Womens Health

Women's Health Newsletters 7/27/03 - 10/5/03




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****** Woman's Health Newsletter *******
              July 27,  2003
Biweekly from BackupMD on the Net

1. Knee taping for osteoarthritis
2. Weight gain as you age
3. Reader submitted Q&A - Mitral valve murmur
4. Medical treatment for shopaholics
5. Health tip to share - Nicotine patches
6. Humor is healthy

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1. Knee taping for osteoarthritis

Osteoarthritis is a devastating disease of the 
elderly causing both pain and disability. Knee 
joints, when affected with osteoarthritis, 
significantly impair the mobility of a person with 
consequential results such as obesity and muscle 
atrophy (wasting) due to inactivity. 

Therapeutic taping of the knee by physical 
therapists is thought to improve knee pain by 
improving alignment of the kneecap (patella) over 
the thigh bone (femur). Taping is endorsed by the 
American College of Rheumatology even though the 
evidence of its benefit is somewhat sparse. In 
this model, the knee is therapeutically taped for 
days or weeks and then the tape is removed until 
pain dictates it should be taped again. 

Investigators in Australia conducted a study of 
over 80 individuals age 50 or older with 
osteoarthritis of the knee. Physical therapists 
taped the knees above and below the knee cap using 
an under layer of hypo allergenic tape and an 
outer layer of a stiffer tape. They taped the 
knees each week for three weeks and then left off 
the tape for three weeks. Assessment of pain and 
symptoms of the study group and the control group 
were made at the end of the three weeks of taping 
and then three weeks after the tape had been 

They found quite a reduction in pain such that 73% 
of the tape group had significant pain reduction 
while only 10% of the placebo group had such a 
reduction. They did find about a 30% incidence of 
minor skin irritation from the tape in the study 
group but felt that overall this was a quite good 
benefit that seem to last for at least 3 weeks 
after the tape was removed. 

The investigators also postulated that even though 
there is a specific manner in which the knee needs 
to be taped, they felt that patients themselves 
could be taught to do their own taping in many 
instances given the correct instruction from a 
physical therapist. 

Efficacy of knee tape in the management of osteoarthritis of the knee

2. Weight gain as you age

Over age 40, most people tend to slowly put on 
weight and increase girth around the middle. It is 
not due to hormones; it happens because our 
metabolism is slowing and we lose muscle as 
activity decreases compared to our younger days. 
Since this tendency begins about the time of the 
perimenopause, many doctors and women try to blame 
declining estrogen levels. The truth is that it 
happens no matter what your estrogen levels are 
and no matter whether you take estrogen 
replacement during the menopause or not. Men have 
the same problem. 

This gradual weight gain over 40 happens to thin 
women and thick women alike. Everyone puts on some 
weight. Of course greater weight gains may just be 
from overeating especially if that is a life long 
problem for you. 

It would be nice to have a magic answer to prevent 
or reverse this gradual weight gain with aging but 
it all boils down to a diet balanced in calories 
versus your physical activity. Exercise is 
important because muscle burns more calories than 
fat. However extreme exercise on a temporary 
weight loss program is no better than starvation 
dieting which cannot be kept up. Rebound weight 
gain after crash weight loss programs often leave 
you worse off than if you had not tried to lose 
weight at all. The bottom line is that nothing 
beats healthy eating and regular exercise. 

Weight gain as you age

3. Reader submitted Q&A - Mitral valve murmur

"I have been told I have a very slight heart 
murmur and it is in the mitral valve.  Is there 
any cure for this through diet or change of 
lifestyle, etc.?" 

"I am age 51 and going through perimenopause.  I 
am slim and a non smoker and drinker." - Lorraine 

I am not a cardiologist so am somewhat hesitant to 
render an opinion about this. On the other hand, 
many women have been told they have mitral valve 
murmurs and a condition called mitral valve 
prolapse so it is something that gynecologists 
come across frequently. Let me share with you what 
I do know and have learned about this. 

First of all, I would suggest you see a 
cardiologist if you have not already done so. For 
your future health, you need to know if you have a 
systolic murmur, mitral regurgitation, an 
irregular heart rhythm, endocarditis (an infection 
of the heart valves) or a ruptured chordae 
tendineae (ligament that stabilizes the valve when 
it closes). All of these are conditions that make 
you more at risk for heart problems. If none of 
those are present, your condition is probably 
benign although you need to be ever mindful of any 
new occurrence of cardiac symptoms. Many symptoms 
have been associated with mitral valve problems 
such as migraine headaches, panic attacks, racing 
heartbeat, chest pain and shortness of breath 
among other things. 

To the best of my knowledge there are no lifestyle 
changes that would help you since you are already 
a non smoker except perhaps discontinuing caffeine 
products if you have any arrhythmia problem such 
as extra ventricular beats. Again, you will need 
to see your cardiologist to determine this. 

Mitral valve prolapse is a condition of both men 
and women and it may be genetic in origin. It 
occurs when the mitral valve does not fully seal 
when it closes allowing a small amount of blood to 
leak through. The leaking blood causes a slight 
murmur or click. It seems to be associated with 
more complications in men than women. In general, 
women do not need antibiotics with procedures to 
prevent infections unless they have any of the 
above problems such as mitral regurgitation (a 
back flow of blood through the valve), a ruptured 
chordae tendineae or past infection of the heart 
or valve. 

Mitral valve prolapse may not just be one 
condition and cardiologists are continually 
refining their definitions and risk factors 
associated with it so that is why I would suggest 
talking with the cardiologist about it and having 
whatever further work-up they suggest just so you 
know your status. While you probably cannot do 
anything to change the  murmur and condition, you 
can find out what symptoms would indicate a change 
in its benign status so you know when to seek 
further evaluation. 

Mitral valve prolapse article 

4. Medical treatment for shopaholics

Yes. There is such a thing as a shopaholic. Many 
more women than men can have this condition. Its 
characteristics include an "uncontrollable urge to 
buy things and a tendency for 'binge shopping' 
often for unneeded items, which can  result in 
disastrous financial consequences." 

