Womens Health

Women's Health Newsletters 2/9/03- 4/20/03



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****** Woman's Health Newsletter *******
              February 9,  2003
Biweekly from BackupMD on the Net

1. Sleep loss is heart risky for women
2. High vitamin A intake and bone fractures 
3. Reader submitted Q&A - Diagnosis of menopause
4. Optimizing male fertility
5. Health tip to share - Hypothermia
6. Humor is healthy

1. Sleep loss is heart risky for women

Sleep may play a role in a woman's risk for heart 
disease. At least that is the suggestion from a 
recent study from Brigham and Women's Hospital in 
the Archives of Internal Medicine. 

The scientists analyzed data from the large 
Nurse's Health Study encompassing over 70,000 
women aged 45-65 at enrollment. They had asked the 
nurses at the beginning of the study how much 
sleep per night they were getting. Then they 
compared that with the development of heart 
disease and conditions over the follow up period 
of 10 years. 

They found that women reporting 5 or fewer hours 
of sleep a night compared with women who had 7-8 
hours of sleep had a risk ratio of 1.8 or an 80% 
increase of coronary heart problems. Those getting 
6 hours of sleep a night even had a 30% increased 

Interestingly, sleeping too much, 9 hours a night 
or more, was also found to be associated with a 
40% increased risk of coronary heart events. 

As we have mentioned before it is not safe to 
assume that sleep is the cause of a cardiac event 
effect. For example, anxiety and stress causing 
insomnia (5 hours of sleep per night or less) or 
depression causing fatigue (9 or more hours of 
sleep) could very likely be the culprits causing 
adverse cardiac events. If this were true than the 
treatment is not sleeping pills but rather stress 
reduction or depression treatment. There could 
also be many other factors that are the cause of 
less sleep and heart problems rather than just the 
amount of sleep itself. 

In either case, however, it makes sense to try to 
examine why a person is sleeping less than the 
ideal 6.5-8 hours of sleep a night. If this is a 
sporadic problem, don't worry but if it is a 
constant habit, try to make changes that allow 
more sleep. 

Skimping on Sleep Raises Heart Risk for Women

2. High vitamin A intake may cause bone fractures

Not all vitamins are beneficial. High levels of 
vitamin A intake have been associated with bone 
deformities in newborn babies and spontaneous bone 
fractures in animals. Some studies have indicated 
an increased risk of hip fracture and low bone 
density in women with a high dietary intake of 
vitamin A. However dietary intake studies where 
investigators depend upon your recall of what you 
ate recently are fraught with inaccuracies. 

In order to see if vitamin A really is associated 
with fractures in adults, scientists have to 
measure Vitamin A levels in blood or a byproduct 
of vitamin A and correlate that with fractures 
over time. That would produce more conclusive 
evidence if there is an association. 

In the study below, investigators measured blood 
retinol levels, a chemical byproduct of vitamin A 
metabolism. The measurements were made in men at 
entry into the study and then they were followed 
for 30 years. The men with the highest retinol 
levels had an overall bone fracture risk that was 
7 times higher than the men with the lowest 

Again, this is association and not proven cause 
and effect. It does not mean for sure that taking 
vitamin A supplements puts you at risk for more 
fractures but it should remind us that too much of 
anything may have a potential to be harmful. 

Vitamin A and bone fractures

3. Reader submitted Q&A - Diagnosis of menopause
"I would like to know how a doctor can assume 
without doing any blood work to check levels that 
you have 'gone thru menopause' and put you on HRT. 
I am 51. I started having irregular cycles about 4 
yrs ago that also began some hot flashes. My OBGYN 
did the blood work, and suggested Lo Estrin 
1/20(R), I am not taking it for birth control. I 
had my tubes tied in '85. The hot flashes went 
away; so did my periods and I have been on Lo 
Estrin(R) with no problems almost 3 years. Now 
every 6 months I have been getting the levels 
checked about (into) 6 days of not taking the 21 
pill regimen and the levels have been normal. Last 
time checked (6 months ago), the FSH level was 

"Last week I go in for my yearly check up and she 
says how long has it been with no period, I said 
over a year, she replied well you're ready for HRT 
(I lost my job 8 months ago and have no insurance 
coverage at this time) so we bypassed the lab 
work, but to me this seems like a very unethical 
way to determine if I have gone thru menopause. 
she would not refill my Lo Estrin(R) and gave me 
about a year's supply of FemHRT." 

"Is this a common practice for obgyn's to just 
assume by looking at your face that you need HRT?? 
She told me it's the exact medicine as in the Lo 
Estrin(R), just a smaller amount of estrogen. I 
had no choice but to start taking it, but I am 
very perplexed and confused especially with all 
the controversy surrounding HRT. If its not time 
for me to be taking this yet, what am I doing to 
myself in the meantime?" -  Suzie 

You may be having a communication problem with 
your Ob-Gyn. So I do not have the same problem, 
let me restate what I think you said. 

You have not had a menses for at least a year even 
though you have been taking Lo Estrin (cyclically) 
during all that time. Also as of about 6 months 
ago your blood test did not measure that you were 
menopausal. Now, the doctor has assumed you are 
menopausal without doing a blood test and she 
wants to switch you to HRT (a continuous 
combination pill with estrogen and progestin 
called FemHRT). You have no insurance coverage and 
so are concerned about expenses. You did not say 
whether you conveyed to the doctor your concern 
over expenses but I suspect she knows if you do 
not have insurance coverage. Finally, you are 
concerned that her decision to assume you are 
menopausal without having you undergo the expense 
of another FSH test is 'unethical". 

Also you sound concerned that HRT (FemHRT) might 
be more dangerous to you than the Lo Estrin(R) 
oral contraceptive. 

If these statements are essentially the facts 
here, I have the following comments: 

I would guess that at age 51 and having had no 
menses for a year on cyclical oral contraception 
pills, it is about 90-95% probable that you are 
menopausal even though 6 months ago you were not. 
Since the doctor is probably concerned about you 
having to spend money, I do not think it is 
unethical to forego the FSH test and go straight 
to HRT. Even if she is wrong, the treatment will 
still help any hot flashes and give more constant 
hormone levels than your body would do without 

She wants to get you on LOWER doses of hormone 
treatment by switching to HRT instead of an oral 
contraceptive. I would think you would want to do 
that too since you are concerned about adverse 
effects from HRT. She is correct in that the 
individual components of LoEstrin(R) and FemHRT 
are identical. Both have 1 mg of norithindrone 
acetate, while FemHRT(R) has only 5 mcg of ethinyl 
estradiol versus LoEstrin(R) which has 20 mcg. 
Thus she is decreasing your estrogen dose to one 
fourth of what it was. 

