Womens Health

Women's Health Newsletters 10/29/00 - 11/26/00



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****** Woman's Diagnostic Cyber Newsletter *******
                October 29, 2000
This week from Woman's Diagnostic Cyber

1. Skin age spots need vitamin A
2. Cholesterol problems
3. Reader submitted Q&A - Endometriosis rx
4. Vulvar cancer grows from embarrassment 
5. Breast cancer quiz and facts
6. Health tip to share - minor skin pain relief
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.

A pregnancy newsletter is available now in which 
you enter your due date and every week you will 
receive information pertinent to that time in your 
gestation. This has been developed by Dr. Steve 
Hasley of Pittsburgh, PA who also uses our Women's 
Health Newsletter for patients in his office. 

Let your pregnant friends know where to sign up: 

Pregnancy newsletter

1. Skin age spots need vitamin A
Age spots are usually hyperpigmented areas of the 
skin brought about by excessive exposure to the 
sun. Female hormones such as naturally estrogens, 
oral contraceptives and postmenopausal estrogen 
replacement can sometimes promote these darkened 
skin areas. 

High concentration vitamin A skin products can 
help reduce the pigment in these skin cells but 
the amount included in over-the-counter 
medications and cosmetics are very unlikely to 
be sufficient enough to make a difference. You 
will require prescription vitamin A creams, but 
even these can sometimes be too potent for your 
skin and who wants to trade the age spots for 
reddened, irritated skin. 

The  answer is to work very closely with a 
dermatologist. The delicate balance of not too 
little or not too much vitamin A is also 
influenced by the carrying agent in the cream that 
governs how much is absorbed into the skin. 
Dermatologists also can prescribe and work with 
you using some pigment reducing solutions, 
containing hydroquinone and kojic acid, that will 
lighten pigmented areas and prevent pigment 

2. Cholesterol problems
We know that cholesterol is an important factor in 
coronary artery disease and lowering one's serum 
cholesterol can be beneficial in heart disease 
prevention. Did you know that by raising the good 
cholesterol (HDL), women benefit from a 
significant lowering of heart disease? 

This section at Onhealth from WebMD has some good 
practical information. Some of the links include: 

Finding the New Wonder Food
Garlic Pills Don't Lower Cholesterol
When Does Genetic Testing Make Sense?
Raising Good Cholesterol
Which Foods Cut Cholesterol?
Cut Down High Cholesterol
Cholesterol Doesn't Tell Whole Story
Other Ways to Lower Cholesterol
Symptom-to-Herb Checker
Women and Heart Disease Clinic
Facts About Blood Cholesterol
So You Have High Blood Cholesterol
Check Your Cholesterol and Heart Disease I.Q.
Everyone can learn some interesting cholesterol 
misconceptions from these. Among them are: 

seafood and garlic do not lower cholesterol
genetically caused Type II hyperlipidemia affects 
  only 1 in 2,500 persons 
for every 1 mg./dL. increase in good cholesterol - 
  high density lipoprotein (HDL), coronary artery 
  disease risk drops by 5 percent in women 
there is no one cholesterol lowering diet that is 
  right for everyone 

Cholesterol problems

3. Reader submitted Q&A - Endometriosis treatments
"Do migraines, severe low back pain, and 
endometriosis have common symptoms? I am 48 years 
old, irregular/painful periods until 38 when had 
child c-section. Now periods are regular but pms, 
low back pain, severe cramping have returned and 
these symptoms are now irregular.  Can have a 
'good' month followed by 3-4 'bad' months or can 
have several 'good' months followed by one 'Bad' 
one.  My doctor is now suggesting a hysterectomy." 


As best I can tell, migraine headaches are 
unrelated to endometriosis, with the exception 
that endometriosis causes pain during the menses 
and there is an entity known as a menstrual 
migraine that occurs when estrogen levels are 
falling during the menses. 

Low back pain is commonly associated with 
endometriosis especially if it does not seem to 
worsen with positional changes and exercise. 
Hysterectomy is certainly a definitive treatment 
for endometriosis and if the ovaries are also 
removed at age 48, this may lessen the migraine 
headaches if they are truly menstrual migraines. 

Short of hysterectomy, other treatments have been 
used to decrease pain from endometriosis and also 
to improve fertility from endometriosis. 
Sometimes, the exact therapies which are really 
successful in treating this condition have been 
anecdotal rather than scientifically studied. 

