Womens Health

Women's Health Newsletters 12/12/04 - 2/20/05



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********** Health Newsletter ***********
              December 12,  2004
Biweekly from BackupMD on the Net

1. Job burnout and its health effects
2. Preventing kidney complications from diabetes 
3. Reader submitted Q&A - What can improve memory?
4. Sleep loss can stimulate your appetite
5. Health tip to share - Coping with hot flashes
6. Humor is healthy
The next newsletter will be in two weeks.

1. Job burnout and its health effects
Job burnout is a term used to describe a mental 
and physical exhaustion that makes you dread to 
return to work after a weekend or vacation. It is 
caused by the long-term exposure to demanding 
work situations. People at risk for job burnout 
are those who: 

identify very strongly with work to the exclusion 
of their  non-working life, 

try to meet everyone else's needs and wants, 

have monotonous jobs, 

or work in the helping professions such as 
medicine, nursing,  counseling, teaching, or 
police work. 

How can you recognize if you or a coworker or 
friend are in the  process of "burning out"?  
Symptoms include increasing sarcasm  or cynicism 
at work, trouble getting started at the beginning  
of the work day, irritability and loss of patience 
with co-workers, customers or clients, an 
alteration of sleep or appetite habits, and 
chronic head or body aches--physical  symptoms 
with vague causes. It is possible, however, that 
the  above symptoms can also indicate an internal 
depression that is  caused by non-work related 
problems rather than job burnout. 

If the feelings are caused by job burnout rather 
than an endogenous depression, you can usually 
identify a lack of  control at work, unclear job 
expectations, dysfunctional workplace dynamics, a 
mismatch in values between you and your company 
or boss, or extremes in job activity from boring 
to chaotic. Identifying these conditions helps 
explain the problem  but does not make it better 
unless you adjust to these circumstances or change 
jobs. You may want to seek counseling  to help you 

Job burnout and its health effects

2. Preventing kidney complications from diabetes 

The major long term complication of diabetes is 
that it affects the blood vessels all over the 
body causing hypertension, heart disease, skin 
conditions and kidney damage eventually leading to 
kidney failure. While many individuals with 
diabetes eventually die from strokes and heart 
attacks, a significant number each year die from 
kidney failure. 

The American Diabetes Association Resource Guide 
for 2004 recommends testing for small amounts of 
protein in the urine (microalbuminuria) once a 
year. It is an early sign of kidney disease and if 
present, a diabetic's medications can be adjusted 
and intensified in order to prevent full blown 
kidney damage and having to go on an artificial 
kidney (kidney dialysis). 

A recent study published in the New England 
Journal of Medicine looked at trying to prevent 
early kidney disease as measured by 
microalbuminuria by aggressively treating the 
blood pressure with either an ACE inhibitor anti-
hypertensive medication or a calcium channel 
blocker or both. These are two commonly used types 
of blood pressure medications. The Italian 
investigators found that the ACE inhibitor, 
trandolapril (Mavik), was over 2 times as 
effective as a calcium channel blocker, verapamil 
(Calan, Isoptin) in preventing microalbuminuria. 

If you have diabetes and are on a blood pressure 
medicine also, you might check with your doctor to 
consider that the anti-hypertensive medication you 
are on is an ACE inhibitor as its mechanism of 
action or at least discuss this study with him or 
her. Also be sure to check annually for any 

Preventing kidney complications from diabetes
3. Reader submitted Q&A - What can improve memory?
"Outside of the Alzheimer's issue, what is good 
for memory?   Any specific food to eat or to 
avoid?  Any specific vitamin to  eat or to avoid?  
Anything outside of Ginkgo Biloba to take?" -  LA 

Some studies of Ginkgo Biloba herbal supplements 
to improve  memory have shown positive results 
while others have shown  negative results, i.e., 
it may or may not help. As I read the  medical 
literature on this, I do not think the evidence is  
enough to make me take any Gingko supplements. Soy 
supplements (60 mg of isoflavones) also have some 
studies supporting improved memory and some 
negative studies. At this time there is not 
enough to say conclusively whether soy is 
beneficial for memory and cognitive function. 

Folic acid (vitamin B9) and vitamin B12 have 
sometimes been recommended as supplements for 
memory and cognitive function because 
deficiencies in these vitamins can produce 
impaired mental functioning. However the clinical 
trials that have been performed using these 
vitamin supplements in normal people and in those 
with early Alzheimer's disease have not shown any  
benefit. The story is the same for vitamin B6. 
Unless you are not eating any green vegetables at 
all or have been shown to have a folate, B6 or 
B12 deficiency, specific vitamin supplements or 
multi B vitamins will probably not enhance any  

Caffeine in small doses (less than 200 mg, two cups 
of coffee) improves attention. In this way it may 
help memory because many of the facts we forget 
are due to lack of complete attention  and 
repetition the first time we heard it. 

An ayurvedic herb used in India for memory 
enhancement, Brahmi  (Bacopa monniera), has one 
report of positive memory  enhancement but again, 
its too little data to say for sure. 

You will not help memory by avoiding any specific 
foods or  vitamins with the exception of alcohol. 
Alcohol in small  amounts can produce temporary 
memory impairment and over two  drinks a day may 
also produce some chronic memory impairment.  Many 
prescription drugs that are used to affect the 
brain  system or alter mood such as anti-
psychotic, anti-seizure or  narcotic pain 
medicines, can have a negative effect on memory. 

The best prescription to preserve your memory 
other than  avoiding memory impairing drinks and 
drugs is to indulge in memory exercises or mental 
aerobics. Do crossword puzzles and word games 
every chance you get. Read a lot and tell someone  
about the book. Play board games or even a musical 
instrument.  Dancing, walking or any regular 
exercise as well as plenty of sleep helps memory. 