Actually I do not think there are excessive risks 
to HRT at all and the benefits outweigh any small 
risks as I have expressed many times in this 
newsletter. However, any risks that HRT have are 
very likely to be LESS than the risks of taking 
the higher estrogen and progestin dose birth 
control pills such as Lo Estrin(R). We feel 
perimenopausal treatment of hot flashes with low 
dose oral contraceptives are still low enough in 
risk to be safe even though they would be a 
smidgen more risky due to the slightly higher 
hormone doses than HRT. 

I would agree with continuing the HRT instead of 
the Lo Estrin(R) whether you are menopausal or 
still perimenopausal. I think it makes more sense, 
all things considered. If you are not sure this is 
the best course of action, just call the office 
and ask if you can have an FSH test or order an 
at-home Menopause Test kit although you will need 
to pay yourself for either one. 

4. Optimizing male fertility

Male factors such as sperm count, sperm motility 
and normality of sperm function actually play a 
large role in producing infertility, up to 40%. 
Both men and women want to know what can be done 
to make sure the male sperm component is as 
healthy as possible when trying to conceive. 

The first step for a male is to have a medical 
sperm analysis performed to make sure there are no 
major problems in count, movement and shape. If 
there are abnormalities, there may be medicines or 
procedures that the doctor can order to improve 
those parameters. 

There are some Don'ts' and Do's for men to further 
optimize sperm health: 

Don't subject the testicles to long periods of 
heat. Prolonged heat such as that from an hour in 
a sauna, steam room or hot tub can lower sperm 
count and motility. 

Don't drink more than one or two drinks of alcohol 
a day. Alcohol also affects sperm counts. 

Don't take illicit drugs. Marijuana decreases 
sperm count, movement and increases the number of 
abnormal sperm. Cocaine can cause difficulty with  
having an erection and amphetamines decrease 

Don't smoke. Smoking over a pack of cigarettes a 
day can cause abnormal sperm shapes and slow 

Avoid exposure to toxic chemicals. Many chemicals 
in standard cleaners, paints, pesticides, 
herbicides, glues and anything with heavy metals 
such as mercury, lead, arsenic, nickel, cadmium 
and others can be toxic to sperm production if 
they accumulate in the body. 

Some other things a man should consider are to eat 
healthy and avoid stress because stress alters 
hormone levels which are needed for sperm 

Sperm smarts: Optimizing fertility

5. Health tip to share - Hypothermia

Cold weather for an extended period of time puts a 
person at risk for hypothermia or low body 
temperature. This is especially true for older 
adults who may be trying to save on heat in their 
home. Hypothermia can be serious and affect muscle 
performance. It becomes serious when you observe 
the "'umbles' -- stumbles, mumbles, fumbles and 

If you observe someone, especially an elderly 
person, with the above, blundering behavior, check 
their oral temperature. If it is lower than 96 deg 
F, get them wrapped in a blanket and to a health 

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

For thousands of years, men have tried to 
understand the rules when dealing with women.  
Finally, this merit/demerit guide will help men 
understand just how it works. Give it to your 
favorite man to promote understanding. 

Merit - Demerit Guide

In the world of romance, one single rule applies: 
Make the woman happy and you get points. Do 
something she dislikes and points are subtracted.  
You don't get any points for doing something that 
she expects. Sorry, that's the way the game is 
played. Here is a guide to the points system: 
You make the bed           +1
You make the bed, but forget to add the decorative 
pillows    -1 
You throw the bedspread over rumpled sheets    -2
You leave the toilet seat up        -5
You replace the toilet paper roll when empty   +5 
When the toilet paper roll is empty, you resort to 
Kleenex    -1 
When the Kleenex runs out you use the next 
bathroom    -2 
You go out to buy her extra-light panty liners 
with wings    +5 
- in the rain           +8
- but return with beer  -1
- and no pads          -25
You check out a suspicious noise at night    +1
You check out a suspicious noise and it is 
nothing        0 
You check out a suspicious noise and it is 
something     +5 
You pummel it with a six iron        +10
It's her cat           -40 

You stay by her side the entire party       0
You stay by her side for a while, then leave to 
chat with a school drinking buddy -2 
- named Tiffany          -5
Tiffany is a dancer!          -10
- with breast implants         -20

You remember her birthday        +1
You buy a card and flowers        +2
You take her out to dinner         +5
You take her out to dinner and it's not a sports 
bar     +5 
Okay, it is a sports bar         -20
And it's all-you-can-eat night        -30
It's a sports bar, its all-you-can-eat night, and 
your face is painted the colors of your favorite 
team          -35 

Go with a pal           0
The pal is happily married         +1
The pal is single          -10
He drives a Ferrari          -20
- with a personalized license plate (GR8 NBED) -25 

You take her to a movie         +2
You take her to a movie she likes        +5
You take her to a movie you hate        +8
You take her to a movie you like        -5
- it's called Death Cop III         -10
- which features Cyborgs that eat humans      -11
You lied and said it was a foreign film about 
orphans     -15 

You develop a noticeable pot belly       -15
You develop a noticeable pot belly & exercise to 
get rid of it    +10 
You develop a noticeable pot belly and resort to 
loose jeans and baggy Hawaiian shirts          -30 
You say, "It doesn't matter, you have one too."      

