywhere outside the physician's medical office by
anyone other than a doctor and compared it to
blood pressure measurements taken by a nurse or a
doctor at the physician's office. They found that
on the average:
systolic blood pressure was almost 19 mm Hg
different (higher) in the physicians office
diastolic blood pressure was 11 mm Hg different
(higher) in the doctor's office
there was poor correlation between the readings
conducted in the doctor's office versus readings
that patients and others obtained themselves by
ambulatory measurement.
The existence of a "white coat hypertension" has
been known for many years. That is why doctors are
hesitant to newly diagnose hypertension without
first seeing what blood pressure measurements are
obtained outside of the physician's office on at
least several occasions. Then if the blood
pressure increase persists with multiple
readings, it is time to start the appropriate
treatment.
This study confirms that there is such a poor
correlation between the blood pressure readings
taken at home (ambulatory) and those in the
doctor's office that the doctor's office reading
should not be used to make any decisions about
therapy. Anyone with hypertension should have
their own blood pressure cuff at home that they
can use to monitor what the pressure is doing.
Measuring blood pressure at home
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3. Reader submitted Q&A - Surgery to lose weight
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I am interested in getting the gastric ring put
on to help me lose weight. What are the pro's and
con's with this surgery, and who makes a good
candidate? Do you have to be a certain amount
over weight?"
"Weight problems run in my family. I have always
had a weight problem, with constant up and down
gain and losses. I have a thyroid condition that
also hinders whatever dieting I do. I am
considered hypothyroid. I am 37 years old and
really am tired of the way I look. Do any of the
insurance companies cover this?" - BWP
There are quite a few different operative
procedures to help people lose weight. Gastric
ring surgery is one of them and it has its
benefits and drawbacks just like most of the other
procedures. They all can have some serious
complications so should not be taken lightly.
The criteria for how much overweight you have to
be can vary from state to state or country to
country. Many hospitalization insurance plans
require a person to have a body mass index (BMI)
of over 40 in order to pay for the surgery
assuming the specific plan covers this type of
surgery at all. A BMI of 40 or more would be
about:
5'0" - 204 lbs or more
5'3" - 225 lbs or more
5'6" - 247 lbs or more
5'9" - 270 lbs or more
The basic principle behind any obesity surgery is
to make the stomach much smaller in its capacity
so that it only holds about an ounce or two of
food. Thus the early stretching of the walls of
the stomach sends a signal back to the brain to
say "I'm full" and therefore presumably you will
eat less. Also the sugars in a meal do not get
absorbed in the stomach and they empty directly
into the intestine. This over stimulates the
intestine so you get very loose stools or
diarrhea. It is a way of cautioning you to not eat
simple sugars very much. All in all, the banding,
stapling or bypass surgical procedures are a way
of altering your eating behavior and making food
less important. If you eat too much and force the
very small stomach pouch to dilate or the rings to
slip or staples to come out, then you can undo the
benefits of the surgery.
Some of the procedures are performed through an
abdominal incision from the bottom of the breast
bone to the navel. Sometimes the procedure is
performed via laparoscopy but my understanding is
that those procedures are not as successful
although they are certainly less invasive.
Complications vary with each different procedure
so you need to carefully discuss with the surgeon
the exact expectations of the surgery you two
decide upon. Over all, some of the serious
complications reported include:
wound infection or rupture 3-4%
death 0-1%
hernia 7%
lung problems 1-2%
re operation 5-10%
slippage or infection of a band or ring
loosening of staples
Side effects include:
difficulty swallowing
vomiting
gastric reflux
diarrhea
Benefits include:
90% of patients reach a weight loss of 25% of
their excess weight
one third reduce excess weight by 75%
10% may reach normal weight
Do not think that this surgery is a simple
procedure. It may be appropriate for you but it is
very important that your expectations are in line
with what the outcome is likely to be.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Eye strain and your computer screen
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Many individuals spend a considerable amount of
time in front of a computer monitor whether it is
for work or entertainment. After a while, the
eyestrain and lack of bodily exercise starts
producing fatigue and discomfort. There is no
evidence that looking at a monitor for hours at a
time causes long term serious health consequences
but you can certainly feel physically bad doing
it.
When you start developing any of the following
symptoms you know you need to take steps to get
out of the rut:
tired, burning, itchy eyes
blurred or double vision
distance vision blurred
headache, sore neck
difficulty shifting visual focus between monitor
and source documents
difficulty focusing on the screen image
color fringes or afterimages when you look away
from the monitor
increased eye sensitivity to light
To prevent problems, you should have your
equipment set up to minimize any eye, neck or
muscle strain. Position the monitor so that the
middle of the monitor is exactly at your eye
height. That way you do not need to hold your head
and neck looking up or down. The monitor and
keyboard should be directly in front of you so you
do not have to hold use any rotational muscles
tense while doing your work.
If you use the mouse much more than the keyboard,
you may consider getting a shortened keyboard (80
keys) so that your hands don't constantly rest
wider than your shoulders. Prolonged periods in
this position will cause "mouse shoulder".
Finally, you need to change your work habits
otherwise you will develop chronic muscular and
visual disturbances. Take a visual break every 10
minutes for 10 seconds or more to rest your eyes.
Focus on a distant point and relax the intensity
of your concentration. Get up from the chair and
move around every hour and a half. This not only
allows the muscles some rest but helps prevent
blood clots in the legs from sitting in one
position too long.
Blinking can help dry eyes. Sometimes
concentration is so intent that people at a
computer blink only once a minute when blinking
every 5 seconds is the norm. If you feel your eyes
becoming dry. make a conscious effort to blink
frequently as well as taking "eye breaks" more
often. Also do not forget the glare of room lights
on the monitor. It can significantly contribute to
eye strain and is relatively easy to change to
produce less strain..
