Womens Health

Women's Health Newsletters 1/11/04 - 3/21/04




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****** Woman's Health Newsletter *******
              January 11,  2004
Biweekly from BackupMD on the Net

1. Mood and food - Understanding the relationship
2. Omega 3 fatty acids and cardiovascular disease
3. Reader submitted Q&A - Is dementia hereditary?
4. Coffee consumption and diabetes
5. Health tip to share - Humidifier in winter
6. Humor is healthy
The next newsletter will be in two weeks.

1. Mood and food - Understanding the relationship

Negative moods, such as stress, anger, anxiety, 
boredom, sadness and loneliness can often be 
counteracted by chemical pain killers that the 
body releases when certain foods are digested. The 
problem is that we can become addicted to using 
these foods to ease our negative feelings. As a 
result we eat more calories than we need in order 
just to feel better. If we could learn to 
recognize our negative moods and and deal with 
them by methods other than eating, we might all be 
a few pounds lighter. 

Fats and simple carbohydrates seem to release the 
most pleasurable body chemicals; but who ever 
heard of eating just a piece of lean beef or piece 
of uncoated fish when we were trying to perk up 
from a negative mood. Complex carbohydrates, such 
as most vegetables, also take longer to digest and 
do not seem to ease negative moods. We might not 
immediately feel better if we reached for carrots 
and celery but we would certainly not put on as 
much weight as when we use chocolate, ice cream, 
pasta or bread to boost our moods. Whether we gain 
weight when trying to emerge from negative 
emotions may also depend upon what's handy to eat 
wherever we are.  

So what can you do if you seem to be addicted to 
eating to blunt or erase a negative mood? Some 
suggestions from Mayo Clinic include: 

learn to identify quickly when you are having a 
negative emotion 

learn to recognize true hunger, an empty stomach 
rather than a mental need 

learn what triggers a mental need for food 

look elsewhere or use methods other than eating to 
improve your mood 

do not keep starchy, high-fat, high-calorie 
comfort foods in the house or handy at your p[lace 
of work 

exercise regularly - it also helps to relieve 
negative moods by producing advantageous body 
chemicals and it is the opposite of fattening 

On the other hand, if you think your depressed, 
irritable, anxious or stressed out mood is a 
chronic problem, seek medical help for diagnosis 
and treatment. 

Mood and food

2. Omega 3 fatty acids and cardiovascular disease 

Omega 3 fatty acids from fish and fish oils have 
been shown to be protective against coronary heart 
disease. This was first discovered because the 
Greenland Eskimos had very low incidences of 
coronary heart disease in spite of a diet very 
high in fat. Since then studies have looked at the 
relationships of these polyunsaturated fats and 
coronary heart disease. Overall, Omega 3 fatty 
acid supplements aid in the prevention of coronary 
heart disease. 

The fish oil derived fatty acid supplements have 
been shown to reduce the risk of sudden death 
following initial survival from a heart attack by 
about 45% and the overall mortality by about 20%. 
This compares very favorably with many of the 
statin drugs although how the omega 3's prevent 
this is not understood. The supplements also tend 
to reduce blood triglycerides if that is a 

The current recommendations of the American Heart 
Association are: 

 Patients without documented coronary heart 
disease: Eat a variety of (preferably oily) fish 
at least twice weekly. Include oils and foods rich 
in linolenic acid 

 Patients with documented coronary heart disease: 
Consume 1 gram of eicosapentanoic and 
docosahexanoic acid daily, preferably from oily 
fish. Supplements could be considered in 
consultation with a doctor 

 Patients with hypertriglyceridemia: Take 2-4 grams 
of eicosapentanoic acid and docosahexanoic acid 
daily, provided as capsules under a doctor's care 

The side effects of most supplements are very low 
and include only occasional abdominal bloating.  

Omega 3 fatty acids and cardiovascular disease

3. Reader submitted Q&A - Is dementia hereditary?
"My mother's sister has dementia, and my mother's 
memory is becoming worrying. My grandmother was in 
a mental institution for many years and I am now 
wondering if she may have had Alzheimer's or 
dementia but went undiagnosed back then. I am 
concerned that there may be some hereditary 
factors? My grandmother also had Parkinson's 
disease and deep depression." 

"I am age 42, with hypertension, diabetes, and 
have complex ovarian cysts" - DLP 

Your question centers on a current medical 
frontier, i.e., determining the types and causes 
of what is known as late onset dementia. To 
summarize in general, there seems likely to be 
both genetic components and environmental 
components in many of the dementias but the 
science is far from conclusive at this point. So 
far, no one single factor has been identified as a 
cause for late onset Alzheimer's disease. It is 
likely that a combination of factors, including 
age, genetic inheritance, environmental factors, 
diet and overall general health, are responsible. 

Early onset dementias, occurring before the age of 
60-65, often do have genetic differences which 
have been described. Fortunately most of these 
early onset degenerative brain diseases are 
relatively uncommon or rare. There is an early-
onset Alzheimer's disease and a Familial 
Alzheimer's disease (FAD) and a Pick's Disease 
that fall into this category among others. These 
have been found to have definite genetic findings 
but their onset is almost always before age 60. 

The most common of the late onset dementias is 
Alzheimer's disease. Next comes vascular dementia 
at about 25% of the cases and the third most 
common (10-15%) is Dementia with Lewy Bodies 
(DLB). The latter has a 70% association with 
Parkinson's Disease. After these types come a 
whole host of rarer types of dementias some of 
which are known to have a genetic basis; most are 
unknown in their causes. In the vast majority of 
late onset Alzheimer's, however, the effect of 
inheritance seems to be small. If a parent or 
other relative has Alzheimer's disease, your own 
chances of developing the disease are only a 
little higher than if there were no cases of 
Alzheimer's in the immediate family. 

I would say that right now, the most important 
thing would be to be sure what type of dementia 
your mother's sister has. This needs to be 
diagnosed by a neurologist or a geriatric 
specialist. Assuming this turns out to be a late 
onset Alzheimer's (you did not mention your Aunt's 
age) then it is still very unlikely you will 
develop this problem. 

