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Women's Health Newsletters 2/11/01 - 3/18/01



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****** Woman's Diagnostic Cyber Newsletter *******
                February 11, 2001
This week from Woman's Diagnostic Cyber

1. Bell's Palsy treatment
2. Considering surgery for snoring?
3. Reader submitted Q&A - ERT and hypertension
4. Herbal teas and pregnancy
5. Leg nerve problems from Taxol(R)
6. Health tip to share - Vulvar pimples 
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. Bell's Palsy Treatment
Bell's Palsy is a sudden weakness of the facial 
nerve on one side of the face. It results in an 
inability to close one eye and to produce facial 
expressions such as smiling. 

Often there is drooling from the mouth on the 
affected side. There may be headaches and pain in 
front or in back of the ear. There may be no tears 
and a dry eye on that side too. 

The cause of the condition is unknown but it has 
not changed since being described by Dr. Charles 
Bell in 1882. Most likely it is due to a viral 
inflammation of the facial nerve and it is a 
temporary condition that eventually goes away on 
its own. The droopy appearance to the face is 
disheartening but not serious. 

Symptoms usually last from 1-3 months and most 
people do not need treatment. For those who do 
have more severe cases, treatments include: 

1) anti inflammatory drugs such as steroids
2) anti viral medicines such as acyclovir or 
3) facial muscle massage

The essence of self treatment is to protect the 
eye by using artificial tears and/or patching it 
to prevent drying damage to the cornea. 

Bell's Palsy treatment

2. Considering surgery for snoring?
We have previously discussed sleep apnea which 
results in an obstructed airway during sleep. It 
is often associated with snoring although not all 
snoring results in sleep apnea. Before any surgery 
is considered for snoring, you must have a sleep 
study to make sure that sleep apnea is not an 
additional problem. 

Snoring is caused by vibration of the fleshy 
tissue in the back of the roof of the mouth called 
the soft palate and uvula. The vibration occurs 
from  airflow from both the nose and mouth 
breathing. To reduce snoring, the soft palate and 
uvula needs to be made smaller and/or stiffened. 

Several different procedures have been used and it 
may take more than one surgery. The surgery can 
sometimes be quite painful as there are many nerve 
endings in that tissue. The best of studies report 
about 85% success but there are also reports of 
lower success rates. 

You should seek out an ears, nose and throat (ENT) 
specialist who does a high volume of these 
procedures. This is after your work-up for sleep 
apnea of course. 

For more information about procedures, see 

3. Reader submitted Q&A - ERT and hypertension
"Does taking estrogen (alone) elevate blood 
pressure in some women? I am 69, have taken 
estrogen for 15 (or more) years after a 
hysterectomy. Have had hypertension most of that 
time controlled with medication.  One year ago I 
discontinued Ogen after blood pressure was very 
high.  Since then blood pressure is down and 
normal.  Any connection? "  Elise 

While the higher doses of estrogens in birth 
control pills are known to raise blood pressure in 
some women, neither estrogen replacement (ERT) nor 
hormone replacement (HRT) have an adverse effect 
on blood pressure. In fact they tend to lower 
blood pressure. 

This is true also in women who have hypertension, 
i.e., newly started HRT or ERT lowers blood 
pressure in almost 50% of women with hypertension 
either on or off anti hypertensive medication.  

There have been studies indicating that 
discontinuing anti hypertensive medication and not 
taking any estrogens can result in a lowering of 
blood pressure after several months. Why this 
happens we do not know. For a discussion of how 
HRT and ERT affects blood pressure and the 
cardiovascular system, see our article at: 

Does ERT cause or worsen high blood pressure?

4. Herbal teas and pregnancy
As women switch from caffeine containing teas to 
herbal teas, the question always comes up as to 
what herbal teas are safe during pregnancy and 
what ones should be avoided if any. It is a hard 
question to answer because there is very little 
toxicological testing that has taken place. 

A general rule-of-thumb is that teas containing 
substances you usually associate as safe foods, 
such as  orange, lemon, lime, mint, cinnamon, 
cloves, are generally safe in pregnancy and breast 
feeding. You might want to avoid more unusual ones 
such as cohosh, pennyroyal, and mugwort, for 
example, because we do not always know that they 
are safe. 

Special teas that claim they are formulated for 
use during pregnancy often contain red raspberry 
leaf, strawberry leaf, lemon grass leaf, nettle 
leaf, alfalfa, fennel seed, rosehips, and lemon 
verbena. These are felt to be safe. 

Teas containing the herb, ephedra, should be 

Herbal teas and pregnancy

5. Leg nerve problems from Taxol(R)

With the high frequency of breast cancer and a 
lesser frequency of ovarian cancer, many women end 
up receiving the chemotherapeutic agent called 
Taxol (R), or paclitaxel. This drug often causes 
damage to the nerves, especially the ones to the 

Primarily it affects sensation of the legs but it 
also can result in weakness of the muscles also. 
Most of the time the numbness and weakness 
gradually goes away but it depends upon how 
extensive the changes are in the first place. 

The nerve damage is dose related. The worse the 
damage, the longer it takes to recover. Neurontin 
(R) is a newer drug that may be helpful in 
treating this. If you develop leg pain or weakness 
from Taxol, be sure to see a neurologist for help. 

Leg nerve problems from Taxol(r) 

6. Health tip to share - Vulvar pimples
After having problems with pimples in my vaginal 
area (including inner and outer labia) that were 
not ingrown hair-related, my doctor recommended: 

(1) using anti-bacterial soap (which I now keep in 
my shower) and 
(2) immediately blow-drying my genital area after 

I have had exceptional results with NO more 
pimples.  Hope this helps someone else. " - 

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

A fellow who's just reached his 150th birthday was 
giving a press conference to the assembled media. 

"Excuse me, sir," one of the reporters said, "but 
how did you come to live to 150? 

"It's actually quite simple," the old fellow 
replied. "I just never argue." 

"That's impossible," the reporter responded. 
"There must be something else, like diet, or 
meditation, or something. Just not arguing won't 
keep you alive for 150 years! 