Eye strain and your computer screen
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Health tip to share - Smoke-free workplaces
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Smoke-free workplaces not only protect non-smokers
from the dangers of passive smoking, they also
result in more smokers quitting and a reduction in
smoking by those who continue. If you do not work
in a smoke-free workplace, see if there is some
way that you can encourage the bosses to change
the rules.
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Mid life"
Mid life is when you go to the doctor and you
realize you are now so old, you have to pay
someone to look at you naked.
The good news about mid life is that the glass is
still half-full...of course, the bad news is that
it won't be long before your teeth are floating in
it.
Mid life women no longer have upper arms, we have
wingspans...we are no longer women in sleeveless
shirts, we are flying squirrels in drag.
Mid life has hit you when you stand naked in front
of a mirror and can see your rear end without
turning around.
You know you are getting old when you go for a
mammogram and you realize it is the only time
someone will ask you to appear topless in film.
You know you've crossed the mid life threshold
when you're in the grocery store and you hear a
Muzak version of "Stairway to Heaven" in the
produce department.
Mid life is when you bounce (a lot), but you don't
bounce back. (It's more like Splat!)
Mid life brings the wisdom that life throws you
curves... and that you're now sitting on your
biggest ones.
It's very hard to "get jiggy with it" in
midlife...jiggly, yes; jiggy, no.
Mid life is when your 1970s Body-by-Jake now
includes Legs-by-Rand McNally. (more red and blue
lines than an accurately scaled map of the state
of Wisconsin).
Mid life is when you want to grab every firm young
lovely in a tube top and scream, "Listen, honey,
even the Roman Empire fell, and those things will
too!
Mid life can bring out your angry, bitter side.
You look at your latte-swilling, beeper-wearing
know-it-all teenager and think, "For this I have
stretch marks?"
Mid life is when you start to repeat
yourself...and your chins follow suit.
Mid life is when you realize that if you were a
dog, you'd need a control top flea collar.
Mid life is when your memory really starts to go.
The only thing you still retain is water.
You become more reflective in mid life. You start
pondering the "big" questions-- what is life, why
am I here...how much Healthy Choice ice cream can
I eat before it's no longer a healthy choice?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
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****** Woman's Health Newsletter *******
September 8, 2002
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Ginkgo biloba for memory enhancement
2. Night vision problems
3. Reader submitted Q&A-Exercise and lethargy
4. Endometrial biopsy
5. Health tip to share - Computer eye strain
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Ginkgo biloba for memory enhancement
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Ginkgo biloba is an over-the-counter herbal
supplement that has been advocated to improve
memory and thinking function. Since there has not
been very good evidence one way or the other as to
whether ginkgo works, this study from
Massachusetts looked at a randomized trial of 203
men and women over 60 years of age to see if 40 mg
three times of day of either ginkgo or placebo
enhanced performance on standardized memory and
problem solving tests.
The principle behind ginkgo is that it is thought
to dilate small blood vessels in the brain which
in turn increases the oxygen to brain cells. The
question has always been does it do that enough to
really affect how our brain works. People have
used ginkgo trying to improve dementia and even
just forgetfulness with age but there has not been
hard evidence that it works at all.
The investigators of this study found that after
taking ginkgo for 6 weeks at the three times a day
dosage that there was no difference in memory or
cognitive function versus just taking a sugar pill
(placebo). That is, in men and women over 60 who
do not have any impairment of mental function
already, taking ginkgo is not effective at all.
Gingko for memory enhancement
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2. Night vision problems
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Why is it more difficult to see distances at
night? Of course low light levels play a role but
many people complain that even with the low light
levels they still have trouble seeing any distance
that they feel they should still be able to see.
This is most prominent with driving in which near
distance is not a problem but far distance is.
Nearly 40% of persons over the age of 60 have
reduced night driving ability. Most of the time
adults under the age of 45 are able to focus
instantly between short and far distances. At
night, however, even young people sometimes lose
this ability to instantly shift focus between near
and far. Some call this night myopia or night
"near-sightedness". The pupil is dilated more at
night and this leads to blurriness of vision at a
distance. Sometimes this can simply be corrected
by a change in glasses prescription or a new
prescription for glasses if you do not already
wear them.
Halos and reflections around lights at night may
be a different problem. Glare from lights is often
due to a windshield that is not clean or contact
lenses or eyeglasses that also need cleaning.
Glare is different than blurry vision. It can also
produce multiple images and if you see those, a
good cleaning of windshields and any eye lenses is
mandatory. Cataracts is one medical condition that
can cause both glare and blurry vision. A visit to
the doctor will quickly clear up whether cataracts
are a problem.
Do special glasses that you see advertised, e.g.,
amber glasses, help night driving vision? There is
no evidence for this and any tinted glasses at
night may reduce vision rather than enhance it.
There are some glasses with anti-reflective
coatings that have been shown to improve night
glare.
in summary, be sure to keep your windows and
eyeglasses clean and your eyes checked. If you have
difficulty driving at night, slow down and keep
your eye on the curb.
Night vision problems
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Lack of exercise and lethargy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"What is the medical scenario that results in
lethargy when a person does not exercise? I have
been trying to list in my mind the bodily
functions/states in poor conditions that lead to
the sleepiness, gasping on exertion, depression,
desire to sit all the time and general feeling of
malaise but I cannot.
"I am 48, no menstrual problems, no menopause
symptoms yet, no medication. I exercise regularly.
