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Women's Health Newsletters 11/17/02- 1/26/02




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****** Woman's Health Newsletter *******
             November 17,  2002
Biweekly from BackupMD on the Net

1. Mild endometriosis and chances to conceive
2. Stress fractures
3. Reader submitted Q&A-Repeat miscarriage
4. Women and men "feel" strokes differently
5. Health tip to share - Effexor XR(R) continued
6. Humor is healthy

1. Mild endometriosis and chances to conceive

The optimal treatment for women with minimal and 
mild endometriosis (stages 1 and 2) in order to 
improve their chances of conception, is not 
totally clear. Many studies have suggested that 
neither surgery nor medical treatment really 
improves the chances of getting pregnant for early 
stage endometriosis. Stage 1 and 2 endometriosis 
involves small spots of powder burn-like lesions 
(tissue from the uterine lining) located in the 
abdominal cavity. These lesions are usually behind 
the uterus but do not involve adhesions (scar 
tissue) or the ovaries or bowel. Stage 1 has only 
a few lesions (typically less than 10) that are 
not very deep while stage 2 has more and deeper 
lesions but again not involving the ovaries or 
bowel or adhesions. Although the criteria surgeons 
use are somewhat subjective, it has served as a 
useful classification to distinguish different 
degrees of endometriosis spread. 

The following study from Greece looked at 151 
women who were diagnosed with stages 1 and 2 
endometriosis and who wanted to become pregnant. A 
third were treated with laparoscopic excision and 
cautery of the endometriosis, a third were given 
medical therapy and a third were given no 
treatment at all. The women were then followed for 
two years. Pregnancies occurred in 36.7%, 30.5% 
and 20.9% respectively. Not all pregnancies 
resulted in live births but 30.6%, 25.4% and 16.2% 
respectively continued beyond the first trimester 
when most miscarriages occur. 

Keep in mind that over two years, about 60-80% of 
normally fertile women will become pregnant. This 
study points out the reduced pregnancy rate with 
endometriosis. It also points out that it is 
possible to become pregnant even without any 
treatment but at a low rate (16%). Endometriosis 
is still an enigmatic disease that needs further 

Endometriosis stage and ability to conceive

2. Stress fractures

Too much exercise too soon. That's the cause of 
tiny stress fractures of the bone. Women are more 
prone to them than men, presumably because of less 
muscle mass to protect bones from high impact 
exercises. Stress fractures occur when the muscles 
become tired and the bones of the feet and legs 
have to absorb the impact of running or jumping. 

Joggers, basketball players, tennis players, 
gymnasts and volleyball players are very 
susceptible to stress fractures but the most 
frequent injuries occur to casual exercisers who 
try too much too soon. After the winter season 
when individuals decide to rid themselves of 
winter fat, physicians start to see foot and leg 
pain that ends up being diagnosed as stress 
fractures. Even prolonged walking and hiking as 
exercise can lead to stress fractures. 

MRI may be used to diagnose stress fractures since 
they may not always show up on conventional x-
rays. Even if you develop a "plantar fasciitis" 
from walking, you may want to have an MRI to make 
sure the persistent pain is not from a stress 

Treatment of a stress fracture is merely to avoid 
the activity that caused the fracture. The bone 
does not need to be splinted or cast. It just 
needs to avoid any repetitive trauma. Stress 
fractures can heal on their own if given time. 
Additional treatment includes: 

Ice the area to reduce swelling and pain. 
Elevate the area to relieve symptoms. 
Control pain with acetaminophen (Tylenol(R), 
   others) or ibuprofen (Advil(R), Motrin(R)). 
See your doctor if pain lasts longer than 2-3 days 

3. Reader submitted Q&A - Repeated miscarriage
"What sorts of things can cause a woman to 
spontaneously miscarry a fetus only a few weeks 
after conception?" 

"I'm 38 and the few times in my life I have 
managed to conceive, I lose the fetus right away, 
with 2 weeks of the positive home pregnancy test 
(or within 3-4 weeks after conception)- too fast 
for me to even get into to see a doctor. I and my 
partner (of three years) were treated for a 
mycoplasma infection found 2 years ago, but my doc 
could not find anything else wrong. Hormone test: 
progesterone & testosterone levels are higher than 
average but still barely within normal limits. 
Estrogen was within normal limits but the ratio of 
estrogen to the other hormones was low. (I've been 
experiencing perimenopausal symptoms for 2 years). 
This miscarriage problem dates back to when I was 
only 16 and has occurred at least three or four 
times over the last 22 years; I've never been able 
to carry longer than those few weeks. I'm still 
childless and running out of time." - LSB 

Miscarriages are more common than most people 
think. It is estimated that 1 million of the 6 
million pregnancies each year in the U.S. end up 
as a miscarriage. For any one pregnancy, a woman 
has about a 1 in 7 chance of miscarrying. As many 
as 5% of couples have 2 miscarriages in a row and 
about 1% of couples have 3 miscarriages in a row. 
This situation is often labeled as habitual 
abortion although a better term is recurrent 
pregnancy loss (RPL). 

Frequent miscarriages are of great concern to many 
women even though statistically a woman who has 3 
miscarriages in a row still has a 50-70% chance of 
conceiving and carrying a normal pregnancy the 
next time she becomes pregnant. I find that the 
biggest problem is the discouragement that women 
have. Often they are unwilling to try again 
faced with the prospect that there can be up to a 
50% chance they would miscarry. When this problem 
occurs, couples are very susceptible to any 
diagnosis and treatment suggestions that doctors 
offer - perhaps sometimes too much so. 