This review from the British Journal of Medicine 
of the clinical evidence for which treatments are 
effective in endometriosis indicates that it 
depends upon whether the treatment is directed 
toward pain caused by endometriosis or toward 
fertility problems from endometriosis. For pain 
problems such as painful menstrual cramps, low 
back pain and pain with intercourse, successful 
treatments include: 

hormonal treatment (gonadotrophin releasing 
hormone analogs, danazol and most progestin only 
drugs such as medroxyprogesterone or gestrinone) 

surgical ablation of implants and uterosacral 

postoperative (after surgical ablation) hormonal 

ovarian cystectomy for removal of ovarian 
endometriomas (as opposed to just cyst drainage of 
an endometrioma) 

oral contraceptives

For fertility treatment, however, the hormonal 
treatments have not been shown to be effective. 
Only surgical treatments such as: 

laparoscopic ablation or excision of endometrial 
cystectomy for ovarian endometriomas 

In cases of mild endometriosis there has been only 
one study that diagnosed the endometriosis by 
laparoscopy, performed no treatment at all for the 
placebo arm of the study and did repeat 
laparoscopy after a year to see what the natural 
history of the disease was. They found that only 
in about half of the instances (47%) did the 
endometriosis get worse. In 24% the endometriosis 
disappeared without treatment and the remainder 
(29%) improved or showed no change even without 
any treatment. 

Clinical evidence about endometriosis

4. Vulvar cancer grows from embarrassment 
Many women are embarrassed about lesions on the 
external genitalia and as a result, there is a 
delay in seeking treatment. The treatment often 
involves a radical excision of skin in the 
perineal area so that may further  frighten women 
into denying that a problem exists. 

It is estimated that about 60-80% of women have a 
symptom from a precancerous condition of the 
vulva. They may have itching, a reddened area, or 
a rough patch of skin that has been present for 
months or years. 

Physicians are taught that most vulvar skin 
lesions occurring in a field of itching or redness 
need to be biopsied, especially those occurring 
after the age of 50.  Vulvar cancer is a disease 
of the late 60's, 70's and 80's but the 
premalignant lesions may occur a decade earlier. 
Smoking and a history of HPV (human papilloma 
virus) infection of the vulva are predisposing 
factors for vulvar cancer. 

5. Breast cancer quiz and facts
See if your knowledge about breast cancer is 
current. This short little quiz at imammogram.com 
is helpful to review your knowledge. Should you 
get a yearly mammogram after 40? Can breast cancer 
be prevented? 

You may also be interested in assessing your risk 
for breast cancer. At this quiz page there is also 
a link for a 14 question breast cancer risk 
calculator. It can categorize your risk into high, 
medium and low. 

Breast cancer quiz and facts

For our California readers, you may be interested 
in purchasing a Breast Cancer Awareness license 
plate for your car. 

Breast cancer license plate

6. Health tip to share - minor skin pain relief
"Domeboro (R) tablets or powders are available in 
generic form,  also called a modified burrow's 
solution.  This stuff is good for lots of problems 
including athletes foot, nail fungus, diaper rash, 
poison oak/ivy .....  it is very soothing and 
effective. It may be used in addition to other 
treatments. It would be safe to use as a vulvar 
itch prep. to cleanse and soothe."   Sandi

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
Weather Vane
To Tell the weather,
Go to your back door and look for the dog. 
If the dog is at the door and he is wet, it's 
probably raining.  But if the dog is standing 
there really soaking wet, it is probably raining 
really hard. 
If the dog's fur looks like it's been rubbed the 
wrong way, it's probably windy. 
If the dog has snow on his back, it's probably 
Of course, to be able to tell the weather like 
this, you have to leave the dog outside all the 
time, especially if you expect bad weather. 

Sincerely, The CAT 
Contributed by: IFund

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

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****** Woman's Diagnostic Cyber Newsletter *******
               November 5, 2000
This week from Woman's Diagnostic Cyber

1. Herb-drug adverse interactions
2. Cyber psychotherapy - Is it for you? 
3. Reader submitted Q&A - What is microscopic cancer?
4. CA 125- Ovarian tumor marker
5. Review and rating of health and wellness stores
6. Health tip to share - Hot flash treatments
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. Herb-drug adverse interactions
Currently there is very little information about 
interactions of herbal medicines/supplements and 
physician prescribed medications. This is probably 
because most herbal medicines are relatively safe 
and there are not many herb drug interactions. 

Some interactions have been reported, however. One 
article which is a review of documented and 
theoretical herb drug interactions lists several 
combinations that might affect many women. If you 
are taking any of these combinations, you will 
want to look at the paper below: 

Xanex(R) and kava - additive sedation
aspirin and ginkgo biloba - blood clotting problems
digoxin and St John's Wort - lowers digoxin levels
indinavir (an HIV med) and St. John’s Wort - 
  lowers indinavir levels 
Levodopa (for Parkinson's) and kava - increases 
phenelzine (Nardil[R]) and ginseng - increases 
  psychoactive stimulation 
Coumadin (anticoagulant) and danshen, dong quai, 
  garlic gingko, ginseng - increases anticoagulation 

There are also other reports of various herb-drug 
interactions based upon anecdotal information that 
you may want to know about. 

Herb-drug interactions

2. Cyber psychotherapy - Is it for you? 
Sometimes it can be easier to express your 
personal feelings and concerns to a computer 
screen on-line than it is to seek face-to-face 
counselling from a professional counsellor, 
psychologist or psychotherapist. From the privacy 
of your home, there are now cyber psychotherapy 
services available. 

