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Women's Health Newsletters 12/16/01 - 2/24/02



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 ****** Woman's Diagnostic Cyber Newsletter *******
              December 16, 2001
Biweekly from Woman's Diagnostic Cyber

1. Facts about lung cancer
2. Screening for osteoporosis detects fracture risk
3. Reader submitted Q&A - Ovary, cervix removal at 50
4. Anaphylaxis - a severe allergic reaction
5. Lichen planus - a skin rash of middle age
6. Health tip to share - Rash from perineal deodorant
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.

The next newsletter will be in two weeks.

1. Facts about lung cancer
Lung cancer is now the most frequent cancer killer 
of women. Even breast cancer does not cause as 
many deaths. While lung cancer is decreasing in 
incidence in men, it is increasing in women. There 
are two main types of lung cancer: 

non-small cell lung cancer (80%)
   squamous cell carcinoma
   large cell carcinoma 

small cell lung cancer (20%)

Most lung cancer (87%) is caused by smoking. There 
are numerous substances in cigarette smoke, many 
of which cause cancer. The longer one smokes, the 
greater the risk of cancer. Stopping smoking helps 
reverse this trend although it does not go back to 
a zero risk. 

Another cause of lung cancer which is greatly 
under appreciated is radon gas. It is the second 
leading cause of lung cancer today. It comes up 
from the soil under a home or building. Some 
experts have estimated that 1 in 15 houses will 
have elevated radon levels. Radon causes about 12% 
of all lung cancer cases. Other causes include job 
related exposure to substances that may induce 
lung cancer such as asbestos, repairing brakes, 
coke ovens, uranium, arsenic and certain petroleum 
products. Both radon and job-related carcinogen 
exposure are additive to smoking, further 
increasing the risk for lung cancer. 

Early lung cancers do not give any symptoms which 
presents a problem in detecting the cancer. 
Symptoms do not occur until late in the disease. 
When they do occur, symptoms may include: 

chronic cough 
coughing up blood
weight loss & loss of appetite 
shortness of breath 
fever without a known reason 
repeated bouts of bronchitis or pneumonia 
chest pain 

Doctors no longer order routine yearly screening 
chest x-rays but if you have any of the above 
symptoms, be sure to talk to your doctor about 
having a chest xray. Even non-smokers can 
sometimes get lung cancer and if you are a smoker, 
it is doubly important to have a chest x-ray 
whenever you have the above symptoms that do not 
completely resolve within 2-3 weeks. 

Prevention of lung cancer includes:
stop smoking 
avoid second-hand smoke
check for job-related exposure
check your home for radon

Early detection of this killer disease is very 
difficult but any lung symptoms that persist 
beyond the 2-3 week cold or flu stage should be a 
warning signal to see your doctor for further 

Facts about lung cancer

You can get home radon detection kits at:

Radon detection kits

2. Screening for osteoporosis detects fracture risk
Osteoporosis is a condition in which bone has lost 
calcium and it becomes fragile. The measurement 
most often used to detect the amount of calcium in 
bone is the mineral density. The gold standard 
technique to measure bone mineral density (BMD) is 
a dual photon densitometry scan which measures 
total body calcium as well as the lumbar spine and 
hip density. It is an expensive test that is not 
covered by most insurance plans, especially when a 
woman is under the age of 65. 

Since many women have to pay for the test on their 
own if they wish to have it, smaller scanning 
units have been developed in order to make an 
osteoporosis screening test that is less 
expensive. These units scan the wrist, the fingers 
or even the heel of the foot. They are not as 
accurate as the larger bone densitometry scanners 
and thus have not become very widespread in use. 
The correlation between the large scanners and the 
peripheral bone scanners is 60%, which seems low, 
but most people do not realize that the 
correlation between a spine measurement and a hip 
measurement in the same woman only has a 60% 
correlation using the most accurate equipment 
available. In other words, individual bones in the 
body have considerable natural variability. 
Scientists and insurers continue to argue about 
whether the peripheral scanners are precise enough 
to be medically useful. 

The following study recently published in the 
Journal of the American Medical Association (JAMA) 
looked at how useful these smaller, peripheral 
bone scanners were in detecting women at risk for 
bone fracture. They looked at over 200,000 
postmenopausal women who did not have suspected 
osteoporosis and who underwent peripheral bone 
densitometry performed at the heel, finger, or 
forearm. Of those whose measured values were in 
the osteoporosis range (7% of all the women 
screened), the fracture risk in the next 12 months 
following screening was increased four times.  
Even those women who had slightly low bone 
density, osteopenia, but not osteoporosis, had a 
1.8 times higher fracture rate in the year 
following the study. 

At the beginning of the study, 11% of the 
postmenopausal women reported having had a 
fracture after the age of 45. Fractures of the 
wrist occurred in 6.2% and hip fractures occurred 
in 1.2%. The new, overall fracture rate in the 
year after scanning was about 3%. 

The bottom line is that these less expensive scans 
are quite useful for screening even if they do not 
find all instances of osteoporosis. The cases they  
discover can have a more formal diagnosis 
performed and treatment begun to prevent a 
disabling fracture. If your doctor offers you the 
availability of such a scan, you should take 
advantage of it to see where in the range of bone 
mineral density your measurements lie. 

Screening for osteoporosis detects risk for fracture

3. Reader submitted Q&A -  Ovary, cervix removal at 50
"Is it possible to keep your ovary and cervix, 
following a diagnosis of adenomyosis, I don't mind 
the uterus being removed, but I am concerned about 
the other organs, if they're healthy." 

"I am 50 yrs. of age still have regular monthly 
periods, 2 days heavy. I only have one ovary, the 
other was removed in my 20's for a large cyst. 
Enlarged uterus, 4 to 5 month pregnancy size, no 
pain involved, just frequent discharge.  I forgot 
I also have fibroids." -   DYR 

It IS possible to have just the fibroids in the 
body of the uterus removed and not remove the 
ovary or cervix. This would be a subtotal 
hysterectomy. You might want to talk to your 
doctor about it. Your menstrual periods would stop 
and the pelvic pressure from the fibroids should 
be cured. 

You need to carefully examine your reasons for 
wanting to keep the remaining ovary and the 
cervix. Both of them can develop cancerous lesions 
in the future and if you have them removed, almost 
all (about 98%) of those cancers could be 
prevented. At age 50 the chance of a future 
cancer of the ovary or cervix is about 1-2%. 

