Womens Health

Women's Health Newsletters 10/3/99 - 11/7/99



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***** Woman's Diagnostic Cyber Newsletter *****
                October 3, 1999
This week from Woman's Diagnostic Cyber

1. Arthritis symptoms - Is it rheumatoid?
2. Fatigue limits recovery speed after hysterectomy 
3. Reader submitted Q&A - Basic infertility dx
4. Allergy reference
5. Depression and anxiety are a common mix
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. Arthritis symptoms - Is it rheumatoid?
Everyone gets aches and pains in the muscles and 
sometimes the joints. Rheumatoid arthritis often 
starts as pain in the wrists and knuckles. 
Stiffness of those joints in the morning lasting 
for an hour or more is a hallmark of rheumatoid 
arthritis. Pain and swelling of the joints has to 
go on for about 6 weeks before a doctor can 
diagnose rheumatoid arthritis versus some of the 
other self-limited arthropathies. 

Rheumatoid arthritis is an immune disease in which 
your body forms proteins that react or destroy 
your own normal joint tissue. The joint fluids are 
swollen but eventually the joint becomes narrow. 
It is different from osteoarthritis, which affects 
older individuals and usually causes pain in only 
a few joints, infectious arthritis, post 
inflammatory arthritis and crystal-induced 
arthritis (gout). 

For a good explanatory article on rheumatoid 
arthritis, check out: 

Rheumatoid arthritis

2. Fatigue limits recovery after hysterectomy
Fatigue after surgery to remove the uterus is the 
major factor that limits recovery according to a 
recent survey presented at the American Society 
for Reproductive Medicine. This is the longest 
lasting symptom after hysterectomy and women are 
not well instructed as to how much of a problem 
fatigue can present. While anemia (low blood 
count) is a common cause of postoperative fatigue, 
many women do not even receive iron therapy after 
surgery to help build the blood count back. 

These investigators found that on the average, 
women were extremely tired for more than 10 weeks 
post hysterectomy, compared with just 4.5 weeks of 
pain. Over a third of the women (37%) said that 
"fatigue interfered with their recovery more than 
any other side effect, including pain, sexual 
dysfunction and hot flashes." 

The take-home message is that if you are going to 
have a hysterectomy (or any other major surgery) 
be sure to discuss this with your doctor and make 
plans for what can be done to minimize this 
excessive tiredness. This may mean iron therapy, 
adequate hormonal replacement, minimal use of 
medications that may compound fatigue, early 
exercise of muscle groups not involving your 
incision and any treatment for sleep difficulty if 

Hysterectomy survey

3. Reader submitted Q&A -  Basic infertility dx
"We are a couple married 9 years. We don't have a 
child. I had a cyst on the right ovary and it was 
removed by open surgery. It seems my tubules are 
in a mess. For my husband, a testicular biopsy was 
done, and the report shows that there is a 
complete maturation  arrest of spermatozoa. Could 
you please help us to overcome this problem and 
inform us what can be done to have a child? 

Already we are getting old. My age is 30 and 
husband's age is 37. I have normal menstrual 
periods without pain (at times I have severe 
pain). Otherwise our sexual life is normal and 

This couple has both a male and a female factor 
that is causing infertility. If her husband has 
had a testicular biopsy showing no mature sperm, 
there is only a 25% chance that  premature forms 
of sperm can be aspirated and using advanced 
reproductive technologies, growing those sperm to 
maturity and then injecting them into an egg, 
intracytoplasmic sperm injection (ICSI) or mixing 
them with an egg using in vitro fertilization 

For a brief overview of a complicated subject, you 
may want to see: 

Basic infertility overview

4. Allergy reference
Fall can be a bear for those with allergies. 
Ragweed pollen hits many susceptible women. At the 
allergy center at Selfcare.com there is a feature 
in which you can enter in your zip code and get 
the latest pollen information. 

Allergy Center at Selfcare.com

There is also a good allergy reference from the 
above page that has some handy articles about: 

What is an Allergy? 
Who Suffers from Allergies? 
What is an Allergic Reaction? 
Diagnosing Allergies 

Allergy reference articles

5. Depression and anxiety a common mix
When I think of depression, the words "blue funk" 
come to mind, a down feeling, don't get out of 
bed. But did you know that anxiety symptoms such 
as phobias, panic attacks, fears, worry and 
agitation occur in as many as 80% of depressed 
individuals. The anxiety component can even 
produce physical symptoms such as headaches 
irritable bowel syndrome and chronic pain in a 
depressed individual. 

Anxiety mixed with depression tends to occur in 
younger individuals and result in a longer 
lasting, more severe depression that is less 
responsive to many anti-depressant medications. 

Many of the pages at Depression.com may be worth 
reading if you are concerned you or a friend may 
be depressed, you live with someone who is 
depressed or you have concerns about depression 
and weight, sex or sleep problems. 

Depression and anxiety problems

6. Humor is healthy

Serious Operation

After a long and serious operation, Lena ended up 
in a coma. Try as they might, the doctors just 
couldn't bring her out of it. When her husband 
Ralph came into the Intensive Care Unit to see 
her, the doctors gave him the bad news. 