There are some conditions that seem to predispose 
to recurrent loss. After 3 miscarriages, the 
typical diagnostic studies and procedures that are 
recommended are: 

Laboratory Tests  
thyroid stimulating hormone (TSH)- to detect hyper 
   or hypothyroidism  
serum progesterone (day 21-22 of cycle) - to 
   detect adequate corpus luteum function  
parental (both) blood chromosome analysis - to 
   determine if there might be a hereditary genetic 
lupus anticoagulant - to detect antiphospholipid 
anticardiolipin antibodies -  to detect 
   antiphospholipid syndrome  


hysterosalpingogram or hysteroscopy - to detect 
   anomalous shapes of the uterus 
pelvic ultrasound - to detect fibroids of the 

It sounds as if your doctor has concentrated on 
possible hormone abnormalities although those have 
not really been shown to be a cause of recurrent 
pregnancy loss. You might try a second opinion 
from another gynecologist or a reproductive 
endocrinologist and discuss if you need some of 
the above studies. You are now old enough that age 
plays a role that it may not have when you were 

4. Women and men "feel" strokes differently
Common symptoms of a stroke include difficulty 
speaking, facial muscle paralysis or weakness, 
dizziness and areas of numbness over the arms, 
legs or body. Many women, however, do not always 
present with these classic symptoms but rather 
they describe atypical stroke symptoms such as 
pain in the arms and legs, disorientation and 
changes in consciousness. Almost 30% of the time 
women have stroke symptoms not usually described 
as typical signs. 

Part of the difference may be that women 
experience more bleeding (hemorrhagic) strokes 
while men experience more occlusion of the blood 
vessels (thrombotic strokes) in the brain. This 
difference, however, does not totally explain why 
many women have different stroke symptoms than 
men. Some investigators think that the symptoms 
are the same but women just describe them 
differently than men. (That may be true but my 
wife believes it is because women use both sides 
of their brain to think and describe while men 
mostly use only one side! From my point of 
thinking, she may be half right.) 

Women also suffer more strokes than men (62% of 
stroke deaths) but investigators point out most of 
the difference is due to living longer than men, 
since strokes increase in frequency with age. Non 
neurological signs also described more often by 
women having strokes, are chest pain and shortness 
of breath. 

The bottom line is that women should be aware of 
this variation in symptoms and seek out diagnosis 
if there are acute episodes of arm or leg pain, 
disorientation, loss of consciousness (fainting) 
or chest pain and shortness of breath. 

Women and men feel strokes differently

5. Health tip to share - EffexorXR (R) continued

"Just wanted to tell the lady who is on Effexor XR 
for night sweats that I had to stop taking it (at 
the same dose, 75 mg, which she stated is a small 
dose and it is actually a very common dose) 
because it increased my appetite greatly and I 
gained 12 pounds in 2 1/2 months.  It also made me 
lethargic.  Be careful driving on it!" - Suzy 

[editor note - This just reminds us that health 
tips or any suggested medical therapies do not 
always work the same for everyone. Be cautious 
with medications but at the same time don't reject 
a recommended alternative treatment just because 
it did not work out for someone you know.] 

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

6. Humor is healthy
"Games For When We Are Older..... "

Remember the games you used to play at birthday 
parties when you were young? Capture your youth 
again at your next birthday with these matured-
with-age games: 

1. Sag, You're it.

2. Pin the toupee on the bald guy.

3. 20 questions shouted into your good ear.

4. Kick the bucket.

5. Red Rover, Red Rover, the nurse says Bend Over.

6. Doc Goose.

7. Simon says something incoherent.

8. Hide and go pee.

9. Spin the bottle of Mylanta.

10. Musical recliners.

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

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****** Woman's Health Newsletter *******
              December 1,  2002
Biweekly from BackupMD on the Net

1. Alternative arthritis treatments
2. Growth hormone for older women
3. Reader submitted Q&A - Aortic aneurysm
4. Beta blocker meds help the heart
5. Health tip to share - Cranberry juice for odor
6. Humor is healthy

1. Alternative arthritis treatments

Arthritis sufferers are well known to be willing 
to try almost any alternative medical treatment in 
order to obtain relief from the almost constant 
joint pain. Many alternative treatments are 
advertised as "natural". You must remember, 
however, that natural does not always equate to 
"safe". Some treatments may have scientific 
evidence suggesting they may help while most are 
unproven and some are even dangerous because of 
side effects or impurities in manufacturing. 

Herbal treatments such as evening primrose oil and 
capsicum for rheumatoid arthritis and ginger as a 
treatment for osteoarthritis may have some 
benefits. Most other herbs have not been shown to 
be beneficial. One example is a Chinese medicine, 
Tripterygium wilfordii Hook F (TwHF) to treat 
inflammation and musculoskeletal injuries but it 
it becomes toxic at high doses. 

Certain nutritional supplements have received 
attention and may be beneficial for arthritis. The 
best data exists for glucosamine use with 
osteoarthritis. Chondroitin sulfate may have 
similar benefits also although the data is not as 
clear. Vitamins C, D and E have shown some promise 
in osteoarthritis although too much vitamin A may 
worsen it. S-adenosyl-methionine (SAM-e) is 
another supplement that has been used and it may 
help with the pain of arthritis. More trials need 
to be conducted but there is promise for SAM-e. 

Metals have also been used. Copper bracelets are 
ineffective but harmless whereas gold injections 
may have a positive benefit but side effects can 
be significant. Magnets have also been used but 
there is little good data to support their use. 

Many other modalities have been used to combat the 
pain and inflammation of arthritis such as 
relaxation techniques, acupuncture, aroma therapy 
and others. All have had mixed results. Sometimes 
food allergies may be linked with arthritis but 
dietary changes should only be based on food 
allergy testing otherwise it is almost impossible 
to tell what foods to eliminate. 

The urge to try additional treatments for 
arthritis is real, but try to use some judgment 
before investing heavily in time and money to self 
test these alternative treatments. 
2. Growth hormone for older women
Some think growth hormone is the fountain of 
youth. There is evidence that it increases muscle 
mass in older adults just like your body did when 
you were a teenager. Growth hormone has to be 
given by injection and it is terribly expensive so 
it is not likely to be used on a large scale basis 
at the current time. Unscrupulous entrepreneurs 
have taken advantage of the theoretical benefits 
of growth hormone by offering derivatives, 
chemical precursors and even animal growth hormone 
sources to entice money from those who want to 
stay young forever.  These products do not work! 

As investigators have begun to study the potential 
of growth hormone, one of the questions that needs 
to be answered is what are the interactive effects 
of growth hormone (GH) and sex steroids such as 
estrogen in women or testosterone in men. We need 
to know if the sex steroids have any influence on 
muscle strength and endurance. The following U.S. 
study of community dwelling men and women lasted 
26 weeks. They gave growth hormone and placebo as 
well as sex hormones and placebo to 57 women and 
74 men testing all combinations. 

