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***** Woman's Diagnostic Cyber Newsletter *****
             March 26, 2000
This week from Woman's Diagnostic Cyber

1. Fifty tips for a fitter you
2. Stopping a period by skipping OCP placebos 
3. Reader submitted Q&A-Fibrocystic breasts and HRT
4. What happens during the normal sexual response?
5. Fluoride and bacteria in bottled vs tap water  
6. Health tip to share--Elevated BP and cholesterol
7. Humor is healthy

1. Fifty tips for a fitter you
We all know about diets, exercise and other 
healthy habits, but how do we make them palatable? 
How can we keep them up beyond the first week or 
two. There are no easy answers as you are aware 
but there are some tips from Michael A. Woo-Ming, 
MD MPH at Personal MD.com 

Some of the things he points out that I enjoyed 

don't diet - embark on a lifestyle change
find a partner to diet or exercise with
add weight training to your program
don't tell friends you are dieting
eat with your opposite hand (slows eating)
plan for the 3-5 pm binge hours with low fat snack
stretch before any exercise and 43 other tips

2. Stopping a period by skipping OCP placebos
While doctors do not encourage manipulating an 
oral contraceptive dosing schedule just to avoid 
having a menstrual period, there often are times 
when it would be convenient for a woman to do so. 

An upcoming weeks vacation or holiday occurring in 
the week you are supposed to get your menses on 
the birth control pill, a wedding, a strenuous out 
of town business trip etc., are all reasons a 
woman might want to just reschedule her menses if 

It is possible to stop a cycle a week early and 
get your menses over before that event or to skip 
the placebo pills the last week of a 4 week pill 
pack and just start the new pack at the end of 
three weeks of active pills. The article below at 
Mayo Health discusses doing this. There probably 
is no harm in doing this several cycles in a row 
because we have experience with women who have 
endometriosis who are on a continuous regimen for 
6-12 months, but breakthrough, unscheduled 
bleeding is a side effect. If you do this 
alteration in dosage schedule, do it with your 
doctor's knowledge. 

3. Reader submitted Q&A-Fibrocystic breasts and HRT
"Are there any herbs or natural treatments, other 
than less caffeine to help in treatment of 
fibrocystic breast disease? And why do the cysts 
keep getting harder? Does HRT therapy aggravate 
the situation? " 

As common as fibrocystic breast disease is, we 
still do not know very much about the causes and 
treatments. HRT which includes estrogen and 
progestin seems to worsen fibrocystic change (FCC) 
but it varies by which progestin is actually used. 
Medroxy progesterone acetate seems to worsen FCC 
but only if it is given with estrogen. By itself, 
it does not worsen FCC. 

You would think oral contraceptives with both 
estrogen and progestins would worsen fibrocystic 
conditions but they do not. Perhaps it is the  
different progestins. 

Treatments for FCC include vitamin E and possibly 
vitamin A. But the best treatments if you have 
severe disease are the antiestrogen ones such as 
tamoxifen. It is better than danazol, a long time 
standard treatment. 

4. What happens during the normal sexual response?
The University of Toronto Sexual Education and 
Peer Counselling Centre has a very practical 
summary of the human sexual response that they 
have taken from the Kinsey New Report on Sex. They 
summarize the different phases of a normal sexual 
response such as: 

Sexual Arousal
Plateau Phase
Resolution Phase 
Multiple Orgasm

There can be abnormalities of any of the phases 
although most women who have decreased sexual 
libido are not even in a state of readiness for 
the first phase of sexual response. These phases 
are worth knowing about if there is any concern 
about sex response. 

5. Fluoride and bacteria in bottled vs tap water
Bottled water doesn't have that awful chlorine 
taste that many municipal water supplies do, but 
chlorine is added to lower the amount of bacteria 
in the water. The study below looked at bottled 
water brands off the store shelves and compared it 
to the water from the tap in Cleveland, Ohio. They 
checked the bacteria count and the amount of 

They found that only 5% of the bottled water fell 
in the recommended fluoride range as required by 
the state of Ohio whereas all of the municipal 
water plants met the requirements. 

As far as bacteria counts are concerned, most of 
the bottled water specimens had lower bacterial 
counts than the tap water but 22.6% had higher 
bacterial counts and 10% had over 1000 times the 
bacterial counts of tap water. 

The bottom line in this study is that bottled 
water is not always "better" than tap water. It 
pays to know what you are drinking and you may 
want to take a sample of your favorite bottled 
water to your local public health department and 
have them check the bacterial count. 
6. Health tip to share - Elevated BP and cholesterol
"I am a 35 year old, who is 5'2" and weighs about 
114lbs. I found out 6 months ago I had high blood 
pressure (135/96), and a total cholesterol level 
of 240." 

