Womens Health

Women's Health Newsletters 1/2/00 - 2/6/00



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***** Woman's Diagnostic Cyber Newsletter *****
                January 2, 2000
This week from Woman's Diagnostic Cyber

1. Computer screens and vision
2. Endometriosis case history and discussion 
3. Reader submitted Q&A - PCOS and baldness
4. Is a red face rash rosacea?
5. Causes of dark circles under the eyes
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. Computer screens and vision
Yes, there is such a thing as too much computer 
viewing - a computer vision syndrome. People tend 
to blink less while looking a computer screens and 
as a result the eyes dry out and there is and 
increase in discharge. 

Computer vision syndrome

2. Endometriosis case history and discussion
Endometriosis is a complex disease that can 
present with  just light menstrual cramps all the 
way to extensive pelvic adhesive disease with 
ovarian masses that can destroy the ovaries and 
cause infertility and even menopause. 

The following article in the Journal of the 
American Medical Association (JAMA) gives a 
clinical case history that is quite typical of a 
woman with severe endometriosis. The best part, 
however is the discussion and summary of all the 
different treatments - Lupron(R), surgery, birth 
control pills, and their effect on infertility and 
pain. It is hard to find all the different aspects 
of endometriosis treatment brought together in one 
place like this. 

Some of the salient points brought out are:

1) if a woman's menstrual cramps do not respond to 
a 3-6 month trial of birth control pills and non 
steroidal anti-inflammatory drugs there is about a 
50% chance endometriosis will be seen at 
2) 6 months of Lupron(R) therapy is about 70-90% 
successful in treating pain. 
3) Lupron(R) treatment does not improve fertility 
rates compared to no therapy, it only delays 
attempting to conceive 
4) initial surgical treatment of endometriosis is 
generally superior to medical treatment for pain 
in patients with more severe disease, but not 
necessarily in patients with chronic pelvic pain 
and minimal or mild disease 

Endometriosis case history/discussion

3. Reader submitted Q&A - PCOS and baldness
"Could you please give more information on 
polycystic ovarian syndrome? I want to become 
pregnant but of course I am starting to bald. 
Everything I read states I better get treatment 
before it really goes bad. Neither my parents nor 
any of my 3 older brothers are balding in the 
crown area, so may I ask where on what side of 
genetics does this come from? My primary MD 
answers that it is probably my (testosterone) 
level which is 102." 

Polycystic ovarian syndrome (PCOS) is a complex of 
symptoms including anovulation, excess hair 
growth, obesity, and sometimes male pattern 
baldness, high blood pressure and diabetes. There 
is an increased incidence of PCOS in some families 
and the genetics of this condition are discussed 
as well as treatments to decrease the testosterone 
excess in the article below: 

Polycystic ovarian syndrome and baldness

4. Is a red face rash rosacea?
Rosacea is a skin condition of the face which can 
range from a mild redness like blushing, to a 
constant redness and acne-like rash. It can be 
mistaken for acne, the facial rash of lupus 
erythematosis, an allergic reaction to a soap or 
cosmetic or even a sunburn. Blushing more easily 
can be an early sign of rosacea. 

The onset of this skin condition is most often in 
the 30-60 age range and in women it tends to be 
slightly milder than in men, but still a major 
skin condition needing treatment. The cause is 
still unknown but the triggers that make it worse 
such as sun exposure, stress, spicy foods, 
exercise, cold wind, hot foods, and hot baths can 
be identified and avoided. 

If your face is beginning to look like W.C. 
Fields, you may want to look at this article at 
Personal MD.com 


5. Causes of dark circles under the eyes
Part way down the page of the article below from 
the Archives of Facial Plastic Surgery is a good 
explanation of what causes those dark circles 
under the eyes. 

Several etiologies are discussed:

1) increased pigmentation of the skin due to 
genetic back ground, chronic inflammation from the 
sun, allergies, estrogens and any type of chronic 
skin irritation in the area below the eye. 
2) increased fine blood vessels just below the 
skin either from chronic skin inflammation or from 
increased fat cell deposition 
3) increased fat deposition causing a bulge below 
the eye that throws a shadow which further darkens 
the skin. 