Women increased their lean body mass by about:

0.8 lb on placebo
2.5 lbs with hormone replacement therapy (HRT) alone
2.2 lbs with growth hormone alone
4.6 lbs with growth hormone plus HRT

Men had similar changes.

All of this weight was muscle mass and not fat. 
There were some side effects. Women had no 
significant change in their strength or 
cardiovascular endurance. They also had a problem 
with edema when taking growth hormone alone or 
growth hormone plus HRT. Men had problems with 
diabetes and glucose intolerance as well as joint 

While there may be some medical benefits from 
growth hormone, it does not appear to be a 
fountain of youth and there are side effects from 
the treatment. Hopefully further studies will 
clarify when it should be used (eg. muscle wasting 
in the elderly). 

Growth hormone for older women

3. Reader submitted Q&A - Aortic aneurysm

"A year ago, I had a lower abdominal scan due to a 
mass in my left side. This turned out to be an 
ovarian cyst.  However, I saw the report, and it 
indicated evidence of an aortal aneurysm and a 
spot on my liver.  I have a history of melanoma.  
There has been no mention of the aneurysm or liver 
abnormality by either my family doctor or surgeon.  
Is this something that should be checked further?  
Should my doctor have told me of this?" - J.H. 

I think your doctor should have mentioned these 
findings to you and made a plan for continued 
evaluation. I'll bet it either was an oversight or 
the aneurysm was very small and the doctor did not 
want to "worry" you about it because most 
aneurysms do not get large and rupture. However 
there is a trend now to do screening ultrasounds 
and if the aneurysm gets bigger, then surgery is 
recommended. Such surgery is very major so it 
should not be undertaken lightly. 

In one screening study, aneurysm was defined as a 
maximum aortic diameter of 3 cm or more. Annual 
re-scanning took place if the diameter was 3 - 4.4 
cm, and at three-monthly intervals if it was 4.5 - 
5.9 cm. This protocol was continued until patients 
either died or underwent surgery or declined 
further follow-up. Aortic diameters of 6 cm or 
more, and  an increase of diameter of 1 cm or more 
in a year, or developments of symptoms 
attributable to the aneurysm all constituted 
criteria for considering surgery. 

The main symptom from an abdominal aortic aneurysm 
is back pain. It is not worsened by movement but 
is present most of the time. It is a mid back pain 
rather than the common low back pain with movement 
that many people have. A pulsating feeling in the 
abdomen and abdominal pain are other symptoms that 
people have. Because aneurysms are often caused by 
atherosclerosis, there is a higher frequency in 
men than women but women get them too. 

Until the recent improvement in imaging 
technology, most aneurysms were only discovered on 
plain x-rays if they were very big and calcified. 
Now, imaging technology has improved and we are 
realizing that aneurysms are more common. I think 
that you should be followed for this and I would 
suggest asking your doctor to be referred to a 
vascular surgeon for an opinion as to whether 
anything should be done right now. It is hard to 
tell from what you describe whether this is an 
incidental finding or something that is 
potentially serious but I would consider it 
serious until a vascular surgeon evaluates you and 
the ultrasound findings. 

The liver abnormality is probably not related to 
the aneurysm but with a history of melanoma, that 
also should be evaluated by your oncologist just 
to make sure. Now that you have seen the report 
ask the doctor about it. I'm sure that since a 
year has passed they will want another scan to see 
if either finding has changed in size. 

4. Beta blocker meds help the heart
After a heart attack, arrhythmia, abnormal heart 
rate rhythms may develop along with weakness of 
the heart muscle.  One medicine commonly used 
after heart attacks is called a "beta blocker". 
Inderal (propanolol) is the most common but others 
like Atenolol, Labetolol and Toprol XL are 
frequently used. These meds block the stimulating 
effect of epinephrine on the heart. 

A recent study shows that patients who were 
continued on the beta-blockers even long after 
their heart attack occurred still have a lower 
death rate. It was 16 % lower after two years and 
34% lower after 5 years compared to people who did 
not get continued on them. 

If you or a relative have had a history of a heart 
attack or major heart arrhythmia, be sure to 
discuss with the doctor about continuing to take a 
beta blocker. Patients who have high blood 
pressure are often continued on beta blockers but 
if there is no hypertension, sometimes the 
medication is just forgotten. 

Beta blocker meds help the heart

5. Health tip to share - Cranberry juice for vaginal odor
"Cranberry juice, everyday, helps with my vaginal 
odor.  I am diabetic and suffer from vaginal odor, 
even if I am not experiencing a yeast infection. I 
understand that vaginal odor can also be caused by 
liver and kidney function, so the cranberry juice 
makes sense. I have also heard that some herbal 
remedies intended for liver and kidney function 
improve vaginal odor." - I.N, 

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

6. Humor is healthy

A man walked into a doctor's office and the 
receptionist asked him what he had.  He replied, 
"I got shingles." 

She said, "Fill out this form and supply your 
name, address, medical insurance number.  When 
you're done, please take a seat." 

Fifteen minutes later a nurse's aide came out and 
asked him what he had.  He said, "I got shingles." 

So she took down his height, weight, and blood 
pressure, then said, "Change into this gown and 
wait in the examining room." 

A half hour later the doctor came in and asked him 
what he had. He said, "Shingles." 

The doctor gave him a full examination, and then 
said, "Well, I just checked you out thoroughly, 
and I can't find shingles anywhere." 

The man replied, "That's because they're outside 
in the truck. Where do you want them?" 

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

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****** Woman's Health Newsletter *******
          December 15,  2002
Biweekly from BackupMD on the Net

1. Diagnosing Alzheimer's disease
2. Nut and peanut butter consumption and diabetes
3. Reader submitted Q&A - SSRI side effects
4. Chronic pelvic pain from a bladder source
5. Health tip to share - Ear pain after flying
6. Humor is healthy

1. Diagnosing Alzheimer's disease
There is no easy way to diagnose Alzheimer's 
disease short of performing a brain biopsy and 
looking at nerve tissue under the microscope. So 
if you suspect one of your loved ones may be 
developing Alzheimer's disease (AD), what do you 

Doctors basically use three different modalities 
to make the diagnosis: 

interview of the patient and family to learn how 
any symptoms have developed over time 

physical exam and laboratory testing to rule out 
other causes of forgetfulness or dementia such as 
drugs, heart failure, diabetes, stroke, brain 
tumor, anemia, thyroid disease, Parkinson's 

testing with mental awareness tests and imaging 
studies such as MRI or PET scans to add weight to 
the diagnosis of AD 

There is no one test that can say whether AD is 
present. Also it is difficult by any means to 
diagnose early disease at a time when there is 
only mild cognitive impairment. This mild 
cognitive impairment is a condition in which a 
person still has good judgment and decision 
making skills but has more recent memory loss than 
would be normal for one's age. It is a stage of 
"sharp mind but shaky memory". A person would have 
the most trouble remembering recent conversations 
and  appointments, while recall of long ago events 
remains intact. 

