Womens Health

Women's Health Newsletters 6/18/00 - 7/30/00



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***** Woman's Diagnostic Cyber Newsletter *****
              June 18, 2000
This week from Woman's Diagnostic Cyber

1. Your community's environmental pollutants
2. Dipstrip testing for UTI not always accurate 
3. Reader submitted Q&A - Perimenopausal bleeding
4. The first menstrual period
5. Sleep apnea symptoms and treatment
6. Health tip to share - Icing an amputated thumb tip
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. Your community's environmental pollutants
Environmental Defense has a database at 
scorecard.org which lists community pollutants as 
reported by businesses and governmental agencies. 
You can enter your zip code and see which 
businesses are releasing large quantities of 
potentially polluting compounds into the air, soil 
and streams. 

You can find out where in the U.S. or for your 
community area, there are: 

potential land contamination sites
chemical air pollutants
criteria (gases) air pollutants
animal waste from farms
manufacturing chemical releases

There is also a section on the health effects of 
the different chemicals. Lead exposure can produce 
menstrual disorders and infertility. Carbon 
disulfide, mercury and PCBs (polychlorinated 
biphenyls) also can cause menstrual 
irregularities. You may want to know what 
chemicals are possible problems where you live. 


Environmental pollution maps and info

2. Dipstrip testing for UTI not always accurate 
There are several ways in which urine is tested to 
see if there is a urinary tract infection (UTI). 
The gold standard test is a urine culture but 
because of expense we often try to shortcut by 
looking at the urine microscopically, doing a gram 
stain for bacteria or now, dipstrip testing of the 
urine looking at nitrites and leukocyte esterase. 

In pregnancy there is dilatation of the urinary 
tract which makes women more susceptible to 
urinary infections so that testing for bacteria in 
the urine is almost routine to prevent more 
serious kidney infections. This study in the 
American Journal of Gynecology looked at the 
different methods of UTI diagnosis in pregnancy. 

They found that the dipstip test (nitrites and 
leukocyte esterase), which is the most commonly 
used test in doctor's offices, picks up about 50% 
of infections but if it is combined with a 
microscopic urinalysis, then it picks up about 80% 
of infections. The study recommends always doing a 
urine culture to diagnose infection. 

Conversely, if a woman suspects she has a urine 
infection, a negative result on a dipstrip of the 
urine should not mean that no treatment is given. 

Urine testing on pregnancy for UTI

3. Reader submitted Q&A - Perimenopausal bleeding
"I have been having a menstrual cycle for the past 
month and had one last August too.  Any 
information???  Still ongoing and today with clots 
passing and great rushes of discharge." 

"I am  46 and my menses were normal until about 10 
months ago. " 


Perimenopausal bleeding is often due to 
anovulation problems that occur as the ovaries 
become depleted of eggs. Because the chance of 
endometrial cancer starts rising above 1% in women 
over 40, investigations must be undertaken to rule 
out precancerous or cancerous changes before 
instituting any hormonal therapy. 

Diagnostic procedures may involve ultrasounds, 
endometrial biopsies or even hysteroscopy and D&C. 

Treatments for bleeding not due to anatomical 
lesions can include injectable or oral progestins, 
oral contraceptives, or even danazol. Vitamin 
supplements may also play a role in reducing 
prolonged bleeding. 

See our article at:

Prolonged perimenopausal bleeding

4. The first menstrual period
Concern and even fear about that first menstrual 
period that a young girl will have, needs some 
practical answers. At Redspot, there is a great 
section on beginning menses that would be 
appropriate to direct a daughter or friend to. 

I like the first section on fast facts. It has 
brief answers to many  questions such as when will 
I start?, how much blood will there be?, is it 
really blood?, Will my period hurt?, will I get 
cramps?, does menstrual fluid really smell bad?, 
what if I am caught by surprise?, how long will it 
last?, what is a normal period?, how do you count 
your cycle?, will I have periods the rest of my 
life? and many other questions that mentors might 
fail to address. 

5. Sleep apnea symptoms and treatment
Do you tend to fall asleep at boring meetings, in 
the late afternoon or in early evening? That may 
be normal or it may be the results of sleep 
deprivation from episodes of apnea (stopping 
breathing) during nighttime sleep. When you fall 
asleep on the phone or are unable to drive more 
than 30-60 minutes in a car without stopping and 
doing something to try to "wake up", then you may 
well have sleep apnea. 

It can be associated with hypertension and even 
heart failure or heart arrhythmias. Mostly though, 
it affects your work and social relationships. 

Treatment varies as to whether the cause is an 
obstructive airway problem, a central brain 
problem or a mixture of both. Sometimes positive 
pressure masks will help or dental appliances that 
help hold the tongue forward. Occasionally laser 
surgery in which part of the soft palate is 
removed can also improve the frequency of apnea 
episodes. This is a treatment that is used for 
loud snoring also. All persons (2% of women and 4% 
of men) with sleep apnea snore. But not all 
snorers have sleep apnea. 

For a very good overview of symptoms, treatment 
and prognosis of sleep apnea, see: 

SLEEP APNEA Society of Alberta 

6. Health tip to share - Icing an amputated thumb tip
"I recently sliced off about 1/4 the width of my 
right thumb (outer side). I knew about putting 
severed parts/pieces on ice and taking it to the 
emergency dept. When I started to do this, I 
thought about the ice being "old" for such a use, 
so I put the piece into a "snack-size" zip-lock 
bag, zipped it up, and placed this into a larger 
bag which contained the ice, along with some 
water, to promote an even cooling process. It 
turned out that they could not have used the piece 
of thumb if it had been placed directly in the ice 
water, it would have been dehydrated, possibly 
contaminated. The piece was sewn back on, 
fingernail and all and on the 16th day, the 
hardened outer piece came off and, although the 
piece is numb but "tingley", it's going to look 
just fine. The only other alternative would have 
been to amputate enough of the tip of my thumb to 
gain enough skin to pull over the end and suture 
in place. This is information that a person would 
have to know at the time of the accident, there's 
not much time to spare." 