4. Sleep loss can stimulate your appetite

It has been known for quite a while that sleep 
deprivation of both animals and humans results in 
a stimulated appetite and overeating behavior, 
usually with unintended weight gain. Until 
recently, the mechanism behind this increase in 
appetite was not clear. 

A recent study from the University of Chicago and 
from  Brussels, Belgium looked at young men who 
underwent sleep deprivation for two days followed 
by two days of extended hours of sleep. 
Investigators measured two hormones that affect 
hunger and appetite: leptin and ghrelin. They 
found evidence that those hormones were 
significantly altered by either too little or more 
than enough sleep. Too little sleep raised the 
appetite stimulating hormone ghrelin.  

Leptin, a hormone produced in fat cells, 
suppresses the desire to eat. It also stimulates 
the burning of calories. Normally the more fat 
cells you have, the more leptin is produced which 
you would think would lead to weight loss. Many 
times it does but in obese individuals, there 
somehow develops a resistance to leptin. Thus the 
hormone leptin is now being closely studied as a 
possible treatment for weight loss. Most obese 
individuals are leptin resistant so if we could 
understand how that works, we might have a 
unusable medical obesity treatment. 

Ghrelin is a blood factor that seems to be the 
opposite of Leptin; it the only hormone we know of 
that stimulates the appetite. Not much is known 
about it yet but it may play a role in anorexia 
and bulemia. For both leptin and ghrelin, it is 
interesting that alteration in the amount of sleep 
one gets is enough to change these appetite and 
calorie burning regulatory hormones significantly. 
Inadequate sleep can change hormone levels that 
regulate how full you feel and hunger in a way 
that could promote overeating and obesity. 

Sleep loss can stimulate your appetite

5. Health tip to share - Coping with hot flashes

"One thing about hot flashes. Mine also instigate 
feelings of unaccountable anxiety, so I started 
taking 250 mg of chelated  magnesium with a multi 
vitamin and it has made a dramatic difference.  I 
can tell when I forget to take it now, it works 
that well for me. Hasn't stopped actual flashes 
but has helped  diminish intensity and frequency 
along with removing related anxiety." - anonymous  

6. Humor is healthy

"Merry Christmas from Mom"

Dear Darling Son and That Person You Married,

Merry Christmas to you, and please don't worry. 
I'm just fine considering I can't breathe or eat. 
The important thing is that you  have a nice 
holiday, thousands of miles away from your ailing 
mother. I've sent along my last ten dollars in 
this card, which I hope you'll spend on my 
grandchildren. Lord knows their mother never buys 
them anything nice. They look so thin in their 
pictures, poor babies. 

Thank you so much for the birthday flowers, dear 
boy. I put them in the freezer so they'll stay 
fresh for my grave. Which reminds me -- we buried 
Grandma last week. I know she died years ago, but 
I got to yearning for a good funeral so Aunt Berta 
and I dug her up and had the services all over 
again. I would have invited you, but I know that 
woman you live with would have never let you come. 
I bet she's never even watched that videotape of 
my hemorrhoid surgery, has she? 

Well son, it's time for me to crawl off to bed 
now. I lost my cane beating off muggers last week, 
but don't you worry about me. I'm also getting 
used to the cold since they turned my heat off and 
am grateful because the frost on my bed numbs the 
constant pain. 

Now don't you even think about sending any more 
money, because I know you need it for those 
expensive family vacations you take every year.   
Give my love to my darling grand babies and my 
regards to whatever-her-name-is --the one with the 
black roots in her hair who stole you screaming 
from my bosom. 

Merry Christmas,.
Love, Mom

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

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********** Health Newsletter ***********
              January 9,  2005
Biweekly from BackupMD on the Net

1. Interstitial Cystitis
2. Selecting an antidepressant
3. Reader submitted Q&A - HDL cholesterol
4. Treating warts yourself
5. Health tip to share - dry skin
6. Humor is healthy

1. Interstitial Cystitis

Interstitial cystitis (IC) is a vaguely defined 
medical condition of the bladder. It is a term 
given to a chronic, relapsing syndrome of bladder 
pain associated with a frequent urge to urinate 
both during the day and also during the night. 
Night time urination frequency (nocturia) of 4 or 
more times an evening is very often associated 
with IC assuming there is not an active, bacterial 
urinary infection. IC remains a diagnosis of 
exclusion of other conditions such as recurrent 
urinary tract infections, bladder stones or other 
anatomical abnormalities of the bladder such as 
polyps or cancer. 

The incidence of IC is less than 1 in a 1000 
adults, mostly affecting women and can be 
difficult to recognize when it occurs. On the 
average, symptoms of urinary frequency and urgency 
and lower abdominal pain over the bladder are 
present for about 3 years before a diagnosis is 
made. Although IC can affect any age, the average 
age of onset of symptoms in women is about 45 
years old. 

Aside from having to go to the bathroom all of the 
time, pain is the symptom that can be the most 
disabling. It is variable from just happening 
occasionally to constant. While most of the pain 
is over the bladder area in the lower abdomen, it 
can also be in the urethral area, the low back, 
the loin area or even the groin area. As many as 
60% of patients with IC also have irritable bowel 
syndrome and many have food or drug allergies or 
sensitivities. Arthritis is also common. 

Different treatments have been used for IC and 
some are partially successful. And yet a recent 
survey in the UK (below) indicates that most 
people with IC have not been tried on many of the 
therapies known to lessen symptoms. Treatments 
used include: 

cimetadine (Tagamet)
antihistamines (hydroxyzine, Vistaril(R), Atarax(R))
pentosan polysulphate (Elmiron(R))
DMSO (dimethyl sulfoxide) instilled into the bladder
anticonvulsants (gabapentin, Neurontin (R))

For symptoms of chronic urinary frequency, 
urination 4 or more times at night and bladder 
pain, be sure to see a urologist or 
urogynecologist to be evaluated for possible 
interstitial cystitis. 