"I began to investigate my cupboards for possible 
culprits and eliminated fat free non-dairy 
creamer, nutrasweet, and started using extra 
virgin olive oil to saute or stir fry. I also 
began to walk 2 miles, three times a week." 

"In a week off the artificial sweetner and 
nutrasweet, my blood pressure dropped to normal. 
Within 3 mos., my cholesterol level was 172!" 

"I recommend walking and watching foods that are 
processed or synthetic.(Also, I stopped having 
migraines every day after giving up the artificial 
sweetner-now I only experience one menstrually). 
The high cholesterol was found after the high 
blood pressure was cleared up--both conditions 
were found by my OB/GYN during my annual pap, 
something my primary physician did not find 
despite going to him for obvious symptoms. 
Sometimes your OB/GYN can prove very invaluable." 


7. Humor is healthy
At the Source

Two storks are sitting in their nest: a father 
stork and baby stork. The baby stork is crying and 
crying and father stork is trying to calm him. 

"Don't worry, son. Your mother will come back. 
She's only bringing people babies and making them 

The next night, it's father's turn to do the job.  
Mother and son are sitting in the nest, the baby 
stork is crying, and mother is saying 

"Son, your father will be back as soon as 
possible, but now he's bringing joy to new mommies 
and daddies." 

A few days later, the stork's parents are 
desperate: their son is absent from the nest all 
night!  Shortly before dawn, he returns and the 
parents ask him where he's been all night. 

The baby stork says, "Nowhere. Just out 
frightening college students!" 

Contributed by: David L.

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

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***** Woman's Diagnostic Cyber Newsletter *****
                April 2, 2000
This week from Woman's Diagnostic Cyber

1. Olive vs sunflower oil effect on hypertension
2. Sinus and stuffy nose problems 
3. Reader submitted Q&A-Non med hypertension Rx 
4. How to survive prescribed bed rest in pregnancy
5. Congenital uterine anomalies tutorial
6. Health tip to share - Oil therapy for hair loss
7. 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. Olive oil vs sunflower oil effect on hypertension
Many women have been made aware that mono-
unsaturated fatty acids such as those in olive 
oil, are better for us than fatty acids that are 
polyunsaturated, e.g., sunflower oil. We are told 
that use of mono-unsaturated fatty acids (MUFA) 
instead of polyunsaturated fatty acids (PUFA) 
will lower your cholesterol and also your blood 
pressure. What may not be appreciated is that 
these are two separate effects, i.e., the blood 
pressure reduction is a direct effect of the MUFA, 
not through the eventual lowering of the 

This study below was a randomized trial in which 
men and women who were hypertensive used either 
measured amounts of extra-virgin olive oil or 
sunflower oil for 6 months and then crossed over 
to the other oil for another 6 months. After two 
months on each oil, doctors tried to lower the 
blood pressure medicines if there had been a drop 
in their systolic and diastolic blood pressure. 

The net result of this Italian study (possible 
bias so take it with a clove of garlic) was that 
when the hypertensive men and women were using the 
extra virgin olive oil, there was a 48% reduction 
in daily drug dosage versus only a 4% reduction in 
those using sunflower oil. 

2. Sinus and stuffy nose problems
Since so many women have sinus problems of various 
sorts, it is a lifelong topic we should learn 
about. In addition to the richness of information 
material at this ENT site, there is a great set of 
3D pictures of the insides of the sinuses and 
nose. If you would like a visual picture of what 
goes on with infections and allergies involving 
the sinuses, be sure to see the illustrations 
Peter J. Casano, M.D. has created and organized. 

Everything you want to know about sinuses and 
noses is at the site below. 

Sinusitis Information
You and Your Stuffy Nose
Earaches and Otitis Media  
The Common Cold
Antihistamines, Decongestants, and Cold Remedies
The "Flu"...It can be dangerous
Ready to Quit Smoking? Read This
Earwax and what to do about it.
Sore Throats, Causes and Cures  
Tonsils and Adenoids
Ears, Altitude, and Airplane Travel
Snoring...Not Funny, Not Hopeless  

3. Reader submitted Q&A-Non med hypertension Rx 
"How does taking calcium supplements affect the 
calcium channel blocker I take for high blood 

I am a  48 yr old Native American woman.  I really 
want to stop taking blood pressure medicine.  I 
think the medicine causes as much harm as it does 
good.  There has to be another  way." 

While it seems that taking calcium supplements 
would work against taking a calcium channel 
blocker, physiology does not actually work that 
way. In fact in one type of essential 
hypertension, calcium supplements themselves lower 
blood pressure and at the same time the blood 
pressure is very treatable by calcium channel 
blockers. The way to look at it as a mental model 
is that the extra calcium desensitizes the system 
so there is not as much  difference in calcium 
levels inside and outside of the muscle cell on 
the two sides of the calcium channel. 

