Women's Health Newsletters 7/29/01 - 9/2/01
****** 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 smell. 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, zinc 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 dysfunction. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 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 out. 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 forget. 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 UTI. 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 damage. 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 ug/dl. 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 iron 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 them. 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 perfect. 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 well? 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. Rick Frederick R. Jelovsek MD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
****** 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 hyperlink and you may need to cut and paste. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 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 women." 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 symptom. 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 joints. 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 level 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 options. 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 kidneys. 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 them. 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 results. 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 parents. 4. Even if you tell jokes as well as Jay Leno, neither your cat nor your teen will ever crack a smile. 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 breathing. 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 furniture. 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. Rick Frederick R. Jelovsek MD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
****** 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 delivery. 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 earache 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." - anonymous 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 secretions. 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 least. 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 touched. 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." - anonymous If you have discovered ways of coping with a disease or condition and it works for you, please share it with us: Health tip suggestion form ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 7. Humor is healthy ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "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 asked. 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. Rick Frederick R. Jelovsek MD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
****** 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 children. 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 negative? 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 unproven. 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 difficulties. 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 studies. 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 yards. An experienced nurse can't hear any alarms at any distance. 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 bath. 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 interesting. An experienced nurse thinks psych patients are crazy. A Graduate Nurse carries reference books in their bag. 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. Rick Frederick R. Jelovsek MD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
****** 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.