She asks, "Does this dress make me ! look fat?" 
You hesitate in responding -10 
You reply, "Where?"          -35
You reply, "No, I think it's your butt"       -100
Any other response          -20

When she wants to talk about a problem, you 
listen, displaying a concerned expression +1 
You listen, for over 30 minutes        +5
You relate to her problem and share a similar 
experience    +50 
Your mind wanders to sports and you suddenly hear 
her saying "Well, what do you think I should do?"         
You talk           -100
You don't talk          -150
You spend time with her         -200
You don't spend time with her        -500

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

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****** Woman's Health Newsletter *******
          February 23,  2003
Biweekly from BackupMD on the Net

1. Topical creams versus pills for athlete's foot
2. Stress at work - Control it 
3. Reader submitted Q&A - Hot flashes
4. Celiac disease and bowel reaction to dietary glutens
5. Health tip to share - Allergy skin test interference
6. Humor is healthy

1. Topical creams versus pills for athlete's foot

Can foot and toenail fungus be treated with over-
the-counter creams or is it better to use 
prescription medicine? To answer this we need to 
look at studies in the literature that compare 
various treatments to see how successful they are. 
From the Bandolier Internet journal about health 
care that reviews evidenced-based medicine 
articles, we can see the efficacy of various 

Topical azole creams such as clotrimazole 
(Lotrimin(R), Mycelex(R)), and miconazole used for 
about 4-6 weeks are about 85% effective at curing 
the fungus. 

Creams with topical allylamines (Lamisil (R) 
creams sprays) are about 75% successful in curing 
foot and nail fungus. 

Topical undecanoates (Tinactin (R))are about 67% 
By prescription, terbinafine (Lamisil® tablets) 
250 mg  was over 80% effective and fluconazole 
(Diflucan (R)) about 90% effective although the 
studies are small. 

This means that topical anti-fungal creams such as 
Mycelex(R) that you can buy without a prescription 
are about as effective as prescription pills that 
you have to visit the doctor to get. It certainly 
is worth trying to treat foot fungus yourself 
before seeking medical attention. If that doesn't 
work, then a prescription for tablets may be the 
next step. 

Topical and oral treatments for foot fungal infections

2. Stress at work - Control it

Stress usually comes from one of three areas: at 
work, from family or relatives or from self-
imposed expectations. For many women, work is a 
major source of stress. Here are some tips from 
Mayo Clinic to reduce stress from the workplace. 

1. Determine your priorities. You cannot do 
everything. Time for family, time for exercise, 
time to eat in a relaxed mode, desire to have a 
house absolutely spotless, need for overtime pay, 
employer assigned tasks that require work beyond 
normal hours, time for sleep and many other 
activities compete for your limited time. Rank 
what is important to you so that if two of the 
activities compete for your limited time, assign 
which one takes precedence and give up your 
concern over having to let go the other activity. 

2. Schedule time for renewal. Each day, set aside 
time to relax. Even at work there should be break 
time or lunch time that you can grab a moment to 
do something to  stress bust. 

3. Take advantage of a workplace wellness program 
if available. 

4. Talk with your supervisor. Whether you have a 
health problem, a child care problem, a co-worker 
problem or even unrealistic expectations from the 
supervisor him/herself, sit down and try to 
discuss these concerns with the supervisor when 
you are not stressed out. Do not be afraid to 
bring up issues as long as you sound like you want 
to constructively work to overcome these problems 
in a way that everyone would benefit from. 

5. Keep stress in check. When you feel stress 
getting the upper hand, make a renewed effort to 
start or resume a stress-busting activity. It will 
help your work performance. You may be able to do 
this by: 

   change your health habits
   get more sleep (7-8 hours)
   practice stress management techniques at work
   build your skills to listen better and manager 
     your time more efficiently

   develop a support system of friends or co-workers
   draw the line between your job and your home life

Finally, you may have to consider a different job. 
Sometimes you cannot change your reaction to work 
related issues or outlast a supervisor who is 
unreasonable. Then it is time to strongly consider 
finding a new job. 

3. Reader submitted Q&A - Hot flashes

"I quit taking my Estratest(R). Didn't feel the 
need to take it any more. Didn't make me feel any 
different. Still had hot flashes." 

"I'm 39 yrs.old and had a total hysterectomy at 37 
yrs.old. What do you think I should do, the hot 
flashes are driving me crazy." - P.R. 

Estratest (R) has both estrogen (estradiol) and 
testosterone in it. The estrogen component is 
expected to help reduce hot flashes whereas the 
testosterone may help sexual desire but not the 
hot flashes very much. There are three main 
reasons that the medicine may not be helping you: 

1) The dose of estrogen may be too low. Women who 
have a surgical menopause often require more 
estrogen than women who undergo natural menopause 
at a later age. Usually a full strength 
Estratest(R) would be enough replacement but 
sometimes not. 

2) You may not be absorbing the full amount of 
medicine into your blood stream from the stomach 
and gastrointestinal tract. Different people have 
different levels of enzymes in the GI tract which 
aid or hinder absorption of hormones. 

3) The hot flashes may be triggered by causes 
other than hormone deficiency such as stress, 
foods, heat sources, other medications or other 
medical conditions such as chronic infections, 
thyroid disease etc. 

The best way to eliminate the 3rd item (other 
cause) is to get blood levels of estrogen drawn 
(serum estradiol) on a day when you have taken the 
Estratest(R) earlier. The blood estradiol level 
should be between 50-100 pg/ml. If it is, then you 
are absorbing the medication and it is very likely 
that hot flashes are from some other cause than 
estrogen deficiency. 

If the level is lower than 50 pg/ml, then you are 
not absorbing the pill. You may want to ask your 
doctor to change you to a different estrogen pill. 
Usually conjugated estrogens absorb better than 
natural micronized estradiol. If that still does 
not work, try a skin patch with estrogen and have 
the blood levels checked. It would be highly 
unusual that your levels could not be brought into 
a normal postmenopausal replacement range with a 
skin patch but if not, every 4 week injections of 
estrogen at the doctor's office are still an 
option although the very last choice in my 

4. Celiac disease and bowel reaction to dietary glutens

Celiac disease is an inflammatory condition of the 
bowel in which the ingestion of gluten-containing 
grains (wheat, barley, and rye) produces an immune 
response in genetically susceptible individuals. 
The inflammation from the immune response causes 
recurrent diarrhea, constipation and abdominal 

While once thought to be a rare disease, recent 
studies show it is more common than doctors 
expect. Since blood tests have been developed that 
can detect this condition, 

Celiac disease test kit

more attention has been paid to this as a cause of 
frequent bowel symptoms. 