[Editor note] Here is thanks for a previous tip:

"I just wanted to say 'Thank You' to the woman who 
submitted the health tip regarding heavy menses 
and taking vitamin C. Timing was perfect. I had a 
regular appointment with my gyn doctor and ran it 
by her, and I then tried it, and it worked. Thanks 


7. Humor is healthy
Medical Shorts

Sign in the obstetrics ward of a hospital:

"Research shows that the first five minutes of 
life can be most risky." 

Underneath someone had scrawled: 
"The last five minutes aren't so great either." 

M Kushnir, MD 4/8/99 

What do you get when a patient upon examination 
presents with signs of insomnia, dyslexia, and 
agnosticism? A patient who stays up all night 
wondering if there is really a DOG!!! 

Dr. Schlesinger 2/18/99 

In the course of a visit for another problem, my 
patient referred to the herbal remedy she had 
recently taken for her cold symptoms. "I sure felt 
better after taking 'euthanasia'(echinacea)!" 

Bryan Cummings, MD 2/12/99 

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

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***** Woman's Diagnostic Cyber Newsletter *****
              June 25, 2000
This week from Woman's Diagnostic Cyber

1. Miscarriage rate rises significantly with age
2. Colorectal cancer facts
3. Reader submitted Q&A - Post hysterectomy probs
4. Brain attacks - TIA to strokes
5. Recommendations for thyroid screening
6. Health tip to share - Chronic yeast infections
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. Miscarriage rate rises significantly with age
We have known for many years that the chance of 
losing a pregnancy due to miscarriage, stillborn 
or ectopic pregnancy rises quite a bit with age. 
How much it rises has been somewhat difficult to 

The following article in the British Medical 
Journal looked at over 1.2 million births in 
Denmark and measured  the loss rates. They found 
the following miscarriage rate (spontaneous 
abortion) by age. 

Age    Rate
12-19  13.3%; 
20-24, 11.1%; 
25-29, 11.9%; 
30-34, 15.0%; 
35-39, 24.6%; 
40-44, 51.0%; 
over45 93.4%. 

Maternal age and fetal loss

2. Colorectal cancer facts
In the case of the colon, most malignant tumors 
develop from benign polyps. This is not true in 
the uterus or cervix however. Endometrial polyps 
and endocervical polyps infrequently become 
malignant but this is not true in the 
gastrointestinal tract. 

Cancer of the colon and rectum is the third 
leading cause of cancer deaths behind lung and 
breast. It causes about 3% of the annual deaths in 
the U.S. Colonoscopy is the best screening test 
although checking the stool for occult blood is 
the easiest but with a lot of false positives. 

This site on colorectal cancer at cancerfacts.com 
has some good anatomical drawings that help 
explain where the colon is in the body. It also 
has a listing of symptoms to look for such as: 

a prolonged change in bowel habits
narrowing of the stool
a feeling of fullness after bowel movements
crampy abdominal pain
blood in the stool

Colorectal cancer

3. Reader submitted Q&A - Post hysterectomy probs
"Since my hysterectomy  4 1/2 months ago, I 
experience bleeding after intercourse.  Is this 
normal?  It is a small amount of fresh blood, 
bright red.  Is it possible that I have not healed 
internally yet? " 

I am age 45. My menstrual history was normal and  
the hysterectomy was performed because of a large 
rapidly growing fibroid tumor." - S.B. 

Why don't doctors tell you all the things that can 
happen after hysterectomy? Because there are 
actually quite a few symptoms that are normal but 
disappear with time and  a large list of rare but 
possible complications that might turn you off. 
You need to know about all of them, however.

For a discussion of what to expect, see our 
article at: 

Expectations of post hysterectomy recovery

4. Brain attacks - TIA to strokes
Is it possible for a stroke to last only 5-20 
minutes. Yes. There is a type of mini-stroke 
called transient ischemic attacks - TIAs. Any lack 
of oxygen to the brain can cause similar symptoms. 
If the  cause is temporary, the symptoms may be 
temporary. If there is a permanent loss of blood 
supply such as a blood vessel that clots off or 
hemorrhages in the  brain, the symptoms are either 
permanent or last until any healing takes place. 

Symptoms can be:

blindness in only one eye
arm/leg weakness, numbness, or paralysis 
confusion or loss of balance
speaking or understanding difficulty
facial paralysis or numbness 
sudden severe dizziness

There are some treatments that can help minimize 
the effects of strokes or possibly prevent them 
once you have the problem. Therefore it is 
important to recognize the symptoms and see a 
doctor right away if you suspect a problem. 

Brain attacks

5. Recommendations for thyroid screening
The American Thyroid Association has come out with 
recommendations for screening for thyroid 

Basically they recommend that adults begin having 
thyroid screening using a blood thyrotropin 
hormone test (serum TSH) at age 35 and every 5 
years after. It is more important for women to 
have this because they have a higher incidence of 
thyroid diseases, but this testing can even be 
justified in men. 

This is a NEW recommendation so be sure to let 
your doctor know if it is five years since your 
last thyroid checkup. 

