Womens Health

Women's Health Newsletters 4/4/04 - 6/13/04



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********** Health Newsletter ***********
              April 4,  2004
Biweekly from BackupMD on the Net

1. Lead can be hazardous to your health
2. Legumes - an alternative to meat
3. Reader submitted Q&A - Fainting upon standing
4. Vulvar vestibulitis and semen allergy
5. Health tip to share - Interstitial cystitis diet
6. Humor is healthy
The next newsletter will be in two weeks.

1. Lead can be hazardous to your health

Lead is a metal salt that can accumulate in the 
body if the lead containing particles get in your 
stomach. It does not come from food but rather 
from dust or small particles of lead paint, lead 
solder in water pipes (usually installed before 
1986), stained glass, curtain weights, foil, 
fishing weights, batteries, linoleum, plaster, 
leaded gasoline fumes and putty among other 
things. A very small amount of lead can cause 
medical symptoms. 

While lead poisoning can produce paralysis, 
seizures, coma and even death, such high levels 
are rarely seen today. More commonly symptoms from 
lower levels of lead toxicity can be seen 
including muscle pains, fatigue, irritability, 
difficulty concentrating, tremors, headaches and 
stomach upset. These symptoms can be caused by 
many other conditions so blood levels of lead are 
rarely tested for by doctors. However if there is 
any suspicion of exposure to lead containing 
substances, testing is indicated. 

There are home testing kits that measure heavy 
metal concentration in hair or finger nail 
samples, since the metals tend to accumulate in 
the body but these are just screening tests. If 
there are any abnormalities on such a screening 
test then blood levels need to be performed. 

Children are more susceptible to lead toxicity 
because their brain and spinal cord systems are 
more actively growing and these are tissues that 
lead attacks. But adults can be exposed just as 
much and since the body accumulates it, older 
individuals can have more of a chronic, low grade 

Lead can be hazardous to your health

2. Legumes - an alternative to meat

Legumes are vegetables such as beans, peas, 
lentils, chickpeas, navy beans, black-eyed peas, 
peanuts and soy beans (also tofu, soy milk, 
tempeh, soy flour). They are higher in protein 
than many of the other vegetables but more 
importantly, as members of the vegetable family 
(and except for peanuts) they are low in fat and 
cholesterol compared to meat. Thus they can easily 
serve as meat substitutes in your diet. 

When shopping for legumes:

shop in ethnic markets for less common and a 
   greater variety of legumes 
look for legumes of a uniform size and condition 
   so they cook more evenly 
choose legumes with a deep, almost glossy color 
   which indicates they have not been stored 
   excessively long 
purchase legumes from a source with high turnover 
   usually where they are sold in bulk 

Also be sure to store what you bought in a cool, 
dry place out of direct light. Rinse the legumes, 
remove misshapen beans and soak over night before 

The only down side of increasing legume intake 
would be in people who are allergic to them, 
especially to soy or peanuts. You need to know 
this prior to increasing them in your diet or if 
you seem to have more stomach, breathing or skin 
problems after switching to them, then you may 
also want to consider that you have a food 
allergy. Additionally some people form more gas 
when they switch to increased legumes, a food 
supplement product such as Beano(R) regularly with 
a high percentage legume containing meal may solve 
that problem, 

Legumes - an alternative to meat

3. Reader submitted Q&A - Fainting upon standing

"I black out frequently when I go from a low 
position, ie. stooping down to get something from 
the low shelf in a grocery store, to standing. I 
have had this problem my entire life. It is not 
related to the amount of food I have had that day, 
water, stress, etc. The fainting spells have been 
a part of me my entire life... I can remember 
fainting in church as a little girl when we would 
have to go from kneeling to standing, etc." - 

One cannot diagnose a specific condition such as 
this without examination and medical studies. 
There can be multiple causes ranging from heart 
rate abnormalities or heart valve disease to brain 
or large blood vessel problems among many other 
things. However, the fact that you have had this 
all of your life might indicate it is not a 
serious progressive disease condition but rather 
something you were born with or acquired very 
early in life. This can include congenital heart 
problems or benign brain lesions so you should be 
checked out by your physician for these. I assume 
you have already done that. 

This description of fainting (syncope) when 
standing up suddenly allows us to discuss a not 
too uncommon condition variously called vasovagal 
syncope or neurocardiogenic reaction. Many times 
the cause of fainting when rising is just an 
exaggerated physiologic response as blood drains 
more down toward your feet. Your heart rate is 
supposed to go up and blood vessels going to the 
brain constrict so you do not lose blood supply to 
the brain. However, with a vasovagal response, 
almost the opposite takes place. The heart rate 
goes down instead of up because of stimulation of 
the vagus nerve. Thus the blood supply to the brain 
is less and you "pass out" or feel very 
lightheaded and dizzy because of it. 

Why does the vagus nerve become stimulated when 
one goes from sitting to standing? Some think it 
is because of holding one's breath and straining 
the neck muscles that stimulate the main arteries 
in the neck where the vagus nerve inserts (carotid 
sinus). Other doctors point out that even if you 
slowly rise and do not strain (valsalva), many 
individuals still get fainting spells upon rising. 
In fact the doctors have a test for this condition 
called a tilt-table. 

For a tilt table test, the head of the bed on 
which a person is lying is raised to about 60 
degrees to see if spontaneous dizziness occurs. 
The dizziness or even fainting may not start right 
away but rather after several minutes to twenty 
minutes or more. People who have a positive tilt 
test may need to have medical treatment if they 
have chronic, recurrent syncope, although there 
does not appear to be one clearly superior medical 
treatment for vasovagal syncope. 

Aside from seeing a good cardiologist or 
neurologist, I would suggest at least drinking 
plenty of fluids and using ample salt in the diet 
to fully expand the vascular system; rise slowly 
while slowly exhaling the air from your lungs and 
avoid any neck movement when going from stooping, 
kneeling or sitting if possible. Breath very 
regularly, paced, after rising to prevent any 
vagal nerve stimulation. Throw away all of your 
tight collared blouses or turtle necks. 

