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Women's Health Newsletters 7/29/01 - 9/2/01



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****** Woman's Diagnostic Cyber Newsletter *******
                July 29, 2001
This week from Woman's Diagnostic Cyber

1. Smell and taste disorders
2. Uterine embolization for adenomyosis
3. Reader submitted Q&A - Bloody nipple discharge
4. Urinary tract infections
5. Iron deficiency anemia
6. Health tip to share - Stopping smoking
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.  Smell and taste disorders
The ability to taste is closely linked with smell. 
When either is impaired, appetite goes down and 
the immune system can be depressed. Smell is 
10,000 times more sensitive than taste and it is 
required for distinguishing all flavors. Taste can 
only distinguish bitter, sweet, sour and salty. 
All other "tastes" are really smells that are 
detected in the skin cells lining the nasal and 
posterior mouth cavity (nasopharynx). 

In younger people, head trauma is a common cause 
of loss of taste. It may disturb the nerves that 
interpret smells or cause a chronic loss of 
nervous system fluid that covers up the skin 
lining cells that sense smell. In older adults, 
viral infections of the upper respiratory tract 
can disturb smell and thus taste. Natural aging 
also results in a gradual loss of our sense of 
smell at the rate of about 1% a year. Any 
degenerative brain disease such as Alzheimer's or 
Parkinson disease also can interrupt taste and 

Other causes of loss of smell include:

medications - Amitriptyline (Elavil(R)),  alcohol, 
nicotine, organic solvents, cocaine and direct 
application of zinc sulfate 

sinusitis, allergies
gum disease or oral cavity inflammation 

radiation therapy to the head and neck

nutritional deficiencies eg, vitamin A, thiamine, 

masses that block the cell smell receptors or 
transmission such as nasal polyps or a brain tumor 
or sarcoidosis 

endocrine disturbances such as hypothyroidism, 
hypoadrenalism, diabetes mellitus 

intravenous or inhaled drugs (eg, aminoglycosides, 
formaldehyde) can contribute to olfactory 

2. Uterine embolization for adenomyosis
Uterine artery embolization is being used to treat 
uterine fibroids that cause irregular bleeding and 
sometimes pelvic pain. Another condition called 
adenomyosis often coexists with fibroids and some 
investigators believe that most of the time when 
pain is associated attributed to fibroids, it 
really is  the coexistent adenomyosis that causes 
the pain. This study looks at women with heavy 
bleeding (menorrhagia) and pain who had 
embolization performed but in whom only 
adenomyosis was found without fibroids. 

Those patients with only adenomyosis had improved 
bleeding and pain. This retrospective, very small 
study suggests, therefore, that uterine artery 
embolization may be a possible treatment for 
adenomyosis. Most women with adenomyosis have 
developed the return of uterine cramps with their 
menses after having years of no or minimal cramps. 
This may be a promising treatment in the future 
for those women. 

Keep in mind this is just a preliminary report. 

Uterine embolization for adenomyosis

3. Reader submitted Q&A - Bloody nipple discharge
"For about the last 2 months I have been having a 
severe burning, some swelling and a rust colored 
discharge from one nipple. That breast is also 
very tender.  My GYN ordered a mammogram which was 
ok, then he ordered a ductogram, which the 
radiologist says can't be performed since " my 
nipples are too small".  My GYN has now 
recommended that I see a surgeon.  No one has said 
yet what this could be.  How is it treated?  Also, 
the radiologist made me feel as if I was a 
freak, because he complained so forcefully that my 
nipples were too small.  Is there such a thing as 
too little? What is the appropriate treatment for 
this breast and nipple problem?" - Terry 

Rust colored nipple discharge implies blood in the 
secretions from the gland and ducts of the breast. 
Bloody discharge is worrisome for basically two 
conditions: intraductal papilloma (about 90% of 
bloody nipple discharge) and intraductal or other 
types of breast cancer (about 10% of bloody nipple 
discharge). Rarely it can indicate other benign or 
inflammatory conditions but intraductal papilloma 
and cancer are the main two to rule in or rule 

Almost always, a rust colored or bloody nipple 
discharge come from only one of the breast ducts. 
A ductogram is an xray procedure in which a very 
small, blunt-ended plastic tube is placed in the 
nipple duct that is producing the discharge in 
order to inject dye and see if there is a 
papilloma in the duct. 

I have not heard that size of nipples affects the 
ability to perform a ductogram and certainly your 
recent radiologist was a clod about making such an 
issue about it even if it was the case. It is 
possible that there are other radiologists in the 
area that have more experience with this and can 
perform the procedure for you. Ask the breast 
surgeon if there is some other radiologist he or 
she has worked with that could be recommended. 

The usual contraindications to ductogram are:

history of dye allergies
previous surgery disconnecting the ducts from the 
  openings on the nipple 
severe retraction of the nipple

In either case, whether an intraductal papilloma 
is seen or not, you will likely have surgery to 
remove the duct that is bleeding to be examined 
for possible malignancy or premalignancy (in situ 
carcinoma) or to remove the papilloma. You will 
need to see the breast surgeon about this and be 
sure to ask any questions you have. Write them 
down beforehand if you need to so you will not 

Imaging the breast ducts

4. Urinary tract infections
Most urinary tract infections (UTIs) are due to a 
bowel bacteria called E. coli. This bacteria comes 
from the rectum or stool and gets in the opening 
of the urethra which leads to the bladder. Other 
bacteria as well as sexually transmitted diseases 
such as chlamydia or gonorrhea may also cause a 

If the infection sets up in the urethra, frequency 
and burning upon urination results. If the 
infection goes higher into the bladder, frequent 
urination and even blood in the urine occur. If an 
infection then gets higher into the ureter or 
kidney, sharp back pain in the loin on the right 
and/or left side of the spine is produced.This is 
very serious and can cause permanent kidney 

Those at risk for UTIs include people with any 
obstruction to urine outflow such as that seen 
with kidney or renal stones, those who have birth 
defects of the urinary tract, those who have to 
wear a catheter for a prolonged time and 
individuals with diabetes. Woman are more prone to 
UTIs because the urethra opens close to the vagina 
and with sex, vaginal bacteria may get into the 
the opening which leads to the bladder. 