Dark eye circles

6. Humor is healthy
Restroom Signs

Friends don't let friends take home ugly men
* Women's restroom, Starboard, Dewey Beach, DE

The best way to a man's heart is to saw his breast 
plate open. 
* Women's restroom, Murphy's, Champaign, IL

Don't trust anything that bleeds for 5 days and 
doesn't die. 
* Men's restroom, Murphy's, Champaign, IL

Beauty is only a light switch away.
* Perkins Library, Duke University, Durham, NC

I've decided that to raise my grades I must lower 
my standards. 
* Houghton Library, Harvard University, Cambridge, MA

If life is a waste of time, and time is a waste of 
life, then let's all get wasted together and have 
the time of our lives. 
* Armand's Pizza, Washington, DC

Remember, it's not, "How high are you?" it's "Hi, 
how are you?" 
* Rest stop off Route 81, West Virginia

God made pot. Man made beer. Who do you trust?
* The Irish Times, Washington, DC

No matter how good she looks, some other guy is 
sick and tired of putting up with her shit. 
* Men's Room, Linda's Bar and Grill, Chapel Hill, NC

To do is to be. - Descartes
To be is to do. - Voltaire
Do be do be do. - Frank Sinatra
* Men's restroom, Greasewood Flats, Scottsdale, AZ

At the feast of ego, everyone leaves hungry.
* Bentley's House of Coffee and Tea, Tucson, AZ

It's hard to make a comeback when you haven't been 
* Written in the dust on the back of a bus, Wickenburg, AZ

Make love, not war. -Hell, do both, get married!
* Women's restroom, The Filling Station, Bozeman, MO

God is dead. - Nietzsche
Nietzsche is dead. - God
* The Tombs Restaurant, Washington, DC

If voting could really change things, it would be 
* Revolution Books, New York, New York.

A Woman's Rule of Thumb: If it has tires or 
testicles, you're going to have trouble with it. 
* Women's restroom, Dick's Last Resort, Dallas, TX

JESUS SAVES! But wouldn't it be better if he had 
* Men's restroom, American University, Washington, DC

If pro is opposite of con, then what is the 
opposite of progress? Congress! 
* Men's restroom, House of Representatives, Washington, DC

Express Lane: Five beers or less
* Sign over one of the urinals, Ed Debevic's, Phoenix, AZ

You're too good for him.
* Sign over mirror in Women's restroom, Ed Debevic's,
Beverly Hills,CA.

No wonder you always go home alone.
* Sign over mirror in Men's restroom, Ed Debevic's,
Beverly Hills,CA.

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

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***** Woman's Diagnostic Cyber Newsletter *****
              January 9, 2000
This week from Woman's Diagnostic Cyber

1. Rheumatology Handbook and "mouse shoulder"
2. Influenza, or is it a cold?
3. Reader submitted Q&A - Postpartum vaginal probs
4. Having children after a cancer treatment
5. Emergency contraception - Plan B
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. Rheumatology Handbook and "mouse shoulder"
The following rheumatology handbook for patients 
written by Dr. B. Pal at the South Manchester 
University Hospital in the UK has some great 
sections for the diagnosis of: 

rheumatoid arthritis
polymyalgia rheumatica
temporal arteritis 
inflammatory arthritis

I also liked the section on work related upper 
limb disorders such as epicondylitis of the elbow 
(tennis elbow), carpal tunnel syndrome, trigger 
finger, and supraspinatus tendonitis (a persistent 
upper shoulder blade pain), professional hand 
cramp (from writing or typewriting), and a 
traumatic inflammation of the tendons of the hand 
or forearm or of the associated tendon sheaths in 
any occupation entailing manual labor or frequent 
repeated movements of the hand or wrist. There are 
many muscles and tendons that can become inflamed 
as a repetitive strain injury. 

I did however, miss his mentioning about "mouse 
shoulder", a problem of shoulder pain probably 
related to using the computer mouse. Remember to 
keep your mouse and pad within your shoulder width 
to minimize this. You may even need a shorter 
keyboard without a numeric keypad. 

Mouse shoulder

2. Influenza, or is it a cold?
What is the difference between just a cold and the 
flu? In general, you start with cold symptoms but 
there is a very rapid progression of symptoms with 
a higher fever and severe muscle aches and pains. 
Most people cannot get out of bed when they have 
the flu. 

If you want to brush up on what the diagnosis and 
treatment for the flu is, you might visit this 
site at Medinfo.co.uk if you missed your flu shot. 