The old fellow stared hard at the reporter for 
several seconds. 

"Hmmm," he finally shrugged, "maybe, you're 

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

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****** Woman's Diagnostic Cyber Newsletter *******
                February 18, 2001
This week from Woman's Diagnostic Cyber

1. Boosting your energy naturally
2. Plantar fasciitis heel pain
3. Reader submitted Q&A - ASCUS Pap under age 50
4. Endometrial polyps and hysteroscopy
5. Wine and your health
6. Health tip to share - Thyroid replacement and calcium
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. Boosting your energy naturally
Fatigue, lack of energy. This is probably the 
number one complaint physicians hear from 
patients. While fatigue can be due to medical 
conditions or medications, the most common cause 
is due to lifestyle factors and habits. 

If lack of energy is one of your complaints ask 
yourself these questions before going to the 

Are you getting 7-8 hours of sleep each night? 
Do you get sleepy after meals? 
Do you exercise 3 times a week or more? 
Are you having more than one caffeine or alcohol 
  servings per day? 
Are you spending time outside each day? 
Do you feel positive each day, not angry or 

Lack of sleep is a big cause for fatigue as well 
as irritability. Sleepiness after meals is due to 
high insulin levels. It means you are eating too 
much and should cut back to smaller meals perhaps 
more frequently. 

Regular exercise and getting out in the daylight 
each day helps keep the biologic clock functioning 
correctly. Caffeine and alcohol deplete body water 
as well as cortisol levels, your stress hormone. 
If you go through each day angry about something, 
you also deplete your cortisol and fight or flight 
hormones. Depression and fatigue go hand in 

Dr. Andrew Weil has a few energizer tips for you 
to pick it up naturally. 

Natural energizers

2. Plantar fasciitis heel pain
Pain on the bottom of the foot where the heel and 
arch join that is worse in the morning and eases 
later in the day is often due to a condition 
called plantar fasciitis.  This is an inflammation 
of a foot tendon that connects to the heel and 
runs across the bottom of the foot. 

The pain worsens overnight as the tendon contracts 
and gets better with use of the foot during the 
day as the tendon stretches.  The original insult 
to the tendon is actually over stretching. The 
over stretching injury is what leads to the 
inflammation of the tendon. 

Causes of over stretching the plantar tendon may 

an unusually high arch 
a sudden increase in physical activity 
excessive weight on the foot, often due to 
pregnancy or being overweight 
improperly fitting footwear 

Treatment for plantar fasciitis is non steroidal 
anti-inflammatory medications like ibuprofen or 
naproxen and also eliminating the cause. You 
should avoid running on hard surfaces and lose 
weight if needed. Orthotic appliances and properly 
fitting shoes are also needed. 

For more explanation, see foot.com :

Heel pain from plantar fasciitis

3. Reader submitted Q&A - ASCUS Pap under age 50
[We had a recent article noting that ASCUS Paps 
over the age of 50 had a lower incidence of 
progressing to dysplasia - 13% vs 30%] 

"Today's newsletter talked about "ASCUS Pap smears 
over age 50". Do you have information for woman 
under 50 with the same condition?  The higher risk 
to get dysplasia for woman under 50?" 

"I have been experiencing ASCUS on and off for 
last 5 years and don't seem to be cured.  Dr. told 
me that it is more worrisome for younger woman 
with this condition because it could develop to 
cervix cancer." 

"Is there cure for ASCUS or even for dysplasia?" 

Women under age 50 have a higher progression of 
ASCUS pap smears to dysplasia than do menopausal 
women, but the rates vary considerably depending 
upon the population studied and the accuracy of 
the laboratory used. Most studies (see below) will 
quote a lower rate of progression to dysplasia 
than the 30% listed in the previous study. 

The point is that it is quite rare for the lesion 
to progress all the way to an invasive cancer as 
long as repeat Pap smears are monitored. Pap 
smears that show only ASCUS can be followed for a 
long time. Since your Pap has not worsened in 5 
years, that is a fairly good sign it is not going 
to progress at all. 

On the other hand, 5 years is a very long time to 
worry about this and undergo the hassle of 
frequently repeated Pap smears. It might be time 
to ask your physician to treat the cervix with 
some method to get it to produce normal cells and 
a normal Pap smear. ASCUS changes and even 
dysplasia are curable by destroying the cervical 
surface cells by freezing, cautery, LEEP, laser 
and any procedure that destroys the abnormal cells 
and stimulates the body's normal cells to repair 
the damaged ones.  

To see how different grades of Pap smears 
progress, see our previous article at: 

Natural progression of an abnormal Pap smear

4. Endometrial polyps and hysteroscopy
Some physicians are still not performing a 
hysteroscopy (looking into the cavity of the 
uterus) at the time of a dilatation and curettage 
for abnormal uterine bleeding or postmenopausal 
bleeding. The problem with omitting the 
hysteroscopy is that anatomical causes of bleeding 
such as fibroids or polyps are missed. 

This study in the American Journal of Obstetrics 
and Gynecology looked at just doing a regular D 
and C not using hysteroscopy and then doing an 
additional hysteroscopy. They found that the D and 
C alone missed quite a few polyps (57%).   

Just be sure that if your doctor suggests a D and 
C that you ask whether a hysteroscopy will be 
performed. It is much more accurate. Also, if you 
have an abnormal endometrial biopsy, that should 
also be followed up with a hysteroscopy and D and 
C because the biopsy can miss abnormal tissue. 

Endometiral polyps and hysteroscopy

5. Wine and your health
Almost anything ingested to excess is bad for your 
health. In moderation, however, many substances 
can actually be beneficial, even alcohol in the 
form of wine. 

Wine lowers total cholesterol and raises the good 
HDL cholesterol. It also has anti-cancer agents 
that help protect against cancer. The net result 
is that it significantly reduces all-cause and 
particularly cardiovascular mortality when 
compared with individuals who abstain or who drink 
alcohol to excess. 

Actually the benefit may not be confined to wine. 
Studies looking at the relative benefits of wine 
versus beer versus plain alcoholic spirits suggest 
that moderate consumption of any alcoholic 
beverage is associated with lower rates of 
cardiovascular disease. 