While UTIs may spontaneously clear with just 
drinking an increased amount of fluids to produce 
frequent urination and wash the bacteria out, it 
is best to treat them with antibiotics. Many 
different, inexpensive antibiotics are effective 
such as those containing sulfa, amoxicillin or 
ampicillin. doxycycline or nitrofurantoin. 
Recurrent infections may develop resistance to 
some of the antibiotics so testing of urine from a 
recurrent infection to see which antibiotics are 
effective may be necessary. 

Urinary tract infections

5. Iron deficiency anemia
Low levels of iron in the body's stores and 
circulation produces a low blood count because 
iron is the central molecule needed to build 
hemoglobin in our blood cells. Hemoglobin is 
essential to carry oxygen in our blood. With 
anemia, if it is severe, we literally suffocate 
slowly because of lack of oxygen. 

Anemia is measured by a low hemoglobin or 
hematocrit. For non pregnant women, the hematocrit 
should be above 35% and the hemoglobin 12 gm/dl or 
above. Levels below this would be considered 
anemia; 10-11.9 gm/dl would be a mild anemia with 
lower levels being much more serious. There are 
other causes of anemia other than iron deficiency 
so to diagnose the cause as low iron, red blood 
cell indices on a CBC blood count need to show a 
mean corpuscular volume (MCV) of less than 82 and 
a serum ferritin level should be less than 12 

The body can be low on iron because of: 

chronic blood loss such as heavy menstruation or 
bleeding from the bowel tract, 

lack of enough dietary iron intake 

an inability to absorb dietary or supplemental 

Bowel bleeding can be detected by a stool guiac 
test but poor iron absorption is very difficult to 
diagnose. Bowel diseases such as Crohn's disease 
or malabsorption or even chronic antacid use may 
interfere with iron absorption. Vegetarians are a 
risk because much iron comes from red meat. 

You may not know you have anemia because your 
body's cardiovascular system compensates until the 
anemia is severe. Symptoms may include: fatigue, 
shortness of breath, headache, lightheadedness, 
palpitations, or loss of appetite. With any of 
these problems, be sure your physician checks a 
blood count looking for anemia. 

6. Health tip to share - Stopping smoking
"My husband and I have not had a cigarette since 
Thanksgiving 1999.  Both of us had smoked for over 
twenty years.  We used herbal cigarettes to help 
us through the tough times.  Last February my 
cousin died and I wanted a cigarette,  I had an 
herbal instead. I believe that is why we have not 
started smoking again.  There is a pack of them in 
the garage and they have been there for over a 
year. I have had maybe two all year. Maybe this 
can help someone.  We are so glad to be smoke 
free!" - Cynthia 

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

Health tip suggestion form

7. Humor is healthy
Words of Wisdom 

Sex is hereditary.  If your parents never had it, 
chances are you won't either. 

When I was born, I was so surprised I couldn't 
talk for a year and a half. 

I live in my own little world, but it's ok, they 
know me here. 

I don't have a big ego, I'm way too cool for that. 

Every time I walk into a singles bar I can hear 
Mom's wise words: "Don't pick that up, you don't 
know where it's been." 

Nobody is perfect until you fall in love with 

Marriage changes passion...suddenly you're in bed 
with a relative. 

I have learned there is little difference in 
husbands, you might as well keep the first. 

I love being married.  It's so great to find that 
one special person you want to annoy for the rest 
of your life. 

I married my wife for her looks...but not the ones 
she's been giving me lately! 

Money can't buy happiness, but it sure makes 
misery easier to live with. 

Regular naps prevent old age.....especially if you 
take them while driving. 

I think your problem is low self-esteem.  It is 
very common among losers." 

Travel is very educational.  I can now say 
"Kaopectate" in seven different languages. 

Shopping tip: You can get shoes for 85 cents at 
bowling alleys. 

I am a nobody, nobody is perfect, therefore I am 

I gave my son a hint.  On his room door I put a 
sign: CHECKOUT TIME IS 18." 

Midlife is when you go to the doctor and you 
realize you are now so old, you have to pay 
someone to look at you naked. 

Middle age is when you choose your cereal for the 
fiber, not the toy. 

"Everyday I beat my own previous record for number 
of consecutive days I've stayed alive." 

"I don't do drugs anymore 'cause I find I get the 
same effect just by standing up really fast." 

"If carrots are so good for the eyes, how come I 
see so many dead rabbits on the highway?" 

Ever notice that people who spend money on beer, 
cigarettes, and lottery tickets are always 
complaining about being broke and not feeling 

The next time you feel like complaining, remember: 
Your garbage disposal probably eats better than 
thirty percent of the people in this world. 

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

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****** Woman's Diagnostic Cyber Newsletter *******
                August 5, 2001
This week from Woman's Diagnostic Cyber

1. Walking and cognitive function in the elderly
2. Psoriasis presents in different ways
3. Reader submitted Q&A - DepoProvera bleeding
4. ITP - Immune (Idiopathic) Thrombocytopenic Purpura
5. Handsome hands and nails
6. Health tip to share - Herbal cigarettes
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
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1. Walking and cognitive function in the elderly
Physical activity helps maintain mental alertness 
especially in the elderly, or so several studies 
suggest. What has not been clear is whether the 
physical activity prevents mental deterioration 
and dementia or if mental deterioration and 
dementia cause less physical activity. 

This article in the Archives of Internal Medicine 
looks at a large sample of almost 6000 women over 
65 still living in their community (as opposed to 
nursing homes). Their activity and mental status 
were measured at the beginning of the study and 6-
8 years later. None of the women were felt to have 
cognitive impairment at the start of the study. 
After 6-8 years, women who started out at higher 
physical activity levels had less mental 
impairment then the women who started with lower 
activity levels. 

The authors concluded that the findings support 
"the hypothesis that physical activity prevents 
cognitive decline in older community-dwelling 

Walking and cognitive function in the elderly

2. Psoriasis presents in different ways
Psoriasis is a chronic skin condition 
characterized by thick red skin plaques that are 
dry and scaly and often itch. The lesions can 
present at the elbows, knees, scalp, lower back, 
face, palms, and soles of the feet. However, it 
can affect any skin site. One type of psoriasis 
(inverse) occurs in the folds of the skin near the 
genitals, under the breasts, or in the armpits. 
Loose and very dry fingernails can also be a 

Psoriasis occurs equally in men and women and can 
affect any ages of adults. About one third of the 
time it is inherited. In 15% of the cases 
arthritis symptoms are present in the larger 

The most common form of psoriasis is called plaque 
psoriasis but there are several other different 
forms that also occur: 

Guttate psoriasis--Small, drop-like red lesions
Pustular psoriasis--Blisters of noninfectious pus 
Inverse psoriasis--Large, red plaques occur in 
  skin folds 
Erythrodermic psoriasis--Widespread reddening and 
  scaling of the skin 

Psoriasis treatment depends upon the severity of 
the lesions. It starts out with topical creams and 
then ultraviolet light treatments are used. 
Finally, systemic medicines including steroids may 
be needed. 