I have done creative dance and weights regularly
(since age 23) up to 2 years ago. The past two
years I have done treadmill jogging and stretching
exercises from my dance knowledge. When I take a
three week break I am so listless I feel just
about to die. The minute I start again I feel
like a kid. The difference is so vast that it
amazes me and I am really keen to find out what
are the physiological changes in the body that
cause the vast changes." - Lawayne
It doesn't make sense that lack of exercise can
actually make you more tired and lethargic. You
are asking also why exercise makes you feel so
much better rather than being worn out. This is
also a significant problem when a medical
condition interferes with one's usual physical
activity level. We frequently observe that
postoperative fatigue and tiredness is due in
large part to the lack of normal physical activity
after a surgical procedure. Any illness or injury
that forces a person to have increased bed rest or
any reduction of their normal energy expenditure
also causes additional fatigue that you have to
recover from, in addition to the illness or
injury.
Muscle fatigue receives very little attention in
textbooks of medical physiology. In general,
muscle movement depends upon stored sugar
(glycogen) for energy to contract muscle fibers.
Muscle enzymes must be present in high enough
amounts to produce that energy from stored sugar
almost instantly. When energy is produced from the
muscle enzymes working on stored glycogen and
muscle contractions take place, calcium is
consumed, and lactic acid is produced which
accumulates in the muscle cells. This lowers the
pH (makes cell fluids more acidy) and releases
phosphorus. Any condition which lowers muscle
glycogen, oxidative phosphorylation enzymes or
calcium will cause fatigue and lethargy. However
the body replenishes the calcium and clears lactic
acid very quickly upon discontinuing the exercise.
Muscle glycogen is only depleted and unreplenished
with severe dieting or starvation. The energy
producing muscle enzymes are another matter
however.
Lack of exercise itself significantly reduces the
amount of muscle enzymes present and is thought to
play a major role in producing fatigue or the
feeling of muscle weakness. On the other side of
the coin, exercise revs up the production of
energy producing muscle enzymes such as citrate
synthatase and 3-OH-acyl coenzyme A dehydrogenase.
When these levels are high, instant energy from
glucose can be produced whereas low levels impede
the ability of the muscle to respond to demand.
Thus it is an "out-of-whack" feedback loop whereby
lack of exercise makes you feel weak and muscle
tone and capability becomes lower and lower. If
you put a healthy person to bed rest and do not
allow them to get out of bed at all, they will
become weaker and weaker until they can hardly
walk at all when they are allowed up. Astronauts
have the same problem when they live in a zero
gravity environment because when muscles do not
have to work against gravity, that is the same
effect as bed rest.
Exercise and physical activity stimulate muscle
enzyme production and this provides quick muscle
energy which makes you feel better (younger too).
If we have been without exercise for awhile, we
should not be amazed at how much better we feel
after a workout. Rather, we need to remember --
tiredness means get active.
Exercise also has another positive benefit. It
releases hormones called endorphins. Endorphins
are "feel good" hormones. They help block pain
and increase our mental "sense of well being".
This may also be the reason you feel so much
better after exercise. In any case I'm glad you
asked this question because it reminds us to keep
up our physical activity on a regular basis.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Endometrial biopsy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Endometrial biopsy is an office diagnostic
procedure that is quite different than a Pap
smear. The Pap smear scrapes loose skin cells off
of the cervix so a trained cytologist can look for
cells that indicate cancer of the cervix (the
mouth of the womb/uterus). It can also pick up
precancerous cells called dysplasia. The Pap
smear, however, is very poor at picking up cells
from inside of the uterus that would be produced
by a uterine (endometrial) cancer. This is one
role for the use of the endometrial biopsy.
An instrument is inserted through the cervix and
up into the inside of the uterus. Skin cells
lining the cavity of the uterus are scraped or
suction is applied to get a tissue sample for the
pathologist to look at. Anesthesia is not usually
used so there is often some pain associated with
the procedure. Uterine cramps can last for several
minutes to several hours afterward but they can be
lessened by taking a non steroidal anti-
inflammatory drug like ibuprofen or naproxen about
30 minutes prior to the procedure.
The endometrial biopsy is often used to diagnose
abnormal uterine bleeding due to cancer or
precancerous cells of the uterine lining. Many
women over age 40 who have abnormal uterine
bleeding will undergo this procedure. Sometimes it
can also pick up benign endometrial polyps but is
also can miss them frequently so the doctors do
not rely on a biopsy to diagnose polyps.
Endometrial biopsy may also be used in an
infertility work up. In this case the biopsy is
performed in the last week of a menstrual cycle in
order to look at the endometrium to see if it has
insufficient hormonal effect to optimize
conception (luteal phase defect). Also looking at
the tissue from biopsy confirms ovulation although
that is now often confirmed by serum progesterone
tests rather than biopsies.
Endometrial biopsy
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5. Health tip to share - Computer eyestrain
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Concerning eye and neck strain and computer use -
those with bi or tri focals will tend to tip their
head back with the screen at recommended level
(producing neck strain). Note there are (comfort)
advantages of having a separate pair of glasses
for using at the comptuer with the full lens
corrected for distance to screen." - Don White
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"25 Things You Should Have Learned By The Time
You Have Reached Middle Age"
1. If you're too open-minded, your brains will
fall out.
2. Age is a very high price to pay for maturity.
3. Going to church doesn't make you a Christian,
any more than standing in a garage makes you a
car.
4. Artificial intelligence is no match for natural
stupidity.
5. If you must choose between two evils, pick the
one you've never tried before.
6. My idea of housework is to sweep the room with
a glance.
7. Not one shred of evidence supports the notion
that life is serious.
8. It is easier to get forgiveness than
permission.
9. For every action, there is an equal and
opposite government program.
10. If you look like your passport picture, you
probably need the trip.
11. Bills travel through the mail at twice the
speed of checks.
12. A conscience is what hurts when all of your
other parts feel so good.
13. Eat well, stay fit, die anyway.
14. Men are from earth. Women are from earth. Deal
with it.
15. No man has ever been shot while doing the
dishes.
