***** 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.
Schizophrenia explained
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
***** 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.
Pregnancy interval
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
***** 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.
Chemicals associated with infertility
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.
Carpal Tunnel Syndrome
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
***** 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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
***** 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.
T4 vs T4 & T3 replacement in hypothyroidism
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.
Be sure to discuss these pros and cons with your doctor.
NEJM editorial on thyroid replacement
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
***** 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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