For more information about psoriasis, check out 
the National Institute of Arthritis and 
Musculoskeletal and Skin Diseases at the National 
Institutes of Health pages on psoriasis.

Psoriasis FAQs

3. Reader submitted Q&A - DepoProvera bleeding
"I've been on the DepoProvera for more than 5 
years now, and have had constant problems with 
bleeding. I constantly have spotting and it is 
really interfering in my life. I'm thinking of 
going off the injection, but I don't know if it is 
wise, I'm scared of picking up weight, and of 
having more problems, but I can't carry on with 
all the spotting, because it causes infections. 
One day there will be nothing and then the next 
day I will bleed, it has been going on like this 
for more than 3 years now!! please give me 
advice!" - C 

Prolonged spotting on either DepoProvera or oral 
contraceptive pills is almost always due to what 
is called atrophic bleeding. In other words, the 
lining of the uterus is very thin and bleeds 
easily because there is not enough tissue 
protecting the cavity from any little rubbing or 
irritation of the front wall of the uterus against 
the back wall. The progestin effect of DepoProvera 
or of birth control pills and the absence or low 
dose of estrogen to promote tissue thickening, 
both contribute to this easy bleedability. 

The treatment, therefore is to slightly increase 
the estrogen dose which allows the lining to 
become more thickened and resistant to abrasion. 
This can be done in several ways: 

estradiol 1 mg a day by mouth
estradiol skin patch 0.1 mg/day

or if on birth control pills,
switch to a pill with a slightly higher estrogen 

Another alternative is to use a recently 
introduced birth control shot called Lunelle (R). 
It has both estrogen and progestin. It is a 
monthly shot rather than every 3 months like 
DepoProvera(R), but you may only need to take it 
for about 3 months to straighten out the bleeding. 

Finally, I would not be concerned about weight 
gain if you switch to the birth control pills. 
DepoProvera(R) is many times worse at causing 
weight gain than are the pills. If that has not 
been a problem on Depo then it should not be a 
problem with the pills. 

Be sure to talk to your doctor about these 

Continuous Bleeding on Birth Control

4. ITP - Immune (Idiopathic) Thrombocytopenic Purpura
ITP is an autoimmune condition that results in 
blood platelets being consumed by the body's 
normal defense clearing mechanisms. It results in 
a low blood level of platelets, a cell in blood 
responsible for stopping bleeding if a blood 
vessel injury occurs. When platelets are low, 
there can be spontaneous bleeding resulting in 
easy bruisability and tiny star-like or pinpoint 
hemorrhages on the skin of the legs or inside the 
mouth. There may be bleeding from the gums, the 
gastrointestinal tract or even hematuria from the 

Women are three times more likely to get ITP than 
men. It can affect all ages including children. No 
one knows the exact cause but in many cases 
antibodies are made toward one's own platelets 
just as if they were foreign bacteria needing to 
be cleared from the body. 

ITP is initially suspected if a platelet count is 
less than 100,000 per cu/ml. As long as the count 
does not get lower than 30,000 per cu/ml there 
usually is not much risk of a spontaneous stroke 
or internal hemorrhage. Once ITP is suspected, 
other causes of low platelets need to be ruled 
out. Tests for Lupus should be performed as well 
as a bone marrow aspiration to rule out different 
types of leukemia or lymphoma. HIV, hepatitis or 
cytomegalovirus infection should also be ruled 
out. Medications can also cause low platelets and 
they may need to be stopped for 2-3 weeks to make 
sure they are not the cause. 

Treatment often includes steroids to suppress the 
body's overactive immune system. Sometimes the 
spleen has to be removed because it is the organ 
that senses antibodies attached to cells and it 
destroys any antibody cell complex. If the 
platelet count gets below 30,000, platelet 
transfusion may be needed. Different physicians 
may have different preferences for treating ITP so 
be sure to thoroughly discuss the options with an 
experienced physician, usually a hematologist. 

ITP - Immune (Idiopathic) Thrombocytopenic Purpura

5. Handsome hands and nails 
Our hands and fingernails really take abuse. They 
are frequently exposed to hot, cold, cleaning 
solutions, prolonged immersion in water, drying 
out and scrubbing. If you want your hands to not 
look all dry and shrivelled, you need to protect 

Wear protective gloves when cleaning in the house 
  or outside. 
Wear warm gloves in the winter. 
Use sunscreen on your hands when outside. 
Use a moisturizer cream after washing and drying 
  the hands. 
Massage your hands and fingers using a massage 
 cream when you have a moment to relax. 

The fingertips and nails also need special digital 
care. Sesame oil can be used to hydrate and soften 
the cuticle. If the skin or nails are excessively 
dry, put a coat of petroleum jelly (Vaseline (R)) 
on the hands and cover them overnight with cotton 
gloves or during the day while working with rubber 
gloves. To improve your nails and hair, take 25g 
(about 2 tbs) of unflavored gelatin daily in water 
or juice. It will take about a month to see the 

For more digital hand and nail tips and 
instructions on a good home manicure, see this 
article at surgerydoor.co.uk. 

Handsome hands and nails

6. Health tip to share - Herbal cigarettes
In our last tip, the writer mentioned about using 
herbal cigarettes as an aid to quitting smoking. 
There were several inquiries about where such 
cigarettes were obtainable. You can not by them on 
the Internet because tobacco sales are banned. One 
of the wholesale distributors offered the 
following suggestions: 

Check your yellow pages for a tobacco shop near 
you and call them to see if they have any herbal 
cigarettes or can get them. Other sources are some 
of the large discount stores such as Costco and 
Price Club. 