You may or may not be aware that physicians and 
other licensed health professionals are not 
allowed to hold themselves out to the Internet 
public as practicing medicine or any type of 
health therapy including psychotherapy unless 
they are licensed in every state. There is no 
such thing as a national license at the present 
time. That is why you see terms such as "medical 
educational consults", "virtual therapy", or 
"cyberanalysis". If one just gives advice and 
listens but does not prescribe medicines or order 
laboratory studies, does that constitute the 
practice of a health profession or is it just like 
the "radio doctor" on call-in shows? 

This review of psychotherapy on the Internet at 
Gomez.com raises some very interesting concepts 
about what you should look for in the explanation 
of services if you are thinking of signing up for 
some of these  sites. A counsellor at the other 
end of the computer loses your facial expressions, 
body language, and vocal inflections but on the 
other hand a face-to-face counsellor may 
misinterpret those non verbal clues and ignore the 
actual words being expressed. 

A second part of this Gomez review compares and 
contrasts 3 different services available: 


It points out that the current rules and 
regulations for psychotherapy/counseling govern 
each particular therapist within his/her own 
state, but at the present time, they do not yet 
account for the cyberworld and its absence of 
geographic barriers. As a possible user of such 
therapy you will need to carefully check out the 
intended mission of the interactive service, the 
privacy policy and the costs among other details. 
It is still buyer beware. 

Cybertherapy - Is it for you?

Cybertherapy Part 2

3. Reader submitted Q&A - What is microscopic cancer?
"What is microscopic cancer of the uterus?  Is 
treatment needed after surgery? I am 67 years old 
and had a complete hysterectomy three weeks ago.  
The report came back that I had microscopic 
cancer.  I had been bleeding (not heavily) for 
eight months prior to seeing the doctor.  Did not 
tell him because I was going through a depression 
since my husband's death and really thought this 
was the answer to my prayers...I wanted to die.  
Doctor found it on his own and said I needed 
surgery.  As stated this was done three weeks ago. 
My doctor called me with the results of the lab 
work - because it was so unexpected to me when he 
called, I couldn't think of the questions I had 
for him then - but will ask more at my appointment 
in another week." - Evie 

In this situation microscopic cancer of the uterus 
refers to either an early cancer of the 
endometrium or one of the cervix. It means that 
the doctor could not see the cancer grossly and 
only after the pathologist looked at the 
hysterectomy specimen was it found that there was 
a cancer. Microinvasive is also a similar term. 

Whether you need further treatment or further 
diagnosis to  see if the cancer has spread, 
depends upon the type of cancer, its grade of cell 
abnormality (grade) and how far it has invaded 
into the uterine or cervical muscle (stage). For a 
discussion of the possibilities, see our article 

What is microscopic cancer of the uterus?

[ed. note - last week we mentioned that 
hysterectomy is a definitive treatment for 
endometriosis. One of our readers pointed out that 
it is not definitive for everyone. That is 
correct. About 5-15% of women may have recurrance 
or persistance of endometriosis after 

4. CA 125- Ovarian tumor marker
Cancer Antigen 125 (CA 125) is used to screen for 
or to diagnose the presence of  certain ovarian 
cancers. The most common ovarian cancers are 
epithelial cancers that will often express this 
CA-125 antigen and it can be detected in blood 
samples. While it seems that this test would make 
early ovarian cancer diagnosable by just having 
a blood drawn, the subject is much more complex 
than it seems at first. 

The main complicating factor is that there are 
many benign conditions that can cause an elevation 
of CA-125 such as: 

pelvic inflammatory disease
liver cirrhosis
breast, colon, lung and pancreas cancer

Before menopause, so many benign conditions can 
cause a positive CA-125 and the chance of cancer 
is so small that it is not at all useful as a 
screening test. However after menopause, ovarian 
cancer is more common  and a positive test can 
indicate ovarian cancer as high as 1 out of 10 
times. Unfortunately 9 out of 10 times a woman is 
falsely concerned and subjected to invasive tests 
and procedures. This makes it a less than perfect 
screening test so insurance companies do not cover 
the cost of the test for screening. 

If you think you might be interested in this test 
as an ovarian cancer screen and you will not 
unduly panic if you end up having a positive test, 
discuss with your doctor if the test can be done 
at your location. 

Ovarian tumor marker CA-125

5. Review and rating of health and wellness stores
Gomez.com also rates many other services on the 
Internet. In this article below, they have looked 
at on-line health and wellness stores such as: 

1. Drugstore.com
2. MotherNature.com 
3. more.com 
4. PlanetRx 
5. DrugEmporium.com 
6. SelfCare.com 
7. CVS (review)
8. NetGrocer.com
9. Medicine Cabinet
10. FamilyMeds.com
11. Eckerd 
12. HealthCentralRx 
13. SmallFlower.com 
14. Wal-Mart.com 
15. VitalRx.com 
16. TheBigRx.com 
17. Costco 
18. healthzone 

and rated them according to:  

Ease Of Use
Customer Confidence
On-Site Resources
Relationship Services

Their reviews and rating systems will be of 
interest to anyone who does any purchasing of 
health products on the Internet. 