4. Vulvar vestibulitis and semen allergy

Vulvar vestibulitis is an infrequent, but 
disabling condition characterized by burning skin 
at the entrance to the vagina. It is often made 
worse by sexual intercourse although the skin can 
be sensitive to almost any touch. When doctors 
look at skin biopsies from that area in women who 
have this condition, they see an inflammatory 
response similar to an allergic reaction rather 
than any bacterial or fungal infection. In spite 
of this, the cause of vulvar vestibulitis is 

In a recent study from New York, investigators 
looked at whether or not women with vulvar 
vestibulitis had antibodies (immune E globulins) 
to semen from men. They compared blood samples 
from these women to blood samples from women who 
did not have vulvar vestibulitis. 

About 31% of the women with vulvar vestibulitis 
had antibodies to semen and only 5% of the normal 
women had antibodies. Of the women who were 
antibody positive, 44% had worsening of symptoms 
right after intercourse while 11% of the 
immunoglobulin E negative women had post sex 
symptoms. Worsening of symptoms after a yeast 
infection was present in 31% of women with 
positive antibodies and in only 3% of women with 
negative antibodies. 

Thus in this study, it appears that an allergy to 
semen MAY play a role in vulvar vestibulitis. The 
authors concluded that "A subset of women with 
vulvar vestibulitis syndrome are sensitized to 
seminal fluid, and an allergic reaction to seminal 
fluid may be associated with the initiation and 
persistence of their symptoms." I would guess this 
subset to be about 15% of women with vulvar 
vestibulitis who are possibly having an allergic 
reaction to semen as the primary cause of their 
symptoms. In truth, we do not know this for sure 
yet and can only guess. 

Vulvar vestibulitis and semen allergy

5. Health tip to share - Interstitial cystitis diet

"For Interstitial Cystitis I have tried numerous 
drugs and procedures from two different urologists 
and finally told to learn to live with the pain.  
Upon searching the Internet for a better solution, 
I came upon a Yahoo group called ICPuzzle.  There 
I found the help of Amrit Willis and her able co-
moderator, Jeanne Karow, who directed me to a 
number of very helpful things to do.  The chief of 
these being changing my diet to help alkalize my 
system.  I read The pH Miracle and another book 
called Alkalize or Die.  After following their 
recommendations not only is my IC under complete 
control, but the fibromyalgia that I've dealt with 
for the past four years is so much better that I 
have returned to work!  It seems acidosis is the 
underlying problem for me with these two 
conditions.  As long as I maintain a more alkaline 
base, I'm good to go!  Hope this helps many, many 
others like me!" - Lisa 

6. Humor is healthy

"The Mommy Test"

I was out walking with my then 4 year old
daughter.. She picked up something off the
ground and started to put it in her mouth.
I asked her not to do that.

"Why?" "Because it's been laying outside
and is dirty and probably has germs." At this
point, she looked at me with total admiration
and asked, "Wow! How do you know all this

"Uh," I was thinking quickly, " . . . everyone
knows this stuff. Um, it's on the Mommy test.
You have to know it, or they don't let you be
a Mommy."


We walked along in silence for 2 or 3 minutes,
but she was evidently pondering this new

"I get it!" she beamed. "Then if you flunk, you
have to be the Daddy."

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

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********** Health Newsletter ***********
              April 18,  2004
Biweekly from BackupMD on the Net

1. Survival after initial diagnosis of Alzheimer's
2. Acupuncture for chronic headaches and migraines 
3. Reader submitted Q&A - Weight and the joints
4. When to end cancer treatment
5. Health tip to share - Preventing cystitis
6. Humor is healthy

1. Survival after initial diagnosis of Alzheimer's

If a loved one is suddenly diagnosed with 
Alzheimer's disease, it is important for a 
caregiver and relatives to know what to expect. 
How long will someone with Alzheimer's live? Are 
there risk factors that are associated with a 
shorter or longer time to live? 

A recent article in the Annals of Internal 
Medicine looked at a community based population of 
23,000 men and women 60 years of age or older who 
were living in the Seattle, Washington area 
between 1987-1996. All were felt to be free of 
Alzheimer's disease at the time of entry into the 
study. The investigators then identified 521 
people who were newly diagnosed with Alzheimer's 
disease (AD) during the years of the study. They 
looked at how long those individuals lived after 
the initial diagnosis and what risk factors they 
had that affected how long they survived after the 
AD diagnosis. 

Men lived on the average 4.2 years after the 
initial diagnosis of AD and women lived 5.7 years. 
This was significantly less than their life 
expectancy at the time. Those men and women who 
had Parkinson like tremors, gait (walking) 
disturbance, history of falls, congestive heart 
failure, ischemic heart disease, or diabetes at 
baseline tended to die even sooner than the 
average. Those who did not have those risk factors 
and who did not have as severe "thinking" 
(cognitive) problems at the time of diagnosis 
lived slightly longer than the averages. 

These data can be used to give caregivers of 
Alzheimer's patients an idea of what to expect as 
far as survival of a loved one with AD. While 
there is no way to fully prepare for a relative 
with Alzheimer's, knowing what to expect in terms 
of survival is one element among many. 

Survival after initial diagnosis of Alzheimer's

2. Acupuncture for chronic headaches and migraines
Many patients with chronic headaches miss work, 
use a moderate amount of pain medication and 
overall have reduced health that can influence 
other daily activities. Both doctors and patients 
look for other non medical treatments to help cope 
with frequent headaches, both chronic tension 
headaches and migraines. One such treatment is 
acupuncture which is commonly prescribed for 
chronic headaches in Great Britain, Canada and 

Randomized clinical medical trials using 
acupuncture for headache treatment have been 
conducted in the past and the evidence that 
acupuncture is beneficial is not clear. The 
results of such trials slightly favor 
acupuncture's use but better clinical trials are 
felt to be needed. 

One such recent randomized trial in England looked 
at over 400 patients who were having at least two 
headaches a month. They assigned half of the group 
to have 3 months of acupuncture treatment  
supplemented with whatever medicines they were 
already prescribed. The other half was told to 
avoid acupuncture and to use only the medicines 
they were prescribed during the normal course of 
their doctor's visits. 

The group receiving acupuncture (compared with 
controls) had 22% fewer days of headache per year, 
used 15% less medicine, had 25% less visits to 
their general practitioner and took 15% fewer sick 
days from work. The improvement in fewer headaches 
persisted even after the end of the 3 months of 
treatment. Patients with migraine headaches seemed 
to improve slightly more than the patients with 
chronic tension headaches. 

