Women's Health Newsletters 3/10/02 - 5/19/02
****** Woman's Diagnostic Cyber Newsletter ******* March 10, 2002 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Biweekly from Woman's Diagnostic Cyber ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Do something about your fatigue 2. Skin boils - the different types 3. Reader submitted Q&A - Urine odors 4. Chance of developing hypertension in your lifetime 5. Cysts in the liver found on ultrasound 6. Health tip to share - Food cutting boards 7. Humor is healthy If you change your email address, don't forget to 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. Do something about your fatigue ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Complaints of being tired all of the time or having a lack of energy are heard commonly by physicians. In fact I can assure you that physicians are frustrated by the lack of an easy fix for this problem. The causes are often multiple and almost always the treatment requires a major lifestyle change on the part of the person who is so tired. Lifestyle changes such as weight loss, stress reduction and good fitness and sleep habits are not something the physician has any control over. They can only recommend and it is up to the patient to figure out what changes work best for them. There are some medical conditions associated with fatigue that recurs day in and day out. Anemia (low red blood cell count), hypothyroidism, and active infections such as hepatitis, Epstein-Barr virus and others can be a cause. Cancer and other chronic medical conditions such as chronic fatigue syndrome can also be a cause as well as medication side effects. Usually a blood chemistry, a complete blood count, a thyroid test (TSH) and a good physical exam can rule out most of these causes. Unfortunately only about 1 out of 20 patients complaining of continuous fatigue will have non-lifestyle, medical problems causing it. Another one or two have fatigue as a side effect from medicine(s) they are taking. Anti- depressants and anti-hypertensives are notorious for this. The other 17 out of 20 people have too much stress, too much weight, too little sleep or are too far out of good physical shape. When a doctor communicates that one or more of these problems may be playing a role as a cause of fatigue, I would guess that almost a third of women will be skeptical and just assume the doctor did not really try very hard to find the cause. Perhaps another third will take the doctor seriously and try to make the difficult changes needed to restore their daily energy. The other third of women realize how life style contributes to the problem but either feel helpless to change it or they try change and become discouraged very early on. The doctor's dilemma is the lack of an easy treatment for stress reduction, weight loss or sleep disorders. Most physicians never learned how to instruct and monitor patients for those problems when they went through medical training. They only learned to prescribe medicines which may reduce the symptoms but never really address the long term solution. On your part, you will probably not be able to rely on much physician help if trying to reduce stress, lose weight or improve sleep. You will need to be your own detective to learn how to tackle these problems and get your living habits back on track so you will feel better on a daily basis. Do something about your fatigue ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2. Skin boils - the different types ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Any infection deep in the skin elicits the body's response to wall off the infected area. This causes redness, soreness and swelling around the infection and as pressure from dead material builds up in the infected compartment, it seeks to break out to relieve the pressure. The path of least resistance is to go to the surface of the skin where it forms a "whitehead" and subsequently breaks through the skin and drains. Many call this a skin boil. Actually there can be different types of deep skin infections like this. They might be started by ingrown hairs, a foreign body or just plugged up skin ducts. When there is only one or a couple of areas infected, they are usually referred to as furuncles or carbuncles. This skin abscess is almost always caused by the Staph. Aureus bacteria. Once drainage of the pus takes place, the body can heal the area on its own even without antibiotics. Another type of skin boil is one that uniquely occurs in the skin near the base of your spinal cord in back. It is called a pilonidal cyst and it often starts at the top of the crease in the buttock after sitting for long periods of time. This boil tends to keep recurring periodically because its origin is in a deep skin cave-like crevice that may be present from birth and has a narrow opening which can easily be plugged off if the skin around it swells at all. Sometimes a pilonidal cyst has to be surgically drained because the skin lining has very small spider-like projections into deeper skin and those areas can continually be "plugged off" causing frequently recurrent abscesses. Skin abscesses unique to the armpit (axilla) areas or the groin and perineal areas are often due to a process called hidradenitis suppurativa. This is a chronic recurrent infection of sweat glands in those areas. Because sweat glands are so extensively present in skin, it is almost impossible to cure the recurrences by just surgical drainage or excision. Finally, the most common type of recurrent skin boils are due to cystic acne. This occurs mostly on the face, neck and back. Acne is also an infection of the sweat glands and hair follicles. The duct of the gland or hair follicle becomes plugged up with dead skin cell material and if any skin bacteria are trapped behind the plugged duct, they grow into an abscess that needs to drain through the skin. If acne or any boil is squeezed so that the infected material breaks through the cavity deeper into the skin, extensive further abscess formation can take place with a much wider area of skin involvement and eventual scarring. The main treatment of any boil is heat to soften the skin over the boil and promote drainage through the skin surface and not deeper into skin structures. Antibiotics are often not needed at all; the critical treatment is drainage of the abscess material. Skin boils - the different types ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3. Reader submitted Q&A - Urine odors ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "I find that when I urinate that there is an odor that lingers in the bathroom. I babysit and the children have complained that I stink. I have asked my doctor if possibly it could be some of my medications. They seem to ignore my statement. What can I do to correct problem. I don't know if the odor is from there or my vagina." "I am 62 and have asthma. Medications include: aspirin, Allegra(R), Singular(R), Verapamil(), Hyzar(R), Synthyroid(R), Servent(R), Flovent(R), Relafen(R), and a breathing machine when needed. I am always wet or moist in the vaginal area. I am overweight." - H I know this is a difficult question for you to ask, but one that is of concern for many women. Odor that is evident with urination can have its origins from basically two sources: bacteria that produce odorous chemicals as they metabolize and proliferate and chemical substances