Also if you missed your flu shot, there is a new 
drug out used to treat the flu called zanamivir 
(Relenza{R}). It is too early to say how well it 
works when used for everyone, but the flu puts you 
down for at least 3-5 days so any relief might be 
worth a try. If started within 30-36 hours of the 
symptoms, there was an average reduction of 1-2.5 
days of symptoms. 

Zanamivir  (Relenza{R}) for the  flu

3. Submitted Q&A - Postpartum vaginal probs

"Does taking a bath increase your chances of 
getting an infection, yeast or UTI? 

I am 29 years old, always have menstrual periods 
on time, although I am 9 weeks post partum. I seem 
to get a lot of yeast infections". 

Yeast infections are not more common after 
delivery than at any other time. Many times it is 
the case that atrophic changes in the postpartum 
vagina make a woman more likely to acquire an 
irritant vulvitis or urethritis that gives 
symptoms often indistinguishable from vaginitis or 
urinary tract infections. 

There are other postpartum vaginal changes such as 
painful intercourse, episiotomy discomfort, 
vaginal looseness and even uterine or bladder 
prolapse. These expectations of possible vaginal 
conditions after delivery are discussed at: 

Postpartum vaginal conditions

4. Having children after a cancer treatment
Many women and men and even some doctors think 
that if you have chemotherapy or radiation therapy 
for cancer treatment that the eggs undergo genetic 
damage and if a woman gets pregnant after therapy 
has ended, any child will have a birth defect. 
This is FALSE information. 

Because the egg cells in the ovary do not 
genetically divide until the cycle in which 
ovulation occurs, they are not very susceptible to 
DNA damage from chemicals or radiation. The cells 
can be totally killed if the insult is great but 
they are not altered genetically. Therefore the 
chemotherapy or radiation can sometimes destroy 
the eggs and cause premature menopause, but if the 
eggs and ovary survive, then when ovulation 
resumes, the eggs are normal. A pregnancy has has 
the same 97% chance of having a baby without birth 

This article explains some of that and also 
includes a list of which chemotherapy drugs as 
treatment for which cancers have the potential to 
destroy the eggs and ovary rendering a woman 
menopausal and infertile. See the Virtual Hospital 
at the University of Iowa Health Care web site: 

Your fertility after a cancer treatment

5. Emergency contraception - Plan B
The recent release of a new emergency 
contraceptive called Plan B(R) provides the 
opportunity to remind us about options available 
to prevent an unwanted pregnancy if involuntary 
(rape) or even voluntary intercourse takes place 
without protection against pregnancy. It can also 
be used if a condom breaks, is forgotten or if a 
diaphragm is not used. This is a progestin only, 
set of two pills taken 12 hours apart and started 
within 72 hours of the episode of intercourse. If 
the 72 hour window is missed, another option would 
be an IUCD insertion. Both of these regimens 
reduce the chance of pregnancy from about 7-8% to 
about 1-2%. 

The new progestin only treatment has a lower 
incidence of nausea and vomitting side effects so 
it looks promising. Discussion about this subject 
can be found at this article below from the 
Journal of the American Women's Medical 

Emergency contraception - a global overview

You may also want to look at our disease profile 
on emergency contraception:

Emergency contraception profile

6. Humor is healthy
Preparing for the Yearly Mammogram

Many women are afraid of their first mammogram, 
but there is no need to worry.  By taking a few 
minutes each day for a week preceding the exam and 
doing the following practice exercises, you will 
be totally prepared for the test, and best of all, 
you can do these simple practice exercises right 
in your home. 


Open your refrigerator door and insert one breast 
between the door and the main box. Have one of 
your strongest friends slam the door shut as hard 
as possible and lean on the door for good measure. 
Hold that position for five seconds. Repeat again 
in case the first time wasn't effective enough. 


Visit your garage at 3 AM when the temperature of 
the cement floor is just perfect. Take off all 
your clothes and lie comfortably on the floor  
with one breast wedged under the rear tire of the 
car. Ask a friend to  slowly back the car up until 
your breast is sufficiently flattened and chilled.  
Turn over and repeat for the other breast. 

Freeze two metal bookends overnight. Strip to the 
waist. Invite a stranger into the room. Press the 
bookends against one of your breasts.   Smash the 
bookends together as hard as you can. Set an 
appointment with the stranger to meet next year 
and do it again. You are now properly  prepared. 