16. A balanced diet is a cookie in each hand.
17. Middle age is when broadness of the mind and
narrowness of the waist change places.
18. Opportunities always look bigger going than
coming.
19. Junk is something you've kept for years and
throw away three weeks before you need it.
20. Experience is a wonderful thing. It enables
you to recognize a mistake when you make it again.
21. By the time you can make ends meet, they move
the ends.
22. Thou shalt not weigh more than thy
refrigerator.
23. Someone who thinks logically provides a nice
contrast to the real world.
24. It ain't the jeans that make your butt look
fat.
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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 *******
September 22, 2002
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Thyroid diagnosis and management
2. Indoor air pollution
3. Reader submitted Q&A - Connected gyn conditions?
4. Carpal Tunnel Syndrome Treatment
5. Health tip to share - Vinegar for dandruff and warts
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Thyroid disease and management
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Thyroid disease can be more complex than many
people realize. Although the most common abnormal
thyroid condition is primary hypothyroidism, there
are many other possible causes. Most of the other
causes are rare except for autoimmune thyroiditis.
Hypothyroidism occurs much more frequently in
women than men. Some estimates put hypothyroidism
at an annual occurrence rate of 4.1/1000 per year
in adult women. In other words over a 10 year
period, 4% of women may develop hypothyroidism.
High thyroid function called hyperthyroidism, is a
less common problem but if it gets severe, it can
be more life threatening than hypothyroidism. The
heart rate becomes greatly increased and a person
can develop fever and abnormal heart rate rhythms.
This condition is called thyrotoxicosis with the
most severe end of the scale being called thyroid
"storm". These patients must be hospitalized and
can die if not quickly treated.
The primary screening test for thyroid disease is
the TSH - thyroid stimulating hormone. It is
extremely sensitive and can detect what are called
subclinical conditions. In fact when most women
have an elevated TSH value (indicating low
thyroid function), it is very likely that any
symptoms they are having are not because of low
thyroid function. This category is subclinical
because the actual thyroid hormones, T3 and T4,
are still in normal range. The thyroid gland may
be working hard to keep T3 and T4 in normal range
and the body's function normal, but eventually T4
will decrease and then T3 will also decrease as
the gland loses function.
The three stages of hypothyroidism and their lab
values are:
subclinical TSH elevated, T4 normal, T3 normal
mild TSH elevated, T4 decreased, T3 normal
overt TSH elevated, T4 decreased, T3 decreased
Therefore if you have a TSH that is elevated, the
doctor will then draw blood tests for T4 and T3
which will tell how bad the low thyroid function
is. Subclinical function may cause some menstrual
abnormalities but most often there are no symptoms
at all. Mild hypothyroidism will produce symptoms
of fatigue and weight gain (increased fat) and
possible dry skin. Overt hypothyroidism produces
the above but also facial swelling, voice
deepening, hair loss, and mental problems.
High thyroid function is called Grave's disease.
Most commonly it is caused by the body's immune
response to its own cells in which thyroid
stimulating antibodies are formed. Symptoms
include a faster heart rate, being hot all of the
time, swelling of the lower legs and even having
you eyes start "bugging out". Treatment for this
may be medical or surgical. but in either case you
should be under the management of a physician
promptly after diagnosis.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Indoor air pollution
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Air in your house can be as polluted as outside
air if there is not a free flow of air circulation
from the inside to the outside. Many houses are
built fairly air tight and do not allow harmful
gases such as carbon monoxide, cigarette smoke or
radon gas from the ground to get out. Gases, toxic
fumes, and molds can also be culprits in producing
symptoms such as:
irritated eyes
runny nose
nasal congestion
scratchy throat
coughing
rashes
fever
nausea
headaches
dizziness
confusion
fatigue
Anyone with allergies or asthma can significantly
be affected by indoor air pollution and figuring
out exactly what are the toxic problems can be
challenging. Be sure to use your nose to tell if
there is any toxin around. Most toxins have a
smell except for ones like carbon monoxide and
radon. Carbon monoxide comes from tobacco smoke,
car exhaust, fireplaces, incinerators, gas
appliances and furnaces. Homes should have carbon
monoxide detectors just like a smoke detector. You
can purchase them at a local hardware store.
About 7% of homes have a problem with radon gas
which comes up from the ground. Radon can break
down into radioactive particles that become
attached to particles in the air. Chronic exposure
to radon is associated with an increased incidence
of lung cancer. There are home testing kits for
radon available at hardware stores and over the
internet.
If your house is air tight and prevents
ventilation, there are solutions other than just
keeping the windows open. You may want to consider
an air-filtration system or a heat-recovery
ventilator. If you have a forced-air furnace or
air conditioner, you should investigate about
higher-grade filters since most systems use very
poor particle filters. The metal anti-allergy
filters may work well for this but remember that
even the best filter will not remove carbon
monoxide, radon or other aerosol chemicals.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Connected gyn conditions?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I have been diagnosed with persistent, simple
endometrial hyperplasia, endometriosis, and a
'severely' tilted uterus. What, if any, is the
connection among these three conditions, and how
do they affect fertility?"
"I am thirty eight (almost 39) YOA; onset of
menses, 11; BCPills 22-31; Difficult periods with
mid-cycle bleeding. D and C, Laparoscopy, and
hysteroscopy in Dec 2000--endometrial polyps,
hyperplasia, adhesion of ovary to bowel, and
endometriosis (mild). Currently undergoing third
month of three month dosage of prometrium--400 mgs
per night. Repeat endometrial biopsy coming up."
- psmd
There are some connections between endometriosis,
a severely tilted or "retroverted" uterus and
simple endometrial hyperplasia.