You will hear some vehement warnings that herbal 
cigarettes are just as dangerous as tobacco 
cigarettes and that is true. Anything that is 
burned will produce tars and byproducts that can 
be cancer producing in the long run. The herbal 
cigarettes, however, do not contain nicotine which 
is one of the strongly addicting substances that 
keep one smoking. Therefore an herbal cigarette is 
a good aid to those who are quitting or have quit 
tobacco cigarettes and who may have a lapse and 
want a smoke. The non nicotine (herbal) cigarette 
should be less likely to cause a relapse to 
resuming tobacco cigarettes. While there are 
several "addictive" aspects to cigarette smoking, 
I believe that people who condemn herbal 
cigarettes miss the point of the powerful role 
that nicotine plays in continuing the habit and 
how people trying to quit should be able to use 
any devices that help them succeed. FRJ                 

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

Health tip suggestion form

7. Humor is healthy
"Of Teenagers And Cats"

For all of you with teenagers or who have had 
teenagers, you may want to know why they really 
have a lot in common with cats: 
1. Neither teenagers nor cats turn their heads 
when you call them by name. 
2. No matter what you do for them, it is not 
enough.  Indeed, all humane efforts are barely 
adequate to compensate for the privilege of 
waiting on them hand and foot. 
3. You rarely see a cat walking outside of the 
house with an adult human being, and it can be 
safely said that no teenager in his or her right 
mind wants to be seen in public with his or her 
4. Even if you tell jokes as well as Jay Leno, 
neither your cat nor your teen will ever crack a 
5. No cat or teenager shares your taste in music. 
6. Cats and teenagers can lie on the living-room 
sofa for hours on end without moving, barely 
7. Cats have nine lives. Teenagers carry on as if 
they did. 
8. Cats and teenagers yawn in exactly the same 
manner, communicating that ultimate human ecstasy 
-- a sense of complete and utter boredom. 
9. Cats and teenagers do not improve anyone's 
10. Cats that are free to roam outside sometimes 
have been known to return in the middle of the 
night to deposit a dead animal in your bedroom. 
Teenagers are not above that sort of behavior. 
Thus, if you must raise teenagers, the best 
sources of advice are not other parents, but 
veterinarians. It is also a good idea to keep a 
guidebook on cats at hand at all times. And 
remember, above all else, put out the food and do 
not make any sudden moves in their direction. When 
they make up their minds, they will finally come 
to you for some affection and comfort, and it will 
be a triumphant moment for all concerned. 
That's it for this time. 
Your BACKUPMD on the Net.
Frederick R. Jelovsek MD 

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****** Woman's Diagnostic Cyber Newsletter *******
                August 12, 2001
This week from Woman's Diagnostic Cyber
1. Depression during pregnancy
2. Grinding your teeth
3. Reader submitted Q&A -Perianal boil-like cysts
4. Abdominal wall pain
5. Ulcerative colitis
6. Health tip to share - Cranberry Juice reduces UTIs
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. Depression during pregnancy
Most are familiar with the significant problem 
that postpartum depression can cause. Sometimes 
there can even be a psychosis resulting in harm to 
the child or children. There has been significant 
media attention to postpartum depression recently 
to the detriment of discussing how much of a 
problem depression DURING pregnancy can be. 

A recently reported study in the British Medical 
Journal looked at the incidence of depression all 
during pregnancy as well as in the postpartum 
period. They administered standardized depression 
tests to over 13,000 women at 18 weeks pregnancy, 
32 weeks pregnancy, 8 weeks postpartum and 8 
months postpartum. At each point in time they 
calculated what percent of women measured as being 
depressed by the test that was given. 

They found the incidence of depression to be:

18 weeks preg        13.9%
32 weeks preg        15.2%
 8 weeks postpartum  10.2%
 8 months postpartum  8.8%

They concluded that depression really starts 
during pregnancy and we should be more aware of 
it. It actually seemed to increase somewhat during 
pregnancy and the incidences postpartum were not 
higher as expected. It turns out that depression 
during pregnancy is more common than postnatal 
depression, at least as measured at 8 weeks after 

The peak incidence of postpartum blues is actually 
at 5 days postpartum so this study might be 
criticized for its timing of when the test was 
given. It does bring attention, however, to 
depression occurring during pregnancy in 
significant numbers. We should turn our attention 
toward picking that up early and trying to 
intervene to prevent it worsening after delivery. 

Depression during pregnancy

2. Grinding your teeth - bruxism
Some people grind their teeth at night. This is 
called bruxism and the grinding noise can be quite 
loud. While a habit like this sounds benign, it 
can result in the tips of the teeth being worn 
down, flattened and even cracked. Sometimes the 
enamel is worn off the teeth and the inside of the 
tooth becomes exposed. 

A dentist can pick up these changes with an exam 
and fit you with a mouthpiece that may protect the 
teeth. However the teeth are not the only victims 
of bruxism. The tensing of the jaw muscles and 
chewing motion while you sleep may produce: 

chronic facial pain
a dull morning headache
chewed tissue on the inside of the mouth
tempomandibular joint (TMJ) disorder

While the cause of bruxism can be an abnormal 
alignment of the upper and lower teeth 
(malocclusion), the more common causes are 
anxiety, stress, anger or frustration. Bruxism is 
more than a grinding of the teeth problem; it 
frequently represents a mental stress or strain 
that needs to be identified and addressed. Tobacco 
and alcohol can make bruxism worse. 
3. Reader submitted Q&A - Perianal boil-like cysts
"I am a 24 year old African American woman. At the 
age of puberty I developed a constant perianal 
odor that would not go away. I have also 
experienced boil-like cysts in my perianal area as 
well as in my armpits, and the back of my thighs. 
This too, is a common nuisance that the women in 
my family experience. I have seen many doctors and 
specialists but as of yet I have found no 
diagnosis of my condition. Upon sharing this 
information with close family members,I found that 
several other women in my family have experienced 
this condition. My Dermatologist told me that this 
is a medical condition and that there is really no 
known cause or cure. I did however inadvertently 
find something that helps. I began taking a 
medication called Bupropion (Wellbutrin & Zyban) 
for a quit smoking aid and an anti-depressant. I 
found that several weeks later, the abnormal odor 
had diminished almost entirely. When I shared this 
with my Dermatologist she told me that certain 
anti-depressant drugs have been proven to help 
clear up symptoms of chronic skin disease and 
conditions (although they are not cures), however 
she had no explanation of why this occurs." 