These are not massive improvements, but 
improvements nevertheless. The study led the 
authors to conclude that acupuncture can be an 
important alternative to just using headache 
medicines for control of chronic symptoms and to 
decrease time lost from work. 

Acupuncture for chronic headaches and migraines

3. Reader submitted Q&A - Weight and the joints

"I am 45 years old and over weight, actually 
obese.  I have been over weight for approximately 
11 years.  Before that I was average weight and 
had been for my whole life.  I have noticed over 
the past year or so that I can literally no longer 
bend my knees very far.  I have trouble getting in 
and out of the car as well as walking.  This seems 
so strange to me.  I am sure it has to do with 
being over weight but I would like to know what 
the cause of this condition is if you know.  I 
also would like to know if it is reversible.  Will 
it get better if I lose weight?" - Lori 

Limitation of knee joint range of motion which 
affects getting in and out of the car as well as 
walking probably comes from two sources: 

1) pain from the knee joints, knee ligaments or 
leg muscles themselves 
2) weakness of the leg muscles for the weight they 
have to support 

What you describe is quite common when a person 
continues to gain weight or even has a sudden 
increase and then stabilization of body weight. 
The difficulty may start fairly soon after the 
weight gain when the muscles do not have the 
constant strength to lift more weight. However, 
movement difficulty may not appear right away with 
weight gain but rather later, as the joint 
cartilage wears down causing an osteoarthritis of 
the major support joints such as the knees and 
lower back. 

I would guess that you may also have difficulty in 
your lower back range of motion and physical 
discomfort if weight is the main culprit. If the 
back is fine but the knees are the only problem, I 
would ask if you ever had a history of knee injury 
in the past that may contribute now to the overall 
problem because age, obesity and previous injury 
are the major risk factors for osteoarthritis. 

There have been studies of taking the supplement 
glucosamine and/or chondroitin sulfate to help 
restore damaged knee cartilage. Thus you may want 
to go to your doctor to see if any x-ray studies 
are indicated to look for loss of joint space 
(damaged knee cartilage) in the knees. 

The question you ask about will this knee joint 
difficulty reverse if you lose weight is an 
interesting one. In general, arthritis damage to 
the joints, if indeed that has already taken 
place, does not usually reverse. As I mentioned 
the only evidence for reversal I know of is to use 
glucosamine supplements for up to three years 
before you can improve the joint space in the 
knees. On the other hand, from studies of massive 
weight loss such as that seen with the gastric 
bypass surgery for obesity, over 3/4s of those 
patients report a significant improvement in how 
they feel physically and how they get around after 
the weight loss. The muscles were used to moving 
around 50-60 pounds more on the average and when 
that weight is gone, the relative muscle strength 
is greatly improved. 

I would have to say that for the most part, weight 
loss will improve how you feel getting in and out 
of the car. It may not make everything go to the 
level of how you felt 11 years ago but more likely 
than not you will be happier with how you feel 
physically if you can get a large amount (15%) of 
your weight reduced. 

4. When to end cancer treatment
It is often a medical axiom that, excluding 
accidents and trauma, all people will eventually 
die from vascular disease (stroke or heart 
attacks) or from cancer. Infection as a cause of 
death is much less common than it once was due to 
our modern day antibiotics. Since many people end 
their lives with cancer and since modern medicine 
can prolong life to the point it is only 
prolonging misery, it is important to have a sense 
of when cancer treatment should end. 

The goals of a patient with cancer change as 
treatment for cure either works or does not. 
Initially everyone involved has the goal to cure 
the cancer so the body is rid of it absolutely. 
When it becomes obvious that the cancer is so far 
spread it will not be cured or if it has come back 
after an initial curative treatment, then the goal 
may shift to just prolonging life as long as 
possible by "beating back" as much of the 
malignant tissue growth as possible. Finally, the 
growth of the cancer may not be able to be kept in 
check and the treatment goal becomes to just 
provide comfort care as one is in the process of 

With the final goal of comfort care only, curative 
treatments are stopped and one must make sure the 
side effects of any further medicines are not just 
making the process of dying more miserable than it 
needs to be. This is a time patients should focus 
on family and relationships exclusively and not on 
a cure. The popular book "Tuesdays with Morrie" 
points out how positive even the process of dying 
can be. 

The decision to quit seeking a "cure" for the 
cancer is not easily reached in the real world. 
Doctors may not be sure there is no hope of a cure 
left or the cancer patient may not want to give up 
that "hope" of a cure even though the physician 
indicates he or she believes that cure is 
extremely unlikely. The treatment decisions, side 
effects and comfort care alternatives need to be 
fully discussed with both physicians and 
relatives. This needs to be done, if possible, 
while the cancer patient can still make rational 

Once the decision is made to stop seeking a cancer 
cure, discussing this with remaining family 
members or friends is an important part of the 
process. The talking about it itself can provide 
comfort to the dying patient. It also allows the 
family to know what to expect and how to accept 
the inevitable death themselves. It give them more 
time to adjust emotionally. Discussing advance 
directives with them will help ensure that wishes 
after loss of decision making abilities have gone 
are carried out. It is best to have someone 
appointed to make health care decisions after a 
cancer has made one unable to make those him or 

Stopping active cancer treatment does not mean the 
cancer patient will die immediately. There often 
will be many months left for activities that can 
be spiritually uplifting. Final days should be 
spent at home as much as possible or in a hospice 
if there is less than 6 months of expected life. 
Sometimes a nursing home or hospital is the only 
choice but it is best to plan this out as much as 
possible before that time comes. The following 
article  at Mayo Clinic .com is quite helpful to 
begin one thinking about these end of life 

Ending cancer treatment

5. Health tip to share - Preventing cystitis

"I never see this simple solution for preventing 
cystitis.  If a woman doesn't have enough 
lubrication during sex, this can lead to this 
infection.  The minute you feel yourself getting 
too "dry" stop and use a lubricant.  I finally 
figured this out after years of problems.  I have 
passed this info to other women who said this 
worked for them also." - N.J. 

6. Humor is healthy

"Murphy's Laws On Work"

Everything can be filed under 'miscellaneous.' 