Mild cognitive impairment does not always progress 
to Alzheimer's, but 50% of the time it does. Early 
symptoms can include loss of smell particularly 
with the lack of awareness of this smell deficit, 
loss of emotional reaction to forgetfulness (most 
people feel bad about forgetting appointments or 
recent information given to them), and inability 
to carry on a thought-provoking conversation. You 
can only use these as clues; mental assessment 
tests administered by psychiatrists, psychologists 
or geriatric specialists are much more diagnostic. 

If you suspect a loved one may have some 
impairment, seek a physician's help. 

Diagnosing Alzheimer’s disease

2. Nut and peanut butter consumption and diabetes

Nutritional studies that are based on dietary 
histories taken from men and women always engender 
some suspicion when investigators announce that a 
certain food may be associated with a higher or 
lower incidence of a given disease. The problem is 
that people make many different choices in their 
lives that may influence a given disease just as 
they make food choices. In spite of the bias 
inherent in dietary studies, they often are the 
best measure to indicate possible new food/disease 
relationships that we have not been aware of 

Unsaturated fat (polyunsaturated and mono 
unsaturated) are thought to improve glucose and 
insulin balance in the body. thus they may have a 
role in preventing diabetes. Nuts are high in 
unsaturated fats and other nutrients that affect 
sugar metabolism. A recent study in the Journal of 
the American Medical Association looked at whether 
increased nut and peanut butter consumption played 
any role in the future development of adult onset 
of diabetes. 

The study referenced below analyzed data from the 
large Nurses Health Study and looked at over 
83,000 women aged 34 to 59 years who had no 
history of diabetes, cardiovascular disease, or 
cancer prior to entry into the study in 1980. They 
were followed on the average of 16 years and 
completed dietary history questionnaires at the 
start of the study. They corrected the data for 
patient weight (BMI), physical activity and 
alcohol and tobacco use. 

The authors found that women who indicated that 
they ate nuts 5 or more times a week had a 23% 
lower incidence of developing diabetes. Women who 
ate peanut butter 5 or more times a week had a 21% 
lower incidence of diabetes. Both of these were 
compared to women who almost never ate nuts or 
peanut butter. The authors did further adjustment 
for intakes of dietary fats and cereal fiber but 
it did not appreciably change the results. 

If you just add nuts to your diet without 
decreasing other calories, that would likely cause 
diabetes. Therefore the authors caution To avoid 
increasing caloric intake but "regular nut 
consumption can be recommended as a replacement 
for consumption of refined grain products or red 
or processed meats." 

Nut and peanut butter consumption and diabetes

3. Reader submitted Q&A - SSRI side effects

"I read with interest the recent health tip 
related to Effexor(R). I would be interested in 
comments on side effects of SSRIs. I had very bad 
reactions to both Paxil(R) and Zoloft(R) and I've 
done fine on Effexor(R). In fact, it works as an 
appetite suppressant, the opposite of what a 
reader said in a recent newsletter." 

"My question is: What do we know about side 
effects and these drugs? Why do you find side 
effects listed as "lethargy or insomnia", "weight 
gain or loss"? Do we know what's going on?" - Judy 

Great question. I'm not sure I can adequately 
answer it but let me give it a try. The selective 
serotonin reuptake inhibitors (SSRIs) include 
Paxil(R), Zoloft(R), Prozac(R), Celexa(R) and a 
few others. Effexor(R) has a mixed mechanism of 
action, so is not officially an SSRI but it is 
used for similar indications. 

The SSRIs as a class of drugs were thought to have 
minimal side effects compared to other 
prescription medications used for depression and  
disorders such as panic attacks, generalized 
anxiety and phobias. They have been used over the 
past decade and the side effect profile is still 
favorable but some people have reactions 
nonetheless. The commonly described side effects 
are nausea, diarrhea, headache, agitation and 
insomnia. Loss of sexual desire and sexual 
dysfunction are also frequently cited. 

I think you can see how insomnia can lead to 
fatigue and lethargy. If loss of sexual desire is 
part of depressive symptoms, you can also imagine 
that if the depression is made better, a person 
might claim improvement in sexual desire while 
another person who did not have loss of libido 
might develop that as a side effect from the SSRI. 
Weight loss and weight gain might be considered 
opposite side effects and you would wonder how one 
drug could produce these opposite effects. To 
answer that you would have to answer the question 
why some people with excessive nervousness eat and 
gain weight while others lose weight due to that 
same degree of anxiety. Many drugs can cause both 
diarrhea and constipation and we don't really know 

The truth is that we know very little about how 
side effects are produced by these medicines. 
Sometimes a side effect is just a coincidental 
change in symptoms or the result of some other 
medication or environmental cause and it is 
misinterpreted as being due to the primary 
medicine. We know from studies of active drug 
versus placebo that there still can be a high 
incidence of nausea, headache, fatigue etc. in the 
placebo group. This must mean these are just 
coincidental symptoms but since they happen also 
in the active drug group, they become listed as 
side effects. 

When any one person says that they developed 
symptom "X" from taking a new medicine, they can 
be right or wrong about the medicine as the cause. 
Thus with new medicines, doctors do not know what 
are the common side effects until they have had 
many patients on that drug and enough return 
visits to be able to gauge what the most common 
adverse reactions are. 

4. Chronic pelvic pain from a bladder source

Chronic pelvic pain is very often attributed to 
conditions of the pelvic reproductive organs such 
as the uterus, tubes or ovaries.  Sometimes, 
however, the pain may be arising from the bladder 
which is also located in the pelvis. Bladder 
infections usually produce urinary frequency along 
with painful voiding. However, urinary tract 
infections are episodic; they do not tend to 
produce a constant, chronic pain. The main bladder 
condition that causes a chronic pain is one called 
interstitial cystitis. 