"Here is my question. Do you have any idea what 
could cause a condition such as this? I have come 
to believe that whatever it is, it is hereditary. 
Any bacteria infection or STD has already been 
ruled out. It is not a matter of feminine hygiene 
either. Another interesting thing is that when I 
began using ultra sensitive under arm deodorants 
on my external vaginal area, I noticed that the 
strong unpleasant smell would disappear 
completely, but I would still retain a normal 
women scent. I believe this rules out a discharge 
of any sort. If you know of any thing that could 
help explain this I would be grateful." - 

While it is very difficult to diagnose cystic-like 
skin lesions in the perineal and perianal area 
without seeing them, there is a condition that is 
very similar to what you are describing. It is 
called "hidradenitis suppurativa" This is an 
inflammatory condition of the sweat glands and 
hair follicles in the genital area as well as the 
armpit area (axilla). These boil-like lesions can 
be come infected and cause significant pain and 
disfiguration. The odor comes from the sweat gland 
secretions that are mixed with skin bacteria. When 
you use an anti-perspirant (as opposed to just a 
deodorant), that decreases the sweat gland 

I am not sure about the Bupropion effect except it 
is known that smoking seems to aggravate the 
hidradenitis. If you were stopping smoking when 
you used the medicine, it is more likely that the 
smoking cessation was responsible for the 
decreased odor rather than the drug itself. 

There are other conditions of the vulvar, perianal 
and axillary sweat gland cysts other than 
hidradenitis suppurativa, although it is the most 
common to produce symptoms as you describe. Fox-
Fordyce disease is similar and often needs a 
biopsy to distinguish it from hidradenitis. There 
are some sexually transmitted diseases that can 
cause similar symptoms but those would be acquired 
at a time later than puberty so it is doubtful 
that is what is going on. 

Hidradenitis suppurtiva is difficult to treat. 
Acute and chronic antibiotics are used. Retin A 
topical cream and Accutane used to treat acne 
sometimes give a response. Perhaps that is why 
hidradenitis suppurativa is also called "acne 
inversa". Radiation has been used but the most 
successful treatment is surgical excision. The 
main problem with surgery is complications of 
scarring. As you can imagine the wide areas of 
tissue that need to be excised. It is a last 
resort treatment. 

Your dermatologist probably knew the name of your 
condition but did not mention it to you. You may 
want to follow up for some antibiotic treatment at 

Vulvar Sweat Gland Cysts

4. Abdominal wall pain
When someone complains of abdominal or pelvic 
pain, doctors and relatives alike all assume that 
the source of the pain is from some internal 
abdominal organ such as the gall bladder, the 
stomach, the small or large bowel, the appendix, 
the ovaries, the tubes or the uterus. We forget 
that occasionally the source of the pain can be 
from the muscles, nerves and skin of the abdominal 
wall itself. 

Pain that originates inside the abdomen usually 
has a relationship to bodily functions such as 
eating, bowel movements, urination or the 
menstrual cycle. Abdominal wall pain is not so 
related. It is more constant or it may vary only 
with physical movement of the muscles and 
overlying skin. 

One of the hints that pain might be from the 
abdominal wall is when a person tenses the 
abdominal muscles and the pain worsens (positive 
Carnett's sign). Other hints include: 

the pain does not vary by eating, bowel movements, 
urination, or menstrual cycle 

the pain varies significantly upon changing 
positions such as standing to sitting, sitting to 
standing, lying to standing etc. 

there are "trigger points" on the skin that when 
touched even lightly produce a wider spread pain. 

Since many doctors do not always consider the 
abdominal wall as the main cause of chronic pain, 
it may be up to you to figure out if your pain 
comes from outside the abdominal cavity rather 
than inside it. Try tensing of the muscles to see 
if the pain worsens. Use a q-tip or light finger 
touch to see if there are any skin areas that are 
quit painful and the pain broadens in area when 

If so, bring it up with the doctor. Sometimes 
injections of local anesthetic in the abdominal 
wall at the "trigger point" can significantly 
relieve the pain. Even if it is not permanent 
relief, it helps establish the diagnosis. If your 
doctor is not familiar with trigger point 
injections, ask if there is a pain specialist 
(usually an anesthesiologist with special 
training) that you can be referred to. 

Abdominal wall pain

5. Ulcerative colitis
Ulcerative colitis (UC) is exactly what it sounds 
like. It is an inflammatory condition of the 
bowel wall that produces ulcers in the lining of 
the large colon and rectum. Sometimes the small 
bowel can also be affected. The ulcers cause 
bleeding, pain and hyperstimulation of the bowel 
resulting in diarrhea. 

Because of its symptoms of diarrhea, ulcerative 
colitis can be confused with irritable bowel 
syndrome (IBS) which is quite common in women. IBS 
does not have blood in the stool, however, nor 
does it cause fever or weight loss as ulcerative 
colitis often does. UC is different than Crohn's 
disease which causes ulcers in the small intestine 
but it has a similar process causing ulcers in the 
bowel wall. 

Diagnosis of UC is by colonoscopy (looking with a 
flexible telescope up the rectum and large colon) 
or by a barium enema x-ray study (dye placed up the 
rectum and colon). While it is uncomfortable to 
have these studies it is very important to have an 
accurate diagnosis because it raises the risk for 
colon cancer. It is a long term disease with no 
known cure other than surgical removal of the 
affected bowel. 

Most people do not have severe cases requiring 
surgery. They can be treated medically with sulfa-
type antibiotics and occasionally steroids to 
reduce inflammation. Other medicines such as 
immune suppressing agents are also used. About 5% 
of people with UC develop cancer of the colon. 
Anyone with longstanding ulcerative colitis needs 
to have a colonoscopy frequently (every 1-2 years) 
to screen for premalignant or malignant changes. 

For more information about ulcerative colitis, see 
this article at The National Digestive Diseases 
Information Clearinghouse of the National 
Institutes of Health. 

Ulcerative colitis

6. Health tip to share - Cranberry Juice reduces UTIs
"I read several scientific articles that described 
evidence that drinking cranberry juice resulted in 
lower bacteria levels in the bladder and fewer 
urinary tract infections.  I had a nasty allergic 
reaction to one of the medications that I took to 
combat the problem of frequent UTIs, so reading 
this article was timely.  What I find is that 
drinking a large glass daily of the low calorie, 
artificially sweetened version of cranberry juice, 
has indeed helped me in prevention of UTIs. This 
has been a recurrent problem for me for about 30 
years, and I am delighted to find a solution that 
does not involve taking a lot of medication.  I 
think this does not help much after you have a 
UTI, but drinking cranberry juice on a regular 
basis does seem to work for prevention.  There are 
also cranberry juice concentrate pills and liquid 
available from nutrition stores such as GNC." - 

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

Health tip suggestion form

7. Humor is healthy
"Arthritis With Complications?"

The middle-aged man was shuffling along, bent over 
at the waist, as his wife helped him into the 
doctor's waiting room. 