Actually you may have to worry more about vascular 
dementia at an elderly age because of your high 
blood pressure and diabetes. These both have been 
associated with with the mini-vascular strokes in 
the brain which are associated with vascular 
dementia. You should keep you blood pressure and 
diabetes under control with medicine and undergo 
as much weight reduction as possible since that 
will help both diabetes and hypertension. 

4. Coffee consumption and diabetes

By this time many of our reader's will have heard 
news reports indicating that those who drink 
coffee have a lower incidence of adult onset 
diabetes. As we have cautioned before in this 
newsletter, it is important to realize that this 
is merely a statistical association and not 
necessarily a cause and effect. 

Here are some of the facts of the study. 

In women, less than 4 cups of coffee per day did 
not lower risk of diabetes 

At 4-5 cups of coffee per day the risk of diabetes 
was 70% as it also was with 6 or more cups a day 
(please not that 5 cups (500 mg of caffeine) of 
coffee per day is considered caffeine toxicity) 

Women who drank 4 or more cups of decaffeinated 
coffee a day  had an 85% risk of diabetes 

I do not think this study should be used either to 
start taking in more caffeine in order to prevent 
diabetes nor should it be used as justification 
for continuing to drink coffee in the range of 
caffeine toxicity. It is just an association for 
scientists to know about when they perform further 
studies. It is not an article to take any action 
upon in my opinion. 

Coffee consumption and diabetes

5. Health tip to share - Humidifier in winter

Many conditions are worsened when you are in an 
overly dry environment (humidity less than 30%). 
This commonly occurs during the winter as heat 
comes on indoors. Flu, a sore throat, colds, 
bronchitis, sinusitis, asthma, and dry skin or 
eyes or nasal linings will all benefit from a 
using a room humidifier. Keep it in mind this 

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

6. Humor is healthy

"Phone Call"

A woman, calling a local hospital, said, 
"Hello, I'd like to talk with the person who gives 
the information regarding your patients. I'd like 
to find out if the patient is getting better, or 
doing as expected, or is getting worse." 

The voice on the other end of the line said, "What is
the patient's name and room number?"

She said, "Sarah Finkel, in Room 302."

"I will connect you with the nursing station."

"3-A Nursing Station. How can I help you?"

"I would like to know the condition of Sarah Finkel
in Room 302"

"Just a moment. Let me look at her records. Oh, 
yes. Mrs. Finkel is  doing very well. In fact, 
she's had two full meals, her blood pressure  is 
fine, her blood work just came back as normal, 
she's going to be taken off the heart monitor in a 
couple of hours and if she continues this 
improvement, Dr. Cohen is going to send her home 
Tuesday at twelve o'clock." 

The woman said, "Thank heaven! That's wonderful! 
Oh! that's fantastic that's wonderful news!" 

The nurse said, "From your enthusiasm, I take it 
you must be a close family member or a very close 

"Not exactly, I'm Sarah Finkel in 302! Nobody here 
tells me nothing!" 

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

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****** Woman's Health Newsletter *******
              January 25,  2004
Biweekly from BackupMD on the Net

1. Everyday muscle aches and pains 
2. Internet breast cancer screening info  
3. Reader Q&A - Post menopausal vaginitis
4. Chronic pain after surgery
5. Health tip to share - Extra sleep
6. Humor is healthy
The next newsletter will be in two weeks.

1. Everyday muscle aches and pains

Many individuals In their 40's,50's and older seem 
to complain of the new onset of increased muscle 
aches and pain. The health question becomes "Does 
this mean I am developing a disease"? Many times 
there is no disease present but lifestyle habits 
may significantly contribute to the problem. 

Lack of a proper amount of sleep time is a common 
cause of increased muscle aches and pains. In 
patients who have fibromyalgia, decreased sleep 
time significantly worsens their symptoms. Loss of 
sleep does this also in normal people. Recommended 
sleep for most people is 7 1/2 - 8 1/2 hours a 
night. It is not uncommon for some people to only 
get 6-7 hours of sleep a night or less. They think 
that is enough or else they are so busy that's all 
they can get. 

If you are running at 90 miles an hour during the 
day and going to bed late and getting up early, 
this high stress makes people ache the next day 
from too much constant tensing of the muscles. You 
can even have muscle tenseness from sitting at a 
desk or computer terminal all day just from the 
lack of movement and intense concentration and 
muscle tensing. 

Does exercise help or hinder? It depends upon how 
much exercise you are doing. If you are pushing 
the muscles further and further with each exercise 
session, then they will hurt the next day. If you 
reach a steady state of exercise then the muscle 
aches and pains improve or go away. 

Your mattress and pillow may also make a 
difference. Too firm and too soft, sagging 
mattresses contribute to daily aches and pains. 
Different firmness of pillows can also make a 
difference with neck pain. 

So what can you do? A hot shower and stretching 
exercises in the morning can help. Getting enough 
sleep at night is also a cornerstone of 
treatment.The important thing is to make sure your 
lifestyle is not contributing to the problem 
before you seek medical diagnostic tests. 

2. Internet breast cancer screening info  

All of us look for medical information on the 
Internet. The accuracy of that information we find 
can be difficult to assess. The site may have 
accurate, unbiased information or it may be trying 
to downplay risks and overestimate benefits in 
order to get us to agree with their point of view. 
How do you tell if the information is correct? 

In a recent article in the British Medical 
Journal, investigators looked at the quality of 
information about screening for breast cancer with 
mammography on 27 web sites all over the world. 
Thirteen sites were from professional advocacy 
groups, 11 from governmental institutions, and 
three from consumer organizations. 

The conclusions of the study were quite 
interesting. They felt there was a significant 
bias in favor of mammography screening on the 
governmental and advocacy group sites; whereas the 
consumer sites seemed to present a more accurate 
discussion of not only the benefits but especially 
the disadvantages and hazards of mammography 

Some of the findings included:

over diagnosis of breast cancer of 33-35% and over 
treatment of carcinoma in-situ of 30% were ignored 
on many of the non consumer sites  

some web sites alleged that breast cancer 
screening leads to less mastectomies when in fact 
the opposite is true 

many sites did not let people know that screening 
leads to  overuse of radiation therapy treatment 
and also downplayed the complications of 

false positive mammography findings were often 
downplayed as sometimes merely creating "anxiety" 
when in fact "more than 10% of women screened will 
at some point experience important psychological 
distress for many months" 

The authors concluded that as a whole, the 
consumer run sites were less biased and tended to 
present the pros and cons of breast cancer 
screening more accurately while many of the 
governmental and advocacy group sites tended to 
gloss over the disadvantages and potentially 
harmful effects of screening. 