If you keep the cervix, you will need more 
frequent Pap smears and occasionally you may have 
some bleeding from the cervix if you take estrogen 
replacement. Ovaries can sometimes form cysts 
after menopause and Pap smears can become abnormal 
also. While these are not cancerous changes, the 
worry and concern that you would undergo at the 
time as well as the extra studies and medical 
visits can be more than worth having them removed 
at the time of the hysterectomy. I would guess 
that the future ovarian or cervical problem that 
you might have that needs medical attention is in 
the range of 5% or 1 out of 20 chance. 

I do not know of negatives from removing the ovary 
at age 50 except that you may need to start 
estrogen replacement  right away rather than in a 
few more months or years with natural menopause. 
Ovaries due secrete small amounts of testosterone 
for a short while after menopause but this too can 
be replaced if needed. 

The main negative from removing the cervix is that 
orgasm with intercourse can change. It is not 
noted as less pleasurable but the fine uterine 
contractions that are sometimes present with 
orgasm either change or go away. A recent patient 
of mine was concerned about this and asked for 
just a subtotal hysterectomy. Unfortunately 
postoperatively she actually complained of a new 
pain with intercourse after her subtotal 
hysterectomy. I do not know the cause of the pain 
but it is reproducible by moving the cervix on 
pelvic exam. It may be because of adenomyosis of 
the cervix or perhaps the stitches that are 
suspending the cervix to keep it from prolapsing 
may be putting a stretch on the ligaments that the 
woman is not used to. I only relate this to you 
as an example that we still do not have all the 
answers about how surgery affects each individual 
person and there can be other disadvantages to 
leaving the cervix in. Truthfully, no one yet 
knows whether the chance of painful intercourse is 
higher after removal of the cervix with 
hysterectomy or higher after a subtotal 

Most gynecologic surgeons who are old enough to 
have performed moderate numbers of both total and 
subtotal hysterectomies will tell you that more 
women in the years post follow-up regret not 
having the ovary or ovaries removed (over age 45)  
and not having the cervix removed, than regret 
having them removed. I do not think these doctors 
are perceiving these complaints erroneously. I 
just would not want you to be someone who later 
regrets a decision about surgery because of not 
investigating the alternatives. 

I'm glad you are evaluating the alternatives and 

4. Anaphylaxis - a severe allergic reaction
Allergies can cause different reactions in the 
body. Skin rashes, pain, bowel upset and 
headaches are among those different types of 
allergy manifestations that frequently occur. The 
most severe reaction, however, is one called 
anaphylactic shock. This is a rare but extreme 
reaction in which the blood vessels lose their 
tone and blood pressure falls very low and the air 
tubes to the lungs (bronchi) narrow making 
breathing difficult. The reaction is all over the 
body, not just in small areas. That is what makes 
anaphylactic shock life threatening. With the 
entire vascular system collapsing and decreased 
oxygen supply, death can take place if treatment 
is not begun quickly. 

The trigger for such a serious allergic event can 
be a medication, an insect sting, a food or even 
just skin contact with a substance that previously 
sensitized the system. The onset of symptoms can 
be within seconds or minutes. Each subsequent 
allergic reaction becomes more and more systemic 
throughout the entire body. Thus even if you are 
unharmed from one episode, the next one may be 
lethal and you need to be prepared. 

Symptoms include:

swollen throat
difficulty breathing 
weak and rapid pulse 
dizziness or fainting, shock 
hives and large red skin welts 
flushing of skin and intense itching 
swelling of the lips and tongue 
nausea, vomiting or diarrhea 

If you think you have ever had a severe allergic 
reaction, double check with an allergist to make 
sure what the specific allergy is. If the allergy 
is to an insect, a food or a contact substance, 
ask the allergist for an emergency kit such as 
that used for bee stings. It contains a syringe 
with epinephrine that can stop the anaphylactic 
reaction until you can get to emergency medical 
care. Also, be sure to get a medical alert 
bracelet to wear. 

5. Lichen planus - a skin rash of middle age
Lichen planus is an itchy skin rash or collection 
of bumps that occurs most often between ages 45 
and 60. It looks like slightly raised, purplish-
red, irregular polygon-shaped itchy skin lesions. 
They commonly occur on the wrists and inside of 
the arms, on the legs and ankles and sometimes on 
the inside of the mouth. There may be just a few 
lesions or large areas that coalesce and form 
violet colored patches. A skin biopsy is needed to 
confirm the diagnosis. 

Lichen planus occurs in only 1% of adults but it 
is more common in women. The basic pathology is an 
inflammatory reaction but no one knows what causes 
the inflammation. The lesions are not contagious 
and do not go away with any known antibiotic 
treatment. They often last for one or two years 
and then go away on their own. 

Certain medications can cause a lichen planus 
reaction. Drugs such as thiazide diuretics, 
antihypertensives including beta blockers, and 
even pain meds such as non steroidal anti-
inflammatory drugs (NSAIDs), are among those known 
to be associated with these lesions. 

Treatment is variable depending upon how extensive 
the rash area is. Steroid ointments may be used as 
well as ultraviolet light treatment. Sometimes 
oral steroids are the treatment of choice and 
occasionally the lesions may need to be injected 
with steroids. 

If you think you might have lesions of lichen 
planus, see your doctor or a dermatologist for a 
biopsy and treatment. 

Lichen planus - a skin rash of middle age

6. Health tip to share - Rash from perineal deodorant
"[As far as the health tip] using deodorant as a 
cover up for odor "down there" [perineum and 
vulva], it does help VERY well. But the problem is 
after about a week of using it, the deodorant  
made me break out in a rash and to tell you the 
truth, I would rather have odor then deal with the 
pain I have right now. Just thought I could let 
you guys know. I hope i helped!! " -  Amanda 

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
"Parrot's Vocabulary"
There's this senior woman who bought a parrot for 
company. The problem was the parrot swears like a 
sailor, I mean he's a pistol.  He can swear for 
five minutes straight without repeating himself.  