A woman in the office viewed the scene in 
sympathy. "Arthritis with complications?" she 

The wife shook her head, "Noooo....Do-it-
yourself," she explained, "with concrete blocks." 

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

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****** Woman's Diagnostic Cyber Newsletter *******
                August 19, 2001
This week from Woman's Diagnostic Cyber

1. Vitamin deficiencies causing anemia
2. Preventing injuries in exercise and sports
3. Reader submitted Q&A - Endometrial ablation
4. Chlamydia symptoms
5. What is a luteal phase defect?
6. Health tip to share - Vitamin C and gall bladder
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. Vitamin deficiencies causing anemia
The most common form of anemia (low blood count) 
is due to low iron. Iron is an essential component 
of hemoglobin, a molecule that carries oxygen. 
There are some vitamins that are essential to 
building blood cells too. Vitamin B-12 
(cobalamin), Vitamin B-9 (folic acid) and Vitamin 
C are needed. Deficiencies in any one of these 
vitamins can produce an anemia just like an iron 
deficiency one. 

These anemias are caused either by a diet 
deficient in the vitamin, or failure to absorb the 
vitamin from the stomach. When vitamin B-12 cannot 
be absorbed in the stomach, it results in 
pernicious anemia. Folic acid may not be absorbed 
when Crohn's disease or high alcohol intake is 
present. Certain medicines such as anti-seizure 
drugs or anti-tuberculosis increase the need for 
folic acid as do the conditions of pregnancy and 
women on hemodialysis for kidney failure. 

Vitamin deficiencies such as those found with B12 
and folic acid take months or even years to 
develop. In addition to the normal symptoms of any 
anemia such as fatigue, dizziness, shortness of 
breath with mild exertion, and numbing of the 
hands and feet, there are some unique symptoms 
with vitamin B-12 deficiency: 

Yellowing or darkening of the skin 
Sore mouth or tongue 
Yellow-blue colorblindness
Mental confusion or forgetfulness

While vitamin B-12 and folic acid are needed to 
build blood cells, vitamin C is required to help 
absorb iron and folic acid. Vitamin C comes from 
fruits, folic acid from fruits and greens, and 
vitamin B12 from eggs, meats and milk. Thus the 
need for a "well-balanced" diet. 
2. Preventing injuries in exercise and sports
Different age groups have different physical and 
personality characteristics so rules of fitness 
and accident prevention are different for children 
than they are for say adolescents or adults. 

Children are much more flexible with their bodies 
and not as strong muscularly so they are not as 
prone to muscle strains and sprains. They do not 
have to warm up as much as adults do but they also 
cannot stand repetitive overuse of the muscles. 
Children also have shorter attention spans so 
their interest must be kept up or mind wandering 
can lead to inadvertent mishaps. Game-playing 
sports and fitness routines work well with 

Adolescents are less flexible than children, but 
muscularly they are stronger. They are also in the 
period of rapid growth spurts which can cause pain 
that is confused with injuries. The tendinous 
areas of the knee, the heel and the back are often 
susceptible to these growth spurts and pain in 
these areas can be a normal response to exercise. 
Adolescents need stretching exercises before 
workouts and need low level, muscle strengthening 
works outs as well as balancing exercises. They 
should avoid heavy weight training with strong 
resistances. Keep in mind however that the biggest 
problem is the different rates of body maturation 
so it is more important to adjust the fitness 
routine to the teens body development than it is 
to follow one specific course or the other. 

Adults lose flexibility and develop muscle 
weakness. They need more stretching exercises to 
warm up with and more muscle strengthening 
routines. Stiffness due to loss of elasticity 
makes adults more prone to muscle injury. Routines 
need to be more gradual and more frequent. 
Footware equipment is more critical to prevent 
injury as is overall movement technique. Adults 
are susceptible to injuries from moving only part 
of their body rather than all of it when 
participating in an exercise or sport. They should 
even consider exercise or sports "lessons" for 
activities they did not master at younger ages. 

For additional tips on preventing injuries, see 
this article at surgerydoor.co.uk 

Preventing injuries in exercise and sports

3. Reader submitted Q&A - Endometrial ablation
"I'd like some information on endometrial ablation 
as I am scheduled to get one done soon." 

"I have been having very heavy long periods for 
about 3 years now on birth control pills.  I have 
a small fibroid and have had two pelvic 
ultrasounds and also a transvaginal ultrasound.  
My doctor says this is "mechanical" meaning that 
every month the fibroid will keep causing my heavy 
periods until its removed.  Right now I am on 
Aygestin(R) to control the bleeding while I have 
my period until I get the surgery done." 

"Please give me any information and risks you have 
on endometrial ablations and the success rate and 
chances of my periods becoming lighter or 
nonexistent." - DS 

Endometrial ablation is a procedure usually 
performed in out patient surgery during which you 
are put under general anesthesia and a 
hysteroscopy is performed to look inside the 
uterine cavity. If the cavity is normal without 
any impingement by a fibroid or any congenital 
anomaly, then the skin lining the uterine cavity 
is heated (thermal), cauterized (roller ball, 
laser), frozen (cryo), or skinned (resectoscope). 

If there are uterine (endometrial) polyps present, 
those are removed before treatment. Endometrial 
ablation should not be performed by the thermal 
balloon method if the cavity is not smooth. Many 
times there is no further treatment given if the 
bleeding is thought to be due to the polyp and the 
polyp is completely removed. 

If your fibroid is impinging upon the cavity (deep 
intramural) or if one is polypoid hanging out in 
the cavity (submucosal), it may be shaved off. 
Then the ablation is performed or not performed, 
depending upon whether the fibroid(s) is suspected 
of causing the heavy bleeding. In other words, if 
any anatomical cause is found that explains the 
heavy bleeding you are having. and it is removed, 
then you may not have to have the ablation done. 

