Womens Health

Women's Diagnostic Cyber Newsletters 7/4/99 - 8/9/99

 

 

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***** Woman's Diagnostic Cyber Newsletter *****
                  July 4, 1999
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

1. Antiviral treatment during pregnancy
2. Raloxifene and breast cancer decrease 
3. Meaning of a positive fecal occult blood test
4. Use of hair chemicals and pregnancy outcome
5. Gum disease and bad breath
6. Humor is healthy

Spread the word! Send a copy of this newsletter
to someone you know.

Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Antiviral treatment during pregnancy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
There are several viral diseases that, if present 
in a woman during pregnancy, can sometimes cause 
birth defects or serious diseases in the newborn 
baby. Several come to mind such as rubella (German 
measles), herpes simplex, human papilloma virus, 
chicken pox, and HIV viruses among others. Most 
antiviral medications are directed at blocking 
reproducing mRNA which is an essential component 
of all living tissue. Thus there is major concern 
that as antiviral medications are developed and 
given to pregnant women as treatment or 
prevention, they may cause more birth defects or 
complications than they prevent. 

A recent study in the Journal of the American 
Medical Association (JAMA) looked at 234 children 
born to mothers who tested positive for HIV but 
the babies did not end up having HIV. 
Approximately half of the mothers had been given 
zidovudine, an antiviral drug to try to prevent 
HIV transmission to the baby. The other half 
received a placebo medication. The investigators 
looked at physical growth measurements, 
immunologic parameters, cognitive/developmental 
function, occurrence of neoplasms, and mortality 
data assessed every 6 months for children younger 
than 24 months and yearly thereafter or as 
clinically indicated. 

There were no significant differences in any of 
the outcomes looked at between those children 
whose mothers took the zidovudine and those who 
took placebo. There were two infants with some 
unexplained eye findings in the zidovudine group 
however, which are still being followed. 

In general this is a very encouraging report that 
opens the possibility of more viral disease 
prevention during pregnancy. As you can imagine, 
it is very difficult to conduct a study like this 
in pregnant women for viruses that are damaging 
but not in the same class as HIV. 

Antiviral medication during pregnancy

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Raloxifene and breast cancer decrease
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Raloxifene is a selective estrogen receptor 
medicine that is closely related to tamoxifen 
which is used to treat breast cancer. Raloxifene 
is marketed under the trade name of Evista® 
for the prevention of osteoporosis. In the large 
study being done with raloxifene and a placebo 
medicine, the authors found that after 3 years of 
therapy, the new occurrence of breast cancer was 
only 25% of that of women on placebo. 

Many women are not aware that, on the average, a 
breast cancer detected by mammogram but not 
clinically palpable has been present in the body 
for about 6 years. A lump you can feel that is 
cancerous has been present in the body for about 9 
years. Thus a study like this one below is 
interesting in that raloxifene is probably 
TREATING subclinical cancers before they are even 
detected by mammogram or exam. 


Raloxifene and breast cancer

We have previously written about these new 
categories of selective estrogen receptor 
modulators (SERMS) at: 


Designer estrogens

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Meaning of a positive fecal occult blood test
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Talking about testing stool for the presence of blood can be 
embarrassing for some, but as a screening test for colon cancer, 
it can detect problems early and actually prevent invasive 
cancer. You may have heard some people say the test is not good 
enough, it has too many false positives and there is some truth 
to that. Red meat in the diet can give a positive test as can 
other ingested substances, but it is still capable of detecting 
many serious gastrointestinal conditions other than colon cancer. 
There is no question that you should have this test performed if 
you are over age 50 or if you are having any gastrointestinal 
problems, but it is very important that you are armed with the 
information of what a positive test means so that you do not 
panic if you do test  positive. See the discussion below or 
bookmark it for reference should you have a positive fecal occult 
blood test. 

Fecal occult blood testing

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Use of hair chemicals and pregnancy outcome
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
There have occasionally been concerns that toxic 
chemicals in hair products may be absorbed through 
the scalp but the data is not clear. In the study 
below, investigators looked at black women in 
North Carolina who used chemicals to straighten 
out hair either during pregnancy or in the 3 
months preceding pregnancy. They found that there 
was no significant difference in preterm delivery 
or low birth weight among women who used or did 
not use these products. 