Endometriosis is the presence of endometrial
tissue outside of the uterus but inside the
abdominal cavity. Most endometriosis comes from
menstrual tissue that goes backwards out the tubes
at the time of menses rather than through the
cervix and vagina like it was meant to. Any excess
tissue in the uterus such as that with endometrial
hyperplasia would be reason enough to promote
endometriosis although you do not need any
hyperplasia to have endometriosis.
Once endometriosis develops in the abdominal
cavity, scarring of the pelvic organs can take
place because of the inflammatory reaction to the
endometriosis speckles of tissue that dot the
abdominal cavity lining as they slough tiny
amounts of blood and tissue at the time of the
menses. This scarring reaction causes the bowel to
stick to the ovary, the tubes to stick to the
pelvic walls and the back of the uterus to get
stuck to the bottom of the abdominal cavity so in
effect the uterus becomes "tipped" permanently.
Estrogen that is not opposed by much progesterone
in the circulation can over stimulate the lining
of the uterus so that it grows excessively
(hyperplasia). Estrogen may come from ingested
medications, supplements, foods or excess body
fat. If ovulation is not regular, progesterone may
not be produced on a regular monthly basis. Rarely
there can be tumors of the ovaries or lungs that
produce excess estrogen but it would be highly
unusual.
Excess body estrogen could be behind all of the
problems but since endometriosis is not usually
related to excess estrogen, we cannot say that
unopposed (no or low progesterone) estrogen ties
together the three problems you mentioned. In
other words there could be more than one cause for
the hyperplasia and the endometriosis and its
related scarring.
All of the above conditions can affect fertility.
If the lining of the uterus is hyperplastic,
implantation of a fertilized embryo may not take
place. Endometriosis can also affect fertility by
scarring which blocks the normal function of the
tube sweeping the ovary to pick up the egg and
transport it down the tube to meet the sperm. If
the uterus is stuck in a backwards "tipped"
position then scarring may be too severe to let
the monthly egg get into the tubes. Thus all of
these conditions can make it much more difficult
to conceive. If you also factor in the age of 38
or 39 with its known effect on weakening ovulation
it may be even longer and harder to conceive
although it is not impossible. I would guess with
all of these conditions that the chance of
pregnancy over the next year of trying would be
about 20%. In vitro fertilization is a possible
consideration.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Carpal Tunnel Syndrome Treatment
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Carpal Tunnel Syndrome (CTS) is a pinched nerve
condition. When the median nerve that goes to the
hand is compressed by one of the ligaments which
it passes under at the wrist, numbness and hand
weakness can result. Usually the thumb, index,
middle and part of the ring fingers lose sensation
and eventually the muscles become weak so a person
loses her/his grip.
Traditional treatment for this problem has been to
wear a wrist brace (splint) so the nerve will not
be pressured by bending the wrist. Then if that
does not work after several months, surgery to cut
the ligament and release pressure is often
recommended. Surgery has been quite successful for
this condition so the question comes up as to
whether it should be the primary treatment.
The following study from the Netherlands looked at
the short term (3 months) and long term (18
months) pros and cons of randomly assigning
patients to either splinting or surgery as their
primary treatment. They found that at 3 months,
80% of the surgery group had significant
improvement in their symptoms where as only 54% of
the splinting group got relief. At 18 months the
surgery group had a 90% success rate. The group
that started out with splinting as their primary
treatment had a 75% success rate but only because
by that time 41% of them had switched over to
having surgery as treatment because the splinting
did not work for them.
This study mainly shows that it is very reasonable
to consider surgical treatment for Carpal Tunnel
Syndrome as the first line of treatment rather
than going through 3 months of splinting first.
The strategy of splinting first and then having
surgery if that does not work is less successful.
Carpal Tunnel Syndrome Treatment
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Health tip to share - Vinegar for dandruff and warts
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I use Bragg's apple cider vinegar for dandruff
and for the removal of warts on my hands.To get
rid of the dandruff you simply apply to the scalp
for at least five days and leave on about one
hour after which you wash and continue the next
day and so forth.To remove the warts just before
retiring for bed apply with a piece of cotton and
after two weeks soak the area with pot salt and
cut with a stainless steel surgical blade if you
have diabetes you must just apply the vinegar
without the use of the surgical blade. Another
helpful tip to use the vinegar for weight control
I find it works for me I lost at least ten pounds
together with exercising." - Sue Mari
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Words Women Use...
FINE - This is the word we use at the end of any
argument that we feel we are right about but need
to shut you up. NEVER use fine to describe how a
woman looks. This will cause you to have one of
those arguments.
FIVE MINUTES - This is half an hour. It is
equivalent to the five minutes that your football
game is going to last before you take out the
trash, so I feel that it's an even trade.
NOTHING - If you ask her what is wrong and she
says NOTHING, this means something and you should
be on your toes. NOTHING is usually used to
describe the feeling a woman has of wanting to
turn you inside out, upside down, and backwards.
"Nothing" usually signifies an argument that will
last FIVE MINUTES and end with the word FINE.
GO AHEAD (with raised eyebrows) - This is a dare.
One that will result in a woman getting upset over
NOTHING and will end with the word FINE.
GO AHEAD (normal eyebrows) - This means "I give
up" or "do what you want because I don't care."
You will get a raised eyebrow "Go ahead" in just a
few minutes, followed by NOTHING and FINE and she
will talk to you in about FIVE MINUTES when she
cools off.
LOUD SIGH - This is not actually a word, but is
still often a verbal statement very misunderstood
by men. A "Loud Sigh" means she thinks you are an
idiot at that moment and wonders why she is
wasting her time standing here and arguing with
you over NOTHING.
SOFT SIGH - Again, not a word, but a verbal
statement. "Soft Sighs" are one of the few things
that some men actually understand. She is content.
Your best bet is to not move or breathe and she
will stay content.