Moderate in the case of women means no more than 
one glass of wine a day but that one glass on a 
regular basis. 

6. Health tip to share - Thyroid replacement and calcium
"At age 37 I was diagnosed with hypothyroidism.  
This caused many health problems that increased 
throughout the years. One of these problems was 
waking up as tired as when I went to bed.  Years 
later it was suggested to me that lack of the 
proper kind of calcium may be the problem.  I was 
taking oyster shell with Vitamin D." 

"I made a trip to the health food store and was 
handed a bottle of calcium. I still had the same 
problem and took the calcium back and was handed 
what was said to be the best they had in the 
store.  It was Calcium and Magnesium Asporatate - 
it was in capsule form, citrate calcium with 
dandelion root that will provide the vitamin D. 
That night I got my first nights sleep in years." 

"I have since learned more about thyroid disease 
and know that calcium and also iron need to be 
taken 4 hours apart from your thyroid hormones 
because it can bind the thyroid hormone so less is 
absorbed. You need to take the calcium at night 
before going to bed and the thyroid hormones early 
in the morning.  Waiting 1 hours before eating 
anything." A. 

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
"PMS Advice"

Every "Hormone Hostage" knows that there are days 
in the month when all a man has to do is open his 
mouth and he takes his life in his hands. This is 
a handy guide as a discussion tool or simply print 
it out and give it to your loved one to keep in 
his wallet... 

DANGEROUS: What's for dinner?
SAFER: Can I help you with dinner?
SAFEST: Where would you like to go for dinner?

DANGEROUS: Are you wearing THAT?
SAFER: Gee, you look good in brown.
SAFEST: Wow!  Look at you!

DANGEROUS: What are you so worked up about?
SAFER: Could we be overreacting?
SAFEST: Here's fifty dollars.

DANGEROUS: Should you be eating that?
SAFER: You know, I've got lots of apples left.
SAFEST: Can I get you a glass of wine with that?

DANGEROUS: What did you DO all day?
SAFER: I hope you didn't overdo today.
SAFEST: I've always loved you in that robe.

From: Joke du Jour

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

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****** Woman's Diagnostic Cyber Newsletter *******
                February 25, 2001

This week from Woman's Diagnostic Cyber

1. Know the signs of heart attack and stroke
2. Cooling coworker conflict 
3. Reader submitted Q&A - Restless legs
4. Tubal sterilization reversal
5. Pain meds may be associated with miscarriage
6. Health tip to share - Morning nasal congestion
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. Know the signs of heart attack and stroke
It is very healthwise to know the common and 
uncommon symptoms of a heart attack because 
quickly seeking medical care can save your own 
life or that of an accompanying relative or 
friend. From the American Heart Association we 
learn that the most common symptoms of a heart 
attack are: 

a pressure, fullness, squeezing or pain in the 
center of the chest that lasts more than a few 
minutes, or goes away and comes back 
pain that spreads to the shoulders, neck or arms 
chest discomfort with lightheadedness, fainting, 
sweating, nausea or shortness of breath 

Sometimes there are some less common signs and 
symptoms of a heart attack that include: 

atypical chest pain, stomach or abdominal pain

nausea or dizziness (without chest pain)

shortness of breath and difficulty breathing 
(without chest pain) 

unexplained anxiety, weakness or fatigue

palpitations, cold sweat or paleness

They also tell us that signs and symptoms of a 
stroke are: 

sudden weakness or numbness of face, arm or leg 
especially on one side of the body. 

sudden confusion, trouble speaking or 

sudden trouble seeing in one or both eyes. 

sudden trouble walking, dizziness, loss of balance 
or coordination. 

sudden, severe headache with no known cause. 

Study these above symptoms and keep them in the 
back of your mind. Check out the American Heart 
Association web site. 

Signs of heart attack and strokes

2. Cooling coworker conflict 
Stress not only comes from yourself and relatives 
in the home environment but many times originates 
at work. Not all workplaces can have a pleasant 
and friendly environment. 

The secret to coping with stress from 
interpersonal interactions at work is to recognize 
that you cannot change anyone else's behavior. You 
can only change your reaction to someone else, 
escape the anxiety provoking situation, or 
practice stress reduction techniques. 

Escape is not a long term solution but some things 
you can do include: 

  use vacation time (days, not weeks) as getaway 

  distance yourself from the situation when you 
  feel anger coming on 

Stress reduction techniques include:

  work off your frustration with exercise

  practice relaxation techniques such as deep 
  breathing or yoga have a life outside the office 

The most difficult of stress management is to 
change your reaction to the behavior of others. 
You must realize that most of others' behavior is 
just their method of reducing their own stress 
rather than being targeted specifically toward 
you. Other tricks to change your own reaction 
might be: 

don't waste your precious mental energy on every 

tell co-workers what's bothering you using "I" 

use no accusation or blame statements 

use humor when someone talks about you 

Most of all, if you absolutely cannot change your 
reaction to coworker's behavior or comments, look 
for somewhere else to work. 
3. Reader submitted Q&A - Restless legs
"I would like some information on restless leg 
syndrome and what are some of the things that you 
can do to help it." 

"I am 31 years old- Had to have a hysterectomy 2 
months ago and I am hypothyroidism and currently 
take estradiol and Synthroid. After surgery my 
physician put me on Elavil to help me sleep and it 
gave me restless legs worse than I have ever had - 
Please give some suggestions or information." 


Restless legs syndrome is a sleep disorder 
characterized by a creepy, crawly sensation in the 
legs just before falling asleep. It can also feel 
like pins and needles and can occasionally occur 
in the arms also. It is more bothersome at night 
although it can occur at any time of rest or 
inactivity. During the night, jerky leg movements  
may keep your bed partner awake. 

This condition is worsened by  lack of sleep and 
also by menopause. If you had your ovaries 
removed, you should make sure you are on high 
enough doses of estradiol (about 2 mg per day by 
pill or 0.2mg/day by patch) otherwise the lack of 
estrogen is worsening, but not causing, your 
restless legs syndrome. 