Guidelines for Detection of Thyroid Dysfunction  

6. Health tip to share - Chronic yeast infections
I was once plagued by chronic yeast infections. 
The Cure? Taking 350 mg of Acidophilus 3 times 
every day. It worked for me. I haven't had one 


If you have discovered ways of coping with a
disease or condition and it works for you,
please share it with us:


Health tip suggestion form

7. Humor is healthy

1) At lunch time, sit in your parked car and point 
a hair dryer at passing cars to see if they slow 

2) Put your garbage can on your desk  and label it 

3) Put decaf in the coffee maker for 3 weeks. Once 
everyone has gotten over their caffeine 
addictions, switch to espresso. 

4) In the memo field of all your checks, write 
'for sexual favors.' 

5) As often as possible, skip rather than walk.

6) Sing Along at the opera.

7) Go to a poetry recital and ask why the poems 
don't rhyme. 

8) Find out where your boss shops and buy exactly 
the same outfits. Wear them one day after your 
boss does. (This is especially effective if your 
boss is the opposite gender.) 

9) Call the psychic hotline and just say, "Guess" 

10) When the money comes out of the ATM, scream 
"I Won!", "I Won!" "3rd time this week!!!" 

11) When leaving the Zoo, start running towards 
the parking lot, yelling "Run for your lives, 
they're loose!" 

12) Every time you see a broom yell  "Honey, your 
mother is here" 

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

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

1. Colas associated with teen bone fractures
2. Accutane for acne and birth defects
3. Reader submitted Q&A - Constipation
4. Trichomonas profile
5. Health related hoaxes and rumors
6. Health tip to share - Vitamin B2 for migraines
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. Colas associated with teen bone fractures
Physically active teen girls who consume colas and 
other non-cola carbonated beverages have over 3 
times the risk of having a bone fracture than 
physically active girls who do not drink colas. 
This is according to an article in the Archives of 
Pediatrics and Adolescent Medicine. 

The authors do not know why this relationship 
holds. They speculate that since "teens have 
doubled or tripled their consumption of soft 
drinks and they have cut their consumption of milk 
by more than 40%" that they may not be getting 
enough calcium and therefore have brittle bones 
more susceptible to breaking. I'm not so sure it 
isn't due to a caffeine-induced over activity but 
then who knows. Again,epidemiological studies do 
not address cause and effect but rather identify 
associations we must learn from. 

Teenaged Girls, Colas and Bone Fractures  

2. Accutane for acne and birth defects
Retinoic acid is an analog of vitamin A marketed 
under the trade name Accutane [R] for nodular 
acne, a very severe form. It has been known for 
many years to cause major birth defects and 
spontaneous miscarriages. In fact women who are 
prescribed Accutane are supposed to be on 
effective contraception. 

Years ago a registry was created for reproductive 
aged women who had the potential to become 
pregnant while taking the Accutane. 454,273 women 
enrolled in the registry from 1989 to October 1999 
and approximately 900 women became pregnant. Many 
of these women had spontaneous miscarriages or 
babies with major birth defects if they did not 
choose to have the pregnancy terminated. The main 
reason for this article however, was to examine 
why a focus group of these women who had been 
warned about the consequences of Accutane and 
pregnancy still got pregnant. 

Major associations were:

1) over half had an episode of intercourse without 
being on contraception and 93% were not using 2 
methods of contraception as they were supposed to 
by the protocol. 

2) 20% had negative pregnancy tests before 
starting but still became pregnant before actually 
beginning the prescription. 

3) about 15% got pregnant while using pills from a 
leftover previous prescription. 

4) some purchased the drug in Mexico, bypassing 
the usual physician instruction safeguards. 

In the focus group of 14 women who became pregnant 
while using Accutane, 5 had induced abortions, 4 
had spontaneous miscarriages, 4 had normal infants 
and 1 had a baby with major birth defects. 

Accutane and pregnancy

3. Reader submitted Q&A - Constipation
"What causes a ripple in the colon?  I have a 
problem trying to have a normal bowel movement.  
My doctor claims the rippling effect is causing 
blockage so the stool cannot come out.  Is there 
anything that can be done for this problem?" 

"I am age 69,  with Non-Hodgkins Lymphoma (in 
remission), taking Estrace ® for hot flashes. 
" - Lorrie 

Constipation is a symptom that may have many 
different causes. Although most of the time 
dietary and general living habits are responsible 
for constipation, sometimes there can be an 
inherent defect in the rippling motion of the 
colon muscle that produces constipation. 

Another cause may be a weakness of the rectum 
(rectocele) or an involuntary spasm of the anal 
sphincter muscle. For these and dietary discussion 
about different constipation causes, see our 
article at: 


4. Trichomonas profile
With many sexually transmitted diseases, the 
question often comes up as to whether it is 
possible to contract the disease, such as 
trichomonas, HPV or bacterial vaginosis, by 
methods other than intravaginal intercourse. In 
other words can a woman get a trichomonas 
infection from a moist toilet seat, hot tub or 
swimming pool. 

The answer is that it is possible. One study 
showed trichomonads can survive up to 3 hours in 
water with varying concentration of minerals. And 
yet many women do not ever contract trichomonas in 
this way. 

It is probably best to consider trichomonas 
vaginitis as 98-99% a sexually transmitted 
disease. Look at our disease profile on 

Trichomonas disease profile

5. Health related hoaxes and rumors
The governmental unit called the Center for 
Disease Control (CDC) based in Atlanta, Georgia, 
USA has the charge to monitor and investigate 
instances of any small or large epidemics of 
contagious or communicable diseases. Their web 
site is a very rich source for recommendations 
about causes and treatments of bacterial, viral 
and parasite diseases. 

