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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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The next newsletter will be in two weeks.
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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
removed.
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 web site
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
habits.
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
hours.
*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
number.
*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.
Rick
Frederick R. Jelovsek MD
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Back to top
****** 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
activities?
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
almonds.
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%
difference.
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
treatment.
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
hurts."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** 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
include:
cannabinoids (marijuana)
depressants
dissociative anesthetics
hallucinogens
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
individuals.
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
therapies.
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
effective.
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:
fibroids
endometriosis
liver disease
pancreatitis
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
levels.
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
assessment?
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
made.
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
smokers.
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.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** 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
barefoot.
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
groups:
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
strength.
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
suggestions?"
"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
literature.
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.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** 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." -
SM
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
factors.
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
pregnancy.
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
vibrating.
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.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Back to top
****** 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.
Loss of height - When to be concerned
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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
risk.
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
outcomes.
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
made.
1. Other women.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time.
Your BACKUPMD on the Net.
Rick
Frederick R. Jelovsek MD
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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