Women's Health Newsletters 3/25/01 - 4/29/01
****** Woman's Diagnostic Cyber Newsletter ******* March 25, 2001 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ This week from Woman's Diagnostic Cyber ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Side effects from anesthesia 2. Vulvar self-exam 3. Reader submitted Q&A - Black skin from rings 4. Elevated prolactin levels 5. Exercise and risk for coronary artery disease 6. Health tip to share - Stress can make you fat 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. Side effects from anesthesia ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ We know that there are differences between men and women in response to pain medications. Now a recent study in the British Medical Journal looks at how men and women differ in respect to recovery from anesthesia for surgery. The investigators found that women wake up from anesthesia quicker than men do by several minutes. However women had more postoperative side effects such as nausea, headaches, and backaches. Both men and women had an equal incidence of sore throat. Even up to 3 days after surgery, women still had about twice as much incidence of nausea and headache. If you are about to undergo anesthesia for surgery and you are a person who is easily nauseated, be sure to ask the anesthesiologist for anti-nausea medicine before and during the surgery so when you wake up you will not have much difficulty with that. Women's side effects from anesthesia ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2. Vulvar self-exam ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Have you ever been told you should do a monthly self-vulvar exam? I'll bet you have not. Many women never look at the vulva skin because it may be difficult to do or because they may have mental inhibitions about looking "down there". It is important to examine the vulva because skin lesions and even cancer can be detected early. Any woman older than 18 years of age should perform vulvar self-exams. From 18 to age 45 the most common vulvar lesions are condyloma accuminata (venereal warts) caused by the human papilloma virus. If detected early, these can be treated before they spread and become uncomfortable. Pigmented lesions in the vulvar skin may indicate melanoma which is cancerous. After age 45 it is even more important to do the exam because cancer of the vulva can be detected early and be totally cured by just a simple skin excision (like a mole) in the office. Cancer of the vulva is more common in the postmenopausal and elderly woman. If you have a spot that itches or burns, it goes without saying that it needs to be examined by your physician but even if it is just a red or white spot that does not feel any different, detecting it early can save your life. To examine your vulva, sit on the bed or a carpet or even with one leg up on a stool in the shower. You will need to use a mirror with one hand and separate the lips of the labia with another. To see what the anatomy should be, check out the vulva self-exam at IVF.com ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3. Reader submitted Q&A - Black skin from rings ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "I think its because my body is acidic that I get black marks under my gold rings. This doesn't happen all the time. On occasion I do get a urinary track problem. My body is highly sensitive to citrus, but on occasion I can eat a fresh orange, but not first thing in the morning on an empty stomach. How do I make my system more alkaline?" - lmo Having a black skin reaction to contact with gold is not a common problem but some women are plagued with it. This is different than a contact dermatitis to gold in which you may get an itchy, red skin rash. With the black skin reaction, some metal in the ring reacts with sweat or even cosmetics to turn into a black ink-like stain on the skin. I do not think anyone knows for sure whether it is acid in the sweat, aminoacids excreted from the food you eat, medications excreted in the sweat or some other salt or compound that causes the reaction. It is possible it may be different causes for different women. For many years this was thought to be due to the other non gold metals that were compounded with the gold such as nickel, or even the metal such as lead in solder joints of the ring, earrings or other jewelry. Sometimes this may be the explanation for a specific piece of jewelry because it seems to happen more often with less pure gold jewelry such as 10 karat, but for the most part it may be a direct reaction with the gold metal. No one knows if this reaction has to do with the acidity of the sweat or, more likely, the salts of sodium (Na), chloride (Cl) and potassium (K) that are secreted in sweat. Chloride from swimming pools is known to discolor gold and it may be that the reaction of your jewelry is predominantly due to the chloride in the sweat. I do not know if alkalinization of the urine and sweat is the answer. If it is, traditionally sodium bicarbonate (the bicarbonate found in antacids) is used. Another method used to decrease sodium and chloride in the urine and also to raise the urine pH is to hyperdiurese by drinking large amounts of water. This dilutes and lessens the salts. Before doing any of these things, however, you may want to get some urine dipsticks at the pharmacy that measure urinary pH (sweat and urine are very similar in their components). Test your urine frequently to see whether it is running acidic or basic. If you can do this right after you notice a black skin mark from gold jewelry, it would be extremely helpful to give a direction in which to go. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 4. Elevated prolactin levels ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Prolactin is a hormone in the brain (pituitary gland) that governs the production of milk in the breast for lactation. It also suppresses ovulation and women with elevated prolactin levels non pregnant can have an absence of menses, infertility and even milky discharge from the breast. Prolactin is secreted very close to the area in the brain where thyroid stimulating hormone (TSH) is secreted so sometimes it can be elevated when there is elevation of TSH in the case of hypothyroidism. A tumor of the pituitary gland is one of the most serious causes of elevated prolactin. Sometimes, however, anti-depressant and other psychotropic medications can cause an elevated prolactin. If a prolactin level is higher than 100 ng/ml, x-ray studies of the brain are recommended such as an MRI. Often small growths are found called microadenomas. Those can be followed or treated medically but sometimes there are larger tumors that need to be surgically excised. For a description of the findings and different causes of hyperprolactinemia, see this article at mdmultimedia.com Elevated prolactin levels ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5. Exercise and risk for coronary artery disease ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Women who are physically active have less coronary artery disease than women who are sedentary. Does this mean you have to go to the "club" to exercise every day or jog several