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

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***** Woman's Diagnostic Cyber Newsletter *****
              January 16, 2000
This week from Woman's Diagnostic Cyber

1. Gall bladder symptoms
2. Breast cancer diagnosis during pregnancy 
3. Reader submitted Q&A - Breast asymmetry
4. Ovulation determination methods
5. Blood clots on OCPs and genetic clotting defects
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. Gall bladder symptoms
Gall bladder disease is two times more common in 
women than men. Both gall stones (cholelithiasis) 
and inflammation of the gall bladder sac 
(cholecystitis) can give symptoms. The gall 
bladder produces bile salts that help digest food, 
especially cholesterol. If a stone partially or 
completely blocks the duct from the gall bladder 
to the intestine, the back up of bile causes 
pressure and acute nausea and vomitting. 

Most symptoms come from the gall stone blockage 
but gradually the stones cause a chronic 
inflammation and bacterial infection. This gives 
chronic rather than episodic pain. The pain is 
usually in the right upper abdomen just below the 
ribs. Sometimes it radiates back through the 
abdomen to the base of the shoulder blade on the 

About 10% of people have gall stones but only 20% 
of those with gall stones have symptoms, i.e., 4 
out of 5 people have no need to have their gall 
bladder removed for stones. If you find out you 
have gall stones you may want to look at: 

Gallbladder stone and inflammation symptoms

2. Breast cancer diagnosis during pregnancy
The diagnosis of a breast lump during pregnancy is 
very difficult for doctors. There are many 
conditions that can produce a lump during 
pregnancy and of course everyone is quite nervous 
about pursuing a diagnostic work up because of the 
pregnancy and also the great vascularity of the 
breast during pregnancy with its enlarging 
lactation ducts. 

Among the different conditions that can produce a 
lump during pregnancy are: 

galactocele (milk filled cyst)
lactational hyperplasia
lactating adenomas 
exaggerated breast enlargement
breast tissue infarct
and breast cancer

Can you perform a mammogram during pregnancy? Will 
a needle biopsy cause a milk fistula during 
subsequent lactation? How likely is a lumpectomy 
to cause a large hematoma (bleeding into the 
tissue)? These are very difficult answers and 
requires experienced physicians to give you the 
best advice. 

Breast cancer diagnosis in pregnancy

3. Reader submitted Q&A - Breast asymmetry
"I am 21 years old and for the past several years 
I noticed my left breast was somewhat larger but 
nothing to worry about. Now my breast is much 
larger and it hangs lower. Do you think this could 
somehow catch up with the other breast? ". 

If very careful measurements are made, almost no 
woman has two breasts of identical shape. Size 
differences are also the rule more than an 
exception but usually those size differences are 
unnoticeable by anyone except the woman herself. 
Larger, noticeable size differences are not too 
uncommon, however, so this subject can be of great 
concern to many women. 

Most size and shape differences are either 
hereditary or just happenstance growth 
differences. Size differences include hyperplasia 
(too large), hypoplasia (too small) and 
asymmetrical size. Shape differences include 
tubular breasts, pseudo ptosis (flattening and 
decreased size after pregnancy) and ptosis 
(drooping or sagging). All of these conditions are 
treatable surgically. Creams and pills cannot 
change breast size significantly. 

For an explanation and  discussion of these 
problems, see: 

Breast asymmetry

4. Ovulation determination methods
When trying to conceive a pregnancy, one of the 
most frustrating parts is being sure of when you 
ovulate. If ovulation were precisely predictable 
to the hour, that knowledge might help improve a 
woman's chances of getting pregnant. Unfortunately 
all of the ovulation determination methodologies 
work in retrospect, i.e., they do not indicate 
ovulation until 24 hours or more after it occurs. 

The site at Am-I-Pregnant.com has a very good 
section that explains all of the different methods 
by which ovulation can be detected. It covers: 

menstrual cycle
basal body temperature (BBT)
endometrial biopsy
ovulation predictor kits
serum progesterone
blood tests
cervical mucous

If you would like to learn more about ovulation 
and the methods that detect it, see: 

Ovulation determination

5. Blood clots on OCPs and clotting defects
One concern in using birth control pills is the 
possibility of blood clots (venous thrombosis). 
This is an uncommon but serious complication. The 
incidence of venous thrombosis in women is 

0.4/10000 women not pregnant or on oral contraceptives
1-3/10000 women on combined oral contraceptives
6/10000 pregnant women

As it turns out, many of the women who develop 
these clots actually have rare genetic clotting 
defects such as: 

protein C deficiency
protein S deficiency
antithrombin deficiency
factor V Leiden mutation
prothrombin 20210 A mutation

Women with the above problems have 3 times the 
incidence of blood clots in the first 3 months of 
starting pills and their risk is increased up to 
the first 12 months of starting pills. 