Never delay the ending of a meeting or the 
beginning of a cocktail hour. 

To err is human, to forgive is not company policy. 

Important letters that contain no errors will 
develop errors in the mail. 

There is never enough time to do it right the 
first time, but there is always enough time to do 
it over. 

If you are good, you will be assigned all the 
work. If you are really good, you will get out of 

If it wasn't for the last minute, nothing would 
get done. 

At work, the authority of a person is inversely 
proportional to the number of pens that person is 

No one gets sick on Wednesdays. 

The longer the title, the less important the job. 

Once a job is fouled up, anything done to improve 
it makes it worse. 

Success is just a matter of luck, just ask any 

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

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********** Health Newsletter ***********
              May 2, 2004
Biweekly from BackupMD on the Net

1. Premenstrual flare of facial acne
2. Low dose contraceptives and stroke risk 
3. Reader submitted Q&A - Hashimoto's thyroiditis
4. Depression during pregnancy
5. Health tip to share - Weight loss
6. Humor is healthy

1. Premenstrual flare of facial acne

Many skin conditions such as atopic dermatitis, 
lupus erythematosus, infections due to herpes 
virus, hives (urticaria) and acne have all been 
reported to flare-up or worsen in the last 1-2 
weeks of the menstrual cycle. Even women who have 
allergies or skin sensitivity to nickel metal on 
jewelry are reported to have worse reactions in 
the last half of the menstrual cycle. It also 
appears that women 35 or older may have worse acne 
flaring than younger women. 

While not every woman who has acne gets a 
premenstrual flare, it has been reported that 
about 40-70% of women do have worsening. A recent 
study of women with acne actually measured the 
number  and size of facial acne lesions and 
documented that 63% of them had, on the average, a 
25% increase in the number of acne lesions in the 
two weeks immediately prior to their menses. 

The hormonal effect on acne is not totally clear. 
Estrogen alone seems to improve acne, probably 
because it inactivates some blood testosterone by 
protein binding. In the second half of the 
menstrual cycle, progesterone and a small amount 
of testosterone are also present in addition to 
estrogen. It is suspected that it is the 
testosterone that is responsible for acne flares 
but no one knows for sure how much of a role 
progesterone plays. 

Birth control pills generally improve acne. For 
example studies with taking the birth control pill 
equivalent to Ortho Tri-Cyclen(R) show that about 
80% of women with acne have significant reduction 
in lesions while only about 3-4% have a worsening 
of acne or start new lesions. The oral 
contraceptives, and probably the patch and vaginal 
ring contraceptives, reduce both ovarian and  
adrenal gland testosterone production. This is 
probably the mechanism by which they improve acne. 

Premenstrual flare of facial acne

2.  Low dose contraceptives and stroke risk 

There is always concern about the use of hormones 
and risks of blood clots (thrombosis). Post 
menopausal estrogen use has a very small, but 
real, increased risk for strokes. The higher dose 
oral contraceptives that used to be marketed also 
had a risk of stoke and other thrombosis events. 
However, studies about the current lower dose oral 
contraceptives tend to support that there is 
either no increased stroke risk or a very low 

A recent review of the medical literature by 
Toronto physicians and scientists concluded also 
that there is either a zero or a very low  risk of 
strokes from modern low dose birth control pills. 
They looked at over 20 large studies of women 
taking low dose oral contraceptives compared to 
women who did not take them. It is important to 
keep in mind that the age-adjusted incidence of 
stroke in the reproductive age population is less 
than 1.5 per 10,000 people. A doubling of the rate 
might sound very serious but the chance of any 
individual having a stroke is still extremely 

Low dose contraceptives and stroke risk

3. Reader submitted Q&A - Hashimoto's thyroiditis

"I have Hashimoto thyroid disease. Is it common to 
have spells where I wake up totally wet and really 
hot?  I take 5m Synthroid(R) daily in the 
mornings.  Thank you," 

"Age 56 , hysterectomy at age 36 (endometriosis), 
Detrol(R), Synthroid(R), Vioxx(R), Nexium(R), 
weigh 140 lbs. have problems with anemia and had 
an iron transfusion two years ago." - Wanda 

Hashimoto's Thyroiditis is an autoimmune thyroid 
disease. The body's own immune system which should 
protect you from infection somehow gets 
misdirected and actually starts attacking the 
thyroid gland. It destroys some of the thyroid 
gland function so that you actually become 
hypothyroid or low thyroid. That is why you are on 
the Synthroid. Hypothyroidism alone would give the 
opposite effect of what you describe with the 
night sweats; it would make you chill easier, not 
be hot. Therefore it would be very uncommon to 
have night sweats from Hashimoto's thyroiditis 

More likely causes of what you describe would be 

1) taking too much thyroid replacement, 

2) menopause in which your ovaries have finally 
stopped functioning, 

3) reaction to one of your other medications or 

4) sometimes just unknown reasons. 

As far as your thyroid replacement dose goes, I am 
not familiar with the "5 m" dose you described. If 
it refers to 5 mg (milligrams) then it is an 
extremely high thyroid dose. Excess thyroid 
replacement can cause symptoms of hyperthyroidism 
such as insomnia, irritability, weight loss 
without dieting, heat sensitivity, increased 
perspiration, thinning of your skin, fine or 
brittle hair, muscular weakness, eye changes, 
rapid heart beat and hand tremors. 

If the Synthroid(R) dose you are on is 5 
micrograms, then it is an extremely low dose and 
you may not be receiving enough. This is something 
you should have checked to make sure you are 
taking the right amount. You might begin by asking 
your pharmacist what dose you are on and whether 
it is a typical dose. If there is any question 
about it you should see your doctor again. 

If the doctor did not remove the ovaries at the 
time of your hysterectomy, then menopause might be 
the main cause of your night sweats. The doctor 
can check a serum FSH level and if it is elevated, 
then the ovaries are no longer working. 

I doubt if the Detrol(R) is causing night sweats. 
It is more likely to cause constipation, dry mouth 
or vision problems. Nexium(R) also does not 
usually cause night sweats. Gastrointestinal 
disturbances or headaches may result from taking 
Nexium(R) but the night sweats are probably due to 
something else. 

Menopause is the most likely explanation for what 
you describe but there can be other causes of 
night sweats so you should consult with your 
doctor about them. 