One of the interesting features on their site is a 
section called Current Health Related Hoaxes and 
Rumors. In it they comment about what 
investigation has actually been done about 
conditions or contagious "scares" that you may 
hear about and wonder what substance there is to 
them. Current examples are statements about: 

Does HIV Cause AIDS? 
(what ways can HIV be transmitted?)

False Email Report: Hantavirus Spread by Contact 
With Soda Cans or Grocery Packages 
(a false rumor) 

False Email Report: Klingerman Virus 
(no such virus)

False Internet Report: Bananas 
(no basis as far as CDC can tell)

Needle Stick Hoaxes 
(one episode was documented but no subsequent 

CDC's Health related hoaxes and rumors

6. Health tip to share - Vitamin B2 for migraines
I am an Ob-Gyn outside of Philadelphia. My wife 
has been a migraineur all her life and even though 
she has been on over 50 different meds including 
experimental ones, she was getting headaches every 
7-10 days even on the SSRI's. I read an article 
last year about a small study in which migraine 
patients placed on 400 mg of vitamin  B2 
(Riboflavin) had a significant success rate in 
markedly reducing the frequency and severity of 
migraine. It took about 2 months to kick in. 
Well, in Feb of this year she decided to try it 
and after about 6 weeks, she suddenly went 5 weeks 
without a headache and the one she did get at that 
point was much less severe. I am happy to report 
hat since Feb, she has had a total of 3 or 4, all 
of which have been mild. So far no toxic effects 
have been observed. She is considering stopping 
the SSRI's to see if this continues. I need not 
tell you how exciting this discovery has been to 
us and I wanted to share this with other migraine 

Louis E. Criden, M.D.

[editor note - Here is a study I found supporting 
the above concept. I was not previously aware of 

Vitamin B2 study on migraines

If you have discovered ways of coping with a
disease or condition and it works for you,
please share it with us:

Health tip suggestion form

7. Humor is healthy
When Life Really Begins

A geneticist, a lawyer, and a family counselor 
meet over lunch to decide once and for all when 
life really begins. 

The geneticist spoke first.  "I've done many, many 
tests, and have come to the conclusion that life 
begins once the sperm and the egg unite." 

The lawyer spoke next.  "I am a person who 
interprets the written law, and, therefore, I 
believe that life begins at different times 
depending on what state one lives in."  

"Well, I'm afraid that I must disagree with both 
of you," responds the family counselor.  
"Over the years, I've met with thousands of 
parents and attended dozens of workshops.  I have 
come to the conclusion that you start living once 
your youngest child goes off to college and your 
dog dies." 

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

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***** Woman's Diagnostic Cyber Newsletter *****
              July 9, 2000
This week from Woman's Diagnostic Cyber

1. Can testosterone really help women?
2  What is sarcoidosis?
3. Reader submitted Q&A - Kegel's for incontinence
4. Inverted nipples
5. Health tip to share - Ingrown toenails
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. Can testosterone really help women?
The Women's Health Information Center at JAMA 
(Journal of the American Medical Association) has 
an article about the role of the male hormone, 
testosterone, in how women feel at all ages. We 
know that with surgical removal of the ovaries 
premenopausally there is a very sudden drop of 
testosterone and that may explain post op fatigue, 
lack of energy and libido problems, but the role 
of testosterone throughout a woman's life is not 

Normal ranges for testosterone levels in women 
have been determined but very rarely do doctors 
measure these levels in looking for a deficiency 
state. Most insurance companies do not recognize 
deficiency states of testosterone in women and 
thus the cost of lab tests may not be covered. 

With scientific trials of a testosterone patch for 
women currently underway, this investigator feels 
that a testosterone deficiency state can explain 
the fatigue, loss of energy and decreased libido 
of many menopausal women. 

If you are interested in this topic, you may also 
want to reread our previous article on this 

Will testosterone help menopausal symptoms?

2. What is sarcoidosis?
Sarcoidosis is a condition occurring more often in 
African-American women ages 20-40 in which small 
granulomas or lumps of inflammatory tissue grow in 
different areas of the body. No one knows the 
cause. These growths can alter the normal function 
of an organ like the lung or lymph nodes if there 
are too many of them growing in one place. 

The most common areas affected are the:

lungs - causing shortness of breath or cough
skin - raised, red bumps under the skin and near 
eye - causing teariness and redness
lymph nodes - causing pain behind chest bone, fatigue
joints - causing arthritis symptoms

It is commonly suspected by an abnormal chest x-ray 
showing spots like old tuberculosis or other xrays 
like CAT scans showing lymph node swelling. 
Diagnosis is confirmed by a biopsy of a granuloma 
and its appearance under the microscope. 

About 50% of the time these granulomas clear on 
their own. In mild cases no treatment is needed. 
Sometimes, however, steroid treatment or other 
chemotherapy is needed. 

What is sarcoidosis?

3. Reader submitted Q&A - Kegel's for incontinence
"Are the Kegel exercise devices found in many 
"home health" catalogs of any help in doing the 
exercises? " 


Kegel exercises involve contracting the muscle at 
the opening of the vagina called the 
bulbocavernosus muscle. This helps strengthen the 
external urethral sphincter muscle which, in turn, 
helps to prevent loss of urine with straining, 
coughing or sneezing. The muscle exercises have 
been well described and are mostly taught now as 
isometric repetitive contractions without any 

Devices have been used for many years to aid in 
this process and to help women identify the proper 
muscle to contract. Vaginal weighted cones have 
been successful and the devices placed in the 
vagina to provide resistance to contractions also 
probably help identify the correct muscle. Devices 
placed between the legs to contract with the thigh 
and buttock muscles are not likely to be helpful. 