While we are not at the point that doctors can 
order several hundreds of dollars of lab tests to 
screen for these rare disorders before starting 
women on the pills, if you have any family history 
of clotting or thrombosis problems, you should 
mention this to your doctor to see if any testing 
is indicated before starting combined oral 
contraceptive pills. 

Thrombosis and genetic clotting problems

6. Humor is healthy
Parents and kids

Whenever your kids are out of control, you can 
take comfort from the thought that even God's 
omnipotence did not extend to God's kids. After 
creating heaven and earth, God created Adam and 
Eve. And the first thing he said was: 

"Don't what?" Adam replied.
"Don't eat the forbidden fruit." God said.
"Forbidden fruit?
We got forbidden fruit?

Hey, Eve...we got forbidden fruit!"
"No way!"
"Yes way!"
"Don't eat that fruit!" said God.
"Because I am your Father and I said so!" said 
God, wondering why he hadn't stopped after making 
the elephants. 

A few minutes later God saw his kids having an 
apple break and was angry. 
"Didn't I tell you not to eat the fruit?" the 
First Parent asked. 
"Uh huh, " Adam replied.
"Then why did you?"
"I dunno" Eve answered.
"She started it!" Adam said.
"Did not!"
"Did too!"
Having had it with the two of them, God's 
punishment was that Adam and Eve should have 
children of their own. 
Thus, the pattern was set and it has never 
But there is reassurance in this story.
If you have persistently and lovingly tried to 
give them wisdom and they haven't taken it, don't 
be hard on yourself. If God had trouble handling 
children, what makes you think it would be a piece 
of cake for you? 

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

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***** Woman's Diagnostic Cyber Newsletter *****
              January 23, 2000
This week from Woman's Diagnostic Cyber

1. Excessive sweating - what can be done?
2. Women and epilepsy initiative 
3. Reader submitted Q&A - Talc and cancer
4. HerbMed - A reference database of herbs 
5. Migraine headaches
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. Excessive sweating - what can be done?
Women who have excessive sweating from the palms, 
soles, armpits, or forehead at any slight anxiety 
stimulation situation, are made even more anxious 
in social or work situations. It can be 
embarrassing and a difficult problem to manage. 

Dermatologists usually recommend or prescribe 
drying agents such as those used in 
antiperspirants. If those do not work, anti-
cholinergic medications can be tried. Some of the 
superabsorbant powders can also be obtained with 
an antifungal component so that if a woman has 
problems with sweating under the breasts or 
abdominal folds that get yeast skin irritations, 
she has a way to prevent that. 

Dermatologist Audrey Kunin, M.D. discusses these 
and other treatments for excessive sweating 
(hyperhidrosis) at Dermadoctor.com 

2. Women and epilepsy initiative 
Much of the information women have received in the 
past about epilepsy is incorrect. An information 
sheet about women's issues in epilepsy has been 
developed by Galaxo Wellcome in response to an 
Epilepsy Foundation survey that identified lack of 
information about women's issues as a concern. 

This fact sheet cover subjects such as:

Special concerns about epilepsy for teenage girls 
Special concerns about seizure medications 
Health issues after your baby is born 
Menopause and epilepsy 
Hormones and epilepsy
Epilepsy and sexual Relations
Birth control for women with epilepsy
Pregnancy and the mother's health
Pregnancy and the developing Child
Parenting concerns for the mother with epilepsy

Women and epilepsy

The Epilepsy Foundation also has a seizure 
recognition chart that you will find invaluable if 
you are ever faced with knowing someone with 
epilepsy. It gives a description of all different 
types of seizures: 

Seizure recognition chart

3. Reader submitted Q&A - Talc and cancer
"I have read that using talcum powder in the 
genital area has been associated with increased 
cervical cancer risks. Does this also apply to 
cornstarch based powders?" 

Talcum powder has been associated with an 
increased risk for ovarian cancer as has asbestos. 
Apparently any particulate matter placed on the 
perineum chronically can migrate up the genital 
tract. Tubal ligation and hysterectomy which block 
this path from outside to inside lower the risk 
for ovarian cancer. Also anything that blocks 
ovarian ovulation for a long period of time such 
as oral contraceptive use, frequent pregnancy or 
breast feeding will also lower this risk. 