The usual treatment is to eliminate all caffeine, 
alcohol and exercise within 6-8 hours of bedtime. 
Medications usually include agents that increase 
the body's dopamine. This is a neurological 
condition different from but similar in treatment 
to Parkinson's disease. 

The Elavil (R) probably does aggravate your 
condition and there are much better drugs for 
this. You will need to see a sleep specialist or a 
neurologist if there is not a sleep specialist 
near you. Your doctor should be able to refer you. 

For more information about restless legs syndrome, 
you may want to see this fact sheet at the RLS 
Foundation web site: www.rls.org

4. Tubal sterilization reversal
Tubal ligation should be considered a permanent 
sterilization procedure. Sometimes situations 
change, however. A child or a husband may die or 
divorce and remarriage may change the 

The surgical procedure that reverses tubal 
ligation is called a tubal reanastamosis. The ends 
where the tubes were previously ligated are 
excised to fresh, unscarred, undamaged tubal 
tissue. Then the ends of the tube are sewn back 

How successful is this procedure? It varies quite 
a bit depending upon how much damage to the tube 
was done from the original tubal ligation and 
where in the tube the ligation was performed. The 
most successful reversal rates are 85% if a clip 
procedure was performed to a lower success of 
about 35-50% if extensive cautery was used for the 
original surgery. 

Cost of the reversal is also variable and is not 
covered by insurance plans. Typical costs may 
range in the U.S. from $2500 - $5000. 

Tubal ligation reversal

5. Pain meds may be associated with miscarriage
Non steroidal anti inflammatory drugs (NSAIDs) are 
not usually recommended in the U.S. to take during 
pregnancy. Unfortunately they are commonly taken 
in over-the-counter preparations by many non 
pregnant women and some pregnant women. Typical 
NSAIDs might include aspirin, ibuprofen 
(Advil®), or naproxen ( Aleve®, 
Anaprox® DS) among others. 

Some investigators believe NSAIDs may cause birth 
defects or premature deliveries while others 
question whether this is true. Large studies 
looking at possible adverse pregnancy outcomes 
from NSAIDs have not been done. 

This study carried out in Denmark looked at almost 
1500 women who had taken NSAIDs and compared them 
with over 17000 women who had not taken any 
medications during pregnancy. They found that 
there was a much higher incidence of miscarriages 
in women who took the NSAIDs in the weeks before 
the event, a risk ratio of almost 7 times higher 
than women who did not take NSAIDs. If women took 
the NSAIDs 7-9 weeks before the miscarriage they 
still had an increased risk ratio of over 2.5 

Thus it is important if you are at all trying to 
conceive to avoid any NSAID pain pills even before 
you conceive. 

Pain medications and miscarriages

6. Health tip to share - Morning nasal congestion
"When you wake up congested, and you don't have 
time for a bath in the morning, try using bath 
salts anyway.  Juniper or eucalyptus salts work 
very well. I sprinkle some on the floor of my 
shower (back far enough so they don't get rinsed 
away) and the moisture and steam triggers the 
effectiveness of the salts. It's extremely 
pleasant and effective yet doesn't take alot of 
time.  It opens you up and gets you going !!  Hope 
you enjoy it too !!" - Kelli 

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. Veterinarian's office sign: "All unattended 
children will be given a free kitten." 

2. In parking lot outside vet's office in 
Silverton: "Parking for customers only, others 
will be  neutered." 

3. In a veterinarian's waiting room: "Be back in 5 
minutes. Sit! Stay!" 

4. Plumber: "We repair what your husband fixed." 

5. At a tire shop in Milwaukee: "Invite us to your 
next blowout." 

6. Door of a plastic surgeon's office: "Hello, can 
we help pick your nose?" 

7. At a towing company: "We don't charge an arm 
and a leg. We want tows." 

8. On an electrician's truck: "Let us remove your 

9. In a non-smoking area: "If we see you smoking, 
we will assume you are on fire and take 
appropriate action." 

10. On Maternity room door: "Push, Push, Push." 

11. At an optometrist's office: "If you don't see 
what you're looking for you've come to the right 

12. On a taxidermist's window: "We really know our 

13. In a podiatrist's office: "Time wounds all 

14. On a fence: "Salesmen welcome, dog food is 

15. Outside a muffler shop: "No appointment 
necessary, we'll hear you coming." 

16. Inside a bowling alley: "Please be quiet, we 
need to hear a pin drop." 

17. In the front yard of a funeral home: "Drive 
carefully, we'll wait." 

18. In a counselor's office: "Growing old is 
mandatory, growing wise is optional." 

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

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****** Woman's Diagnostic Cyber Newsletter *******
                March 4, 2001
This week from Woman's Diagnostic Cyber

1. Recognizing a subdural hematoma
2. The care of menopausal skin changes
3. Reader submitted Q&A - postmenopausal yeast
4. Psychological causes of decreased sexual desire
5. Heart arrhythmias
6. Health tip to share - Using a pessary
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. Recognizing a subdural hematoma
A fall with a bump on the head, hitting your head 
on a cupboard corner, no loss of consciousness but 
perhaps seeing stars for a few seconds. Then in 
the next week or two or three, a general feeling 
of not doing well, having difficulty with normal 
daily tasks, mild headaches and tiredness. These 
can be signs of bleeding inside the skull putting 
pressure on the brain. 

The events leading up to and the signs and 
symptoms of a subdural hematoma can be subtle. It 
happens more often to older people but can occur 
at any age. Since the head injury may be nothing 
more than a sharp bump on the head without 
immediate problems, it is often ignored as a 
serious medical problem. If untreated, however, 
paralysis can occur as well as permanent memory 

Symptoms of a subdural hematoma include:

Mild to moderate headaches that do not get better 
and, in fact, slowly seem to get worse 
Desire or need to sleep more 
Blurred or decreased vision 
Trouble speaking or understanding speech 
Loss of balance or fine motor skills 
Numbness, weakness or paralysis on one side of the 
The lesson is if you bump your head, be sure to 
have it medically checked out and even followed up 
later if you do not feel up to par. 