There are other non medical ways to lower high 
blood pressure. In addition to the standard stop 
tobacco and alcohol and exercise more, switching 
to olive oil or including fish or fish oil in the 
diet helps. Eliminating simple carbohydrates and 
replacing them with complex carbohydrates will 
also help. Salt restriction does not help as much 
as most people think.

4. How to survive prescribed bed rest in pregnancy
There are certain pregnancy complications for 
which doctors will prescribe almost absolute 
bed rest. Conditions such as: 

pregnancy induced hypertension (PIH) 
placenta previa and abruptio placenta 
Incompetent cervix 
PPROM: Premature pre-term rupture of membranes 
multiple gestation (twins, triplets, etc)

are reasons to decrease activity during pregnancy 
so as not to go into labor too early. 

Any woman who has been prescribed bed rest in 
pregnancy will tell you it drives them crazy. 
While the first two weeks might seem a rest from 
the numerous chores at home, succeeding weeks and 
months can be the worst times of your life. 

The frequently asked questions (FAQs) on "all you 
ever wanted to know about pregnancy bed rest" at 
this site by Judy Maloni, PhD, RN, FAAN, are 
invaluable to surviving the ordeal should it be 
prescribed for you or your family. 

I especially like the activity list which helps 
the woman and doctor define just what activities 
are allowed. This is often a source of confusion. 
The explanations about medications you might be 
prescribed and the procedures you and the baby may 
go though are also extremely informative. 

5. Congenital uterine anomalies tutorial
Birth defect anomalies of the uterus can be 
associated with chronic miscarriage or difficulty 
getting pregnant. Sometimes it is not very clear 
how much a given anomaly affects the ability to 
carry a pregnancy or to conceive. 

There are quite a few different anomalies.

Images of different uterine anomalies

As you can see it is most important to make an 
accurate diagnosis of the specific anomaly before 
determining whether and what treatment is needed. 
The tutorial below emphasizes the different tools 
such as MRI, ultrasound, hysterosalpingogram (dye 
injection into the uterus and taking an xray) and 
laparoscopy that are used to diagnose the type of 
Treatment surgically of a septate, bicornuate, 
didelphic, and unicornuate uterus are also 

Congenital uterine anomalies tutorial

6. Health tip to share - Oil therapy for hair loss
A condition of non scarring, patchy hair loss 
called alopecia areata can be treated with some 
success with essential oil therapy. Rubbing a 
mixture of a base of jojoba or grape seed oil with 
essential oils of thyme, rosemary, lavender, and 
cedarwood into the scalp on a daily basis lessens 
the hair loss. (Keep in mind this has not been 
tested for generalized hair loss.) FRJ 

7. Humor is healthy

1. Patient has chest pain if she lies on her left 
side for over a year. 

2. The patient has been depressed since she began 
seeing me in 1993. 

3. Discharge status: Alive but without my 

4. The patient refused autopsy. 

5. The patient has no previous history of 

6. Patient had waffles for breakfast and anorexia 
for lunch. 

7. Between you and me, we ought to be able to get 
this lady pregnant. 

8. She is numb from her toes down. 

9. While in ER, she was examined, x-rated and 
sent home. 

10. The skin was moist and dry. 

11. Occasional, constant infrequent headaches. 

12. Rectal examination revealed a normal size 

13. She stated that she had been constipated for 
most of her life, until she got a divorce. 

14. Examination of genitalia reveals that he is 
circus sized. 

15. The lab test indicated abnormal lover 

16. The patient was to have a bowel resection. 
However, he took a job as a stock broker instead. 

17. Skin: somewhat pale but present. 

18. The pelvic exam will be done later on the 

19. Patient was seen in consultation by Dr. Blank, 
who felt we should sit on the abdomen and I agree. 

20. Patient has two teenage children, but no other 

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

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***** Woman's Diagnostic Cyber Newsletter *****
                  April 9, 2000
This week from Woman's Diagnostic Cyber
1. Food irradiation - FAQs
2. Estrogen by nasal spray 
3. Reader submitted Q&A - Informed consent
4. Fast facts on primary hyperparathyroidism
5. Antibacterial activity in cranberry juice
6. Health tip to share - For excessive bruising
7. 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. Food irradiation - FAQs
The Centers for Disease Control and Prevention in 
Atlanta has put together some information about 
food irradiation. Admittedly, they emphasize the 
benefits of food irradiation and the safety of it. 
They claim it does not change food such as leaving 
radiation behind or causing a change in the 
nutrition value. They also say it is very 
difficult to test food to know if it has been 
irradiated or not because there is so little 
change with irradiation. The CDC thinks 
irradiation is much safer than the use of ethylene 
oxide gas. 