The study below as reported in the Archives of 
Internal Medicine looked at different groups of 
people across the U.S. to see how common this 
disease is. They found: 

in individuals who have a parent, sibling or child 
   with celiac disease, the risk was 1 in 22 

in individuals who have an aunt, uncle, 
   grandparent, niece or nephew with celiac 
   disease, the risk was 1 in 39 

in individuals who are having bowel symptoms, the 
   risk is 1 in 56 

in individuals who are asymptomatic and so not 
   have a family history of celiac disease, the 
   risk is 1 in 133. 

This prevalence is more frequent than most doctors 
have previously thought and it turns this 
condition from a rare one to something that should 
be looked for more commonly. If you or someone you 
know is suffering from frequent bowel problems or 
has gastrointestinal intolerance to pasta, breads, 
cereals and so forth, you may want to seek out 
testing for celiac disease. 

Celiac disease prevalence

5. Health tip to share - allergy skin test interference

If you are going to have an allergy skin test 
performed to determine what allergies you may 
have, certain medications can interfere with the 
test. Anti-histamines should not be taken before 
allergy testing as well as antidepressants or 
heartburn medications. Be sure to let your doctor 
know what meds you are taking. 

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

"Grave Humor"

On the grave of Ezekial Aikle in East Dalhousie
Cemetery, Nova Scotia:
  Here lies
  Ezekial Aikle
  Age 102
  The Good
  Die Young.

In a London, England cemetery:
  Ann Mann
  Here lies Ann Mann,
  Who lived an old maid
  But died an old Mann.
  Dec. 8, 1767

In a Ribbesford, England, cemetery:
  Anna Wallace
  The children of Israel wanted bread
  And the Lord sent them manna,
  Old clerk Wallace wanted a wife,
  And the Devil sent him Anna.

Playing with names in a Ruidoso, New Mexico,
  Here lies
  Johnny Yeast
  Pardon me
  For not rising.

Memory of an accident in a Uniontown,
Pennsylvania cemetery:
  Here lies the body
  of Jonathan Blake
  Stepped on the gas
  Instead of the brake.

In a Silver City, Nevada, cemetery:
  Here lays Butch,
  We planted him raw.
  He was quick on the trigger,
  But slow on the draw.

A widow wrote this epitaph in a Vermont cemetery:
  Sacred to the memory of
  my husband John Barnes
  who died January 3, 1803
  His comely young widow, aged 23, has
  many qualifications of a good wife, and
  yearns to be comforted.

A lawyer's epitaph in England:
  Sir John Strange
  Here lies an honest lawyer,
  And that is Strange.

Someone determined to be anonymous in
Stowe, Vermont:
  I was somebody.
  Who, is no business
  Of yours.

Lester Moore was a Wells, Fargo Co. station
agent for Naco, Arizona in the cowboy days
of the 1880s. He's buried in the Boot Hill
Cemetery in Tombstone, Arizona:
  Here lies Lester Moore
  Four slugs from a .44
  No Les No More.

In a Georgia cemetery:
  "I told you I was sick!"

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

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****** Woman's Health Newsletter *******
              March 9,  2003
Biweekly from BackupMD on the Net

1. Dietary fat intake affects hormone levels
2. Sinus treatment with saline nasal spray
3. Reader submitted Q&A - Vulvar burning/dystrophy
4. Sexual Health
5. Health tip to share - Allergic rhinitis
6. Humor is healthy

1. Dietary fat intake affects hormone levels

You would think from the popular press that 
cholesterol is entirely bad, bad, bad. Actually, 
however, dietary fats containing cholesterol are 
absorbed into the blood stream when you eat them 
and then the cholesterol is used as a building 
block for many hormones that are essential to the 
functioning of the body. 

It is an interesting concept as to whether eating 
more fats would result in higher hormone levels. 
The body usually stores excess cholesterol as fat 
but it is possible that some excess fat goes into 
producing more hormones also. Investigators from 
Philadelphia looked at this premise in a group of 
teenage girls who had to be on a low fat diet and 
compared them to teens on a regular diet. They 
then measured estrogen, progesterone and 
testosterone blood levels at 1, 3 and 5 years of 
the dietary study. 

They found that estrogen and progesterone levels 
were lower in the teen girls on the low fat diet 
while their testosterone levels were higher. The 
levels were 25-50% different which is quite a 
large change considering. 

This implies either that restricting fat in the 
diet lowers female reproductive hormone levels or 
that high fat diets increase hormone levels. The 
investigators are trying to make the case that 
dietary modification may be able to reduce your 
risk for breast cancer by lowering estrogen 
levels. I am not sure you can make that leap of 
logic but it is interesting how dietary fat may 
alter the estrogen levels by an amount that could 
affect menstrual bleeding and other reproductive 

Dietary fat intake affects hormone levels

2.  Sinus treatment with saline nasal spray

Many individuals suffer from chronic sinusitis. 
They have yellowish green drainage when they blow 
their nose along with a constant head congestion 
fullness. Most of the time treatment includes 
antibiotics to fight off the bacteria that cause 
the infection in the first place. 

There have not been many studies about what to do 
to prevent sinus infection flare-ups. The study 
below looked at the use of a daily hypertonic 
saline (salt water) spray irrigation to reduce 
sinusitis recurrences. The principle behind 
hypertonic saline is that the extra salt draws 
some of the fluid out of the skin lining the nasal 
passages. Thus it reduces edema (swelling) around 
the sinus openings that may have been blocking 
normal sinus mucous drainage and predisposing to 

Seventy six subjects were tested with half using 
hypertonic saline irrigation on a daily basis and 
half not using any routine spray. The study group 
had a 57% improvement with less episodes of 
antibiotic and nasal spray use and fewer days of 

They concluded that daily irrigation with 
hypertonic saline which is an over-the-counter 
product, is an effective strategy to reduce the 
frequency of sinusitis. 

Sinus treatment with saline nasal spray

3. Reader submitted Q&A - Vulvar burning/dystrophy
"I am a married female suffering from what my 
gynecologist said is called vulvar dystrophy.  
This means that I have a part of the vagina always 
burning to the extent that my husband cannot even 
touch me let alone intercourse.  This has happened 
after total hysterectomy 10 years ago and after 
taking HRT which I have stopped taking.  My 
gynecologist told me that the only cure is by 
surgery but it may not be a total success.  Is it 
not possible that in these modern times and age 
there is no other cure? - J.M. 