Thermal balloon ablation is one of the more common 
methods used for destroying the lining of the 
uterus. The procedure takes totally about 15-20 
minutes. You will have some heavy bleeding and 
cramps about 1-3 weeks after the procedure as the 
cauterized tissue sloughs. After that bleeding 
tends to be much less. The more thoroughly the 
tissue is destroyed, the less bleeding you will 
have in the future. 

Rates of complete amenorrhea (no bleeding at all 
again) are only about 15-35% depending upon the 
type of ablation done and how completely the 
tissue is destroyed. Another 35-55% have bleeding 
reduced each month enough so that they are happy 
they had it done. About 30% of women having the 
procedure do not have enough improvement that they 
are happy with it. That group usually goes on to 
have a hysterectomy later. 

You should know by the 3rd or 4th month after the 
procedure how good the results are going to be. 
Long term bleeding patterns after ablation have 
not yet been well categorized. In general it is 
better for the woman in her 40's rather than one 
in the early 30's because heavy bleeding patterns 
tend to recur over the long run and the sooner a 
woman undergoes menopause, the less the likelihood 
of heavy bleeding returning. There are not good 
numbers on this exact frequency. 

The ablation procedure is best reserved for the 
woman whose main problem is heavy bleeding but 
less than 7 days duration and who is not 
intolerant of prolonged (greater than 7 days) 
bleeding but light/spotting in amount. 

Interview on endometrial ablation

4. Chlamydia symptoms
Chlamydia infection is a sexually transmitted 
disease that is often called the silent epidemic. 
Up to 70% of women and 25% of men have absolutely 
no symptoms of infection. In fact we often get 
questions from women who have been married for 
several years and all of a sudden have a positive 
test for chlamydia at a routine new obstetric 
work-up, or just a regular screening culture 
performed during an office gyn visit. They ask if 
this means their husband has been unfaithful to 
them or is it possible they could have had the 
infection all along from sexual relations prior to 
their marriage. 

The truth is, both explanations are possible. This 
is because chlamydia can remain in the cervix for 
so long without producing symptoms that would make 
a woman seek treatment. There are no scientific 
studies I could find that have examined how long 
it can be carried without symptoms but I have seen 
instances that are very likely for 3 years or 
more. I would guess it could be quite a bit longer 
and there is no reason to say it couldn't take 
place for 10 years or more. Most people receive an 
antibiotic occasionally which probably clears the 
chlamydia infection up without knowing it. 

When symptoms do occur, they may be one or more of 
the following: 

bleeding after intercourse or in between periods
burning on urination or frequent urgency 
an unusual yellowish vaginal discharge
a low grade fever
acute pelvic pain building up over 12-24 hours

Men can also be asymptomatic carriers of chlamydia 
but when they have symptoms, they usually present 
like a urinary tract infection with burning on 
urination, frequent urination or a pus-like 
discharge from the end of the penis. 

Do not be afraid to ask the doctor to perform a 
cervical smear for chlamydia at the time of doing 
a pap smear or at anytime you think you may have 
some of the above symptoms. The test is quite 
accurate for chlamydia and doctors do not mind 
doing that test at all. 

Actually doctors tend to not do the test as often 
as they should. Some women become quite offended 
if a doctor suggests a test for an STD like 
chlamydia. and yet study after study shows that 
women with extra bleeding during the month and 
women having urinary tract symptoms and vaginitis 
symptoms will have a fairly high incidence of a 
positive test for chlamydia or gonorrhea. 

Wouldn't it be better to know for sure you were 

Chlamydia symptoms

5. What is a luteal phase defect?
Many women who are trying to conceive become more 
and more involved with self-diagnosing why they do 
not conceive as each cycle goes by without 
becoming pregnant. This is a normal reaction to 
any medical problem, but the desire to become 
pregnant can be so strong that a woman will 
subject herself to any treatment that she hopes 
will improve her chances. 

Luteal phase defect is one such condition whose 
treatment becomes convoluted with the overwhelming 
desire to do something, rather than nothing, even 
if the treatment is not effective. While 
physicians recognize that such a condition as 
luteal phase defect exists, its treatment is 

If a menstrual cycle is less than 28 days or a day 
21-22 luteal phase progesterone is below 10 or 14 
ng/ml or a BBT does not show 12 days or more of 
temp elevation, many women are led to believe that 
they should take progesterone supplements under 
the premise that they have a luteal phase defect. 

This concept can be wrong on two accounts. First 
of all. any one cycle can be abnormal and have a 
short luteal phase or a low progesterone level but 
it is not a regular pattern. A woman needs to have 
at least two menstrual cycles with either biopsies 
that show out of phase endometrium or progesterone 
levels on day 7-8 after proven ovulation of less 
than 10 ng/ml in order to conclude that luteal 
phase defect might play a role in their conception 

Secondly, it is unlikely that any progesterone 
supplementation either by shot or by vaginal 
suppositories improves the ability to get 
pregnant. Only one randomized controlled study has 
looked at this that I could find. It found no 
significant improvement in pregnancy rates. Non 
randomized studies have had the same outcome with 
most showing no benefit and some occasionally 
showing a difference. This kind of evidence would 
suggest that progesterone supplementation for 
luteal defects is probably not beneficial. 

Clomid is another treatment used for luteal 
defects and although it improves luteal 
progesterone levels, the few studies done do not 
show an improved pregnancy rate in the case of 
"luteal phase defects". 

Well if it doesn't hurt, why not use it on the 
chance it might help? Some reasons might be: 

1) Progesterone sometimes delays menses even 
though pregnancy does not occur thus delaying the 
next attempt at conceiving. 

2) We do not know if there are subtle, long term 
effects of taking progesterone in early pregnancy 
because it has not had large scale, long term 

3) There is an unnecessary expense involved and 

4) it produces false hope. 

The intent of this is not to discourage women who 
are trying to conceive and may have evidence of 
luteal phase defects. Women need to understand 
that when no clear evidence for a treatment 
exists, accepting an experimental treatment 
involves risks. Also, shopping around for a 
physician who will give you some treatment rather 
than none also involves risks.

Luteal defect criteria

Effect of treatment on pregnancy rate

6. Health tip to share - Vitamin C and gall bladder
Women who have higher serum vitamin C levels have 
a lower incidence of gallstones. From animal 
studies we know that  vitamin C supplementation 
can prevent cholesterol gall stones. It is very 
likely that a vitamin C supplement can help 
prevent some development of gall stones in women. 