miles? This study looked at over 39,000 healthy female health professionals aged 45 years or older and their exercise levels and incidence of coronary artery disease. They looked at vigorous activity, walking less than an hour a week, walking 1-1.5 hours a week and walking 2 hours a week or more all compared to no exercise at all. They found that both vigorous activity as well as walking an hour or more a week was associated with a 50 percent reduction in the number of adverse heart events. This positive effect held true regardless of weight, cholesterol levels, or smoking. This study continues to lend credence to the positive health effects of even a light exercise such as walking 30 minutes 2 or 3 times a week. Exercise and risk for coronary artery disease ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6. Health tip to share - Stress can make you fat ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "Stress increases cortisol, epinephrine and norepinephrine, our "fight or flight" hormones. This is a beneficial reaction if we are facing an emergency situation but when we have frequent micro-emergencies each day in a stressful environment, cortisol is elevated too frequently and causes fat to deposit around our midsections." "If stress and weight gain are a one-two punch for you, concentrate on the stress reduction before embarking on a diet. You will be more successful in losing the weight you desire." FRJ Why Stress Can Make You Fat ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 7. Humor is healthy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Kids on Life -=-=-=-=-=-=- How Do You Decide Who To Marry? You got to find somebody who likes the same stuff. Like, if you like sports, she should like it that you like sports, and she should keep the chips and dip coming. - Alan, age 10 How Can A Stranger Tell If Two People Are Married? You might have to guess, based on whether they seem to be yelling at the same kids. - Derrick, age 8 What Do You Think Your Mom And Dad Have In Common? Both don't want any more kids. - Lori, age 8 What Do Most People Do On A Date? Dates are for having fun, and people should use them to get to know each other. Even boys have something to say if you listen long enough. - Lynnette, age 8 When Is It OK To Kiss Someone? When they're rich. - Pam, age 7 Is It Better To Be Single Or Married? It's better for girls to be single but not for boys. Boys need someone to clean up after them. - Anita, age 9 How Would The World Be Different If People Didn't Get Married? There sure would be a lot of kids to explain, wouldn't there? - Kelvin, age 8 How Would You Make A Marriage Work? Tell your wife that she looks pretty even if she looks like a truck. - Ricky, age 10 Contributed by: Moodyfan ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ That's it for this time. Your BACKUPMD on the Net. Rick Frederick R. Jelovsek MD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
****** Woman's Diagnostic Cyber Newsletter ******* April 1, 2001 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ This week from Woman's Diagnostic Cyber ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Health and wellness just for girls 2. Facts about Chlamydia 3. Reader submitted Q&A- Ca-125 cancer screen test 4. How much do you know about anxiety disorders? 5. Screening recommendations for colon cancer 6. Health tip to share - Herbal supplements 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. Health and wellness just for girls ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ iEmily.com is a web site just for teen girls that informs about health and wellness. It is a place for teens to learn about their bodies, and their feelings. to see if what they are thinking about their hair or weight or sexual concerns are the same as what other teens have on their mind. In the sex-body-health section, topics range from "What You Need to Know About Getting a Pap Smear" to "Natural Face Mask for Oily Skin". These topics are written in a very clear, understandable terminology for the younger woman who has not already been exposed to medical jargon through frequent gynecological or obstetrical encounters. Categories of articles include: A Healthy You: How to Stay Well All About Skin and How to Protect It Caring for Your Hair and Its Problems Fooling Around: All About Sex Girl Problems It Can Happen to Me: Sexually Transmitted Diseases Itchy and Scratchy:The Lowdown on Vaginal Infections Living With Injury, Disability, or Illness Playing It Safe:A Guide to Birth Control Pregnancy and What to Do If You're Not Ready for Momhood Quiz Yourself Self Care--Naturally! You Can't Be Too Careful:Skin Safety Your Changing Body ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2. Facts about Chlamydia ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Chlamydia is a silent sexually transmitted disease. Approximately 75% of women who have infections are asymptomatic and may never seek help. If it does strike symptomatically, women get urinary tract infections and/or pelvic inflammatory disease of the tubes that can lead to later infertility, chronic pelvic pain or ectopic (tubal) pregnancies. Infections are more common in men and women under the age of 25 but it can occur at anytime. As many as 10% of teen girls may get chlamydia infections. Doctors can check you for this by doing a cervical smear similar to that done for the Pap smear test. Treatments with specific antibiotics are quite effective for chlamydia so it is best to have it picked up before it causes serious infection. Don't be ashamed to ask the doctor to do a smear to check for it. It is often done routinely at the beginning of pregnancy but can be done anytime you ask. Condoms can be used to prevent transmission of chlamydia and should always be used if you do not have a long term partner. Contrary to the belief of many, chlamydia does not produce vaginal discharge, itching, burning or odor. You may want to review some of the health statistics about chlamydia at the Center for Disease Control STD Prevention site: Some facts about chlamydia ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3. Reader submitted Q&A - Ca-125 cancer screen test ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "Prior to a complete hysterectomy in 1997, I had periodic CA 125 tests for Cancer. The test numbers gradually escalated over the years. No cancer was found when I had the hysterectomy but I have not had a CA 125 test since. Should I? My father died at age 50 of colon cancer and my mother was diagnosed with breast cancer at 75, at 84, she is a breast cancer survivor. Does the CA 125 only address uterine or ovarian cancer or is it a more general indicator of the presence of cancer somewhere in the body?" - DMG Ca-125 is a blood cancer antigen that measures almost any disease in the abdominal cavity (peritoneum). It is primarily used to detect ovarian cancer since that spreads over the peritoneal cavity. Unfortunately it can pick up endometriosis, fibroids, liver disease, colon inflammatory disease among other conditions. It is not effective as a screen for uterine cancer. While a rising CA-125 is worrisome, many times it turns out to be nothing identifiable or a benign condition. In fact if the CA-125 is elevated, a pelvic ultrasound is next performed. If it is normal, usually no further diagnostic tests are performed except for a follow-up ultrasound. Now that you have had both the uterus and ovaries removed, there is no point in having a CA-125 test done any more. It would be best to concentrate on detecting early breast cancer (mammograms) and colon cancer (stool testing for occult blood or colonoscopy. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 4. How much do you know about anxiety disorders? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Anxiety and stress are a fact of life. Sometimes they get out of hand and significantly cripple a person's everyday activities. When anxiety becomes overbearing it may be classified into one of several mental health problems: Panic Disorder, Obsessive-Compulsive Disorder, Post-Traumatic Stress Disorder, Phobias, Generalized Anxiety Disorder, These problems can be coexistent with other problems such as drug or alcohol abuse, eating disorders, depression and other anxiety disorders. For a description of these disorders, see the Facts About Anxiety Disorders at the National Institute of Mental Health. How much do you know about anxiety disorders? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5. Screening recommendations for colon cancer ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Screening for colon cancer is not well agreed upon. Most people are at average risk except if you have a family history of colorectal cancer, hereditary nonpolyposis colorectal cancer, familial adenomatous polyposis or ulcerative colitis. The screening tests used for colon cancer are: testing stool for occult blood, flexible sigmoidoscopy, colonoscopy, and double contrast barium enema. Occult blood testing is very safe and inexpensive but returns a lot of false positive tests. The other tests are more expensive and have many more risks. Additionally, many people fear the pain and discomfort of the scopes and enemas. Current recommendations for women at average risk are ONE of the following regimens at age 50 or over: 1. Fecal occult blood testing annually. 2. Flexible sigmoidoscopy every five years. 3. Fecal occult blood testing annually and flexible sigmoidoscopy every five years. 4. Double-contrast barium enema every five to 10 years. 5. Colonoscopy every 10 years. Each different screening strategy has it advantages and disadvantages. If you choose to use the screening for occult blood, then you must abstain from red meat, Vitamin C, turnips, NSAIDs such as Alleve(R), aspirin or Advil(R) for two days before the test. If the test shows positive, a colonoscopy must be performed. Screening recommendations for colon cancer Home tests for occult blood are available: Colocare for occult blood ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6. Health tip to share - Herbal supplements ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Most herbal supplements are quite safe but there are some that should be discontinued before surgery. There have been no scientific trials but there have been some anecdotally reported postoperative bleeding problems in patients taking gingko biloba, garlic extract, feverfew, ginger, and ginseng. This is not a negative report about these herbs for they can be quite useful. Just remember that it may be safer to discontinue the above herbal supplements about a week before any surgical procedure. Your doctor may not be aware of this. - FRJ Herbal supplements and postoperative bleeding ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 7. Humor is healthy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Hearing Aid -=-=-=-=-=-=-=- A man goes to his doctor and says, "I don't think my wife's hearing is as good as it used to be. What should I do?" The doctor replies, "Try this test to find out for sure. When your wife is in the kitchen doing dishes, stand fifteen feet behind her and ask her a question, if she doesn't respond keep moving closer asking the question until she hears you." The man goes home and sees his wife preparing dinner. He stands fifteen feet behind her and says, "What's for dinner, honey?" He gets no response, so he moves to ten feet behind her and asks again. Still no response, so he moves to five feet. Again, no answer. Finally he stands directly behind her and says, "Honey, what's for dinner?" She replies, "For the fourth time, I SAID CHICKEN!" ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ That's it for this time. Your BACKUPMD on the Net. Rick Frederick R. Jelovsek MD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
****** Woman's Diagnostic Cyber Newsletter ******* April 8, 2001 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ This week from Woman's Diagnostic Cyber ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Women smokers at higher bladder cancer risk than men 2. Foot-And-Mouth: Anatomy of an epidemic 3. Reader submitted Q&A - Cervix remaining after TAH 4. Rectal and anal pain - proctalgia fugax 5. High heel shoes and arthritis of the knees 6. Health tip to share - Growth hormone releaser 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.Women smokers at higher bladder cancer risk than men ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Lung cancer is the best known malignancy caused by smoking but bladder cancer has also been associated with smoking. With lung cancer, it has been shown that women who smoke the same number of cigarettes as a man actually have a higher chance of getting lung cancer. This study looked at whether women also have a higher chance, cigarette per cigarette, of getting bladder cancer than men. In studying over 1500 subjects and comparing them with non-smoking control subjects they found an overall 2.5 times increased risk ratio for bladder cancer among both men and women. There was no variation by the use of filtered versus non filtered cigarettes, low-tar versus higher tar cigarettes, or the pattern of inhalation. Women, however, had a higher risk than men who smoked the same number of cigarettes. They also had a higher blood level of the substance produced by arylamine exposure which is thought to be the inducing agent for bladder cancer. More reasons not to smoke. Women smokers at higher bladder cancer risk than men ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2. Foot-And-Mouth: Anatomy of an epidemic ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Foot and mouth disease ALMOST NEVER affects humans. It is a highly contagious disease caused by the picorna virus. It can infect cattle, pigs, sheep and goats as well as several wild animals (deer, water buffaloes, bears, antelopes, llamas, camels, giraffes, elephants, rats, hedgehogs). There is a similarly named condition, hand-foot- and-mouth disease, in humans which is caused by other enteroviruses, i.e. Coxsackie virus and enterovirus 71. It is not at all part of this recent concern over foot and mouth disease in animals. In spite of that, it might be helpful to know a little about what is going on with the attempts to contain this recent epidemic that can affect our meat supply. This United Press International article is a good review of how widespread the