For a discussion of Kegel's exercises, devices and 
an instruction sheet, see our article at: 

Kegel exercises and devices

4. Inverted nipples
Having breast nipples that are flat or inverted 
and don't come out is not as uncommon among women 
as you would think. When a woman has them all of 
her life, they are due to a congenital shortening 
of the ducts of the breast. Sometimes upon 
stimulation, the nipples can evert but again, it 
depends upon the degree of shortening of the 

Plastic surgeons can fix this problem but the 
surgery costs about $2000 a breast. 

This can also be a problem with breast feeding but 
usually it is overcome with practice and effort. 

Breast feeding with flat or inverted nipples

5. Health tip to share - Ingrown toenails
"For temporary (sometimes longer) relief of ingrown 
toenails, take a warm bath to soften nails, dry 
your feet and trim toenails. Then take the bar of 
soap and gently scrape it from the edge of the 
nail toward the foot at the corners of the nail.  
This causes a soft soap pacing to collect under 
the nail and it lifts the painful corners to give 
you relief.  I usually do this before bed but I 
also do it during the day. It really gives me 
relief and I haven't had to see a doctor about it 


6. Humor is healthy
Subject: Women's Dictionary

Argument (ar*gyou*ment) n. -- A discussion that 
occurs when you're right, but he just hasn't 
realized it yet. 
Airhead (er*hed) n. -- What a woman intentionally 
becomes when pulled over by a policeman. 
Bar-be-que (bar*bi*q) n. -- You bought the 
groceries, washed the lettuce, chopped the 
tomatoes, diced the onions, marinated the meat, 
and cleaned everything up, but he "made the 
Cantaloupe (kant*e*lope) n. -- Gotta get married 
in a church. 
Childbirth (child*brth) n. -- You get to go 
through 36 hours of contractions; he gets to hold 
your hand and say "focus... breathe.... push...." 
Clothes dryer (kloze dri*yer) n. -- An appliance 
designed to eat socks. 
Diet Soda (dy*it so*da) n. -- A drink you buy at a 
convenience store to go with a half pound bag of 
peanut M&M's. 
Eternity (e*ter*ni*tee) n. -- The last two minutes 
of a football game. 
Exercise (ex*er*siz) v. -- To walk up and down a 
mall, occasionally resting to make a purchase. 
Grocery list (grow*ser*ee list) n. -- What you 
spend half an hour writing, then forget to take 
with you to the store. 
Hair Dresser (hare dres*er) n. -- Someone who is 
able to create a style you will never be able to 
duplicate again.  See "Magician". 
Hardware Store (hard*war stor) n. -- Similar to a 
black hole in space:  if he goes in, he isn't 
coming out anytime soon. 
Lipstick (lip*stik) n. -- On your lips, coloring 
to enhance the beauty of your mouth.  On his 
collar, coloring only a tramp would wear. 
Park (park) v./n. -- Before children, a verb 
meaning "to go somewhere and neck."  After 
children, a noun meaning a place with a swing set 
and slide. 
Patience (pa*shens) n. -- The most important 
ingredient for dating, marriage, and children.  
See also "tranquilizers". 
Valentine's Day (val*en*tinez dae) n. -- A day 
when you have dreams of a candlelight dinner, 
diamonds, and romance, but consider yourself lucky 
to get a card. 
Waterproof Mascara (wah*tr*pruf mas*kar*ah) n. -- 
Comes off if you cry, shower, or swim, but will 
not come off if you try to remove it. 

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

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***** Woman's Diagnostic Cyber Newsletter *****
              July 16, 2000
This week from Woman's Diagnostic Cyber
1. Dry eye syndrome - Be aware of the causes
2. Vulvar pain (vulvodynia) vs vestibulitis
3. Reader submitted Q&A -
4. Bunion Background
5. Selecting exercise and sport shoes 
6. Health tip to share - Recurrent yeast infections
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. Dry eye syndrome - Be aware of the causes
Dry eyes can occur from so many causes that there 
is actually an entity called dry eye syndrome. 
Gritty, red watery eyes are the main symptoms and 
many people are amazed that something can actually 
be done about them. 

Women may have dry eyes due to hormonal changes 
associated with pregnancy, lactation, oral 
contraceptives, menstruation, and post menopause. 
While no one knows for sure, it is probably a low 
estrogen state or one with an increased 
progesterone/estrogen ratio that makes eyes dry. 

Other causes are from the diseases of rheumatoid 
arthritis, diabetes, thyroid abnormalities, 
asthma, cataracts, glaucoma, lupus. Medications 
such as antidepressants, decongestants, 
antihistamines, antihypertensives, birth control 
pills, diuretics, ulcer medication, and 
tranquilizers can also cause eye dryness.

The treatment is basically conserving a person's 
natural tears or adding artificial tears. If the 
condition is temporary then artificial tears may be 
the best treatment. The tear duct which drains 
away normal eye tearing can be plugged with a 
small device (punctum plug) and this may be a 
better long term treatment for some people with a 
chronic problem. 

If you are on birth control pills, you might ask 
your doctor to switch you to a pill with a lower 
progestin potency and a higher estrogen dose. The 
same is true of hormonal replacement therapy after 
the menopause. Raising the estrogen level and 
decreasing or changing the progestin may help.

Dry eye awareness 

2. Vulvar pain (vulvodynia) vs vestibulitis
Pain on the outside of the vagina (vulva) can be 
due to many causes. As a symptom, it is called 
vulvodynia. Sometimes you hear about a disease or 
condition called vulvar vestibulitis. You may 
wonder when a painful, sometimes burning vulva is 
vulvar vestibulitis and when is it just a symptom 
of some other condition. 