Health and wellness stores rated at Gomez.com

6. Health tip to share - Hot flash treatments
There are several things a woman can do to reduce 
night sweats and sleep difficulties that  are non 
hormonal treatments. Avoid any foods, alcohol or 
caffeine within 3 hours of going to bed. Avoid 
exercise, hot liquids or smoking within 3 hours of 
going to bed. Drop the evening thermostat by about 
two or three degrees without adding more covers. 
Wear light bed clothing. If you feel stressed out 
from daily work or family events, take at least an 
hour before bedtime for some relaxation activity 
(if you cannot "afford" an hour before bedtime to 
do this, there's your answer). 

Non hormonal hot flash instructions


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

Advantages of Age

A list of the advantages you gain, as you grow 

- You can eat dinner at 4:00 p.m.

- Your investment in health insurance is finally 
  beginning to pay off.

- Kidnappers are not very interested in you.

- It's harder and harder for sexual harassment 
  charges to stick. 

- If you've never smoked, you can start now and it 
  won't have time to hurt you.

- People no longer view you as a hypochondriac. 

- Your secrets are safe with your friends because 
  they can't remember them, either.

- Your supply of brain cells is finally down to a 
  manageable level. 

- Your eyes won't get much worse.

- Things you buy now don't have time to wear out.

- No one expects you to run into a burning 

- There's nothing left to learn the hard way.

- Your joints are more accurate than the National 
  Weather Service. 

- In a hostage situation you are likely to be 
  released first. 

Contributed by: Moody Fan

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

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****** Woman's Diagnostic Cyber Newsletter *******
                November 12, 2000
This week from Woman's Diagnostic Cyber

1. The pain after shingles
2. Parkinson's disease - sometimes a genetic cause  
3. Reader submitted Q&A - Milky nipple discharge
4. Not all cyclic symptom changes are PMS
5. Head and body lice and crabs
6. Health tip to share - to test for early dementia
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 pain after shingles
Did you know that the chicken pox virus never 
leaves the body. It can become reactivated in 
later life and produce an outbreak of "shingles". 
Shingles is caused by the herpes zoster virus that 
is dormant in a nerve cell and becomes activated 
by a stressful event, illness, trauma or even 
fatigue to cause an acute skin infection. 

This causes skin lesions along a nerve pathway to 
erupt. At first, there is severe pain in a narrow 
band of the body such as the chest, groin, face, 
one eye, or the outer side of one leg. This may be 
accompanied a general sick feeling including 
nausea, and vomiting. After several days, a 
linear, raised skin rash develops. The skin 
lesions last about 2 weeks but herpes zoster can 
keep breaking out in new lesions for 4-6 weeks. 

One of the worst problems is the pain that may 
persist in the affected nerve. This is called 
post-herpetic neuralgia if the pain continues more 
than 3 months. You may want to see the article 
below about the diagnosis and treatment of post 
herpetic neuralgia if you ever have the misfortune 
to develop it. 

Post Herpetic Neuralgia

2. Parkinson's disease - sometimes a genetic cause  
Parkinson's disease is a disorder of brain cells 
that control movement. This results in tremors, 
stiff muscles in the arms and legs, dementia, 
depression, a decreased sense of smell and 
sometimes problems with heart rate and blood 
pressure. Characteristically, the handwriting of a 
person who develops Parkinson's disease becomes 
very small in height (micrographic). Even so, 
diagnosis can be quite difficult and many times 
the diagnosis is missed while at other times it is 
falsely made. 

There is an early onset disease before age 50 
which is mostly genetic in origin, Most (90-95%) 
Parkinson's disease occurs after age 50 and seems 
to be more environmental than genetic. People who 
live in rural areas are more likely to get 
Parkinson's and there has been some recent 
evidence that exposure to pesticides such as 
rotenone may play a role in developing the 

Rotenone exposure

3. Reader submitted Q&A - Milky nipple discharge
"I have been having a milky breast discharge for a 
long time which I overlooked, but recently my 
menstrual period ceased which I believed was as a 
result of the discharge. Can it cause barrenness 
in future, whom do I meet for treatment?" 

"I am 29 and single, with irregular menses. The 
first Doctor I saw prescribed Parlodel(R) which 
makes me sick each time I take it."  


Milky nipple discharge can be associated with 
infertility due to anovulation and menstrual 
abnormalities but it is not the cause of those 
problems. It is the result of an abnormality of 
hormone secretion at the brain (hypothalamic 
level). Usually there is too much prolactin 
hormone. That can be due to different causes and 
it is those causes that need to be treated first. 

Prescription medications are a common cause of 
galactorrhea. It is also possible that just local 
breast factors or any nipple stimulation can 
produce prolactin a discharge. For a discussion of 
the causes and treatments of milky nipple 
discharge, see our updated article at: 

Breast milk hormone (prolactin) and anovulation

4. Not all cyclic symptom changes are PMS
Most women are aware that menstrual cramps do not 
necessarily mean a woman has PMS. They are an 
independent symptom that signal the onset of 
menstrual bleeding. There are other non PMS 
physical symptoms that may worsen premenstrual 
such as migraines, irritable bowel, endometriosis, 
allergies, seizures, and asthma. 

