Womens Health

Women's Health Newsletters 2/7/99 - 3/14/99

 

 



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***** Woman's Diagnostic Cyber Newsletter *****
                March 14, 1999
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

1. Constipation, proctitis and other GI problems
2. Exercise different for health vs. fitness
3. Risk that a pelvic mass is ovarian malignancy
4. Understanding the causes of schizophrenia
5. What follow-up needed if you have breast cancer?
6. Humor is healthy

Spread the word! Send a copy of this newsletter
to someone you know.

Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Constipation, proctitis and other GI problems
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Only on the Net could there be a site called 
constipated.com. It is hosted by Christopher J. 
Lahr, M.D., F.A.C.S., and Michael F. Chen, M.D. 
The focus is complete colon care. There are some 
very practical tips not only for constipation but 
also about medications that alter bowel function. 
Topics include: Anal Problems, Rectal Bleeding, 
Colitis and Crohn's Disease, Proctitis, 
Diverticulosis, Diarrhea After Gallbladder 
Surgery, Coccygodynia, Proctalgia, Polyps, 
Medications that Alter Bowel Function, 
Constipation: The Last Taboo, Special Tests for 
Constipation, Incontinence (Leakage), 
Sigmoidoscopy, Colonoscopy, and Colon Cancer. 

Constipated.com

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Exercise different for health vs. fitness
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Physical activity designed to improve blood 
pressure, lower stress or just to decrease your 
overall body fat is different than that needed to 
enhance your performance in a specific measured 
outcome for a sport. For example it has been shown 
that people are more likely to stick with an 
exercise program if they do it at a lower 
intensity than previously recommended, e.g., 55% 
of target heart rate. Also, women who exercised 
for four 10 minute periods with a break in between 
had just as much benefit as those who exercised 
continuously for 40 minutes. See a good summary of 
the new recommendations from the  American College 
of Sports Medicine (ACSM) at Healthcalc Online: 

Exercise for health and fitness

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Risk that a pelvic mass is ovarian malignancy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Ovarian cancer is a very bad malignancy because it 
can be a silent disease. Early stage ovarian 
cancer (Stage I A and B) confined to the ovaries 
and not spread further in the pelvis, usually does 
not cause any symptoms. 

When a pelvic/ovarian mass is discovered, the 
concern about possible malignancy is very 
justified but most often the masses turn out to be 
benign. In advanced stage ovarian cancer, the best 
survival is obtained when all of the tumor is 
resected and then chemotherapy is given. 
Gynecologic oncology specialists have had special 
training beyond that of general gynecologic 
surgeons and beyond that of general surgeons, to 
thoroughly resect all tumor down to less than 1 
inch diameter even if there is extensive spread in 
the abdominal cavity. Many non-gynecologic cancer 
surgeons will not resect extensive disease as well 
as specially trained surgeons. Thus there is an 
advantage to knowing when a gynecologic oncologist 
should become involved since there are a limited 
number of these specialists available. 

This week's article discusses predicting risk of 
ovarian malignancy. 

Risk of ovarian malignancy

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Understanding the causes of schizophrenia
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The editorial below was written in response to 
another article in the New England Journal of 
Medicine that found an association of 
schizophrenia with a family history of 
schizophrenia, being born in an urban vs a rural 
area and being born in the months of February and 
March! What does February and March have to do 
with it you say? That's the point of the editorial 
-- probably nothing, just an association quite 
remote from cause and effect. The editorial was a 
concise explanation of a very complex disease. If 
you know anyone with hallucinations, delusions, 
disorganized speech or flattened affect, this may 
be about them. 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. What follow-up needed if you have breast cancer?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The American Society of Clinical Oncology has 
issued 1998 updated clinical guidelines for what 
studies are needed to keep a checkup on a woman 
who has had breast cancer. They did this by a 
thorough literature review for evidence that 
would justify each item they recommended. They 
concluded that data are sufficient to recommend 
monthly breast self-examination, annual 
mammography of the preserved and contralateral 
breast, and a careful history and physical 
examination every 3 to 6 months for 3 years, then 
every 6 to 12 months for 2 years, then annually. 
Data are not sufficient to recommend routine bone 
scans, chest radiographs, hematologic blood 
counts, tumor markers (carcinoembryonic antigen, 
cancer antigen [CA] 15-5, and CA 27.29), liver 
ultrasonograms, or computed tomography scans. 