4. Depression during pregnancy

While pregnancy is a time of joy for many women, 
sometimes it brings overwhelming feelings of 
unexpected or unwelcome responsibility. This can 
result in clinical depression rather than an 
exciting  positive outlook. The prevalence of 
depression during pregnancy has not been well 
established so investigators from Toronto, Canada 
looked at different studies in the medical 
literature. These studies used various written 
tests as well as structured interviews by trained 
investigators to discover how often pregnancy was 
associated with depression and when in pregnancy 
it was likely to manifest. The studies identified 
and tested over 19,000 women in various stages of 

The occurence of depression was 7.4% during the 
first 3 months of pregnancy, 12.8% during the 
second 3 months of pregnancy and 12.0% during the 
final 3 months of pregnancy. These are quite 
substantial numbers of women and have 
ramifications for treatment. 

With the tendency to treat most depression 
symptoms with medications rather than counselling, 
this means that many infants will have been 
exposed to anti-depression medications, usually 
SSRIs (selective serotonin reuptake inhibitors). 
Although we currently consider the SSRIs probably 
safe to take during pregnancy, whenever there are 
millions of pregnant women on a drug, we worry 
about possible unknown effects on the unborn 
fetus. I still think that pregnant women should 
strive to take the least amount of medications 
during pregnancy as possible. 

Depression during pregnancy

5. Health tip to share - Weight loss

Diet programs can be discouraging when you realize 
that most dietary weight loss is regained within a 
couple of years. However Weight Watchers 
International Program is more successful than 
others. They report a 75% maintenance of weight 
loss over two years and about 50% maintenance of 
weight loss over 5 years. Year in and year out, 
this is the most successful diet program available 
and the long term results, while not perfect, are 
well worth trying for. - FRJ 

6. Humor is healthy

"Martha's Way Vs My Way"

Martha's way #1: Brush some beaten egg white over 
pie crust before baking to yield a beautiful 
glossy finish. 

My way: The Mrs. Smith frozen pie directions do 
not include brushing egg whites over the crust and 
so I don't do it. 

Martha's way #2: Place a slice of apple in 
hardened brown sugar to soften it. 

My Way: Brown sugar is supposed to be "soft?" 

Martha's way #3: When boiling corn on the cob, add 
a pinch of sugar to help bring out the corn's 
natural sweetness. 

My Way: The only kind of corn I buy comes in a 

Martha's way #4: To determine whether an egg is 
fresh, immerse it in a pan of cool, salted water. 
If it sinks, it is fresh, but if it rises to the 
surface, throw it away. 

My way: Eat, cook, or use the egg anyway. If you 
feel bad later, you will know it wasn't fresh. 

Martha's way #5: Cure for headaches: Take a lime, 
cut it in half and rub it on your forehead. The 
throbbing will go away. 

Martha, dear, the only reason this works is 
because you can't rub a lime on your forehead 
without getting lime juice in your eye, and then 
the problem isn't the headache anymore, it is 
because you are now blind. 

Martha's way #6: Don't throw out all that leftover 
wine. Freeze into ice cubes for future use in 
casseroles and sauces. 

My way: Leftover wine? 

Martha's way #7: If you have a problem opening 
jars: Try using latex dishwashing gloves. They 
give a non slip grip that makes opening jars easy. 

My way: Go ask the very cute neighbor to do it. 

Martha's way #8: Potatoes will take food stains
off your fingers. Just slice and rub raw potato on
the stains and rinse with water.

My way: Mashed potatoes will now be replacing the 
antibacterial soap in the handy dispenser next to 
my sink. 

Martha's way #9: Now look what you can do with 
Alka Seltzer. * Clean a toilet. Drop in two Alka-
Seltzer tablets, wait twenty minutes, brush and 
flush. The citric acid and effervescent action 
clean vitreous china. 

*Clean a vase. To remove a stain from the bottom 
of a glass vase or cruet, fill with water and drop 
in two Alka-Seltzer tablets. 

*Polish jewelry. Drop two Alka-Seltzer tablets 
into a glass of water and immerse the jewelry for 
two minutes. 

*Clean a thermos bottle. Fill the bottle with 
water, drop in four Alka-Seltzer tablets, and let 
soak for an hour (or longer, if necessary). 

My way: Put your jewelry, vases, and thermos in 
the toilet. Add some Alka-Seltzer and you have 
solved a whole bunch of problems at once. 

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

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********** Health Newsletter ***********
              May 16,  2004
Biweekly from BackupMD on the Net

1. Infections from household pets
2. Men's reaction to erectile dysfunction and Viagra(R) 
3. Reader submitted Q&A - Calcifications on mammogram
4. Lactose intolerance is different than food allergy
5. Health tip to share - Natural and herbal 
6. Humor is healthy

1. Infections from household pets
While household pets may be beneficial to your 
health by reducing stress and blood pressure, they 
can also carry infectious diseases that you should 
be aware of. Most adults will not have life 
threatening symptoms from an infection contracted 
from a pet. However, household members who may be 
at serious life threatening risk would be anyone 
under 5 years of age, the unborn child of a 
pregnant woman and anyone whose immune system 
might be compromised such as having HIV, 
hepatitis, on chemotherapy or having had a kidney 

Dogs and cats can transmit diseases especially if 
they spend much time outdoors where they may be 
exposed to live wild animals or their carcasses, 
birds and reptiles or the insects that infest 
them. Some of the concerns for infections from 
different possible pets include: 

Dogs - rabies, roundworms (toxocariasis parasites) 
Cats - rabies (from bites by raccoons, bats, 
cattle, rabbits, skunks, foxes), cat scratch 
disease, toxoplasmosis, Q fever 
Rabbits - tularemia, rabies
Birds (including parrots, macaws, cockatiels and 
parakeets) - psittacosis, cryptococcosis 
Fish - mycobacteria
Frogs, lizards, snakes - salmonella

While the human symptoms for these varied 
infections are diverse, many of them include 
unexplained fever, muscle and joint aches, 
headaches and fatigue; Watch for these if you have 
pets. Some of the infections also produce lymph 
node swelling or ulcerative skin lesions. If you 
do have pets or intend on adding a pet to your 
household, make sure you know what infections and 
symptoms to look for. The following article at 
Mayoclinic may be helpful. 