If a woman has a preexisting problem with 
depression, substance abuse, self-mutilation, 
anxiety, or an eating disorder, that condition can 
also worsen in the two weeks prior to menses. If 
there is any question whether a symptom or a group 
of symptoms represents PMS, please check with your 

Other Types of Cyclic Changes

5. Head and body lice and crabs
Head lice, body lice, crabs, scabies - what do 
they all mean? Kids can come home from nursery 
school with head or body lice. Adults can get them 
too from bed clothes or body contact with someone 
who has an infestation. These lice are little 
insect like creatures about the size of a sesame 
seed but somewhat more difficult to see. Itching 
is the predominant symptom. 

The lice come in different types called head lice, 
body lice, scabies and crab lice but they are  all 
very similar. They lay eggs called "nits". The 
nits hatch and reproduce about 7-10 days later. 
That is why at least two treatments are needed; 
one to kill the existing adult lice and one about 
7-10 days later to kill any hatched lice. Usually 
a shampoo with 5 percent permethrin is used as 

For more information about these pesky critters, 
see the FAQs at headlice.org . 

FAQs about head and body lice

6. Health tip to share - to test for early dementia
"If you are concerned that one of your forgetful 
family members may be developing dementia or 
Alzheimer's, there is a home test you can do that 
may give an early warning sign. Have that person 
draw a clock with all the numbers and place the 
hands of the clock at a given time, eg., 10 
minutes after 11. Someone with dementia changes 
will have placed all 12 numbers with much of the 
clock circle to go (eg. 18 numbers in the space 
where 12 chould go). They lose spatial 
discernment, and cannot place the hands of the 
clock correctly either. Please have them see a 
doctor for a more complete evaluation." 

Dr. Rick 

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

Neurotics build castles in the clouds.
Psychotics live in the castles in the clouds.
Psychiatrists charge both of them rent.  
That's it for this time. 
Your BACKUPMD on the Net.
Frederick R. Jelovsek MD 

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****** Woman's Diagnostic Cyber Newsletter *******
               November 19, 2000
This week from Woman's Diagnostic Cyber

1. Kidney function basics
2. Your posture defines you
3. Reader submitted Q&A - Microscopic hematuria
4. Human papilloma virus and warts
5. Something about water
6. Health tip to share - Crohn's disease
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. Kidney function basics
Most women know that we try to protect the kidneys 
from damage due to ascending infection from the 
bladder or from toxic responses to medicines such 
as non steroidal anti-inflammatory pain drugs 
(NSAIDS). We know that the kidneys eliminate waste 
products and urine but most people are not aware 
of the other functions the kidneys provide. 

As blood passes through the kidneys, about 200 
quarts of water are filtered each day and all but 
about 1 or 2 quarts are resorbed. The rest is 
produced as urine to carry out all of the excess 
salts and waste products. Hormones are secreted to 
stimulate the bone marrow to produce red blood 
cells. Renal disease affecting this hormone, 
erythropoetin, can result in anemia. The kidney 
also helps the body use vitamin D. Finally, the 
kidney secretes a substance called angiotensin 
which helps  blood pressure under control. 

Partial damage of the kidneys will affect these 
hormones and may contribute to anemia but until 
there is about 90% damage of both kidneys, kidney 
failure will not take place. For a good 
educational review of the kidneys and their 
function, see kidneydirections.com.

2. Your posture defines you
If your posture is not great, it can affect your 
image and how people think about you. Posture 
sends out non verbal messages - standing tall, 
chin up is confidence. Slightly bent over, looking 
down implies shyness, insecurity and a lack of 

A person with poor posture often has less energy, 
cannot concentrate well and is thought of as 
depressed. Even if you do not feel this way, your 
posture conveys such an image. An unnatural 
position, slouched over, may even take 60-70% more 
energy than it does to hold the body in proper 

Few doctors are concerned about poor posture as a 
medical problem so you may want to see a good 
chiropractor who cares more about postural 
abnormalities and spinal alignment. This article 
at chiroclinix.com may stimulate you to look at 
this aspect of the image you portray to others. 

The Power of Postural Thinking

3. Reader submitted Q&A - Microscopic hematuria
"What does blood in the urine from the urinalysis 
indicate? You can't really see in urine, but it is 
detected through the urine test. Background is a 
42 year old, diabetic, who gets very sick when ill 
because of diabetes" J.E. 

Blood in the urine can be from infection, stones, 
tumors, kidney disease and many times just due to 
unknown causes. More often it is an indication of 
kidney disease or damage. Medications such as non 
steroidal pain medications, aspirin or even anti-
hypertensive or diuretic prescriptions can cause 
kidney bleeding. 