Breast cancer follow-up guidelines

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

A woman runs into the vet's office carrying her 
dog, screaming for help. The vet rushes her back 
to an examination room and has her put the dog 
down on the examination table.  The vet examines 
the still, limp body and after a few moments tells 
the woman that her dog, regrettably, is dead. 

The woman, clearly agitated and not willing to 
accept this, demands a second opinion. 

The vet goes into the back room and comes out with 
a cat and puts the cat down next to the dog's 
body. The cat sniffs the body, walks from head to 
tail poking and sniffing the dog's body and 
finally looks at the vet and meows. 

The vet looks at the woman and says, "I'm sorry, 
but the cat thinks that your dog is dead too." 

The woman is still unwilling to accept that her 
dog is dead. The vet brings in a black labrador.  
The lab sniffs the body, walks from head to tail, 
and finally looks at the vet and barks.  The vet 
looks at the woman and says, "I'm sorry, but the 
lab thinks your dog is dead too." 

The woman, finally resigned to the diagnosis, 
thanks the vet and asks how much she owes. 

The vet answers, "$650.

"$650 to tell me my dog is dead?" exclaimed the 
woman.... 

"Well," the vet replies, "I would only have 
charged you $50 for my initial diagnosis. " 

"The additional $600 was for the cat scan and lab 
tests." 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time. We will bring you 
accurate women's health answers again soon.
Rick
Frederick R. Jelovsek MD 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~



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***** Woman's Diagnostic Cyber Newsletter *****
               March 7, 1999
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

1. Pharmaceutical information
2. Caffeine consumption and menstrual function
3. Ulcer diagnosis and Helicobacter pylori
4. Breast cancer in pregnancy
5. Interval between pregnancies is important
6. Humor is healthy

Spread the word! Send a copy of this newsletter
to someone you know.

Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Pharmaceutical information
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

I found the FAQ listings at Pharmaceutical 
Information Network quite interesting. For example 
if you have a question about Zoloft, their FAQ's 
include: 

What % decrease in obsessive symptoms constitutes 
a positive response? 

How long does it take for Zoloft to work? 

What are the side effects of Zoloft that were not 
reported by the manufacturer? 

What is the difference between Zoloft and Prozac? 

Is it OK to take for my daughter, who is 
breast feeding her baby, to take Zoloft? 

Is it true that Zoloft causes tiredness? 

Am I experiencing withdrawal symptoms from 
decreasing my Zoloft dosage? 

Is Zoloft causing my body odor problem? 

Is sexual dysfunction a side effect of taking 
Zoloft? 

Not all prescription drugs have FAQ's but some of 
the more widely prescribed ones do. The general 
description of pharmaceuticals by both generic and 
trade name is handy and the ones listed have some 
fairly good information. It is not a "PDR" online 
but more useful than many drug listings. 

http://www.pharminfo.com/drugfaq/faq_mnu.html

Drug FAQ's

http://www.pharminfo.com/drugdb/db_mnu.html

Pharmaceutical Information Network

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Caffeine consumption and menstrual function
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Having seen many questions about heavy menses, 
light menses, early menses and late menses, this 
article from the American Journal of Epidemiology 
was quite thought provoking. It found that heavy 
caffeine intake was associated a LOWER risk for 
long menses (8 days or longer) and a higher risk 
for short cycles (24 days or less). It was NOT 
related at all to anovulation or a short luteal 
phase. Interesting huh? 