"We just can't wake her. It doesn't look good I'm 
afraid," the doctor told Ralph in a quiet somber 

Ralph looked at Lena and with a soft trembling 
voice said, "But doctor, she's so young.  She's 
only 45." 

"37," came the weak reply from Lena.

Contributed by: Raman
That's it for this time. 
Make confident self-help care decisions.

Frederick R. Jelovsek MD 

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***** Woman's Diagnostic Cyber Newsletter *****
              October 10, 1999
This week from Woman's Diagnostic Cyber

1. Eyecare
2. Women and sex - Science is behind 
3. Reader submitted Q&A-Non menopausal hot flashes
4. Treatment of depression during pregnancy
5. A digital health conscience - just what I need
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. Eyecare
Everything you always wanted to know about the 
eyes is included in this extensive article and 
listing at the Health 0n the Net Foundation. 

Different conditions of visual acuity are covered 
as well as how to read an eyeglasses prescription 
and the ins and outs of glasses and contacts. If 
you are having any problems with your vision or 
contact lenses, this section can answer some 

Eye diseases and conditions such as 
conjunctivitis, eyelid problems of stys or flaking 
eyelashes are among the topics and the topics all 
have secondary links to other web sites to expand 
upon a given condition. 

Vision and Eyecare Overview FAQs

2. Women and sex - Science is behind
Viagra for mens' erectile dysfunction has brought 
to light just how little science is behind is 
studying sexual desire, libido and arousal in 
women. Lack of sexual desire is a very common 
problem in women. It is different, but related to, 
sexual arousal. In other words, many women will 
complain that they just have no desire to be 
involved in sex, but if they do get involved, they 
can still undergo arousal with their feelings very 
easily. Its the "getting started" that is 

A recent article below from the women's section of 
the New York Times points out how little is known 
of the physiology. One psychologist, Dr. Sandra 
Leiblum said she thinks many sexual complaints in 
women are psychological, that women feel pressured 
to perform,  or that "they feel concerns about how 
they look or how they are formed or how they 

Surveys show twice as much lack of sexual desire 
in women as men, up to a third of them. 

We will do some future articles on this very 
complex subject. In the meantime, you may want to 
look at: 

Women and sex New York Times article

3. Reader submitted Q&A - non menopausal hot flashes
"I am a 32 year old female. Throughout the last 
year, I've developed "night sweats". I have them 
sporadically about once a month. I know this is a 
common occurrence with menopause, but I'm only 32! 
I also know that I could be starting menopause 
early. However, are there other conditions that 
would cause night sweats? Is there a way to 
prevent them? Thanks a bunch." J.S. 

Hot flashes are not always menopausal. In fact 
most hot flashes are often due to other causes and 
occur in both men and women. Once a month hot 
flashes are not worrisome for menopause or 
serious diseases. For an explanation of hot 
flashes that may not be caused by hormone 
deficiency, see the article below. 

Non menopausal causes of hot flashes

To submit a question for consideration for our 
weekly reader submitted question:

Submit your question

4. Treatment of depression during pregnancy
The safety of anti depressant pharmacologic 
therapy during pregnancy has always been a 
concern. On the one hand, some medications have 
been associated with birth defects such as lithium 
or Dilantin. Recently, there have been many new 
products developed for depression treatment. 

This article from the Journal of the American 
Medical Association (JAMA) looks at different 
studies in the medical literature to see which 
medications appear safe during pregnancy. 

There were only four good studies that they found 
- mostly concerning tricyclics (Elavil, Pamelor, 
Sinequan, Tofranil, Triavil), fluoxetine (Prozac) 
and serotonin reuptake inhibitors (Paxil, Prozac, 
Zoloft). They concluded that "exposure to these 
agents did not increase risk for intrauterine 
death or major birth defects. Decreased birth 
weights of infants exposed to fluoxetine in the 
third trimester were identified in 1 study. The 
development of children whose mothers took 
tricyclics or fluoxetine during gestation did not 
differ from that of controls. Direct drug effects 
and withdrawal syndromes occurred in some neonates 
whose mothers were treated with antidepressants 
near term." 

Keep in mind that babies do have withdrawal and 
therefore are being affected by these drugs. 
Therefore treatments should not be used unless 
they are very necessary. 

Depression treatment during pregnancy

5. A digital health conscience - just what I need
If you have personal goals to:

Lose weight
Stop smoking
Get in shape
Take care of myself

then this site at iVillage's Allhealth.com is for 
you. Here they have a program to sign up for a 
weekly email on one of the above topics. They even 
go further and let you choose whether the tips, 
advice and reminders you receive  will come from 
"Mom", your "friend" Constance, or "Coach" - all 
members of the digital conscience team. 

Mom encourages you with lots of love and warm 
words of wisdom! 

Your friend, Constance, is forever by your side! 

and Coach, drives you to get off your butt and 
work harder! 

I would probably choose the coach but I wonder who 
most women will choose? 