Hair straightener use and pregnancy outcome

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Gum disease and bad breath
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The American Dental Association has a set of 
frequently asked questions for consumers that you 
might be interested in if you are having any 
dental problems. One section that caught my 
attention was on gum disease because this is one 
problem that, if corrected, can head off tooth 
loss in later life. The section covers several 
questions such as: 

I've heard a lot about gum disease lately. How do 
I know if I have it? 
What are some of the ways to treat gum disease? 
What causes bad breath? 
What can I do about bad breath? 


Gum disease and bad breath

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The Marina by Stan Kegel:

It was a hot summer's day, and Luke was in the 
marina, having a few beers aboard his boat, 
patriotically named the "Fourth of July." 

He was waiting for his friend, Opie, to arrive so 
they could go for a cruise. Opie was late, 
unfortunately, because he had to pick up his wife 
from her appointment with the obstetrician. 

Her antenatal examinations were free because the 
doctor, a fellow named Juan, was Opie's cousin. 
Anyway, the appointment went over time, and Opie 
was late getting to the marina. 

Luke had been drinking all this time, and was 
feeling no pain. When he saw Opie finally walking 
down the pier, he jumped up, staggered to the side 
of the boat to wave to his friend, and nearly fell 
in! 

Opie got there just in time to grab Luke. ...

Thus, it was that 
O. B. Juan's kin, Opie, saved Luke from falling to 
the dock side of the Fourth. 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time. We will bring you 
accurate women's health answers again soon.
Rick
Frederick R. Jelovsek MD 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~





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***** Woman's Diagnostic Cyber Newsletter *****
                 July 11, 1999
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

1. Lupus - patient care guide
2. Food allergies or intolerances 
3. Hysterectomy for endometriosis in young women
4. Asthma medication during pregnancy
5. Estrogen and memory tasks
6. Humor is healthy

Spread the word! Send a copy of this newsletter
to someone you know.

Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Lupus - guide for patients
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Lupus (systemic lupus erythematosis - SLE) can be 
a confusing disease. It is not only difficult to 
diagnose but also it is very similar to other 
autoimmune connective tissue diseases. A commonly 
used screening test is the anti-nuclear antibody 
(ANA) test which is positive almost all of the 
time with active lupus. It is also positive with 
other autoimmune diseases such as: mixed 
connective tissue disease, systemic sclerosis, 
primary Sjogren's syndrome, rheumatoid arthritis, 
and even in women with no systemic rheumatic 
disease. 

The section on laboratory tests useful in the 
diagnosis of lupus and other connective tissue 
diseases interested me but there are many 
different and complicated tests used. If you have a 
positive ANA test, you will want to see an 
immunology specialist to sort out all of the 
possibilities. 

There are also excellent sections on SLE symptoms, 
medications, psychosocial aspects and how to take 
care of yourself with all the different symptoms and 
situations that this chronic disease may present. 

Lupus guide

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Food allergies or intolerances 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Having a bad reaction to eating a certain food may 
cause you to conclude you have a food allergy to 
that food. Often, however, that reaction can just 
be an intolerance to the food or something in the 
food rather than a true allergic reaction. There 
may be a reaction to a bacteria in the food, a 
toxin, a histamine substance or the unpleasant 
effects may be due to lactose or gluten 
intolerance in the person eating the food. 

The most common food allergies in adults are to 
shellfish, peanuts, other tree nuts such as 
walnuts, eggs and fish. 

Whenever you have such an adverse reaction to a 
food, it is critical to know the difference 
between an allergy and an intolerance because an 
allergy can be life threatening by causing an 
immune reaction that can result in death by 
circulatory collapse or blocked breathing ability.  

If you think you may have a food allergy or even 
an intolerance, be sure to check the fact sheet at 
the National Institute of Allergy and Infectious 
Disease. I especially liked the section on 
diagnosis of how doctors go about differentiating 
by history and by testing whether the reaction to 
a food is an allergic one or just an intolerance. 
Did you know there is even such a thing as an 
exercise-induced food allergy? 

Food allergies versus food intolerance

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Hysterectomy for endometriosis in young women
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Having endometriosis can be as bad as having 
cancer. While it does not cause death in a typical 
case, it can cause a very severe, debilitating, 
chronic pain. As a result, many young women with 
severe pain from endometriosis may choose 
hysterectomy as a last attempt to permanently get 
rid of their unrelenting pain. What can those 
young women expect if they forgo further 
childbearing just to have a more pain free life? 