Caffeine and menses

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Ulcer diagnosis and Helicobacter pylori
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

If you have stomach pains that are relieved by 
eating should you be tested for H. pylori 
infection? Up until the 1980's doctors felt that 
ulcer disease was caused by poor eating and 
drinking habits or a stressed-out personality. We 
used to even think that the stomach had so much 
acid in it that no bacteria could live in there. 
Now we know that a bacterium called Helicobacter 
pylori is strongly associated with ulcers; so much 
so that treating with certain antibiotics and 
antacids can cure ulcer disease.  The majority of 
the world's population has been exposed to H. 
pylori and yet most of them do not have ulcers. 
See the article below for the answers to questions 
about this topic. 

Ulcer symptoms and H. pylori

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Breast cancer in pregnancy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The diagnosis of breast cancer in pregnancy is 
actually quite unusual in spite of the high 
estrogen levels present. It is even uncommon right 
after pregnancy. Anyhow, the dilemma is how to 
treat. Many breast cancer treatment regimens 
include chemotherapy and there is a very 
legitimate concern about the effect of 
chemotherapy  on the unborn baby. The oncology 
group at MD Anderson Cancer Center in Houston 
Texas reports their experience of 24 patients with 
breast cancer treated with mostly modified radical 
mastectomy and chemotherapy which started in the 
2nd trimester of pregnancy. There were no adverse 
outcomes in the babies with a mean age at 
delivery of 38 weeks. Apgar scores, birth weights, 
and immediate postpartum health were reported to 
be normal for all of the children. While this 
study does not include long term follow up on the 
infants, it is still extremely encouraging for 
women who may have the misfortune to have a breast 
cancer detected during pregnancy. 

Breast cancer treatment during pregnancy

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Interval between pregnancies is important
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

If a woman has a pregnancy loss, stillborn, 
neonatal death or even a miscarriage, sometimes 
there is a tendency to want to replace that loss 
right away with another pregnancy. Is that a good 
or a bad thing to do? We have known for many years 
that becoming pregnant within 6 months of a 
previous pregnancy has a higher risk for an 
adverse outcome. But what is the ideal interval?

This article in the New England Journal of 
Medicine looks at what might be the ideal interval 
between pregnancies from a pregnancy outcome point 
of view. They found the optimal interpregnancy 
interval to prevent adverse perinatal outcomes 
is 18 to 23 months. While you cannot tell from the 
abstract below, the original article shows an 
increased risk of preterm birth, low birthweight, 
or intrauterine growth retardation of about 40% in 
the first 5 months following a pregnancy, 10% in 
6-11 months, and 10 % increase in the 12-17 months 
compared to the lowest adverse outcome in the 18-
23 month time period. While you do not need to 
wait a year and a half to get pregnant again, it 
seems wise to wait at least 6 months. 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

PREGNANCY AND GIVING BIRTH Q & A:
Q. What is the easiest way to figure out exactly 
when I got pregnant? 
A. Have sex once a year.

Q. Can a woman get pregnant from a toilet seat?
A. Yes, but the baby would be awfully funny looking.

Q. What is the most common pregnancy craving?
A. For men to be the ones who get pregnant.

Q. I normally wear a size 34-C bra. Now that I'm 
pregnant, should I continue to wear a bra? 
A. Not if you don't mind switching in the future 
to a size 34-Long. 

Q. Should I have a baby after 35?
A. No, 35 children is more than enough.

Q. My husband and I are very attractive. I'm sure 
our baby will be beautiful enough for commercials. 
Whom should I contact about this? 
A. Your therapist.

Q. I'm two months pregnant now. When will my baby 
move? 
A. With any luck, right after he finishes college.

Q. Since I became pregnant, my breasts, rear end, 
and even my feet have grown.  Is there anything 
that gets smaller during pregnancy? 
A. Your bladder.

Q. Ever since I've been pregnant, I haven't been 
able to go to bed at night without onion rings.  
Is this a normal craving? 
A. Depends on what your doing with them.