This is an interesting article that all women 
should read. 

Internet breast cancer screening info 

3. Reader Q&A - Postmenopausal vaginitis

"I am 46 years old and am currently being treated 
for candidiasis with Nystatin(R).  I am also 
menopausal having severe night sweats and hot 
flashes that kept me up all night.  I started HRT 
4 months ago to relieve the menopausal symptoms 
since none of the natural products had any effect.  
The problem I am having is that the hormones feed 
the yeast problem, and I am unable to get rid of 
the yeast.  I am in a real catch 22 situation.  
Have you heard of this condition before, and how 
do other women handle it?" - anonymous 

Yeast vaginal infections (candidiasis) is very 
common before menopause but much less frequent 
after menopause unless a woman has diabetes. 
Actually the most common cause of vaginal 
discharge, itching and burning after menopause is 
atrophic vaginitis. 

Atrophic vaginitis is basically a bacterial 
infection when the normal resistance of the 
vaginal skin lining is very weak. The "weakness" 
is usually from low estrogen levels although it 
can also be from antibiotic therapy or high blood 
sugar levels just as it can premenopausally. Even 
though you are taking hormone replacement, if you 
are still having hot flashes then your estrogen 
levels are too low. Even if the hot flashes are 
controlled on HRT, the vaginal skin lining may 
still not be getting enough estrogen to sustain 
the normal lactobacillus acidophillus that the 
vagina depends on to fight of bowel and skin 

Most of the time the doctor's initial therapy for 
the problem you describe is to prescribe topical 
estrogen cream (eg., Estrace® vaginal cream or 
Premarin® vaginal Cream) to the vagina or use the 
estrogen impregnated silicone rings (eg. Estring®, 
Femring®) that are placed in the vagina to 
continually provide estrogen to the vaginal skin. 

This therapy is often sufficient on its own to 
prevent the vaginal symptoms whether the source of 
discharge is bacterial or yeast. In other words, 
for this problem women do not necessarily need any 
anti-yeast therapy or anti-bacterial therapy 
because those are only secondary invaders of a 
weakened vaginal lining. After a woman used the 
topical estrogen product for several months, it 
can be discontinued to see if the problem returns 
or not. Many times it does not return even if the 
estrogen levels are still low. 

Finally, I am not aware of any over-the-counter, 
non prescription substitute for this except 
perhaps taking lactobacillus acidophilus 
supplements. If the estrogen therapy does not 
work, then you need to have your doctor take a 
specific bacterial culture of the vagina to see 
what organism predominates. 

4. Chronic pain after surgery

When giving you informed consent about an upcoming 
surgical procedure, many doctors forget to tell 
you that chronic pain can often result from any 
surgery about 5-10% or more of the time. The 
doctors focus on telling you about curing pain or 
curing the symptom for which you are undergoing 
operative treatment but neglect to tell you that 
sometimes, not often, any body incision can result 
in a chronic, daily pain that was not there before 
the surgery. 

Post operative pain is a significant problem for 
many surgeries including gall bladder removal, 
hernia repair, breast surgery, hysterectomy, 
Cesarean section, lung or heart surgery 
(thoracotomy) and most orthopedic procedures among 
others. Some procedures have a lower incidence of 
post-operative pain while others have higher 
incidences. The pain may reside mostly at the 
incision or deeper in internal tissues. 

No one is absolutely sure what causes the new post 
surgical pain but many doctors postulate that 
nerve injury in the skin and sometimes in deeper 
tissues is the initiating stimulus. As the nerve 
or nerves try to heal, they may develop a focus of 
electrical  irritation that makes the nerve send a 
signal to the brain that is painful. 

Doctors are working on methods to try to lessen 
the incidence of persistent post surgical pain but 
for now, the important concept is that you should 
be aware that this can happen if you are to 
undergo an operation. 

Chronic post-surgical pain

5. Health tip to share - Extra sleep
" I enjoy being an early riser but sometimes on 
the weekends I like to just laze in bed.  On a 
lark, I bought a sleep mask made of silky material 
at the Dollar Store and tried it. I could not 
believe the difference it made.  I slept an extra 
hour or two when I wanted to and couldn't believe 
the sun was so bright when I woke up at 8:30 a.m." 
- dmg 

6. Humor is healthy
From Joke Du Jour
"Best Deal Yet"

No nursing home for me. I am checking into the 
Holiday Inn!  With the average cost for a nursing 
home per day reaching $188.00, there is a better 
way when we get old and feeble. I have already 
checked on reservations at the Holiday Inn. For a 
combined long term stay discount and senior 
discount, it's $49.23 per night.  That leaves 
$138.77 a day for: 

1. Breakfast, lunch and dinner in any restaurant I 
want, or room service. 

2. Laundry, gratuities and special TV movies. 

Plus, they provide a swimming pool, a workout 
room, a lounge, washer, dryer, etc.  Most have 
free toothpaste and razors, and all have free 
shampoo and soap.  They treat you like a customer, 
not a patient. 

$5 worth of tips a day will have the entire staff 
scrambling to help you. There is a city bus stop 
out front, and seniors ride cheap. 

To meet other nice people, call a church bus on 
Sundays. For a change of scenery, take the airport 
shuttle bus and eat at one of the nice restaurants 
there.  While you're at the airport, fly 
somewhere. Otherwise, the cash keeps building up. 

It takes months to get into decent nursing homes. 
Holiday Inn will take your reservation today. And 
you are not stuck in one place forever, you can 
move from Inn to Inn, or even from city to city. 

Want to see Hawaii? They have a Holiday Inn there too.
T.V. broken?  Light bulbs need changing?  Need a
mattress replaced?  No problem.  They fix everything,
and apologize for the inconvenience.  

The Inn has a night security person and daily room 
service.  The maid checks to see if you are OK.  
If not, they will call the undertaker or an 

If you fall and break a hip, Medicare will pay for 
the hip, and Holiday Inn will upgrade you to a 
suite for the rest of your life. 