problem is and how viruses can be spread in meat and other products. Foot-And-Mouth: Anatomy of an epidemic ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3. Reader submitted Q&A - Cervix remaining after TAH ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ I am entering my 5th week after a total abdominal hysterectomy (removal of the uterus and cervix). In the 3rd week, I returned to the doctor's office for an emergency appointment due to severe sharp pains in my lower left side which extended to the pelvic area. I am also experiencing a lot of pressure at the end of urination, as well as a loss of appetite, insomnia, night sweats and extremely cold feet and hands during the day. The doctor ordered a urinalysis to determine if I had a urinary tract infection (the test was negative). During the visit the doctor conducted a vaginal examination, at which time she stated that it "looked like my cervix was still there and she was sure that it was removed." She then read the pathology report and stated that the cervix was removed, however, she still saw it during the exam. She mentioned that "maybe they didn't get it all." She also stated that the pain I was having was "nerve degeneration" and was normal after the surgery and suggested that I take Motrin. She wanted to prescribe sleeping pills for the insomnia but I refused, at which time she told me take Benadryl. Although I am concerned about the pain I am having as well as the other symptoms described above, I am more concerned about the comment regarding my cervix. Am I at any risk if indeed parts of the cervix was not removed and if so, what risks? Also, is it unusual for only parts of the cervix to be removed during a hysterectomy? In addition, what could be causing the other symptoms I am experiencing? I have my 6 week follow-up appointment next week and would like suggestions on what questions I should ask the doctor regarding my symptoms and concerns. - Anonymous The most common types of abdominal hysterectomy are total (body of the uterus and cervix) and subtotal (just the body of the uterus). Doctors who recommend leaving the cervix feel that orgasm during sexual response is better preserved as well as future support of the end of the vagina. The downside is that the junction of skin between the glandular lining of the cervix and the flat skin lining of the vagina is not removed and this is where dysplasia and cancer can occur. Also the glandular tissue remaining in the endocervix can occasionally bleed or become infected (cervicitis). Doctors who remove the entire cervix feel that the need for future Pap smears and potential for cancer of the cervix is almost totally prevented in the future and that good support of the end of the vagina can be accomplished surgically with the correct technique. Orgasm may be slightly changed but is not noted to be less pleasurable by most women undergoing the procedure. Sometimes, when doing a total hysterectomy (this has nothing to do with the ovaries), in an effort to make sure the vagina is not shortened and to prevent injury to the bladder, a small amount of the tip of the cervix is left. This would be like removing the entire nose and nostrils but leaving a small amount of the firm but moveable tip of the nose. When looking straight on, it looks like the entire cervix may still be present but in fact only a slight external surface is still present. It happens to all surgeons unintentionally sometimes and some surgeons actually try to leave this tissue intentionally. Almost always the squamocolumnar junction is removed which gets rid of the need for future Paps (or decreases the frequency). It also means the vagina has not been shortened at all which can happen sometimes. When this happens to me either intentionally or unintentionally, I look with a colposcope at about 3 months after the surgery to make sure there is no endocervical tissue present. You might ask your doctor about doing that. As far as your other symptoms of night sweats and insomnia, you did not mention if the ovaries were removed or not and how old you are. These could be symptoms of low estrogens. The pain you are having needs to be evaluated by your surgeon. It sounds as if your post operative exam was not by the same person who did the surgery. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 4. Rectal and anal pain - proctalgia fugax ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Proctalgia fugax is an uncommon but very painful condition in which the muscle of the anal sphincter undergoes an unexpected cramp just like a "charlie horse" cramp of the calf muscle. The cramp may last up to 20 minutes before going away. It is closely related to, and sometimes indistinguishable from, pain in the other pelvic floor muscles such as levator ani syndrome and pelvic floor dyssynergia. There are no special tests to diagnose this condition, just the history of the periodic recurrence of a severe pain in the anal area. GI studies should be performed in order to rule out any higher rectal or colon conditions such as cancer or inflammatory bowel disease. There is no surgical treatment that keeps this pain from recurring. Just as massage is the most common treatment for calf muscle cramps, so is pressing on the anal area. This can be done with the fingers or by straddling the edge of a bath tub. Heat from a hot bath may help. There has been one report of proctalgia fugax which responded to 0.3 percent nitroglycerin ointment. In patients with severe, prolonged attacks, salbutamol inhalation (Serevent(R) for asthma) has been shown to shorten the duration of severe pain. and clonidine has decreased the frequency of attacks. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5. High heel shoes and arthritis of the knees ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ High heel shoes have always been known to cause feet problems but now even the chunky lower heels are thought to cause knee problems. The wide heels are not as uncomfortable as high heels and thus are worn longer. Investigators in Lancet medical journal report that either narrow or wide 3 inch heels put additional pressure on the inside of the knee by as much as 26% more than normal barefoot walking. Previous studies found that narrow high heels were associated with knee osteoarthritis. This study confirmed that even wide heels are likely to cause the same osteoarthritis that narrow heels do. Wearing heels once in awhile is probably not very damaging in the long run whereas frequent heel use heel use may cause permanent osteoarthritis of the knee. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6. Health tip to share - Growth hormone releaser GHR-15 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Several readers have asked about GHR 15 (Growth Hormone Releaser) herbal supplement which is heavily advertised as an anti-aging, increased libido and energy booster. Its premise is to release your own body's growth hormone which is a master hormone that somewhat influences the positive effects of several of the other hormones (ACTH, cortisol, prolactin). Growth hormone declines with age and studies giving growth hormone injections have shown a very beneficial effect with increasing energy and improving muscle mass and decreasing fat mass. I could not find any scientific studies showing this this GHR-15 or any similar formulation actually releases your own growth hormone. In theory it should because it has sheep derived pituitary extract in it (presumably containing sheep growth hormone releasing factor) but it is uncertain whether that extract is inactivated and unabsorbed by oral administration. I am not concerned about most of the components except for the bovine pituitary extract which is derived from the brain of sheep and thus carries a very small but still possible risk of bovine spongiform encephalopathy (mad cow disease). Personally I would wait until the synthetic growth hormone releasers are available. FRJ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 7. Humor is healthy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ A man in Florida, in his 80s, calls his son in New York one November day. The father says to the son, "I hate to tell you, but we've got some troubles here in the house. Your mother and I can't stand each other anymore, and we're getting a divorce. I've had it! I want to live out the rest of my years in peace. I'm telling you now, so you and your sister shouldn't go into shock later when I move out." He hangs up, and the son immediately calls his sister in the Hampton and tells her the news. The sister says, "I'll handle this." She calls Florida and says to her father, "Don't do ANYTHING till we get there! We'll be there Wednesday night." The father agrees, "All right." He hangs up the phone and hollers to his wife, "Okay, they're coming for Thanksgiving. Now, what are we going to tell them for Christmas?" ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ That's it for this time. Your BACKUPMD on the Net. Rick Frederick R. Jelovsek MD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
****** Woman's Diagnostic Cyber Newsletter ******* April 15, 2001 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ This week from Woman's Diagnostic Cyber ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Dietary fat's bad rep is exaggerated 2. Breast implants and connective tissue diseases 3. Reader submitted Q&A - Prolonged nausea after TAH 4. Environmental chemical exposure levels 5. Good grief, bad grief - am I losing my mind? 6. Health tip to share - Swimming and water exercises 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. Dietary fat's bad rep is exaggerated ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Our percentage of food fat consumption as a nation has dropped over the last 30 years from 40% to 34% today. And yet in spite of that drop, the rate of obesity has risen from 14% to 22%. Why is that? Perhaps the main problem is that we really have not decreased total calorie consumption along with our low fat diets. Many have switched to carbohydrate-rich foods that stimulate insulin. High insulin levels actually cause hunger and may promote excessive eating. An article in Science journal actually goes farther and suggests that there is very little hard evidence that decreasing dietary fat will make us live longer. Can you believe that? Low fat evangelists may argue that there are just not enough long term trials of people on sustained low fat diets. But if you think about the decades of research and hundreds of millions of dollars that have tried unsuccessfully to prove low fat prolongs life, then you may agree that perhaps fat has received a bad rap. Dietary Fat's Bad Characteristics Exaggerated ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2. Breast implants and connective tissue diseases ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ You may remember that due to allegations that silicone breast implants caused connective tissue diseases (e.g., systemic lupus erythematosis, rheumatoid arthritis), in 1992 the FDA restricted silicone gel-filled breast implants until further studies could be done. Subsequent studies have failed to show a relationship between the implants and such diseases. This Danish study looked at 2761 women with breast implants and 8807 control subjects. They found there was no difference in the incidence of connective tissue diseases or cancer in those who had cosmetic surgery with silicone implants and those who had cosmetic surgery without any implants. Then the implant and the control group were compared to the general Danish population rates of connective tissue diseases. Both of those groups had higher rates of connective tissue diseases than the general population. This means that the implants were NOT associated with increased rates of connective tissue diseases but women who undergo any form of cosmetic surgery probably have higher rates. This is not to say that women with breast implants do not have a higher rate of local breast problems such as implant rupture, thickened capsule formation and other localized reactions. They do. It happens in over 30% of women with the implants. But the evidence continues that the implants do not cause systemic connective tissue disease problems. Connective tissue diseases following breast implants ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3. Reader submitted Q&A - Prolonged nausea after TAH ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ I was reading about the woman who had total abdominal hysterectomy surgery who had some of the same symptoms that I had. I also had a TAH Surgery where my uterus, cervix, appendix, ovaries, tubes, and a very large fibroid were removed. My question is that since coming home from the hospital 6 weeks ago, I have lost 17 lbs. and I only weigh 103 lbs. My normal weight is 120 lbs, I am 5'4 and have a medium build. It seems that I have a poor appetite and get full after a few bites of food.If I try to eat all my portions and get very full, I sometimes vomit up all the food I just ate. I also experience some nausea every day along with a lot of burping. I want to gain back my weight but it seems like I can't eat enough to gain it back. Frequent small meals have not helped with weight gain. Is this normal after surgery? My tests are normal and the post op exams are normal. My doctor doesn't know what is wrong and keeps telling me to continue to eat small meals. Any comments? Most of the time, nausea after gynecological surgery subsides in the first week, or possibly two. Occasionally it persists for a long time and then we need to know if something is wrong or is it just the body's response to the insult of surgery and all of the perioperative bowel preps, anesthesia, antibiotics, and other medications. Nausea and loss of appetite can persist after two weeks and when this happens, we honestly just do not know why it takes so long for the bowel function to return to normal. I suspect that antibiotics during and possibly after surgery are the main culprits that disturb the normal bacteria of the gastrointestinal tract. Taking capsules with live Acidophilus cultures may help this. Sometimes you have just been eating different foods than you normally did and the stomach is sensitive to these. You may have discontinued smoking or caffeine or a medication you were on which increased bowel motility and now the bowel is quite lazy