Infections from household pets

2. Men's reaction to erectile dysfunction and Viagra(R) 
Erectile dysfunction can affect men of any age 
although the common consumer view is that it only 
affects men over retirement age. With the advent 
of potentially successful treatment drugs such as 
Viagra(R) (sildenafil), the commercial media has 
made expectations for cure very high. 
Unfortunately not all men with erectile 
dysfunction have successful treatment. The 
dysfunction affects not only the men but their 
partners as well. 

A recent study in the UK looked at a comparison of 
20 men who had a successful response to sildenafil 
versus 20 men who did not. The age ranges were 22-
72 years with a median age of 51.8 years. The 
investigators conducted interviews with the men to 
determine the impact that erectile dysfunction had 
on their self esteem and relationships, as well as 
exploring their expectations of sildenafil as a 
treatment and the impact its success or failure 
had on how they felt. 

As far as age goes, the investigators found 
sildenafil to be more successful under age 45 and 
less successful over age 65. The feelings of the 
men with erectile dysfunction before treatment 

severe depression - 12%
emasculation  - 30%
letting partner down - 22%
felt partner would "go elsewhere" - 15%
inability to discuss with partner - 37%

After treatment, investigators also found a 
rebound negative effect in the men who did not 
have a curative response from the sildenafil. In 
other words their expectations were raised by the 
media hype of the drug and when it did not work 
for them, the new blow to their self esteem was 
even more severe than the original feelings. 

Even though there is now a treatment for erectile 
dysfunction, the disease and its treatment has a 
significant impact on both men and their women 

Men's reaction to erectile dysfunction and Viagra(R)

3. Reader submitted Q&A - Calcifications on mammogram
"Can calcifications in the breast be serious?"

"I will be undergoing a breast biopsy in the very 
near future because my mammogram showed some 
calcifications (clustered) in the left breast. I 
used Activella(R) - a progesterone-estrogen 
combination hormone about 9 months for hot flashes 
after going into menopause. Could there be any 
relation to these calcifications showing up now.?" 
- Sue 

To take the last part of the question first, there 
is no relationship between the nine months of HRT 
and the calcifications as far as I can tell. 
Neither estrogen alone, nor estrogen plus 
progestin is known to cause calcium deposition in 
breast tissue. It does help calcium deposition in 
the bone where calcium is supposed to go but not 
in other soft tissues such as muscle and fat. Even 
postulating the small increase (1%) in breast 
cancers from HRT after 5 years of taking it would 
not explain the calcium now. 

On the other hand, calcifications on mammogram can 
sometimes be associated with breast cancer and 
that is why your doctor recommends a biopsy. There 
are radiological classifications of the type of 
calcium deposits and also for the pattern of 
distribution of deposits. 

Calcification types include: round or oval 
(punctate), indistinct shape (amorphous), granular 
(pleomorphic), round, round with lucent center, 
and fine, linear branching (casting). Of these 
types or shapes, only the last one, the linear 
branching (casting) shape is more likely to be 
associated with malignant breast changes rather 
than benign. 

Distribution in the tissue of the calcifications 
no matter what shape they are, include: linear (in 
a line), clustered (grouped in a small area), 
segmental (following the pattern of a duct and its 
branching), regional, and diffuse (generalized 
throughout the entire breast. The most worrisome 
pattern for malignancy is the segmental pattern. 
Clustered pattern, such as on your report, used to 
connote suspicion for malignancy. By the more 
recent radiological definition used since 1993, it 
just means confined to a small area and is not 
more or less likely to be associated with a breast 
cancer. It is often associated with benign breast 
disease. However, you must have a biopsy to 
determine if there is a small cancer present that 
cannot yet be felt by exam or just benign changes. 

While it would not be good to have a biopsy return 
as a malignancy, it sounds as if this area is 
small and if malignant, perhaps it has been 
detected very early while it is completely 
curable. I hope all goes well with the biopsy and 
it comes back benign. 

4. Lactose intolerance is different than food allergy
In order for our body to digest milk and milk 
products such as cheese, cottage cheese, cream 
cheese, and yogurt, it needs an enzyme which is 
produced in the small bowel called lactase. this 
enzyme is needed to break milk sugar down into 
simple sugars so the body can absorb them. If a 
person has a low level of lactase in the small 
intestine, they often develop nausea, bloating, 
abdominal pain, gas and diarrhea about 30-120 
minutes after consuming cows milk or milk 

This is not an allergy in which the immune system 
has produced an antibody to milk or one of its 
components, but rather it is just a chemical 
defect. The defect can be congenital (inherited) 
or can just develop after childhood when our 
bodies shut down from the high-milk-only diet we 
are fed as infants. Also, surgery or trauma to the 
bowel as well as some chronic diseases such as 
Crohn's disease, celiac disease, or irritable 
bowel syndrome can cause your small intestine to 
decrease its lactase production thus producing 
lactose intolerance. 

The diagnosis of lactose intolerance is usually 
made by a test in the doctor's office in which you 
drink a liquid high in lactose. Blood is then 
drawn a couple of times and the blood sugar 
measured. If the lactase enzyme is working, your 
blood sugar will rise; if it is not working, the 
blood sugar stays level. 

Treatment is not necessarily only to avoid milk 
products. Some cheeses, for example, have low 
levels of lactose and will not significantly 
bother a lactose intolerant adult. Similarly 
yogurt may already have had its lactose levels 
fermented to low amounts so it does not produce 
symptoms. Lactase enzyme tablets or liquids are 
also available to take with your meals to help 
lactose metabolism. 

The biggest problem is finding and avoiding 
"hidden" lactose in foods such as cereal, instant 
soups, salad dressings, milk chocolate and baking 
mixes. Before putting these items in your grocery 
cart, check their labels. Look for ingredients 
such as whey, milk solids, nonfat dry milk powder, 
malted milk, buttermilk and dry milk solids. If 
you have a severe lactose intolerance, be sure to 
take your calcium supplements. 

Lactose intolerance is different than food allergy

5. Health tip to share - Herbal preparations

"Remember that the term "natural" or "herbal" does 
not necessarily mean safe. Calcium from natural 
crushed rock may contain arsenic. When evaluating 
an herbal preparation be sure the label contains 
information on the product's scientific name, 
plant parts used, name and address of the 
manufacturer, batch and lot number, and dates of 
manufacture and expiration." - FRJ 

6. Humor is healthy


Part of being sane, is being a little bit crazy. 