And no worries about visits from family. They will 
always be glad to find you, and probably check in 
for a few days mini-vacation. The grand kids can 
use the pool.  What more can you ask for? 

So, when I reach the golden age, I'll face it with 
a grin. Just forward all my email to: 

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

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****** Health Newsletter *******
         February 8,  2004
Biweekly from BackupMD on the Net

1. Breast augmentation and mammography accuracy
2. Red yeast rice for cholesterol lowering 
3. Reader submitted Q&A - Nighttime arm numbness
4. Complex carbohydrate low fat diet
5. Health tip to share - Sleep tips
6. Humor is healthy

1. Breast augmentation and mammography accuracy

doctors do not believe that breast augmentation is 
associated at all with causing breast cancer. 
However, some doctors and many patients are 
worried that an implanted breast prosthesis makes 
it  more difficult to diagnose an early breast 
cancer using mammography. 

In order to test the accuracy of mammography in 
patients who have had a breast augmentation, 
investigators from several centers across the U.S. 
looked at women who had breast augmentations and 
who also had mammography and compared them with 
women without augmentations. They checked the 
outcomes of stage of cancer, size and spread to 
the lymph nodes in both groups of women. 

The findings showed several things: 

mammograms were less sensitive in discovering 
cancers in women with augmentations versus in 
those without (45% vs 67%) 

even though mammograms did not pick up as many of 
the breast cancers in women with augmentations, 
the severity and size and spread of the breast 
cancers when they were finally found were the same 
in both groups. In other words, not finding the 
cancers as soon did not result in eventually 
finding more advanced cancers 

there were not more false positive mammography 
results when a woman had a breast augmentation 

The bottom line of the study is that mammograms 
are less accurate when a woman has had a breast 
augmentation, but not so low in accuracy that the 
breast cancer is significantly more advanced when 
it is finally found.If a woman has had a breast 
augmentation, she should still have regular 

Breast augmentation and mammography accuracy

2. Red yeast rice for cholesterol lowering

Nutritional supplements containing rice that has 
been fermented by a strain of red yeast (Monascus 
purpureus) have been shown to have cholesterol 
lowering properties by about 20-40%. In fact, red 
yeast rice was found to have statin chemicals in 
it that are identical to a manufactured drug 
called lovastatin (Mevacor(R)). 

Apparently the lovastatin was a natural 
fermentation product in this preparation and the 
FDA challenged that they should regulate its sale 
as a drug because this is identical to a drug that 
they currently regulate. This position was 
initially defeated in the courts and then reversed 
so that most of the red yeast rice was removed 
from the food supplement market. Since that time 
some products have reappeared and are available. 

It is important to remember that even though the 
red yeast rice is a natural product, the statin 
chemical in it has the same risks as the 
prescribed statin, ie., possible liver or muscle 
toxicity. If someone takes  red yeast rice they 
also should have their liver enzymes checked 
periodically and be sure to report any excessive 
fatigue or muscle weakness to their physician. 

3. Reader submitted Q&A - Nighttime arm numbness

"About 4 hours into my sleep at night, I wake up 
and my right arm is numb. It goes down my whole 
arm and into my fingers. My fingers feel tingly. I 
have to get out of bed and stand up and wait for 
my arm to return to normal. What's going on with 
me?" - PJS 

Numbness and tingling of any extremity or large 
area of the body is commonly due to some 
compromise or abnormality of the nerve or nerves 
supplying the skin and muscles of the area that 
has gone numb or tingly. This can be due to a 
nerve being compressed (sleeping on it), 
abnormally stretched, or any disease or trauma 
that has involved a nerve. 

The fact that your symptoms only occur at night 
when sleeping and resolve with change in position 
make me suspect that there is nerve compression 
taking place while you sleep. It might be due 
either to your arm position or clothes that band 
tightly across the upper arm when you are asleep. 

If your right arm is almost always the problem, I 
would think you are probably lying on your right 
side and somehow putting pressure on the nerves to 
your right arm. If the numbness is at the shoulder 
or above then the compression is near the spine or 
neck. If the numbness starts below the shoulder, 
the compression is likely on the upper arm just 
between your armpit (axilla) and your elbow. If 
this is the case, you might try arranging some 
pillows to either force yourself to lie on your 
left side or to cushion between your chest/breast 
and right arm when you lay on your right side. 

Tingling and numbness of the arm are called 
paresthesias and can be due to many other reasons, 
however. If this persists in spite of making 
changes in your sleeping position, you should see 
your physician. Conditions such as diabetes, 
multiple sclerosis, tumors of the arm or spine, 
arthritis or spinal disc problems, vitamin 
deficiencies, and circulatory disorders, among 
other things, can cause the symptoms you describe. 

4. Complex carbohydrate low fat diet

While low carbohydrate diets ala Atkin's are quite 
the rage now, they are not tolerated by everyone. 
Older adults, especially those over age 60 do not 
do well with high protein and fat consumption. In 
fact most older adults tend to normally eat more 
carbohydrates than younger adults. 

Investigators in Arkansas looked at giving a diet 
high in complex carbohydrates and low in fat to 
men and women (average age 66) with impaired 
glucose tolerance. They had two diet groups and 
one control group. Both diet groups received a 
high carbohydrate diet (18% fat, 19% protein, 63% 
carbohydrates, and 26 gm of fiber per 1000 kcal) 
and one of the diet groups additionally had an 
aerobic exercise program while the other one did 
not. The diet groups actually were not restricted 
in their number of calories at all but just the 
ratio of the protein, fats and carbohydrates. 

Both of the diet groups lost more weight (7-11 lbs 
on the average over 12 weeks) than the controls. 
The diet group with an exercise program lost 
slightly more than the diet group not on an 
exercise program. 

The interesting aspect about this study is that 
the people were not restricted in the amount they 
were allowed to eat, just in the proportion of 
fats and proteins in the diet. Thus this is very 
similar to a vegetarian diet that is high in 
complex carbohydrates. 

Complex carbohydrate low calorie diet

5. Health tip to share - Sleep tips

"My proven tips on getting more and better sleep:

1) Make your room dark. Purchase black-out 
blinds or simply nail up an old dark blanket. 