Digital conscience

6. Humor is healthy
A doctor was having an affair with his nurse.

Shortly afterward, she told him she was pregnant. 
Not wanting his wife to know, he gave the nurse a 
sum of money and asked her to go to Italy and have 
the baby there. 

"But how will I let you know the baby is born?" 
she asked. 

He replied, "Just send me a postcard and write 
'spaghetti' on the back. I'll take care of the 
child's expenses."  

Not knowing what else to do, the nurse took the 
money and flew to Italy. 

Six months went by and then one day the doctor's
wife called him at the office and explained, 
"Dear, you received a very strange postcard in the 
mail today from Europe, and I don't understand 
what it means." 

The doctor said, "Just wait until 
I get home, and I will explain it to you". 

Later that evening the doctor came home, read the 
postcard, fell to the floor with a heart attack. 
Paramedics rushed him to the ER. The lead medic 
stayed back to comfort the wife. He asked what 
trauma had precipitated the cardiac arrest. 

So the wife picked up the card and read: 

"Spaghetti, Spaghetti, Spaghetti, Spaghetti -
Two with sausage and meatballs, two without."

That's it for this time. 
Get quickly to the medical nitty gritty,
Frederick R. Jelovsek MD 

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***** Woman's Diagnostic Cyber Newsletter *****
              October 17, 1999
This week from Woman's Diagnostic Cyber

1. Osteoporosis fracture prevention 
2. Snoring and sleep apnea 
3. Reader submitted Q&A - Pelvic organ prolapse
4. When PMS needs an antidepressant
5. Are supplements needed for vegetarian diets?
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. Osteoporosis fracture prevention 
A report of a new drug for treatment of women who 
ALREADY have osteoporosis is worth knowing about 
because it has less side effects than a current 
standard treatment drug, Fosamax (alendronate). In 
a recent issue of the Journal of the American 
Medical Association, authors report a very 
significant reduction over three years of use, of 
new spinal cord (vertebral) fractures (11% vs 16%) 
and non vertebral fractures (5.2% vs 8.4%) using a 
drug called Actonel (risedronate). This drug did 
not have as high an incidence of gastrointestinal 
side effects like Fosamax and reduced non 
vertebral fractures more effectively than another 
drug for osteoporosis  called Evista (raloxifene). 

Therefore if these study results hold up, it will 
probably replace Fosamax and Evista as the non 
estrogen treatment for women who already have 
osteoporosis. Keep in mind that estrogen therapy 
is still the drug of choice for fracture 
prevention with or without existing osteoporosis 
as long as a woman does not have problems with it 
or is adverse to taking estrogen because of cancer 

Prevention of osteoporosis fractures.

2. Snoring and sleep apnea
Sleep apnea, a condition in which a person stops 
breathing at night for periods up to 10 seconds 
and sometimes as often as 100 times an hour, is 
often considered an overweight man's disease. But 
many women are probably not diagnosed with this 
condition when they should be. 

Hallmarks of sleep apnea are daytime sleepiness, 
morning headaches and often mood changes with 
severe irritability or depression. Before you 
decide that you and many others you know have this 
condition, you may want to learn about it.  This 
is especially so if you or your partner is a heavy 
snorer. Most snorers do NOT have sleep apnea, but 
those with sleep apnea almost always snore, wake 
up with a "snort", and if carefully watched while 
sleeping, they can be seen to stop breathing for 
several seconds on many occasions. The lack of 
oxygen at night causes the daytime sleepiness. 
High blood pressure, personality change, and night 
sweats can also be symptoms. 

The only way to correctly diagnose this condition 
is by a test in a special sleep laboratory called 
polysomnography. While one sleeps, certain 
physiological measurements are made of oxygenation 
of the blood and other signs. Please keep in mind 
that just because you snore does not mean you need 
this test done. But if someone tells you that you stop 
breathing sometimes, during sleep, be sure to 
investigate about this topic at The Sleep Apnea 
Information Clearinghouse. 

Sleep apnea FAQs

3. Reader submitted Q&A - Pelvic organ prolapse
"I am 50 yrs old and have been diagnosed with a 
prolapsed uterus, bladder, and rectum. From what I 
have read, this will be an increasing problem for 
the baby boom generation, as we age. The only 
treatment my doctor recommends is hysterectomy 
with rectal and bladder repair, which can fail and 
lead to other problems. Is any research being done 
into more effective ways to correct this problem? 
Are uterine resuspensions, using materials other 
than the patient's own tendons, a good option for 
older women? " 

If you are going to undergo surgery for any type 
of pelvic organ prolapse, you want to know that 
the surgery being performed is the best surgery to 
permanently cure your problem. Any hernia surgery 
can fail so what questions can you ask to make 
sure you are being treated according to the latest 
techniques, technology and concepts? This is 
discussed in the article below. 

The observation that many doctors suggest 
hysterectomy at the time of prolapse surgery is 
also discussed as why that may be done and whether 
hysterectomy needs to be included. 