This FAQ page below gives an excellent history and 
differentiation of vulvar pain conditions. In 
vulvar vestibulitis, which is an inflammatory 
condition of the glands of the vestibule, the skin 
between the vulva and the hymen on the lower part 
of the vaginal opening usually presents with 
redness of the vulvar vestibule, especially with 
small red spots; pain with intercourse or tampon 
insertion and a stinging pain when urine touches 
the skin in that area. 

A second type of vulvodynia, similar to but 
different from vestibulitis, is like a constant 
irritation of the skin nerve endings (neuralgia). 
It presents with tingling and itching ranging from 
mild to severe and often involves the entire 
vulva. Its pain sensation does not require 
something to touch it to produce the pain. 

Finally, there are a host of other causes of 
vulvar pain and irritation such as candida 
vaginitis, genital herpes infections, vaginismus 
(spasm of the vaginal opening muscle), allergic or 
irritant reactions and many other less frequent 
but possible causes. 

Another very comprehensive links page about vulvar 
pain can be found at: 

Vulvar pain links 

3. Reader submitted Q&A - Vitamin supplementation
"Is 10,000 mg of Vitamin A too much to take per 
day? I am 69, happy and healthy and exercise 1 
hour daily." - Evelyn 

The recommended daily allowances (RDA) of most 
vitamins and minerals are set at minimum amounts 
to prevent deficiency states. We have learned, 
however, that supplements of vitamins and minerals 
can help prevent certain diseases or even treat 
them just as prescription medicines can. 

If you are interested in what levels of vitamins 
are safe to take, please look at our article: 

Vitamin Intake - How Much is Too Much?

4. Bunion Background
A bunion is a bone deformity of the great toe. 
Women are more susceptible to them because of 
wearing pointed shoes. As a woman gets older, 
arthritis can also cause this defect where the toe 
tip is deviated and pointing toward the other toes 
and the great toe base sticks out to the side 
making the foot wider with a painful compression 
of the toe base by any shoes.
The American Society of Foot and Ankle Surgeons 
(podiatric physicians) has a very good fact sheet 
about bunions, what they are and how they are 
treated. There can be an hereditary predisposition 
to bunions so if your parents had them you may 
also develop them at sometime in your life. 

Treatments vary whether the deformity is mild or 
severe. Padding, inserts and medication may help, 
but sometimes surgery is need to really get the 
great toe back in line. 

5. Selecting exercise and sport shoes 
As long as we are on the subject of foot problems, 
and also to give the medical foot specialists 
(orthopedists) equal time, there is a very good 
review of how to go about selecting sports shoes 
for different activities. 

The American Orthopaedic Foot and Ankle Society produced this guide to help 
you find the best shoe to help you enjoy exercise 
and sports and lessen your chance of injury. 

For example, joggers need overall cushioning and heel control 
walkers need heel cushioning and rocker bottom design
aerobics requires lightweight shoes with ball cushioning
tennis requires side stability with inner/outer supports 

They also give some tips on buying: 
Don't go just by size. Have your feet measured 
Visit the shoe store at the end of a workout when 
  your feet are largest 
Wear the sock you normally wear when working out 
Fit the shoe to the largest foot 

Finally, there are some suggestions about when 
certain painful foot conditions may benefit from a 
heel cup, an arch support or a metatarsal pad.
6. Health tip to share - recurrent yeast infections
"I suffered from recurrent vaginal yeast 
infections, each month, for three years. I was 
tested for diabetes, and it was ruled out. I went 
to a surgeon that was going to be uplifting my 
bladder, and I mentioned to him about my fungus on 
my toenail and the yeast infections, as I was at 
wits end. He told me about his own toe/fungus 
and how he treated it. He prescribed Diflucan (R) 
one pill per week for one year. That was the end 
of the problematic yeast infections and the fungus 
toenail. This was five years ago, and have only 
had one yeast infection in all this time." 

7. Humor is healthy
Good Old Fred

Fred had been faithful to his religion but was now 
in the hospital, near death. The family called 
their pastor to stand with them. 

As the pastor stood next to the bed, Fred's 
condition appeared to deteriorate and he motioned 
frantically for something to write on. 
The pastor lovingly handed him a pen and a piece 
of paper, and Ol' Fred used his last bit of energy 
to scribble a note, then he died. 

The religious leader thought it best not to look 
at the note at that time, so he placed it in his 
jacket pocket.
At the funeral, as he was finishing the message, 
he realized that he was wearing the same jacket 
that he was wearing when Ol' Fred died. He said,
"You know, Ol' Fred handed me a note just before 
he died. I haven't looked at it, but knowing Fred, 
I'm sure there's a word of inspiration there for 
us all." 

He opened the note, and read, "Hey, you're 
standing on my oxygen tube!" 

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

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

1. Fitness routines - the ultimate workout
2. Facelift nips and tucks
3. Reader submitted Q&A - DES exposure liability
4. Toxic shock syndrome 
5. A brief history of childbirth
6. Health tip to share - Cooling down a sunburn
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.

You can now access our web site from most search 
engines or by just typing in your browser URL 
window - BACKUPMD or backupmd

Browsers and search engines using Realnames will 
find us. This will not work for AOL users.
1. Fitness routines - the ultimate workout
In fitness workouts, most women know about how to 
calculate their maximum heart rate (220 minus age) 
and then to monitor your exercise workout so that 
the heart rate is at about 75-85% of the maximum 

But this does not tell you what type of workout to 
use. There are several to choose from. 

Interval training - varies the intensity up to 
high intensity with periods of low and medium 

Strength training - needs to include upper body 
pushing and pulling, knee straightening and 
bending, low back straightening and abdominal 

Muscular failure - repetitions of one movement 
until muscle exhaustion followed by another 
movement cycle of a  rested muscle. 