Trouble is, the woman who owns him is a quiet, 
conservative type, and this bird's foul mouth is 
driving her crazy. 
One day, it gets to be too much, so the woman 
grabs the bird by the throat, shakes him really 
hard, and yells, "QUIT IT!!!"  (She used to be a 
high school teacher and always wanted to do that!) 
This just makes the bird madder and he swears 
more than ever. 
The woman decides to get tough and locks the bird 
in the kitchen cabinet.  This really aggravates 
the bird and he claws and scratches at the door.  
When the woman finally lets the bird out, he lets 
loose with a stream of vulgarities that would make 
a veteran sailor blush. 
At this point the woman gets so angry herself 
that she throws the bird into the freezer.  For 
the first few minutes there is a terrible din. 
Kicking and clawing and thrashing and swearing.  
At first, the woman just waits.  Concerned that 
the bird may be hurt, she opens the freezer door. 
The bird calmly climbs onto the woman's 
outstretched hand and says, "So sorry about the 
trouble I've given you.  I'll do my best to 
improve my vocabulary from now on." 
The woman is astounded!  She was hopeful but 
really cannot understand the transformation that 
has come over her foul parrot. 
Then the parrot says, 

"By the way... what did the chicken do?" 

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

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****** Woman's Diagnostic Cyber Newsletter *******
                December 30, 2001
Biweekly from Woman's Diagnostic Cyber

1. Attacking mold growth in your home
2. Mother's weight at your birth predicts your adult weight
3. Reader submitted Q&A - Vaginismus - spastic muscles
4. What is pelvic inflammatory disease?
5. Weight Watchers (R) Online
6. Health tip to share - Dry skin in the winter
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.

The next newsletter will be in two weeks.

1. Attacking mold growth in your home
Mold spores are a common cause of household and 
work allergies. Every home has some mold growth in 
it. Rarely, certain types of molds can act almost 
like a poison if they are inhaled or produce a 
serious anaphylactic shock if the spores are 
stirred up. Less severe reactions can be breathing 
problems, burning, itching or watery eyes, and 
even fatigue or memory loss. 

When the mold is on a surface, it does not present 
much of a problem. When it or its spores become 
dispersed in the air you breathe, that is when 
reactions occur.  Most of the time when you touch 
mold spores, nothing noticeable happens. However, 
if you spray chemicals on large areas of mold, you 
can cause spores to become airborne and thus 
produce a medical reaction when they get in your 
eyes nose or lungs. Ventilator ducts and air 
filters  with their almost constant airflow must 
be kept clear of mold. 

Proper procedure is to soak mold areas in a 
solution of water  mixed in a ratio of about one 
cup of bleach to a gallon of water. On porous 
surfaces such as wood or plasterboard, the 
solution should be left on for about 15 minutes. 
If an area is extensively covered with mold, there 
are professional services that clean up after 
flood damage that can restore the area to a 
relatively mold-free state. 

Look around your home for any areas that have been 
flooded, had sewer back-up, had leakage around 
pipes. damp areas, ventilators or crawl spaces. 
Check any humidifiers and the pipe areas under 
sinks. Clean these areas as best you can unless 
you are a person who gets severe reaction to mold 
spores. In that case, have someone else do the 

We have previously mentioned about severe allergic 
reactions such as anaphylactic shock in this 
newsletter. If you are a person who experiences 
these reactions but you are not absolutely certain 
about the causative agent, be sure to be tested by 
an allergist or your family physician to be sure 
what causes your reactions. 

Attacking mold growth in your home

2. Mother's weight at your birth predicts your adult weight 
Many of us have assumed that a big heavy baby at 
birth often means that individual will be a big 
person in childhood and adult life. There is some 
truth to this, but predictors of adult weight from 
measurements at birth have not  previously been 
carefully examined. A recent study in the British 
Medical Journal looks at whether one's birth 
weight or one's mother's weight at time of 
delivery is more predictive of how much you will 
weigh as an adult. 

This study looked at all babies (over 10,000)  
born in a study period in 1958 and their birth 
weights, their mother's weight and body mass index 
(BMI) and how much these individuals weighed at 
ages 7, 11, 16, 23, and 33 years. 

The authors found two strong predictors of adult 
weight. Mother's body mass index (BMI) which is 
calculated as a function of weight for height, was 
more predictive of her offspring's adult weight 
than was birth weight alone. Secondly, being 
overweight by age 7 was strongly predictive of 
being overweight as an adult, especially in male 

We still do not know if this is a genetic effect 
or an environmental one. Until we do know, it is 
best to assume that something about mother's 
weight during gestation or at delivery sets an 
internal thermostat that strongly governs what 
that child is going to weigh as an adult. Perhaps 
that is why significant weight change as an adult 
is so difficult. It also means that being at ideal 
body weight before conception may protect a child 
from future adult obesity. 

Mother's weight at your birth predicts your adult weight

3. Reader submitted Q&A - Vaginismus - spastic muscles
"Why do I experience pain while having sex? I am 
25 years and lost my virginity at 23.  I didn't 
enjoy the experience as there was pain.  Also I 
have not had a climax since I started having sex.  
My menstrual circle is normal, not heavy not 
light." - Jane 

I cannot say for sure without an exam, but 9 times 
out of 10, the reason for painful intercourse as 
you describe above is because of a condition 
called vaginismus, an involuntary contraction of 
the muscles around the vagina prior to penile 
insertion during intercourse. Sometimes it can be 
due to other reasons such as a birth anomaly of 
the vaginal canal or a vulvar or vaginal lesion 
that produces the pain and for that reason you 
must have a pelvic exam by a doctor to make sure 
there is not another cause. 

The medical term for this condition would be 
called primary dyspareunia (painful intercourse) 
and primary anorgasmia (lack of ever having a 
climax). Vaginismus is probably the cause for over 
90% of primary dyspareunia.  Sometimes painful sex 
can develop later in a woman's sexual experience 
and vaginismus may only be the cause in those 
instances about 20-40% of the time. 