Compulsive shopping disorder is a form of 
obsessive-compulsive disorder (OCD). As such, it 
may respond to some of the same drugs used to 
treat OCD. In one study, investigators examined 
the use of citalopram (Celexa(R), Cipramil(R)) to 
see if it benefited this compulsive disorder. They 
chose subjects who had this disorder for 10 
years or more; most of whom had suffered major 
financial consequences. 

The scientists indeed found that although a few 
subjects dropped out of the study due to headache, 
rash or insomnia, most found that they were "very 
much" or "much" improved. Furthermore, when some 
of the women who had been on the medicine had the 
medicine withdrawn, they relapsed into their old 

If you find yourself "binge shopping" and 
especially bringing home articles you do not 
really need, there may be medical help for you -- 
if you want it! 

Medical treatment for shopaholics

5. Health tip to share - Nicotine patches

"In reference to the nicotine patches, I will have 
to tell you although the percent may be low I was 
one of the success stories, however not following 
the directions completely, this is how I did it. I 
smoked for 25 years, tried to quit on my own cold 
turkey "no go" tried to be hypnotized twice quit 
for 6 weeks and started again, got ahold of the 
patches, this was when they were prescription only 
too, found that even though I smoked 1 and one 
half packs a day 21 mgs was too strong, used the 
14 mg wore one every day and went against the 
directions by continuing to smoke just a few like 
15 then 12 then 10, 7, 5, 3 ,2, 1, none, this took 
over 2 weeks of just cutting back and then finally 
quitting. You really have to want to do it too, 
just putting the patch on is not the panacea. I 
wore that 14 mg patch about 6 weeks after just 
quitting so about 8 weeks total on that then the 7 
mg about 6 weeks and then cut the 7 mg in half (a 
direction no-no) and wore it about 2-3 more weeks, 
that was 1992 and it worked for me. Don't know if 
I was lucky, but I feel like the old saying "if I 
can do it anyone can" Just don't always follow the 
directions & remember the choices on the market 
now generic patches, I have been told don't work, 
so keep it in mind. Nicoderm is still the best. 
Pass it on good luck." - anonymous 

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

Health tip suggestion form

6. Humor is healthy

Here are some suggestions for new medicines for 
the pharmaceutical companies to work on: 

*St. Mom's Wort:* 
Plant extract that treats mom's depression by 
rendering preschoolers unconscious for up to six 

*Empty Nestrogen: * 
Highly effective suppository that eliminates 
melancholy by enhancing the memory of how awful 
they were as teenagers and how you couldn't wait 
till they moved out. 

*Flipitor: * 
Increases life expectancy of commuters by 
controlling road rage and the urge to flip off 
other drivers. 

*Antiboyotics: * 
When administered to teenage girls, is highly 
effective in improving grades, freeing up phone 
lines, and reducing money spent on make-up. 

*Menicillin: * 
Potent antiboyotic for older women. Increases 
resistance to such lines as, "You make me want to 
be a better person... can we get naked now?" 

*Buyagra: * 
Injectable stimulant taken prior to shopping. 
Increases potency and duration of spending spree. 

*Extra Strength Buy-One-all:* 
When combined with Buyagra, can cause an 
indiscriminate buying frenzy so severe the victim 
may even come home with a Donny Osmond CD or a 
book by Dr. Laura. 

*JackAsspirin: * 
Relieves headache caused by a man who can't 
remember your birthday, anniversary or phone 

*Antitalksident: * 
A spray carried in a purse or wallet to be used on 
anyone too eager to share their life stories with 
total strangers. 

*Sexcedrin: * 
More effective than Excedrin in treating the, "Not 
now, dear, I have a headache," syndrome. 

*Ragamat: * 
When administered to a husband, provides the same 
irritation as ragging on him all weekend, saving 
the wife the time and trouble of doing it herself. 

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

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****** Woman's Health Newsletter *******
              August 10,  2003
Biweekly from BackupMD on the Net

1. Low back pain - Is spinal manipulation helpful?
2. Cholesterol lowering diet versus medication 
3. Reader submitted Q&A - Generic drugs
4. Migraines and other headaches
5. Health tip to share - Nicotine patches
6. Humor is healthy

1. Low back pain - Is spinal manipulation helpful?

Low back pain is commonly due to an acute muscle 
or ligament strain and it goes away on its own in 
a few days or few weeks. Back pain persisting 
longer then a couple of weeks should signal the 
need for a doctor's visit to rule out any spinal 
bone problems before assuming it is due to just 
continued muscle/ligament strain. 

When low back pain does not go away on its own, 
many different treatments have been advocated and 
tried. One treatment sometimes used is spinal 
manipulation. This is when a "chiropractor, 
osteopathic physician, or physical therapist uses 
his or her hands to move the bones in the spine." 
Most of the time, in the U.S. at least, these 
treatments are not covered by insurance. The 
question becomes, how effective is spinal 
manipulation at improving the low back pain and 
returning one to regular work or living 

The review below looked at almost 40 studies that 
were conducted to compare spinal manipulation to 
known effective therapies such as pain killers, 
physical therapy, exercises, back school 
(education about back care) as well as to 
ineffective therapies such as traction, bed rest, 
and heat therapy, or sham manipulation. 

The investigators found that spinal manipulation 
was more effective than sham manipulation or the 
therapies already known to be unhelpful. It was 
not more or less effective than general physician 
care, pain killers, physical therapy, exercise or 
back school. In other words it was just as 
effective as any of the traditional therapies for 
low back pain.  

Effectiveness of spinal manipulation

2. Cholesterol lowering diet versus medication 

When desirable cholesterol and LDL levels were 
lowered by medical experts, many individuals were 
placed on statin drugs to lower their blood lipids 
below these new levels. Of course most people are 
supposed to try diet first to lower cholesterol 
but many are either unable to stick to a low fat, 
high fiber diet or perhaps they or their doctors 
do not think the diet will really work. 