that are excreted in our sweat and urine. Bacteria that cause odor are either on the skin of the perineum, where it stays moist, and bacteria in the vagina that are not normally there but that are causing chemical reactions with the vaginal secretions. Contrary to what you might think, urine that smells is almost never due to a bacterial urinary tract infection but rather it is due to the chemicals from food metabolism as previously stated. Your doctor should be able to perform a vaginal exam to check for bacterial infection such as an atrophic vaginitis or a bacterial vaginosis. If either of those are present, they need to be treated. A common cause of perineal odor is from skin bacteria that grow in the moist folds of skin. The only way to combat this is to frequently keep the skin folds exposed to air and keep them dry. It is strains of bacteria that do not need oxygen to grow (anerobic bacteria) that usually produce the strongest odor. By "air drying" the skin folds you introduce oxygen which impedes growth of these bacteria as well as it removes moisture needed for their growth. If you are overweight and sweat a lot, you will have to take breaks in privacy where you lie down or sit with your legs very wide apart and with no underwear, until the skin dries out. Doing this several times a day may significantly help this problem and certainly you should try to air dry right after voiding each time. I am not aware that any of your medicines would cause a skin odor but it certainly is possible because most prescription medicines are not naturally occurring human chemicals. Ampicillin is a compound that causes an asparagus type smell to the urine so the question you ask about medicines causing some of this is a very good one. You will have to work very closely with your doctor as far as trying to go without a medicine for 3-4 days to see if it makes a difference in the odor. I am not sure I would recommend this until you look more at skin bacteria in a constantly moist environment as the main cause. There are some metabolic diseases such as diabetes and liver cirrhosis that can be associated with an increased body acetone or amine odor. Your doctor should be able to easily check you out for those. There is also a metabolic condition called trimethylaminuria in which your body abnormally secretes an odorous chemical in the sweat and urine that comes from bowel bacteria breakdown of food products such as eggs, fish, soy, and liver. Total elimination of these foods from your diet for about 2 weeks would be recommended to see if it makes a difference. Finally, you did not mention that you noticed the odor as strongly as the children. As aging takes place, sometimes our own sense of smell declines or we become very used to an odor since we live with it all the time. You will need to be your own detective about his to see if a decreased sense of smell on your part can be playing a role in not recognizing the problem soon enough to prevent a concentrating odor. Some additional tips for body odor control: have a daily aerobic workout before going to work - this can help dissipate sweat gland compounds and then bath or shower before work to remove as much skin bacteria as possible - this will help daytime odors avoid seafood, soy, liver and egg yolks as well as pungent vegetables such as onions, garlic asparagus etc., for awhile to see if this makes any difference minimize stress and any sweating at work if possible - if you feel you have excessive sweating, ask your doctor about medications to help this. keep the perineal area clean and dry especially in the skin folds Perineal odor ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 4. Chance of developing hypertension in your lifetime ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ As a person ages, it is common for their blood pressure to rise. In fact it used to be taught to physicians that the systolic pressure (140 in a 140/90 blood pressure measurement) was naturally 100 plus your age when you got to 50 or older. This is not true, but for many years it was a rule-of-thumb based upon the premise that most older individuals developed higher blood pressures. The lower number in the blood pressure (diastolic, 90 in the 140/90 measurement) should not rise as much with age, however. Stage 1 hypertension is defined as a blood pressure of 140/90 mm Hg or over and Stage 2 hypertension is a blood pressure of 160/100 or more. The study below looked at data from the large Framingham Heart Study. They looked at individuals who started the study between the ages of 55 and 65 and had no evidence of hypertension. After following them to see if their blood pressure went up as they aged, the authors calculated that the residual lifetime risk for developing stage 1 or greater hypertension for study participants was 90%. It was not more or less frequent for women than men. Approximately 40% of study participants developed stage 2 hypertension. While you might think this is just an aging phenomenon, the encouraging news is that the frequency of stage 2 hypertension has actually decreased in recent years. This means it is a disease process and not just a natural physiologic progression because some individuals are managing to prevent the age progression. About 60% of both men and women received anti-hypertensive medication at sometime in their life. This indicates that many people either try to treat the high blood pressure with only lifestyle modification or perhaps they or their doctors do not think the pressure was elevated enough to begin medical treatment. Chance of developing hypertension in your lifetime ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5. Cysts in the liver found on ultrasound ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ With all of our modern medical imaging technologies such as ultrasound, CAT scans and MRIs, more and more often we come across an abnormal x-ray finding that surprises us. An imaging report such as cysts in the liver is not uncommon at all. Before such powerful x-ray techniques ere available, liver cysts were only discovered when they were quite big and causing symptoms just from their size alone. Now we know that liver cysts can often occur on their own, not produce any symptoms, and be left alone without any problem. Many liver cysts are present from birth as the result of the developmental process when the liver was being first formed. There may just be one or two cysts or multiple cysts called a polycystic liver condition. Sometimes the liver cysts can be the result of infection by parasites although the radiologist should have been able to tell that. Cystic tumors and abscesses are also possible causes of liver cysts but again, the radiologist should be able to tell if those are possibilities. Most of the time the report just indicates simple cysts(s) of the liver and it is assumed that they are of the simple cyst, congenital origin and do not need any treatment. Occasionally liver cysts can become very large and cause pain in the right abdomen just below the ribs or even pain with taking a deep breath. When these simple cysts become big and cause symptoms, the most common treatment is surgical. It may involve use of the laparoscope to remove the top of the cyst or the surgery could be more major and require a large abdominal incision. Cysts in the liver found on ultrasound ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6. Health