When we see women with pain that started with 
first intercourse and persists with subsequent 
attempts at intercourse, almost always we will see 
an involuntary tightening of the vaginal opening 
upon attempt to insert a speculum for visual 
vaginal exam or at finger insertion for the 
bimanual exam to feel the uterus and ovaries. It 
is the fear of pain that makes the bulbocavernosus 
muscle at the entrance to the vagina and the 
pelvic diaphragm muscles just inside the vagina 
contract involuntarily. Normally those muscles 
should relax and the vaginal opening dilates with 
sexual arousal and foreplay. In the case of 
vaginismus, those muscles contract instead of 

The lack of orgasm (climax) follows along from not 
going through any of the physiological stages of 
the sexual response cycle. The normal progression 
would be: 

arousal with increased vaginal/vulvar lubrication
excitement with dilatation of the vaginal opening 
   and inner vagina 
plateau phase with further lubrication and 
   movement of the uterus 
orgasm (climax) with fine muscle contractions and 
   release of blood vessel congestion 
resolution with further return to normal of the 
   blood engorged tissues 

Curing the vaginismus problem should cure the lack 
of orgasm problem. Unfortunately, the treatment 
for vaginismus is not easy and it is very 
difficult to do on your own without a trained 
therapist or physician. The reason for this 
difficulty is that there is a considerable 
emotional response on the part of your mind -- 
fear of pain, apprehension of the future, 
depression etc. All of these responses are normal 
to this problem but they are at a subconscious 
level and you have very little control over 
fighting them. 

Vaginal dilators are sometimes used to treat this 
condition. They start out with small sizes and 
gradually increase in diameter. Kegel exercises 
are used to gain voluntary control over those 
muscles so that a woman with vaginismus can learn 
to relax those muscles and allow the vaginal 
opening and canal to dilate rather than contract 
with spasm and produce painful intercourse. 

Vaginismus - the frightened vagina

4. What is pelvic inflammatory disease?
Pelvic inflammatory disease (PID) is a condition 
in which bacteria from the vagina and cervix go up 
through the uterus to the faloppian tubes and the 
ovaries as well as the abdominal cavity. Most of 
the time it is due to bacteria that are sexually 
transmitted such as gonorrhea and chlamydia but it 
can also occur from any bacteria at the time of 
gynecologic procedures such as endometrial biopsy, 
LEEP,  cervical cryotherapy or insertion of an 
intrauterine device. Teens when they first start 
intercourse are most susceptible to PID although 
it can happen at any age. 

PID is a common cause of infertility because if 
not treated within the first 18-24 hours it 
produces adhesions or scarring that either blocks 
the faloppian tubes or impairs their movement over 
the ovary to gather the egg at ovulation. Chronic 
pelvic pain is another long term consequence of 
PID. Once scarring is produced, pain from the 
scarring cannot be treated with antibiotics. 

Symptoms of acute pelvic inflammatory disease 

gradual onset of pelvic pain worsening over 12-24 
the onset of pain is often within a week of menses 
low back pain and pain with intercourse
low grade fever, fatigue
nausea or diarrhea do not occur until after about 
   18-24 hours of pain 
yellowish mucous vaginal discharge may be present

The symptoms become similar to an acute 
appendicitis if no antibiotic treatment is begun. 
While the symptoms also can present similar to a 
gastrointestinal flu, it is characteristic for PID 
that nausea and vomiting or diarrhea do not occur 
when the pain begins. Rather these GI symptoms 
only occur when the pain has been present for some 

If you have a pelvic pain like this that slowly 
builds up in intensity over 12-24 hours and you 
have recently had a gynecologic procedure or 
possibly been exposed to a sexually transmitted 
disease, be sure to seek medical attention right 
away because early antibiotic treatment may 
preserve your fertility. 

What is pelvic inflammatory disease?

5. Weight Watchers (R) Online
It is that time of the year again and this time 
there is no excuse. Weight Watchers now has an 
online site that you can go to instead of 
attending a local meeting. There is still a 
monthly charge ($14.95) plus a joining fee but if 
you are serious about dieting, that monthly charge 
will more than be made up for by your decreased 
monthly food bill if you are really sticking to a 

Weight Watchers(R) now has a point system for food 
which sort of combines calories, fat and fiber. It 
is not hard to learn and you can look up the point 
value of all your foods online. They have also 
added a system whereby you can get more points 
added to your daily allotment by exercise and you 
can also "bank" some points during the week for 
that occasional splurge. They still target no more 
than a 2 pound loss (one kilo) per week as the 
safest rate at which to lose weight. 

The web site has many online tools for meal or 
recipe planning to help you keep to your program. 
Features like: 

 Food Ideas
 Recipe Renovations
 Community Recipe Swap
 Recipe Search
 Food Lists
 Eating Out Guide
help make this agonizing task easier.

I have mentioned in previous newsletter articles 
that the common feature to all successful weight 
loss programs is counting and  keeping a record of 
the amounts you eat. Whether it is a high protein, 
low carbohydrate, special food or other type of 
diet, it is more likely to result in significant 
weight loss if some sort of calorie counting or 
food portion recording is done. Without that 
painful step of counting and recording how much 
you actually eat, diets tend to be uniformly 
unsuccessful for most individuals. 

I have joined the ranks of the New Year's dieters 
via Weight Watcher's (R) Online just because I 
need the discipline of reminding me at each meal 
to stick to a program. If you have not looked at 
Weight Watchers(R) in a long time, you might find 
their new system is just what you need to reduce 
your health risk by losing weight. 

Weight Watchers (R) Online

6. Health tip to share - Dry skin in the winter

Healthy skin has between 10-20% water in it. When 
the heat comes on in winter, water evaporates from 
the skin and when less than 10%, the skin becomes 
dull, rough and flaky. In addition to the use of 
skin moisturizers which keep water in, do not 
forget to humidify your environment. At home, use 
a room humidifier at night. At work, see if you 
can put out a pan of water close to the heat. Even 
a wet towel will give up water to the air at low 
humidity. Be creative. Have some plants with 
large saucers for excess water underneath them. An 
electric water fountain on your desk might be just 
what you need. And don't forget to drink plenty of 
water. That helps the skin in winter too.  

Dry skin in winter

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
From Joke du Jour

"Let's Have Male & Female Nouns"

Many languages have male and female nouns but 
English impersonalizes them. It has often been 
suggested that English should have some male and 
female nouns and here are a few candidates for 

SWISS ARMY KNIFE -- male, because even though it 
appears useful for a wide variety of work, it 
spends most of its time just opening bottles. 

KIDNEYS -- female, because they always go to the 
bathroom in pairs. 

PENLIGHT -- male, because it can be turned on very 
easily, but isn't very bright. 

TIRE -- male, because it goes bald and often is 

HOT AIR BALLOON: male, because to get it to go 
anywhere you have to light a fire under it... and, 
of course, there's the hot air part. 

SPONGES -- female, because they are soft and 
squeezable and retain water. 

WEB PAGE -- female, because it is always getting 
hit on. 