Interstitial Cystitis

2.  Selecting an antidepressant

It used to be that psychotherapy by psychologists 
or psychiatrists was the recommended treatment for 
moderate or severe depression. Health care 
financing policies in the last decade have pushed 
doctors to almost exclusively use antidepressant 
medications with very little professional 
counselling. As a result, many patients are placed 
on medical therapy for their depression even 
though doctors would like to see them undergoing 
cognitive-behavioral therapy also. People with 
depression are often left to fend for themselves 
with overcoming depressive feelings as well as 
coping with the side effects  of various 
antidepressant medications used. 

There are many different mechanisms of action of 
the drugs currently used by doctors as 
antidepressants. For a fairly complete list, see 
the article below at MayoClinic.com. Each of the 
different types of antidepressant drugs manifest 
different therapeutic as well as side effect 

Side effects of antidepressants are most 
pronounced within the first few days of starting a 
new medicine. Usually your body adjusts quickly 
but if after about two weeks of taking a new 
antidepressant you still have some of the 
following symptoms,  you should talk to your 
doctor about switching to a different med. 

All antidepressants may cause minor or major side 
effects. Most side effects are mild and temporary 
and disappear within a few days or a week or so. 
In general, the most common are: 

decreased sexual desire or arousal 
bladder problems 
dry mouth 
changes in sleep patterns 

Many of the drugs also have a warning about the 
increase in thoughts of suicide in children and 
adolescents who use them. Certain classes of drugs 
will cause different side effects, for example. 
SSRIs have more sexual dysfunction side effects 
than do norepinephrine reuptake inhibitors; 
tricyclics seem to produce more dry mouth and 
constipation side effects. Some alpha2 receptor 
blockers are worse for drowsiness, lightheadedness 
and dizziness while others (monoamine oxidase 
inhibitors) may cause low blood pressure or cross 
react with other antidepressants. 

Most people only have to take an antidepressant 
for 6-12 months at the most. If you find you are 
having problematic symptoms on an antidepressant 
or have been on one for a year or more, talk to 
your doctor about making a switch in treatment. 

Selecting an antidepressant

3. Reader submitted Q&A - HDL Cholesterol

"My HDL level of good cholesterol is 72. Is it 
good for me? I am a 75 year old woman With total 
cholesterol level 295, triglycerides 199 and LDL 
194. I can not tolerate statins medication"- E.F. 

In women, a good HDL level above 35 mg/dl (or 45 
mg/dl if you have a family history of heart 
disease), trumps a high total cholesterol level or 
a high LDL (bad cholesterol level. Women who have 
a good cholesterol level (HDL) generally have a 
lower incidence of atherosclerosis. If you already 
have heart disease or atherosclerosis, doctors 
would be pleased to see your HDL level above 55 
mg/dl as a therapeutic goal of any diet or medical 
therapy. Your level of 72 is excellent and 
probably represents good genes. I would be very 
pleased if my HDL level were as good as yours and 
I would not take any statin drugs. 

Even small increases in HDL cholesterol are 
associated with a reduced frequency of heart 
attacks. For each 1 mg/dl increase in HDL 
cholesterol there is a 2 to 4% reduction in the 
risk of coronary heart disease. This does not 
absolutely mean you will not get a heart attack or 
stroke in the near future, but the odds are quite 
favorable that you won't especially if you are 
also a nonsmoker and do not have diabetes. 

4. Treating warts yourself

Most warts of the hands or feet take care of 
themselves within a year or two. Your immune 
system isolates the virus (a human papilloma 
virus) and they go away by themselves. However 
warts can be unsightly and uncomfortable for that 
amount of time so treatment to get rid of them is 
important to know. Many times you can self treat 
warts rather than going to a dermatologist or 
general practitioner. 

The most common self treatment of warts is the use 
of salicylic acid. This can be purchased without a 
prescription at a pharmacy as a liquid, a patch, 
or a gel. Usually you try to first file away dead 
wart skin so the salicylic acid can get to the 
center and base of the wart. You can use a nail 
file, an emery board or a pumice stone for this. 
Then you need to soak the wart for about 10 to 15 
minutes with water so that the dry skin is 
softened to absorb the salicylic acid. Apply the 
salicylic acid and repeat this once or twice a day 
for about 3 months. 

Another home use technique that has been described 
as successful is to "cut a piece of duct tape to 
match the size of the wart and wear the duct tape 
on the wart for six days. Then, remove the duct 
tape patch and soak and file the wart. Leave it 
uncovered for the night and reapply a duct tape 
patch the next morning. Repeat this process for 
two months or until the wart is gone." 

If these choices make you too squeamish or are too 
much bother, you can always go to a physician who 
can freeze the wart using liquid nitrogen or 
cauterize it using a needle. Then they scrape the 
dead skin away just like you would at home. It may 
take only 3 or 4 treatments to get rid of the wart 
this way. 

Treating warts

5. Health tip to share - Dry skin

Moisturizing lotions, creams and gels for dry skin 
generally contain lanolin, but the most effective 
ingredients are urea (most effective) and 
glycerine. Urea containing creams ranging from 4%-
30% are the most effective for decreasing water 
loss from the skin. At the 20-30% urea level, hard 
calloused skin of the feet can be softened. 
Propylene glycol is very drying and should be 
avoided in skin preparations for dryness. - FRJ 

6. Humor is healthy

"Hey Doll . . ."

What's in a name? Apparently, a lot more than you 
(or I) ever thought there was. Here's what his pet 
name for you *really* means..... 

Darling -- Depends on how he says it. If he 
stresses the first syllable, then he's probably 
done something wrong or wants money. 