Interstitial cystitis is characterized by an 
inflammatory response in the bladder wall but 
bacterial cultures are negative. Antibiotics do 
not help the pain and urinary frequency. End stage 
interstitial cystitis (IC) often results in ulcers 
in the bladder wall that can be seen when a scope 
(cystoscopy) is used to view the inside of the 
bladder. The skin lining the bladder wall is 
usually waterproof. In other words the waste 
products and salts in urine never touch the nerve 
endings and blood vessels in the layer under the 
bladder skin (epithelium). Ulcers allow direct 
contact to this layer and produce pain and often 
urinary frequency. 

Concepts about IC are changing, however. It used 
to be thought you did not get bladder pain until 
there was an ulcer present. Now it is felt that in 
early disease there may be small holes, leaking in 
the bladder skin, that allow urine salts to get to 
the nerve endings and cause pain for years before 
there are actual ulcers. A test has been developed 
to see if this leaky epithelium is present. It is 
called a potassium sensitivity test. 

In this test, a mild potassium salt solution is 
instilled into the bladder by a catheter. If it 
produces a severe pain compared to instilling just 
sterile water, then the test is considered 
positive. Patients who have a positive test often 
respond (about 60% of the time) to a medicine used 
to treat interstitial cystitis called  pentosan 
polysulfate (Elmiron(R)). This is significant 
because up until now, we have not had any good 
medicines that permanently treat pelvic pain. 

With this concept in mind, i.e., that maybe many 
instances of chronic pelvic pain really represent 
an early bladder skin dysfunction (IC), 
investigators set out to test if women with 
chronic pelvic pain who were not diagnosed as 
having chronic bladder problems, might have 
positive potassium (K+Cl) sensitivity tests. They 
found that in 244 women with pelvic pain, 81% had 
a positive potassium sensitivity test. None of the 
47 control patients had a positive test. This 
would indicate that possibly these women may have 
an early interstitial cystitis and may benefit 
from therapy for it. 

Chronic pelvic pain from a bladder source

5. Health tip to share - Ear pain after flying

Individuals who fly when they have a cold or sinus 
congestion risk blockage of the Eustachian tube 
that can result in ear pain, infection, hearing 
loss, ear ringing and dizziness. To help prevent 
this, use a decongestant nasal spray such as 
oxymetazoline (Afrin(R), Dristan(R)) or 
medications containing pseudoephedrine 
(Actifed(R), Sudafed(R)) an hour before takeoff 
and an hour before landing. This can help prevent 
blockage that leads to ear pain or damage. - FRJ 

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

Health tip suggestion form

6. Humor is healthy

"Painful Side"

At Sunday School they were teaching how G~d 
created everything, including human beings. 

Little Johnny, a child in the Kindergarten class, 
seemed especially interested when they told him 
how Eve was created out of one of Adam's ribs. 

Later in the week his mother noticed him lying 
down as though he were ill, and asked,  "Johnny 
what is the matter?" 

Little Johnny responded, "I have a pain in my 
side. I think I'm going to have a wife." 

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

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****** Woman's Health Newsletter *******
              December 29,  2002
Biweekly from BackupMD on the Net

1. Antidepressant use and pregnancy
2. Alzheimer's disease and vitamin B3 - niacin 
3. Reader submitted Q&A - Serzone(R) warning
4. Gingivitis
5. Health tip to share 
6. Humor is healthy

1. Antidepressant use and pregnancy

The newest class of antidepressant drugs called 
selective serotonin reuptake inhibitors (SSRIs- 
Paxil(R), Prozac(R), Zoloft(R)) are so widely used 
now for treating depression and other anxiety-
related disorders that concern has been raised 
about their possible effects in pregnancy. It used 
to be that pregnant mothers were advised to stop 
almost all medications during pregnancy but as 
information evolves that certain drugs seem to be 
safe, it becomes common to see mothers on more and 
more prescription medicines while they are 

SSRIs have been shown in other studies not to 
produce birth defects or developmental 
abnormalities and not to produce behavioral 
changes in newborns. Therefore doctors have 
allowed women to stay on these medicines when they 
become pregnant. 

The study below in the American Journal of 
Psychiatry looked at a group of women using SSRIs 
who became pregnant and found that although there 
was no increase in birth defects, the babies were 
born about a week earlier (prematurely) than were 
babies whose mothers did not take SSRIs. 

A week premature (on the average) does not seem 
like much of a difference but it can sometimes be 
a key difference in survival. This is the first 
report that I know of that implies there may be an 
adverse effect of SSRIs in pregnancy. 

Antidepressant use and pregnancy

2. Alzheimer's disease and vitamin B3 - niacin 

Alzheimer's disease affects almost half of all 
individuals over the age of 85. As we adopt 
healthier lifestyles in an attempt to prolong our 
lives, Alzheimer's becomes more of a concern since 
it is almost an epidemic at the age we wish to 

I do not know of any medicine that cures 
Alzheimer's once an individual has it so the main 
strategy we look for is how to prevent it in the 
first place. At the present time the only agent 
associated with prevention of Alzheimer's is 
estrogen replacement therapy after menopause. With 
many women avoiding estrogens due to fear of a 
small but real increase in breast cancer with long 
term estrogen use, we must continue searching for 
something else that may prevent Alzheimer's. 

Investigators have looked at different vitamins in 
the food we eat to see if any help prevent the 
onset of Alzheimer's. There is some suggestion 
that vitamin E may have a preventative role. 
Recently a study out of the Rush Institute for 
Healthy Aging and the Rush Presbyterian-St Luke's 
Medical Center, both in Chicago, Illinois looked 
at the B vitamins to see if either dietary levels 
or vitamin supplements were associated with any 
decrease in the development of Alzheimer's. 

They found that individuals who consumed the 
highest levels of vitamin B3 (niacin) (over 22 mg 
a day) were almost 80% less likely to be diagnosed 
with Alzheimer’s in the succeeding 4 years than 
those who took in less than 13 mg of niacin per 
day (approximately the current recommended daily 
allowance).The intake amount of the other B 
vitamins did not seem to show any relationship to 
an Alzheimer's diagnosis. 