If you think about trying to protect the food 
supply from bacteria such as such as E. coli 
O157:H7, or Salmonella on raw meats or parasites 
such as trichina on pork, you can see why 
irradiation is used as a tool. 

The FAQs include among others:

What is food irradiation?
Which food borne diseases could be prevented with 
What is the actual process of irradiation?
How does irradiation affect foods?
How do you measure the amount of irradiation used?
How does irradiation affect disease-causing 
Which foods can be irradiated?
Which foods have been approved for irradiation in 
the United States? 
Which foods are being irradiated in the U.S.?
How can I tell if the food has been irradiated?

2. Estrogen by nasal spray
Most estrogen replacement is accomplished by 
pills, skin patch, creams and occasionally 
injections. This multicenter European study tested 
delivery of estrogen by a nasal spray. It was 
compared with an oral estradiol preparation. 

The nasal preparation did as well as the pills at 
treating hot flashes. Interestingly it was 
associated with less bleeding problems and less 
breast soreness than the oral preparation. 

This nasal preparation of estradiol is not 
available for use at the present time but it 
implies that some of the side effects of hormone 
replacement can be lessened by the route of 
administration. The main difference between nasal 
or skin administration is that the estradiol does 
not first pass through the liver where some of it 
is processed before going to the target organ as 
it does with oral pills. This first-liver-pass 
effect may be the cause of abnormal bleeding 
because of uneven blood levels. The lower 
incidence of breast pain with the intranasal 
estradiol is not explainable unless the liver is 
processing some of the estrogen from oral 
ingestion to compounds that cause breast pain. 

3. Reader submitted Q&A - Informed consent
" The surgical consent form I have been given does 
not spell out any direct risks for hysterectomy, 
but rather just gives some generic risks that 
might apply to an ingrown toe nail. " 

"What are the  ACOG guidelines for an 'INFORMED 
PATIENT SURGICAL CONSENT'  for a hysterectomy, 
partial and radical? ". 

We get questions periodically like this that are 
essentially asking what is the standard of medical 
care in a given situation. As you may be aware 
these are extremely difficult to answer. 

To help in this, we are fortunate to have  an 
editor with an RN and a legal background (JD). I 
have convinced Sandra Jelovsek JD, RN to 
participate with us in answering these sticky 
questions in order to give women the best 
information possible about their health and law 
options. Sandy has also agreed to field email 
reader submitted questions and write an article 
once a week if there are enough questions. 

To see how she handles the above question, see:

Ethical Considerations of Informed Consent 

4. Fast facts on primary hyperparathyroidism
Primary hyperparathyroidism is a metabolic 
disorder in which one of the small parathyroid 
glands located by the thyroid gland becomes 
overactive and secretes excess parathyroid 
hormone. Too much parathyroid hormone results in 
excess calcium being released from bone and 
eventual osteoporosis. 

It is a rare disease but twice as common in women 
as men. It is usually picked up in early stages 
because of high serum levels of calcium on a 
screening blood chemistry. The reason to know 
about this condition even though rare, is because 
it can produce symptoms similar to fibromyalgia 
and chronic fatigue syndrome which are more 
common conditions. 

The excess calcium in the body produces appetite 
loss, thirst, frequent urination, tiredness, 
muscle weakness, joint pains, and constipation. If 
the blood calcium levels stay too high too long, 
symptoms of abdominal pains, nausea and vomitting, 
memory loss and depression can result. Kidney 
stones and the bone thinning are also 
manifestations of hyperparathyroidism. 

See these fact sheets at the NationalInstitutess 
of Health Osteoporosis and Related Bone Diseases 
National Resource Center: 

5. Antibacterial activity in cranberry juice
There have been previous publications about the 
antibacterial activity in cranberry juice which is 
sometimes used to help prevent recurrent urinary 
tract infections. Originally scientists thought it 
was the acidity that killed bacteria. Then the 
tannins were thought to inhibit the bacteria 
especially E.Coli, a common urinary pathogen. 

This recent report in JAMA indicates that it is 
not just the acidity (the investigators 
neutralized that) but some compounds in cranberry 
juice have a wide range of antibacterial activity 
against many different bacteria. The cranberry 
juice is best used as concentrated as possible. 

6. Health tip to share - For excessive bruising
"For excessive bruising, I use arnica and ginger 
gel. Rub a small amount on bruise each morning. 
The bruising dissipates slowly. This worked for me 
when I needed to take heparin subcutaneously in my 
stomach. In a few days the massive bruising caused 
by the shots went away. "  - NG 

[Editor note for source but not endorsement -
Arnica-Ginger Gel. By Ginger Delivery System, 
External Herbals. For Product info contact New 
Moon Extracts, Inc. Brattleboro, VT, 1-800-543-

7. Humor is healthy
A fellow is going on a tour of a factory that 
produces various latex products.  

At the first stop, he is shown the machine that 
manufactures baby-bottle nipples.  The machine 
makes a loud "hiss-pop" noise.  "The hiss sound is 
the rubber being injected into the mold," explains 
the guide. "The popping sound is the needle poking 
a hole in the end of the nipple." 
Later, the tour reaches the part of the factory 
where condoms are manufactured.  The machine makes 
a noise: "Hiss. Hiss. Hiss. Hiss-pop!"  