Also there is a question still as to how much a 
healthy diet can actually lower cholesterol. Is it 
as good as the statin drugs? To answer that, 
investigators enrolled 46 men and women and placed 
them on one of 3 diets: a diet very low in 
saturated fat, based on milled whole-wheat cereals 
and low-fat dairy foods, the same low fat diet 
plus lovastatin (Mevacor). and a diet high in 
vegetables (plant sterols), soy protein, fiber and 

They found that the low fat diet only (control 
group) lowered cholesterol by about 10% while the 
diet plus lovastatin and the high fiber diet alone 
lowered cholesterol by about 30%. In other words, 
about 30% of your cholesterol is diet controlled. 

Cholesterol lowering diet versus medication 

3. Reader submitted Q&A - Generic drugs

"Are generics really as potent as the brand name 
drug?  A recent tip on smoking cessation made the 
point that generic brands of nicotine are not as 
good as brand names.  I have had the same 
experience with prescription drugs and asked 
pharmacist after pharmacist.  One finally told me 
that they do not match exactly but have to match 
the brand name drug *within 5%*.  How vital is 
that 5% and do these generics have to work or been 
tested in vivo, not just in vitro?  It wouldn't be 
so much of a problem if we DID have a choice, but 
on most HMO's, we don't.  It's generic or pay the 
wallet busting price." 

"I have been forced on several generic versions of 
my previously useful medications to find they did 
not work as well as the standard." - MCAW 

Generic drugs are similar to brand name drugs in 
their characteristics but they are not identical. 
This is regulated by the Food and Drug 
Administration (FDA) in the United States. The FDA 
standards that a generic drug must meet include: 

1. Contain the same active ingredients as the 
innovator drug (inactive ingredients may vary) 

2. Be identical in strength, dosage form, and 
route of administration 

3. Have the same use indications 

4. Be bioequivalent (have the same blood levels of 
active chemical compound over the same time frame 
as the brand name) 

5. Meet the same batch requirements for identity, 
strength, purity, and quality 

6. Be manufactured under the same strict standards 
of FDA's good manufacturing practice regulations 
required for innovator products 

Of the above, bioequivalence is the main point for 
deciding if a generic drug is as good as a brand 
name drug. The FDA applies a statistical test and 
in general almost all generic drugs are within 10% 
blood levels of the brand name after a dose is 
taken. Occasionally there can be up to a 20% 

The generic drugs do NOT need to be tested for 
therapeutic equivalence, however. The FDA assumes 
that if the active drug metabolite (the component 
thought to produce the therapeutic effect) is 
within about 10% of the brand name as measured 
chemically, then they consider it "equivalent". 
They are not required to be tested for having the 
same therapeutic in vivo. 

Obviously generics are not really exactly 
equivalent to the brand name drug. The question 
becomes how close are they and do they produce the 
same effect in you as in someone else. Hormone 
supplementation is well known by physicians not to 
be generally the same as brand names. On the other 
hand,in many people generic drugs suffice to 
accomplish the same therapeutic goals as the 
original brand name drug. 

I hate to say it is a matter of trial and error 
but if your doctor thinks the drugs are 
equivalent, you should give it a try. Remember 
that most generics are very close to the original 
brand name and can save you money. On the other 
hand if you feel the generic is not the same, 
i.e., not producing the same beneficial effect, 
then you need to say something and usually your 
doctor can get your health plan to provide the 
brand name. It is an extra effort both on your 
part and the doctor's part but worth pursuing if 
the medicine is worth taking in the first place. 

Finally, remember that there are not generic 
substitutes for all drugs. In fact many drugs 
prescribed are still on patent protection and may 
not have generic competition for many years until 
the patent protection runs out. 

4. Migraines and other headaches

When headaches become chronic or recurrent, it is 
important to know what type of headache you have. 
Different types of headaches tend to respond to 
different treatments. Do you know the common types 
of headaches such as: chronic migraine, cluster 
headache, migraine, tension-type headache or the 
unusual headaches: 

cough headache
exertional headache
carbon monoxide headache
hangover headache
hot dog headache
ice cream headache
monosodium glutamate headache
orthostatic headache
(after) sex headache
swim goggle headache
thunder-clap headache 

This site at MayoClinic.com gives good 
explanations of the different types of headaches. 
If this is a chronic problem for you or someone 
you know, be sure to look at the different type to 
see which might be applicable to you. Then when 
you see your doctor, mention the type of headache 
you think you have. While many doctors are against 
self-diagnosis, the truth is that you have to take 
a very active part in both your diagnosis and 

Migraines and other headaches

5. Health tip to share - Nicotine and MIs

A few people wrote in about the health tip 
concerning use nicotine patches and the person 
still smoking some cigarettes while using the 
patches. They were concerned that the added 
nicotine plus smoking would put the person at 
increased risk for heart attack. They worried that 
this could be dangerous. As best I can tell this 
is not true. 

There have been some isolated reports of use of 
the nicotine patch and a subsequent first 
myocardial infarction (MI) but I could find only 
one such report in the medical literature. The 
authors admit this could be coincidental so I 
looked for larger studies assessing nicotine patch 
use and myocardial infarction. The large studies 
did not show any relationship. 

Nicotine and first MI

While it does not seem to make sense to use the 
nicotine patches while continuing to smoke, there 
is no evidence that this causes heart attacks. 
That is not true for tar in cigarettes, however. 
The higher the tar content, the greater the risk 
of MI. 

As far as I can tell from the medical evidence the 
nicotine patches are fairly safe and while you 
should not abuse them, whatever works to stop 
smoking may be the way to go. 

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

"I'm Dead"

An older couple is lying in bed one morning, 
having just awakened from a good night's sleep. He 
takes her hand and she responds, "Don't touch me." 

"Why not?" he asks.

She answers back, "Because I'm dead." 

The husband says, "What are you talking about? 
We're both lying here in bed together and talking 
to one another." 

She says, "No, I'm definitely dead." 

He insists, "You're not dead. What in the world 
makes you think you're dead?" 