As it turns out, many of the young women (less 
than 30 years of age) who have a hysterectomy for 
endometriosis treatment still have residual pain 
but mostly in the vagina (pain with sex), urinary 
tract (pain with voiding) and gastrointestinal 
tract (pain with bowel movements) but not in the 
pelvis (80% cure rate). 

Endometriosis and hysterectomy

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Asthma medication during pregnancy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Asthma is a much more common disease than most 
people realize. Up to 7% of pregnant women will 
have asthma and most of them are being treated 
with medicines that will cause worry about harm to 
the baby. However, as many as 10% of women with 
asthma during pregnancy will require an emergency 
treatment because of uncontrolled asthmatic 
breathing difficulties. Therefore medications 
cannot just be indiscriminately stopped because 
doing so may put two lives in jeopardy. 

Almost all asthma medications are safe during 
pregnancy so be sure not to stop any such 
treatment before consulting with your allergist 
and antenatal care specialist. 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Estrogen and memory tasks
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
While some studies have suggested that estrogen 
improves memory, clinical trials have not always 
been clearly positive. This study looked at brain 
activation patterns using MRI to pinpoint which 
areas of the brain were more active in women 
taking estrogens compared with women not on 
estrogen. It found that certain areas of the brain 
associated with verbal and memory tasks were more 
active but in spite of this increased activity, 
estrogen did not affect actual performance of 
verbal and nonverbal memory tasks. 

The story on estrogens and their effect on memory 
is still not clear and it may not help memory and 
decision tasks as much as many people think. 

Estrogen and brain activity

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
An elderly male resident of the nursing home said 
to the female resident in a wheel chair, "Betcha 
can't guess how old I am." 

She replied, "I can if you take off all of your 
clothes." 

So he disrobed and she instructed him to turn 
around slowly. Then she said, "You're 95." 

"That's amazing!!" he exclaimed. "How could you 
tell?" 

"You told me at breakfast."

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time. We will bring you 
accurate women's health answers again soon.
Rick
Frederick R. Jelovsek MD 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~




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***** Woman's Diagnostic Cyber Newsletter *****
                 July 18, 1999
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

1. Mammograms and supplemental diagnostic imaging
2. Thyroid medication interactions and concerns 
3. Different treatments for genital warts 
4. Sperm counts and motility for IUI
5. Fitness during pregnancy
6. Humor is healthy

Spread the word! Send a copy of this newsletter
to someone you know.

Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Mammograms and supplemental diagnostic imaging
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Imaginis.net is a web site specifically devoted to 
breast health. While it contains much information 
about breast cancer, its richness lies in the
extensive descriptions of different diagnostic 
tests that go along with mammography and biopsies. 

Women who have not yet had mammograms will 
appreciate the concise descriptions of: 

Breast self-exam    
Screening mammography 
What is mammography and how is it performed? 
How can I prepare for my mammogram and what to 
   expect during mammography? 
Where can I receive a mammogram? 

Women who have ever been called back by radiology 
or their physician to have "additional" xrays 
taken may panic at the thought that someone thinks 
there is a suspicious area on mammogram that needs 
to be investigated. While over 80% of women who 
are called back for special xrays turn out just to 
have benign findings, it is very reassuring to be 
able to look up what kind of studies are going to 
additionally be done and what they mean. 

Some of these studies might include:

Special mammography: spot and magnification views 
Ultrasound and magnetic resonance breast imaging 
Ductography/Galactogram: imaging the breast ducts 
Sestamibi nuclear medicine breast imaging 
T-scan breast imaging (a new form of imaging)

Book mark this site should you EVER have an 
abnormal mammogram xray, or if your first 
mammogram is coming up soon. 

Mammograms and breast self-exams

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Thyroid medication interactions and concerns 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Many women end up taking thyroid medication 
because of hypothyroidism especially around the 
time of menopause. What most physicians forget to 
tell you is that there are many other medications 
that can interfere with thyroid replacement 
therapy as well as medical problems such as 
gastrointestinal conditions that impair 
absorption. Also, thyroid medication can interfere 
with other medications and make them less 
effective such as anticoagulants, some anti-
hypertensive medications, asthma medical 
treatments and even digitalis for the heart. 