Foods such as chicken, nuts, beans and peas and 
enriched grains and rice and wheat bran cereals 
are high in vitamin B3. 

Vitamin B3 and Alzheimer's disease

3. Reader submitted Q&A - Serzone(R) warning

"I have just learned that the antidepressant 
Serzone  which I have taken for the past five 
years has been "black labeled" by the FDA. What 
does this mean, and why is the drug still on the 
market?" - MAC 

The term which is being used is a "black box 
warning" which is required by the U.S. Food and 
Drug Association (FDA) where a major side effect 
problem has been identified with a pharmaceutical 
product. This is a method of drawing specific 
problems to the attention of physicians and is 
designed to help them prescribe products 

In effect, the FDA required the manufacturer, in 
this case Bristol-Myers Squibb Co., in in December 
2001 to put words inside a heavy black box that 
warns about the chance of fatal liver failure that 
has been reported with the use of Serzone. 
Nefazodone is the generic name for this 
SSRI/tricyclic antidepressant. The warning appears 
in the drug insert that comes with the medicine, 
in any advertising of the medicine and in the 
Physician's Desk Reference (PDR) that doctors use 
to look up the dose and side effects. 

The chance of liver failure is rare. The reported 
rate in the United States is about 1 case of liver 
failure resulting in death or need for liver 
transplant per 250,000 - 300,000 patient-years of 
Serzone (R) treatment. In other words, for each 
25,000 individuals taking the drug for 10 years, 
there was one case of liver failure. Symptoms of 
liver failure include jaundice (yellowing of the 
skin), extreme loss of appetite, stomach and bowel 
complaints and severe tiredness. 

You ask why the drug has not been withdrawn from 
the market? I would guess it was because the 
incidence of severe problems is very low and the 
medicine has much greater benefit than harm. 
Additionally, there are many medicines on the 
market today that have rare but very serious or 
deadly side effects. If the FDA required all of 
them to be withdrawn from the market, there would 
not be many prescription medicines left standing. 
Even Tylenol(R) would not make the cut. 

The best action you can take right now is to see 
your physician who placed you on Serzone and ask 
if you can have blood chemistries performed to 
check for any elevated liver function enzymes. If 
they are normal, you will then have to decide if 
you wish to stay on the drug or be switched to 
another. Be careful though; they all have rare 
reactions that can be serious. It is best to try 
to discontinue all of the medicines you can, 
otherwise there is always the risk of a serious 
reaction to them. 

4. Gingivitis

Inflammation of the mouth gum tissue is very 
common and as many as 80% of individuals have some 
degree of gum infection. Bacteria in the mouth and 
minerals in the saliva form dental calculus 
between the teeth and gums. This scaly mineral 
deposit that the dental hygienist chips off when 
you have your teeth cleaned provides a site for 
additional bacteria. These bacteria cause further 
gum inflammation. 

If infection stays too long between the teeth and 
gums, eventually the bone of the jaw that holds in 
teeth can also become infected. Bone infection is 
very difficult to cure with antibiotics once it 
gets going. Eventually the bone infection, 
periodontitis, causes the teeth to loosen and 
eventually fall out. 

Repetitive bleeding of the gums when you brush 
your teeth is a sign of gingivitis. Sometimes the 
gums become swollen and tender but not very 
painful. Regular brushing of the teeth and dental 
flossing is the way to prevent gingivitis but a 
visit to the dentist for regular teeth cleaning 
also helps make up for those times when we forget. 

Certain conditions predispose to gingivitis: 

any medicines that decrease saliva production
decreased immunity
genetic predisposition

To keep your gums healthy, Mayo Clinic offers the 
following suggestions: 

Choose the right toothbrush
Use fluoride toothpaste
Brush twice daily
Angle your toothbrush to 45 degrees to get under 
  the gums 
Floss daily

And don't forget the regular visits to the dentist.


5. Health tip to share - Heartburn
You should seek medical advice when:

heartburn occurs several times a week
heartburn wakes you up at night on a recurrent 
heartburn comes back shortly after using an 


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

6. Humor is healthy

Thoughts on aging

Eventually you will reach a point when you stop 
lying about your age and start bragging about it. 

The older we get, the fewer things seem worth 
waiting in line for. 

Some people try to turn back their odometers. Not 
me, I want people to know "why" I look this way. 
I've traveled a long way and some of the roads 
weren't paved. 

How old would you be if you didn't know how old 
you are? 

When you are dissatisfied and would like to go 
back to youth, think of Algebra. 

You know you are getting old when everything 
either dries up or leaks. 

One of the many things no one tells you about 
aging is that it is such a nice change from being 
One must wait until evening to see how splendid 
the day has been. 

Ah, being young is beautiful, but being old is 
Old age is when former classmates are so gray, so 
wrinkled, and so bald they don't recognize you. 

If you don't learn to laugh at trouble, you won't 
have anything to laugh at when you are old. 

 And best of all--

I don't know how I got over the hill without 
getting to the top. 

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

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****** Woman's Health Newsletter *******
              January 12,  2003
Biweekly from BackupMD on the Net

1. Is female sexual dysfunction a new disease?
2. Age bumps and melanoma skin cancer
3. Reader submitted Q&A - Arthritis flare after HRT
4. Heart disease knows no gender
5. Health tip to share - Ice cream headache
6. Humor is healthy

The next newsletter will be in two weeks.

1. Is female sexual dysfunction a new disease?

An interesting (and bound to be very 
controversial) article about defining the entity 
of female sexual dysfunction has recently appeared 
in the British Medical Journal. In it, the author 
essentially accuses the pharmaceutical industry of 
sponsoring the definition of female sexual 
dysfunction so that they can conduct clinical 
trials that might show their drug sildenafil 
(Viagra) to have a place in treating women just as 
it does in treating men who have "erectile 
dysfunction". The author states that "a cohort of 
researchers with close ties to drug companies are 
working with colleagues in the pharmaceutical 
industry to develop and define a new category of 
human illness at meetings heavily sponsored by 
companies racing to develop new drugs." 

