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Women's Health Newsletters 9/17/00 - 10/22/00



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****** Woman's Diagnostic Cyber Newsletter ******
                September 17, 2000
This week from Woman's Diagnostic Cyber

1. Transdermal testosterone after oophorectomy
2. Lymphoma, lymphatics lymp-confusing
3. Reader submitted Q&A - Aspirate all breast cysts?
4. Preparing a young girl for menstruation
5. Arrhythmia - A funny heart rate
6. Health tip to share - Crazy glue for small cuts
7. 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. Transdermal testosterone after oophorectomy
By now, if you have followed the popular  health  
news media, you have heard of a study recently 
published in the New England Journal of Medicine 
about women undergoing  surgical menopause (most 
by ovary removal at time of hysterectomy) and 
receiving testosterone skin patches in addition to 
estrogen replacement. The study contends that the 
addition of transdermal testosterone to .625 mg 
oral conjugated estrogens improved measures of 
"general well-being" and "sexual functioning" more 
than just the .625mg of conjugated estrogens 

This should come as no surprise to our long term 
readers. We have always advocated a role for added 
testosterone, but this study has a major flaw that 
you should be aware of and probably makes a 
difference as to how much benefit added 
testosterone produces and what a woman should 
expect from it. 

Women who have not undergone menopause before 
removal of the ovaries (and those within about 2-3 
years of a natural menopause) need much more than 
0.625 mg of conjugated estrogens to feel right. 
This is about half the dose such a woman newly 
menopausal really needs and when you add 
testosterone to an inadequate estrogen dose and 
get a significant  improvement, this could send  
the wrong message. Don't misunderstand, I think 
added testosterone for a surgical menopause can 
be beneficial, but it is not as much difference as 
this study would lead a woman to believe. The 
added testosterone should have been compared with 
a 1.25 mg conjugated estrogen dose (estradiol 
equivalent would be 2 mg). 

Only the abstract is available at the link below 
because you have to subscribe to see the full 
paper. But I have reviewed the full paper. The 
investigators even drew and published blood levels 
of estradiol that showed the average level for all 
women in the study was below the therapeutic range 
(estradiol 50-100 pg/ml) that we know women need 
to be free of hot flashes and feel right. 

The take home message is to first advocate with 
your physician to be on enough estrogen to be 
therapeutically replaced, and THEN try added 
testosterone  to see if  you feel better. Some 
women  will feel even better with added 
testosterone but many will not if they are at the 
correct estrogen dose. 

2. Lymphoma, lymphatics lymp-confusing
The medical terms of lymphoma, leukemia, and 
Hodgkin's disease can be very confusing. Are they 
cancers? Yes they are. They are cancers of the 
blood forming lymphatic tissues. 

The lymphatic system is mysterious to most. This 
is the body's system that forms blood elements, 
fights off viral and bacterial infections and 
carries excess fluid in the tissues back into the 
blood stream while the lymph nodes filter out 
destroyed bacteria and repair cells. Of course 
other cancer cells can get into the lymph nodes 
and cause metastatic cancers, but primary 
cancers of the lymphatic system are non Hodgkin's 
and Hodgkin's lymphomas and leukemias. 

The organs involved in the lymphatic system are: 
the bone marrow, spleen, thymus gland, lymph 
nodes, tonsils, appendix, and a few other organs.  
The bone marrow produces white blood cells (T 
cells and B cells) that fight off infection. 
However the different stages of white blood lymph 
cell formation can each have an abnormal cell 
reproductive process that produces too many cells. 
This overproduction becomes a leukemia or a 
lymphoma (non Hodgkin's or Hodgkin's) depending 
upon which cell type becomes cancerous. 

There is a very good explanation process and 
illustration at the Lymphoma Information Network 
about these conditions. 