"Because I woke up this morning and nothing 

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

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****** Woman's Health Newsletter *******
              August 24,  2003
Biweekly from BackupMD on the Net

1. Drugs of abuse and principles of addiction treatment
2. Cancer antigen CA-125
3. Reader submitted Q&A - Iodine allergy
4. Obesity and life expectancy 
5. Health tip to share - mosquitoes 
6. Humor is healthy

1. Drugs of abuse and principles of addiction treatment
There are many drugs and substances that people 
can become addicted to or use  habitually to alter 
how they feel. Most are legitimate medical drugs 
that are prescribed but which often find their way 
to a street black market. The categories of drugs 

cannabinoids (marijuana)
dissociative anesthetics
opioids and morphine derivatives
stimulants and other compounds

For a complete list of commonly abused drugs and 
their major intoxication effects and potential 
adverse health consequences, see the list below at 
the National Institute of Drug Abuse of NIH. 

If you or any of your family or friends has 
substance addiction problems, you will also be 
interested in the principles of addiction 
treatment that are included there. Click on the 
link to see more explanation of these principles. 

1. No single treatment is appropriate for all 

2. Treatment needs to be readily available.

3. Effective treatment attends to multiple needs 
of the individual, not just his or her drug use. 

4. At different times during treatment, a patient 
may develop a need for medical services, family 
therapy, vocational rehabilitation, and social and 
legal services. 

5. Remaining in treatment for an adequate period 
of time is critical for treatment effectiveness.  

6. Individual and/or group counseling and other 
behavioral therapies are critical components of 
effective treatment for addiction. 

 7. Medications are an important element of 
treatment for many patients, especially when 
combined with counseling and other behavioral 

8. Addicted or drug-abusing individuals with 
coexisting mental disorders should have both 
disorders treated in an integrated way. 

9. Medical detoxification is only the first stage 
of addiction treatment and by itself does little 
to change long-term drug use. 

10. Treatment does not need to be voluntary to be 

11. Possible drug use during treatment must be 
monitored continuously.  

12. Treatment programs should provide assessment 
for HIV/AIDS, hepatitis B and C, tuberculosis and 
other infectious diseases, and counseling to help 
patients modify or change behaviors that place 
them or others at risk of infection. 

13. Recovery from drug addiction can be a long-
term process and frequently requires multiple 
episodes of treatment. 

Drugs of abuse and principles of addiction treatment

2. Cancer antigen CA-125

Cancer antigen number 125, CA-125, is a blood 
protein that is increased in the presence of some 
cancers and certain benign conditions. It is 
commonly, but not always elevated in women who 
have ovarian cancer. If a woman is found to have 
ovarian cancer and the CA-125 is elevated, then it 
can be followed as a marker for successful removal 
of the cancer. As all ovarian cancer cells are 
killed off by chemotherapy or radiation therapy, 
the CA-125 blood level should decrease 
dramatically. The therapy then needs to be 
continued until the levels are in normal range. 

Unfortunately there are other non cancerous 
conditions that can be associated with increased 
CA-125 blood levels: 

liver disease
other bowel disease
pelvic inflammatory disease
and even normal menstruation

As a matter of fact, if the CA-125 is used as a 
cancer screening test BEFORE menopause, about 34 
out of 35 women with elevated CA-125 levels will 
have benign conditions, not cancer. This produces 
a very high false positive rate. After menopause, 
about 10% of women with elevated CA-125 levels 
will have ovarian cancer. This is certainly higher 
than before menopause (2-3%), but still is a high 
false positive rate. Additionally, 20% of women 
with known ovarian cancer will have normal CA-125 

Because of the high false positive rate, CA-125 is 
not used as a cancer screen. It is only used as a 
tumor marker to follow treatment if the diagnosis 
of ovarian cancer is already made. 

Cancer antigen CA-125

3. Reader submitted Q&A - Iodine allergy

"A hospital accidently injected an overdose of 
iodine. Can this be cleansed out? Is this what 
brought on the sudden allergy of seafood? Is an 
allergic reaction to iodine related to the seafood 
allergy? The hospital's mistake was nearly fatal. 
Should salt be avoided, or is sea salt okay? Is 
there any way to enjoy fresh halibut again?" 

"I am 32, and only use homeopathic tablets for 
migraines." - G.M. 

Iodine toxicity from an overdose can cause eye 
problems (retinopathy), thyroid problems (both 
hypothyroidism and hyperthyroidism) and bone 
formation problems. You should be sure to be 
checked especially for any thyroid abnormality. I 
do not know of any treatment or washing out other 
than waiting for the body to eliminate the excess 
iodine. Did your doctor actually calculate that 
you had an overdose of iodine or is that your 

While many people think that a shellfish allergy 
is an allergy to iodine, they are not related. 
Shellfish allergy, shrimp, crayfish, clams etc. is 
due to a protein in the meat, not iodine. See our 
article at: 

Shellfish allergy

You should be able to eat iodized salt and sea 
salt without any difficulty. There are no known 
allergic responses to iodized salt. Even if you 
have a skin sensitivity or skin allergic reaction 
to iodine containing products, you can still eat 
iodized salt. 

4. Obesity and life expectancy 

We know that the condition of overweight (body 
mass index BMI 25-29.9) or  obesity (BMI >=30) is 
not healthy. The question is how unhealthy is it. 
Do people die earlier because they are obese or 
overweight? If so, how much earlier. 

This study below looked at the Framingham Heart 
Study data from 1948-1990 and individuals who were 
aged 30-49 at baseline. They calculated life 
expectancy tables to see what difference weight 

They found that 40 year old non smoking women who 
were OVERWEIGHT lost 3.3 years of life and OBESE 
non smoking women lost 7.1 years of life. Men in 
those categories lost about the same number of 
years of life. Obese Women who were smokers lost 
7.2 years compared with normal weight smokers and 
13.3 years compared with normal weight non 

It is interesting that the changes in survival due 
to obesity are about the same as for smoking and 
they are additive decreases. The authors caution 
us that obesity prevention and treatment programs 
may not necessarily regain these lost years. We 
hope that weight loss can prolong our lives but 
right now there is no proof one way or the other. 