Having Prolapse Problems Fixed Without Hysterectomy

4. When PMS needs an antidepressant
Most doctors do not like to prescribe anti-
depressants for PMS symptoms until a woman has 
made as many positive changes in lifestyle habits 
as possible. After caffeine discontinuance, sleep 
deprivation reversal, switching to a low 
carbohydrate diet, adding in regular exercise, and 
possibly even using magnesium supplements, 
antidepressants have been shown to help. 

But which class of antidepressant? This paper in 
the Archives of Clinical Psychiatry about a 
clinical trial comparing Zoloft (sertraline) 
versus Norpramin (desipramine) versus placebo in 
189 women with PMS showed that the SSRI (selective 
serotonin reuptake inhibitor) class drug 
sertraline was much more effective than the 
tricyclic drug desipramine in improving symptoms. 
This would seem to indicate that PMS may be more 
related to a serotonin problem specifically since 
the generalized anti-depressant qualities of 
desipramine were not any better than placebo, 
i.e., PMS does not respond to just generalized 
antidepressant drugs like the tricyclics. 

Comparison of antidepressants for PMS

5. Are supplements needed for vegetarian diets?
Vegetarian diets have been shown to be beneficial 
for certain chronic diseases and conditions such 
as obesity, coronary artery disease, hypertension, 
diabetes mellitus, and some types of cancer. Those 
diets can also have some deficiencies in necessary 
food elements if they are not well balanced. The 
American Dietetic Association has a position paper 
written and available about vegetarian diets and 
their suggestions. 

They address the main two types of vegetarian 
diets - the lacto-ovo-vegetarian eating pattern 
and the vegan pattern that does not include eggs 
or milk products or other animal products. While 
iron sources are low in vegetarian diets, 
increased vitamin C may enhance iron absorption. 
Vitamin B-12 supplements are recommended for vegan 
dieters as well as vitamin D supplements if sun 
exposure is infrequent. In all types of vegetarian 
diets calcium and zinc requirements can be met if 
the balance and source of food is closely watched. 
Because adequate calcium is difficult to get in a 
vegan diet, supplements or calcium enhanced 
vegetarian foods should be considered. 

American Dietetic Association vegetarian diet paper

6. Humor is healthy

What about those telephone answering menus?

"You have reached the psychiatric hot line--

if you are obsessive-compulsive, please press 1 

if you are co-dependent, please ask someone to 
press 2 

if you have multiple personalities, please press 
3, 4, 5, and 6 

if you are paranoid-delusional, we know who you 
are and what you want. Just stay on the line long 
enough for us to trace your call. 

if you are schizophrenic, listen carefully, and a 
little voice will tell you which number to press 

if you are manic-depressive, it doesn't matter 
which number you press, no one will answer." 

if you have PMS, all the numbers lead to wrong

That's it for this time. Accurate answers for
when a symptom or health problem concerns you.
Frederick R. Jelovsek MD 

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***** Woman's Diagnostic Cyber Newsletter *****
              October 24, 1999
This week from Woman's Diagnostic Cyber

1. Panic attacks 
2. Why MDs do not always follow clinical guidelines 
3. Reader submitted Q&A-Uterus needed postmenopause?
4. Irritable bowel syndrome diagnosis
5. Safe use of medicines - your responsibility
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. Panic attacks
Panic attacks can affect as much as 5% of the 
population. All of a sudden, out of the home, at 
home, anywhere, a sudden terror strikes with a 
very rapidly beating heart rate, difficulty 
breathing, dizziness and even a fear of death. 
There may be no obvious reason for these feelings. 
If you have ever had an anxiety or panic attack, 
you would remember it. 

Almost 75% of panic attacks occur in women, mostly 
in their 20's-30's but it can be at any age. The 
underlying condition is called panic disorder and 
it can progress over time so that a woman fears to 
leave the house, to go in public places. It can 
masquerade as other diseases. The immediate cause 
of a panic attack is believing one is trapped and 
helpless, by some overwhelming threat. 

There is help for this disorder. Check out: 


2. Why MDs do not always follow clinical guidelines
Guidelines, algorithms or decision trees, for 
diagnosis or treatment of a condition or disease 
are often developed by individuals or committees 
of experts who analyze the scientific literature 
and proclaim a "best" way to manage a medical 
problem. Managed health care companies, HMOs and 
medical insurance companies like guidelines 
because they define a standard method of spending 
money for medical care. Non physicians have a much 
easier time determining whether a guideline was 
followed than determining when a deviation from 
that guideline is appropriate medical care. 

The question of why such guidelines do not have 
100% compliance has not been well examined. 
However a recent article in the Journal of the 
American Medical Association looked at what the 
barriers were to why physicians did not always 
follow guidelines. This topic is important to 
women to know about because if a doctor is not 
aware of the recommended method to diagnose of 
treat a condition, that is quite a different 
situation for your health than if the doctor is 
aware of a guideline but also has strong feelings 
that she or he can improve upon the 
recommendations and get a better health outcome 
because of some additional knowledge. 