I doubt very much whether the condition you 
describe was caused by either the hysterectomy or 
the hormone replacement therapy or lack of it. If 
it were, we would see a much higher incidence of 
the problem. 

What you describe is vulvodynia or "painful 
vulva". Sometimes it is due to vulvar dystrophy 
which is a skin change that may or may not produce 
pain. Sometimes you hear about a disease or 
condition called vulvar vestibulitis. You may 
wonder when a painful, burning vulva is vulvar 
vestibulitis, vulvar dystrophy or when it is just 
a symptom of some other condition such as candida 
vaginitis, genital herpes infections, vaginismus 
(spasm of the vaginal opening muscle), allergic or 
irritant reactions or one of many other less 
frequent but possible causes. Your doctor has 
hopefully narrowed it down from some of these 
other etiologies. 

Assuming your condition is vulvar dystrophy 
causing the pain, I think it is safe to say that 
even in these modern times the treatments for this 
are not universally successful. Surgery may only 
be 60-80% successful but none of the other 
treatments such as steroid injections or 
ointments, nitroglycerin paste, capsaician 
(chemical from hot peppers), dietary 
interventions, muscle relaxation training, 
biofeedback therapy, and electrical stimulation 
are any more successful; often they are less. 

I cannot tell you if surgery is the right answer 
for you. For my own part, I lean more and more 
toward surgery to treat this if it has been a long 
term problem for two or more years and the woman 
has tried some of the other treatments 
unsuccessfully. We are always looking for newer 
successful treatments for this uncommon but very 
perplexing and debilitating problem. 

4. Sexual Health

Sex is enjoyable but it can also be stressful. 
Many couples wonder if their sexual activity and 
frequency is normal. There is a very wide range of 
normal, however, and it does not really matter if 
one couple's frequency of intercourse or specific 
sexual behavior is the same as that of another 
couple as long as both partners are satisfied and 
comfortable with the relationship. 

There actually is no definition of normal sexual 
behavior and no exact norms to fit into. Frequency 
of sexual intercourse might be normal at once a 
year, once a month, once a week or once or several 
times a day, as long as both partners are 
satisfied. If one partner has a significantly 
different level of sexual desire than the other, 
then it becomes a problem. 

If there is a large difference in sexual desire in 
a couple, concerns are raised and both people may 
feel unloved. There are things that can be done 
even when the levels of desire are greatly 
different. A therapist may need to be involved and 
you might be interested in the comments via the 
link below of one of Mayo Clinic's psychologists 
about this problem. 

What happens if one partner considers a certain 
sexual activity that the other partner requests, 
as repulsive? How do you reconcile widely 
different behavior desires? The activities need to 
be negotiated and that is where the help of a 
therapist may come in. There can be difference 
among partners, some of which are negotiable and 
some of which are not. It often takes a third 
party to sound out and iron out the different 

In order to function normally with regard to 
sexual arousal, the following conditions are 

partners need to have a feeling of self-confidence 
they need to be free from anxiety
they must have arousing mental AND physical 
they must have ability to focus attention on 
   sexually arousing thoughts or behavior (free 
   from distractions) 

5. Health tip to share - Allergic rhinitis

"I am almost 70 years of age and suffer with runny 
nose and eyes watering in the summer when pollen 
starts to appear.   I used to take Claritin (R) 
and it worked well, but I developed stomach 
problems.  Other medications made me very sleepy.  

I started wearing an over-the-nose painting mask 
that you can purchase at Walmart  or other places.  
Now I do not suffer from the runny nose and watery 
eyes. As soon as I'm out the door, on goes the 
mask.   I live in the country so I don't care if I 
do look weird. If I suffered enough and lived in 
the city, I'd wear it anyway." - Marian 

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

First mammogram practice exercises
Many women are afraid of their first mammogram, 
but there's no need to worry.  By taking a few 
minutes each day for a week preceding the exam, 
and doing the following practice exercises, you 
will be totally prepared.  And you can do this 
right in your own home! 
Exercise 1:       

Open your refrigerator door and insert one breast 
between the door and the main box.  Have one of 
your strongest friends slam the door shut and lean 
on the door for good measure.  Hold that position 
for five seconds (while you hold your breath).  
Repeat again, in case the first time wasn't 
effective enough. 
Exercise 2:

Visit your garage at 3 am when the temperature of 
the cement floor is just perfect.  Take off your 
clothes and lie comfortably on the floor with one 
breast wedged under the rear tire of the car.  Ask 
a friend to slowly back the car up until your 
breast is sufficiently flattened and chilled.  
Turn over and repeat for the other breast. 

Exercise 3: 

Freeze two metal bookends overnight.  Strip to the 
waist.  Invite a stranger into the room.  Press 
the bookends against one of your breasts.  Smash 
the bookends together as hard as you can.  Set an 
appointment with the stranger to meet next week 
and do it again!! 
Now you have nothing at all to worry about when 
you go for your Mammogram! 
That's it for this time. 
Your BACKUPMD on the Net.
Frederick R. Jelovsek MD 

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****** Woman's Health Newsletter *******
              March 23,  2003
Biweekly from BackupMD on the Net

1. Do vitamin supplements help prevent infections?
2. Accidental loss of stool
3. Reader submitted Q&A - Postoperative back pain 
4. Vitamins E and C to prevent vascular disease
5. Health tip to share - Vulvar burning
6. Humor is healthy

1. Do vitamin supplements help prevent infections?

Many people who take vitamin supplements do so to 
prevent common infections such as colds, flu, 
bronchitis, GI upset and other minor but annoying 
infections. While vitamin supplements have been 
studied as preventatives for many different 
illnesses and conditions such as cancer and heart 
disease, they have not been looked at very much 
for their ability to prevent common infections. 

A recent study conducted in North Carolina and 
reported in the Annals of Internal Medicine, 
looked at infection rates among 158 individuals 
who took multivitamin and mineral supplements 
versus a placebo that contained only vitamin B12, 
B2, calcium and magnesium. 

Participants who had adult onset diabetes had 
lower infection rates when taking the multivitamin 
then did those taking the placebo (17% vs 93%). 