Since this main drug, sildenafil, accounts for 
over 1.5 billion dollars in sales, we have to take 
this concern seriously, i.e., that they are trying 
to create a medical market for which they have a 
drug. On the other hand, maybe this is an area 
which has been overlooked by physicians as 
something that they should be identifying and 
offering treatment for. 

As best I can tell about the development the 
author makes reference to, a consensus panel (with 
pharmaceutical ties) divided female sexual 
dysfunction into four categories of disorders: 
sexual desire disorders (libido)
sexual arousal disorders
orgasmic disorders
sexual pain disorders

The purpose was to identify arousal in the female 
as a problem separate from the lack of desire or 
interest in having sex. It is this area that the 
pharmaceutical companies were interested in to see 
if a drug like sildenafil could play a role. In 
other words, this would target women who say it 
isn't that they do not have any desire to have 
sex, but rather they just have major difficulty 
becoming sexually aroused even with an adequate 

Once this category of "medical problem" was 
defined, clinical studies could be conducted to 
see if drug treatment could play a role in 
reducing the problem. Of three studies that have 
been conducted in women with "arousal disorder" 
that I could find, two have shown no benefit from 
sildenafil and one showed only a slight benefit. 

Thus there is still a question as to whether there 
is a separate disorder in women of "arousal 
problems" versus "desire" problems as there is in 
men. The article itself is worth reading but more 
fascinating are the comments by readers that 
follow the article as to whether this is just a 
contrived problem for financial benefit on the 
part of pharmaceutical companies or an overlooked 
problem that needs medical attention. 

What do you think?

The making of a disease: female sexual dysfunction 

2. Age bumps and melanoma skin cancer

Seborrheic keratoses (age bumps) are elevated skin 
lesions that come with age. They may appear as 
large freckles that are scaly, raised and often 
darkened (pigmented) more than a normal freckle so 
that they can be hard to differentiate from a 
melanoma skin cancer. As one gets older, they can 
appear frequently all over the body. 

This presents a problem if one has many seborrheic 
keratoses to be excised from the skin. Should 
every one be sent to pathology to make sure they 
are not really a malignant melanoma skin cancer? 
The following study in the Archives of Dermatology 
looks at how often skin lesions that are thought 
to be seborrheic keratoses turn out to be 

The investigators looked at over 9000 consecutive 
pathology reports containing a diagnosis of 
seborrheic keratosis in the clinical information 
provided with the biopsy. We do not know how many 
lesions were removed so the 9000 represents a 
subset of seborrheic keratoses treated by those 
physicians. Among all of the biopsied lesions, 
less than one percent (0.66%) were identified as 

While this is not a high number, it is a real 
possibility, so the authors recommend the practice 
of submitting all biopsies to continue. However, 
it is important for you to know that these lesions 
rarely turn out to be malignant. 

Age bumps and melanoma skin cancer

3. Reader submitted Q&A - Arthritis flare after HRT
"Is it normal to have significant joint soreness 
after quitting H.R.T.? My Dr. took me off about 4 
months ago and I now feel 10 years older as far as 
stiffness and joints are concerned." 

"I am 63 years old and took H.R.T. for 8 years.  I 
take a mild med for high blood pressure and 
average meds for thyroid. I went off H.R.T. all at 
once and have since heard that others tapered off 

"I have not been back to my Dr. as I am in the 
middle of changing insurance companies again.  
I've checked with many pharmacists and none of 
them have heard of this problem." - RUE 

What you describe is not common, but physicians 
hear this frequently as far as joint and muscle 
pain flare up upon discontinuing hormone 
replacement therapy (HRT) or estrogen replacement 
therapy (ERT). With either arthritis or muscle 
conditions, the relationship of hormone therapy is 
somewhat complex. 

Osteoarthritis in humans does not seem to benefit 
at all from HRT/ERT even though there is evidence 
in animals that it may play a protective role. 
Osteoarthritis, and thus its joint pain, should 
not worsen with HRT withdrawal. 

Rheumatoid arthritis sometimes benefits from 
HRT/ERT especially if there is an overall calcium 
loss. Any arthritis associated with cortisone-like 
therapy (glucocorticoids) especially is helped 
because the estrogens in HRT/ERT help prevent bone 
loss which worsens the joint pain. 

An excessive rate of bone loss, osteoporosis, can 
be superimposed upon any type of arthritis, even 
osteoarthritis. Therefore going off the HRT could 
make joint pain worse if there is an osteoporosis 
component going on. 

I would suggest asking your doctor to order a bone 
density scan to see if your total body bone 
mineral density is low. If so, you can take non-
hormonal medicines such as raloxifene (Evista®) or 
bisphosphonates (Fosamax®,Actonel®, Didronel®). 
You should be taking calcium supplementation at 
least 1500 mg a day and a preventative like 
raloxifene whether or not your total bone mineral 
density is low. 

Finally, make sure your doctor is evaluating you 
for what type of arthritis you might have or refer 
you to a hematologist for diagnosis and 
consultation. IF you have an early rheumatoid or 
osteoarthritis, diagnosing it at this stage may 
help you slow the progression of joint 
inflammation down. 

A last alternative is to consider resuming the 
HRT. The benefits (decreased joint pain) may 
outweigh the risks (about a 1% increase in breast 
cancer) of taking it.

I have not heard of any advantage of tapering HRT 
but I doubt it would be harmful and perhaps it 
would allow the body to accomodate to withdrawal 

4. Heart disease knows no gender

Heart disease is the number one cause of death for 
women. I suspect most of our readers know that but 
across the country, many women have other concepts 
as to what they are at the most risk for. In order 
to delay that time of a fatal heart attack, 
exercise and diet are the best prevention 
strategies. The following suggestions from 
Personal MD.com may help remind us to keep our 
health resolve: 

1. Buy the deepest color of ground beef you can 
find. The darker the red, the less fat it 

2. Do your own yard work. Mow your lawn. Rake the 
leaves or grass. It's great exercise for your 

3. When eating at a restaurant, split an entree. 
Portions at restaurants tend to be large. Before 
eating a pizza, blot up the oil with a napkin. 

4. Take the stairs whenever you can. Each flight 
burns 10 calories and keeps your thigh muscles 

5. Don't use creamy dressings or croutons on your 
salad. If you must have something crunchy on it, 
walnuts can be a good alternative because they are 
high in omega-3 fatty acids. 