SHOE -- male, because it is usually unpolished, 
with its tongue hanging out. 

COPIER -- female, because once turned off, it 
takes a while to warm up. Also, because it is an 
effective reproductive device when the right 
buttons are pushed. Also, because it can wreak 
havoc when the wrong buttons are pushed. 

ZIPLOC BAGS -- male, because they hold everything 
in, but you can always see right through them. 

SUBWAY -- male, because it uses the same old lines 
to pick people up. 

HOURGLASS -- female, because over time, the weight 
shifts to the bottom. 

HAMMER -- male, because it hasn't evolved much 
over the last 5,000 years, but it's handy to have 
around and it's good for killing bugs. 

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

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****** Woman's Diagnostic Cyber Newsletter *******
                January 13, 2003
Biweekly from Woman's Diagnostic Cyber

1. How to avoid injuries from jogging and running
2. What symptoms does prolapse cause?
3. Reader submitted Q&A - Osteoporosis and HRT
4. The effects of body weight on infertility
5. Lifelong management of diabetes
6. Health tip to share - Caffeine calculator
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.

The next newsletter will be in two weeks.

1. How to avoid injuries from jogging and running
Most injuries from jogging or running result in 
tearing or bruising muscles and tendons in the 
legs and feet. Occasionally tripping and falling 
or twisting the foot or ankle is the cause of an 
injury but most of the time, the injury is caused 
by muscle strain or overuse.Almost exclusively, a 
muscle not yet "in shape" or not properly 
stretched, is the one that is injured. 

The secret to avoiding injuries is to properly 
stretch and warm-up the muscles prior to any 
running, as well as to slowly increase the level 
of exertion that is expected of the muscle. There 
are several warm up stretches and exercises 

wall push-up - straighten one leg back, bend one 
at the knee and lean forward with your hands 
against a wall. Repetitively push yourself away 
from the wall. 

hamstring stretch - place a leg forward, straight 
at the knee and rest it on a chair or stool. Bend 
your body and head toward the leg. 

knee clasp - lying down, bring both knees to the 
chest and hold for 10 seconds. 

bent leg sit-up - lying down with both knees up, 
raise your head and body slowly. 

straight leg-lifts - lying down, flex one knee to 
a right angle and repeatedly lift the other leg 
with knee extended to a 30-60 degree angle off of 
the floor. 

The back and posterior muscles of the legs are the 
ones that tighten up the most with running. Those 
are the ones that need to be stretched prior to a 
repeat session of running or jogging. Sessions 
need to slowly increase the level of running. Also 
sessions with short episodes of speeding up and 
slowing down should precede sessions of long times 
of running fast. 

Please keep in mind that your shoes may wear out 
in their inner support from repeated impact long 
before the upper parts look worn. You may need to 
change them every 4-8 months if you are running 

How to avoid injuries from jogging and running

2. What symptoms does prolapse cause?

Vaginal relaxation of the anterior wall (below the 
bladder) and the posterior wall (on top of the 
rectum) is often called prolapse or cystocele and 
rectocele and produces various symptoms of pelvic 
pressure. Sometimes there are bladder or bowel 
voiding problems. You would think that the more 
the tissues sag, the more severe the symptoms 
become. In fact, doctors have noticed that some 
women seem to have moderate symptoms with only 
small amounts of relaxation, while others do not 
present to doctors for treatment until the vaginal 
walls are actually coming out of the opening of 
the vagina. 

In the study below, the physicians performed 
precise physical measurements during pelvic exam 
in 237 women and compared the results to their 
symptoms graded by severity. They found that the 
symptoms only minimally correlated with the 
physical findings. This confirms what doctors have 
observed; some women with 2nd degree prolapse  
might have just as severe symptoms as others with 
4th degree (complete) prolapse. In fact, urinary 
incontinence symptoms occurred less with the more 
severe instances of prolapse. This is probably 
because when the bladder falls enough to start 
coming out of the vagina, it kinks the urethra, 
the tube from the bladder to the outside.  The 
kinking blocks urine loss with coughing and 
straining so that symptom gets better with more 
severe prolapse. 

The meaning of the study is that severity of the 
symptoms is not predicted by the physical degree 
of prolapse alone. Symptoms may be caused by 
factors other than just straight stretching of 
tissue. Nerve damage that produces numbness, 
rectal or urinary unintentional leakage or just 
difficulties in voiding urine or passing stool is 
very likely a component of the prolapse symptoms. 
Nerve damage does not improve with surgery; it may 
even become worse after surgery so some symptoms 
may not be cured in spite of undergoing a fairly 
extensive operation. 

What symptoms does prolapse cause?

3. Reader submitted Q&A - Osteoporosis and HRT
"I am 56, no periods for 3 years, no significant 
menopause problems (hot flashes,etc.), but my 
mother has severe osteoporosis.  What are the pro 
and cons of HRT for me. My bone density test shows 
slightly below normal, even though I run, and have 
been very athletic all my life. I am Caucasian, 
not obese, and have good muscle mass due to my 
active lifestyle. I am not on any meds and have no 
medical problems." -  Sandy 

The question you raise is about the use of 
postmenopausal estrogen therapy (and progestin) 
solely for the purpose of preventing bone mass 
loss with aging. Continued bone loss over time 
will gradually lead to spontaneous fractures when 
the density falls below a critical threshold. It 
takes a while for a woman to lose that much bone 
density so that the age at which spontaneous 
fractures happen will depend upon the original 
starting bone density and the rate at which bone 
mass is lost. 

Women start gradually losing bone density at about 
age 40. At menopause, with loss of natural 
estrogens, the bone loss accelerates and can 
average EACH YEAR as high as 3.5% ("fast losers") 
or as low as 1%. The annual rate of loss tends to 
be more in the first 5 years after the last menses 
and then the rate of loss lessens after that. It 
is very important to try to prevent loss in those 
initial menopausal years since a larger amount of 
bone mass disappears then. Therefore you are not 
too late to start. 