THAT'S OKAY - This is one of the most dangerous
statements that a woman can say to a man. "That's
Okay" means that she wants to think long and hard
before paying you retributions for whatever it is
that you have done. "That's Okay" is often used
with the word "Fine" and used in conjunction with
a raised eyebrow "Go ahead." At some point in the
near future when she has plotted and planned, you
are going to be in some mighty big trouble.
PLEASE DO - This is not a statement, it is an
offer. A woman is giving you the chance to come up
with whatever excuse or reason you have for doing
whatever it is that you have done. You have a fair
chance to tell the truth, so be careful and you
shouldn't get a "That's Okay."
THANKS - A woman is thanking you. Do not faint;
just say "you're welcome."
THANKS A LOT - This is much different from
"Thanks." A woman will say, "Thanks A Lot" when
she is really ticked off at you. It signifies that
you have hurt her in some callous way, and will be
followed by the "Loud Sigh." Be careful not to ask
what is wrong after the "Loud Sigh," as she will
only tell you "Nothing."
See, its really very easy to understand what women
are saying!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** Woman's Health Newsletter *******
October 6, 2002
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Ads for weight loss pills are often deceptive
2. Evidenced based reviews of medical treatments
3. Reader submitted Q&A - Palpitations and supplements
4. Low salt diet - does it really make any difference?
5. Health tip to share - Lead poisoning
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Ads for weight loss pills are often deceptive
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
What about those ads for weight loss products.? Do
you believe most of them or none of them? Which
ones can you believe?
The U.S. Food and Drug Administration (FDA)
examined 300 weight-loss ads for dietary
supplements, meal replacements, patches, creams,
wraps and other weight-loss products and services.
They found that over half of them had at least one
claim that was either false or very unlikely to be
true. They also compared current ads with those
for weight loss products from 10 years ago and
found an increased incidence of deceptive ads in
the recent year.
Even though the FDA has taken action against some
of the false and misleading weight-loss claims,
the number and percentage of un factual claims is
rising. Certain types of claims should raise red
flags to signal that the ads are untrue or
misleading:
Claims for rapid weight loss such as 10 lbs in a
week
Testimonials with before/after photos that make
implausible claims
Ads stating that no dieting or exercise is needed
The main hazard of all the false ads is not only
that people are spending money on products that do
not work, but that use of these products takes
people away from plans and services that do work.
As of this date there still are no pills that
significantly alter the balance between "calories
in" versus "calories out". People who are looking
for a "magic" pill that enhances weight loss are
just encouraging entrepreneurs to continue false
claims. Don't you be one of them.
Ads for weight loss pills are often deceptive
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Evidenced based reviews of medical treatments
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The Cochrane Collaboration Consumer Network is a
very helpful tool to aid in making health
decisions. Basically this site uses scientific
reviews of medical studies that have been
conducted in order to answer whether there is any
clear superiority in one treatment versus another
for a given medical problem. The list of topics is
fairly extensive and includes:
Addiction & dependence
Allergies
Arthritis & autoimmune diseases
Asthma
Back, bones, joints & limbs
Behavior & development problems & disabilities
Blood diseases
Cancer
Chest, lungs, nose & throat
Complementary (Alternative) therapies
Cystic fibrosis
Dementia, Alzheimer's & cognitive impairment
Diabetes, endocrine system & metabolism
Ears, balance & hearing
Epilepsy
Eyes & vision
Family planning & abortion
General medical & surgical techniques
Gut, bowel & stomach
Heart & blood pressure
HIV/AIDS
Improving care & communication
Incontinence
Infertility
Injuries & poisoning
Kidneys, bladder & urinary system
Leg ulcers, pressure sores & chronic wounds
Liver & gall bladder
Menopause
Menstrual & gynecological problems
Mental health
Movement disorders (Parkinson's & cerebral palsy)
Neuromuscular diseases & multiple sclerosis
Nutrition, weight & eating disorders
Oral health (mouth & teeth)
Pain, fatigue problems & palliative care
Parasites, malaria & infectious diseases
Pregnancy & childbirth
Premature & ill newborns
Prostate & testicular problems
Sexual health & sexually transmitted diseases
Skin
Stroke & circulation problems
Tuberculosis
Well babies & children
For example if we look under Heart in "Heart and
Blood Pressure", we see the subtopics of:
Drug treatment
Other
Prevention
Rehabilitation
Surgery
Under "prevention", you can find out that reducing
dietary fats for longer than 2 years reduces the
number of heart attacks (cardiac events) although
it does not significantly reduce mortality. Also,
fish oil supplements lower triglycerides (one form
of fat) but tended to raise bad cholesterol (LDL)
while not changing good cholesterol (HDL). These
studies were done in patients with adult onset
diabetes and at least the fish oil supplementation
did not alter blood sugar control. It is not as
helpful for your health, however, as some product
advertising and magazine claims would have you
believe.
As you or your family are diagnosed with medical
conditions, or the doctor recommends a specific
preventative strategy, this resource can be used
to see what has been shown to be the best
approach. Actually you may be surprised at how few
medical topics have been thoroughly studied.
Cochrane Reviews Consumer Network
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Palpitations and supplements
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"Can additional doses of potassium, maybe too
much, cause heart palpitations? Each night I take
two regular calcium with vitamin D pills along
with one calcium magnesium potassium mix pill. I
have been doing this for years. Recently I had
occasional palpitations. They stopped and began
again then stopped. I noticed that they had
stopped when I ran out of the calcium mag
potassium pill and so excluded that. They came
back once I added this pill again. I have now
stopped taking the mix and the symptoms have
stopped. Now I only take 2 calcium + Vitamin D
pills each night."