and produces an intermittent illeus (lack of bowel muscle movement). Just being at home all day if you were used to going out of the house for work or leisure can lead to swallowing more saliva and air which causes increased gas and nausea. Be sure to try to restart all of your presurgical eating and activity habits now that you are six weeks out. There are, however, conditions or complications of surgery that your doctor should look for. A chronic infection at the appendiceal stump can cause these problems as can adhesions affecting the bowel. A CAT scan may be needed to detect an abscess; adhesions can only be suspected but not confirmed short of repeat surgery. Injury at the time of surgery to the bladder or ureter can also cause this prolonged bowel problem. A kidney xray (IVP) may be needed to see injury although a CAT scan may also pick this up. In summary I would say to use the Acidophilus capsules, closely examine any food or medication changes that have taken place and try to resume your normal activities. If there is no explanation there or if the nausea and loss of appetite persists or seems to worsen, ask your doctor about the possibility of further studies to look at the gastrointestinal tract and kidneys. Hysterectomy and Postoperative Problems ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 4. Environmental chemical exposure levels ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ One of the difficulties in evaluating our exposure to toxic or harmful chemicals in the environment is that there has not been good data on what are the background levels of exposure in the population. In other words what is normal. For many of the known toxic metals such as lead or mercury we do know what levels are common in people without health problems but for more uncommon but suspected toxins such as pesticides (organophosphates) or byproducts of plastics manufacturing (phthalates), good information about "normal levels" has been lacking. Recently, the National Center for Environmental Health has begun a project to provide an ongoing assessment of the U.S. population's exposure to environmental chemicals using biomonitoring. They have issued a report on the background levels of 27 environmental chemicals measured in 12 different geographical locations across the U.S. The report covers chemicals such as metals (e.g., lead, mercury, and uranium), cotinine (a marker of tobacco smoke exposure), organophosphate pesticide metabolites, and phthalate metabolites. They intend to update the data each year with new measurements. This recent report mainly sets "normal range levels" for compounds but it also concluded that lead levels in children have fallen in the last decade and exposure to 2nd hand smoke (cotinine) has fallen by over 75% in the U.S. over the last decade. It is very difficult right now to be screened in a doctor's office for such a wide range of chemicals although if there is suspected exposure to one or two specific chemicals, those tests can be ordered and sent off to special labs. There are some home test kits that analyze levels of certain minerals and metals using hair samples( e.g., Mineral Check http://www.wdxcyberstore.com/minchechommi.html) but there are no home tests measuring the organophosphate pesticide metabolites, or phthalate metabolites from plastic manufacture. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5. Good grief, bad grief - am I losing my mind? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Losing a child through stillbirth, neonatal death, congenital anomalies, SIDS, any child's death or even an early miscarriage can lead to a devastating human emotional experience. It is normal to fear you are losing your mind during this time. Symptoms of grief in this situation may include: tightness in the throat or chest rapid breathing an empty stomach feeling extreme appetite change (none or excessive) difficulty concentrating restlessness headaches impatience extreme fatigue excessive guilt or anger sensing your (dead) child's presence ambivalence toward surviving children The best treatment for grief is to know that these symptoms are normal. Even though they seem irrational and out of place they are the same feelings that other women have in this situation. Support groups of other women who have had similar experiences are invaluable. These women have been through it and know that you are not going crazy; you are reacting to the intense grief that accompanies death of a child. Am I losing my mind ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6. Health tip to share - Swimming and water exercises ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Swimming has always been good conditioning exercise but you can use water for other exercises, especially if you are not yet in good physical shape for this spring and summer. Running in the water increases your heart rate just as swimming does. Many people who cannot run on land because of back, hip, knee or foot pain can run in the water without a problem. Because of the water's buoyancy, the jarring impact on your bones is much less. In chest-high water, begin by running with your hands on your head, and as you become more fit, paddle with your arms. Other suggestions from Health Fitness Tips: Kick with a kick board or holding on to the side of the pool to tone legs, buttocks and stomach. Treading water improves arm and leg strength. Bobbing up and down in the water improves breathing and muscle tone Leg lifts also condition legs, buttocks and stomach. On your back but holding on to the side of the pool, lift each leg 10 times in front of you, behind you and to each side Even though the water helps prevent you from overheating, remember to cool down after even water exercise, whatever your level of ability. A swim a day ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 7. Humor is healthy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "New BMW" A perimenopausal woman just splurged and bought a new BMW. She was out on the interstate for a nice evening drive. The top was down, the breeze was blowing through her thinning hair, cooling off all of her hot flashes. She decided to open the sports car up. As the needle jumped up to 80 mph, she suddenly saw flashing red and blue lights behind her. "There's no way they can catch a Beemer," She thought to herself and opened her up further. The needle hit 90, 100.... Then the reality of the situation hit her. "What in heck am I doing?" she thought and pulled over. The cop came up to her, took her license without a word and examined it and the car. "It's been a long day, this is the end of my shift, and it's Friday the 13th. I don't feel like more paperwork, so if you can give me an excuse for your driving that I haven't heard before, you can go." She thought for a second and says, "Last week my husband ran off with one of your female cops. I was afraid you were trying to give him back!" "Have a nice weekend," said the officer. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ That's it for this time. Your BACKUPMD on the Net. Rick Frederick R. Jelovsek MD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
****** Woman's Diagnostic Cyber Newsletter ******* April 22, 2001 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ This week from Woman's Diagnostic Cyber ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Access to your medical records 2. Vulvodynia: Diagnosis and treatment 3. Reader submitted Q&A - Bladder falling down 4. Stomach cancer risk factors 5. Medical contraindications to air travel 6. Health tip to share - Boric acid for yeast 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. Access to your medical records ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Have you ever been frustrated when trying to get a copy of a report from your doctor or even a copy of your entire medical record? You certainly are not alone if you have found obstacles to a timely release of your medical record. Many people are not aware that the records belong to the health care institution or the specific doctor and not to the patient. In spite of this, many state and some federal laws have established that patients have a right to their own medical record. The only exception to that is when the record contains information which the physician feels is harmful for the patient to see. This usually applies to psychiatric records so it rarely gets invoked for general medical conditions. Most of the time, the delay in getting your records stems from two causes: 1) A long standing office inefficiency in copying and transferring records because it is the lowest task on an office's priority. 2) A physician's reluctance to OK release of the records because of the perception that you, the patient, do not trust what is being said by the physician. This usually only results in "foot dragging" rather than outright refusal. These are not good excuses but they are the realities. Just be persistent. The article below contains some helpful suggestions if you run into either this delay in obtaining records or in an outright refusal on the part of a doctor's office to give you records or reports. Your medical records ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2. Vulvodynia: Diagnosis and treatment ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ We have had some recent questions about vulvodynia so it may be time to review this difficult and uncertain subject. Vulvodynia refers not to a specific disease, but rather to a symptom - vulvar pain. In this case the pain is chronic and either recurrent or almost constant. The following article is as concise as I have seen this problem discussed. It notes that there are 4 main subcategories of vulvodynia: vulvar dermatoses cyclic vulvovaginitis vulvar vestibulitis syndrome dysesthetic vulvodynia Again, these four subcategories are not diseases themselves but rather clusters of different diseases or descriptive syndromes whose etiology is unknown. Vulvar dermatoses often require a biopsy for diagnosis. Sometimes a dermatologist is the person to see for this rather than a gynecologist especially if the vulva seems to have a chronic redness. Cyclic vulvovaginitis is frequently due to a recurrent yeast infection but it can also be bacterial in origin. In this instance, secretions from the vagina are the skin irritants and if use of a tampon eases the burning, it is very likely that cyclic vulvovaginitis is the major factor. The remaining two subcategories, vulvar vestibulitis and dysesthetic vulvodynia are totally unknown as to their etiology. Vulvar vestibulitis shows inflammation of the vestibular gland on biopsy but what causes the inflammation is unknown. HPV virus was postulated as a possible cause but current concepts are that HPV is not the cause. Dysethetic vulvodynia tends to be found in postmenopausal women and is postulated to be an inflammation of the nerves similar to a herpetic vulvitis. There are no histological changes on biopsy so it is really just the existence of vulvar pain in the absence of inflammation on biopsy. Vulvodynia diagnosis and treatment ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3. Reader submitted Q&A - Bladder falling down ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "What is the best way to treat a dropped bladder beside surgery? If surgery is the only option, which one for this problem has the best success rate?" "I am a 51 yr. old, white female, 5' 3-1/2", weighting 190 lbs. I had a complete hysterectomy in 1998 due to fibroid tumors and a uterine prolapse. At that time something was done to my bladder for it was pulled down by my uterus. " "I have urine leakage really bad, when I exercise. I have to wear a pad during the day in case of leakage, if I don't my panties get wet and I have to change them three to four times during the day. I AM MISERABLE! HELP!" - I.M. A dropped bladder can represent several different conditions such as a cystocele, descent of the bladder neck (urethrocele) or vaginal vault prolapse. You may have any one, two or three of the above conditions so without an exam it is difficult to give a precise answer to your question. In general the non-surgical treatments are muscle strengthening exercises such as Kegel's, use of vaginal weighted cones, pelvic floor muscle stimulation (microelectrical or magnetic), and artificial support devices such as a pessary. After age 50 and especially if you have had previous bladder support surgery at the time of your hysterectomy, the non surgical treatments are less likely to be successful in the long term. While the exercises may not be curative, they are always beneficial even if you end up having surgery so I would encourage those. Since you have symptoms of stress urinary incontinence, it is very likely that you have a dropping of the bladder neck. There are several procedures that are very effective to repair this and it depends upon the skill of your doctor with what procedure works best for him or her. The vaginal procedures would include transvaginal tape, a sling with bone anchors, a fascial sling procedure and abdominal procedures would include a bladder suspension such as a Burch or MMK procedure. These can be done open incision or some physicians can do these laparoscopically. If the bladder is also falling down and causing pressure and difficulty starting to void and to completely empty the urine, surgical repair can be performed vaginally or abdominally with a paravaginal repair. The biggest risk with this surgery for future failure is if the physician does not recognize whether or not the end of the vagina is also prolapsing again like the uterus did. If it is moving more than an inch with intraabdominal straining (vaginal vault prolapse), then it needs to be fixed as well along with the other support defects. If it is not, you will have recurrence of relaxation problems within a few years. This vault support is done the easiest by an abdominal incision although some surgeons are skilled in a vaginal vault suspension that does not significantly shorten the vagina. I think your best course is to have the physician who did the original surgery refer you to someone whom they know is skilled in this type of secondary repair. Members of the Society of Gynecologic Surgeons (http://www.sgsonline.org) specialize in these problems. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 4. Stomach cancer risk factors ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Stomach cancer is not as common in the U.S. as some other countries. In fact its incidence has been declining since the 1930's. The reason for the decrease compared to the incidence in Asia, South and Central America and Central Europe is postulated to be due to increased use of refrigeration for food storage and decreased use of salted and smoked foods. Helicobacter pylori infection is a major risk factor as is smoking and alcohol use. A diet high in smoked or salted products also raises the risk. Stomach cancer is often a disease of the 60's and 70's but since there are different types, it can occur at any age. Depending upon where in the stomach the cancer occurs, symptoms may vary: lack of appetite unintended weight loss abdominal pain vague discomfort in the abdomen above the navel abdominal fullness after eating only a small meal heartburn, indigestion, or ulcer-type symptoms nausea and or vomiting, with or without blood swelling of the abdomen due to fluid (ascites) As you can see these symptoms are not unique for stomach cancer. Many of these can occur with viruses, ulcers, gastric reflux and even stress and depression. Anyone over 50 with these symptoms should see a physician for possible evaluation with xrays or endoscopy. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5. Medical contraindications to air travel ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Doctors are often asked if it is safe to travel by air with a certain medical condition. Air pressure and oxygen levels are lower in an airplane so it makes sense that certain conditions that lower oxygen levels in tissues may put one at more risk with flying. The International Transport Association (IATA) has come up with a list of conditions that would be either absolute or relative contraindications to flying. After an uncomplicated heart attack (myocardial infarction), passengers should not fly for at least 7 days. Angina, if stable with infrequent attacks, is not usually a problem. 10 days after uncomplicated surgery for coronary artery bypass grafting should be safe. After a coronary angioplasty one should wait 3-5 days before travelling Individuals with asthma and chronic lung disease (including chronic obstructive pulmonary disease and pulmonary fibrosis) are usually able to travel safely if the condition is stable without recent deterioration. A rule-of thumb to use is if a passenger can walk 50 yards (meters) or walk up one flight of stairs without getting moderately short of breath then it is generally safe to fly. Travelling with other conditions such as anemia (hemoglobin less than 7.5 grams), recent stroke and diabetes are also covered by this article at PersonalMD.com Medical contraindications to air travel ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6. Health tip to share - Boric acid for yeast ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Occasionally we see references to the use of boric acid for chronic recurrent yeast infections. Several scientific papers have demonstrated their efficacy. Unfortunately commercial products with boric acid for vaginal use are almost impossible to find. If you are absolutely sure your problem is recurrent yeast vaginitis you can ask your doctor to prescribe them or go directly to a compounding pharmacist to make them up. Gelatin capsules are used and the dose is 300 mg once a day intravaginally for 14 days and then use on days 1- 5 of the menses for the 5 months following the first treatment as per a recent article, (Am J Obstet Gynecol 2001 Mar;184(4):598-602.) (Note - this is somewhat a lower dose than was recommended in the past for boric acid). FRJ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 7. Humor is healthy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ LIFE'S A TEST - AND YOU'RE GRADED ON A CURVE At age 4, success is...not peeing in your pants. At age 12, success is...having friends. At age 16, success is...having a driver's license. At age 20, success is...having sex. At age 35, success is...having money. At age 50, success is...having money. At age 60, success is...having sex. At age 70, success is...having a driver's license. At age 75, success is...having friends. At age 80, success is...not peeing in your pants. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ That's it for this time. Your BACKUPMD on the Net. Rick Frederick R. Jelovsek MD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
****** Woman's Diagnostic Cyber Newsletter ******* April 29, 2001 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ This week from Woman's Diagnostic Cyber ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. About Sjogren's syndrome 2. Cancer news service for Rx breakthroughs 3. Reader submitted Q&A - Rate of food digestion 4. HRT and ovarian cancer risk 5. Carpal Tunnel Syndrome 6. Health tip to share - Yogurt for preventing yeast 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. About Sjogren's syndrome ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Sjogren's syndrome is an autoimmune condition that affects several million women each year. While it can occur at any age, it typically presents in women in their late 40's. The major symptoms are dry eyes and dry mouth but other associated symptoms can make a woman think she is just menopausal. The disease can affect many internal organs such as the liver or kidneys and it may produce a profound fatigue and joint pains. It is basically the dry eyes and mouth that differentiate it in early phases from chronic fatigue syndrome or fibromyalgia although sometimes medicines can cause those symptoms also. Symptoms may go on for two years or more before diagnosis or there may be mistaken diagnoses of lupus, multiple sclerosis, or even rheumatoid arthritis before the correct diagnosis is made. Once you or the physician starts thinking about possible Sjogren's syndrome there are several tests available, which can help, make the diagnosis. The basic challenge is to think of Sjogren's in the first place. If you want to learn more about Sjogren's syndrome, visit Sjogren's Syndrome foundation at sjogrens.org ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2. Cancer news service for Rx breakthroughs ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If you or a friend are diagnosed with cancer it totally changes and consumes your daily life. Part of that consumption is the fight to beat the cancerous cells in your body - to get totally cured. Some early stage cancers have well established treatments that you do not want to deviate from. However the more advanced stages of cancer or recurrence of cancer are a different matter. With any poorly treated or not frequently cured condition, there is a continual search on the part of medical science for a better treatment. With highly funded problems such as cancer there are new reports about possible curative therapy almost every day from somewhere in the world. Robertsreview.com scans about 2500 news sources each day looking for cancer news. They categorize the news for over 30 different cancers. That way if you want to follow the latest news about a given type of cancer treatment, you can bookmark that cancer page.