Dear -- Probably a leftover from his parents. 
Expect him to wear woolly cardigans, smoke a pipe 
and prefer a mug of Ovaltine to lager. 

Sweetheart -- If it's said patronizingly, it's not 
so sweet. But when uttered in earnest, it may send 
your own sweet heart aflutter. 

Babe -- Not to be confused with the film of the 
same name. Check for flares or signs that he's a 
70s throwback. He's a bit of a medallion man. 
Chances are he's got his initials on his chunky 
ring. Leave immediately if he tries to sell you a 
second-hand car. 

Baby doll -- This type of man will probably 
require you to wear transparent frilly nighties 
even in the dead of winter. He doesn't want you to 
grow up, and obviously can't deal with real women. 

Princess -- Never trust a man who calls you 
princess. You may think you're being treated like 
royalty, but beware of Prince Charmings - they may 
be secretly plotting your over- throw. 

Sexy -- Fine if you're sexy. If you're not, who 
cares? He probably thinks you are anyway!! 

My girlfriend -- He's honest, open and probably 
glad to have you around. The next thing you know 
he'll be using your name! 

The wife -- If you're married then he probably 
thinks he owns you. If you're not, he probably 
thinks you act like his wife, in which case, he 
thinks he owns you. 

My other half -- You complete the set - he's only 
half a man without you. But it may make you feel 
as though you are losing your identity somewhere. 

The missus -- See The Wife.

My partner -- He's right on. Probably likes eating 
tofu and hugging trees. 

My significant other -- He's even more right on. 
Probably thinks it's cruel to eat tofu and that 
trees need their own space. 

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

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********** Health Newsletter ***********
              January 23,  2005
Biweekly from BackupMD on the Net

1. Dry nose
2. How much water/fluid a day is enough?
3. Reader submitted Q&A - Fosamax and blood pressure
4. Folic acid and lower hypertension risk
5. Health tip to share - Shedding pounds
6. Humor is healthy
The next newsletter will be in two weeks.

1. Dry nose

Dry nasal passages are common in cold climates 
during the winter. Inside heat often reduces the 
humidity in the air to very low levels causing 
this abnormal dryness. The dried, inside-nose skin 
not only becomes dysfunctional for filtering 
particles in the iar you breathe but it can also 
lead to nose bleeds as the skin loses its natural, 
protective secretions. People who have allergies 
and sinusitis even have a worse time of it in the 
winter months. Individuals who use nasal CPAP 
(controlled positive airway pressure) for sleep 
apnea have problems with dry nasal passages all 
year round. 

You might want to know what is safe to put in the 
nasal passages to restore moistness, prevent 
nosebleeds and just give an overall modicum of 
relief during the dry winter months. Some people 
have recommended putting Vaseline(R) (petrolatum 
jelly) in the nose but while generally safe, it 
can produce a lipoid (fat) pneumonia if the 
petrolatum is inhaled into the lungs too often. 
This is also true if you use mineral oil. 

If the dryness is not too severe, use of a 
isotonic saline (salt) spray without any medicines 
in it is the fastest way to moisten the nasal 
passages and even wash out secretions that have 
caked to the nose hairs inside. Isotonic means it 
is the same salt concentration as is normal in all 
of your body's liquids (about 0.9%). Nasal 
isotonic saline sprays are available without 
prescription at any pharmacy and most food stores. 
It can be used as often as you want since no drugs 
are involved. 

A water-soluble nasal gel (e.g., Entsol(R) Nasal 
Gel) or even just a general water soluble gel such 
as K-Y Jelly (R) can also be used to moisturize 
the nasal passages without any risk of a lipoid 
pneumonia. Just use your finger to place a small 
amount in each nostril especially before going to 
bed and then upon rising or early in the day. 

If your nasal dryness is compounded by swelling in 
the nasal passages, allergies and even colds, you 
can use a hypertonic (about 3%) saline nasal wash 
(e.g. Entsol Buffered Hypertonic Nasal Spray) 
which will draw fluid out of the swollen skin and 
make breathing easier. 

Dry nose

2. How much water/fluid a day is enough?

In the doctor's office, it is not uncommon to see 
women who are drinking excessive amounts of water 
each day. They have been told by friends and media 
that water is healthy and dehydration is bad for 
you (which it is). Unfortunately excessive fluid 
intake causes you to have to urinate more often. 
If a person has any bladder problems such as 
urgency, overactive bladder or urinary 
incontinence, then those problems are compounded 
by the excessive water intake. 

How can you tell if you are getting enough fluids? 
Basically you need to look at the color of the 
urine. If it is totally clear like water, you are 
taking in too much fluid. If the urine is 
light/pale yellow you are probably at the correct 
amount. If the urine is a deep yellow, then you 
are somewhat dehydrated and should increase fluid 

The amount of fluid your body needs each day 
varies with your physical activity, the 
temperature, the humidity and even the altitude at 
which you live. You need more water when you 
exercise, when its hot, when it is dry and if you 
live at higher altitudes. There are some rules-of-
thumb about drinking fluids. The old adage of 
eight 8 oz glasses a day (about 2 liters) when 
added to a normal amount of water in the daily 
food you consume, is about right if your activity, 
temperature etc., are normal. 

Keep in mind that many glasses, cans or bottles 
which your liquid comes in are more than 8 ounces. 
Twelve and 16 oz (500ml) containers may be the 
rule rather than the exception. You do not 
generally need eight 12 oz bottles or even six 16 
oz bottles of liquid a day. Sipping all afternoon 
on a 32 oz Big Iced Tea will make anyone have to 
run to the bathroom quite a bit. 

If you are not sure you a taking in enough liquid 
or you think you may be drinking too much, just 
look at the color of your urine. 

How much water/fluid a day is enough?