"I am 48, regular menses always To date, no major
illnesses. Not overweight (5 ft 7 ins, 128 lbs). I
also exercise regularly. Eat vegetarian and fish
only. Take cod liver oil and vitamin B tabs
regularly plus valerian root. " - Lawayne
In general, low blood potassium levels
(hypokalemia) are much more associated with heart
palpitations in those people prone to them than
are high potassium levels or potassium
supplements. In fact potassium supplements
normally help prevent palpitations if the blood
levels of potassium are low. Many people who take
water pills (diuretics) for hypertension can
develop irregular heart rates because potassium is
lost in the urine when diuretics are clearing
sodium (salt) from your blood.
The main reasons to take any potassium supplement
at all is if you are taking a regular diuretic or
if your diet is quite restricted in fruits and
vegetables (yours is not I assume) which are the
main sources of potassium. Otherwise there is
probably not a good reason to take a pill that has
potassium in addition to calcium and magnesium.
Actually you have done a very good job in
detecting that the palpitations are associated
with the specific pill you have taken. Even though
you may have taken that same preparation for many
years without palpitation problems, you must
consider that the recent "batch" of the calcium-
magnesium-potassium pills may have some sort of
contamination in the manufacturing process and may
have something else in it that is causing the
palpitations. Caffeine is one contaminant that
could produce palpitations but there may be other
additives or contaminants that we are not aware
of. The way to examine this would be to try a
different brand of pill that had the same
ingredients. Palpitations are annoying but most of
the time they are very benign.
Another possibility is that something in your
health condition has changed so that you are more
susceptible to any alterations in body salt
levels. Conditions such as thyroid disease,
especially hyperthyroidism, can cause this. You
may want to have a TSH (thyroid stimulating
hormone) test to make sure that has not changed if
you have not had one recently.
Also look for contaminants in other ingested
products. Valerian root can promote sleep and have
an anti-anxiety effect but toxicity has also been
reported including kidney damage, headaches, chest
tightness, visual problems, abdominal pain, and
tremor of the hands and feet. This doesn't mean
that your valerian root is the problem but
whenever you are ingesting multiple commercially
manufactured agents, there are always chances of
interactions that are not consistently
predictable. Just because you are ingesting
"natural" products does not mean they are safer.
In fact they are more likely to have contaminants
since they are much less regulated by the FDA. Be
careful!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Low salt diet - does it really make any difference?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Low salt diets have been recommended not only for
those who are being treated for hypertension, but
also for the general population. Many people who
are not hypertensive restrict their salt intake
under the supposition that a low salt diet is
healthier. Many studies have been performed using
salt restricted diets and surprisingly there is no
reduction in deaths or adverse cardiovascular
events in people who restrict their salt. The
average blood pressure reduction is on the order
of of about 1 mm Hg systolic (upper number) and
about 0.5 mm Hg diastolic (lower number).
While salt restriction does not seem to be very
effective in reducing blood pressure on the
average, it does allow some people to come off of
antihypertensive medications so there is some
benefit. For the general population without high
blood pressure, there is not any benefit of
reducing salt intake. The final conclusion of this
study in the British Medical Journal was:
"Lower salt intake may help people on
antihypertensive drugs to stop their medication
while maintaining good control of blood pressure,
but there are doubts about effects of sodium
reduction on overall health."
Most of the studies used to draw these conclusions
lasted only a limited time, e.g., 5-7 years. It is
possible that there are health benefits from
longer term salt intake reduction but we really
have no way of knowing.
Low salt diet - does it really make any difference?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Health tip to share - Lead poisoning
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Lead poisoning affects children worldwide. While
it can affect adults also, children are more
susceptible because they tend to put things in
their mouth and chew on objects that may have lead
paint more than adults do. In the United States,
elevated blood lead levels (BLLs) (>10 microg/dL)
result primarily from exposure to lead-based paint
or from associated lead-contaminated dust and
soil; however, other sources of lead exposure,
including folk remedies, Mexican terra cotta
pottery, Indian herbal preparations, ingestion of
air rifle pellets and certain imported candies,
also have been associated with elevated blood
levels in children. Symptoms can include fatigue
(anemia), stomach upset, joint pains, and liver
toxicity. More serious brain and spinal cord
effects can include:
lower IQs
headaches
memory problems
reduced coordination
learning disabilities
irritability
hyperactivity
increased sleeping
decreased activity and fatigue
hearing loss
vomiting
slow reflexes
muscle weakness, affecting mainly the upper extremities
seizures, coma, hypertension in high levels
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
WEDDING PLANS
Jacob age 85, and Rebecca age 79 are all excited
about their decision to get married. They go for a
stroll to discuss the wedding and on the way go
past a drugstore. Jacob suggests that they go in.
He addresses the man behind the counter:
"Are you the owner?"
The pharmacist answers, "Yes."
Jacob: "Do you sell heart medication?"
Pharmacist: "Of course we do."
Jacob: "How about medicine for circulation?"
Pharmacist: "All kinds."
Jacob: "Medicine for rheumatism?"
Pharmacist: "Definitely."
Jacob: "How about Viagra?"
Pharmacist: "Of course."
Jacob: "Medicine for memory?"
Pharmacist: "Yes, a large variety."
Jacob: "What about vitamins and sleeping pills?"
Pharmacist: "Absolutely."
Jacob: "Perfect! We'd like to register here for
our wedding gifts."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** Woman's Health Newsletter *******
October 20, 2002
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Biweekly from BackupMD on the Net
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Screening tests for women
2. Children of divorces - how to lower problems
3. Reader submitted Q&A - Progesterone after hysterectomy?
4. Burning mouth syndrome
5. Health tip to share - Waist size and heart risk
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Screening tests for women
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Occasionally we receive questions about how often
a women should have various medical screening
tests performed in order to stay healthy and head
off any diseases. This recent list at
Mayoclinic.com may be helpful to those who want to
know this.