Q. Will I love my dog less when the baby is born?
A. No, but your husband might get on your nerves.

Q. Under what circumstances can sex at the end of 
pregnancy bring on labor? 
A. When the sex is between your husband and another woman.

Q. My childbirth instructor says it's not pain 
I'll feel during labor, but pressure.  Is she 
right? 
A. Yes, in the same way that a tornado might be 
called an air current. 

Q. I'm modest. Once I'm in the hospital to 
deliver, who will see me in that delicate 
position? 
A. Authorized personnel only--doctors, nurses, 
orderlies, photographers, florists, cleaning 
crews, journalists, convicts, etc. 

Q. What does it mean when the baby's head is crowning?
A. It means you feel as though not only a crown 
but the entire throne is trying to make it's way 
out of you. 

Q. Under what circumstances should a baby not be 
circumcised? 
A. When it's a girl, for starters.

Q. What does it mean when a baby is born with 
teeth? 
A. It means that the baby's mother may want to 
rethink her plans to nurse. 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time. We will bring you 
accurate women's health answers again soon.
Rick
Frederick R. Jelovsek MD 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~



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***** Woman's Diagnostic Cyber Newsletter *****
               February 28, 1999
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

1. Environmental causes of infertility
2. Exercise in pregnancy
3. Bleeding problems on oral contraceptives
4. Comprehensive diagnostic test listing
5. A patient's guide to Carpal Tunnel Syndrome
6. Humor is healthy

Spread the word! Send a copy of this newsletter
to someone you know.

Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Environmental causes of infertility
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Dr. Wayne Sinclair has put together a web page 
about different environmental factors and 
chemicals that may cause infertility. These 
include cigarettes, alcohol, coffee, pesticide 
use, food additives, MSG, aspartame, nutrasweet, 
cosmetic chemicals, geographic locations, vehicle 
exhaust, job occupation exposures and more. 

The same factors that may cause infertility may 
also be associated with miscarriages and some 
birth defects. There are also many general facts 
about infertility here. Be somewhat careful of 
believing the animal only studies since it is well 
known that humans have greatly different enzyme 
systems and metabolic pathways. With that caveat, 
however, there is some valuable information here 
for thought. 

You may also be interested in the site at Shared 
Journey - for Infertility and Adoption 
Information. 

Shared Journey - Infertility and Adoption

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Exercise in pregnancy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Exercise in pregnancy has not been well studied 
but the evidence there is, suggests that exercise 
at the same level during pregnancy as during non 
pregnancy is very safe. This article about 
exercise at Fit Pregnancy Magazine is worth 
reading if you want information about the safety 
of exercise in pregnancy. 

Fit pregnancy online - exercise

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Bleeding problems on oral contraceptives
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
How often does breakthrough bleeding occur while 
taking birth control pills? It is much more 
frequent then you would think. From 15-55% in the 
first 3 months of taking the pills. Also how about 
the use of the Pill to lessen acne. Did you know 
that most birth control pills, not just the one 
approved by the FDA, lessen acne? A few women can 
get worse though. See the article at: 

Bleeding problems on pills

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Comprehensive diagnostic test listing	
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The search engine, Excite, has a very extensive 
and clear listing of diagnostic medical tests at 
their Medical Encyclopedia. This is one link you 
will want to file away for later reference. 

Medical test listing

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. A patient's guide to Carpal Tunnel Syndrome
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Ever wake up in the middle of the night and feel 
hand pain or that your hand is asleep. If you check 
it carefully and note that the little finger is 
actually NOT involved in the pain or numbness, 
then you may have Carpal Tunnel Syndrome. The 
following guide has great information about 
diagnosis and treatment as well as educational 
illustrations. 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Mad Pig Disease

Medically these days, we have to worry not only 
about human diseases, but diseases of our 
companion and service animals. 

The possibility of the agents responsible for mad 
cow disease being transmitted to humans is of 
considerable recent notoriety in the media. 

Oprah has just been the tip of the iceberg, to mix 
a metaphor. 