These authors found several different barriers to 
physician use of a clinical guideline: 

Lack of Awareness - did not know at all about a 
given guideline 

Lack of Familiarity - knew of guideline but not 
familiar enough with the details in order to 
actively change what they were previously doing 

Lack of Agreement - did not agree that the 
guideline was the best way to manage a condition 

Lack of Self-efficacy - did not have the personal 
skills to manage the guideline as it was intended 
(for example nutrition counselling may be 
efficacious but some doctors did not feel 
comfortable with their diet counselling skills 

Lack of Outcome Expectancy - even knowing a 
guideline was effective (eg. smoking cessation 
counselling) but very pessimistic that they would 
be effective to change the incidence that much 

Inertia of Previous Practice - old habits die hard

External Barriers - lack of resources such as 
staff or equipment,inconveniences of 
implementation, not easy to use or lack of 
consultant support among other things 

Unfortunately this study did not determine what 
percent of MD non compliance is due to the 
different categories of barriers. It is very 
likely that the specific barriers vary greatly 
depending upon the topic of the guideline. 

Following clinical guidelines

3. Reader submitted Q&A-Uterus needed postmenopause?
"What are the advantages of keeping your uterus 
over a lifetime? Does the uterus perform any 
functions past child-bearing years? Some sources 
say the uterus continues to produce needed 
hormones during a woman's entire life; that it is 
part of the endocrine system; and that the loss of 
the uterus decreases sexual enjoyment." 

"I am 50 and still having regular periods. In the 
1960's my mother had a hysterectomy. Those years 
seemed to be the start of an epidemic of 
hysterectomies similar to tonsillectomies, which 
now are being thought to be often unecessary. 

In essence, this question tries to get at what are 
the effects a woman can expect after just a 
hysterectomy. This is separate from the concept of 
menopause, either natural or surgically induced 
due to premenopausal removal of the ovary. 

See the answers at:

What does the uterus do after childbearing?

4. Irritable bowel syndrome diagnosis
Abdominal cramping, loose stools, increased gas -- 
these can all be signs of irritable bowel syndrome 
(IBS) or "spastic colon". It is difficult to 
diagnose this condition because often it is a 
diagnosis of exclusion. Ulcerative colitis and 
regional enteritis (Crohn's disease) must be 
ruled-out. There are no specific blood tests or 
xrays that can be done to diagnose IBS so 
researchers have come up with a set of symptom 

Called the Rome criteria, the article below at the 
Mayo Health website points out that there must at 
least be a three month history of: 

Abdominal pain or discomfort relieved with bowel 
movements or associated with a change in frequency 
or consistency of stool. 

In addition to that, at least 25% of the time, 
there should also be a history of at least 2 of 
the following 4 symptoms: 

Altered stool frequency and form (lumpy/hard or 

Altered stool passage (straining, urgency, or 
feeling of incomplete evacuation). 

Passage of mucus. 

Bloating or feeling of abdominal distention. 

If these symptoms are present then there is a very 
good likelihood of irritable bowel syndrome. Three 
times as many women as men get IBS. Often the 
symptoms of gastrointestinal upset are worse just 
before menses. 

Irritable bowel syndrome

5. Safe use of medicines - your responsibility
Improper use of prescribed medicines causes more 
deaths each year than illicit drugs. You would 
like to depend upon your physician and the Federal 
Drug Administration to protect you from serious 
side effects but the truth is you need to protect 

You need to know the name and dose of your drugs 
and what side effects you may expect. Also, be 
sure to ask the doctor or pharmacist what you 
should do if one of those side effects occur. 
Sometimes a side effect may be confused with the 
disease effect for which you are being treated and 
if you fail to stop the medicine when you are 
having a serious side effect, complications can 

It is also important to know what foods, drinks or 
other medicines may interact with your medication. 
When you are on multiple medications prescribed 
from different physicians it is even more 
important to be aware of possible drug-drug 

I would add one of the most critical pieces of 
information to know is "what are the consequences 
of not taking a prescribed medicine". The worst 
complications I know come from not taking an 
antibiotic prescription or a diabetic who 
eventually goes blind from not taking their 
diabetic medicine as directed on a regular basis. 

Safe use of medicines

6. Humor is healthy

"Your Tattoo"

The doctor noted with astonishment a tattoo of a 
bluebird on the shoulder of his high society 70 
year old patient, who was in his office for her 
annual check up.  She told him that she had wanted 
one her whole life, so she and her 16 year old 
grandson decided that they would birthday tattoos 

The doctor inquired why she had not got one 

"Until now," she replied, "I was afraid of what my 
mother would say." 

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

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***** Woman's Diagnostic Cyber Newsletter *****
                 October 31, 1999
This week from Woman's Diagnostic Cyber

1. Ectopic pregnancy - medical or surgical rx?
2. Hair loss - What's normal, what's abnormal? 
3. Reader submitted Q&A - Osteoporosis 
4. Gestational diabetes
5. Dizziness in the elderly
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.