Several medicines have been shown to either reduce 
the rate of loss or in some cases actually cause 
an increase in bone density. Estrogens have always 
been the most effective. The average dose of .625 
mg of conjugated estrogens or 1 mg of estradiol 
will result in about a 1-1.5% annual INCREASE in 
bone density especially in the first several years 
of taking them. Alendronate (Fosamax®) can add 
about 1% a year and raloxifene (Evista®) can add 
in the range of about 0.5-1% annually. 
Phytoestrogens such as the ipriflavone found in 
red clover (Promensil®) or soy phytoestrogens may 
add a small amount of bone density but for the 
most part they just keep a woman from losing bone 
mass. Calcium supplements alone (1000-1200 mg/day) 
are very helpful but they do not increase mass by 
themselves; they do slow down the rate of loss. 
Calcium supplementation is recommended with all of 
the other medicines. 

If estrogen is the best therapy to make up some of 
your lower than average bone density, the question 
becomes what dose is the best. For many years it 
was felt that .625 mg of conjugated estrogens or 1 
mg of estradiol was the lowest dose effective for 
osteoporosis prevention. Recently doses as low as 
0.3 mg of conjugated estrogen with 2.5 mg of 
medroxyprogesterone acetate (Provera®) have been 
shown to increase lumbar spine bone density. The 
positive effects of estrogen on lowering total 
cholesterol and raising HDL (good cholesterol) are 
still present at the lower doses but not quite as 
potent as at the higher doses. For women concerned 
about the effect of estrogens on breast cancer, 
these lower doses might be the best regimen. 

Don't forget to take the supplemental calcium. 
Almost all of the osteoporosis prevention studies 
included calcium supplements and we actually do 
not know how effective some of the above therapies 
might have been without them. Right now you would 
need two separate prescriptions (pills) for HRT at 
the lower doses. Companies are working on new 
pills that include both the estrogen and progestin 
at the lower doses of 0.3/1.5 and 0.45/1.5 
conjugated estrogen/medroxyprogesterone 
combinations. They should become available not too 
long from now. 

4. The effects of body weight on infertility
Women who are underweight as well as women who are 
overweight may have reduced fertility. A lower 
than normal range body mass index (BMI) can be 
associated with lack of ovulation often designated 
as "hypothalamic anovulation". This form of egg 
production difficulty is not as treatable with 
Clomid as is anovulation due to overweight or 
polycystic ovarian syndrome (PCOS). Being 
overweight is often associated with PCOS but it 
can affect ovulation even if PCOS is not present. 

Weight's effect on fertility is almost always 
restricted to its effect on blocking ovulation 
from the ovary each month or at least making it 
more difficult. Women who are overweight and 
undergo in-vitro fertilization (IVF) also have a 
lower pregnancy success rate than normal weight 
women because it is harder to induce ovulation. 
Once an equal number of eggs are obtained in an 
IVF cycle, the clinical pregnancy rate and the 
miscarriage rate do not vary by mother's weight. 

The best feature about excess weight and fertility 
is that even a small amount of weight loss (5%) 
can restore ovulation in many (60%) women. This 
also applies to IVF success, i.e., if a woman 
loses weight prior to IVF there is a higher 
success rate in overweight women. Women who have 
insulin resistance and take an insulin enhancer 
like metformin may resume ovulation just because 
of the weight loss and not necessarily due the 
direct effects of the metformin. 

Weight can also adversely affect pregnancy so that 
is a double reason for a woman trying to conceive 
to lose weight. Excess weight can cause high blood 
pressure in pregnancy, diabetes, and more frequent 
urinary tract infections and Cesarean sections. 

Miscarriages also tend to be increased in women 
who are overweight. It is not clear whether there 
are just more blighted ova/chemical pregnancies 
or whether later miscarriages are also increased. 
The former may have to do with ovulation problems 
affecting the quality of the follicle. 

The effects of body weight on infertility

5. Lifelong management of diabetes

Before the discovery of  insulin and other 
diabetic medications, those who suffered from 
diabetes face an early death. With modern 
medicines, diabetics live much longer but still 
face chronic disease complications from the 
diabetes such as: 

kidney disease/failure
visual problems/blindness
more frequent infections
high blood pressure
vascular insufficiency
skin ulcers

Any of these conditions can lead to early death so 
it is very important to take all steps possible to 
prevent these problems if possible, or at least 
detect them in the earliest stages to begin 
additional preventive treatment. Doctors and 
nurses can tell you what to do but it is up to the 
diabetic person themselves to take the time to 
carry out the preventative measures. 

Once diabetes is diagnosed, a woman should put all 
of the following on her highest health priority: 

1) frequent blood pressure checks 

2) annual ophthalmologic eye exam - to detect 
glaucoma, retinal vascular or detachment problems 

3) annual blood testing for kidney disease 
(microhemoglobinuria), hemoglobin A1c 

4) every 6 months dental visit for teeth cleaning 
and gum check 

5) flu shots annually, all vaccinations including 
pneumovax (to prevent pneumonia) and their 
recommended boosters as per schedules. 

6) daily foot and skin care 

The recommendation for daily foot and skin care 
needs some explanation. Diabetes is the most 
common cause of foot and leg amputation because of 
the vascular disease it produces. The smallest 
blood vessels which are furthest away from the 
heart get narrowed and the feet and toes lose 
normal blood supply. This makes them more 
susceptible to infections, ulcers and fungus. 
Diabetics also have dry skin which is more easily 

Examine the feet for cracks, blisters, redness and 
dry skin. Wash your feet and dry thoroughly 
between the toes without rubbing. Make sure shoes 
and socks fit well without areas that put abnormal 
pressure on any part of the foot. Don't use 
chemicals on the feet  and have calluses, corns, 
bunions or warts taken care of by a podiatrist 
rather than trying to treat these yourself. 

Lifelong management of diabetes

6. Health tip to share - Caffeine calculator
For those of you who try to watch your caffeine 
intake by drinking decaffeinated coffee (it still 
has some caffeine), tea, and soft drinks, you may 
want to know how much caffeine you are really 
getting. Here is a handy calculator.  It includes 
chocolate too. Actually it would take 5 oz of dark 
chocolate to equal a small cup of coffee but milk 
chocolate has much less. 

Caffeine calculator

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

"Water Pills"

A woman goes to the doctor and tells him that she 
hasn't been feeling well. The doctor examines her, 
checks her urine and blood, leaves the room and 
comes back with three different bottles of pills. 

The doctor says, "Take the green pill with a big 
glass of water when you get up. 

Take the blue pill with a big glass of water after 

Then just before going to bed, take the red pill 
with another big glass of water." 

Startled to be put on so much medicine the woman 
stammers, "My goodness, doc, exactly what's my 

The doctor says, 
"You're not drinking enough water."