Obesity and life expectancy

5. Health tip to share - Mosquito illnesses 
With increased attention to the spread of Blue 
Nile virus by mosquitoes in the U.S., we sometimes 
lose sight of other common mosquito borne viruses. 
Dengue fever and malaria are still epidemic 
problems in Mexico, the Caribbean and South 
America as well as some areas of the southern 
United states. Travellers from the U.S. to these 
areas bring back 100-200 dengue fever infections 
and 1500 malaria infections annually. 

In addition to using DEET containing insect 
repellents, be sure to support community efforts 
of elimination of standing water breeding grounds 
for mosquitoes, spraying for mosquitoes where 
standing water cannot be eliminated and local bat 
colonies or houses. Bats feed on night flying bugs 
and one bat can consume up to 1000 mosquitoes per 
hour. No one approach is sufficient itself but 
rather multiple approaches must be taken to 
decrease mosquito-borne illnesses. 

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

"In My Next Life"

In this life I'm a woman.

In my next life, I'd like to come back as a bear. 
When you're a bear, you get to hibernate. You do 
nothing but sleep for six months. I could deal 
with that. 

Before you hibernate, you're supposed to eat 
yourself stupid. I could deal with that, too. 

When you're a girl bear, you birth your children 
(who are the size of walnuts) while you're 
sleeping and wake to partially grown, cute cuddly 
cubs. I could definitely deal with that. 

If you're a mama bear, everyone knows you mean 
business. You swat anyone who bothers your cubs. 
If your cubs get out of line, you swat them too. I 
could deal with that. 

If you're a bear, your mate EXPECTS you to wake up 
growling. He EXPECTS that you will have hairy legs 
and excess body fat. 

Yup... gonna be a bear. 

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

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****** Woman's Health Newsletter *******
              September 7  2003
Biweekly from BackupMD on the Net

1. Plantar warts
2. Do muscle exercises help chronic neck pain? 
3. Reader submitted Q&A - Trimethylaminuria
4. Luteal phase defect
5. Health tip to share - Colloidal minerals
6. Humor is healthy

1. Plantar warts

Plantar warts are thickened, tough non cancerous 
skin growths on the bottom of the feet. They are 
caused by the Human Papilloma virus (HPV) that 
enters the skin through microscopic cuts and 
abrasions. The virus usually comes from public 
floors such as showering areas, locker rooms, 
bathrooms or other areas where people walk 

The warts are not a major medical problem except 
that they can be uncomfortable with shoes or 
actually cause pain. It takes about 3 months after 
exposure to the virus for the growth to appear. 
Most of the time the warts will eventually go away 
by themselves but it can take years. A more common 
way to get rid of plantar warts is to see a 
dermatologist who can freeze the growths so they 
slough off.  

Sometimes the warts are cut away with electric 
needles (electrodesiccation) or lasers. Chemical 
compounds may be applied such as salicylic acid or 
cantharidin. A recent immunotherapy treatment used 
for plantar warts is Aldara (R) (imiquimod) cream 
which has been successfully used for perineal 
warts. It is applied several times a week for 
several months. 

Self care of plantar warts includes salicylic acid 
bandages, donut bandages (just for discomfort 
relief) and something called duct tape therapy. If 
you want to know more about the self care of 
plantar warts, see this article at mayoclinic.com 

Plantar warts

2. Do muscle exercises help chronic neck pain?

Neck pain is a common complaint, more so among 
women than men. Certain occupations have a higher 
incidence of neck pain and that of "office worker" 
has a fairly high incidence of neck pain 
complaints. It is estimated that up to 2/3's of 
adults will have a significant problem with neck 
pain in their lifetime. 

The predominantly used treatment for neck pain has 
been physical therapy including muscle stretching, 
strengthening and relaxation exercises. There has 
been some debate however as to which form of 
exercises are most effective. 

The following study was conducted in Finland with 
almost 400 female office workers who had chronic, 
nonspecific neck pain lasting 12 weeks or more. 
They randomized the women into one of three 

1) dynamic muscle training - lifting weights and 
stretching muscles chosen to activate large muscle 
groups in the neck and shoulder region 

2) relaxation training - exercises designed to 
remove tension from all inactive muscles 

3) normal physical activity

The main outcome measurement at the end of 12 
weeks was the intensity of muscle pain still 
present. The investigators found no difference at 
the end of the study between any of the 3 groups. 
In other words, normal physical activity (no 
special neck muscle exercises) produced the same 
reduction in pain as both dynamic and relaxation 
muscle training. There also was no difference 
among the groups in the degree of neck disability, 
subjective work ability, range of motion for 
cervical flexion and extension, or dynamic muscle 

Basically, normal activity was as helpful as any 
physicial therapy regimen. 

Do muscle exercises help chronic neck pain?

3. Reader submitted Q&A - Trimethylaminuria

"Trimethylaminuria. I have this disease. Any 
"Age 72. I have had this disease for 10 years. 
Previously I had Sweet's Syndrome and was given 
prednisone which I took at low dosage for 2 years 
resulting in osteoporosis." - pmh 
Trimethylaminuria is a rare, inherited condition 
in which a specific liver enzyme (flavin 
monooxygenase) is missing that metabolizes 
trimethylamine. The net result is that individuals 
excrete a fishy body odor in urine, sweat, breath, 
and other body excretions. Trimethylaminuria is 
also known as Fish-Maloder Syndrome. There are 
less than 100 cases reported in the medical 

Since this is a rare disorder, treatment is not 
really clear. The mainstay is dietary restriction 
of substances containing cholines which are broken 
down to trimethylamines. This means avoiding salt-
water fish, eggs, liver, bacon, wheat germ, dried 
soybeans and pork. Most people, but not all, get 
rid of any fish odor when eliminating these foods 
from their diet. 

You may want to see an experienced nutritionist 
for further information about food containing 
choline. I hope this helps but as is the case with 
all rare diseases, you will need to find a doctor 
who is familiar with the condition and willing to 
work with you.   

4.  Luteal phase defect

Luteal phase deficiency is a condition of 
ovulation in which the uterine lining is not 
hormonally ready to receive a fertilized egg for 
implantation. It is thought to be due to either a 
"poor" ovulation or a low secretion of 
progesterone from the corpus luteum gland that 
forms after ovulation. The suspected frequency of 
this condition varies from about 2-20% in women 
who have trouble conceiving. 