Individuals who did not have adult onset diabetes 
had no differences in infection rates according to 
whether they took multivitamins (59%) or did not 

The purpose of this study was "to assess the 
effect of a typical 'one-a-day' multivitamin and 
mineral supplement on infection rate and perceived 
quality of life in a fairly broad sample of 
relatively healthy adults." Basically, they found 
no difference between the treatment and placebo 
groups in physical and mental health measures of 
quality of life.  Thus, it seems that multivitamin 
and mineral supplements do not increase health or 
energy levels any more than placebos do unless you 
have a condition like diabetes which makes you 
more susceptible to infections. 

Do vitamin supplements help prevent infections?

2.  Accidental loss of stool

The inability to control stool and prevent any 
"leaking" of both fecal material or bowel gas is 
called fecal, rectal or anal incontinence. It is a 
very socially debilitating condition. It can be 
just a small amount of "leakage" or it can range 
to total loss of bowel movement control. 

Most people never have this problem unless they 
develop a severe case of diarrhea. It is more 
common in women after childbirth and in adults 
over the age of 65 who have some muscle or nerve 
weakness of the anal sphincter muscle. 

Causes of fecal incontinence include:

constipation with impaction
irritable bowel syndrome, chronic diarrhea
multiple sclerosis
spinal column trauma or arthritic disc problems
injury from childbirth 
rectal irradiation or surgery
Crohn's or any inflammatory bowel disease
Alzheimer's and other dementias

Diagnosis of the cause of fecal incontinence 
involves ruling in or out any of the above 
diseases. If a bowel condition or diet is the 
cause, treatment is directed at controlling the 
diarrhea or constipation process. This may be 
through both diet control and medications. 

If any muscle weakness or injury is the primary 
problem, sacral nerve stimulation and biofeedback 
may be used to strengthen the internal and 
external anal sphincter muscles. The nerve 
stimulation produces muscle contractions which in 
turn gives a person more voluntary muscle control. 

Permanent nerve damage from something such as a 
stroke, long standing diabetes, multiple sclerosis 
or Alzheimer's is much more difficult to treat. 
Sometimes it requires a colostomy so that stool 
soiling does not break down the skin and cause 
ulcerative infections. 

If the external anal sphincter is damaged with 
childbirth or other rectal surgery it can 
sometimes be either surgically fixed using 
existing muscle tissue or an artificial anal 
sphincter muscle may be inserted in the anus. 

Be sure to see your doctor if there is any 
difficulty holding stool or bowel gas. You may 
need a referral to a bowel specialist but your 
physician can direct you to the specialist most 
likely to help you. 

Incontinence of stool

3. Reader submitted Q&A - Postoperative back pain 

"I had my uterus removed over a year ago due to a 
9 cm cyst that was attached to it. I also had 
endometriosis on my right ovary that was 
cauterized during surgery. While I am pain free in 
the menstrual and ovulation process, I have 
developed intense low back pain. My massage 
therapist and chiropractor both agree it is due to 
the groin muscle or iliopsoas muscle being 
extremely tight! I had the surgery through my 
belly button and vagina, not through the abdomen. 
I have been told that I have scar tissue as well. 
Is there anything that can be done to alleviate 
the constant visits and expense to these 
therapists? I have tried all the stretching 
techniques but everyday I am still in constant 
pain...Help!" - Susan   

Post-operative low back pain is an often 
underestimated complication of any surgery, not 
only hysterectomies. Some doctors try to ignore it 
while others admit it is a complication but they 
are unable to determine the causes. Some guess at 
the cause as inflammation around the muscles and 
nerves of the back and pelvis caused by the 
surgery itself while others think it just has to 
do with injury from lying on the hard operating 
room tables for a couple of hours followed by 
hospital mattress support (poor) for a few days 
that is different than one is used to on their 
home bed. 

One study from Great Britain looked at women who 
had hysterectomies and found that the overall low 
back pain incidence following hysterectomy was 
about 15-18% and lasted on the average for 7 
months after surgery. They also looked at whether 
it made a difference in the rate of low back pain 
whether a women had the surgery with the legs 
elevated like a pelvic exam is done (lithotomy) or 
whether the legs are flat with the body (supine) 
during the surgical procedure.  There was not much 
difference in the incidence of postoperative low 
back pain (14% lithotomy, 20% supine) although the 
supine position was slightly worse. 

Another study found that the rate of low back pain 
was less if the surgery was less than 40 minutes 
and if patients were made to walk and sit up 
sooner after the surgery than if they were allowed 
to lie in bed for a prolonged time. 

Keep in mind that at any one time, between 14% and 
42% of all adults will admit to having some degree 
of back pain. It is a common problem that is often 
coincidental with the surgery rather than caused 
from it. 

Unfortunately, knowing that low back pain can be 
associated with surgery is not any help in 
treating it. Basically you have to have x ray 
studies such as an MRI to rule out any spinal 
abnormality that may be contributing to the pain 
and you need a good exam to make sure what nerves 
or muscles are involved. If you have not had an 
MRI study of the pelvis and lumbar spine, that 
would be the next step. It sounds as though you 
have been through this part already and the pain 
has been determined as associated with the 
iliopsoas muscle. 

I am sorry I cannot give you any tips for 
improving the low back pain. That is best left up 
to the orthopedic and physical therapy specialists 
along with your treatments from the massage 
therapist and chiropractor. 

Be sure if you have any problem with being 
overweight that you are dieting to lose at least 
15 pounds or 10% of your body weight. It will make 
a significant difference in the low back pain. 

4. Vitamins E and C to prevent vascular disease

Vitamin supplements of E (136 IU) and slow-release 
C (250 mg) have previously been reported to slow 
the progression of atherosclerotic heart disease 
and heart attacks in individuals with elevated 
cholesterol. Unfortunately at 3 years of the main 
Finnish study looking at this, the reduction was 
only significant in men but not women. 