"Wait a minute!" says the man taking the tour, "I 
understand what the 'hiss, hiss,' is, but what's 
that 'pop!' every so often?" 
"Oh, it's just the same as in the baby-bottle 
nipple machine," says the guide. "It pokes a hole 
in every fourth condom." 
"Well, that can't be good for the condoms!"

"Yeah," says the guide "but it's great for the 
baby-bottle nipple business!" 

Sue Hunter FF/EMT

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

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***** Woman's Diagnostic Cyber Newsletter *****
                April 16, 2000
This week from Woman's Diagnostic Cyber

1. The Merck Manual Home Edition on the net
2. Circumcision and genital skin problems   
3. Reader submitted Q&A-Bacterial/yeast vaginitis
4. Polycystic ovarian syndrome and anti-insulin rx
5. Endometrial (uterine) cancer links
6. Health tip to share - Flaxseed and constipation
7. 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. The Merck Manual Home Edition on the net
It is very handy to have a good quality, 
understandable medical reference book at home. One 
such classic is the Merck Manual, Home Edition. 
The original manual was written for physicians to 
have a handy synopsis of many different diseases 
and conditions. The home edition takes much of 
that material and puts it in an easy to read 
format that people without a medical background 
can understand. 

Each chapter does not have the depth of detail an 
experienced medical surfer might want about a 
specific disease of condition they have or have 
researched, but this manual is a great beginning 
place to learn a general overview of a topic. Even 
physicians who are removed in time from a subject 
can find this resource a handy review of a topic 
before going on to more depth of detail. 

I especially like the explanation for 
hypoglycemia. Low blood sugar can cause many 
symptoms and be the result of different causes. 
The manual has an understandable description of 
blood sugar, insulin and the interplay among 
different dietary influences and medicines. 

2. Circumcision and genital skin problems  
Circumcision in a male, surgical removal of 
foreskin covering the head of the glans penis, is 
usually performed as a child for either religious, 
ritual or conformity reasons. As an elective 
procedure in a newborn baby, many question whether 
it should be done because there can be rare 
complications and it does not reduce medical 
problems until later in life. 

Male circumcision has been studied and does 
significantly reduce the incidence of penile 
carcinoma in later life. This study in the 
Archives of Dermatology was carried out to see if 
there was a relationship between circumcision 
status in males and skin diseases and infections 
of the penis. They studied males who presented for 
genital skin problems (357) and for non - genital 
skin problems (305) and looked at how many males 
were circumcised in each group. 

They found that uncircumcised males were 3 times 
more likely to have inflammatory skin conditions 
such as: 

Zoon balanitis
bowenoid papulosis
nonspecific balanoposthitis
lichen sclerosus
lichen planus
seborrheic eczema

3. Reader submitted Q&A -Bacterial/yeast vaginitis 
"What oral medication would you recommend for 
bacterial and yeast infection?". 

It is quite uncommon to have both yeast and 
bacterial vaginitis but it can happen. It is still 
very important to make a correct diagnosis. 

Traditional treatment is usually vaginal gel or 
suppositories for yeast infections and oral 
metronidazole (Flagyl[R]) for bacterial vaginosis. 
Many women may prefer an oral agent like 
fluconazole (Diflucan[R]) for yeast infections but 
doctors try to reserve it for more recurrent or 
systemic infections because resistance yeast 
strains are becoming more prevalent (C. glabrata) 
and C.albicans strains seem to be requiring higher 
and higher doses of fluconazole to eradicate the 

4. Polycystic ovarian syndrome and anti-insulin rx
In women who have polycystic ovarian syndrome, 
many have a condition called insulin-resistance. 
In those women with this condition, the current 
recommended treatment is with insulin sensitizing 
drugs such as would be used in treating a diabetic 
woman (Type2 diabetes). This is especially the 
case if menses are irregular and there is evidence 
of excess hair growth. 

Dr Mark Perloe at IVF.com has a good article that 
explains how it is the insulin resistance that 
causes the hormonal problem (androgen excess) 
rather than vice versa.  The high insulin levels 
decrease sex hormone binding globulin which makes 
blood testosterone and androstenedione higher. 
Once the androgens are elevated, they produce 
abnormalities of the ovulatory system. Therefore, 
the best treatment is directed at lowering insulin 
levels with drugs like metformin (Glucophage[R]). 
Besides improving excess hair growth (hirsutism), 
this treatment also improves obesity, blood 
pressure, triglyceride levels, and reestablishes 
normal ovulatory cycles almost 90% of the time. 