Supersetting - alternate contraction and 
stretching of opposing (antagonist) muscles. 

Pre-exhaustion - paired exercises of large and 
small muscles of the same regional group. 

Stretching - between exercises helps flexibility 
and reduces soreness. 

Circuit training - fast repetitions of whole body 

Priority system weight training - entire muscle 
groups have a workout with rests in between to 
prevent exhaustion. 

Weight training alternating with  aerobic training 
- bursts of aerobic activity interspersed for 1-3 
minutes in between strength exercises. 

Remember that body fat is burned systemically, not 
from the area that is being exercised. Sorry! 

The ultimate fitness routine

2. Facelift nips and tucks
Did you ever worship the summer sun before you 
found out that life's skin wrinkles are mostly a 
result of long term sun damage? Ever think about a 
facelift to get rid of those jaw or neck wrinkles? 

Its possible to have a facelift at age 40 or 70 
but having realistic expectations of what the 
results will look like is key to procedure 
success. Finding a good plastic surgeon is also 
important because each face is different and 
requires a "custom" procedure. 

There are some common incisions, however, and 
consistent postoperative bruising and puffiness. 
You may not want to be seen in public for awhile. 
Take a look at Mayohealth.org for an explanation 
and pictures. 

Facelifts - what to expect

3. Reader submitted Q&A - DES exposure liability
"I am a DES daughter, i.e., exposed in utero to a 
nonsteriod estrogen that causes cellular and 
formation defects in the reproductive system and 
possibly autoimmune, bone, and other problems. I 
have been told that the only successful lawsuits 
involve infertility or cancer. I would like to 
know why more cases are not settled in 
relationship to other known problems this drug has 
caused. My problems are related to a cellular 
defect (adenosis) caused by this drug." 

"The makers of DES claim adenosis has other 
causes. How prevalent was adenosis before DES was 
marketed, if the condition was known at all before 
this time? What are the other known causes? I have 
only heard of DES being the possible cause. I have 
also been diagnosed with a deformity called a 
hooded cervix which is also considered caused by 
DES drugs. " 

"Adenosis has caused continued periods AFTER a 
hysterectomy and sapped much of my energy all my 
life due to heavy irregular bleeding that caused 
chronic anemia. Recent research has shown that 
effects most likely can be passed down to future 
generations also. I have 3 children. Two with 
autoimmune problems and one with a gynecological 
problem. I would like to take the drug companies 
to court, but what are my chances? Is there any 
justice for us?" 

Actually there have been some lawsuits won against 
the manufacturers of DES for just adenosis 
problems and not cancer or infertility but awards 
would be expected to be higher if cancer or 
infertility are the injuries. 
4. Toxic shock syndrome
Except for the small increase in cases about 20 
years ago when one type of super absorbent tampon 
was associated with toxic shock syndrome, this is 
actually a very rare disease. Anyone, even men and 
children can get this disease. About half the 
instances are from infections following burns, 
boils, insect bites or surgery. The other half are 
associated in women with tampon use. 

It is caused by a toxin produced by a 
staphlococcal infection of the vagina. Symptoms 
include the very sudden onset of a high fever 
(over 102 deg F), a sunburn like rash over the 
face and upper trunk and extremities. Vomiting, 
faintness, dizziness, diarrhea, and confusion are 
also symptoms which indicate a generalized 
systemic reaction to the toxin. It can lead in 
some instances to death. 

At the information site on Toxic Shock Syndrome in  
the UK, the following tips for using tampons are 

  wash your hands before and after inserting a 

  change tampons regularly, as often as directed 
on the pack 

  never insert more than one tampon at a time 

  when using at night, insert a fresh tampon 
before going to bed and remove it on waking 

  remove a tampon at the end of a period 

It may also be a good idea to intersperse the use 
of pads or liners in between tampon use. 

Toxic shock syndrome

5. A brief history of childbirth
We often forget how much the medical guidance of 
childbirth has changed over the centuries. The 
following brief medical history article by Dr. Ian 
Carr at the University of Manitoba in Manitoba 
Canada is very much worth reading. 

It guides us from the first early Cesarean 
sections in which women never survived, through 
the use of obstetrical forceps and operative 
maneuvers for obstructed labors. 

Until the time that it was realized that sepsis 
due to bacterial infection was the leading cause 
of death in childbirth, there were very poor 
survival statistics, at least as we currently 
experience them. 

6. Health tip to share - cooling down a sunburn
When summer sun exposure gets too much and you 
develop a stinging sunburn, several remedies may 
help. Aspirin (if you are not allergic or on blood 
thinners) is better than acetaminophen  or 
ibuprofen because it reduces the swelling and 
inflammation along with pain relief. Cool soaks or 
a cool bath as soon as coming out of the sun will 
help. Low dose steroid ointments available over 
the counter (with hydrocortisone for example) will 
help you get sleep at night but remember that pain 
from a burn is a signal not to go out in the sun 
again and if the pain is eased by steroid 
ointments, you still should not get more sun. 
Remember that the major risk factors for skin 
cancer (basal cell) include the lifetime number of 
blistering sunburns, being red-headed, and having 
blue, hazel or green eye color as opposed to 


7. Humor is healthy
Are men quick about vasectomies?

One day, after a man had his annual physical, the 
doctor came out and said, "You had a great check-
up. Is there anything that you'd like to talk 
about or ask me?" 

"Well," he said, "I was thinking about getting a 

"That's a pretty big decision. Have you talked it 
over with your family?" inquired the doctor. 

"Yeah." said the man.

"Well, what did they have to say about it?" asked 
the doctor. 