Luteal phase defect is somewhat controversial as 
to whether it really affects fertility or not. It 
seems to occur in up to 5% of all ovulatory cycles 
even in women who have no difficulty conceiving. 
Diagnostic criteria are also controversial with 
some physicians depending upon endometrial biopsy 
and others on serum progesterone in the luteal 
phase (day 21-22 after the start of a menses). 

Treatment focuses on the physician's perception of 
the cause of luteal defect. Clomid or ovulation 
enhancing drugs are given to stimulate a "better" 
egg formation and  subsequent corpus luteum 
formation. Supplemental progesterone is also given 
in the luteal phase if the defect is just 
perceived as low progesterone levels. 

A good article from OBG Management that describes 
what is known and proven about luteal phase 
defects can be found at: 

Luteal phase defect

5. Health tip to share - Colloidal minerals

Minerals are essential metal salts that the body 
needs for many of its nutritional functions. Most 
of the time mineral supplements come from 
inorganic salts and crushed rocks; from non-
growing earth sources. Colloidal minerals refer to 
those same metal salts that are attached to 
organic sources such as oyster shells, coral, 
seaweed etc. 

There is no evidence that colloidal minerals are 
any safer or better for you than those from 
inorganic sources. Do not pay a premium for 
minerals from a colloidal source. In fact with any 
mineral supplements you buy, make sure the 
manufacturer is a large reputable company. Purity 
and freedom from contamination are the most 
important factors rather than a colloidal or non 
colloidal source. 

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

SINGLE BLACK FEMALE seeks male companionship, 
ethnicity unimportant.  I'm a very good looking 
girl who LOVES to play. I love long walks  in the 
woods, riding in your pickup truck, hunting, 
camping and  fishing trips, cozy winter nights 
lying by the fire. Candlelight dinners  will have 
me eating out of your hand. Rub me the right way 
and watch me respond. I'll be at the front door 
when you get home from work, wearing only what 
nature gave me. Kiss me and I'm yours. 

Call   (999)  999-9999 and ask for Daisy.

Over 15,000 men found themselves talking to the 
Atlanta Humane Society about an 8-week old black 
Labrador puppy 

Men are so easy! 

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

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****** Woman's Health Newsletter *******
              September 21,  2003
Biweekly from BackupMD on the Net

1. High protein diet and mild kidney disease
2. Health hazards after a hurricane 
3. Reader submitted Q&A - Cholesterol and diabetes
4. Fertility problems due to tubal disease
5. Health tip to share - Broken ribs
6. Humor is healthy

1. High protein diet and mild kidney disease
One of the concerns of low carbohydrate, high 
protein diets like Atkin's are that the high 
protein amounts in the blood stream cannot be 
handled by "weak" kidneys and can actually cause 
the kidney function to decline over time. 

Investigators have finally tried to answer the 
question of "can high protein diets worsen kidney 
function?" They looked at protein intakes in 1624 
women aged 42-68 in the Nurse's Health Study 
conducted between 1989 and 2000. They correlated 
the protein intake with kidney function. 

The scientists found that if a woman had normal 
kidney function, any level of protein intake did 
not alter that function. However, if a woman had 
impaired kidney function, those who were on high 
protein intake had a slight further decline in 
their renal function more so than if they had a 
low protein intake. 

The test to measure kidney function was GFR ( 
kidney glomerular filtration rate) which is 
calculated from a blood test and a 24 hour urine 
collection. If GFR was above 55 ml/minute then 
protein diet made no difference. If GFR was below 
55 ml/minute, then high protein diets may possibly 
further degrade kidney function. 

This study tells me that if a woman wants to see 
if it is safe for her to embark upon a low 
carbohydrate, Atkins-like diet for weight loss, 
then she should ask the doctor to order a 24 hour 
creatinine clearance test which is used to 
calculate a GFR value. This would be even more 
important before diet onset if the woman was at 
all at high risk for kidney function impairment 
such as having diabetes, autoimmune collagen 
diseases, high blood pressure or a history of 
frequent urinary infections. 

While drinking a larger volume of water during any 
weight loss diet is smart, it may not be enough to 
protect the kidneys if there is already a 
reduction in function. 

High protein diet and mild kidney disease

2. Health hazards after a hurricane

There are many health hazards to watch out for 
after a hurricane has passed through. Bacterial 
contamination of water and from food spoilage are 
major concerns. Accidents due to downed power 
lines, broken glass and penetrating items like 
exposed nails from storm damage or power tool 
mishaps from digging out and cleaning up are also 
high on the list of post storm health risks. 

Food in the refrigerator that has been without 
power for more than 2 hours should not be 
consumed. It is best to just throw it away. Eat 
only dry packaged foods or from cans. You must 
also be very careful of any tap water that has not 
been boiled. 

You may be able to wash dishes in water that has 
had chlorine bleach added to it (15 drops of 
bleach to a quart of water) but you should only 
drink purified water from the store or boiled 
water. You may also want to check your water 
supply several times after such a storm for 
bacterial contamination using an at-home bacteria 
test for water. 

Bacteria test kit for water

Any diarrhea after a storm may indicate exposure 
to bacterial contamination of food or water so 
seek immediate medical attention. 

Beware of any downed power lines and do not 
attempt to remedy the situation yourself. If you 
are driving through water and a power line comes 
down, continue driving away from the line. If your 
car stalls in the water, just sit there. Do not 
attempt to start the car or touch anything metal. 

Also watch out for animal bites from critters 
displaced by the storm such as snakes, squirrels, 
raccoons, rats and mice. Rabies can be carried by 
any of these animals so be careful. 

Finally, be prepared prior to a storm as much as 
possible with lanterns, flashlights, water, 
bleach, dry and canned foods and very secure 
containers for hazardous chemicals. 