Blood pressure - every two years as long as it is
below 130/85
Pap smear - Initially at age 18 or the start of
sexual intercourse. After 3 normal (negative)
smears in a row, exams can be every 3 years unless
you have ever had an abnormal result or you have
had a new sexual partner since your 3 negative
smears. In the case of abnormal smear history or
new sexual partner, the Pap smears should be
annually or as recommended by your doctor.
Mammogram - annually after age 40. Some recommend
a baseline at age 35.
Colon cancer screening - If you do NOT have
adenomatous colon polyps or inflammatory bowel
disease and if you do NOT have a family history of
colorectal cancer or polyps, you should have a
stool screen for blood (fecal occult blood)
annually after age 50 or a colonoscopy or flexible
sigmoidoscopy every 5 -10 years.
Dental check-up - yearly or as often as your
dentist recommends
Eye exam - every 3-5 years but after age 50, more
frequently (e.g. every 2 years)
Bone density - at age 65 unless at high risk for
osteoporosis. Then it should start at least by age
60 or whenever a doctor recommends it to you.
Blood chemistry - not routine at all unless you
are having symptoms for which the doctor
recommends it.
Complete blood count (CBC) - not routine at all
unless you are having symptoms for which the
doctor recommends it.
Cholesterol - Baseline in your 20s. If values are
within desirable ranges (total cholesterol less
than 200), every 5 years.
Thyroid-stimulating hormone (TSH) test - Some
doctors suggest a baseline test by age 35 and then
every 5 years.
Transferrin saturation test - to detect
hemochromatosis which is hereditary and can lead
to diabetes, arthritis, heart disease or liver
disease. They recommend baseline test around age
30, with periodic repeat testing.
Urinalysis - not routine, only as directed by your
doctor.
Sexually transmitted disease screening tests -
gonorrhea, chlamydia, HIV, syphilis as directed by
your doctor or as you request because of new
sexual partners on the part of you or a spouse.
EKG electrocardiogram - only as recommended by
your doctor
Chest x-ray - only as recommended by your doctor
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Children of divorces - how to lower problems
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Teenagers of divorced parents have it rough in
many aspects. They have a higher incidence of
mental health problems such as depression,
generalized anxiety disorder, they drop out of
school more, use drugs more and become pregnant
more often than teens whose parents are not
divorced.
A recent Arizona study looked at some different
interventions with divorced mothers and their
adolescent children. For the control group,
mothers and children were just given reading
materials about post divorce adjustment. There
were two study groups:
a mother (alone) program: in which mothers
underwent 11 group and 2 individual counseling
sessions and a
mother plus child program: in which the mother
underwent the above counseling and the children
had 11 counseling sessions
The outcome measures they looked at were
externalizing (acting out) and internalizing
(depressive reaction) problems, diagnosed mental
disorders, drug and alcohol use, and number of
sexual partners.
They had the best outcomes for the mother plus
child program in which they found:
diagnosed mental conditions in only 11% (versus
23% in controls)
decreased number of sexual partners (0.7 vs 1.6)
decreased adolescent use of alcohol, marijuana and
other drug use
The bottom line seems to be that you cannot just
read about it. A divorced mother should take
advantage of enrolling herself and her children in
any locally available counseling program for post
divorce adjustment.
Children of divorces - how to lower problems
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Reader submitted Q&A - Progesterone after hysterectomy?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I had a complete hysterectomy 5 years ago with
everything removed. I am on a estrogen pill but
the hot flashes are worse than ever. My doctor is
getting ready to put me on a estrogen/progestin
pill. Even though I have no ovaries or uterus can
I still take progestin?"
"I am 52 yrs old. Hysterectomy in 1997. On BP
medication, Lipitor, estrogen and vitamins." -
Kookie
You can still take natural progesterone or
progestin even though your uterus has been
removed. However it is usually not recommended as
necessary. Progestin is usually only part of
hormone replacement therapy (ERT) when a uterus is
still present in order to protect against a small
but real incidence of endometrial (the lining of
the uterus) cancer. If there is no uterus, then
there is not a risk of endometrial cancer and you
do not "need" to take progesterone/progestin.
Sometimes progestin is used even though there is
no uterus. The progestin may be metabolized into
estrogen in the body and can help augment
prescribed estrogen to reduce hot flashes. This is
why some women get relief from progesterone cream
or oral progesterone (but usually not as much from
synthetic progestins). There is no evidence at all
that estrogen plus progestin is any better or more
effective than just raising the estrogen dose
alone for the treatment of only hot flashes. Since
progestin does not really protect against breast
cancer, there is no real reason to use it.
Additionally, there can be some adverse effects of
progesterone/progestin.
In spite of a popular media physician who
advocates progesterone as a wonder drug that
should be replaced in all women after menopause,
most physicians find that women have mild to
severe mood changes as well as physical symptoms
when progesterone is used with ERT. Irritability
and abdominal bloating are common complaints when
taking added progestin.
There is one instance I know of where the
progesterone (not progestin) might be beneficial
even though you have had a hysterectomy. That is
if you are having trouble waking up at night so
you do not get much sleep. This is different from
insomnia where you cannot fall asleep.
Progesterone may help the waking up at night.
I do not think that taking the progesterone (e.g.,
Prometrium) will hurt you since it does not block
the coronary artery dilatation benefit that
estrogen causes, but if you are going to use it
for hot flash control you may as well just try
raising the estrogen dose.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Burning mouth syndrome
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Burning mouth syndrome is different from having
mouth ulcers that are sore. With burning mouth
syndrome there is a generalized burning pain that
may include the tongue, the roof of the mouth, the
gums, the inside of the cheeks and/or the back of
the mouth or throat. T