The investigators have now updated their results 
with a six year follow up. They continue find a 
significant reduction in atherosclerosis in men 
but in women, the reduction of only 14% was not 

Vitamin E and Vitamin C to prevent atherosclerosis progression 

5. Health tip to share - Vulvar burning

"This comment is for the woman who was suffering 
from vulva burning.  I am post menopausal and was 
suffering from that problem also. It was due to 
the lack of estrogen and it was awful. Taking 
estrogen by mouth did not agree with me and I was 
leary with all the bad press on estrogen.  My GYN 
gave me estrogen suppositories called Vagifem(R).  
He said it would treat the problem, but was not 
systemic. I only needed to insert one once every 
10 days although the doctor prescribed once or 
twice a week. I gradually went down to once a 
month and now I have not needed one for several 
months.  When I feel the irritation and burning 
starting again, I use one of the suppositories.  
Also, for women suffering from menopause symptoms, 
especially hot flashes, Effexor(R) is wonderful.  I 
was in the constant state of hot flashes and when 
I started taking Effexor(R) for anxiety attacks all 
my menopause discomforts vanished along with the 
anxiety attacks.  I hope these tips help other 
women." - CLF 

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

"Of Cats and Dogs... Maybe"

If you want someone who will bring you the paper 
without first tearing it apart to remove the 
sports section ...buy a dog. 

If you want someone willing to make a fool of 
himself simply over the joy of seeing you ...buy a 

If you want someone who will eat whatever you put 
in front of him and never says its not quite as 
good as his mother made it ...buy a dog. 

If you want someone always willing to go out, at 
any hour, for as long and wherever you want ...buy 
a dog. 

If you want someone to scare away burglars, 
without a lethal weapon which terrifies you and 
endangers the lives of your family and all the 
neighbors ..buy a dog. 

If you want someone who will never touch the 
remote, doesn't care about football, and can sit 
next to you and watch a romantic movie ...buy a 

If you want someone who is content to get up on 
your bed just to warm your feet and whom you can 
push off if he snores ...buy a dog. 

If you want someone who never criticizes what you 
do, doesn't care if you are pretty or ugly, fat or 
thin, young or old, who acts as if every word you 
say is especially worthy of listening to, and 
loves you unconditionally, perpetually ..buy a 

But on the other hand, if you want someone who 
will never come when you call, ignores you totally 
when you come home, leaves hair all over the 
place, walks all over you, runs around all night, 
only comes home to eat and sleep, and acts as if 
your entire existence is solely to ensure his 
happiness, then my friend --- Buy a cat. 

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

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****** Woman's Health Newsletter *******
              April 6,  2003
Biweekly from BackupMD on the Net

1. Severe acute respiratory syndrome (SARS)
2. Blood mercury levels in women and children 
3. Reader submitted Q&A - Brittle fingernails
4. Diagnosis of overactive bladder
5. Health tip to share - Vitex for perimenopause
6. Humor is healthy

1. Severe acute respiratory syndrome

Severe acute respiratory syndrome (SARS) is the 
name given to a recent form of illness 
characterized by fever over 100.4F (38.0C), cough, 
shortness of breath and extreme tiredness. The 
difference between this condition and a serious 
cold or flu is that the illness can cause death or 
a pneumonia that requires hospitalization. 

The current suspected agent that causes this is a 
coronavirus that has mutated from the same family 
of coronaviruses that produce common colds and 
respiratory tract infections. A large outbreak of 
this disease started in China and apparently has 
spread from there via travellers. 

The infection is spread by being in the near 
vicinity (10 feet or less) of someone with the 
virus who is coughing and sneezing. The symptoms 
start about 2-7 days after exposure. In addition, 
you have to have been exposed to someone who 
recently travelled to Asia before doctors worry 
that you may have this severe form of illness and 
not just a common cold or respiratory infection. 

Hopefully we will see more and more people wearing 
paper face masks when they have colds to prevent 
spreading even the common cold virus. Because of 
SARS, there are also some travel restrictions and 
warnings especially when going to Hong Kong and 
China as well as other Asian countries. Be sure to 
check on this if you are taking a trip to the far 
2.  Blood mercury levels in women and children

If the toxic metal mercury accumulates in a 
person's body, it can produce symptoms such as 
fatigue, memory loss, confusion, tremors, metallic 
tastes and hair loss. Usually mercury levels in 
blood are below 5 parts per billion but those 
individuals who eat fish that have high mercury 
levels from feeding in mercury contaminated water 
will have higher blood levels themselves. 

A recent study looked at 1250 children aged 1 to 5 
years and 2314 women aged 16 to 49 years and 
checked their blood levels of mercury. They found 
mercury levels almost 3 times higher in women than 
in children and it was highest in women (4 times) 
that had eaten fish 3 or more times in the 
previous 30 days. Approximately 8% of all the 
women tested had elevated levels. 

This study did not correlate blood mercury levels 
with symptoms, but other studies have shown that 
blood mercury levels above the Environmental 
Protection Agency's limits of 5.8 ug/L is 
associated with many of above symptoms. There is a 
home test that can screen for elevated levels of 
many of the toxic metals: 

Mineral Check home mineral analysis

Blood mercury levels in women and children

3. Reader submitted Q&A - Brittle fingernails

"I have two nails that keep splitting (in the 
middle) of the nail. It is on the fourth finger of 
both hands. It is very annoying because it causes 
those nails to snag on everything I touch. What is 
causing this and what can I do to prevent this 
from happening? Is there any supplement that I can 
take to help this condition? I already take a 
daily vitamin supplement each day. Thank you for 
any suggestions that you can give me." - SAE 

This is not a topic I am very familiar with so I 
have had to hit the books and journal articles to 
see what dermatologists have said about this 

Basically what you are describing are "brittle" 
fingernails or a condition the dermatologists call 
"onychoschizia". Approximately 20% of women have 
this problem and it is aggravated by dehydration 
of the nails from frequent washing and drying the 
hands. In addition to repeated exposure to water, 
it can also be associated with Working with 
household cleaners, overuse of nail polish 
remover, and certain sports and outdoor 

Some people have attributed zinc deficiencies and 
thyroid abnormalities to producing brittle nails 
but the only hard evidence I could find was that 
individuals with hematologic abnormalities 
(anemia, iron deficiency) have a higher incidence 
of this problem. Therefore make sure your doctor 
checks you out for anemia with a complete blood 
count to make sure there is not any problem there. 