2) Purchase a 'white noise' device.  It will mask 
noise such as barking dogs and traffic. (I use an 
air cleaner, but a humidifier works well also.) 

3)  If you live in a colder climate, purchase and 
use an electric blanket. 

Sleep like a baby!" - Val

6. Humor is healthy

Dear Dogs

When I say to move, it means go someplace else, 
not switch positions with each other so there are 
still two dogs in the way. 

The dishes with the paw print are yours and 
contain your food. The other dishes are mine and 
contain my food. Please note, placing a paw print 
in the middle of my plate and food does not stake 
a claim for it becoming your food and dish, nor do 
I find that aesthetically pleasing in the 

The stairway was not designed by NASCAR and is not 
a racetrack. Beating me to the bottom is not the 
object. Tripping me doesn't help, because I fall 
faster than you can run. 

I can not buy anything bigger than a king size 
bed. I am very sorry about this. Do not think I 
will continue to sleep on the couch to ensure your 
comfort. Look at videos of dogs sleeping, they can 
actually curl up in a ball. It is not necessary to 
sleep perpendicular to each other stretched out to 
the fullest extent possible. I also know that 
sticking tails straight out and having tongues 
hanging out the other end to maximize space used 
is nothing but doggy sarcasm. 

When I am playing the pinball machine, jumping up 
and trying to grab the ball through the glass is 
not helpful. Barking at me because I'm not helping 
you achieve your goal does not win you any extra 
brownie points. 

My compact discs are not miniature Frisbees.

For the last time, there is not a secret exit from 
the bathroom. If by some miracle I beat you there 
and manage to get the door shut, it is not 
necessary to claw, whine, try to turn the knob, or 
get your paw under the edge and try to pull the 
door open. I must exit through the same door I 
entered. In addition, I have been using bathrooms 
for years, canine attendance is not mandatory. 

The proper order is kiss me, then go smell other 
dogs butt. I can not stress this enough. It would 
be such a simple change for you guys to make. 

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

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********** Health Newsletter ***********
              February 22,  2004
Biweekly from BackupMD on the Net

1. Protect your arthritic joints to prevent pain
2. Spider veins - what can be done?
3. Reader submitted Q&A - Zocor concern
4. Risk factors for new onset kidney disease
5. Health tip to share - Numb, tingling arm
6. Humor is healthy
The next newsletter will be in two weeks.

1. Protect your arthritic joints to prevent pain

Our joints wear and tear with aging often causing 
some discomfort with certain activities that 
stress the joints. Even if age is not a problem 
but you have arthritis, the joints may become 
quite painful, lasting a long time even with 
minimal physical motion at the joint bone 
connection. Protection is necessary for not only 
the large joints like the hip, knee and shoulder, 
but also fingers, wrists, elbows and feet can 
benefit from change in our everyday movement 
habits in order to function without pain. 

The experts at Mayoclinic.com have come up with 
some tips to guard those joints from unnecessary 
pain and stiffness: 

  Move each joint through its full pain-free range 
of motion at least once a day. 

  Learn to Understand the difference between the 
general discomfort of arthritis and pain from 
overuse of a joint. 

  Be careful how you use your hands - avoid tight 
grips; avoid bending the large knuckles of your 
hand while keeping the middle and end joints 
straight and your thumb parallel to your fingers; 
avoid pinching items between your thumb and your 
fingers -- rather hold the objects in your entire 
palm if possible. 

  Use proper body mechanics when sitting or 
standing for a long time, when lifting or carrying 
heavy objects and when picking objects off of the 

  Use the strongest joint available for the job. 

  Avoid keeping the joint in the same position for 
long periods of time 

  Intermix periods of joint rest and activity 
during the day. 

Do not be afraid to use assistant devices to help 
carry, move or open items. You may want to use 
utensils with larger handles or add extenders to 
knobs or dials for leverage to turn them. You may 
even benefit from items to help you get dressed or 
even to walk. All of these aids will help protect 
the joints from becoming painful or will assist a 
stiff joint to still do the job. 

Arthritis: Protect your joints to prevent pain

2.  Spider veins - what can be done?

Spider veins are small red, blue or violet veins 
that often occur on the thighs, calves and ankles. 
They may look not only like a spider with "legs" 
radiating out from a central body, but also like a 
series of lines or branches. Sometimes the veins 
may cause aching, burning, swelling or night 
cramps although most of the time they do not 
produce any physical symptoms. These veins are not 
the same as varicose veins which actually are much 
larger; usually a 1/4 inch diameter or more. Many 
people consider spider veins simply as 
unattractive and they may wish to have them 

Doctors are not absolutely sure what causes these 
small veins but several factors seem to contribute 
to their development: heredity, pregnancy, weight 
gain, physically straining occupations or 
activities requiring the use of certain 

Even though these small surface skin veins are 
part of the larger vein system of the body, they 
are not essential to the vascular blood flow. This 
allows doctors to go ahead and use lasers or 
inject scarring chemical solutions (sclerotherapy) 
that seal off the vessel from allowing any more 
blood to go through it. When the blood flow is cut 
off, the redness of the spider vein on the surface 
of the skin disappears. 

Sclerotherapy is commonly used by plastic surgeons 
and dermatologists to get rid of these veins 
although lasers are being used more and more. 
There may even be a response from using Vitamin K 
cream on the spider veins. With sclerotherapy, the 
veins are injected with a chemical to seal off the 
vein but it may take more than one session to 
effectively do this. 

Serious complications are rare but can happen. One 
may develop blood clots in nearby veins, severe 
inflammation of the skin, or even allergic 
reactions to the sclerosing solution and skin 
injury that could leave a small but permanent 
scar. Less serious, but not rare, complications 

some pigmented (splochy) areas that take awhile to 
go away and, 

developing new spider veins around the previously 
injected vein. 

If you think you might be interested in this 
procedure, check out the article at the American 
Society of Plastic Surgeons. 

Spider veins - what can be done?