Grossly visible blood in the urine is more likely 
to represent lower tract (bladder) disease or even 
cancer or benign tumors. Even so, microscopic 
hematuria should include a cystourethroscopy to 
evaluate the bladder. This is in addition to the 
laboratory studies needed and an IVP (intravenous 
pyleogram) to check for damage to the kidney 

For a discussion of microscopic hematuria and its 
diagnosis, see our article: 

What is the significance of microscopic 

4. Human papilloma virus and warts
Human papilloma virus causes genital warts but it 
is also the same 70 virus group that causes warts 
on the face, hands, feet, cervix and other areas 
of the skin. Some HPV virus types affecting the 
cervix and vulva can be associated with cancer at 
a later date. 

Becoming infected is often due to contact with a 
wart on another person, but HPV can also be caught 
indirectly from bathroom and locker room surfaces. 
Genital warts are not always contracted through 
intercourse or intimate genital contact. 

One of the best current treatments for genital HPV 
on the perineum is imiquimod cream (Aldara(R)) 
which stimulates the body's own immune system to 
produce an antiviral response. There are other 
treatments, however, that can be used depending 
upon where the wart is. 

This consumer health reference at Praxis.md is a 
good review of HPV. 

Human papilloma virus

5. Something about water
How much water do you need a day? The average 
woman loses about 8 cups of water a day through 
passing urine, bowel movements, breathing and 
sweating. About half of that comes from food and 
the other half from liquids you drink. In other 
words if you are not restricting your food through 
dieting, or sweating off extra amounts of water 
because of exercise, then you need to drink about 
4-5 cups of liquid per day. 

These are 8 oz cups we are talking about. Three 12 
oz. drinks a day may be sufficient. If you are 
dieting you need to drink more and if you are 
exercising you need to drink more also. Dieting 
alone might mean you have to increase from 4-5 
cups a day to 8 cups a day. With light exercise, 
10 cups a day or 5, 16oz drinks or 7, 12 oz drinks 
a day is the most you need. More than that can 
wash away salts your body needs. 

If you are drinking the right amount, your urine 
should be a light straw color, not yellow or dark 
yellow. At light straw, your hydration is just 
about right. If the urine is almost water color, 
you are taking in excessive amounts of water. 

You may want to review this article at 

Something about water

6. Health tip to share - Crohn's disease
"I have had Crohn's disease for many years.  I 
have found that drinking small amounts (about 1/2 
cup) of aloe vera juice each day is very soothing 
to the digestive system and prevents severe 
discomforts of diarrhea.  Be careful...too much 
juice will act as a laxative.  I recently tried 
the aloe vera capsules (2 per day) and they work 
well, too, and are more convenient, especially on 
trips."  Donna H. 

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
Dear Tech Support (Classic)

Dear Tech Support,

Last year I upgraded from Girlfriend 7.0 to Wife 

I soon noticed that the new program began 
unexpected  child processing that took up a lot of 
space and valuable resources. No mention of this 
was included with the product information. 

In addition, Wife 1.0 installed itself into all 
other programs and now launches during system 
initialization, where it monitors all other system 

Applications such as Poker Night 10.3, Drunken 
Boys Night 2.5, Football 5.0, Hunting and Fishing 
7.5 and Racing 3.6 no longer run, crashing the 
system whenever selected. 

I can't seem to keep Wife 1.0 in the background 
while attempting to run my favorite applications. 
I'm thinking about going back to Girlfriend 7.0, 
but the Uninstall doesn't work on Wife 1.0. Please 
help! Thanks, 

A Troubled User


Dear Troubled User,

This is a very common problem that men complain 
about. It is due to a primary misconception among 
men. Many people upgrade from Girlfriend 7.0 to 
Wife 1.0 thinking that it is merely an Utilities 
and Entertainment program. 

Wife 1.0 is an OPERATING SYSTEM and is designed by 
its creator to run everything! It is also 
impossible to delete Wife 1.0 and return to 
Girlfriend 7.0. Hidden operating system files 
cause Girlfriend 7.0 to emulate Wife 1.0 so 
nothing is gained. 

It is impossible to uninstall, delete, or purge 
the program files from the system once installed. 
You cannot go back to Girlfriend  7.0 because Wife 
1.0 is designed to not allow this. Some have tried 
to install Girlfriend 8.0 or Wife 2.0 but end up 
with more problems than in the original system. 
Look in your Wife 1.0 manual under "Warnings: 
Maintenance/Child Support". 

I recommend that you keep Wife 1.0 and work on 
improving the situation. I suggest installing the 
background application program Yes_Dear to 
alleviate software augmentation. Having installed 
Wife 1.0 myself, I also suggest that you read the 
entire section regarding "General Partnership 
Faults (GPFs)". 

You must assume all responsibility for any faults 
and problems that occur, regardless of their 
cause. You will also find that GPFs tend to be 
somewhat cyclical, occurring approximately 28 days 
apart. The best course of action is to enter the 
command C:APOLOGIZE. Avoid excessive use of 
C:YES_DEAR because ultimately you will have to 
use the APOLOGIZE command before the system will 
return to normal anyway. 