tip to share - Food cutting boards ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ While experts agree that an ideal type of cutting board for food preparation would be non porous and easy to clean, the word is not in on whether plastic, wood, ceramic or glass are the safest. All of them depend upon cleaning in between uses, especially when meat or poultry is cut on the board. You need to wash the cutting board after cutting meat on it before using it for vegetables or fruits. If the board cannot be washed in between types of foods, a chlorine bleach solution, 2 teaspoons (10ml) of liquid chlorine to a quart of water, should be used to wash the board or use a commercial antibacterial cleanser. If you use a wood board to cut, be sure to make up a bleach solution to soak the board after every use. - FRJ Cross contamination from cutting boards 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 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "ER Visit" I am five feet, three inches tall and pleasingly plump. After I had a minor accident, my mother accompanied me to the emergency room. The triage nurse asked for my height and weight, and I blurted out, "Five-foot-eight, 125 pounds." While the nurse pondered over this information, my mother leaned over to me. "Sweetheart," she gently chided, "This is not the Internet." ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ That's it for this time. Your BACKUPMD on the Net. Rick Frederick R. Jelovsek MD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
****** Woman's Diagnostic Cyber Newsletter ******* March 24, 2002 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Biweekly from Woman's Diagnostic Cyber ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. What is a heart arrhythmia? 2. Pregnancy at an older age 3. Reader submitted Q&A - What estrogens for menopause 4. Low birth weight infants from infertility treatments 5. About prostate cancer 6. Health tip to share - Breast cancer without lumps 7. Humor is healthy If you change your email address, don't forget to 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. What is a heart arrhythmia? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ The electrical system that controls our heart rate is an amazingly precise system. It accommodates our different emotions and physical activities 24 hours a day, 7 days a week for over 70 years, on the average, without failure. Sometimes the conduction system can develop abnormal electrical activity and when it does, that is known as a heart arrhythmia. If you want to understand arrhythmias, you must understand the normal conduction pathway. Blood comes into the heart in the right upper chamber (atrium). It is pumped down to the right lower chamber (right ventricle) and then out to the lungs to receive more oxygen. This oxygenated blood returns from the lungs to the left upper chamber (left atrium) and then is pumped to the left lower ventricle for distribution to the rest of the body. The pacemaker of the heart is located near the top of the right atrium and is called the sino-atrial node. The electrical impulse to trigger the heartbeat essentially starts at the sino-atrial node in the right atrium and spreads over the both upper chambers. As the impulse spreads over to the lower chambers, it crosses a specialized electrical conduction tissue called the septum. The tissue there takes the electrical signal from the top chamber, slows its progression down slightly, and then passes it on to specialized fibers that transmit the impulse across the ventricle chambers to signal these muscles to contract and pump blood to the lungs (right) and rest of the body (left). The slowing down of the first impulses allows the atria to contact first and then fractions of a second later, for the ventricles to contract. Whenever this normal sequence of electrical conduction is disrupted, an arrhythmia occurs. It can be due to extra electrical impulses starting at locations other than the sino-atrial node (premature atrial or premature ventricular contractions, atrial tachycardia or ventricular tachycardia) or it can be due to poor conduction along the pathway which blocks some or all of the impulses from initiating a heart muscle contraction (partial or complete heart block). Sometimes the tissue that is supposed to slow down the impulse is abnormal or there is an electrical pathway around it (Wolf-Parkinson-White syndrome). There may even be a block of any starting impulses from the node or a complete block of any impulses being transmitted to the ventricles. Some arrhythmias are caused by damage to the normal heart muscle such as that from a heart attack. Most abnormal heart rates however are just due to these abnormal electrical impulses that we do not understand. Any arrhythmia that alters normal blood pumping action enough can be life threatening, although most times a common arrhythmia such as premature ventricular contractions (PVCs) gives no problems at all except an occasional awareness of a "pounding heart". Symptoms to look for that may indicate a heart arrhythmia are: a pounding heart rate or pulse, shortness of breath, dizziness chest discomfort or pain Since these same symptoms can be caused by other conditions, a physician should be consulted to detect if the heart is likely to be the source of these symptoms. Sometimes a 24 hour EKG type of heart monitoring is needed to pick up the abnormal rhythm if it does not occur all of the time. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2. Pregnancy at an older age ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ How old is too old for pregnancy? While the ideal pregnancy outcome is for women who deliver between ages 15 and 30, many women delay childbearing until after 30. Pregnancies in the 40's are not that uncommon either and rarely, there are pregnancies in the early 50's. Pregnancy at a later age has some more risks to it but for the most part they are not excessive risks. With age comes a higher incidence of uterine fibroids. These can decrease the chance of conception but if a woman does become pregnant with fibroids in the uterus, growth of the baby must be closely watched. High blood pressure is more common with advancing maternal age as well. Perhaps one of the worst daily reminders of being pregnant after 35 or 40 is just the general bony and muscular aches and pains that occur more often during the antepartum course. The mother over 40 has a much higher rate of cesarean section due to poor labor, fetal distress and abnormal presentation problems (the baby is not directly head first). Even a greater chance of having a baby with a birth defect is a standard risk for the older mother. This risk can be discovered mostly by an amniocentesis procedure which involves a needle stick to the abdomen of the mother to draw off fluid from the baby's bag of waters. So this adds another hassle to the older mother's pregnancy because it is recommended for any mom who will be over the age of 35 when she delivers. All of these problems add up for the mother who becomes pregnant after 35 but they are not surmountable problems and they do not raise the risk so high that a woman should be talked out of becoming pregnant if she really wants to. If you or a woman you know wants a pregnancy but is afraid her age is a barrier, please suggest seeing a physician who can explain