Health hazards after a hurricane

3. Reader submitted Q&A - Cholesterol and diabetes

"I just had a complete physical and my blood work 
was normal except for my triglycerides and VLDL 
(very low density lipoproteins) and LDL (low 
density lipoproteins) and C reactive protein. HDL 
(high density lipoprotein/good cholesterol) was 
within normal limits. They told me I am likely to 
become a diabetic if I do not lose weight and 
exercise. Glucose was 90. What does cholesterol 
have to do with diabetes?" 
"I am 55. Last period 2 weeks ago-very light-am 
having lots of hot flashes. Take Allegra(R) and 
Niaspan(R). five foot five inches. weigh 225." - 

Elevated LDL (bad cholesterol) and diabetes are 
basically only related in that they are both risk 
factors for atherosclerosis. Both of them together 
are much worse than any other two risk factors 
such as hypertension, overweight, smoking, family 
history etc. In fact the current recommendations 
for LDL cholesterol goals indicate that you should 
try to keep your LDL level: 

less than 160 mg/dL if you don't have coronary 
heart disease or diabetes and have one or no risk 

less than 130 mg/dL if you don't have coronary 
heart disease or diabetes and have two or more 
risk factors 

less than 100 mg/dL if you do have coronary heart 
disease or diabetes 

If your fasting glucose is 90 mg/dL you do not 
have diabetes now. That is good. However, elevated 
triglycerides are more common in individuals with 
diabetes or heart disease. I think your doctors may 
be worried that you may either have a tendency 
toward diabetes, a genetic disposition toward 
elevated triglycerides (and atherosclerosis) or 
just a poor fast food, fatty diet. You can have a 
3 hour glucose tolerance test or even a hemoglobin 
A1C to check for the near term tendency toward 
developing frank diabetes. 

Many of the risk factors go away with diet and 
weight reduction. The lipid lowering drugs are 
used when diet does not work or you cannot stick 
with one very well. It is best to try to get this 
under control without medicines if you can. 

The medication Niaspan(R) is a lipid lowering drug 
that contains niacin-like potency. It produces 
less hot flashes than niacin but it still has a 
very high incidence of producing hot flashes (up 
to 88% in some studies). You did not indicate if 
your lipid/cholesterol levels were elevated before 
you started Niaspan(R) or after. 

4. Fertility problems due to tubal disease
In couples who are having difficulty trying to 
conceive and who have been unable to do so for a 
year of more of trying, tubal disease may play a 
role between 12-33% of the time. The fallopian 
tube is not only a conduction path for the sperm 
to get to the egg and the egg to be picked up from 
the ovary, but also to guide the fertilized egg to 
the uterus to implant and grow into a healthy 

The tubes can become damaged and impair fertility 
because of infection, surgery which produces 
scarring and conditions such as endometriosis or 
fibroids. Infection of the tubes is by far the 
most common cause of tubal damage. 

Tubal infection is commonly caused by sexually 
transmitted infections such as chlamydia or 
gonorrhea. Although uncommon in the U.S. and most 
developed countries, tuberculosis organisms can 
also cause tubal blockage from scarring. The test 
to determine whether there is enough scarring in 
the tube to cause blockage to sperm and eggs is 
injection of the tubes with a dye that can be seen 
on x-ray (hysterosalpingogram) or at laparoscopy 
by direct visualization. 

Unfortunately the tubes can be damaged but not 
completely blocked. There is no good way to know 
about this if the dye goes all the way through the 
tubes, i.e., they are not totally scarred shut. 
With one episode of pelvic inflammatory disease 
there may be a 10% incidence of tubal blockage up 
to as high as 50% with 3 episodes of infection. 

Many women who have infection which is damaging to 
the tubes may not even realize they have it. 
Therefore an evaluation of the tubes is an 
important part of any workup for difficulty when 
trying to conceive. 

Tubal subfertility

5. Health tip to share - Broken ribs

Not much can be done for broken ribs. Doctors used 
to recommend compression wraps around the chest 
but they now find that those wraps restrict deep 
breathing and lead to more lung infections like 
pneumonia. Symptoms of broken ribs are basically 
pain with deep breathing and pain with any 
movement of the rib cage such as twisting or 
turning motions of the upper body. Basically pain 
medication to ease the discomfort is the only 
treatment. Ribs take about 2 months to heal. 

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
"Signs You're Stressed"
You wonder if brewing is really a necessary step 
for the consumption of coffee. 
You have an irresistible urge to bite the noses 
off the people you're talking to. 
The SUN is too loud. 
You can achieve a "runner's high" by sitting up. 
You ask the drive-through attendant if you can get 
your order to go. 
You can see the individual air molecules 
You keep yelling, "STOP TOUCHING ME!" even though 
you are the only one in the room. 
Relatives that have been dead for years come visit 
you and suggest that you should get some rest. 
Your heart beats in 7/8 time. 
You and reality ...file for divorce. 
That's it for this time. 
Your BACKUPMD on the Net.
Frederick R. Jelovsek MD 

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****** Woman's Health Newsletter *******
              October 5,  2003
Biweekly from BackupMD on the Net

1. Vitamins ineffective for heart disease and cancer
2. Loss of height - When to be concerned 
3. Reader submitted Q&A - Antiphospholipid Syndrome
4. Invalid infertility tests
5. Health tip to share - Cancer diagnosis
6. Humor is healthy

1. Vitamins ineffective for heart disease and cancer

The U.S. Preventive Services Task Force (USPSTF) 
is a committee of health experts that meets 
periodically to review medical research studies 
about preventing various health care problems. 
After reviewing the published research, they may 
make public recommendations about preventive 
health care. Recently they looked at the use of 
supplements of vitamin A, C, E, beta-carotene, and 
folic acid. These are all important factors for 
the body to have health blood vessels. The outcome 
measurement was cardiovascular disease and 
cancers. They wanted to see if taking the 
supplements over a long period of time reduced 
heart problems or any cancers. 

Basically they found that while there was some 
evidence in what they considered "weak studies" 
that heart disease was lowered, overall there were 
too many conflicting results about any benefit 
from taking the supplements. 

They concluded that they could not recommend 
either for or against taking vitamin A, C, E or 
folic acid supplements. They did however, 
recommend against taking beta carotene supplements 
because in two high-quality studies, smokers 
taking beta-carotene supplements developed cancer 
more frequently than those who did not take them. 