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

Back to top

****** Woman's Diagnostic Cyber Newsletter *******
                January 27, 2002
Biweekly from Woman's Diagnostic Cyber

1. Should seniors take multi vitamins?
2. Recurrent miscarriage and antiphospholipid syndrome 
3. Reader submitted Q&A - Grapefruit juice and drugs
4. Wild yam cream does not have a hormonal effect
5. Too much vitamin A associated with hip fractures
6. Health tip to share - Aspirin for heart disease 
7. Humor is healthy

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re subscribe using the new address.

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

The next newsletter will be in two weeks.

1.  Should seniors take multi vitamins?

While it is easy for a health provider to just say 
"take a vitamin", the answer is not so straight 
forward. There can actually be a risk of taking 
too much of a given vitamin when what you take by 
pill is added to fortified cereal and other food 
products and your normal diet. In fact most people 
do not need to take an added multi vitamin. While 
their diets are not perfect, they are reasonable 
and the vitamins and minerals present absorb well 
from the food. 

Seniors, especially those over 65, do not absorb 
certain vitamins and nutrients as efficiently as 
younger persons. These would include vitamins B-6,  
B-12, D and zinc. Vitamin B-12 is important in 
preventing anemia, high blood pressure and 
cardiovascular disease. Vitamin D is needed to 
absorb calcium which seniors lose almost 
constantly from their bone mass. Vitamin B-6 can 
lower blood homocysteine which is felt to be a 
risk factor for heart attack and improve the 
immune system. It is used by the body for protein 
metabolism and hormone manufacture also. On the 
other hand, excessive vitamin B-6 can produce 
nerve toxicity. Zinc is needed for enzymes that 
affect digestion and wound healing. 

Elderly seniors may have even more severe nutrient 
problems because of aging changes which diminish 
taste and smell and produce denture problems. Poor 
appetite and diet can also be due to factors like 
eating alone or having depression. Other chronic 
diseases accompany age and can cause loss or 
impede absorption of vitamins. The vitamins that 
are water soluble (thiamin (B-1), riboflavin (B-
2), niacin (B-3), pantothenic acid (B-5), 
pyridoxine (B-6), folic acid (B-9) and cobalamin 
(B-12). vitamin C, choline, and biotin) especially 
have to be supplemented if diet or absorption are 

Because of the increased chance of having low 
levels of multiple vitamins, a general multi 
vitamin supplement should strongly be considered 
for those over 65 and any seniors with impaired 
diets or diseases affecting gastrointestinal 
absorption of micronutrients. Additionally, there 
may even need to be supplements of certain 
vitamins beyond the amount found in multi 
vitamins. Extra vitamin D and calcium supplements 
are commonly needed for seniors in addition to a 
multi vitamin. 

There are some vitamins and minerals that have 
narrow safe vs. toxic levels. For example seniors  
age 50-70 are often recommended to take 400 IU per 
day of vitamin D and those over 70 to take 600 IU 
per day. The lowest no-observed adverse effect 
level (NOAEL) is 800 IU and the lowest level at 
which adverse effects have been observed (LOAEL) 
is 2000 IU per day. For vitamin A, the recommended 
daily allowance is 2600 IU, but many vitamins have 
5000 IU (a previous recommended daily allowance by 
the Food and Nutrition Board but lowered by the 
recent Council for Responsible Nutrition) and some 
people take supplements of 10,000 IU in addition 
to a daily vitamin with 5000 IU. The NOAEL level 
is 10,000 IU and the LOAEL is 21,600 IU. As you 
can see the margin of safety is not very good when 
you add in the amount contained in a daily diet. 
Vitamin A is a fat soluble vitamin than can 
accumulate in the body; too much can produce 
permanent liver damage. 

Be sure to ask your doctor about safe vitamin 
levels and, more importantly, try to look at the 
ingredient listings on foods you commonly eat on a 
regular basis for what amounts of vitamins and 
nutrients have already been. Only you, not your 
doctor, can calculate if you may be getting too 
much or not enough of the various micronutrients. 
Vitamin Intake - How Much is Too Much?

2. Recurrent miscarriage and antiphospholipid syndrome
Women who have had one or more miscarriages often 
hear about taking aspirin to prevent pregnancy 
loss. Actually that therapy has been used for 
women with 3 or more consecutive miscarriages (or 
sometimes only 2) and with a diagnosis of what is 
called antiphospholipid antibody syndrome. This is 
a condition detectable by having lupus 
anticoagulant (LA) and/or anticardiolipin 
antibodies (aCL) in blood serum. These are tests 
which need to be ordered by a physician. 

The study below looked at randomized clinical 
trials that have been conducted and reported in 
the medical literature in women with recurrent 
miscarriage and antiphospholipid syndrome. They 
found that 3 trials using aspirin alone DID NOT 
SHOW ANY BENEFIT. Two trials evaluated aspirin 
plus injectable heparin, a potent blood thinner, 
versus just aspirin alone. These studies did show 
a benefit in improving subsequent pregnancy 
outcome but from the other aspirin alone studies, 
we can surmise that it is probably just the 
heparin that helps. One study looked at 
prednisone, a strong steroid medication, plus 
aspirin and it actually increased the rate of 
premature delivery with no reduction in 

The take-home message from this review is that 
women should NOT self-medicate with aspirin in an 
attempt to prevent a miscarriage. It does not 
work. Aspirin can affect platelet-mediated blood 
clotting in the body so there is always the 
possibility of harm from taking it..  Also, if a 
woman has had 3 miscarriages in a row then testing 
for antiphospholipid syndrome should be started 
with your physician because there is a treatment 
that helps. 

Recurrent miscarriage and antiphospholipid syndrome

3. Reader submitted Q&A - Grapefruit juice and drugs
"I have heard that when dieting, grapefruit juice 
blocks some of the medications people take. Should 
I avoid grapefruit juice on my diet if I take 
birth control pills?" - Anonymous 

The bad news is that grapefruit juice CAN alter 
the absorption of some medicines. The good news is 
that you can get around this interaction and most 
of the time do not need to worry about drinking 
grapefruit juice or eating grapefruit on your diet 
as long as you follow a few simple rules. 