Life is like a camel: you can make it do anything 
except back up. 

She was only a whisky maker, but he loved her 

I know it's just a diet, but my body thinks it's 

Punctual people have nothing better to do. 

It's too bad that stupidity isn't painful.

The best way to make a long story short is to stop 

I had plastic surgery last week. My wife cut up my 
credit cards. 

This house is protected by killer dust bunnies. 

A TV can insult your intelligence, but nothing 
rubs it in like a computer. 

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

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********** Health Newsletter ***********
              May 30,  2004
Biweekly from BackupMD on the Net

1. Lipid lowering meds in women - ? as effective
2. Osteoporosis fracture incidence and HRT
3. Reader submitted Q&A - Spironolactone and Crohn's
4. Low carbohydrate diets
5. Health tip to share - Slippery elm for constipation
6. Humor is healthy

1. Lipid lowering meds in women - ? as effective
Most of the medical clinical trials of statin 
drugs for lowering cholesterol, have had a much 
larger proportion of men than women included in 
the study. Recently investigators looked back at 
many of the cholesterol lowering studies to see if 
they had the same benefits in women as in men. 

In women who did not have current cardiovascular 
disease, the statin drugs used in the studies did 
NOT lower the overall incidence of cardiovascular 
disease death rate or non fatal myocardial 
infarction. This is different than the studies 
show for men. Since many women are being placed on 
statin drugs such as: 

lovastatin (Mevacor, Altocor) 
fluvastatin (Lescol) 
atorvastatin (Lipitor) 
pravastatin (Pravachol) 
simvastatin (Zocor) 

we need to be careful that the risks of the drugs 
do not outweigh the benefits. 

We have known for a long time that in women, the 
HDL (high density lipoprotein good cholesterol) 
level is more important than the total cholesterol 
level. If a woman is in the normal ranges for HDL 
levels then it is unlikely, in my opinion, that a 
woman will benefit from statin cholesterol 
lowering drugs even if the total cholesterol is 
above what doctors like to see. 

Statin drugs can have side effects of nausea, 
diarrhea, constipation and muscle aching as well 
as the rare occurrence of serious muscle necrosis 
(auto-dissolving). Therefore a woman should 
carefully question if the physician recommends 
statin drugs, or at least be aware of what her HDL 
level is and if it is normal or too low. 

Lipid lowering meds in women - ? as effective

2. Osteoporosis fracture incidence and HRT

We sometimes forget that the reason many women 
were taking hormone replacement in the past was to 
decrease the incidence of bone fractures from 
falls. Osteoporosis, bone thinning due to very low 
calcium, and osteopenia (low bone calcium but not 
at the spontaneous fracture level) are very real 
conditions that many women over 50 years of age 
are subject to. In general, women 50-70 years of 
age taking hormone replacement have about 40% less 
fractures than women of the same age who do not. 

A recent British study found the same results and 
also found that after stopping hormone replacement 
for one year, a woman was no longer protected from 
fractures compared to women who were still taking 
any hormones. Also, older women, 60's, 70's, had a 
higher absolute reduction in fractures if they 
were taking hormone replacement. Thus there is 
some reason to continue on the therapy for longer 
than 5 years after menopause with respect to 
osteoporosis protection. 

Many women have decided not to take hormone 
replacement therapy due to the small (1-2) per 
thousand increase in stroke incidence. However I 
have observed that these same women are not taking 
medications to help prevent bone loss or actively 
engaging in exercise or physical activity that 
would help prevent osteoporosis.  I suspect we 
will see in the next 10 years a higher incidence 
of fractures and deaths from fractures in older 

It is very important for the menopausal woman who 
chooses not to take estrogen or estrogen and 
progestin replacement therapy to discuss with her 
physician about preventing bone thinning and 
subsequent fractures using other medicines or life 
style changes. 

Osteoporosis fracture incidence and HRT

3. Reader submitted Q&A - Spironolactone and Crohn's
"I am currently taking the medication 
spironolactone and read where it is a synthetic 
steroid. Could this drug have the same effect as 
prednisone as far as my Crohn's Disease is 
concerned? The reason I ask this is because I 
received Remicade approximately three years ago 
and stopped taking prednisone. At the same time, I 
began taking spironolactone for hair loss. I have 
been in "remission" since then and wondered if the 
spironolactone was responsible in some way. I also 
take probiotics, mercaptapurine, and Pentasa 
daily. I have never in my 20 years of living with 
Crohn's been without symptoms (or prednisone) 
until 3 years ago." - LAB 

Spironolactone is a synthetic, steroid-like drug 
that actually works the opposite of one of the 
body's normal hormones, aldosterone. Aldosterone 
is secreted by the adrenal glands that sit above 
the kidneys and it causes retention of sodium salt 
and fluid to maintain a good healthy blood 
pressure. Spironolactone is an antagonist of 
aldosterone and works to lower blood pressure in 
people who have hypertension. Thus it causes salt 
and water excretion like a diuretic. In people who 
have normal blood pressure, it does not cause too 
low blood pressure. 

Spironolactone also has an effect to stimulate sex 
hormone binding proteins in the blood. These 
binding proteins in turn bind any excess 
testosterone (male hormone) in the blood thus 
lowering the blood testosterone levels. If your 
hair loss is due to excess testosterone that 
produces male pattern baldness, then 
spironolactone will help reverse that. 

There is no evidence that I know of that 
spironolactone produces a prednisone-like effect. 
In fact it would probably produce the opposite 
effect if anything. I would guess that your 
Crohn's disease improvement is more likely to due 
to the past Remicade treatment than it would be to 
be due to spironolactone treatment. That being 
said, there is still a lot we do not know about 
medicines and diseases so I do not think you 
should test out the hypothesis by stopping the 
spironolactone just to see if the Crohn's disease 
4. Low carbohydrate diets - short term and long term

With more new diet studies coming out about low 
carbohydrate diets, it should be official now -- 
people lose weight quicker on low carb diets than 
on low fat diets and it is easier for most people 
to stick to the low carb diets. However after time 
passes (such as one year), the final weight loss 
is not different on a low carb diet versus a low 
fat diet. 