2. The care of menopausal skin changes
Our skin does not last forever and at the time of 
menopause it seems to have more problems all of a 
sudden. Loss of estrogen causes a decrease in 
sebum production. If you were still a teenager 
this might be a good side effect but when 
menopausal, it leads to dryer skin that shows 
wrinkles easier. 

The male type androgen hormones become more 
prominent in some women at the time of menopause 
or at least are not as well counterbalanced by 
estrogen. this can result in unwanted hair growth 
or even loss or thinning of hair on the head or 

Skin tags or growths called seborrheic keratoses 
seem to come faster right after menopause and 
removal of these by a dermatologist may be needed. 
Graying of hair is an aging problem and not caused 
by menopause per se, but all of this seems to 
happen at the same time. 

You may want to see how a woman dermatologist 
handles these problems after her own menopause to 
see if you can get some tips for menopausal skin 

3. Reader submitted Q&A - Postmenopausal yeast infections
"I had a complete hysterectomy 4 months ago and 
have been feeling great.  Except I keep developing 
monthly what seems to be a yeast infection (but 
without much discharge). It is REALLY aggravating 
and painful.  I see my gyn who prescribes 
Diflucan(R) (the last time she prescribed 5 to 
me). My husband has also been treated with the 
same.  Yet, every month here it comes again!  
Could this be related to my hormones? I am using 
the Climara(R) patch and have NOT experienced any 
other problems. Thank you." - Arlene 

Chronic yeast infections are actually uncommon 
after the menopause. Most frequently, symptoms like 
you describe are an irritant vulvitis which is a 
secondary bacterial or yeast skin inflammation of 
the vulva. It is not from yeast (candida) from the 
inside of the vagina. It can be secondary to 
pads, topical chemicals from soaps, creams or 
powders, urine leakage, just washing with soap too 
frequently or too low an estrogen dose. 

There are a couple of exceptions to this. If you 
develop diabetes, a yeast vulvovaginitis can be 
common after menopause. The other situation is one 
that dermatologists caution us about and that is 
the situation in which a woman has yeast organisms 
on her feet which contaminate underwear as it is 
put on. the yeast cells seed the vulvar area and 
if there is any skin irritation, a yeast vulvitis 
can ensue. There are not good scientific studies 
that indicate how much of a problem this is but it 
is good to keep in mind if you continue to have a 
recurrent yeast vulvovaginitis at any age. A 
shampoo such as Nizoral(R) used on the feet may 
help this. 

If you are under age 50 and had a surgical 
menopause, the estradiol dose in even the largest 
strength Climara(R) patch may be too low for you. 
Be sure to have your blood sugar checked and also 
a vaginal culture to confirm the yeast is from the 
vagina. If the blood sugar and culture are 
negative, then you are having an irritant vulvitis 
which is a different problem. You may want to 
discuss raising your estrogen dose, using a 
topical vaginal estrogen such as an Estring(R) and 
using good skin care practices to prevent vulvar 
skin breakdown. 

See our patient instruction sheet at:

Instructions for chronic vulvar pain management

4. Psychological causes of decreased sexual desire
With the exception of sudden hormonal decreases 
around the time of surgical or natural menopause, 
the most frequent causes of decreased sexual 
desire are psychological conditions or 
circumstances that suppress desire. To make things 
worse, when a woman is having those conditions or 
feelings, it is very difficult for her to see the 
cause and effect. 

AT Newshe.com from the Female Sexual Medicine 
Center at UCLA Medical Center, some of the 
identified psychological causes are: 

sexual or emotional abuse
drug or alcohol abuse
sexual addiction
body esteem or self image problems
relationship problems

If you suspect some of these conditions may be 
affecting your sexual desire, it is important not 
to wait too long before seeking help from a 
trained sex therapist professional. Do not wait 
until your relationship is totally falling apart 
before seeking help. 

For a brief discussion about how the above 
psychological conditions may contribute to libido 
problems, see: 

Psychological causes of decreased sexual desire

5. Heart arrhythmias
The normal heart rate at rest is 60-100 beats a 
minute. When a person feels her own heart beating 
that is called palpitations. Some women are more 
aware of their heart beat while others only feel 
palpitations when the beat is faster than normal 
or irregular. Either fast heart beats or irregular 
heart beats should be be investigated to see if 
they represent heart arrhythmias. 

Many heart arrhythmias are benign and not 
worrisome while others can be life threatening. 
The causes of arrhythmias can be unknown or they 
may be due to coronary heart disease, previous 
heart attacks with heart muscle damage, or heart 
valve problems. 

The EKG may miss arrhythmias that occur 
irregularly so a 24 or 48 hour continuous EKG 
monitor is needed to diagnose the exact type of 
heartbeat irregularity. This often quantitates the 
most common arrhythmia, ventricular ectopic beats 
or premature ventricular contractions (PVCs). PVCs 
are generally benign but may be worsened by 
certain medicines, caffeine and alcohol. 

For a list of some of the other arrhythmias and 
their treatments, see: 

Abnormal heart rhythms

6. Health tip to share - Using a pessary
"It has been over a year now since I had the 
information from the Woman's Diagnostic Cyber 
network about a pessary and got one." 

"I went for my yearly checkup and all my tests 
were in normal range. I keep the pessary 
immaculately clean, I douche two times a week and 
clean it daily. I keep my weight down and work out 
daily. All these factors play a important role in 
everyday health and play a factor in not having to 
have surgery for something that may be avoided." 

"I encourage you women to try a pessary (if you 
have prolapse, cystocele or rectocele). After all, 
once surgery has removed everything, what is there 
to try, Try this first, what do you have to lose, 
Trust me, you have your health in your own hands."  
- C.S. 