the magnitude (or lack of great magnitude) of what she might face. Pregnancy at an older age The Complete Guide to Pregnancy After 30 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3. Reader submitted Q&A - What estrogens for menopause ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Two questions this week have a similar thread. "This is a general question. Is taking Estroven (R) (sold over the counter at pharmacies) harmful in anyway? This is a natural soy plus vitamin B6, E, black cohosh, Kava Kava etc. product. Can women without menopausal symptoms take this product?" - Kay "Aside from contraception, what medical indications would lead you to prescribe a non- human hormone (Premarin(R), Provera(R), ...) in preference to a human estrogen or progesterone?" - DRW To the best of my knowledge and from what I could find in the scientific literature, Estroven (R) is not harmful if taken at the suggested dose of one capsule per day. The only thing you have to remember is that there is only a small amount of calcium in it (150 mg or about 10% of what is recommended per day if you are not taking estrogens in the menopause). So if you are using it for your total calcium source then it would be harmful by omission. The isoflavones in it from the soy content should be helpful with hot flashes and they may help slow down bone loss after the menopause also. The black cohosh component is probably not effective one way or the other but it is not harmful. There are several different Estroven(R) products as you may know. The original formulation for menopause, one for memory and concentration, one for bone density, one for mood and one for PMS. They are all combinations of different herbs and do not have the same amount of isoflavones (plant estrogens) in them as the original formulation. I do not think from their components they are harmful. The one for mood has St John's Wort in it and there are always some cautions about taking it with prescribed mood medications containing monoamine oxidase inhibitors, but this has not turned out to be a real problem at the doses used that I know of. You can take it even if you are not menopausal. The estrogenic plant components (isoflavones) are not very potent at all and since they do not stimulate the uterine lining to any great degree, they should not cause a problem at all. They actually may help some perimenopausal hot flashes. Like many herbal and plant remedies, the safety profile for Estroven(R) should be much better than many prescribed medications. The efficacy is less, but that is the trade-off people make. Within prescribed estrogens, the conjugated equine estrogens (Premarin(R)) have some similarities to herbal medications in that they are composed of multiple different estrogenic substances in small amounts. There are over 10 different estrogenic compounds in Premarin(R) and over twice as many other chemicals, some of which have been shown to have a beneficial effect on the heart and other systems. The aggregate of these 30+ compounds are like herbal medicines that are safe because of such small doses of one or a few components that might give an adverse effect but a synergistic beneficial effect among the rest of them to produce a clinically beneficial effect. Even when compared to generic conjugated estrogens, there is a slower, time release characteristic of the original equine estrogens (Premarin(R)) than with the synthetic conjugated estrogens. The main cardioprotective effects of Premarin may be due to one particular component that seems even better than pure estradiol (natural estrogen) as far as its effect at dilating coronary blood vessels. Premarin was approved for use in the late 1940's and we have a much more extensive scientific experience than we do with the natural estrogens (estradiol) which were used in large scale studies mainly in Europe. The studies showing lower colon cancer incidence and lower Alzheimer's disease incidence was mainly collected from conjugated estrogen users and not from women using estradiol. In fact in animal studies looking at the protective effect of estrogens on the nervous system, the conjugated estrogens had a much more protective effect (3+) than did "natural estrogen" (estradiol)(1}+. Natural estrogen and progesterone have had a history of being quite variably absorbed from the stomach, thus producing lower levels in some women than in others. Now that they have been processed to be "micronized" they absorb in oral form much better but there still can be more variability among different woman. For while it looked as if there was a higher incidence of breast cancer associated with estrogens in Europe (where they predominantly use estradiol) than in the U.S. where conjugated equine estrogens have the largest share of the market. I could not confirm this with the scientific studies I found, but I still worry about it. So to answer your question about when would I prescribe any "non-human" hormone other than natural estradiol and progesterone, my answer is 'when first prescribing hormone replacement in a woman who has not had it previously'. The first rule of medicine is to do no harm and the conjugated equine estrogens still have the best safety profile and clinical evidence of a long term benefit in heart, colon cancer and Alzheimer's. Estradiol is certainly as good in the bone and hot flash studies as well as for vaginal and skin atrophy. I do switch to estradiol when women are having difficulty getting on the right dose for hot flash and mood problems. It is much better for measuring blood levels than with use of conjugated equine estrogens. I also use estradiol when money is a problem. Generic estradiol (but not progesterone) is very inexpensive compared to Premarin(R). I also will use it if a woman just objects to conjugated estrogens because of what she has heard and believes. I would guess that this is not the answer you expected to hear but having followed this literature for over 30 years now, my first choice to prescribe would be conjugated estrogens. with the other estrogen products being a second choice under various circumstances. I would guess my thoughts are the same as the majority of gynecologists prescribing estrogen replacement and is the same reason why women seek so many non prescription hormone replacement treatments. The popular news media has done women a great disservice by selective reporting in my opinion. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 4. Low birth weight infants from infertility treatments ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Women who undergo infertility treatments such as ovulation induction, in vitro fertilization and other advanced reproductive technologies always have a higher risk of twin and higher multiple pregnancies such as triplets, quads etc. Because multiple pregnancies often result in premature, low birth weight infants, women undergoing these treatments are at higher risk of having premature, low birth weight (below 5 1/2 lbs/2500 kg) babies. It has not been clear, however if the risk is only due to multiple pregnancies or whether singleton pregnancies are also at the same risk for lower birth weights. This study below looked at over 42,000 infants born to women who received infertility treatments. They compared those children to over 3 million children born in the U.S. in 1997. The expected low birthrate rate was about 7.2% in the general population. In women undergoing infertility treatment, the low birth rate in singleton pregnancies was 13.1% which is almost twice as frequent. This is not a reason for a woman to avoid infertility treatment but it is one of those factors that should be taken into account. Women who are just very anxious to start fertility treatment before having an adequate trial of attempting pregnancy should consider all of the risks. Low birthweight infants from infertility treatments ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5. About prostate cancer ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Men have a high frequency cancer just like breast cancer in women. Prostate cancer is the most common cancer in men and the second leading cause of cancer deaths in men. Actually it is a some what slow growing cancer and may be present in many men by age 50 and by age 80 one in every two men may have prostate cancer cells in their body. Men often die with it but not necessarily because of it. The prostate gland is a walnut sized gland that surrounds the tube from the bladder, through the penis to the outside. It manufactures semen for sperm. Symptoms of prostrate cancer often come from the mass effect of a growth that is enlarging in the prostate gland and compressing urinary tract outflow: difficulty urinating slow urine stream and dribbling irregular flow of urine stream urinary urgency both day and night painful urination blood in urine painful ejaculation during sex Early in the course of prostate cancer there are often no symptoms, so to detect it early, screening exams are needed. The two major screens are the digital rectal exam done by the doctor during the physical exam to feel the size and shape of the prostate gland through the rectal wall, and a blood test called the prostate specific antigen (PSA). This antibody test is not limited to only prostate cancer; any prostate infection, cancer or even just benign enlargement can cause an abnormal result. If a man has either an elevated PSA test or an abnormal finding on the doctor's rectal exam other imaging studies will be needed such as ultrasound, MRI, bone scan and then a biopsy of the gland itself. Cancer of the prostate can be treated well with surgery or radiation therapy if it is found early. Large tumors often need to be shrunk with hormone therapy such as Lupron (R) or other anti-hormone medications that block testosterone. The American Urological Association and the American College of Radiology recommend annual digital rectal exams and PSA blood test screening beginning at age 50 and annual PSA screening beginning at age 40 for African-American men and other men with a positive family history of prostate cancer. When you get your annual mammogram test and physician breast exam, remind any men close to you that it is their turn to suffer the screening test that can save their lives. At home prostate cancer screening test ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6. Health tip to share - Breast cancer without lumps ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Why don't most people know you don't have to have a lump to have breast cancer? My daughter was diagnosed with inflammatory breast cancer 4 plus years ago .. she continues to do amazingly well. With the proper diagnosis and treatment lives can be saved. " "Just knowing there is more than one type of breast cancer and you don't have to have a lump to have breast cancer can literally save lives. Inflammatory breast cancer is too commonly misdiagnosed as mastitis and after ten days the patient should have a biopsy. Public Awareness of inflammatory breast cancer and it's symptoms are vital not just for the general public but for physicians, nurses, technicians, etc. " - M. K. 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 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ The following list of phrases and their definitions might help you understand the mysterious language of science and medicine. When you hear the news media interview or quote a physician or scientist and they say... it may mean.... "It has long been known" ... I didn't look up the original reference. "A definite trend is evident" ... These data are practically meaningless. "While it has not been possible to provide definite answers to the questions" ... An unsuccessful experiment, but I still hope to get it published. "Three of the samples were chosen for detailed study" ... The other results didn't make any sense. "Typical results are shown" ... This is the prettiest graph. "These results will be in a subsequent report" ... I might get around to this sometime. "In my experience" ... once "In case after case" ... twice "In a series of cases" ... thrice "It is believed that" ... I think. "It is generally believed that" ... A couple of others think so, too. "Correct within an order of magnitude" ... Wrong. "According to statistical analysis" ... Rumor has it. "A statistically oriented projection of the significance of these findings" ... A wild guess. "A careful analysis of obtainable data" ... Three pages of notes were obliterated when I knocked over a can of pop. "It is clear that much additional work will be required before a complete understanding of this phenomenon occurs" ... I don't understand it. "After additional study by my colleagues" ... They don't understand it either. "Thanks are due to Joe Blotz for assistance with the experiment and to Cindy Adams for valuable discussions" ... Mr. Blotz did the work and Ms. Adams explained to me what it meant. "A highly significant area for exploratory study"... A totally useless topic selected by my committee. "It is hoped that this study will stimulate further investigation in this field" ... I quit. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ That's it for this time. Your BACKUPMD on the Net. Rick Frederick R. Jelovsek MD ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
****** Woman's Diagnostic Cyber Newsletter ******* April 7, 2002 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Biweekly from Woman's Diagnostic Cyber ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Pulmonary hypertension-High blood pressure of the lung 2. FDA advisory about Kava Kava herb 3. Reader submitted Q&A - Aspirin for heart protection 4. Stress reduction techniques 5. At what age should I get a test for colon cancer? 