3. Reader submitted Q&A - Zocor(R) concern

"I am now taking 80 mg. of Zocor(R) (simvastatin). 
I hear of the serious side-effects of this drug. 
Please give me an herbal alternative." - anonymous 

Zocor belongs to a class of drugs called statins. 
They are used to lower bad cholesterol (LDL) and 
many times they also raise good cholesterol (HDL). 
There are studies that show they not only lower 
cholesterol but also can reduce adverse 
cardiovascular events in people who have risk 
factor for heart attacks and strokes. There is 
still a question as to whether or not they reduce 
the death rate overall in patients who do not have 
risk factors other than the high cholesterol. 

You are correct that any of the statin drugs can 
cause some major complications although not very 
frequently. One of the worst complications is 
killing off the body's muscle cells 
(rhabdomyolysis) which can lead to extreme and 
permanent muscle weakness. This probably happens 
in about one person per 10,000 or more. Muscle 
soreness is more frequent at about 2%. Liver 
toxicity is also a rare (less than 0.5%) but 
serious problem. 

Dietary lowering of LDL cholesterol can be brought 
about by following a low saturated fat diet that 
includes added fiber, soy protein and almonds. 

Red yeast rice has been shown actually to have 
statins (lovastatin) in it. We wrote about it in 
the newsletter in the last issue. It can lower 
cholesterol by about 20-40%. I would not consider 
it an herb but rather a nutritional supplement. 
You still should have your liver enzymes checked 
periodically when using it. This has the most data 
with it as a non prescription way of lowering 
cholesterol but it probably should be considered 
almost the same as the drug lovastatin 

Red wine with or without the alcohol in it and 
grape juice from red grapes lowers the absorption 
of lipids from meals as well as raising good 
cholesterol (HDL) blood levels. 

Other herbs that are in the literature about 
lowering cholesterol but of which I have no 
experience are: 

fenugreek (Trigonella foenum-graecum), 
artichoke leaf extract (Cynara scolymus) 
red glory bower (Clerodendron colebrookianum Walp 
  (family, Verbenaceae) from China 
Indian gooseberry (amla - Emblica officinalis) 

It seems if you are going to go to the trouble of 
taking either a medicine or a supplement to lower 
cholesterol, it would be smart to permanently 
change eating habits to increase fiber as much as 
you can and regularly use red grape products, 
almonds and soy. 

4. Risk factors for new onset kidney disease
Chronic kidney disease is much less common than it 
was in the days before widespread use of 
antibiotics, yet many individuals still develop 
life-threatening kidney disease. If the kidney 
impairment becomes bad enough and you lose too 
much function, kidney hemodialysis several times a 
week is the only way to stay alive. While several 
diseases are known to be associated with chronic 
kidney disease, the factors associated with the 
new development of kidney disease are not well 

In a recent study of over 2500 individuals living 
in a community, investigators looked at risk 
factors for the development of chronic kidney 
problems in individuals who were not known 
previously to have kidney problems or active 
medical diseases. Both men and women who averaged 
43 years of age at the start of the study were 
followed for almost 20 years. 

Over 9% of the study individuals developed chronic 
kidney impairment over that time. The major risk 
factors associated with this were diabetes, 
hypertension, smoking and obesity. The biggest 
risk, however was with preexisting low kidney 
blood flow (glomerular filtration rate or GFR). 
This is a measurement based on a collection of 
urine for 24 hours along with a blood test called 
a 24 hour creatinine clearance. It measures GFR on 
the average how much blood is being cleared of 
waste products by the kidneys. 

A mildly reduced GFR (<90 mL/min per 1.73 m2) 
predicted a 3-fold chance of progression to kidney 
disease. This means to me that kidney impairment 
can develop over a fairly long time, many years 
before any other disease or risk factor is 
present. While doctors do not order this 24 hour 
urine test as a screening for future kidney 
disease, it appears that maybe they should. 

I do not know if you asked your doctor to order 
such a test - a 24 hour creatinine clearance - 
that he or she would comply with your request, but 
it is not an expensive test. It might not hurt to 
ask especially if you have high blood pressure, 
diabetes or are moderately overweight. If the test 
indicated slightly low flow, it might be more 
incentive to lower your blood pressure, weight or 
blood sugar through dietary or lifestyle 
modification than you have at the present time. 

Risk factors for new onset kidney disease

5. Health tip to share - Numb, tingling arm

"I have carpal tunnel syndrome. I would wake up 
with a numb, tingling arm. My entire arm was 
aching. I bought a special splint designed 
specifically for the carpal tunnel syndrome. I 
found almost instant relief. I take 100 mg of 
vitamin B6, along with other B vitamins.  I hope 
this information helps others!" Jennifer 

6. Humor is healthy

"English Nouns, Male or Female"

 In many languages, nouns are considered wither 
masculine or feminine and take different words as 
modifiers. From the Washington Post Style 
Invitational in which it was postulated that if 
English were to have male and female nouns, and 
readers were asked to assign a gender to nouns of 
their choice, and explain their reason. 

The best submissions:

Detective Novel -- f., because you're not supposed 
to peek at its end the minute you pick it up. 

Swiss Army Knife -- m., because even though it 
appears useful for a wide variety of work, it 
spends most of its time just opening bottles. 

Kidneys -- f., because they always go to the 
bathroom in pairs. 

Penlight -- m., because it can be turned on very 
easily, but isn't very bright. 

Hammer -- m., because it hasn't evolved much over 
the last 5,000 years, but it's handy to have 
around and is good for killing spiders. 

Tire -- m., because it goes bald and often is 

Hot air balloon -- m., because to get it to go 
anywhere you have to light a fire under it. And, 
of course, there's the hot air part. 

Web page -- f., because it is always getting hit 

Web page -- m., because you have to wait for it to 

Shoe -- m., because it is usually unpolished, with 
its tongue hanging out. 

Copier -- f., because once turned off, it takes a 
while to warm up. Because it is an effective 
reproductive device when the right buttons are 
pushed. Because it can wreak havoc when the wrong 
buttons are pushed. 

Magic 8 Ball -- m., because it gives monosyllabic 
answers that usually indicate it did not pay 
attention to your question. 

Ziploc bags -- m., because they hold everything 
in, but you can always see right through them. 

Sponges -- f., because they are soft and 
squeezable and retain water. 

Critic -- f. What, this needs to be explained? 