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1. Ectopic pregnancy - medical or surgical rx?
An interesting recent article below highlights 
some of the present conflicts within our medical 
care and insurance payor system. It has to do with 
an economic analysis of whether surgery 
(lapaoroscopic removal of a tubal pregnancy) is 
more or less expensive than the medical therapy of 
a tubal (ectopic) pregnancy. At first glance you 
might wonder why anyone would prefer to have 
surgery rather than to have some shots and blood 
tests and several doctors visits.  The major 
difference in treatment is that with surgical 
treatment a woman would undergo anesthesia and 
laparoscopic surgery and return to work within 3-4 
days after surgery. With medical treatment 
encompassing a methotrexate drug injection 
(intramuscular), a woman may have continued pain 
for up to 7-10 days or more, miss time from work and have 
to have 4 or more visits to the doctor for 
laboratory tests. When you add up the costs and 
time lost from a wage earning job, it turns out 
that the medical treatment can be more expensive, 
on the average than surgical treatment. At lower 
levels of HCG less than 1500 IU/L, the two treatments 
are about equal in cost.

It seems that whether or not a woman chooses 
surgical treatment or medical treatment depends 
upon whether loss of time from work or activity is 
more negative than fear of surgery or being put 
asleep. Either choice of treatment can be 
reasonable. Remember, however, from an insurance 
company point of view, medical treatment is always 
preferable because they do not bear the cost of 
time out of work or other activity. You do! 
Therefore a managed care company may try to push 
women toward medical therapy when in fact surgical 
treatment may be the best choice in your own 
situation and value system. 

Treatment of tubal pregnancy

2. Hair loss - What's normal, what's abnormal 
Ever have clumps of hair come out in your hair 
brush? Did you know that normally, women lose 50-
100 hairs a day and the average hair grows for 5 
years before it undergoes a resting phase and then 
comes out? These and other facts about hair growth 
will help you in the self-diagnosis of hair loss 
via an article at regrowth.com. 

Some hair loss in women occurs about 3-9 months 
after a pregnancy because the hormones of 
pregnancy forced many hairs into a synchronized 
growth phase during pregnancy and a resting phase 
after pregnancy. But aside from that instance, 95% 
of permanent hair loss is genetic. The follicles 
are sensitized and damaged by a male hormone, DHT 
or dihydrotestosterone. That hormone can occur in 
women also. While much has been written about male 
pattern baldness, did you know that there is a 
definite female pattern of baldness? The scales 
used to measure that (the Ludwig Scale) can also 
be viewed at the link below. Patches of hair loss 
or extreme thinning are not normal. 

Self-diagnosis of hair loss

Hair growth FAQs, which apply to women as well as 
men, are also located at: 

Hair growth FAQs

3. Reader submitted Q&A - Osteoporosis
"I am 51 years old. I have three children, and I 
had a total hysterectomy when I was 44. I had been 
on Premarin 1.25 mg for the first 5 years, and for 
the past two years I have been doing a hormone 
implant. My problem is my bone density which keeps 
decreasing every year. My mother has osteoporosis, 
which she had diagnosed when she was in her 
seventies. She also had six children which could 
have attributed to this condition. 

My bone density test shows that I have 
osteoporosis. I have heard of a new kind of 
treatment for osteoporosis, but I know nothing 
about this product, and how safe it is. Could you 
please help me. " MOS@gnm 

There is a new biphosphonate treatment that has 
been reported and it seems to have less side 
effects (only one study) than alendronate 
(Fosamax) which is the standard osteoporosis 
treatment in addition to estrogens. Its name is 
risedronate but I do not believe it is approved 
yet in the U.S. for osteoporosis. It was just 
recently approved in Sweden. Probably you should 
ask your doctor to start you on alendronate first 
to stop further bone loss and then use the new 
drug only if you have problems with alendronate. 

4. Gestational Diabetes
Did you have gestational diabetes mellitus (GDM) 
during pregnancy? Are you pregnant now? Women who 
are over 30 at the time of pregnancy or are 
overweight are at a higher risk to develop 
gestational diabetes. This can lead to 

large birth size 
low blood sugar in the baby after birth 
early birth 

If you had GDM in pregnancy there is about a 2% 
chance that you actually have diabetes after the 
pregnancy is over, and an 8% chance to have 
impaired glucose tolerance. Almost 60% of women 
with GDM will get diabetes later in life so be 
sure to have the doctor keep checking your glucose 

If you ever develop GDM or even diabetes, 
Diabeteswell.com is the place to go to learn about 
the disease and how to manage it. They have a good 
track record. 

Gestational diabetes at the Diabeteswell

5. Dizziness in the elderly 
Dizziness is not a disease or diagnosis but rather 
it is a symptom. It can be the result of 
infection, inner ear disease, vascular disease in 
the ear or brain or even due to heart rate 
abnormalities among others. Many elderly patients 
have dizziness but also have vascular disease or 
heart rate problems that are just coincidental and 
not the cause of the dizziness. Diagnostic work-
ups for dizziness can be quite expensive or 
intensive and possibly not yield the actual cause 
of the symptom. 