Vitamins ineffective for heart disease and cancer

2. Loss of height - When to be concerned 
Your maximum height is usually reached before age 
20. After age 40, however, your height can slowly 
decrease from age related compression of the 
cartilage in the spinal column. This is normal but 
the loss of height should not exceed one inch from 
your maximum height. 

If you lose more than an inch of height after age 
40 or 50, it is very likely that bone loss from 
the vertebrae is what is actually taking place 
rather than just compression of cartilage in 
between the vertebrae. The loss of bone from the 
vertebrae can even result in vertebral compression 
fractures. If this is taking place you definitely 
need to know about it (osteoporosis related 
fractures) because the bone loss can be stopped 
and even reversed. 

Be sure to ask the nurse at the doctor's office to 
measure your height in bare feet and record it at 
each annual exam. Also try to find an accurate 
height measurement from you medical records at 
some time between 25 and 40. If at any time your 
height decreases by more than an inch from your 
maximum height or more than about a half an inch 
from a height measured after 50 years of age, then 
ask your doctor to have a bone scan for 
osteoporosis. If you are having any back problems, 
you may also need an MRI or plain xray of the 
spinal cord to look for compression fractures. 

Preventative therapy of taking 1200 mg of calcium 
and getting enough vitamin D after age 40 delays 
and decreases age related osteoporosis. Remember 
that estrogens (low dose) after menopause are 
still recommended for the prevention of 
osteoporosis in spite of the small risks 
determined from the WHI estrogen and Provera 
hormone replacement study. There are also 
medicines such as raloxifene that can be used 
instead of estrogens to help prevent age related 
bone loss which accelerates after menopause. The 
key point is to make sure you know if you are 
losing calcium from your bones more than the 
average person who ages. Height loss can be such a 
signal that something is wrong. 
3. Reader submitted Q&A - Antiphospholipid Syndrome

"What is antiphospholipid antibody syndrome and 
how can it cause a stroke? What else can it cause? 
I am 53 years old and on Wellbutrin, lisinopril, 
estradiol, progesterone cream, DHEA (5 mg). I am 
not menstruating." - CAJ 

The antiphospholipid syndrome (APS) is an acquired 
blood clotting disorder characterized by recurrent 
vein or artery blood vessels that clot off 
(thrombose) or recurrent miscarriages, or both. It 
is associated with the presence of blood 
anticardiolipin antibodies (aCL) and/or lupus 
lupus anticoagulant (LAC). APS may occur as a 
primary disorder (PAPS) or be associated with 
connective tissue diseases, mainly systemic lupus 
erythematosus (secondary APS). Primary and 
secondary APS are both associated with a 
significant increase of cardiovascular and stroke 

During pregnancy, both aspirin and heparin (a 
potent anticoagulant) have been used to prevent 
pregnancy miscarriage and premature delivery. In 
the non-pregnant state, the general consensus is 
that you should be taking some sort of 
anticoagulant. However, as best I can tell, there 
is no agreement on which specific medicine or even 
degree (mild, moderate, potent) of anticoagulation 
should be recommended. Keep in mind that there are 
two types of stroke, i.e., blood clot strokes or 
blood vessel bleeding (hemorrhagic) strokes. While 
anticoagulants may prevent blood clotting strokes 
(which you are at risk for with APS), they also 
increase the risk of hemorrhagic strokes. 

For example in the large study that examined 
whether aspirin could reduce heart attacks 
(thrombosis of heart blood vessels), they found 
that while heart attacks were reduced, there was a 
slight increase in hemorrhagic strokes in the 
brain. Thus the use of anticoagulants, even 
aspirin alone, can cause complications even while 
they prevent other major complications. While most 
doctors would recommend that you take some sort of 
anticoagulation in a regular basis to prevent 
thrombotic strokes, you will have to be careful 
not to take too  much anticoagulant so you are at 
risk for the bleeding kind of strokes. 

Your therapy should be prescribed and monitored 
closely by a hematology specialist who has had a 
moderate amount of experience with 
antiphospholipid syndrome. APS is still relatively 
rare so general practitioners may have very little 
experience with it. 

4. Invalid infertility tests

The Royal College of Obstetricians and 
Gynecologists conducted a recent review of 
immunologic tests that have been promoted over the 
Internet as possible tests that couples who are 
trying unsuccessfully to conceive might want to 
have performed. 

The review looked for scientifically valid 
evidence for a battery of immunological tests, 
such as: anti-phospholipid antibody; thyroid 
antibody; ovarian antibody; anti-nuclear antibody; 
antisperm antibodies; natural killer cells and 
shared parental human leukocyte antigen (HLA) and 
finally, a test that looks at two subsets of CD4 T 
helper cells (Th1 and Th2). They also examined 
several immune therapies. 

They found that the only test that has evidence 
supporting it is the anti-phospholipid antibody 
test in women who have had recurrent miscarriages. 
Women who are positive for this test may benefit 
from therapy with aspirin and heparin. 

All of the other immunological tests should not be 
run at the current time. 

Unsound tests for infertility

5. Health tip to share - Cancer diagnosis

If the doctor tells you you have cancer the 
initial shock can be overwhelming. However cancers 
come in many different varieties with many 
different treatments and many different expected 

The single, MOST IMPORTANT thing to do is to 
schedule a visit at sometime (a few days or a 
week) after you are told the diagnosis for the 
first time. The purpose of this visit is "to get 
the facts". You want to know what kind of cancer, 
where is it, has it spread, what are the 
treatments and their side effects, and what can 
you expect about the success of any of the 
therapies used? 

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

"Things Only Women Understand"

10. Cats' facial expressions.

9. The need for the same style of shoe in 
different colors. 

8. Why Bean sprouts aren't just weeds. 

7. Fat clothes.

6. Taking a car trip without trying to beat your 
last time. 

5. The difference between beige, off-white, bone, 
and ecru. 

4. Cutting your bangs to make them grow. 

3. Eyelash curlers.

2. The inaccuracy of every bathroom scale ever 

1. Other women.

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

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