3. Reader submitted Q&A - Fosamax and blood pressure

"Is there any evidence that long term use of 
Fosamax may cause higher blood pressure levels and 
may cause a higher risk for heart disease or 

I am age 66, high blood pressure under control 
with diuretics (goes out of control after 
ingestion of Fosamax)" - RE 

Fosamax(R) (alendronate) is used to lay down extra 
calcium in bone in people who have bone thinning 
(osteoporosis). It can be taken as a daily dose or 
even a long acting weekly dose. Fosamax(R) can 
irritate the esophagus to cause heartburn in 
people who lie down flat right after taking the 
medicine. It can cause a decrease in blood calcium 
levels. Most of its side effects are confined to 
the gastro intestinal system with things like 
heartburn, nausea, abdominal pain etc. I have not 
heard of any problem with raising blood pressure 
and I could not find an incidence of that when 
scanning the medical literature. 

This does not mean that in you it is not causing 
elevated blood pressure; everyone reacts 
individually to a medicine and I am sure something 
about the Fosamax may not be agreeing with your 
body's blood pressure control. It is a sodium salt 
but the sodium level is so small that I would not 
think the sodium (salt) in it is the culprit. 

It would be important to know what you mean by the 
blood pressure "going out of control". The 
diastolic blood pressure rising to between 100 and 
110 for a hour or so would not be too worrisome. 
Diastolic rising above 110 or a systolic blood 
pressure in you (age 66) rising above 200 for 
anything more than 5 or 10 minutes would indicate 
maybe you should consider trying another 
osteoporosis medicine to see if it produces less 
of a problem. 

Also I am not aware of a long term effect of 
Fosamax on blood pressure and strokes. Obviously 
in you if it is raising your blood pressure for 
any length of time after taking it then it could 
produce long term, increased risk. Be sure to talk 
to your doctor about that. I am assuming you are 
not a smoker which can cause both osteoporosis and 
cardiovascular and stroke risk. If you are, stop 
the cigarettes right away; it produces the 
greatest cardiovascular and stroke risk.  

4. Folic acid and lower hypertension risk

Folic acid (vitamin B9) is a building block of 
many of the body's cells. It plays an important 
role in the cells that line blood vessels. 
Investigators recently looked at the large Nurse's 
Health Study of over 150,000 women during the 
1990's in which dietary histories were taken and 
updated periodically. 

They found that young women who had a dietary plus 
supplemental folic acid intake of 1000 micrograms 
per day (one milligram) had a only a 50% new 
incidence of hypertension compared with women 
taking only the recommended daily allowance level 
of 200 micrograms a day. Women aged 43 and older 
also had a reduction (about 20%) in hypertension 
when ingesting a gram of folic acid a day. 

Sources of folic acid include:

leafy greens such as spinach and turnip greens
dry beans and peas
fortified cereals and grain products
fortified juices

It is interesting that we recommend only about 200 
micrograms a day of folic acid for men and non 
pregnant women. Pregnant women should have 400 
micrograms a day to prevent certain spinal cord 
and brain defects in babies. It seems that this 
new hypertension data should be added to what we 
know to raise the recommended daily intake of 
folic acid. 

Too little folic acid can cause diarrhea, anemia, 
loss of appetite, weight loss, sore tongue and a 
variety of other symptoms. 

Folic acid and lower hypertension risk

5. Health tip to share - Shedding pounds

"As we head into the New Year, shedding pounds and 
starting an exercise regime is on everyone's mind! 
Women balk that they don't have enough time to 
exercise but here are some suggestions that work 
for me and my co-workers to add at least 20-30 
minutes of cardio into your busy work day! It's 
easy to break up your workout into 10 minutes 

If you sit all day at work, take a break and walk 
around the building or walk around a different 
floor for at least 10 minutes. 

If you are planning to go out to lunch with 
coworkers, weather permitting (or carry an 
umbrella!), pick a restaurant close by and walk to 
and from the restaurant. 

Instead of taking that 3 pm coffee or snack break, 
invite a coworker or two to take a 10 minute walk 
with you.  If you want a more difficult workout, 
climb stairs for 10 minutes. 

Also, another trick if you work in a building that 
has stairs and an elevator, opt to take the stairs 
instead of the elevator. 

It's easy to break up your day with "small" 
workouts...so no complaints that you don't have 
enough time! Just think "small" and you'll be able 
to get in at least 20-30 minutes of cardio in your 
busy work day!!" - Therese 

6. Humor is healthy

A man observed a woman in the grocery store with a 
three year old girl in her basket. As they passed 
the cookie section, the child asked for cookies 
and her mother told her "no." The little girl 
immediately began to whine and fuss, and the 
mother said quietly, "Now Ellen, we just have half 
of the aisles left to go through; don't be upset. 
It won't be long." 

He passed the Mother again in the candy aisle.
Of course, the little girl began to shout for candy.
When she was told she couldn't have any, she
began to cry. The mother said, "There, there, Ellen,
don't cry. Only two more aisles to go, and then we'll
be checking out."

The man again happened to be behind the pair at
the check-out, where the little girl immediately began
to clamor for gum and burst into a terrible tantrum
upon discovering there would be no gum purchased

The mother patiently said, "Ellen, we'll be through this
check out stand in five minutes, and then you can go
home and have a nice nap."

The man followed them out to the parking lot and
stopped the woman to compliment her. "I couldn't
help noticing how patient you were with little Ellen..."

The mother broke in, "My little girl's name is Tammy...
I'm Ellen."

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

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********** Health Newsletter ***********
              February 6,  2005
Biweekly from BackupMD on the Net

1. Chronic pain without physical cause
2. Excess weight and birth control efficacy
3. Reader submitted Q&A - Weight loss programs
4. Depo-Provera and bone density thinning
5. Health tip to share - Foot pain and aspartame
6. Humor is healthy

The next newsletter will be in two weeks.