We often depend upon our local pharmacist to warn 
us of any of these medication conflicts. Be sure 
to let your pharmacist know about all the 
medicines you take. If you are on thyroid 
replacement therapy and taking other prescribed 
drugs, you may want to look at this thyroid 
medication fact sheet from rxfactstat.com 


~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Different treatments for genital warts
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Genial warts are not only embarrassing but 
sometimes very annoying due to their tendency to 
keep occurring in spite of treatment. Topical 
treatment either in the physician's office or by 
self-application at home are the standard 
therapies but sometimes surgical or laser 
treatment is needed. In women over 40, biopsy 
should be considered prior to treatment because 
there is a higher incidence of the warts 
representing a premalignant lesion, dysplasia, as 
women near and pass the menopause.

Treatments are discussed at:

Treatment for genital warts

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Sperm counts and motility for IUI
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Intrauterine insemination of sperm (IUI) is a 
reproductive technique used in infertility not 
only for male factor problems, but also for women 
with cervical factor problems, ovulation 
dysfunction and even endometriosis. In this 
technique, sperm are washed in a test tube after 
collection and they are directly placed inside the 
uterus at the time of ovulation. From large 
studies of IUI, we can learn what sperm counts and 
motility percentages give the best pregnancy 
results. 

While IUI counts and results are not directly 
comparable to regular sperm counts from a semen 
analysis, a recent study of IUI in over 9900 
cycles gives us some interesting statistics. 

Pregnancy rates were OPTIMAL (about 10-12% per 
cycle) when:

sperm numbers were greater than 4 million
sperm motility was greater than 60%
a woman's age was less than 32

Even though not optimal, keep in mind that
pregnancies did occur with instillations of less 
than 2 million sperm and motilities of less than 
40% 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Fitness during pregnancy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Pregnancy-info.net has an excellent collection of 
articles about different exercises and physical 
activities during pregnancy. Topics include: 
Exercises and Depression, Safe 
Exercises, Yoga and Swimming, the Benefits of Water and more.


~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Two men waiting at the Pearly Gates strike up a 
conversation. 
"How'd you die?" the first man asks the second. 
"I froze to death," says the second. 

"That's awful," says the first man. 
"How does it feel to freeze to death?" 

"It's very uncomfortable at first", says the 
second man. "You get the shakes, and you get pains 
in all your fingers and toes. But eventually, it's 
a very calm way to go. You get numb and you kind 
of drift off, as if you're sleeping. How about 
you, how did you die?" 

"I had a heart attack," says the first man. 
"You see, I knew my wife was cheating on me, so 
one day I showed up at home unexpectedly. I ran up 
to the bedroom, and found her alone, knitting. I 
ran down to the basement, but no one was hiding 
there, either. I ran up to the second floor, but 
no one was hiding there either. I ran as fast as I 
could to the attic, and just as I got there, I had 
a massive heart attack and died." 

The second man shakes his head. 
"That's so ironic," he says.

"What do you mean?" asks the first man. "

If you had only stopped to look in the freezer, 
we'd both still be alive." 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time. We will bring you 
accurate women's health answers again soon.
Rick
Frederick R. Jelovsek MD 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~



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***** Woman's Diagnostic Cyber Newsletter *****
                     July 25, 1999
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

1. Beauty tips for scarred skin
2. Bacterial vaginosis increases miscarriages
3. IUCD as an under-used contraceptive
4. Ovarian masses in pregnancy
5. Insomnia - its different types 
6. Humor is healthy

Spread the word! Send a copy of this newsletter
to someone you know.

Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Beauty tips for scarred skin
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Beauty is... is a great web site devoted to the 
self- esteem of women disfigured through accident, 
injury or surgery. There are articles on general 
scar healing and treatments, emotional issues and 
quite a few on burn injury. The article on skin 
moisturizing of a burn scar points out how a water 
soluble moisturizing product is needed to 
penetrate to the "internally dry" layer of burn 
scar rather than the normal oil based-moisturizing 
cream typically used for "externally" dry skin. 
Also I like the article on skin color and pigmentation 
where it mentioned about "medical tattooing" 
(tattooing to cover scars) as an alternative way 
of filling in normal skin color where there are 
small areas of de-pigmentation within a scar. 

Beauty is...

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Bacterial vaginosis increases miscarriages
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
While infections of any type are thought to affect 
fertility and the ability to carry a pregnancy, 
hard evidence is not available to confirm these 
common sense opinions. From a large in-vitro 
fertilization study (867 women) in Leeds, England, 
investigators looked at whether the presence of 
bacterial vaginosis (BV) affected the pregnancy 
conception rate. They found it did not lower the 
conception rate compared to women without 
infection (approximately 30% in both groups), but 
it increased the miscarriage rate by about two-
fold. Women with bacterial vaginosis in this study 
had a miscarriage rate of 31.6% compared with 
18.5% in women without BV. 