Remember, the system will run smoothly as long as 
you take the blame for all GPFs. Wife 1.0 is a 
great program, but tends to require very high 
maintenance. Wife 1.0 comes with several support 
programs such as Clean_and_Sweep 3.0, Cook_It 1.5 
(which replaces Burn_It 1.0) and Do_Bills 4.2. You 
must however be very careful how you use these 

Improper use will cause the system to launch the 
program Nag_Nag 9.5. Once this happens, the only 
way to improve the performance of Wife 1.0 is to 
purchase additional software. I recommend Flowers 
2.1 and Diamonds 5.0 should this happen. WARNING!! 
*DO NOT*  under any circumstances, install 
Secretary_With_Short_Skirt. This application is 
not supported by Wife 1.0 and will cause 
irreversible damage to the operating system. 

Best of luck.
Tech Support

Contributed by: Koo

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

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

1. Overactive bladder may have several causes
2. Back care basics
3. Reader submitted Q&A-Everything removed vaginally
4. Bone loss while taking HRT/ERT
5. Ten unhealthy eating behaviors women may have
6. Health tip to share - Check child's cholesterol
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. Overactive bladder may be due to several diseases 
Many women suffer from having to urinate 
frequently every day. Voiding more than 8 times 
during the day or more than 1-2 at night can be 
signs of bladder detrusor muscle irritability. 
Various terms have been coined such as overactive 
bladder or urgency frequency syndrome. 

Sometimes (about 40%) frequent urination occurs 
with unexpected loss of urine - leakage, or 
incontinence. Most of the time, however, the 
urgency just leads to frequent bathroom trips and 
not to loss of urine. 

Contrary to what the TV and magazine media would 
have you believe, overactive bladder or urgency 
frequency syndrome are merely symptom names and 
not diseases. They should not be treated with 
medicines until a diagnosis has been made as to 
what the cause is for the bladder muscle to 
contract involuntarily so frequently or at least 
to rule out other serious causes. 

Causes may include:

chronic bladder infections, interstitial cystitis, 
spinal cord injury, multiple sclerosis, stroke, 
urethral syndrome, unstable bladder, chronic 
ureterovesical reflux, bladder stones or tumors. 

For this reason, it is important that if you have 
this problem, make sure the doctor has you undergo 
a diagnostic work up before prescribing treatment. 

Urinary urgency and frequency

Overactive bladder

Also, be sure to see our instruction sheet on 
bladder retraining which is a mainstay of 
treatment for any cause of overactive bladder.

Bladder retraining instruction sheet 

2. Back care basics
As we historically moved out of the fields doing 
heavy labor into the office chairs staring at 
computer screens, you would think that back 
problems would be less frequent. It is almost the 
opposite, however, because  our back muscles have 
weakened and are not able to protect our spines as 
well as they used to. 

Different causes of back muscle and joint pain 

strained muscles, tendons or ligaments
osteoarthritis or degenerative joint disease
"slipped" or herniated disc 

Protecting your back muscles is a primary goal. 
Avoid impact sports including running. Exercise 
which strengthens your upper body, your stomach 
muscles and you legs will help support the muscles 
of the back. Watch your posture while walking and 
sit properly in a good chair with back support. 
Lift with your legs and arms and be sure to sleep 
on your side on a slightly firm mattress. 

If the  cause of the back pain is muscular and not 
arthritis or a slipped disc, stretching exercises 
are very important to stop muscle spasm. Sometimes 
it is as easy as sitting down and  slowly letting 
your head and upper body bend down so as to let 
your head descend to between your legs if 
possible. Conscious relaxation of the lower back 
muscles while lowering your upper body toward the 
floor is important. After the stretching exercises 
come the back muscle strengthening exercises. 

To read about these and other back care basics, 
see the article at: 

Back muscle basics

3. Reader submitted Q&A - Everything removed vaginally
"I am facing a hysterectomy. Just saw the doctor 
for this, but we have not discussed the procedure 
yet.  I want to know if the uterus, ovaries and a 
bladder suspension and possible removal of the 
appendix is possible all through the vagina?" 

"I have fibroids causing my excessive bleeding, 
but they are not large. I would like to avoid a 
scar on my abdomen." L. 

The hysterectomy, removal of the ovaries and 
bladder suspension are all possible to do strictly 
through the vagina. The appendectomy would not be 
a vaginal procedure and not all the time can the 
ovaries be removed vaginally. 

A laparoscopic assisted vaginal hysterectomy 
(LAVH) would leave some very small scars on the 
abdomen, usually about  3-5. This would allow 
removal of the appendix, ovaries and uterus. If 
your physician is experienced in a laparoscopic 
assisted bladder suspension (Burch retropubic 
urethropexy) then that can be done at the same 
time. If not, a needle suspension or sling 
procedure can be performed vaginally by your gyn 
surgeon or a urologist. All of this is under the 
assumption that the fibroids are not too big. 