The cause and effect of talcum powder is not known 
for sure but it would be wise to try not to 
chronically use any powder on the perineum. 

Perineal powder and pads can cause problems

4. HerbMed - A reference database of herbs
The quality of information about herbal therapy 
has great variability on the net. It is always 
helpful to find a source on herbs that has 
comprehensive data about activity, mechanism of 
action, warnings, preparations available, and 
mixtures thought to have a synergistic effect. 

The database is much better at allowing you to 
look up all of the scientific data on a specific 
herb than at allowing you to look at a condition 
and find out what is the best herbal treatment, 
but this is still a very valuable resource that 
you will want to bookmark. 

A recent woman patient swore by using a tea of 
echinacea root and Goldenseal after the onset of a 
cold. She felt the cold went away in 2 days after 
that. While I could not find the exact answer to 
their efficacy after the onset of a cold, I found 
that there has been a randomized, prospective 
study using echinacea to try to prevent colds. It 
does not seem to prevent them. 

HerbMed - a herbal database

5. Migraine headaches	
The AMA has a relatively new health consumer 
section with some good background on common health 
problems. One of them covers the diagnosis and 
treatment of migraine headaches. These disabling 
headaches can last from several hours to several 
days. They tend to run in families. 

Caution signs to look for that may indicate a 
headache is NOT a migraine, include: 

headache began after age of 50 years 
headache is of sudden onset 
accelerating pattern of headaches 
new-onset headache in someone who has cancer or HIV 
headache accompanied by fever, stiff neck, or rash 

If a woman has mild to moderate migraines and has 
never been given treatment that includes a 
compound pill with aspirin, caffeine and 
butabarbital, a short acting sedative, this is 
something that should be tried. Drugs used for 
moderate to severe migraines include: 

Ergot Alkaloids
Triptans (Selective Serotonin Agonists)
Isometheptene/Acetaminophen/Sedative Combination

One other section that is quite helpful is on 
"Important Information About Drugs That Prevent 
Migraine". There are some good drug selections that 
can decrease the frequency of occurrence. 

6. Humor is healthy
Women Talk More than Men
A husband, proving to his wife that women talk 
more than men, showed her a study which indicated 
that men use on the average only 15,000 words a 
day, where as women use 30,000 words a day. 

"See dear. I told you women are always rattling 

She thought about this for awhile and then told 
her husband 

"If women use twice as many words as men, it must 
be because they have to repeat everything they 

"What dear?"

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

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***** Woman's Diagnostic Cyber Newsletter *****
              January 30, 2000
This week from Woman's Diagnostic Cyber
1. Age-related eye (macular) degeneration
2. St John's Wort for depression
3. Reader submitted Q&A - Cervical Cancer in Situ
4. Sexual functioning after hysterectomy
5. Treating menstrual cramps the  natural way
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. Age-related eye (macular) degeneration
A common reason for loss of vision in women over 
60 is called age-related macular degenderation 
(AMD). In this condition the cells of the retina 
undergo degeneration for reasons we do not totally 
understand. It may be related to arteriosclerosis. 
It does not usually cause blindness but the center 
of one's vision becomes blurry. 

It is more common in women but also it is lower in 
incidence in women who have taken hormone 
replacement therapy. There are two forms, dry and 
wet AMD. Most of the people who get AMD have the 
"dry" form. Vision can be lost slowly. Only 10% 
have the "wet" form of AMD but in it, vision can 
be lost quickly. 

There is no pain with this condition, only the 
slow loss of vision. It is important to have 
regular eye check-ups. This patient information 
sheet from the National Eye Institute will help 
explain this condition. 

Age-related macular degeneration

2. St John's Wort for depression
St John's Wort, an herbal preparation, has been 
used for treatment of insomnia and depression for 
many years in Germany where it still significantly 
outsells a medication like Prozac (R). In the last 
few years St John's Wort sales have mushroomed in 
the U.S. There has still been some question as to 
how effective it really is. 

This article in the Annals of Internal Medicine is 
a review of articles in the medical literature 
about the efficacy of St John's Wort. They 
concluded that it is more effective than placebo 
with a 23% to 55% higher response rate, but ranged 
from 6% to 18% lower compared with tricyclic 
antidepressants such as Elavil(R). It also had a 
good safety profile. 

This would indicate its usefulness for mild 
depression, but it is still better to have a 
formal diagnosis of depression than to self-treat. 