Treatment is to minimize exposure of the hands and 
nails to repeated washing, cleansers and nail 
polish remover. Also, the B vitamin, biotin, 2.5 
mg a day, has been described as helpful in 
restoring nail hardness after about 3-5 months of 

I remember as a child my mother saying that Knox 
gelatine, at that time used for desserts and jams, 
was very helpful to produce good nails. Knox 
orange-flavored gelatine is still available in the 
drug and grocery stores and it contains 0.3 mg of 
biotin along with vitamins C, B3 and B6. It is 
used now primarily as a supplement for nail health 
and the gelatine may work in addition to the 
biotin for nail health. 

Thanks for asking this question. I learned a lot 
about a common problem from trying to answer it! 

4. Diagnosis of overactive bladder

Overactive bladder is a relatively new diagnostic 
term which as been coined or at least popularized 
in the last decade by a pharmaceutical company 
that developed a treatment for urinary frequency, 
urinary urgency and urge urinary incontinence. 

Most of these urgency, frequency symptoms are 
thought to be associated with measurable bladder 
contractions called uninhibited bladder detrusor 
muscle contractions or "bladder spasms". These 
contractions are discovered and measured on a 
bladder test called a cystometrogram. 

In a recent study from the United Kingdom of over 
800 women who had symptoms consistent with 
overactive bladder, only about half of them had 
these uninhibited bladder contractions measurable 
on the cystometrogram study. Also, in the all the 
women who did have uninhibited contractions on 
cystometrogram, only about 2/3's of them had 
"overactive" bladder symptoms. 

These results indicate that you do not have to 
have uninhibited bladder contractions to make the 
diagnosis of overactive bladder, but the authors 
still recommend the cystometrogram because there 
may end up being a difference in the treatment for 
women with overactive bladder that have 
uninhibited bladder contractions versus those that 
do not. 

Overactive bladder

5. Health tip to share - Vitex for perimenopause

"I'm an over 40 woman who may be perimenopausal. I 
started having night sweats over the past year and 
just recently 'hot flashes'. My doctor has not 
issued a hormone test to determine if I'm in fact, 
menopausal --- maybe because I have hope that I 
may still become pregnant. I recently saw a 
broadcast that featured an older couple who'd had 
their first child. The new mom attributes it to an 
herbal supplement called 'Fertility Blend'. I've 
since ordered and am taking the supplement. To my 
delight, the night sweats have ceased and so have 
the 'hot flashes'. I believe one important herbal 
ingredient is largely responsible -- VITEX or 
Vitex Berry. The 'Blend' is also rich in Folate 
and B vitamins. I am not 'new' to herbs and herbal 
remedies. VITEX has long been recommended by 
herbalists to treat women's health...from cervical 
dysplasia to menopause. I'm not pregnant --- yet, 
but I'm hopeful and pleased with the results of 
the 'Blend'. I think the supplement is helpful, 
even for women who feel they've passed their 
child-bearing years." - Tami 

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
"The Rules of Chocolate"

Q:  Why is there no such organization as 
Chocoholics Anonymous? 
A:  Because no one wants to quit.

Q:  Is there life without chocolate?
A:  We don't know.  No one dared to
attempt it yet.

If you've got melted chocolate all over your
hands, you are eating it too slowly.

Chocolate covered raisins, cherries, orange
slices & strawberries all count as fruit, so eat
as many as you want.

The problem: How to get 2 pounds of chocolate
home from the store in a hot car. 
The solution:
Eat it in the parking lot.

Diet tip: Eat a chocolate bar before each meal. 
It'll take the edge off your appetite, and you'll 
eat less. 

If calories are an issue, store your chocolate on 
top of the fridge.  Calories are afraid of 
heights, and they will jump out of the chocolate 
to protect themselves. 

If I eat equal amounts of dark chocolate and white 
chocolate, is that a balanced diet? Don't they 
actually counteract each other? 

Money talks. Chocolate sings.  Beautifully. 

Chocolate has many preservatives. Preservatives 
make you look younger.  Therefore, you need to eat 
more chocolate. 

Put "eat chocolate" at the top of your list of 
things to do today.  That way, at least you'll get 
one thing done. 

A nice box of chocolates can provide your total 
daily intake of calories in one place.  Now, isn't 
that handy? 

If you can't eat all your chocolate, it will keep 
in the freezer.  But if you can't eat all your 
chocolate, what's wrong with you? 

If not for chocolate, there would be no need for 
control top pantyhose. An entire garment industry 
would be devastated.  You can't let that happen, 
can you? 

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

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****** Woman's Health Newsletter *******
              April 20,  2003
Biweekly from BackupMD on the Net

1. Should you be screened for diabetes?
2. How aging affects your driving 
3. Reader submitted Q&A - Progesterone cream
4. Organic food standards
5. Health tip to share - Hot flashes
6. Humor is healthy

If you wish to change this newsletter from 
TEXT style to HTML style for subsequent 
newsletters, go to the very bottom of this 
page and choose the "Update your profile" link.

The next newsletter will be in two weeks.

1. Should you be screened for diabetes?

When should you ask your doctor to order a test 
for diabetes? Many people ask to have testing if 
they have a family history of diabetes or if they 
want a general checkup prior to starting a weight 
reduction diet. The whole question is whether 
detecting diabetes early before a person has 
symptoms helps reduce any long term disability 
that diabetes can produce. The answer to that is 
probably "no" but there are some exceptions. 

There are two major types of diabetes: juvenile 
onset which requires insulin shots because the 
pancreas does not make any insulin, and adult 
onset (Type 2) in which the pancreas makes insulin 
but the body is unable to use it normally. For the 
most part, juvenile diabetes is discovered before 
the age of 20 and adult onset diabetes after the 
age of 20 although this is not a hard and fast 
rule. Juvenile onset diabetes is treated with 
insulin while adult onset diabetes is treated with 
diet and oral hypoglycemic medications. 

Symptoms of diabetes are excessive thirst, 
fatigue, weight loss and frequent urination. If 
you have any of those symptoms, you should asked 
to be checked for diabetes or take one of the 
Hemoglobin A1c Home Test Kits. 

The U.S. Preventive Services Task Force looked at 
whether screening for diabetes in the absence of 
symptoms had any benefit to discovering the 
disease early. They found that only in patients 
with high blood pressure or with elevated 
cholesterol did the early testing make a 
difference. Therefore individuals who have 
hypertension or high cholesterol levels should 
periodically be screened for diabetes even though 
they do not have symptoms. 

Screening for diabetes mellitus

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