The study below looked at elderly patients with 
and without dizziness and found that there were 
similar rates of diagnostic abnormalities in both 
groups, i.e., elderly patients WITHOUT dizziness 
tended to have the same abnormalities as patients 
WITH dizziness. Therefore it is very unlikely that 
the abnormality found is really the cause of the 
dizziness. They did complicated diagnostic tests 
and found "there were no differences in the 
results of blood tests or 12-lead EKGs; 24-hour 
ambulatory EKG showed abnormalities in 30 % of 
both groups, usually short-lived episodes of 
atrial fibrillation. Approximately 80% in both 
groups showed two or more abnormalities on 
electronystagmography. MRI results showed that 
approximately 70% of both groups had facet joint 
degeneration in their necks, and 80% had signs of 
cerebral atrophy." 

Therefore if you are over 65 or have a relative 
over 65 years old with dizziness, don't waste your 
time with complicated diagnostic studies UNLESS 
your doctor finds other abnormalities on physical 
exam that may indicate a serious disease. 
Conversely, do not be disappointed if your doctor 
does not do a "full court diagnostic press" for 
dizziness if there are no other symptoms. You may 
want to go straight to treatment of the symptom. 

Dizziness in elderly patients

6. Humor is healthy
The Nun

A cabbie picks up a nun. She gets into the cab, 
and the cab driver won't stop staring at her. She 
asks him why is he staring and he replies, 

"I have a question to ask you but I don't want to 
offend you." 

She answers, "My dear son, you cannot offend me. 
When you're as old as I am and have been a nun as 
long as I have, you get a chance to see and hear 
just about everything. I'm sure that there's 
nothing you could say or ask that I would find 

"Well, I've always had a fantasy to have a nun 
kiss me." 

She responds, "Well, let's see what we can do 
about that: #1, you have to be single and #2 you 
must be Catholic." 

The cab driver is very excited and says, "Yes, I 
am single and I'm Catholic too!" 

The nun says "OK, pull into the next alley." 

He does and the nun fulfills his fantasy. But when 
they get back on the road, the cab driver starts 

"My dear child," said the nun, "why are you 

"Forgive me sister, but I have sinned. I lied, I 
must confess, I'm married and I'm Jewish." 

The nun says, "That's OK. 
My name is Bruce and I'm on my way to a Halloween 

Contributed by: Andrea and the Halloween Archives!

That's it for this time. 
Your BACKUPMD on the Net.
Frederick R. Jelovsek MD 

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***** Woman's Diagnostic Cyber Newsletter *****
              November 7, 1999
This week from Woman's Diagnostic Cyber

1. Foot health care network
2. Chronic pelvic pain 
3. Reader submitted Q&A -Vulvar sweat gland cysts
4. Newly acquired herpes infections
5. Acute appendicitis at any age
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. Foot health care network
Have you ever had heel pain that wouldn't seem to 
go away? And you have no idea whether it might be 
due to shoe heels that are too low, overactivity 
with increased foot impact, an Achilles tendonitis 
from running, a plantar fasciitis from having flat 
feet and overpronation, or a heel spur calcium 
deposit. I knew that poorly fitting shoes could be 
a culprit in causing foot pain, but I did not 
realize how, as we age, the fat pad on the bottom 
of the foot can get thinner and lead not only to 
heel pain problems but pain almost anywhere on the 
foot. These and many other foot problems have some 
helpful fact and diagnosis sheets at 
foothealthnetwork.com. Each condition includes a 
definition, causes, treatment and prevention. 
Other topics include: 

 AIDS & Your Feet
 Arch Pain / Arch Strain
 Bunions (Bunionettes)
 Claw Toes
 The Diabetic Foot
 Hammer Toes
 Mallet Toes
 Mortons Neuroma
 Mortons Toe 
 Overlapping Toes
 Over Pronation (Flat Feet)

Conditions and diagnosis of foot problems

2. Chronic pelvic pain
Pelvic pain is a frequent cause for visits to the 
gyn physician, perhaps up to 20%. It accounts for 
about a fifth of all diagnostic laparoscopies. 
Doctors have a primary goal to determine if there 
is a serious cause for the pain such as cancer, 
endometriosis, infection and other continually 
damaging diseases. There can be many causes and 
most of them can only be "ruled out" rather than 
just precisely pin-pointing the certain cause. 
Clues as to cause come from physical exam, pelvic 
exam, ultrasound, CAT scans, laboratory studies 
and sometimes from investigations of the bowel and 

Chronic pain can also lead to emotional upset, 
depression or anxiety which in turn worsens the 
pain because it lowers your coping skills. In 
other words a woman with any chronic pain may 
perceive the pain as being at higher and higher 
levels because her pain threshold goes lower and 
lower due to the emotional upset from the pain in 
the first place. 

You need to help the doctor out in figuring out 
the cause. Be sure to note exactly what seems to 
bring on the pain, is there anything that eases 
the pain, how long does it last and to what degree 
is it affecting your daily activities and coping 

Chronic pelvic pain

3. Reader submitted Q&A - Vulvar sweat gland cysts
"For the last 6 months I have been having problems 
with sweat gland cysts on my vaginal area.  I have 
had 2 removed and now have a third on that needs 
removing, what caused these and is there anything 
that can be done to prevent them?  My doctor says 
no! Thank you ". 