Subway -- m., because it uses the same old lines 
to pick up people. 

Hourglass -- f., because over time, the weight 
shifts to the bottom. 

Cars -- f., most of the time they're ok, but if 
you mistreat them or don't service them often 
enough, they soon break down and/or turn into a 

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

Back to top

********** Health Newsletter ***********
              March 7,  2004
Biweekly from BackupMD on the Net

1. Using antibiotics sensibly
2. How long to treat a UTI? 
3. Reader submitted Q&A - Weight and OCPs
4. Massages to relieve muscle tension
5. Health tip to share - Too many fluids
6. Humor is healthy
The next newsletter will be in two weeks.

1. Using antibiotics sensibly

Why not take an antibiotic when you have a cold, 
sore throat or flu symptoms? It can't hurt you can 
it? Yes it can hurt. 

The overwhelming majority of upper respiratory 
tract infections in otherwise healthy people 
during the cold and flu season are caused by 
viruses. Antibiotics have no effect against 
viruses, only against bacteria. The viral caused 
cold, flu or sinus drainage symptoms do not go 
away any quicker when you take an antibiotic. 
Viral infections are usually self-limited and do 
go away on their own but the clearing of symptoms 
is not because you took an antibiotic. 

If you take left over antibiotics or pressure your 
doctor to prescribe them when you really do not 
need them, you run not only the risk of an 
allergic reaction, a bowel infection or vaginal 
yeast infection, but also you contribute to 
letting other bacteria in your body become 
resistant to that antibiotic. The bacteria 
themselves form a defense against the specific 
antibiotic. The next time you get a bacterial 
infection, that antibiotic might not work. It may 
take a week or more to find out that the 
antibiotic does not work and all the time the 
infection causes damage to your body. You may end 
up needing hospitalization for the infection or a 
more expensive antibiotic; there may not be any 
antibiotics that are effective for the infection. 

When antibiotics are overused, infections caused 
by these bacteria may not respond. Illnesses from 
the infection can last longer. Complications from 
such an infection and even the risk of death can 
rise. Failure of an antibiotic to treat a 
particular infection leads to longer periods in 
which a person is contagious. That person, 
possibly your best friend, has a longer time to 
spread the resistant strains to others. 

Since most upper respiratory tract infections are 
viral, assume that is the case until you have 
reason to suspect otherwise. Then if you are not 
sure, do not self medicate but rather seek a 
medical opinion. If the doctor still thinks 
antibiotics are not needed, go along with that 
rather than pressuring for an antibiotic 

Using antibiotics sensibly

2. How long to treat a UTI?

If you have ever have had urinary tract infections 
(UTIs), you may know that sometimes you receive 
antibiotics for 1 day, 3 days, 5 days, 7 days, 10 
days or 14 days. You may think it depends upon 
which antibiotic the doctor prescribes but many 
times it does not. Doctors do not always know the 
optimal length of time needed to treat 
uncomplicated urinary tract infections. 

A recent study in Canada looked at treating 
urinary tract infections in older women who did 
not have signs of a higher kidney infection 
(pyleonephritis), diabetes, recent treatment with 
antibiotics, urinary tract abnormalities or 
contraindications to the specific antibiotic used. 
In other words, they had uncomplicated UTIs. The 
drug used was Cipro(R)(ciprofloxacin) and they 
tested two doses: 250 mg twice a day for 3 days 
and 250 mg twice a day for 7 days. The authors 
looked at both immediate treatment success, as 
measured by a urine culture two days after 
completion of antibiotics and also the relapse 
rate of infection by urine culture at six weeks 
after treatment. 

The investigators found that for the 3 day course 
and the 7 day course, the immediate cure rates 
were 98% and 93% (yes better in the 3 day group) 
and the relapse rates were approximately 15% in 
each group. In addition, the group taking only 3 
days of antibiotics had significantly less (about 
half) side effects from the antibiotics such as 
nausea and vomiting, drowsiness, loss of appetite, 
headache, abdominal pain or diarrhea. 

This study suggests that at least for Cipro(R) 
treatment of uncomplicated UTI, the duration of 
treatment is best confined to only 3 days rather 
than 7. 

How long to treat a UTI?

3. Reader submitted Q&A - Weight and OCPs

"Recently, my obgyn informed me that I have to 
change my birth control pill because I am too 
heavy (195 lbs). He informed me that a new study 
indicated that heavy patients need to take birth 
control pills with high content of estrogen 
(35mg). I was using the Ortho Evra(R) patch which 
was falling off my skin! Does taking high doses of 
estrogen effect my chances of having any side 
effects (breast cancer or blood clots formation)?" 

"I am 26 years old and do not smoke! I am not on 
any medications, I do exercise and am in a good 
health" - KRA 

The question you raise stems mainly from one 
article in 2002 from the University of Washington 
that suggests there is a higher risk for oral 
contraceptive failure in heavy women (greater than 
155 lbs or 70.5 kg). To understand what the 
magnitude of risk is to you and whether switching 
to a higher dose oral contraceptive (Ortho Evra 
has only 20 mcg of estrogen) will lower your 
pregnancy rate, you need to know a little 
background of what the study actually found. 

Failures of contraception that result in pregnancy 
are measured in 100 women-years, i.e., 100 women 
taking the pill for 1 year or 50 women taking the 
pill for 2 years for example. Using that 
definition, the overall failure rate of all oral 
contraceptives is about 3-4%. This takes into 
account all women, even the ones that tend to 
forget their pills. The best case failure rate of 
women who are "good pill takers" is about 1% 

Most modern oral contraceptives come with estrogen 
doses of about 20-25 mcg (very low dose), 30-35 
mcg (low dose) and 50 mcg (high dose). Your patch 
birth control would be considered very low dose. 
In the 1960's, estrogen doses above 80mcg were 
linked to increasing rates of blood clots 
(vein thrombosis). Average doses came down very 
quickly. In the 1990's there became questions 
about different progestins (not the estrogen dose) 
that seemed to have different blood clot rates. As 
far as we know at these modern estrogen doses, 
there is no higher incidence of thromboses. In 
fact your weight alone is probably more of a risk 
for thromboembolism. Also, there is no known 
increase of breast cancer with any of these doses 