The most surprising finding with these diet 
studies is how you can eat more fats (but less 
simple carbohydrates) and your triglyceride levels 
get lower and HDL (high density lipoprotein levels 
rise to "good "levels. It does not make sense that 
the diets with higher fats would actually improve 
cholesterol levels more than low fat diets, but it 
does. This sort of throws suspicion on any diet 
recommendations that professionals or non 
professionals give without a scientific study to 
back it up. 

Low carbohydrate diets - short term and long term

5. Health tip to share - Slippery elm for constipation
"I have had chronic constipation as long as I can 
remember.  I also suffer from endometriosis, and 
bowel problems are a normal side effect of that.  
I have researched, and tried many different things 
to alleviate the constipation.  I was told by 
another women who suffers from both about Slippery 
Elm Bark powder.  After two days, I had regular 
movements, and am not nearly as nauseated.  It 
needs to be taken daily.  I notice it is more 
effective if taken at night.  It even helps an 
upset stomach.  You can mix it into tea, or milk 
and drink it.  Just make sure it is the powder 
form, I've been told that the other forms don't 
work as well. " - Anon 
6. Humor is healthy
"How To Ask A Man To Do Something"

Always remember these important rules when asking 
a man to do something: 

1. Make sure the man is conscious. 

2. Crash the hard drive on his computer and line 
the bird cage with the sports section. 

3. Be brief! Limit your nagging harangue to two, 
three hours, max. 

4. Reward him for cooperative behavior. Offer to 
cook him something that doesn't have a peel-back 

5. Punish him when he refuses to cooperate. 
Microwave his remote on high power for 55 minutes. 
Rotate 1/4 turn, and microwave again for another 
35 minutes. 

6. Use "would you" or "will you" instead of "you'd 
better" or "do as I say and no one will get hurt." 

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

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********** Health Newsletter ***********
              June 13,  2004
Biweekly from BackupMD on the Net

1. Your periodic health check-up 
2. Practical tips for Alzheimer's care givers
3. Reader submitted Q&A - Postmenopausal vaginitis
4. Diabetes and heart disease risk
5. Health tip to share - Pool exercise
6. Humor is healthy

1. Your periodic health check-up 

It is not that we are unaware of the benefits of 
screening for high cholesterol, high blood 
pressure, colon and other cancers; its just that 
we do not always take the time to have an annual 
physical exam or a battery of screening tests 
done. About 70% of women have their mammograms as 
often as recommended by current guidelines but 
compliance about other screenings is much less. 
Men are worse than women and comply way less than 
50% of the time on their recommended screenings. 

Screening for high cholesterol is especially low 
in younger adults as well as children or teens. 
Did you know that "starting at age 20, everyone 
should have their cholesterol checked at least 
every 5 years? Children and teens who have 
relatives with a history of early heart disease or 
a family history of individuals with a total 
cholesterol above 240 mg/dL should be screened 
sooner than age 20. 

Also there is still misinformation about certain 
screening tests. Even among women who know about 
having a regular Pap smear test for detection of 
cervical cancer or premalignant cervical 
dysplasia, as many as one in seven women think 
that ovarian cancer, endometrial (uterine) cancer 
or even sexually transmitted disease is detected 
by the Pap test. They are not! 

Screening for colon and rectal cancer after age 50 
has a slightly different problem in that many 
people may be hesitant to have a colonoscopy 
because of exaggerated fears that it is 
embarrassing and uncomfortable. Actually, you are 
almost always sedated with intravenous medicine to 
the point you are hardly aware it is being done. 
Most people who have had it do not really think it 
is a big deal. 

Current recommendations for colorectal cancer 
screening are: 

Beginning at age 50, both men and women should 
follow ONE of these five testing schedules: 

yearly fecal occult blood test  

flexible sigmoidoscopy every 5 years 
yearly fecal occult blood test plus flexible 
   sigmoidoscopy every 5 years 

double-contrast barium enema every 5 years 

colonoscopy every 10 years 

Be sure to take the time for a periodic health 
screening visit. Every time you have a birthday, 
make a reminder to yourself to take care of your 
health to ensure future birthdays. 

Your periodic health check-up

2. Practical tips for Alzheimer's care givers

Taking care of someone with Alzheimer's disease 
(AD) is a task no one  can imagine until they have 
done it. To say it is very difficult is an 
understatement. It takes immense patience and 
dedication to a loved one. One in 10 individuals 
over age 65 has AD and half of individuals over 
age 85 develop it. Mayo Clinic has some practical 
tips for AD care givers that are worth book marking 
in case you ever find yourself in that situation. 

Independence of performing daily living tasks such 
as bathing, shaving, dressing, driving and eating 
meals declines fairly quickly after the diagnosis 
of AD is made. Therefore the first step is to 
assess what degree of independence is possible and 
to frequently (sometimes even daily) reassess if 
that amount of independence is still feasible. Try 

  Involve your loved one in tasks as much as 
possible. Give choices of clothes or meals but 
make the choices limited. 

  Reassess needed assistance daily. "For example, 
can your husband shave by himself if you set out 
his supplies? Or can he shave by himself if you 
turn on an electric razor and put it in his hand? 
Or does he need you to provide assistance with the 
entire task?" 
  Strive for balance between rest and activity. 
Minimize activity later in the day when your loved 
one is more likely to be tired. 

Alzheimer's disease impairs judgment and problem-
solving skills so it is important to create a safe 
environment at home. Remove clutter such as 
electrical cords, throw rugs and small pieces of 
furniture. Put locks on medicine cabinets, 
cleaning closets and storage areas of any 
dangerous weapons, tools or toxic substances i.e., 
child proof the house! Make sure you have working 
fire and smoke alarms as well as a fire 
extinguisher and first aid kit. Keep your hot 
water heater at 120 deg F or less and eliminate 
electrical appliances from the bathroom. You may 
need to put a slidebolt or deadbolt lock requiring 
a key on every door that leads to the outside or 
down stairs. Car keys may need to be locked up. 

Most importantly, an AD care giver needs to change 
his or her expectations. Tasks take much longer to 
do with AD. Trying to hurry it up does not often 
work. If someone with
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