6. Health tip to share - Coffee and high blood pressure 7. Humor is healthy If you change your email address, don't forget to 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. Pulmonary hypertension - High blood pressure of the lung ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Not all hypertension is the same. The body has two different networks of blood vessels that are under different resting tone control. Blood is pumped from the heart to the lungs to receive oxygen and then back to the heart. From there, blood is pumped all over the rest of the body. The blood flow to the lungs is a lower pressure system and normal systolic ranges are 14-40 mm Hg. This compares to a systolic pressure of about 80-135 mm Hg in the rest of the body. Hypertension is a tightening in the diameter of blood vessels somewhat like pinching a water hose and restricting the flow of water from the hose nozzle. Both types of hypertension make the heart pump harder and can lead to heart failure over time. While systemic hypertension is most often due to atherosclerosis, pulmonary hypertension has different causes. Drugs like fenfluramine (part of the Phen-fen for dieting) or cocaine can cause the lung vessels to constrict. Emphysema is a common cause for pulmonary hypertension and chronic liver disease (cirrhosis), AIDS, sickle cell anemia, and connective tissue diseases such as scleroderma and lupus are other conditions that can cause this. About 10% of the time there is a genetic disposition to pulmonary hypertension. Sometimes we just do not know what causes high blood pressure of these blood vessels going to the lung - we call that primary pulmonary hypertension. If we do know the cause it is called secondary pulmonary hypertension. Symptoms of pulmonary hypertension are mainly those of heart failure: shortness of breath difficulty breathing with exercise dizziness racing pulse of increased heart rate swelling of the legs or feet a bluish color to your lips and skin Thus, this is a situation where you can have problems of heart failure even though your regular blood pressure measured in the arm has always been normal. Be sure to see your physician if you are at all concerned about the above symptoms. Pulmonary hypertension ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2. FDA advisory about Kava Kava herb ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ You may have heard about the warning issued by the FDA about the herbal supplement, Kava kava. This herb has traditionally been used to promote relaxation and induce sleep or to relieve stress and anxiety. Apparently there have been instances of liver toxicity associated with using it. Those instances are rare but they have caused deaths. There have been about 25 reports internationally of liver toxicity, some even requiring liver transplants. There has only been one episode reported in the U.S. but the FDA has still given a warning just in case this turns out to be a real complication. Some other countries have taken action ranging from consumer warnings about the risks of kava use to removing kava-containing products from being sold at retail. Although this seems to be a rare occurrence, any woman with liver disease such as past hepatitis, cirrhosis or taking prescription drugs known to have liver toxicity would be best to avoid taking kava until we know more. Also anyone with any adverse effects thought to associated with taking kava kava should report these events to the FDA at: FDA Medwatch FDA advisory about Kava Kava herb ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3. Reader submitted Q&A - Aspirin for heart protection ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "Should women take one baby aspirin daily?" "I am 50; complete hysterectomy 1 year ago; take Celebrex(R) daily; have mitral valve prolapse - no treatment. My doctor prescribed that I take one baby aspirin daily, which I do, but I am beginning to feel uncomfortable about it. I have read that it increases the chance of stroke through bleeding, and the dose has not been proven to be beneficial to women." - ST Aspirin is a platelet inhibitor, the blood component that causes clotting if there is blood vessel injury. It has been used after heart attacks and strokes to prevent consequences of the attack or to prevent a second heart attack or stroke. It has also been used to prevent new heart attacks in men who have never had a previous heart problem. There are some pros and cons about aspirin's use in this manner. Your reading has been right on target and the answers are not yet clear. Almost all of the studies have been carried out with men as the subjects and proven beneficial in those men, ages 45 - 70 who are at low risk for coronary events. The studies show a reduction of about 20 - 30% in the rate of non-death producing heart attacks. In other words, taking aspirin does not prevent deaths but it will reduce the number of total attacks. For men who already had high blood pressure, this treatment did not have a positive or negative effect. As to the dose of aspirin used in the studies, anywhere from 50 mg to more than a full aspirin tablet (325 mg) have been used. So the lowest effective dose is not yet clear and we know that as you increase aspirin ingested, the bleeding problems may also increase. This makes us worry about possible brain attacks (strokes) from any of the doses, but especially the higher doses. That is why doctors have settled on the lower 80 mg aspirin dose or what has been called a "baby aspirin". The overall incidence of strokes in men at low risk did not go down as the heart attacks went down. It was expected that the incidence of blood clot (thrombotic) strokes would go down if heart attacks went down because the mechanisms of clotting should be similar but there were some more bleeding (hemorrhagic) strokes that offset the thrombotic strokes so the overall incidence did not go down. That is where you heard that hemorrhagic strokes increased on aspirin but you really can't go by that because one merely balanced the other. I believe the consensus now is that the baby aspirin reduces non-fatal heart attacks by about 25% and does not increase or decrease the overall incidence of strokes in men who are at low risk for heart problems. Women tend to be about 10 years later than men in starting their heart attacks so it has been recommended as a cardiac event preventative in women over age 50 who are not already at high risk for heart problems. The truth is we will not know if it works in women until completion of the Women's Health Study in 2004 which is testing low dose aspirin and vitamin E for cardiac protection in a randomized, controlled trial. Before you decide whether or not to continue taking the baby aspirin a day (or every other day as the Women's Health Study is doing), keep in mind that while aspirin may reduce the cardiac events by about 25%, a Mediterranean diet consisting of olive oil, pasta, fruits, vegetables, fish, and wine, is also associated with a low rate of cardiovascular events (over 35% reduction). There are probably many healthy habits that can reduce your risk for heart attacks just as much as an aspirin can. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 4. Stress reduction techniques ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Stress and anxiety can cause medical problems if left unchecked. It is essential to learn how to reduce stress for your own long term health. There are basically two ways to attack stress. One way is to identify exactly what is the trigger that causes stress and change your thought process to minimize your own emotional reactions to the trigger. This is extremely difficult to do on your own because it takes a constant effort and insight as to what your emotional thought process really is. The second stress attack method is to use anti-stress techniques to relax your mind and the body's physiological response to that stress. This is very successful as a stress buster and anyone can do it. While stress relaxation only treats the symptoms and not the cure, it is a very useful tool in our everyday lives. The preface to any relaxation technique is to reduce your mental load "to do" list. Most of us get aggravated by overloading ourselves with tasks and errands. Make a written list for the day and then eliminate those tasks you don't absolutely have to do. Just put the essentials on the list. Secondly, you need to create a good ambience for stress relaxation. Quiet spaces, soft music, outdoor light or cozy corners help set the stage. Immediate techniques to handle stress might include: distraction relaxed breathing counting to 10 muscle isometrics facial massage visualization laughing or crying End of the day relaxation activities might include: warm bath warm drink sit in the sun drawing music Finally, remember to get enough sleep and exercise. Finding a daily 30 minutes for some physical activity is difficult due to anxiety and overloading your daily tasks but if you have no time for exercise, that is the time you need it the most. You may want to look at this site that has some practical tips. Stress reduction techniques ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5. At what age should I get a test for colon cancer? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Current screening recommendations are divided into those for women and men at low or average risk for colon cancer versus different recommendations for those at higher risk. Most people are at average risk if you do not have a family history of colon or rectal cancer, hereditary non polyposis colorectal cancer, familial adenomatous polyposis or ulcerative colitis. While there are different recommendations from different agencies and organizations, the essence of them are that all low to average risk women and men aged 50 or older should be screened for colorectal cancer with yearly fecal, occult blood testing (FOBT), a flexible sigmoidoscopy every five years, or both. Fecal occult blood testing involves a smear on a piece of special paper of a stool specimen from the glove after a rectal exam by the doctor or nurse. This is then tested by adding a drop of a special dye. A color change indicates blood in the stool. Another FOBT method is to drop a dye impregnated piece of paper in the toilet after a bowel movement and to look for a color change that would indicate blood in the stool. These at home tests are available on the internet or at some drugstores. The flexible sigmoidoscopy test requires you to have a bowel prep in which you take laxative agents to clean out the stool in your colon and rectum. Then in the doctor's office or sometimes in the outpatient hospital surgical suite, you are given sedation (but not put asleep) and a cord- like, well-lubricated scope is placed into the rectum and threaded up the colon to visualize any polyps or cancer areas. You are at high risk for colon or rectal cancer if you have one or more parents, brothers, sisters or children (first degree relatives) with a history of colon cancer. If that relative was diagnosed with cancer at age 55 or greater, then you should have the sigmoidoscopy every 5 years, FOBT testing annually or both, STARTING at age 40. If that relative was under age 55 when diagnosed, or if you have two first degree relatives with colorectal cancer, you need to have the complete colon exam every 5 years starting at age 40 or starting 10 years before the age at which the youngest relative was diagnosed with colon cancer. Those are some helpful guidelines for preventative medicine and screening for colon and rectal cancer. But what if you get symptoms? Which conditions warrant immediate testing for colon cancer? The following circumstances should alert you to see your doctor for further testing. unexplained iron deficiency anemia any rectal bleeding of undetermined cause sudden narrowing of the caliber of bowel movements anyone with long-standing (> 8 years) chronic ulcerative colitis or Crohn's Colitis Colorado guidelines for colon cancer screening Recommendations for different at risk groups ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6. Health tip to share - Coffee and high blood pressure ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Coffee drinking can raise the blood pressure slightly but on the average, it does so by less than 1 mm systolic and 1 mm diastolic. Drinking less than 5 cups of regular coffee per day does not cause long term hypertension. Caffeine in any amount, however, worsens fibrocystic breast disease, PMS and just plain stress. Coffee and hypertension 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 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Inner Strength If you can start the day without caffeine or pep pills, If you can be cheerful, ignoring aches and pains, If you can resist complaining and boring people with your troubles, If you can eat the same food everyday and be grateful for it, If you can understand when loved ones are too busy to give you time, If you can overlook when people take things out on you when, through no fault of yours, something goes wrong, If you can take criticism and blame without resentment, If you can face the world without lies and deceit, If you can conquer tension without medical help, If you can relax without liquor, If you can sleep without the aid of drugs, THEN YOU ARE PROBABLY THE FAMILY DOG.
****** Woman's Diagnostic Cyber Newsletter ******* April 21, 2002 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Biweekly from Woman's Diagnostic Cyber ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Body piercing and tattoos 2. Diabetes dangers in women 3. Reader submitted Q&A - Rectal pain 4. Postpartum Depression 5. Dementia treatment to improve quality of life 6. Health tip to share - Pill identifier 7. Humor is healthy Spread the word! Send a copy of this newsletter to someone you know. The next newsletter will be in two weeks. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1. Body piercing and tattoos ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Rings through body parts or dye injected in various areas of skin are assaults on our protective barriers that can become infected, bleed, or even tear. Besides bacterial infection, those who get tattoos are at risk for hepatitis C. In fact women with tattoos have a 6 times increased incidence of hepatitis C. The Red Cross will not allow someone recently tattooed to donate blood within a year of the tattoo procedure. Other infections include HIV, tuberculosis and tetanus. These can originate from instruments and needles that are not sterilized. Piercing guns for earrings and body rings are notorious for introducing skin infection since they are not easy to sterilize. Also you have to watch out for rings and posts that are allergenic. Many irritative metals promote infection. Only use stainless steel (300 series), gold, niobium, titanium or platinum that has been sterilized in the autoclave. Some women will pierce their tongue, nipples or genitals with the intent of increasing sexual pleasure for themselves and their partners. The problem is that bacteria from the other person gets in the pierced holes and commonly leads to a chronic infection that causes pain and permanent scarring. If you are going to get a tattoo or have a body part pierced, be sure to check out the cleanliness of the establishment. The person who does the piercing or tattoo art should wear gloves. Instruments should be soaked in disinfectants or processed in a sterilizer machine (autoclave). They should be willing to discuss health and safety issues as well as the training they have had. Finally, when you have had enough of body art display and want it removed, see this article at Mayoclinic.com for tips on removing the tattoo with excision, laser surgery. dermabrasion