Iowa pig farmers have an additional worry -- that 
the mad cow disease may be transmitted to pigs 
resulting in MAD PIG DISEASE. 

In other words, they are worried about . . . 
the daze of swine neurosis. 

(By Patrick Hester) 


~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time. We will bring you 
accurate women's health answers again soon.
Rick
Frederick R. Jelovsek MD 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~



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***** Woman's Diagnostic Cyber Newsletter *****
                February 21, 1999
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

1. Quitting smoking - a classic "how to"
2. Head and neck injuries at birth
3. Surgery for pelvic relaxation problems
4. A vulvar lesion mistaken for warts
5. Instructions for men on how to be romantic
6. Humor is healthy

Spread the word! Send a copy of this newsletter
to someone you know.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Quitting smoking - a classic "how to"
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
At a site called QuitNet.org, a partnership effort 
by the Boston University School of Public Health, 
the Robert Woods Johnson Foundation and the 
Massachusetts Tobacco Control Program,  there is a 
great guide in their library that is a classic 
paper on how to quit smoking. While you may have 
already quit, this is the type of resource you 
should refer any smoking friends to. It covers: 
Before You Quit, Just What's In a Cigarette?,  
Getting Ready to Quit, Taper or Fade, The Fresh 
Start, Dos and Don'ts for Quitting, Getting 
Through the First Few Weeks, Why Quitting is Hard, 
Skinner, Pavlov and Freud: Triggers And Cues, 
Managing Your Triggers, Withdrawal and Recovery 
Symptoms, Recovery, Symptoms, Withdrawal Symptoms, 
Oops ...., Getting Through the Next Few Weeks, 
Relaxation Exercises, What About, Weight Gain?, 
Additional Therapies, Nicotine Fading and 
Tapering, Nicotine Replacement Therapy, 
Acupuncture, Hypnosis, and A Calendar for Quitting 

Guide to quit smoking

They have some news about the tobacco legislation 
but if you want to lobby your senators and 
representatives about legislative actions, you may 
want to visit Kickbutt.org at: 

Kickbutt.org

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Head and neck injuries at birth
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The Archives of Otolaryngology Head and Neck 
Surgery had a nice review of where they looked at 
birth associated injuries to the head and neck of 
newborn infants. In general, these occur about 1% 
of the time (9.5/1000 livebirths). As I look at 
most of these injuries, they are events that just 
happened by chance; they were unlikely to be due 
to any operative intervention. You may want to 
look at the different types of injuries that may 
occur. 

Birth associated head and neck trauma

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Surgery for pelvic relaxation problems
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Many women avoid surgery for pelvic relaxation 
findings such as cystocoele, rectocoele, stress 
urinary incontinence and vaginal or uterine 
prolapse not only because they are embarrassed, 
but also because they have heard of the lack of 
long term success of some of the operative 
procedures used to fix these problems. This is one 
women's health set of conditions that does not 
receive much press in the usual media sources. If 
you want to learn about what symptoms are caused 
and cured by rectocoeles and surgery for them, 
what to expect for the success rates of 
incontinence surgery, and what sort of 
complications may need further surgery, visit this 
week's news article at: 

Pelvic support surgery

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. A vulvar lesion mistaken for warts
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Vulvar genital warts, condyloma accuminata are so 
characteristic that they only rarely need to be 
biopsied. In the Archives of Dermatology a recent 
case report gives an exception. In this instance, 
a woman had a 15- to 20-year history of severe, 
erosive, macerated lesions in the creases of her 
genitalia that occurred monthly around the time of 
her menses and worsened in the summer. She also 
complained of chronic, severe vulvar pruritus. The 
lesion was mistaken for condyloma accuminata but 
turned out to be -- benign familial chronic 
pemphigus. 

Vulvar lesion case report

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Instructions for men on how to be romantic
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If you think your husband/partner could use some 
advice on the art of romance, this site is worth a 
visit. Michael Webb publishes a newsletter on 
romantic tips to enrich your relationships. He 
says that 50% of the subscriptions are gift 
subscriptions from women to men. This is a great 
chance for an experiment that can make you feel 
better. 

