Womens Health

Women's Health Newsletters 3/25/01 - 4/29/01



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****** 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 

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 

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 

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 

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 

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 

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 

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.
Frederick R. Jelovsek MD 

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****** 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 
  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 

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,  
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 

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 

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 
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 

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

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****** Woman's Diagnostic Cyber Newsletter *******
                April 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 

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 

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 

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.
Frederick R. Jelovsek MD 

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****** 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 

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 

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 

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 
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
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.
Frederick R. Jelovsek MD 

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****** 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 

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 

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 

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 

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 

"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.  

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 

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 

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 

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 

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


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.
Frederick R. Jelovsek MD 

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****** 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 

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 

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.
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