1. Chronic pain without physical cause

There are many pain syndromes for which the exact 
cause is unknown or for which treatment is not 
good at relieving the pain. After a while it does 
not matter what label your pain-causing disease 
has; just the existence of chronic pain makes it 
its own disease regardless of whether your doctor 
calls it fibromyalgia, chronic fatigue syndrome, 
irritable bowel syndrome, interstitial cystitis or 

Chronic pain takes over your life and makes you 
focus on it day in and day out. Your pain 
threshold can lower, making you more sensitive to 
even small amounts of pain. Your mind is connected 
with the nerves producing the pain and any stress 
can magnify the pain intensity. Depression, as it 
develops, may actually be a pain coping behavior. 

Once a chronic pain cycle sets in place, the 
treatment regimen is different than that commonly 
used for the original disease. The treatment may 
include pain medicines but more likely it includes 
central nervous system medications which alter 
your brain's perception of the pain. 
Antidepressant meds such as amitriptyline 
(Amitril, Elavil) and nortriptyline (Aventyl, 
Pamelor) can bolster the chemical processes in 
your spinal cord and brain that normally suppress 
pain. If your doctor prescribes these, it is with 
the realization that your chronic pain situation 
needs a multimodal approach to changing how your 
brain processes pain signal inputs from the 
peripheral nerves. 

Physical activity such as increased aerobic 
exercise also plays an important role. It not only 
distracts your brain from processing (or obsessing 
about) pain signals but it also produces 
endorphins, your body's natural pain killers. It 
is not a quick fix for the doctor to recommend 
increased exercise instead of a pill but it is an 
effective strategy that you should listen to if 
you want to be able to cope better with the 
chronic pain. 

Chronic pain without physical cause

2.  Excess weight and birth control efficacy

Sometimes the dose in milligrams for a medicine is 
calculated by how much a person weighs. For other 
medicines it is presumably a one-dose-fits-all. 
This may work for conditions in which the benefit 
of the medicine is not an all or none success 
rate. A medicine like birth control pills, 
however, has a definite end point, prevention of 
pregnancy, so it may be more important to increase 
the dose as weight increases. 

Over several decades, the original high dose of 
estrogen in birth control pills has been 
periodically lowered. Originally the most commonly 
prescribed pills had over 100 micrograms of 
estrogen in them. Now estrogen doses in oral 
contraceptives range from a low of 20 micrograms 
to a high of about 35 micrograms. This has been 
beneficial in reducing side effects and 
complications but there is evidence that women who 
weigh more than 200 lbs may have a higher 
pregnancy rate on these lower doses of oral 

A recent study indicated that 5 percent of 
overweight women taking the pill became pregnant 
each year versus 3 percent of normal weight women. 
While even 3% is a high pregnancy rate, most other 
studies show that is what actually happens in a 
large study group, i.e., not everyone takes their 
pills as regularly as they should and some get 
pregnant. Among consistent birth control pill 
users in this study, the risk of pregnancy was 70 
percent higher in women weighing more than 165 
pounds and nearly double in women weighing more 
than 190 pounds. Currently only the birth control 
patch, Ortho Evra(R), has warnings about an 
increased pregnancy rate for women who are 

Keep in mind that there is no evidence yet that if 
an overweight woman increases the dose of a birth 
control pill can she reduce her pregnancy rate to 
that of normal weight women. Increasing the dose 
may just promote more complications rather than 
protecting better against pregnancy. On the other 
hand, it probably does not make sense for an 
overweight woman to be on the lowest (20 
micrograms) oral contraceptive. Any woman over 200 
lbs should probably take a 30 or 35 microgram of 
estrogen pill. 

Rather than changing doses of pills, it may be 
more beneficial for overweight women to make a 
double effort not to start pills late or miss 
pills. The most susceptible time to become 
pregnant is to start a cycle late after being off 
of the active pills for more than 7 days. This is 
much more likely to result in pregnancy than by 
missing a pill or two in the middle of taking the 
active pills. 

Excess weight and birth control efficacy 

3. Reader submitted Q&A - Weight loss programs

"I want to enroll in a weight loss program.  Which 
one do you suggest?  I have 25-30 pounds to lose 
from now to August 1st.  I'm 50 years old and it 
is getting harder for me to lose weight.  I'm 
doing great health wise but somewhat depressed 
about my weight. My height is 5-2' and my weight 
is 180." A.H. 

Which weight loss program? That's a great 
question. There certainly are so many to choose 
from: Atkin's, South Beach, Sugarbuster's, Weight 
watcher's, Jenny Craig, etc. Are any of those 
programs better than any other? It really depends 
somewhat on what you can tolerate. Some people 
cannot stomach high protein and high fat diets 
while others love it. 

There have been several principles established 
about weight loss programs by well controlled 
randomized medical trials: 

1. Low carbohydrate diets result in quicker weight 
loss but not a greater amount of weight loss over 
a year's time. 

2. Diets in which there is some sort of calorie 
counting or points that represent energy 
consumption are much more successful than any 
program that seems to allow you unlimited amounts 
of any food category. 

3. Regular daily exercise (but not excessive 
workouts) together with dieting results in more 
weight loss than just dieting alone. 

You would think that more principles than the 
above have been discovered about dieting but these 
are the only major ones I am familiar with. There 
are no herbs or prescription pills that help over 
the long run. 

Based upon the above, I would recommend trying 
Weight Watcher's which can be done over the 
internet if you like rather than having to attend 
weekly meetings in your local area. For your 
points for each meal that you are allowed, if you 
wish to use them in more protein and fat and only 
little carbohydrate, that is up to you. It may get 
you started with weight loss more quickly than 
not. You can record your point count that you eat 
each day online. This program works if you stick 
to it. For any program, do not set your goals any 
higher than about 2 pounds (one kg) a week except 
for that initial week when you may lose more in 
water weight. 