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
"Women and Mirrors..."
Age 3: Looks at herself and sees a Princess! 
Age 8: Looks at herself and sees herself as 
Cinderella / Sleeping Beauty. 
Age 15: Looks at herself and sees herself as 
Cinderella / Sleeping Beauty / Cheerleader; or if 
she is PMSing,  sees Fat / Pimples / UGLY ("Mom, I 
can't go to school looking like this!"). 
Age 20: Looks at herself and sees "too fat/too 
thin, too short/too tall, too straight/too curly" 
--but decides she's going out anyway. 
Age 30: Looks at herself and sees "too fat/too 
thin, too short/too tall, too straight/too curly" 
--but decides she doesn't have time to fix it, so 
she's going out anyway. 
Age 40: Looks at herself and sees "too fat/too 
thin, too short/too tall, too straight/too curly" 
--but says, "At least I'm me," and goes out 
Age 50: Looks at herself and sees "I am" and goes 
wherever she wants to go....the hell with the 
Age 60: Looks at herself and reminds herself of 
all the people who can't even see themselves in 
the mirror anymore.  Out she goes unafraid of the 
world, seeks new experiences. 
Age 70: Looks at herself and sees wisdom, laughter 
and ability.  Goes out and enjoys life..... and 
enjoys being her. 
Age 80: Doesn't bother to look.  Just puts on a 
purple hat and goes out to have fun with the 
Maybe we should all grab that purple hat a little 
That's it for this time. 
Your BACKUPMD on the Net.
Frederick R. Jelovsek MD 

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****** Woman's Diagnostic Cyber Newsletter *******
                March 11, 2001
This week from Woman's Diagnostic Cyber

1. Comparison prescription shopping on the Net
2. Enough oxygen when flying?
3. Reader submitted Q&A - OCD, depression and menses
4. ERT, Leiden and risk of thrombosis/heart attack
5. Effectiveness of an Internet weight loss program
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. Comparison prescription shopping on the Net
Comparison shopping web sites like mySimon.com are 
quite helpful when you know exactly what product 
you want and you want to find the least expensive 
source that you can on the Net. Now there are 
comparison shopping sites for pharmaceutical 
prescription medications, herbs and vitamins and 
other beauty and personal health care products. 

Destinationrx.com is one such site that spiders 
pharmacies that are verified by the National 
Association of Boards of Pharmacy. You can go to 
the site and search on a specific brand or a 
generic product. You can also search by a medical 
condition to see what different medications are 
used to treat something like hypertension for 
example. Also there is a section to search by 
insurance companies to see if a specific product 
is covered by your plan. 

For example if you were taking Premarin 0.625 mg 
as estrogen replacement and you wanted to compare 
to estradiol 1 mg, you might find the price 
difference is substantial (about $47.00 vs 
$12.00 for 90 tablets). While not all physicians 
would admit these are equivalent medicines, for 
many women the difference would not be noted. 

2. Enough oxygen when flying?
Airplanes have plenty of oxygen in the cabin but 
because the air pressure is lower, equivalent to 
being on an 8000 foot mountain, less oxygen 
reaches the blood. Originally the standards were 
set by testing healthy military men and this 
pressure was felt to be quite adequate. With an 
increase (although still quite unusual) of 
fainting and heart attacks on airplanes, cabin 
pressure levels are being questioned. 

More and more people with medical conditions are 
flying and anyone with heart problems or 
respiratory problems should be wary. It doesn't 
mean you should not fly but be aware of any 
increased headaches or fatigue with flying. This 
can be a sign of low oxygen tension in the blood. 

For a discussion of this, see:

Enough oxygen when flying?

3. Reader submitted Q&A - OCD, depression and menses
"I have been treated for OCD (obsessive compulsive 
disorder) and depression for the past 3-4 years 
with much success until recently.  I began having 
'breakthrough' episodes that really seemed to 
coincide with my menstrual cycle.  My symptoms 
would worsen around the time of ovulation and 
lessen with the beginning of my period.  I also 
have PCOS and insulin resistance and am being 
treated accordingly for those.  My question is: 
what is the correlation between my female hormones 
and this OCD/depression?" -  K. 

There is a correlation between depressive symptoms 
and menses as well as obsessive compulsive 
disorder (OCD) and menses. Both have worsening 
symptoms in the week or two before menses, i.e., 
in the 2 weeks after ovulation. The symptoms are 
often twice as bad on objective scales. It is very 
possible that with your polycystic ovarian 
syndrome you were not ovulating at all or at least 
regularly. Therefore you did not have ovulation 
and symptoms did not noticeably worsen before 

Now with treatment for insulin resistance, we know 
that ovulation occurs more frequently in PCOS 
patients. Therefore if you have just noticed the 
relationship of OCD and depression symptoms since 
treatment for insulin resistance, there is a good 
explanation for it. 

We know from PMS studies that depression worsens 
before menses. In fact about 5% of women with PMS 
actually just have depression that worsens 
premenstrual. The literature also has studies that 
indicate worsening of OCD before menses, 
especially in those women who have eating 
disorders and who are chronic hair pullers 

For a discussion of premenstrual syndrome symptoms 
and disorders often confused with PMS, see our 
article at: 

PMS vs. Premenstrual Dysphoric Disorder (PMDD)

4. ERT, Leiden and risk of thrombosis/heart attack
Postmenopausal estrogen replacement has a very low 
risk for blood clots or vascular occlusion leading 
to heart attacks. The risk is about 4 per 10,000 
women compared to about 1 or 2/10,000 women not 
taking ERT. The risk goes up, however if you 
already have coronary artery disease to about 3-
4/1000 women. There is a subgroup of women, 
however, who are at much higher risk for 
thrombosis if they use estrogen replacement. 

Certain women have a genetic risk for developing 
blood clots, pregnancy vascular complications and 
strokes or clots to other body areas. These 
genetic variants go under the weird names of 
factor V Leiden, prothrombin 20210, methylene 
tetrahydrofolate reductase (MTHFR677) and factor V 
HR2 haplotype. By far the most common is factor V 
Leiden deficiency. Women who have anticardiolipin 
antibodies have a higher incidence of this. 

Only about 6% of the Caucasian population and 3% 
of the African-American population have these 
genetic changes. In the study below, 
postmenopausal women who had previously had a 
heart attack (myocardial infarction) were followed 
for 3 years and analyzed for hypertension and 
factor V Leiden and prothrombin 20210 GA variants. 