St John's Wort for depression

3. Reader submitted Q&A - Cervical Cancer in Situ
"I was recently diagnosed with carcinoma in situ 
or severe dysplasia of the cervix, I had a LEEP 
procedure and recently had a normal pap test. I 
was wondering if I am at increased risk for this 
to happen again and if it comes back does it start 
as minor and progress to severe?" 

LEEP treatment of the cervix is an electrical wire 
excision of the abnormal tissue on the face of the 
cervix. It cures severe dysplasia/carcinoma in 
situ about 75% of the time. If it were to be left 
untreated for 5-20 years, it would probably go on 
to an invasive cancer about 50% of the time. 

See a discussion of this topic at:

Carcinoma In situ of the Cervix Expectations

4. Sexual functioning after hysterectomy
A very frequent concern of women undergoing 
hysterectomy is whether or not sexual functioning 
will change. We have mentioned in the past the 
lack of good studies about this topic and how 
inaccurate retrospective studies can be due to a 
bias in recall of past events. 

The study below published in the Journal of the 
American Medical Association interviewed over 1100 
women who had hysterectomies. They obtained 
histories of sexual functioning one month prior to 
hysterectomy and at 6, 12 and 24 months after the 
surgery. They found some differences in 
functioning before and after surgery that are 

             30d before hyst  12 months after hyst
intercourse/mo        2.3             3.1
painful sex          41%             18%
orgasm               63%             72%
strong orgasms       45%             58%
no vaginal dryness   37%             47%
decreased libido     10%              6%

Overall, sexual functioning is improved after 
hysterectomy but please remember that these 
hysterectomies were being performed for many 
reasons such as pain, bleeding and prolapse. 

Sexual functioning after hysterectomy

5. Treating menstrual cramps the natural way
Menstrual cramps may range from mild lower 
abdominal discomfort to fairly severe cramps with 
low back and leg pain to nausea and diarrhea. It 
is important to learn non prescription ways of 
lessening those cramps. 

This primer below from the The University of 
Chicago Primary Care Group, covers the different 
ways nutrition, exercise, temperature and touch 
can be used to cope with severe menstrual cramps 
(dysmenorrhea). Calcium and magnesium supplements 
often help as well as some herbal teas although 
the herbal teas mentioned have not been rigorously 

Exercise and heat are often forgotten treatments 
of menstural cramps and even orgasm can improve 
cramps in some women. Substances such as 
endorphins produced by exercise can be a potent 
pain reliever. 

Menstrual cramps

There also are non-prescription medicines such as 
ibuprofen and naproxen that are available over-
the-counter and have been shown in randomized 
studies to be effective in reducing menstrual 

Non-prescription treatment of menstrual cramps

6. Humor is healthy
Trust in a doctor

The patient shook his doctor's hand in gratitude 
and said, "Since we are the best of friends, I 
would not want to insult you by offering payment.  
But I would like for you to know that I had 
mentioned you in my will." 

"That is very kind of you," said the doctor 
emotionally, and then added, "May I see that 
prescription I just gave you? I'd like to make a 
little change..." 

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

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***** Woman's Diagnostic Cyber Newsletter *****
              February 6, 2000
This week from Woman's Diagnostic Cyber

1. Heart disease is slightly different in women
2. Female sexual arousal disorder 
3. Reader submitted Q&A - Bleeding on HRT
4. Unusual endometriosis presentations
5. Ankle sprain
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. Heart disease is slightly different in women
Women develop coronary artery disease about 10 
years later than men but it is still a major 
killer of women. Did you know that a 50 year old 
woman has a 31% lifetime chance of dying from 
heart disease and a 3% chance of dying from breast 

Many of the risk factors for coronary artery 
disease are the same in women as in men, however 
there are some differences. Women are less 
sensitive to total cholesterol and LDL levels than 
men but if their HDL (high density lipoprotein) 
levels are low their risk is greater. Diabetes is 
a stronger risk factor in women than men. Women 
have a higher occurrence of chest pain not from 
heart disease so the diagnosis is more difficult. 
Also women may have more atherosclerotic changes 
in the small vessels which are harder to pick up 
on imaging studies. 

Most importantly, "Women are more likely to have 
neck and shoulder pain, abdominal pain, nausea, 
vomiting, fatigue, and shortness of breath in 
addition to chest pain. Silent heart attacks are 
more common in women." For these reasons there may 
be a delay in diagnosis in women. 