Doctors will still caution you to be on the lowest 
dose possible and I agree fully with that. If we 
look at the different weight ranges and the 
pregnancy rates for the different estrogen doses 
in the pills in the above mentioned study we see: 

          Pregnancy rate/100 women yrs
                     estrogen dose
(Weight in lbs) 20-25mcg 30-35mcg 50mcg =+
less than 125       1.8    3.2     1.6
125-137             3.4    2.7     3.3
138-155             2.3    2.0     8.2
155 and plus        6.8    5.2     5.4

As you can see, women over 155 lbs have in general 
higher pregnancy rates (5-7%) than women under 125 
lbs (1.8-3.2%). However, you do not gain very much 
lowering in rate (6.8 to 5.2 or 5.4) if you, at 
the higher weight, switch to a higher dose pill. 
You will need to decide for yourself if these 
differences are worth switching contraceptive 
doses. Basically you are at slightly higher risk 
for pregnancy no matter what you do. 

Keep in mind one of the things we have mentioned 
before, i.e., that the biggest risk for pregnancy 
from pill failure is starting the pills LATE after 
you have been off of them for 7 days. If you are 
very good about prompt starting of a new pill pack 
or patch, you may be a lower risk than the general 
population on which this study is based. 

4. Massages to relieve muscle tension
Did you know there a quite a few different types 
of massages? Different massage types vary in how 
the hands are used in the  massaging stroke and 
the amount of pressure applied to the different 
muscles or parts of the body. 

Types of massages

Swedish - long smooth hand strokes and kneading 
movements along the skin 

Deep - slow heavy strokes on deep muscle tissue 

Sports - specific muscle directed massage both 
deep and superficial 

Craniosacral - focuses on the muscles and 
ligaments of the head, neck and spine 

Neuromuscular - concentrates on painful or trigger 
point areas of specific muscles 

Rolfing - significant pressure on connective 
tissue throughout the body using the hands, 
knuckles and elbows 

Massages are not only for spa treatments but 
medically they can relieve stress and muscle 
tension, relieve anxiety, lessen muscle pain and 
even stimulate the immune system. They can be 
safely performed by licensed health professionals 
such as a massage therapist, physical therapist or 
occupational therapist. 

If you have a massage, be sure to let the 
therapist know if you have any skin burns or 
wounds, or have had a recent heart attack, cancer, 
arthritis flare, unhealed fracture or bone 
thinning (osteoporosis). You do not want to have a 
serious complication of massage such as internal 
bleeding, nerve damage or temporary paralysis 
which can rarely happen with an untrained massage 

Massages to relieve muscle tension

5. Health tip to share - Too many fluids

"The traditional advice to treat a cold with 
bedrest and plenty of fluids may be at least half 
wrong. Recently investigators have found cases in 
medical reports in which excessive fluid intake in 
people with upper respiratory tract infections has 
produced a dangerous lowering of body salts 
(hyponatremia). This could possibly result in 
congestive heart failure, pneumonia and even 
death." - FRJ 

6. Humor is healthy

Little Known Illnesses

Rash caused by wearing a toupee in a pool.

Rash caused by movie tickets priced at $9.50.

The heart-stopping sensation brought on by
exceeding your credit limit.

Disorder caused by too many cookies, not enough

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

Back to top

********** Health Newsletter ***********
              March 21,  2004
Biweekly from BackupMD on the Net

1. Hypertension drug therapy
2. Is routine use of antibacterial soap helpful?
3. Reader submitted Q&A - Hypothyroidism control
4. Melatonin hormone declines with age
5. Health tip to share - IUCD for heavy bleeding
6. Humor is healthy
The next newsletter will be in two weeks.

1. Hypertension drug therapy

If a person with high blood pressure is treated 
correctly, physicians and friends have high 
expectations that future strokes and heart attacks 
will be prevented. In practice, those events are 
often not prevented because hypertensive 
individuals either do not regularly take their 
recommended medicines or they are not prescribed 
the best regimen to control the blood pressure. In 
the U.S. only about 30% of hypertensive 
individuals have the blood pressure controlled at 
140/90 or less. In Europe the number is about 10%. 

The latter issue, that of prescribing the best 
anti-hypertensive treatments possible, has been 
the subject of several guidelines from the U.S., 
Europe and now from the British Hypertensive 
Society. Most of the recommendations in the 
consensus guidelines are very similar although 
there are some differences of emphasis. Most 
importantly, different classes of antihypertensive 
drugs seem to have better results and less 
complications in different age and ethnic groups. 

The recommendations of the British Hypertensive 
Society are to initially start non black patients 
under the age of 55 on either an ACE inhibitor or 
a beta-blocker.  Black men and women or non black 
individuals over the age of 55 should be started 
on either a calcium channel blocker or a diuretic. 
The combination of a beta blocker and a diuretic 
is avoided because it may be associated with a 
higher incidence of  diabetes. 

If initial single drug therapy is not successful 
in keeping the blood pressure below 150/90 (yes 
150/90), then other combinations can be tried. The 
preferable combinations would be an ACE inhibitor 
plus a calcium channel blocker or a diuretic. As 
combination therapies are tried, the important 
concept is to avoid using a beta blocker with a 
diuretic if possible. 

Hypertension drug therapy

2. Is routine use of antibacterial soap helpful?

There is a plethora of cleaning products available 
in stores that advertise antibacterial components. 
The antibacterial additives are expected by buyers 
to reduce the incidence of infectious diseases in 
a household. Unfortunately many infectious 
diseases are viral in origin and one would not 
expect antibacterial soaps to substantially reduce 
those infections. 

A study was carried out in inner city New York 
households in which half the households were given 
unlabeled, antibacterial cleaning, laundry, and 
hand washing products. The other half were given 
the same products but without antibacterial 
chemicals. After almost a year of follow up, the 
number of respiratory, fever, vomiting and 
diarrhea symptoms were recorded in each group. 
There were no statistical differences between 
those using antibacterial cleaning products and 
those not. 

This would imply that at least for most 
infections, routine use of antibacterial cleansing 
products is not worth any price difference. There 
may be a place for them if people are involved in 
a lot of food preparation but even that still has 
to be proven. 

Is routine use of antibacterial soap helpful?

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