It is possible that the standard of care for PCOS 
with insulin resistance is evolving to have a 
trial of metformin therapy before trying to induce 
ovulation with Clomid[R] in a woman who desires 

5. Endometrial (uterine) cancer links 
Cancerlinksusa.com has put together quality links 
governing all phases of cancer including not only 
diagnosis, treatment and prognosis, but also 
support groups, clinical trials, risk factors and 
prevention, suggested reading, general information 
and FAQs. 

The page of links on endometrial cancer also 
includes references to articles on the prognostic 
significance of hormone receptors in endometrial 
cancer (estrogen receptor positive have a much 
better prognosis) and tamoxifen and endometrial 

6. Health tip to share - Flaxseed and constipation
I read in the Prevention Magazine that flaxseed 
oil tablets can help prevent constipation.  I went 
to the health food store and found some.  They 


[editor note-- raw flaxseeds can also be used for 
constipation. Both the oil and the raw seeds are 
rich in phytoestrogens.] 

7. Humor is healthy
The Masked Man

The couple left the gynecologist's office with the 
wife in tears. They were just told that she could 
never become pregnant. They would never have the 
family they both desired so fervently. 

Suddenly, a masked man appeared before them. 

"I think I can help you," he said, handing them a 

"Why are you masked?" the husband asked. 

"Because the government has declared our 
activities illegal. Go to the address on this 
card. The doctor will take a scrapping from one of 
your mouths and culture it. In less than a year, 
we will have your baby for you." 

"This is the answer to our prayers!" the wife 
exclaimed. Then she turned to thank the stranger 
but he was gone. 

"Who was that masked man?" she asked her husband. 

He answered, ... "That was the Clone Arranger" 

By Stan Kegel

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

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***** Woman's Diagnostic Cyber Newsletter *****
                April 23, 2000
This week from Woman's Diagnostic Cyber

1. Family Meds pharmacy treatment suggestions
2. Gall bladder disease and high vitamin C levels  
3. Reader submitted Q&A - Evista and soy
4. Cancer of the ovary background
5. Understanding panic disorder
6. Health tip to share - Don't fear psych drugs
7. 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. Family Meds pharmacy treatment suggestions
There are now more than several online pharmacies 
competing for your business but most of them look 
alike. The online pharmacy at familymeds.com, 
however, has much more health information that you 
may find useful. They also make their own 
recommendations in each of the treatment 
categories. This is very helpful, especially when 
confronted with the many options available (and 
confusing) in today's pharmacy. 

For each of over 300 different diseases and 
conditions, they provide short infobits about: 

leading causes
symptoms of note
over-the-counter choices
natural choices
prescription choices
other treatments

It was interesting for many conditions,  to see 
all of the prescription, non prescription and 
natural choices listed close together. While we 
need to be aware that many of the "other 
treatments" and "natural choices" are also 
pharmacy products they are trying to sell, there 
still is a wealth of information that pharmacists 
have about treating medical conditions and 
everyday problems. They get to see what treatments 
seem to be successful with the least side effects 
and what people actually purchase on a repeat 
basis because they work. Many of their 
recommendations look quite reasonable. 

2. Gall bladder disease and high vitamin C levels 
You may have already heard about vitamin C and 
gallbladder disease. Here's the scoop from the 
Archives of Internal Medicine. 

In over 7000 women and 6000 men surveyed, the 
incidence of a history of gall bladder disease was 
higher in women than men (11% vs 4%). Of the 
remaining men and women without a history of gall 
bladder disease, asymptomatic gallstones on 
ultrasound were found in 8% of women and 6% of 
men. They then looked at serum vitamin C levels 
(ascorbic acid) and found that in women, but not 
in men, the higher the blood level of vitamin C, 
the lower the incidence of symptomatic gall 
bladder disease and asymptomatic gallstones. 

This study is important on several counts. First 
of all, it does not necessarily mean that taking 
vitamin C will prevent gallbladder disease in 
women, but there is a good likelihood it may. The 
second item is that women have more gallbladder 
disease then men. That is probably due to 
estrogens. We have known for years of the higher 
gallbladder problems in women taking birth control 
pills and estrogen replacement. 

Vitamin C supplements for all women, but 
especially those taking oral contraceptives or 
hormone replacement therapy, would seem to be a 
wise strategy for the possible prevention of gall 
bladder disease.  

3. Reader submitted Q&A - Evista and soy
"Do you have information regarding interactions 
between the hormone Evista, and use of soy or 
other non-pharmaceutical products for relief of 
hot flashes during menopause?" 