You should be able to lose your 30 pounds in 4 
months. That would allow you to reach your goal by 
August even with a week or two of slipping here or 
there. Maintenance is actually the more difficult 
task; even more difficult than losing weight in 
the first place. 

4. Depo-Provera and bone density thinning

Depo-Provera is contraceptive by shot that many 
women choose to use to prevent pregnancy. It is 
very effective in blocking ovulation from the 
ovary but as a result, it also blocks most of the 
estrogen production of the ovary also. Birth 
control pills have estrogen in them but the Depo-
Provera shot does not. 

The lower estrogen levels have been associated 
with bone thinning, osteoporosis, in women using 
this contraceptive. In fact in the study below, 
women lost about 5% of their total body bone 
mineral density in two years when just taking 
Depo-Provera shots every 3 months as it is usually 
prescribed to most women. I do not think that 
doctor's have realized that the bone loss is this 
great with Depo-Provera. This rate is higher than 
it is at menopause even. 

The concept of adding some estrogen to take 
together with the Depo-Provera in order to prevent 
bone loss is not new, however we have not had good 
scientific studies showing whether it is effective 
or not. In this recent study from Case Western 
Reserve University in Cleveland, OH, investigators 
gave women who were using DepoProvera, a monthly 
injection of estrogen (estradiol cypionate). The 
other half of the group using DepoProvera did not 
get any estrogen injections. At the end of two 
years, the group receiving estrogen injections 
increased their total body bone density by 4.7% 
while the group using DepoProvera alone lost 5.1%. 
This is a significant change and indicates that 
women using DepoProvera for contraception should 
receive some type of supplemental estrogen. 

If you are using DepoProvera for contraception, 
ask your doctor about using some estrogen 

Depo-Provera and bone density thinning

5. Health tip to share - Foot pain and aspartame
"I have had problems with my feet, very sensitive, 
hurt if walked too long,in general I was very 
concerned with my feet. One doctor x-rayed them 
and told me I had arthritis on my big toes.  
Doctor prescribed me Ultram(R) and it did help 
quite a bit. I decided one day I was not going to 
use aspartame, the artificial sweetener, in my 
food or drinks any more. All of the sudden my feet 
don't hurt anymore and I quit my medicine.  I 
don't know for sure if the quitting of aspartame 
did it or not.  But maybe someone else has done 
this and got same results." - DCH 

6. Humor is healthy

"Over The Hill?"

Women are the easiest to tell when they hit 40. 
You just count the rings under their eyes. 

For men, you're middle aged if your crowd 
considers you sexy just because you still have 

Men and women know they've reached middle age when 
they notice kids are getting noisier and the 
latest music is getting worse. 

Anybody who can remember when "boobs" meant "the 
dumb kids" surely qualifies for middle age. 

Ain't it hell though to reach your "September 
Years" and discover that you blew the best of July 
and August. 

And ain't it funny how when you're 50, suddenly 60 
doesn't sound all that old anymore. 

I'd love to know what part of the body whoever 
said "Life begins at forty" was referring to -- 
seems to me that every damn thing else is starting 
to wear out then. 

Middle age is usually reckoned at between 40 - 60. 
It's easy to tell when you hit there though, 
regardless of age, by the way it hits you back. 

You younger people out there -- wait until the 
first time your kids or Grandkids reveal that they 
are studying in "history class" events you lived 

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

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********** Health Newsletter ***********
              February 20,  2005
Biweekly from BackupMD on the Net

1. Screening for abdominal aortic aneurysm
2. Zinc deficiencies
3. Reader submitted Q&A - Menstrual cramps and OCPs
4. Home firearm injuries related to gun/ammo storage
5. Health tip to share - Aloe Vera for dry skin
6. Humor is healthy

The next newsletter will be in two weeks.

1. Screening for abdominal aortic aneurysm
The very large artery leading from the heart down 
to your legs is the abdominal aorta. Rarely, 
especially as one ages, the aorta can have a 
hernia of the arterial wall that creates an 
aneurysm, a ballooning out. That ballooning out is 
a weak point that can rupture spontaneously with 
almost certain sudden death. You may have heard 
that the presence of an aneurysm can be easily 
diagnosed by ultrasound, a painless, non invasive 
imaging study. A current medical question being 
posed is whether individuals over the age of 50 
should have screening ultrasounds to see if they 
have abdominal aortic aneurysms. 

The problem is that aneurysms are a rare 
occurence. The incidence is perhaps 2/10000 
individuals. You can see that you would have to do 
quite a few ultrasounds (about 5000) to pick up 
one case of an abdominal aortic aneurysm. If you 
could identify people who are at higher risk for 
an aneurysm then it might be worth screening. 

A recent U.S. Preventive Services Task Force 
committee looked at all of the available medical 
evidence for screening for abdominal aortic 
aneurysms by ultrasound. They found that men over 
the age of 65 would benefit from a one time 
ultrasound. Women have such a low incidence of 
aneurysms that screening them with ultrasound 
would not at all be cost effective. Also, it 
appears that with new Medicare rules, a one time 
screening for both men and women has been 
authorized to be paid for by Medicare. 

Screening for abdominal aortic aneurysm

2. Zinc deficiencies

Everyone needs zinc, but young children, teen 
girls and older adults are especially vulnerable 
to mild zinc deficiency. Vegetarians who limit 
zinc-rich foods, like meat, poultry, fish and 
seafood, may need up to 50% more zinc. Zinc 
deficiency is one of the biggest contributors to 
disease in developing countries because of low 
protein intake. It can cause stunting of growth 
and an increased death rate due to infection. 