6. When talking on the cordless phone, stretch 
your arms and legs or do arm curls with a can of 
food in your hand. 

7. Keep high-calorie, high-fat foods out of sight 
in your pantry. Put raw vegetables and fruits in 
the front of the refrigerator so you see them 

8. Play with your children or pet. Play chase with 
the dog or take him for a walk. Take the kids to a 
park for a game of tag or push them on the swings. 
Badminton, volleyball and swimming are fun things 
you can do together. 

9. Eat crunchy, healthy snacks such as carrots, 
celery or rice cakes instead of chips, cookies and 

10. Walk as much as you can. Park you car at the 
far end of the lot, and walk to the grocery store 
or the dry cleaners. When you take your kids to 
soccer practice, spend the time walking around the 
field while your kids play. 

Heart disease knows no gender

5. Health tip to share - Ice cream headache

Ice cream headache refers to a short duration 
headache when eating a cold substance like ice 
cream. It occurs when very cold food or drink 
touches and stimulates the roof of the mouth. Over 
80% of individuals have experienced this at 
sometime in their lives. 

Eating cold food slowly, e.g., ingesting a small 
scoop of ice cream over a minute or more versus 
eating it in 5-10 seconds, will reduce the chance 
of a headache by 50%. But even eating it slowly 
can produce a headache in 10% or more of 
individuals.  FRJ 

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

Health tip suggestion form

6. Humor is healthy

"New Year's Resolutions for Internet Junkies"

1. I will try to figure out why I *really* need 9 
e-mail addresses. 

2. I will stop sending e-mail to my husband. 

3. I resolve to work with neglected children --
my own. 

4. I will answer my snail mail with the same 
enthusiasm with which I answer my e-mail. 

5.  I will stop sending e-mail, ICQ, Instant 
Messages and be on the phone at the same time with 
the same person. 

6. I resolve to back up my 12GB hard drive daily...
well, once a week...
okay, monthly then...
or maybe...

7. I will spend less than one hour a day on the 
Internet.  This, of course, will be hard to 
estimate since I'm not a clock watcher. 

8. When I hear "Where do you want to go today?"
I will not reply "MS Tech Support."

9. When I hear a funny joke I will not reply, 
"LOL... LOL!" 

10. I will read the manual...  just as soon as I 
can find it. 

11. I will think of a password other than 

12. I will stop checking my e-mail at 3:00 in the 
4:30 is much more practical.

13.  I resolve... I resolve to... I resolve to, 
uh... I resolve to, uh, get my, er... I resolve 
to, uh, get my, er, off-line work done, too! 

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

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****** Woman's Health Newsletter *******
              January 26,  2003
Biweekly from BackupMD on the Net

1. Dandruff
2. Night time heartburn and sleep apnea 
3. Reader submitted Q&A - Steroids and osteopenia
4. Pap smear interval and cancer of cervix
5. Health tip to share - Yoga for health
6. Humor is healthy

1. Dandruff

Dandruff is a minor health problem that many 
adults have. It is characterized by flaking skin 
and itching of the scalp. It is more embarassing 
than a serious medical concern, but those who have 
it don't want it. Fortunately most of the time 
dandruff can be controlled. 

Actually there are several conditions that can 
result in itchy, flaky skin of the scalp: 

dry skin - especially in the winter months, small, 
non waxy flakes 

seborrheic dermatitis (classic dandruff) - 
reddened oily flaky skin with white or yellow 
scales. often involves eyebrows, back of ears, 
side of nose, armpits and groins. 

psoriasis - silvery scales often with skin 
cracking and bleeding. Involves also elbows, 
knees, forehead and trunk 

scalp ringworm (tinea capitis) - the only 
contagious cause of dandruff causes red, inflamed 
scalp as well as hair loss 

contact dermatitis - scalp skin sensitivity to 
hair products, dyes 

The cause of most dandruff (seborrheic dermatosis) 
is thought to be a yeast-like fungus, malassezia, 
previously called pityrosporum. It is present on 
most adult scalps but sometimes grows out of 
control feeding on hair follicle oil. It causes 
skin irritation which leads to flaking. 

If you try over-the-counter products and they do 
not seem to work, you may want to see a 
dermatologist. they will probably suggest other 
shampoo treatments varying by the active 
ingredient in the shampoo. The active ingredient 
may be zinc pyrithione (Suave Dandruff Control 
Shampoo, Head & Shoulders), tar-based shampoos 
(Ala Seb-T, Neutrogena T/Gel, Tegrin), salicylic 
acid (Ala Seb, Ionil T), selenium sulfide (Selsun, 
Exsel), and ketoconazole  (Nizoral).  

Sometimes you have to just try different types of 
shampoos to see what one works the best. It may be 
necessary to alternate shampoos or switch types if 
one loses its effectiveness. Be sure to let the 
shampoo stay on for at least 5 minutes to get an 
adequate dose of the active ingredient to the 


2. Night time heartburn and sleep apnea 

Gastroesophageal reflux disease (GERD), better 
known as heartburn, affects many individuals. 
Investigators have recently found out that 
individuals with sleep apnea who have heartburn at 
night, show significant reduction of symptoms when 
they are properly treated for the apnea. 

The treatment for sleep apnea is usually CPAP or 
continuous, positive airway pressure. It is a  
breathing machine attached to a face mask that the 
person wears at night and it generates a slight 
inflow of air that presumably causes increased 
pressure in the respiratory cavity. The increased 
pressure must keep down reflux because symptoms of 
heartburn are reduced by almost 50% when the CPAP 
treatment is used. 

I would like to suggest that we consider turning 
this finding around and ask if symptoms of 
heartburn are present at night, could that mean a 
person is more likely to have sleep apnea? The 
study below did NOT address that possibility but I 
think that it and other articles offer indirect 
evidence that should make us consider this 

Thus I would recommend to you that if you 
currently have heartburn that frequently bothers 
you at night, ask your physician to consider 
ordering a sleep study for you to see if sleep 
apnea is a major cause of that heartburn. If it 
is, then treating the sleep apnea is a much better 
strategy than just taking oral heartburn medicine 
because there are many other health problems (eg. 
tiredness, fatigue) that would be helped along 
with the heartburn if an accurate diagnosis is 

Night time heartburn and sleep apnea

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