Effect of BV on conception and miscarriage rates

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. IUCD as an under-used contraceptive
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The intrauterine device, IUCD, got a bad rep back 
in the 1970's. As a result very few women in the 
U.S. use it even though it is a very frequently 
used contraceptive method internationally. While 
it may not be an ideal contraceptive method for 
all women, it has a very low long term pregnancy 
rate, low cost and low concern level after it has 
been successfully inserted. Women who do not like 
how they feel on hormonal contraceptives, and do 
not have a history of recent pelvic inflammatory 
disease, heavy menstrual bleeding or moderate to 
severe menstrual cramps may find that the IUCD is 
an almost IDEAL contraceptive method once they 
know the facts. 

IUCD - intrauterine contraceptive device

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Ovarian masses in pregnancy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Occasionally a routine ultrasound in pregnancy 
will detect a pelvic mass in the region of the 
ovary and a question arises as to whether there is 
a chance it can be malignant. Doctors certainly 
try to avoid surgery during pregnancy so as not to 
cause a premature birth but there is a tradeoff 
when malignancy is a concern. 

Traditionally, most surgery during pregnancy is 
put off until at least 3-4 months (about 14-18 
weeks) and it is also avoided later in pregnancy. 
The study below indicates that up until 23 weeks 
the surgery is fairly safe for the baby but after 
that, preterm labor complications rise. It also 
shows that the chance of a worrisome ovarian mass 
(a diameter of more than about 5.9 cm/2 inches) in 
pregnancy is about one in 1300. Only  6% of those 
masses turned out to be malignant compared with 
about 3% in other studies. The take-home message 
is that if an ovarian cyst or tumor is found 
during pregnancy, surgery should probably be 
deferred until after delivery unless the 
ultrasound characteristics are very worrisome for 
possible malignancy. If surgery needs to be 
performed for diagnosis or any other reason, it is 
best to time that surgery between 14 and 23 weeks 
gestation, i.e., the early 2nd trimester. 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Insomnia - its different types 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
There can be many different forms of sleep 
disorders such as insomnia, sleep apnea, restless 
legs syndrome, narcolepsy, and shift work sleep 
problems among others. 

Insomnia is classified into three types - 
transient, short-term, and long-term. It can be 
associated with medications, alcohol, and other 
ingested substances. Did you know that many 
antidepressant or anti-anxiety medications 
actually disturb sleep more that help it? Even 
small amounts of alcohol are not recommended as 
sleep aids. If you have any long term sleep 
problems, you may want to look at this fact sheet 
on insomnia from the Sleep/Wake Disorders Canada. 

Insomnia - the facts

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Two female transplant surgeons were seen in the 
hospital corridor lamenting the high cost of 
organs and their availability for transplant. 

"Did you see the latest waiting list for livers?" 
said the first organ transplant surgeon. 

"Yes, I'm going broke because we can't get any" 
said the second, "but fortunately brains have 
become much more available and we have quite a few 
attorneys who are waiting for them 
(chuckle,chuckle)." 

"How much are they charging for the brains?" asked 
the first surgeon. 

"Well its sort of strange" said the second 
surgeon, " they want $100,000 for a male brain and 
$50,000 for a woman's brain." 

"What!" exclaimed the first one. "That's blatantly 
sexist." Why would they have such a differential 
price and charge so much more for a male brain?" 

"Well, apparently they found out that all of the 
female brains had been previously used!" 


~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time. We will bring you 
accurate women's health answers again soon.
Rick
Frederick R. Jelovsek MD 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~



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***** Woman's Diagnostic Cyber Newsletter *****
                 Aug 1, 1999
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

2. Pregnancy tips 
3. Drugs that cause urinary incontinence
4. Hypothyroidism and depression needs extra meds
5. Pap smear reminder
6. Humor is healthy

Spread the word! Send a copy of this newsletter
to someone you know.

Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Pregnancy tips
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
While selling you their book, pregnancy tips.com 
offers some free tips you may want to look at. 