or salabrasion. Body piercing and tattoos: More than skin deep ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2. Diabetes dangers in women ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Both patients and doctors have a tendency to treat diabetes lightly. After all, it is quite uncommon for someone to die in insulin shock or a high blood sugar crisis. To most people without diabetes the condition seems to be only associated with complications in the later years of life. But did you know that women have diabetes more frequently than men and they are at greater risk for diabetes-associated heart disease and blindness than men are? Not all women with diabetes develop heart disease but almost half do. And women with heart disease die from heart attacks more frequently than men do. Whether this is because the degree of heart disease is underdiagnosed in women or because they just have an inherently increased cardiovascular reaction to the diabetes compared to men is unknown at present. A major effect of early diabetes is to reduce sexual functioning in both men and women. In men, the diabetes effects sexual functioning through the vascular and local nerve systems making it more difficult for men to have an erection. Diabetes has a different effect on women's sexuality though. For them, sexual health becomes impaired more by depression and frustration with diabetes treatment than it does by effect on the local vascular and nerve system of the genital tract. Feeling unhealthy, afraid or unattractive causes more sexual dysfunction from diabetes in women more than it does in men. The answer to this potential health problem is early detection and aggressive early treatment including weight reduction along with medications to improve sugar tolerance. If you have ever been diagnosed with gestational diabetes (sugar intolerance during pregnancy) or polycystic ovarian syndrome, it is especially important to maintain your ideal body weight and frequently check for diabetes or pre-diabetes through special tests from your physician. Diabetes dangers in women ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3. Reader submitted Q&A - Rectal pain ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ "Do you have any information on the disease called Levator Ani syndrome? How can it best be treated? Are there any natural supplements that could help treat it? Is there a web site on the disease?" - E. T. Levator syndrome is a condition in which there are muscle spasms in the rectum that produce pain. The episodes of spasm may last several seconds or many minutes at a time. In severe cases the pain can last for hours. The pain is unrelated to having a bowel movement and it is more likely to be associated with sitting or just occur randomly. This problem also goes under other names such as proctalgia fugax or coccydynia. The pain can easily radiate to front of the pelvis where the bladder is, the perineum, buttocks and even the legs. Thus it can mimic back, pelvic and urologic disease so sometimes the presentation is not as straight forward as it seems. To diagnose this condition. the doctor needs to perform a vaginal and a rectal exam to put pressure on the various muscles of the pelvic floor to see where the pain is originating from. To see if the tail bone (coccyx is a major source of the pain, an injection of local anesthetic and steroid into the joint of the coccyx and the sacrum may need to be performed. Almost instant pain relief from this injection would confirm that the coccyx is the main source of pain. No one knows the cause of the muscle spasms. In some cases it has even been proposed that the muscles in spasm are the lower colon and not the anal sphincter muscle. In that case this would be a variant of irritable bowel syndrome. Others believe that prolonged sitting on a soft seat that puts pressure on the tail bone (coccyx) can be a major cause of this problem. Treatment is mostly symptomatic for this benign, but painful condition. Heat from a sitz bath or a mild analgesic pain medicine is used. Sometimes muscle relaxants such as Valium (R) or Xanex (R) are needed. Anal sphincter massage can also be used to reduce the spasm and physical therapy, involving a mild electrical stimulation to the muscles can be helpful, in decreasing recurrences of these spasms. I do not know of any natural products that have been tested on levator ani syndrome. It would make sense, however, to try calcium and magnesium supplements which sometimes help muscle spasms in general. Peppermint is thought to help bowel spasms in general and might also be worth a try. It should not be harmful for this at least. Finally, I could not find a web site that is dedicated primarily to levator syndrome. It is not a common problem so there is not a big collection of experience that I know of. The best course is probably to find a gastroenterologist, a colon and rectal surgeon or a urogynecologist who will work with you on trying various approaches to this unusual problem. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 4. Postpartum Depression ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ There is a very good reason to know about postpartum mood illness even though you may never have a future pregnancy yourself. It is not to diagnose your own health that this knowledge is important; it is to help relatives or friends. When postpartum depression strikes, a woman is unable to lift herself out of the depths of sadness, lack of energy, or guilt feelings. While she may think she can fight it on her own, she can't. Control over actions and thoughts is lost and she needs someone to look out for her until significant time passes. Probably 60-80% of women have some degree of "postpartum blues" over the several weeks following delivery of the baby. For most women this period passes without significant long term effects or permanent harm to the mother or baby, but it does not mean that it is not a painful period to experience. Both our culture and physicians seem to be unconcerned about postpartum blues. Everyone seems to focus only on the extreme case in which there is a full blown postpartum psychosis that results in a mother harming herself or her child. Actually there is a category between mild "blues" that last for several weeks or so and a full psychotic loss of reality. Let us call this "postpartum depressive illness" or "chronic depressive disorder", realizing it is but a part of the collection of postpartum depression that also includes "blues" as well as "psychosis". It is still poorly defined but is characterized by "despondency, tearfulness, feelings of inadequacy, guilt, anxiety, irritability and fatigue." This postpartum depressive illness category probably comprises about 5-20% of women after delivery but it is the group that you can help the most just by recognizing that it exists. These women rarely seek help on their own. While over 90% of them realize something is greatly wrong, less than 20% report it to a health care provider. To understand it, you may want to read this book by Marie Osmond: Behind the Smile: My Journey Out of Postpartum Depression What you can do to help is to ask questions of the new mother each time you see her: What is her energy level? Has she worried about harming herself or the baby? Does she feel hopelessness? If any of these are yes, she needs to see a professional right away.