Coronary artery disease in women

2. Female sexual arousal disorder
Arousal disorder is a persistent or recurrent 
inability to attain sufficient sexual excitement 
so that it causes personal distress. It may be 
manifest by lack of desire, inability to have 
orgasm, or problems with lack of vaginal 
lubrication leading to intercourse avoidance. 

There can be many non psychological causes such a 
medications (anti-depressants, anti-
hypertensives), diabetes, spinal cord injuries and 
decreases in vaginal/clitoral blood flow due to 
menopause and low estrogens. 

It is very likely that this web site below is 
mainly an advertisement for "Viagra for women" or 
an investigational medical device to increase 
blood flow to the vagina, but it does bring 
attention to an under-investigated problem in 

Female sexual arousal disorder

3. Reader submitted Q&A - Bleeding on HRT
"Is it normal for a woman on Natural Hormone 
Replacement (from a compounding pharmacy) to 
experience a period after 2 and one-half months on 
the NHR? I have not had a "real" period for 2 
years. Can hormones initiate ovulation AGAIN?? "  

It does not matter what type of hormone 
replacement therapy women are on. Most women who 
still have a uterus will have some sort of 
bleeding within the first three months of starting 
HRT. Even after a year of use, one in 4 or 5 women 
will still have some bleeding. 

Ovulations are rare on HRT but they can happen 
especially in younger women who undergo menopause 
prematurely and women within the first few months 
of turning menopausal. 

For a discussion of doses to try to start on HRT 
or to minimize bleeding, see: 

Bleeding on natural hormone replacement therapy

4. Unusual endometriosis presentations
Most of the time endometriosis presents with 
severe menstrual cramps and other pelvic pain. 
Because of the nature of the symptoms, 
gynecologists see most women with endometriosis 
when they have difficulties. Sometimes, however, 
endometriosis presents in unusual ways and to 
learn about those, we have to look at episodes 
that present to different specialties. The study 
below looked at presentations to general surgeons 
that ended up being endometriosis. Out of 9 
patients, none had had a previous diagnosis of 
endometriosis. Only two were suspected 
preoperatively to have it, albeit in unusual 

These presentations included swelling in a lower 
abdominal scar, swelling in the groin (inguinal 
canal), a lump in the navel, rectal bleeding, 
recurrent abdominal pain, symptoms mimicking an 
ovarian tumor and one presenting like a ruptured 
appendix (pelvic peritonitis). 

Unusual endometriosis presentations

5. Ankle sprain
How can you tell if an ankle is just sprained or 
broken? It is difficult for even an orthopedic 
surgeon. Normally a sprain is a torn or stretched 
ligament on the outside of the ankle. The ankle is 
almost always swollen and discolored, so much so 
that a break is often suspected. Unfortunately 
even tests for joint instability cannot always 
tell if it is just a sprain or a fracture. Since a 
fracture may need surgery (internal fixation) an 
X-ray almost always is necessary. Then if it is 
negative, which it almost always is, treatment can 
be started. 

Ice, ibuprofen or naproxen, elevation and 
eventually physical therapy are the standard 
treatments. Dr Zeman also adds that the treatment 
cannot stop there. The main treatment is then 
prevention which means taping, wrapping or a brace 
with any high risk exercise or athletic activity. 
This is needed so that recurrent sprains and 
arthritis are not the end result. 

Ankle sprain

You may also want to look at hip replacement, shin 
splints, tennis elbow, knee problems, carpal 
tunnel and heel pain at the main page for Sports 
Medicine and Orthopedic Surgery. 

Sports Medicine and Orthopedic Surgery

6. Humor is healthy
Jake was dying.  

His wife, Becky, was maintaining a candlelight 
vigil by his side.  She held his fragile hand, 
tears running down her face. Her praying roused 
him from his slumber.  He looked up and his pale 
lips began to move slightly. 

"My darling Becky," he whispered.

"Hush, my love," she said.  "Rest.  Shhh.  don't 

He was insistent.  "Becky," he said in his tired 
voice.  "I.......I have something I must confess 
to you." 

"There's nothing to confess," replied the weeping 
Becky........"Everything's all right, go to 

"No, no.  I must die in peace, Becky.  I.....I 
slept with your Sister, your best friend, her best 
friend, and your Mother!" 

"I know..."  Becky whispered softly, 

"That's why I poisoned you." 

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

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