Sweat gland cysts can be one of many different 
vulvar problems so it is impossible to say what 
the treatment might be. Except for a few vulvar 
lesions that can be identified visually with fair 
certainty, most cysts of the vulva need to be 
biopsied in order to know for certain what they 
are. While a doctor can "guess" that a vulvar 
lesion is likely to originate from a sweat gland, 
if you have not had a biopsy, you may want to 
suggest that to the doctor. Epidermoid cysts can 
often be mistaken for sweat gland cysts and two 
sweat gland diseases, Fox-Fordyce disease and 
hidradenitis suppurativa are almost impossible to 
be distinguished unless a biopsy is done. 

For a discussion of other possible conditions, see 
the article below: 

Vulvar Sweat Gland Cysts

To submit a question for consideration for our 
weekly reader submitted question:

Submit your question

4. Newly acquired herpes infections
In spite of the many information sheets spread 
across the Web about herpes infections, there is 
still a lot that is not well known about how 
herpes spreads. 

There are two main strains of herpes simplex virus 
(HSV), type 1 and type 2. Type 1 usually causes 
cold-sore type of lesions in the mouth or lips but 
sometimes, it can also cause genital herpes sores 
on the vulva, in the vagina or on the cervix. Type 
2 is usually the virus associated with genital 
herpes but we really do not know how often it is 
passed on and causes symptoms (versus being 
asymptomatic) and even how often it is correctly 

A recent study in the New England Journal of 
Medicine followed 2393 men and women who were 
initially negative by blood titers for any HSV-2 
exposure. Of those people, 1508 were seropositive 
for HSV-1 past exposure. The authors found that 
new HSV-1 and HSV-2 infections occurred in 1.6 and 
5.1 cases per 100 person-years, respectively. In 
other words, each year, 5% of sexually active 
individuals were newly exposed to genital herpes 
(HSV-2). Of the new HSV-2 infections, 37% had 
symptoms of infection, usually painful genital 
sores. Of those who has symptoms, 82% were 
correctly diagnosed at presentation, 18% were not. 
Of those patients who did not have symptoms of 
HSV-2 when their blood indicated they had been 
exposed, 15% of those individuals actually had 
lesions even though they were not aware of them. 
Women were more likely than men to acquired HSV-2 
and were more likely to have symptoms. 

In a question that is commonly asked - "does 
having previously had HSV-1 infection protect 
against getting HSV-2 infection" - this study 
found that "previous HSV-1 infection did not 
reduce the rate of HSV-2 infection, but it did 
increase the likelihood of asymptomatic 
seroconversion". That is  HSV-1 did not protect 
against HSV-2 but it made it more likely (risk 
ratio of 2.6) that a person would not have 
symptoms from the infection. 

5.  Acute appendicitis
While acute appendicitis occurs more commonly in 
the age range of 10 to 30, it can occur at any 
age. There is a lifetime incidence of 7% for an 
acute infection in this bowel appendage. There are 
a few new twists in the diagnosis of appendicitis. 
It used to be almost exclusively a diagnosis based 
on history and physical exam. Now a CAT scan, an 
appendiceal computed tomographic scan is about 90-
100% accurate in picking up an inflamed appendix. 
Unruptured, the mortality rate from acute 
appendicitis is less than 1% but if it ruptures, 
death may occur as high as 5%. Mortality is higher 
in older patients so the questions becomes, if you 
are having other abdominal surgery (hysterectomy, 
ovary removal) should you have your appendix 
removed incidentally to the other surgery. This 
article does not answer that question but the fact 
that CAT scan is quite accurate now, it is 
probably less necessary to remove the appendix 

I especially liked the table listing the 
differential diagnosis of acute appendicitis. It 
includes not only other bowel problems. but also 
gyn problems such as ectopic pregnancy, ovarian 
cyst rupture or torsion, endometriosis, and PID. 
Lung problems, urinary problems and other systemic 
problems are also included in the differential 

Acute appendicitis

6. Humor is healthy
"Wedding Vows"

During the wedding rehearsal, the groom approached 
the pastor with an unusual offer. 

"Look, I'll give you $100 if you'll change the 
wedding vows. When you get to me and the part 
where I'm to promise to 'love, honor and obey' and 
'forsaking all others, be faithful to her 
forever,' I'd appreciate it if you'd just leave 
that part out."  

He passed the minister a $100 bill and walked away 

It is now the day of the wedding, and the bride 
and groom have moved to that part of the ceremony 
where the vows are exchanged. When it comes time 
for the groom's vows, the pastor looks the young 
man in the eye and says: 

"Will you promise to prostrate yourself before 
her, obey her every command and wish, serve her 
breakfast in bed every morning of your life and 
swear eternally before G-d and your lovely wife 
that you will not ever even look at another woman, 
as long as you both shall live?" 

The groom gulped and looked around, and said in a 
tiny voice, "Yes." 

At the reception, the groom leaned toward the 
pastor and hissed, "I thought we had a deal." 

The pastor put the $100 bill into his hand and 
whispered back, "She made me a much better offer." 

That's it for this time. Your BACKUPMD on the Net. 
Frederick R. Jelovsek MD 

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