They found not only that women who have 
hypertension have a higher risk of heart attacks 
but those who had hypertension and the genetic 
variation AND took estrogen replacement were at an 
11-fold risk for non-fatal heart attacks. 

These findings have been confirmed in other 
studies and the net result of this is that if you 
have had a history of blood clots, stroke, other 
vascular thromboses or pregnancy abruption 
problems, then you should consider asking your 
doctor to check you or refer you to be tested for, 
factor V Leiden factor deficiency. This test is a 
cDNA-PCR test of the prothrombin gene (about 
$150). If you are positive, you should avoid 
taking hormonal replacement therapy. 

ERT and risk of thrombosis and heart attack

5. Effectiveness of an Internet weight loss program
There are several resources on the Internet for 
weight loss and quite a large amount of 
educational, informational articles. Some net 
programs include more than just articles and chat 
areas. They include active email assignments, form 
submissions, email reminders and other 
encouragements to continue sticking to a diet. 

One recent study looked at 91 hospital employees 
who were overweight. Half of the group were given 
organized links to informative resources on the 
Internet to read about weight loss. The other half 
received additional behavioral procedures, 
including a set of "24 weekly behavioral lessons 
via e-mail, weekly online submission of self-
monitoring diaries with individualized therapist 
feedback via e-mail, and an online bulletin 

In the group receiving active, behavioral 
intervention, the average weight loss at 6 months 
was 4.1 kg (9 lbs.) while in the group having 
primarily educational links, the weight loss at 6 
months was 3.3 kg (7.25 lbs). The difference is 
not much but remember that many drug studies of 
appetite suppressants do not show much more 
difference on the average. 

Effectiveness of an Internet weight loss program

6. Health tip to share - Perineal odor
"Ladies, I know this is tedious, but I know that 
odors are also very disturbing.  I usually bring a 
washcloth and clean myself 2-3 times a day, 
usually after I use the bathroom, in addition to 
showering in the evening.  This will help a lot. 
If you don't like the washcloth, use baby wipes, 
or even the tissue that is in the bathrooms, just 
bring your soap, and wash.  Actually, this makes 
me feel so much better and more confident about 
myself."  - Anonymous 

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) No matter how hard you try, you can't baptize 
2) When your Mom is mad at your Dad, don't let her 
brush your hair. 
3) If your sister hits you, don't hit her back. 
They always catch the second person. 
4) Never ask your 3-year old brother to hold a 
5) You can't trust dogs to watch your food. 
6) Reading what people write on desks can teach 
you a lot. 
7) Don't sneeze when someone is cutting your hair. 
8) Puppies still have bad breath, even after 
eating a tic-tac. 
9) Never hold a Dust-Buster and a cat at the same 
10) School lunches stick to the wall. 
11) You can't hide a piece of broccoli in a glass 
of milk. 
12) Don't wear polka-dot underwear under white 
13) The best place to be when you're sad is 
Grandpa's lap. 

1) Raising teenagers is like nailing Jell-O to a 
2) There is always a lot to be thankful for, if 
you take the time to look. For example, I'm 
sitting here thinking how nice it is that wrinkles 
don't hurt. 
3) One reason to smile is that every seven minutes 
of every day, someone in an aerobics class pulls a 
4) Car sickness is the feeling you get when the 
monthly payment is due. 
5) The best way to keep kids at home is to make a 
pleasant atmosphere, and let the air out of their 
6) Families are like fudge . . . mostly sweet, 
with a few nuts. 
7) Today's mighty oak is just yesterday's nut that 
held its ground. 
8) Laughing helps. It's like jogging on the 
9) Middle age is when you choose your cereal for 
the fiber, not the toy. 
10) My mind not only wanders; sometimes it leaves 
11) If you can remain calm, you just don't have 
all the facts. 

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

Back to top

****** Woman's Diagnostic Cyber Newsletter *******
                March 18, 2001
This week from Woman's Diagnostic Cyber

1. Toenail trouble: Causes and cures
2. Recurrence of dysplasia after LEEP
3. Reader submitted Q&A - Delaying menses with OCPs
4. Acidophilus and other probiotics
5. Quitting smoking support group web site
6. Health tip to share - Support garment for prolapse
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. Toenail trouble: Causes and cures
Foot care is often a neglected task and can result 
in pain and infection that limits our activity. 
Toenails can especially bear the brunt of neglect 
and end up with a fungal infection, discoloration, 
pain or even active bacterial infection of the 
surrounding skin. 

The most common problems include ingrown toenail, 
black toe (or runner's toe), fungus toenail 
infection and occasionally a bone spur under the 
nail (subungual exostosis). Exercise or athletic 
involvement are common causes of problems although 
ill-fitting shoes in the toebox area are also 
common culprits of toe problems. 

Ingrown toenails produce infection in the skin and 
even antibiotics will not cure this until the 
ingrown toenail is removed. Black toe comes from 
bruising of the toe (usually the large toe) with 
blood under the nail. It arises from tight shoes 
or the sudden starting and stopping movements that 
jam the toe against the end of the shoe. If there 
is not much pain it is best to leave the toenail 
alone. Pain indicates pressure from the blood 
under the nail and you may need to have a hole 
drilled in the nail to relieve the pressure. 

Fungus of the toenails, onychomycosis, can be very 
difficult to get rid of once it sets up. While  
natural treatments such as tea tree oil and thyme 
oil applications can be tried, the quickest and 
most effective treatment is medication such as 
difluconazole (Diflucan[R]) or itraconazole 
(Sporonox[R]). By quick we mean 6-12 months. 
Removal of the nail can get rid of the fungus also 
as long as the conditions that cause the fungus 
(hot, sweaty feet, poor fitting shoes, poor foot 
care) are reversed. 

A bone spur under the nail can only be diagnosed 
by xray. Pain is produced by pushing straight down 
on the nail rather than at the sides. Removal of 
the spur is the definitive treatment.  

Check this article at runningnetwork.com for tips 
on toenail care. 