This being said, my personal preference for this 
surgery would be to do it all abdominally. 
Although the hysterectomy and ovary removal are 
easily performed LAVH or vaginally, I feel I get 
better long term successful suspension results 
with an abdominal approach. Whenever there is 
bladder relaxation, there is usually relaxation of 
the upper vagina, the upper bladder and the sides 
of the vagina. I am looking to have a lower 
occurrence of postoperative cystocele, enterocele, 
vaginal vault prolapse and recurrence of the 
stress urinary incontinence. In my hands I can 
accomplish this better using an abdominal approach 
for all of the defects you mentioned including the 
bladder suspension. 

Many scientific papers would support that 
an abdominal approach often yields a more 
successful long term outcome whenever pelvic 
relaxation is present. A good vaginal surgeon, 
however has as good results with a vaginal 
approach so sometimes it is very dependent upon 
your surgeon's experience. 

You may decide that the lack of an abdominal 
incision  and scar and two weeks quicker recovery 
are worth a few percent less long term successes. 
Be sure to talk with your gyn surgeon about the 
pros and cons of the different procedures. For a 
discussion of  laparoscopic assisted vaginal 
hysterectomy, see one of our previous articles: 

Laparoscopically assisted vaginal hysterectomy 

4. Bone loss while taking HRT/ERT
We know that women who take postmenopausal hormone 
replacement therapy will gain bone density for the 
most part. We forget that this data is based on 
averages and it is possible that not 100% of women 
on HRT/ERT will have a positive calcium balance. 
It is also just as possible that women not taking 
HRT/ERT may not lose bone density, or at least not 
all of them. 

This study looked at clinical trials of women 
taking either HRT or placebo and who were all 
compliant with their medications (76%). While the 
original studies all looked at the average 
increase or decrease in bone density, this study 
looked at how many women lost more than 1% or 3% 
of bone mass at the end of one or more years. 

They found that over 3 years of taking HRT, 
spinal bone - 0.6% lost 3% of bone per year
              8% lost 1% per year
hip bone    - 0.4% lost 3% of bone per year
              11.8% lost 1% per year

In other words, HRT helps 90% of women prevent 
bone loss leading to osteoporosis but about 10% 
may still have significant bone loss. 

Of the placebo users,  
spinal bone - 11.7% lost 2.5% of bone per year
hip bone    - 7.9% lost 2.5% of bone per year
In other words, not all women who were not taking 
HRT lost bone mass. In fact, bone loss is far from 

5. Ten unhealthy eating behaviors women may have
Many women have very unhealthy eating habits. 
Sometimes they are just in a rush to lose weight 
while at other times it is just a matter of not 
realizing how unhealthy a given habit is. A 
psychologic counsellor, Nadia Amanda Alterio, has 
written an article at Whispers Magazine about 
destructive eating behaviors she has observed in 

You're a caffeine-a-holic! 
You eat only fruits and vegetables
You restrict yourself to only 1 meal a day
You avoid meat at all costs 
You are addicted to aspartame
You live on salads 
You abuse supplements 
You never eat breakfast 
You skip meals so you can eat more later 
You are obsessed with counting calories and fat grams 

6. Health tip to share - Check child's cholesterol
"Children can have a genetic disposition to 
elevated cholesterol and thus be at risk for 
premature vascular disease. Children who should be 
tested at age 2 or older include those who have 
any of these conditions: 

1. at least one parent who has been found to have 
high blood cholesterol (240 mg/dL or greater), 
2. a family history of early heart disease (before 
age 55 in a parent or grandparent)." 

The National Cholesterol Education Program (NCEP) 

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

Do you realize that the only time in our lives 
when we like to get old is when we're kids? If 
you're less than ten years old, you're so excited 
about aging that you think in fractions. 

"How old are you?"

"I'm four and a half."

You're never 36 and a half ....You're four and a 
half going on 5. 

You get into your teens; now they can't hold you 

You jump to the next number. "How old are you?" 

"I'm gonna be 16." 
You could be 12, but you're gonna be 16. 

Then the great day of your life; you become 21. 

Even the words sound like a ceremony. 

You BECOME 21....Yes!! 

Then you turn 30. What happened there? Makes you 
sound like bad milk. He TURNED; we had to throw 
him out. What's wrong? 

What changed? You BECOME 21; you TURN 30. 

Then you're PUSHING 40....stay over there. 

You REACH 50. 

You BECOME 21; you TURN 30; You're PUSHING 40; you
REACH 50; then you MAKE IT to 60.

By then you've built up so much speed, you HIT 70. 
After that, 

it's a day by day thing. You HIT Wednesday...

You get into your 80's; you HIT lunch, you HIT 
4:30. My Grandmother won't even buy green bananas. 
"Well, it's an investment, you know, and maybe a 
bad one." And it doesn't end there.... 

Into the 90's, you start going backwards. "I was 
JUST 92." 

Then a strange thing happens; if you make it over 
100, you become a little kid again. "I'm 100 and a 

What happened to just being thankful you are 

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

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