Valentines Day just passed. Write down on a piece 
of paper what happened this past February 14th. 
Then direct your significant other to this web 
site or get a subscription to the newsletter. Next 
February 15th, 2000, pull out that paper and see 
how your experiment worked! 

The RoMANtic

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
From: "Joe Lex" 
Subject: provided for in death

An Irishman named Murphy went to his doctor after 
a long illness.  The doctor, after a lengthy 
examination, sighed and looked Murphy in the eye 
and said, "I've some bad news for you... you have 
the cancer and  can't be cured. I'd give you two 
weeks to a month."  Murphy, shocked and saddened 
by the news, but of solid character, managed to 
compose himself and walk from the doctor's office 
into the waiting room.  There he saw his son who 
had been waiting. Murphy said, "Son, we Irish 
celebrate when things are good and celebrate when 
things don't go so well.  In this case, things 
aren't so well. I have cancer and I've been given 
a short time to live. Let's head for the pub and 
have a few pints." 

After three or four pints the two were feeling a 
little less somber.  There were some laughs and 
more beers. They were eventually approached by 
some of Murphy's old friends who asked what the 
two were celebrating. Murphy told them that the 
Irish celebrate the good and the bad... He went on 
to tell them that they were drinking to his 
impending end. He told his friends, "I've only got 
a few weeks to live as I have been diagnosed with 
AIDS." 

The friends gave Murphy their condolences and they 
had a couple more beers. After his friends left, 
Murphy's son leaned over and whispered his 
confusion... "Dad I thought you said that you were 
dying from cancer.  You just told your friends 
that you were dying from AIDS?" Murphy said, "I am 
dying from cancer son - I just don't want any of 
them sleeping with your mother after I'm gone." 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time. We will bring you 
accurate women's health answers again soon.
Rick
Frederick R. Jelovsek MD 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~



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***** Woman's Diagnostic Cyber Newsletter *****
               February 14, 1999
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

1. Thyroid replacement - Is T3 AND T4 needed?
2. Fetal alcohol syndrome
3. Laparoscopy for diagnosis of ovarian masses
4. Varicose veins-should they ever be operated on?
5. Mild dysplasia is likely to revert to normal
6. Humor is healthy

Spread the word! Send a copy of this newsletter
to someone you know.

Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. Thyroid replacement - Is T3 AND T4 needed?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

For all women on thyroid replacement, these New 
England Journal of Medicine articles/editorials 
are MUST reads. There is evidence being presented 
that T3 given along with the doses of thyroxine 
(T4, Synthroid) results in improved psychological 
well being. There is also dissension to this view, 
however.

The editorial in the same issue should also be 
read for a history of thyroid replacement and also 
for a contrary view as to why T4 is enough 
replacement. The history explains why physicians 
of different ages may have different approaches to 
thyroid replacement and the contrary view points 
out that animal studies show different data for 
brain levels of T3 which makes the one study's 
results surprising, and current formulations of 
T3/T4 combinations contain too much T3 relative to 
the T4 dose. 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Fetal alcohol syndrome
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
While most women have heard of the birth defect 
damage that drinking alcohol during pregnancy can 
cause, most are not aware of what the actual 
defects are. Three developmental areas are 
affected: (1) prenatal and/or postnatal growth 
retardation (e.g. infants shorter in length and 
less in weight); (2) Central Nervous System (CNS) 
damage such as permanent and irreversible brain 
damage, learning and behavioral disorders, 
deficits in memory and attention, hyperactivity, 
speech and language delays, poor coordination; (3) 
head and facial abnormalities (e.g. small head 
circumference and abnormally small eyes). 

How much alcohol does it take? While it is not 
known for sure, binge drinking (more than 5 drinks 
on any occasion) and drinking during the first two 
months of pregnancy is considered to be the two 
strongest maternal predictors of fetal alcohol 
syndrome (FAS). 