There is an enzyme in the bowel and liver called 
cytochrome P-450 (CYP) that is very important in 
metabolizing food and medicine ingested by mouth. 
The enzyme changes the base food or drug compound 
by adding small chemical groups to the molecule. 
Sometimes these changed compounds are absorbed 
from the stomach more easily; sometimes the change 
inhibits absorption. CYP can change the drug to a 
more potent form as far as medical action and at 
other times it will deactivate it and change it to 
a less active compound. In other words, any 
substance that stimulates CYP or inhibits CYP can 
make ingested substances more active in its 
medical effects and side effects or less active, 
less potent. 

Grapefruit juice is one substance that has been 
found to inhibit the CYP enzyme system. It does 
this much more than other citrus juices like 
orange juice. Grapefruit juice is not the only 
compound that inhibits CYP. Even red wine or St 
John's Wort, among others, have been shown to 
affect this system. There are undoubtedly many 
other food and drug substances that have the same 
effect that we just do not know about at the 
present time. Inhibition of CYP often results in 
HIGHER BLOOD LEVELS of a drug because inhibited 
drug absorption means that the liver, which often 
breaks down the drug, does not get the first 
chance to inactivate the drug before it has its 
medical effect. 

Most of the drugs that I could find that have been 
tested, are INCREASED in the blood by about 0- 50% 
if they are taken with a glass of grapefruit 
juice. While decreased blood levels can happen 
too, almost every agent was actually increased and 
when it was, it was at about the 50% level. I 
could not find testing that showed how long after 
ingesting grapefruit juice the altered absorption 
levels lasted. It is likely that the effect is 
short lived under 60 minutes. 

Women will be glad to know that the estrogen 
(ethinyl estradiol) in birth control pills is not 
decreased by grapefruit juice but rather increased 
by 37%.  The estrogen often used for menopausal 
replacement, 17 beta-estradiol, is also altered 
somewhat in its absorption by grapefruit juice. 
Estrone (a weaker estradiol metabolite) levels are 
increased after taking estradiol with grapefruit 
juice but estradiol itself is not increased. 

For the most part, the differences in active drug 
levels with or without grapefruit juice are not 
very great and probably less important than your 
body weight in determining medical effect. 
However, with a drug that has a narrow range 
between adequate treatment of a medical problem 
and toxicity producing side effects, then this 
amount of interaction can make a difference. 
Chemotherapy agents would be one instance where 
the different levels could produce very 
undesirable side effects. Anti-depressants and 
anti-anxiety agents are another class of drugs 
that grapefruit juice could affect. On the other 
hand, if you were not seeing a therapeutic effect 
from a medication, taking it with grapefruit 
theoretically might help (eg. low dose estrogens 
for hot flashes). 

The wisest course of action with regard to eating 
grapefruit or drinking grapefruit juice,  however, 
would be to follow these simple rules: 

Take most medicines at least 30 minutes before or 
60 minutes after you ingest the grapefruit. Take 
them with water or orange juice if you have to (OJ 
has some effect but much less than grapefruit 

If you are having side effects from the drugs you 
take, avoid grapefruit for at least 6-8 hours or 
altogether and check with the doctor to see if 
drug dose adjustment is possible. 

If you are taking any cancer chemotherapy drugs, 
check with your doctor about all substances which 
may alter their absorption or blood levels. 

4. Wild yam cream does not have a hormonal effect
Since wild yam extract contains a plant steroid 
which can be a chemical precursor to manufacture 
estrogen and progestin hormones, it has often been 
used in a cream form to rub on the skin to 
alleviate symptoms of perimenopause and menopause. 
The theory behind this is that maybe the plant 
steroid (diosgenin) would either act as a steroid 
or stimulate steroid manufacture in people and 
improve some of the symptoms such as hot flashes. 
Wild yam extract has also been used in 
progesterone creams to make people think the 
progesterone cream is an all natural product. 

The study below from Australia looked at whether 
the use of a wild yam extract cream versus placebo 
cream affected the number of hot flashes, or other 
menopause symptoms or whether it changed any 
hormone levels. They found in comparing wild yam 
extract cream with placebo that "after 3 months of 
treatment, no significant side-effects were 
reported with either active treatment or placebo, 
and there were no changes in weight, systolic or 
diastolic blood pressure, or levels of total serum 
cholesterol, triglycerides, high-density 
lipoprotein (HDL) cholesterol, FSH, glucose, 
estradiol, or serum or salivary progesterone." 
They concluded that there was no beneficial effect 
for menopausal symptoms from wild yam extract 
cream and no influence on any of the reproductive 
hormones either. They also found there was no harm 
to using it. 

 Wild yam cream does not have a hormonal effect

5.  Too much vitamin A associated with hip fractures
In animal studies, one of the toxic effects of 
vitamin A is that it causes bone problems such as 
fractures. The study below looked at the effect of 
non-toxic doses of vitamin A from supplements and 
fortified food sources among over 72,000 
postmenopausal women followed for 18 years in the 
Nurses Health Study. 

The study looked at the incidence of hip fractures 
among women who were taking over 3000 mcg/day of 
vitamin A (the recommended daily allowance is 800 
mcg/day). In both the women who were taking 
vitamin A supplements and those who were not on 
supplements but were taking more than 3000 mcg/day 
from food they were eating, there was an increased 
risk of hip fracture. The overall increase in risk 
was about 50%. 

Epidemiological studies that try to correlate 
certain food intake with diseases are always 
subject to many sources of error because they did 
not check for the effect of other factors that 
might have caused the same disease or condition. 
This study claimed that they did correct for many  
possible confounding factors so their results may 
have merit. I think we have to accept that there 
is a possibility that vitamin A can have adverse 
effects above the recommended daily requirement. 

The significance of this study is to remind us 
again that just because a little of something is 
good for us, twice as much may not be better. I do 
not have trouble with the vitamin A levels in most 
multi vitamins, usually about 800-1600 mcg (2500 
IU - 5000 IU). However, anyone taking supplemental 
vitamin A or vitamins advertised as "mega" 
vitamins needs to calculate their total daily dose 
between the supplements and their normal food 
intake to make sure they are not placing 
themselves at an unknown risk. 

6. Health tip to share - Aspirin for heart attack prevention
After age 40 or 50, you only need to take one baby 
aspirin a day (80 mg) to help prevent heart 
attacks. A regular aspirin (325 mg) is actually 
not better and may cause blood clotting problems. 
- FRJ 

Baby Aspirin Recommended for Heart 

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