Natural remedies for morning sickness
What you need to know before you have your baby 
Leading New Discoveries on Nutrition During Pregnancy 
Breastfeeding Facts 
Preventing Episiotomy 
Prenatal Classes 
Kegels
Planning a waterbirth 
Packing your bag 
Your Partner's Role in Childbirth
Secrets to having a faster and easier Labor and Delivery
Breastfeeding Tips 
Care of the Mother

Pregnancy tips

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Drugs that cause urinary incontinence
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Many women with occasional urinary leakage will 
become worse when they are started on 
antihypertensive medications or diuretics. Even 
some anti-convulsant or anti-Parkisonian drugs 
worsen incontinence. Any medications which cause 
constipation or even chronic cough will turn a 
minor urinary loss problem into a very 
inconvenient one. 

If you suffer from even mild loss of urine with 
coughing or straining or urgency that causes 
occasional embarrassment, you may want to read 
about medications that can cause urinary 
incontinence. 

Drugs causing urinary incontinence

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Hypothyroidism and depression needs extra meds
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Hypothyroidism is common among women and often 
presents initially with main symptoms of 
depression in addition to fatigue and cold 
intolerance. Traditional medical therapy for 
hypothyroidism incudes only thyroid hormone 
(thyroxine) to the level of lowering the TSH 
hormone level back into normal range. 

Hasimoto's autoimmune thyroiditis, is a common 
form of hypothyroidism. The following paper 
discusses the use of an anti-depressant and d-
amphetamine in addition to thyroid hormone 
replacement for thyroiditis in order to treat the 
symptoms of depression and fatigue which often do 
not resolve for a long time after adequate thyroid 
replacement. 

If you have been recently diagnosed with 
hypothyroidism, you may need more than just 
thyroid replacement: 

Thyroiditis and depression


~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Pap smear reminder
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The College of American Pathologists has organized 
a service to remind you of your annual Pap smear. 
Just enter a date to be reminded by email and your 
email address and they will send you that reminder 
for you to call and schedule your appointment. 

Pap smear reminder email

You may also be interested in their series on 
frequently asked questions (FAQs) about Pap smears 
at: 

Pap smear FAQs

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The genie from the yard sale
Contributed by: Katy

After buying an unusual looking vase at a local 
yard sale, a woman was cleaning it up when a Genie 
popped out. Being a traditional Genie, she offered 
the woman three wishes before she would escape 
forever. 

The woman thought for a moment and said, 

"I wish I was the most beautiful twenty year old 
woman in the world, I wish I had more money than I 
knew what to do with, and I wish you would turn my 
cat into the most handsome prince around."  

The Genie nodded and after a huge cloud of dust 
cleared, the Genie was gone and so was the vase. 

The woman looked at herself and she was certainly 
beautiful.  She was surrounded with scads of money 
in large bills. She flung an armful in the air and 
watched it flutter down around her. She giggled 
with delight at the mountains of cash. Then she 
turned to look where her adoring cat once stood. 

There in the feline's place stood a tall dark, 
handsome man with chiseled features, a washboard 
stomach, broad shoulders, and a soccer-player's 
tush. 

She walked over to him, he put his arms around 
her, brushed his hand upon her cheek, looked deep 
into her eyes, and whispered softly, 

"Now, aren't you sorry you had me neutered?"


~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time. We will bring you 
accurate women's health answers again soon.
Rick
Frederick R. Jelovsek MD 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~



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***** Woman's Diagnostic Cyber Newsletter *****
                 August 8, 1999
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

1. Online consumer health publications
2. Progesterone cream and breast cancer
3. What is a healthy weight?
4. Postpartum weight and breast changes
5. Exercise and susceptibility to infection
6. Humor is healthy

Spread the word! Send a copy of this newsletter
to someone you know.

Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Online consumer health publications
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
You may or may not be aware that the U.S. 
Government publishes many documents abut various 
aspects of health. The Consumer Information Center 
at Pueblo, CO, USA is the clearing house to order 
many of these publications in print form. Some are 
free, some have charges, but on their web site, 
many of the publications are free to read. 