Fetal alcohol syndrome

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Laparoscopy for diagnosis of ovarian masses
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Just as a breast mass can stir fears of breast 
cancer, so does an ovarian mass on ultrasound stir 
fears of ovarian cancer. And yet most instances of 
ovarian masses turn out to be benign. The question 
becomes, is it safe to diagnose an ovarian mass 
that might be cancerous by ultrasound? Recovery is 
certainly faster from laparoscopy but can it miss 
a cancer or spread it unnecessarily? A recent 
article seems to point out that laparoscopy can 
safely be used to diagnose masses that may 
possibly be cancerous: 

Laparoscopy for diagnosis of ovarian masses

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. Varicose veins-should they ever be operated on?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
A recent study in the British Medical Journal 
tried  to determine if varicose veins cause 
symptoms. They concluded that when men and women 
have symptoms from varicose veins, the cause of 
the symptoms is likely to be something OTHER than 
the veins themselves. They then made a jump to a 
conclusion that may or may not be warranted, i.e., 
since most symptoms do not come directly from the 
veins, then for surgeons to operate on the veins 
(vein stripping) would be unwarranted, unneeded 
surgery. 

Varicose veins

When to operate

An informative booklet on varicose veins can be 
found at: 

Varicose Veins

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Mild dysplasia is likely to revert to normal
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
We've discussed before the fact that mild 
dysplasia of the cervix often goes away on its 
own. Another article in the British Medical 
journal reemphasizes this. Mild dysplasia 
progresses to a more severe lesion at the rate of 
1% a year. Over 70% of women who have mild 
dysplasia regress to normal within 2 years. These 
researchers use this data to support the concept 
that Paps with mild dysplasia do not need an 
initial colposcopy and biopsy, but rather should 
wait for 6 months to be repeated. 

Mild cervical dysplasia often reverts to normal 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
From: Gil Ross 
Subject: just how cold is it?

It is all relative..........
         
Degrees (Fahrenheit)
   
65   * Hawaiians declare a two-blanket night

60   * Californians put on sweaters (if they can 
       find one) 

50   * Miami residents turn on the heat

45   * Vermont residents go to outdoor concerts

40   * You can see your breath
     * Californians shiver uncontrollably
     * Minnesotans go swimming

35   * Italian cars don't start

32   * Water freezes

30   * You plan your vacation to Australia

25   * Ohio water freezes
     * Californians weep pitiably
     * Minnesotans eat ice cream
     * Canadians go swimming

20   * Politicians begin to talk about the homeless
     * New York City water freezes
     * Miami residents plan vacation further South

15   * French cars don't start
     * Cat insists on sleeping in your bed with you

10   * You need jumper cables to get the car going

 5   * American cars don't start

 0   * Alaskans put on T-shirts

 -10  * German cars don't start
      * Eyes freeze shut when you blink 

 -15  * You can cut your breath and build an igloo 
        with it
      * Arkansans stick tongue on metal objects
      * Miami residents cease to exist

 -20  *Cat insists on sleeping in pajamas with you
      * Politicians actually do something about the homeless
      * Minnesotans shovel snow off roof
      * Japanese cars don't start

 -25  * Too cold to think
      * You need jumper cables to get driver going

 -30  *You plan a two week hot bath
      * Swedish cars don't start

 -40  * Californians disappear
      * Minnesotans button top button
      * Canadians put on sweaters
      * Your car helps you plan your trip South

 -50  * Congressional hot air freezes
      * Alaskans close the bathroom window

 -80  * Polar bears move South
      * Viking Fans order hot cocoa at the game

 -90  *Lawyers put their hands in their own pockets 

 -135 *HMO's allow emergency treatment without 
       pre-certification, under extra-ordinary 
       circumstances only, final determination 
       to be made upon receipt of charges (see plan 
       for details )

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time. We will bring you 
accurate women's health answers again soon.
Rick
Frederick R. Jelovsek MD 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~



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***** Woman's Diagnostic Cyber Newsletter *****
                February 7, 1999
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
This week from Woman's Diagnostic Cyber
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

1. Bladder infections and other types of cystitis
2. Screening Jewish women for breast cancer genes
3. Pregnancy loss psychological reactions
4. First aid bookmark
5. Uterine fibroids
6. Humor is healthy

Spread the word! Send a copy of this newsletter
to someone you know.

Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
1. UTI's and other types of cystitis
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The Virtual Hospital at the University of Iowa has 
an informational guideline about the diagnosis and 
treatment of different types of cystitis such as: 

Acute cystitis, Chronic cystitis, Interstitial 
cystitis, Radiation cystitis, Noninfectious 
Hemorrhagic Cystitis, Urethritis Asymptomatic 
bactiuria, 

UTIs and cystitis

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
2. Screening Jewish women for breast cancer genes
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Many women ask about the genetics of breast and 
ovarian cancer and whether they should have a 
screening test for that. The test is quite 
expensive (about $2000) and the yield is very 
small in the general population so no one is doing 
it. There is a subgroup of women who are at 
increased risk - women of Askenazi Jewish ethnic 
background. A recent study in the Journal of 
Clinical Oncology looks at whether screening this 
subset of women would be cost-effective. They 
conclude that if all the women who tested positive 
would undergo preventative surgery (prophylactic 
breast tissue removal and/or prophylactic ovary 
removal) it would cost just over $20,000 for each 
life saved. See what you think about it! 

Screening for BRCA1, BRCA2

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
3. Pregnancy loss psychological reactions
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Do you have a friend who has had a miscarriage 
and seemed to take it extremely hard for a very 
long time? 

Miscarriages are frequent source of emotional 
reactions both because they are so frequent (12-
15%) and because most of the time only the woman 
and her partner know about it so the normal 
supports for sympathy and grieving are not 
present. This week's article discusses the risk 
factors for depression or anxiety/panic reactions 
that occur after pregnancy loss as well as 
recognizing the difference between a normal 
grieving process and serious depression that needs 
medical treatment. 

Pregnancy loss emotional reactions

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4. First aid for bookmarking
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
It is always hand to have a quick access for 
information about emergencies. After checking out 
this site to make sure your home first-aid kit is 
complete, be sure to book mark this site for quick 
information on: 

Bites and Stings, Burns, Cuts and Abrasions, 
Dislocations, Fainting, Fractures, Frostbite, 
Hypothermia, Nosebleeds, Poisoning, Sprains, 
Strains, Asphyxiation, Bleeding, Choking, 
Concussions, Contusions, Convulsions, Electric 
Shock, and Heatstroke 

First Aid

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
5. Uterine fibroids
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Sometimes it is difficult to understand uterine 
fibroids and how they can cause abnormal uterine 
bleeding without having seen what fibroids look 
like and where they can be located. Dr. Paul Inman 
has some nice graphics and explanation of all the 
different types of fibroids and their treatments. 
There are also some links to hysteroscopy and used 
of the resectoscope for removal of submucous 
fibroids. 

Fibroids

We also have a good patient education booklet at:

Fibroids - a Guide for Women

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
6. Humor is healthy
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

9 WAYS TO KNOW IF YOU HAVE PMS

1. Everyone around you has an attitude problem. 

2. You're adding chocolate chips to your cheese 
omelet. 

3. The dryer has shrunk every last pair of your 
jeans. 

4. Your husband is suddenly agreeing to everything 
you say. 

5. Your using your cellular phone to dial up every 
bumper sticker that says "How's my driving-call 1-
800-***-****." 

6. Everyone's head looks like an invitation to 
batting practice. 

7. You're counting down the days until menopause. 

8. You're sure that everyone is scheming to drive 
you crazy. 

9. The ibuprofen bottle is empty and you bought it 
yesterday. 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
That's it for this time. We will bring you 
accurate women's health answers again soon.
Rick
Frederick R. Jelovsek MD 
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~



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