Toenail trouble: Causes and cures

2. Recurrence of dysplasia after LEEP
Women who undergo treatment of the cervix to get 
rid of moderate or severe dysplasia are counselled 
that treatment is not 100% successful. The main 
reasons for this are two: 

1) Not all of the tissue that has undergone 
dysplastic change  is removed by the LEEP 
procedure, cryosurgery or cervical conization, 
i.e., there is residual dysplasia. 

2) Other cells which are infected by virus such as 
HPV  but which have not yet undergone dysplastic 
change are still left behind because there is no 
way of identifying those infected, but not yet 
dysplastic cells. 

The net result is that some women have recurrent 
dysplasia even after standard treatment. This 
study looked at the long term cure rate for 
dysplasia after having a LEEP (loop electrical 
excision procedure) in 184 women. 

The overall, long term recurrence rate for 
dysplasia after  LEEP was only 9.2% at 6 months 
but went as high as 31% with an average follow-up 
of 2 years. In women who had high grade dysplasia 
(moderate or severe dysplasia) and had all of the 
dysplasia removed at LEEP (negative margins), the 
recurrence rate was 26%; while if they had 
remaining dysplasia, the recurrence rate was 55%. 

You would think that with remaining dysplasia the 
recurrence rate would be 100% but many times 
dysplasia goes away on its own given time. As our 
bodies mount an immune response the virus and its 
changes are stopped. 

The bottom line is that a LEEP is about 70% 
effective in the long term for curing moderate or 
severe dysplasia. If  all of the dysplastic skin 
changes are removed it is 75% effective but only 
about 50% effective if there is still dysplasia 
remaining behind after the procedure. 

Recurrence of dysplasia after LEEP

3. Reader submitted Q&A - Delaying menses with OCPs
"Can you tell me how to use my birth control pills 
to prolong getting a period? I have a vacation 
coming up and my menstrual is scheduled to occur 
right in the middle of it." Anonymous. 

While birth control pills are normally taken with 
21 active hormonal pills followed by 7 placebo or 
iron pills, there are other ways of taking the 
pills to control the timing of when you get your 

Menses usually starts after no active hormone 
pills for 3 or 4 days. That is why if you miss 
more than two birth control pills, a menstrual 
period often starts prematurely. Then it is best 
to let it proceed and just start a new pack 7 days 
after the first missed pill. 

You could start your menses earlier than usual by 
just discontinuing the active pills and starting a 
new pack 7 days later. Ovulation rarely takes 
place in less than 10 days after stopping a pill 
so this should not lead to pregnancy unless you 
forget to restart them at the correct time. 

Rather than having your menses earlier and 
starting a new cycle, you could start a new pack 
right after the 21 days of active pills and then 
your menses would be delayed by 3 weeks. 

We know from women who take pills continuously for 
endometriosis that eventually you may have 
breakthrough spotting or bleeding if you continue 
on active pills but that still should not affect 
getting pregnant. 

Be sure to see our instructions on birth control 
pills for other questions about taking pills. 

Instructions for birth control pill use

4. Acidophilus and other probiotics
Probiotics refer to bacteria and yeasts that help 
rather than harm the body. Lactobacillus 
acidophilus is one of the best known of these 
helpful bacteria that colonize the mouth, the 
gastrointestinal tract and the vagina in women. It 
helps digestive function and keeps down harmful 
bacteria by competing with them for limited 

Antibiotics often disturb the balances of these 
natural organisms. The result can be bad mouth 
odor, diarrhea, yeast or bacterial vaginal 
infections. Normally you do not need daily doses 
of these probiotics but when vaginitis is a 
problem or traveller's diarrhea greets you, then 
taking some of these probiotics can be a natural 
way of overcoming the disease-disturbed balance. 

Milk and dairy products now have live cultures of 
some of these bacteria added. Other sources 
include supplements which are widely available in 
powder, liquid, capsule, or tablet form at natural 
health food stores and pharmacies. The organisms 
in these preparations must be alive, however, not 
dried up on the shelf. Therefore be cautious of 
your source. 

Conditions that may benefit from probiotics 

irritable bowel syndrome
chronic vaginitis
ulcerative colitis

You may also want to take some along with, and 
after taking, prescribed antibiotics. For more 
information about these natural organisms, check 
out thenaturalpharmacist.com. 

Acidophilus and other probiotics

5. Quitting smoking support group web site
Stopping smoking can be a painful experience 
because it is an addiction that makes us lose our 
voluntary control over choice of action. 
Quitnet.org is based at the Boston University 
School of Public Health and provides scientific 
for the support of smokers trying to quit. 

Their quitting guides are well-organized, concise 
and very informative. They explain all about 
addiction both physiologically and psychologically 
as well as the phases that a quitter goes through. 
The different prescription medicines that are 
available are also explained and categorized and 
appropriate warnings and side effects listed. 

Informational sources available include:

 Quitting Guides - help you plan your quit. 
 Quitting Calendar - details the day-to-day steps 
to quit smoking. 
 National Directory - connects you to local 
smoking cessation programs. 
 Pharmaceutical Guide - helps you sort out your 
options to end your addiction. 
 Daily Tobacco News 

The site also provides personal tools that a 
smoker can use to aid in quitting: 

 Peer to peer support - means you are not alone 
 Quitting Tools - track your progress and 
recommend strategies to stop smoking. 
 Quit Date Wizard -  helps you set a Quit Date. 
 Q-Gadget - tracks lifetime and money saved. 
 Quit Tips and Anniversary Emails - provide long-
term support. 
 Personal Profile - puts you in control of what's 
public, what's private. 
 Expert Counselors make sure you have the latest 

Support for smoking cessation

6. Health tip to share - Support garment for prolapse
"I saw your newsletter with a tip about wearing a 
pessary for prolapse." 
"I have a prolapsed uterus. While there are women 
who can wear a pessary there are many women that 
can't wear a pessary for various reasons such as 
infection, slipping etc. I was in this predicament 
until found a great new support garment for women 
with prolapse. It's working wonders for me. It's 
called the V-brace and it's available at 
"I wanted to pass this tip along as I know there 
are many women like me who can't have surgery and 
who can't wear a pessary." - Elise 

If you have discovere
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