"I am 53, and have been taking Evista® 
(raloxifene) for almost four months as hormone 
replacement therapy; I also take vitamin 
supplements and 1200 mg of calcium daily.  I have 
been suffering from hot flashes numerous times 
daily and at night." - Anonymous 

Evista [R] (raloxifene) is an anti-estrogen used 
to help prevent osteoporosis. It tends to make hot 
flashes and vaginal dryness worse than even just 
menopause alone. Women who take it have symptoms 
similar to women with breast cancer on tamoxifen 
therapy. It is natural to ask if some of the hot 
flashes can be lessened by taking soy or other 

There is not much written about this in the 
medical literature. One study mentioned in the 
article below suggests that adding soy will not be 
harmful but it will not really  reduce hot 
flashes. Adding estrogens may help but the 
combination of estrogens and anti-estrogens has 
not been adequately studied yet. 

4. Cancer of the ovary background
CancerNet from the National Institute has very 
good overviews of many different cancers. For 
ovarian cancer they cover: 

Treating Ovarian Cancer
Clinical Trials
Genetics, Causes, Risk Factors, Prevention of Ovarian Cancer
Complementary and Alternative Medicine
Testing for Ovarian Cancer
Coping with Ovarian Cancer
Support and Resources
Cancer Literature 

In the section on screening for ovarian cancer you 
will find explanations of CA-125 cancer antigen 
test, vaginal ultrasound and Pap smears. Also you 
may be interested in some of the screening trials 
for cancer detection going on. 

5. Understanding panic disorder
Every once in a long while, a person might have an 
episode of panic or anxiety in which there is a 
rapid heart beat, sweating, choking, dizziness, 
or fear of losing control or even fear of dying. 
But does this mean a panic disorder requiring 

At the Panic Disorder Institute, you can see the 
possible symptoms that make up the official 
diagnosis of panic disorder. Also, you can see 
that the diagnosis requires that "your panic 
attacks be unexpected and recur every two weeks or 
that a single attack be followed by one month or 
more of persistent concern about future attacks, 
worry about the attacks causing physical illness 
or going crazy, or significant behavioral changes 
related to the attacks." 

If panic disorder persists, it may evolve into an 
agoraphobia, which is a fear of being unable to 
escape or get help if there is an attack. A women 
with this will not go out in crowds, to the mall 
or hardly any places outside of the home. 

One in 75 people have this problem. It can also 
have medical consequences such as: 

2 times increased risk of hypertension 
4.5 times increased risk of heart attack 
12 times increased risk of stroke  

6. Health tip to share - Don't fear psych drugs
"If you suffer from Panic Attacks, Anxiety, 
Depression or any similar disorder, do not fret, 
there is help at hand - go and see your doctor 
about anti-depressant pills - or your psychiatrist 
- don't be afraid, or embarrassed. There are that 
many people that suffer from them. It can be 
controlled - I have been there and it is the worst 
experience of my life. I am one of the weakest 
people around - but I needed to get help. It is a 
hard struggle but if you can talk to somebody else 
that has had them it is so much better." 


7. Humor is healthy
A group of senior citizens were exchanging notes 
about their ailments. 

"My arm is so weak I can hardly hold this coffee 

"Yes, I know.  My cataracts are so bad I can't see 
to pour the coffee." 

"I can't turn my head because of the arthritis in 
my neck." 

"My blood pressure pills make me dizzy." 

"I guess that's the price we pay for getting old." 

"Well, it's not all bad. We should be thankful 
that we can still drive!" 

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

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***** Woman's Diagnostic Cyber Newsletter *****
              April 30, 2000
This week from Woman's Diagnostic Cyber

1. Embarrassing medical problems website
2. Guidelines for vulvar skin care 
3. Reader submitted Q&A - BCP drug interactions
4. Amenorrhea - When menstruation stops
5. Ménière's disease - dizziness and ear ringing 
6. Health tip to share- Casein causing skin allergy
7. 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. Embarrassing medical problems website
Some people are too embarrassed about certain 
health problems to even bring them up with a 
physician. Physicians will also admit that there 
are many health conditions that are not serious 
but present significant problems for the person 
with that condition as well as their family and 
friends, and they don't really know the answers 
for those questions. 

Dr. Margaret Stearn, a British physician wrote a 
book and created a web site about many of these 
embarrassing problems that patients in a 
genitourinary clinic she attended were asking. 
Some of the topics include: 

bad breath, belly button discharges, blushing and 
flushing, breast size and shape, nipples, anal 
itching, condom use, dandruff, memory problems, 
excessive shyness, snoring, stammering, sweaty arm 
pits, sweaty feet, sweaty hands, no 
sexual interest, wind 

2. Guidelines for vulvar skin care
On several occasions we have highlighted irritant 
vulvitis which is often mistaken for a candida 
yeast vulvovaginitis. This is a condition in which 
the skin of the vulva becomes irritated or 
hypersensitive so that any substance or material 
that comes in contact with it makes the problems 
worse. There can be a secondary candida yeast 
infection but the treatment is to discontinue all 
of the skin irritants. 