The World Health Organization (WHO) has looked at 
the feasibility of giving zinc supplements to 
individuals in developing countries because it can 
reduce infant morbidities as well as prevent 
complications for diarrheal disease. But zinc 
deficiencies tend to run along with iron 
deficiency as well as deficiencies in vitamins 
such as A and C. Therefore it probably is a better 
strategy not to take just a separate supplement of 
zinc alone, but rather to include zinc along with 
other micronutrient supplements. 

Most non-vegetarians in developed countries do not 
need to take zinc supplements unless they are 
anemic or have depressed immune systems. Others 
should benefit from taking just a general mineral 
supplement that comes in many of the multivitamins 
available today. 

There are home tests available (e.g. Mineral 
Check) for determining if one is low nutritionally 
in any of the standard minerals. 

Zinc deficiencies

3. Reader submitted Q&A - Menstrual cramps and OCPs
"Which birth control pill is better in helping 
with menstrual cramps? I am 20 yrs old, very 
painful cramps which sometimes cause vomiting. 
Currently on Ortho Tri-cyclen Lo®.  Helps some." - 

Menstrual cramps are smooth muscle contractions of 
the uterus of fairly high amplitude. They start 
when tissue lining the uterus (endometrium) is 
being sloughed at the time of the menses. The 
purpose of the cramps is to expel that tissue and 
blood from the uterus. If the amount of tissue is 
great, or the uterine muscle (myometrium) is 
hypersensitive to the substances (prostaglandins) 
in the sloughing tissue that cause contractions, 
then cramps become very painful. 

Progesterone and its synthetic look-a likes called 
progestins which are used in birth control pills, 
work by two methods to reduce cramps. The more 
potent the progestin in a pill, the less 
endometrial tissue is produced each month and the 
less sensitive to contractions the uterine muscle 
becomes. Therefore you want a birth control pill 
that has a relatively high progestin potency. You 
may also benefit from taking an anti-prostaglandin 
medication such as ibuprofen while on your menses. 

Higher progestin potency pills would include: 
Yasmin®, Desogen®, Ortho-Cept®, Mircette®, 
Loestrin® 1.5/30, Demulen® 1/35, Zovia® 1/35E, 
Demulen® 1/50, Zovia® 1/50E. You can see a list of 
the different potency pills at: 

Another alternative is to use a pill such as 
Seasonale® which is not so high potency progestin 
but it blocks menses for 3 months at a time 
because you take the active pills continuously for 
3 months before taking any placebo pills which 
allow your menses to come on. 

Women who have had pregnancies tend to have less 
severe menstrual cramps but if they do have severe 
cramps, a progesterone intrauterine contraceptive 
device (Mirena® IUCD) often works very well to 
reduce the severity of those cramps. 

4. Home firearm injuries related to gun/ammo storage
People in households that have guns in them have 
much higher chance of having a firearm injury than 
people living in households without firearms. 
However, many people have guns in their homes and 
may have them just for the feeling of safety or 
for hunting or practicing shooting skills. 
Injuries in the home occur from accidents, 
suicides and domestic disputes. 

Recently, medical investigators at the University 
of Washington in Seattle looked at the risk of 
youth suicide and unintentional firearm injuries 
and how it varied according to how guns and 
ammunition were stored in the home. They looked at 
whether the guns were locked up, whether the 
ammunition was locked up either together with the 
guns or separate from the guns. Specific outcomes 

(1) whether the subject firearm was stored in a 
locked location or with an extrinsic lock; 

(2) whether the firearm was stored unloaded; 

(3) whether the firearm was stored both unloaded 
in a locked location; 

(4) whether the ammunition for the firearm was 
stored separately; and 

(5) whether the ammunition was stored in a locked 

They then corollated children and teens under age 
20 that had been admitted for firearm injuries 
with a control group of children/teens whose 
household had at least 1 firearm and children 
living or visiting in the home. They found that 
"the 4 practices of keeping a gun locked, 
unloaded, storing ammunition locked, and in a 
separate location are each associated with a 
protective effect and suggest a feasible strategy 
to reduce these types of injuries in homes with 
children and teenagers where guns are stored." 

If you keep guns and ammunition in your home and 
have children under the age of 20, you will 
definitely want to review this article. 

Home firearm injuries

5. Health tip to share - Aloe Vera for dry skin

"Most people know that the leaves from the aloe 
Vera plant work wonders for burns but I recently 
discovered that the gel from the aloe Vera plant 
works well for dry skin.  I am going through early 
stages of menopause and my skin is very dry.  I 
apply aloe Vera on my skin before going to bed as 
a night moisturizer and it works wonders!!!" - CW 

6. Humor is healthy
"The Birthday Wish"

A man asked his wife what she'd like for her 

"I'd love to be six again,"she replied. 

On the morning of her birthday, he arose early, 
got up, made her a nice Big bowl of Lucky Charms 
and then took her off to the local theme park. 
What a day! He put her on every ride in the park: 
the Death Slide, the Wall of Fear, the Screaming 
Monster Roller Coaster, everything there was. Five 
hours later she staggered out of the theme park. 
Her head was reeling and her stomach felt upside 

Right away, they journeyed to a McDonald's where 
her loving husband ordered her a Happy Meal with 
extra fries and a refreshing chocolate shake. Then 
it was off to a movie to see the latest 
blockbuster, a hot-dog, popcorn, a soda pop, and 
her favorite candy, M&Ms. What a fabulous 

Finally she wobbled home with her husband and 
collapsed into bed exhausted. He leaned over his 
precious wife with a big smile and lovingly asked, 
"Well, dear, what was it like being six again?" 

Her eyes slowly opened and her expression suddenly
changed. "You idiot, I meant my dress size!"

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

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