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

Health tip suggestion form

7. Humor is healthy
"Graduate Nurses vs Experienced Nurses"

A Graduate Nurse throws up when the patient does. 
An experienced nurse calls housekeeping when a 
patient throws up. 

A Graduate Nurse wears so many pins on their name
badge you can't read it.
An experienced nurse doesn't wear a name badge for
liability reasons.

A Graduate Nurse charts too much.
An experienced nurse doesn't chart enough.

A Graduate Nurse loves to run to codes.
An experienced nurse makes graduate nurses run
to codes.

A Graduate Nurse wants everyone to know they are
a nurse.
An experienced nurse doesn't want anyone to know
they are a nurse.

A Graduate Nurse keeps detailed notes on a pad.
An experienced nurse writes on the back of their 
hand, paper scraps, napkins, etc. 

A Graduate Nurse will spend all day trying to 
reorient a patient. 
An experienced nurse will chart the patient is
disoriented and restrain them.

A Graduate Nurse can hear a beeping I-med at 50 
An experienced nurse can't hear any alarms at any 

A Graduate Nurse loves to hear abnormal heart and 
breath sounds. 
An experienced nurse doesn't want to know about 
them unless the patient is symptomatic. 

A Graduate Nurse spends 2 hours giving a patient a 
An experienced nurse lets the CNA give the patient 
a bath. 

A Graduate Nurse thinks people respect Nurses.
An experienced nurse knows everybody blames
everything on the nurse.

A Graduate Nurse looks for blood on a bandage 
hoping they will get to change it. 
An experienced nurse knows a little blood never 
hurt anybody. 

A Graduate Nurse looks for a chance "to work with 
the family" 
An experienced nurse avoids the family.

A Graduate Nurse expects meds and supplies to be 
delivered on time. 
An experienced nurse expects them to never be
delivered at all.

A Graduate Nurse will spend days bladder training 
an incontinent patient. 
An experienced nurse will insert a Foley catheter.

A Graduate Nurse always answers their phone.
An experienced nurse checks their caller ID before 
answering the phone. 

A Graduate Nurse thinks psych patients are
An experienced nurse thinks psych patients are

A Graduate Nurse carries reference books in their 
An experienced nurse carries magazines, lunch, and 
some "cough syrup" in their bag. 

A Graduate Nurse doesn't find this funny.
An experienced nurse does.

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

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****** Woman's Diagnostic Cyber Newsletter *******
                August 26, 2001
This week from Woman's Diagnostic Cyber

1. Vioxx, Celebrex and cardiovascular events
2. Yellow and pink, eye growths
3. Reader submitted Q&A - Tubal ligation clips
4. IUCD is not associated with infertility
5. Cryptosporidium parasite in swimming pools
6. Health tip to share - Perineal odor
7. Humor is healthy

Spread the word! Send a copy of this newsletter
to someone you know.

Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.

1. Vioxx, Celebrex and cardiovascular events
Be cautious about Media Medicine! 

The drugs Vioxx(R) (rofecoxib) and Celebrex(R) 
(celecoxib) are relatively new anti-inflammatory 
drugs used for arthritis and other forms of 
chronic inflammatory pain. Their major benefit is 
longer action (once a day dose) and less 
gastrointestinal upset compared to traditional non 
steroidal anti-inflammatories (NSAIDs) such as 
aspirin, ibuprofen (Advil(R)) and naproxen 
(Alleve(R)). However, aspirin is known to reduce 
adverse thrombotic cardiovascular events such as 
heart attacks and the other NSAIDs may also cause 
a reduction. 

This recent Journal of American Medical 
Association study "reanalyzed" studies in the 
literature that tested Vioxx(R) against naproxen 
and Celebrex(R) against ibuprofen. The Vioxx study 
show an increased relative risk for cardiovascular 
events (risk ratio 2.38) but the Celebrex study 
did not. If naproxen happens to be more effective 
than ibuprofen in preventing heart attacks like 
aspirin does, that would explain the total 
difference, i.e., not causing increased heart 
attacks but rather not preventing them as well as 
the naproxen. Neither ibuprofen nor naproxen have 
been tested in randomized studies to see if or how 
much they prevent heart attacks. Just the rate of 
GI upset being lower with naproxen than ibuprofen, 
so that people on ibuprofen skip more doses, could 
make this difference true. 

This JAMA study went on to compare the Vioxx(R) 
and Celebrex(R) cardiovascular events with the 
placebo groups of a different collection of 
aspirin studies. They looked as far as the annual 
rate of myocardial infarctions (0.74% per year 
versus  0.52% in placebos) and concluded that 
these new Cox inhibitor drugs of Vioxx(R) and 
Celebrex(R) raise the risk of heart attacks. 

I would suggest to you that this is an example of 
a dense scientific fog that should not be reported 
by the media until further studies show more 
definite differences. Even if it is a true 
difference, the rate of heart attacks of .74% a 
year versus .52% a year among individuals with 
arthritis is not a clinically meaningful 
difference. In my opinion, if you have to take 
long term anti-inflammatory medicine for arthritis 
or a chronic inflammatory disease, the benefits of 
the once-a-day dose of a medicine with low GI side 
effects outweighs the currently known risks 
including cardiovascular ones. 

Cardiovascular Events and Selective COX-2 Inhibitors 

2. Yellow and pink eye growths
The inside of the upper and lower eyelids as well 
as the white part of the eyeball (sclera) and lens 
have very thin membranes that cover them called 
the conjunctiva.  This membrane is invisible 
unless it becomes inflamed (red eye) or develops 
growths in it. The two most common benign growths 
in this tissue are pinguecula and pterygium (what 
a mouthful). 

Pinguecula in the more common of the growths and 
occurs in adults and increases with age. Commonly 
it will present as small, raised yellow spots on 
the conjunctiva. The spots of tissue can also be 
gray, white or colorless. They are more commonly 
on the nasal side of the lens but can be on either 
side. These spots are caused by a chronic, 
irritant eye  exposure of some sort. It can be due 
to toxic vapors, saltwater spray or even sun 
exposure. Heat, dryness, wind, dust, smoke, and 
other irritants make the spots worse. Treatment is 
to remove the irritant source and keep the 
conjunctiva moist. Sometimes pinguecula may need 
to be removed surgically. 

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