Urinary Tract Infections in Adults
Varicose Vein Treatments. 
What to Do When a Friend is Depressed. 
So You Have High Blood Cholesterol
Overcoming Infertility
Laser Eye Surgery - Is It Worth Looking Into?. 
Hepatitis C. 
Fever Blisters & Canker Sores. 
Anxiety Disorders
Walking for Exercise and Pleasure
Setting Goals for Weight Loss
Dieter's Brews Make Tea Time a Dangerous Affair
Guide to Contraceptive Choices
How Folate Can Help Prevent Birth Defects

Government health publications online

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2. Progesterone cream and breast cancer
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Originally, physicians felt that progesterone 
might counteract the effects of estrogen on the 
breast just as it does in the uterus to prevent an 
increased occurrence of endometrial cancer as 
opposed to estrogen alone situations. This was not 
found to be the case in the large Nurses study 
about hormone replacement and breast cancer in 
the U.S. However, a recent French study, which was 
performed to see if the use of progesterone cream 
on the breast for benign fibrocystic changes 
raised the incidence of breast cancer, found that 
not only did the progesterone cream NOT increase 
breast cancer, but when it was taken along with 
oral progesterone, breast cancer occurrence was 
decreased by about 50%. 

It would not be wise to conclude on the basis of 
this one study in Cancer Detection and Prevention 
1999; 23(4):290-296, that progesterone protects 
against breast cancer. At least it is supportive 
evidence that it does not increase breast cancer. 
Progesterone cream and breast cancer

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3. What is a healthy weight?
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Everyone tells us fat is unhealthy especially if 
it settles in our body. Being overweight or obese 
has its health hazards. Not only heart attacks and 
death, but diabetes, gall bladder disease and 
osteoarthritis are also linked to overweight 
individuals. Some cancers of the breast, uterus, 
ovary and gallbladder also are increased in 
incidence in overweight women. 

Well what should we weigh? What is ideal, what is 
doable? Experts recommend a 5-10% weight loss held 
off for a year as the most important first step 
for overweight or obese women. 

What is a healthy weight

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4. Postpartum weight and breast changes
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Will the pounds just melt away after delivery if 
you  breast feed? What about the hip and tummy 
changes, do they go away? Getting your body back 
in shape after a pregnancy and delivery can be 
challenging and there are many rumors about how 
easy or hard it is. 

What is the experience of most women? The facts 
are that your body will probably not look the same 
after giving birth. Maybe the article below at 
epregnancy.com will challenge you to prove them 
wrong. 
The truth about your postpartum body

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5. Exercise and susceptibility to infection
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
One episode of vigorous exercise can make you more 
susceptible to respiratory infections but regular 
exercise seems to enhance the immune system so you 
get less infections. Many sports medicine experts 
are aware that excessive physical activity like 
running marathons, can reverse the beneficial 
curve of exercise and infection and suppress your 
immune system for hours to weeks afterward. A 
scientific article in Physician and Sports Medicine 
looks at this theory and offers evidence that 
increased infections after very extensive physical 
activity may be due to other causes rather than 
immune system suppression. 

While the article is somewhat technical, it points 
out how the different things affect the increased 
respiratory infection rate with extensive 
exercise. Mucous secretions which protect against 
viral infections may dry up with extended 
activity. Vitamin C supplements have been shown to 
reduce respiratory tract infections with sports. 
Runners' risk of respiratory infection over a 1-
year period included running more than 15 km per 
week, living alone, and having a low body mass 
index. 

Keep up the exercise but if you are in extensive 
training or if you seem to get more colds and flu 
with exercise, you may want to check out: 
Exercise effect on immune system

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6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
MAIL ORDER GROOM

Two women in the one horse town of Parched Gulch 
had daughters, each of marriageable age.  But 
there were no prospective husbands in town due to 
shootings, running off with outlaws and drunk 
riding.  And there was no chance at all of any 
bridegrooms turning up. 

The two mothers pooled their meager resources, 
advertised, and sure enough, they got results: 
twin brothers in Cactus Corners looking for wives.  
The twin bridegrooms were sent for. 

Along the way the twins met up with outlaws.  One 
was killed, the other escaped.  Upon his arrival, 
the mothers were in immediate conflict as to whom 
the surviving twin belonged. They were going to 
kill each other over it.  After all, each had a 
daughter's future at stake. 

They took the case to Judge A.K. Hornswoggle, 
alcoholic, disbarred, but with Solomonic frontier 
wisdom.  After due deliberation, Hornswoggle ruled 
that the young man be chopped in half and one half 
awarded to each daughter. 

The first mother was outraged.  If Hornswoggle 
wasn't drunk or stupid, he was a monster for 
suggesting such a thing. 

The second mother thought it would not be a bad 
solution. 

And pointing to the second mother, Hornswoggle 
said, "Your daughter gets him. You are the real 
mother-in-law!" 

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That's it for this time. Helping women understand 
in order to make better self health care decisions.
Rick
Frederick R. Jelovsek MD 
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