At the University of Iowa Clinics, you can find a 
great instruction sheet on how to avoid this 
irritation. There are suggestions for detergents 
free of dyes, enzymes and perfumes. This also 
applies to soaps used on the skin. Clothing needs 
to be all cotton and any drying off needs to be a 
gentle patting dry, not a rubbing. They also 
suggest not to shave the vulvar area at all. 

There is a well advised caution that lubricated 
condoms, contraceptive jellies, creams, or 
sponges may cause itching and burning and 
aggravate any existing vulvar irritation. 

3. Reader submitted Q&A - BCP drug interactions
"Do weight-loss pills (xenedrine) effect birth 
control pills, or cause breakthough bleeding?". 

Any woman using oral contraceptives for birth 
control should be concerned if taking certain 
medicines or having certain medical conditions may 
decrease the contraceptive  action of the pill. 
For many years, women may have heard that some 
antibiotics might decrease the effectiveness of 
birth control pills. As best we can tell, this is 
a theoretical interaction but is not a practical 
problem. We do not know for sure about diet pills 
but it is unlikely that they  increase the pill 
failure rate and break through bleeding has not 
been reported excessively on diet pills. 

Anti-epileptic drugs, however, are one drug 
interaction that is likely to increase the chance 
of pregnancy while taking oral contraceptives. 
Women with epilepsy on medication for it should 
probably take higher dose oral contraceptives in 
order to be assured of protection. 
4. Amenorrhea - When menstruation stops
When menses stops, it is not always caused by 
pregnancy or menopause. In fact most of the time, 
the cause of amenorrhea has to do with the lack of 
ovulation from the ovary. There are many factors 
that can affect the hormones that control 

Causes of anovulation, and thus amenorrhea may 
range from rare pituitary tumors, to polycystic 
ovarian disease, medications, stress, chronic 
illness, malnutrition and obesity among other 

You might think "why worry about this? No menses 
is good!" At Mayo Health Oasis there are some good 
explanations and visuals about hormones and 
ovulation control. It is worth becoming educated 
about this because amenorrhea that occurs before 
menopause can make a woman at risk for: 

heart disease
endometrial cancer

Also included are symptoms to watch for and  how 
to prevent amenorrhea. 

5. Ménière's disease - dizziness and ear ringing 
Dizziness is a common symptom. It is not usually 
due to  an inner ear problem but when it is, it 
can be quite frequent and annoying. Attacks of 
dizziness and loss of balance come on quickly and 
peak in intensity within minutes and may last more 
than an hour with the unsteadiness lasting even 
longer. Attacks may come in a series over weeks or 
months or even have periods of no attacks for 
awhile. If the dizziness or vertigo (spinning 
sensation) gets bad, it may be accompanied by 
nausea, vomiting and sweating. This disease is 
more common after the age of 20 but peaks in the 
40-50 age range. 

Untreated, symptoms may regress over years. There 
are actually many different treatments that have 
been used and different ones work for different 
people. Dietary change, medicines and several 
different surgeries may be used so this is a 
condition you would want to work very closely with 
your doctor about. 

6. Health tip to share - Casein causing skin allergy
Eczema was my biggest nightmare for 3 years. I was 
given cycle upon cycle of prednisone with only 
temporary relief. I now have "prednisone eyes". I 
still buy triamcinolone by the pound, but that and 
some antihistamines is all I need, since I decided 
to try the dietary route and give up all milk 
products, (especially, or including) Casein. 
BINGO! It's not an easy thing to avoid, but 
considering the alternatives, it's well worth the 
denial of some very wonderful foods. 

I wondered why tuna sometimes bothered my skin, 
read the label, casein is used in the canning 
process, products like Bumblebee, Chicken of the 
Sea have it. Starkist does not. This change in my 
life has made my skin tolerable. I work in a 
hospital, and OSHA requires us to be constantly 
washing our hands. They are always a mess. They 
provide latex-free and cornstarch-free gloves for 
me.  I will probably always have some form of 
dermatitis going on, but before, my eczema was 
total body, and very red in patches. I could not 
work for 9 months because clothing hurt me. 

The dietary route for a cure for skin eczema 
should not be overlooked. 


7. Humor is healthy
A man is diagnosed with prostate cancer and the 
doctor says he wants to put the man on hormone 

"Okay," the man says, "what does it do?" 

"It reduces the testosterone which feeds the 

"Okay," the man says. "Are the any side effects?" 

"Some loss of sex drive. Possibly some hot 
flashes. And an inexplicable urge to ask 
directions when lost." 

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

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