"They're in favour, 15 to 2." replied the man. 

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

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

1. Multiple sclerosis facts
2. Growths on the vulva	
3. Reader submitted Q&A - Can't void after surgery
4. Find a gynecologic cancer specialist
5. The music of healing
6. Health tip to share - Perineal odor
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. Multiple sclerosis facts
Multiple sclerosis (MS) is a weird disease because 
it causes episodic symptoms that seem to come and 
go. It strikes between the ages of 30-50 more 
often in women. 

Symptoms may be mild or severe as the disease goes 
through its exacerbations and remissions. While 
fatigue is a common symptom, although nonspecific, 
it is the loss of coordination, muscle weakness, 
spastic muscle contractions, numbness, slurred 
speech, and visual problems that finally bring a 
person to a doctor. 

Unfortunately, early in this disease, tests used 
to diagnose multiple sclerosis such as magnetic 
resonance imaging (MRI) may not yet be positive. 
This may make you think the symptoms are 
imaginary. It is not uncommon for symptoms to go 
on for two years or more before the diagnosis of 
MS is made. 

Be sure to take a look at MSfacts.org for more 
information about this difficult-to-diagnose 

Multiple sclerosis fact sheet

2. Growths on the vulva	
We often get questions about a growth or sore area 
on the vulva near the vaginal opening of "what can 
it be?" It is very difficult to diagnose vulvar 
lesions without looking at it so most of the time 
the answer is to go see your doctor. Sometimes the 
web has descriptions with images to match so you 
can try to temporarily self diagnose. 

On many occasions the concern is about the 
possibility of genital warts or condyloma 
accuminata, a fleshy-like skin growth caused by 
the HPV virus. While many times a text description 
is adequate, in this case photos are very helpful 
in order to temporarily self-diagnose. 

At Dr. Koop's encyclopedia, there is a good page 
with images about condyloma accuminata. 

Condyloma accuminata

3. Reader submitted Q&A - Can't void after surgery
"Thirteen weeks ago I had a laparoscopic assisted 
vaginal hysterectomy and a bladder suspension 
using a sling. I have not been able to urinate 
since; I've been doing clean intermittent 
catheterization (CIC) to empty my bladder. The 
doctors say to wait six months to see if I will 
eventually urinate on my own. They believe my 
bladder is weak from years of drinking too much 
fluid and not urinating often enough. Are they 
being realistic that six months will cure this? Or 
should I save myself the trouble and have the 
sutures removed now?" 

"I am 43 years old and in good general health." 


The inability to void urine after surgery can 
happen with a hysterectomy but it is more common 
after a procedure to correct urinary incontinence. 
It seems to occur more often after a certain type 
of anti-incontinence surgery called a sling 
procedure, but it can happen with any of the other 
procedures used. 

For a discussion of why this happens and what to 
expect about it clearing up with or without 
additional surgery, see our article at: 

Voiding difficulty after incontinence surgery

4. Find a gynecologic cancer specialist
When a diagnosis of cancer comes, it comes 
suddenly. Some early stages of cancer can be 
treated by any gynecologic surgeon but if a cancer 
has spread, sometimes a specialist surgeon will 
make more effort to track down every possible 
group of malignant cells. 

At Women's Cancer Network there is a FIND A DOC 
database that has the gynecologic oncologists, 
women's cancer specialists, that you can look up 
by state. 

5. The music of healing
Music therapy has a definite but under appreciated 
role in healing. Music is known to lessen the 
level of chronic pain and even improve or relieve 
depression. People who have had strokes and cannot 
talk have sometimes been to sing a favorite old 

Music certainly can relieve stress and its range 
of healing powers are probably not yet fully 
known. Be sure to include it in your daily life 
more than just to soothe road rage in the daily 

The music of healing

6. Health tip to share - Perineal odors
I've found that drinking pineapple juice decreases 
perineal odors. 


(Ed. note - please give us feedback on this one!)

If you have discovered ways of coping with a
disease or condition and it works for you,
please share it with us:

Health tip suggestion form

7. Humor is healthy
"Catching The Virus"

The "I Love You" virus that infects users of 
Microsoft's outlook has morphed. Watch for these 

- The "I love you, too" virus: 
Responds with an appropriate letter stating that 
the user loves you as well.  Spreads peace and 
harmony throughout the corporate workplace, 
causing lost productivity and chaos on Wall Street 
as no one tries to screw anyone else out of a 

- The "I'm looking for more of a commitment" virus  
Receives the "I love you" virus email and 
immediately schedules a recurring event called 
"hold for my sweetie" for Friday and Saturdays 
into your calendar and the calendar of the person 
who sent the mail, registers you for a year of 
pre-paid videos at Blockbuster.com, and deletes 
any appointments called "Golf with the guys" or 
"Night out with the Girls."  It also erases the 
phone number from the contact card for your 'ex', 
and puts in a monthly reminder for the anniversary 
of your first date. 

- The "Let's just be friends" virus - 
Immediately deletes the "I love you" virus, sends 
a "Let's Just be friends" response, and books you 
for a discount weekend at Hedonism at an online 
travel site. 

- The "Unsafe Sex" virus - 
Spreads unprotected files to every other hard disk 
on the net. 

- The "Safe Sex" virus - 
Wraps the "I Love You letter" in a container that 
keeps it from spreading 99.45% of the time. 

- The "Sexual Harassment Lawsuit" virus -
Forwards a copy of the "I Love You" virus to
Human Resources and to your lawyer with
threatening legal language attached.
Automatically accepts settlement offer e-mails
over $100k.

More variations are being discovered every day, so 
make sure you update your virus protection. 

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

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