Lymphoma Information Network
3. Reader submitted Q&A - Aspirate all breast cysts?
"After having a mammogram and then an ultrasound, 
I was told that I had cysts. After a repeat 
mammogram one year later I was told that the cysts 
had shrunk in size and a couple had disappeared. I 
asked if there was any reason for concern or if I 
should have this checked out further by a surgeon 
and I was told this was not necessary. However 
after reading your recent letter, I am somewhat 
confused and concerned." 


Our recent article on breast cysts brought up this 
question. The answer is NO. Not all breast cysts 
have to be aspirated (drained with a needle). You 
did not mention how big the cysts were. Almost all 
physicians will recommend draining macrocysts of 
the breast greater than 1.5 cm in diameter and 
palpable by the woman or her physician. These 
large cysts can hide (although only about 1% of 
time) solid areas within them that represent 

If the cysts are microcysts (less than 1.0 cm in 
size and not palpable) many physicians will not 
attempt to drain them unless there are other signs 
such as calcifications that are worrisome for 
malignancy. If the cyst cannot be felt, it would 
have to be done under ultrasound guidance. For this 
reason, many of the smaller cysts are just 
followed with repeat imaging at a later time. 

There are instances of recurrent cysts in which a 
woman has had multiple cysts aspirated all showing 
benign and finally the physician says "enough is 
enough". The new cysts are not drained unless they 
get quite big. 

Therefore it would not be against normal 
guidelines to just follow some breast cysts rather 
than aspirate them.
Here are some more breast cyst references along 
with the original article. 

The Evaluation of Common Breast Problems

Cysts of the breast

Breast Cyst Aspiration

Breast Cyst on Mammogram

4. Preparing a young girl for menstruation
Most doctors are notoriously poor at discussing 
and preparing a young girl for menstruation. They 
tend to focus on the anatomy and biology along 
with the globalization of this being a "transition 
from childhood to adulthood". This is not what 
young women want to hear and is the exact opposite 
of the recommendations of this article at 

Adolescents starting menstruation want information 
and tips about menstrual hygiene. They also want 
support and reassurance but they are least likely 
to want an explanation of the biology behind 
menstrual periods. 

This leads to suggestions such as:

girls benefit when adults see and speak of 
menstruation as healthy (keep the negatives to 

give consistent, not contradictory messages 

be open about menstruation in discussion but 
respect privacy 

give practical tips 

dispel myths and stereotypes 

fathers do not need to be an information source 
but they do need to be supportive, understanding 
and considerate 

Preparing daughters for menstruation

5. Arrhythmia - A funny heart rate
The electrical system of the heart which controls  
the heart rate sometimes becomes disturbed. This can 
happen because of stress, caffeine, excessive 
alcohol, medications, salt abnormalities. 
hereditary conditions or even a heart attack. It 
can happen only occasionally or it can be 
continuous for years.  

Symptoms of an arrhythmia  may  include:

palpitations (an abnormal awareness)
heart rate too fast
heart rate too slow
heart rate skipping beats
shortness of breath
chest pain
passing out

Most heart rate problems are benign but they can 
sometimes be serious and even result in death. 
Don't try to self diagnose this condition but 
rather see your doctor for an EKG or even a 24 
hour cardiac monitor. Once you have the diagnosis  
made and know it is a benign problem, then you can 
begin to ignore the rhythm change. 

This article at PersonalMD.com will give you some 

Cardiac arrhythmias - funny heart beats

6. Health tip to share - Crazy glue for small cuts
" 'Crazy' Glue and 'Super' Glue can be used to 
seal small cuts that would not normally be 
sutured. For example, you could safely put a small 
amount of 'Crazy glue'  on a paper cut on the hand 
or fingers. It could also be used on small cuts 
(not actively bleeding) that children get. You 
then just let it wear off in 7-14 days. The 
protective covering makes the cut much less 
painful and makes a better bacterial seal than a 
bandage. Doctors sometimes use this glue instead 
of suturing a laceration under a cast, for 
example, but if you think a cut might need 
stitches, it is safer to go to the doctor to see." 

"Be sure any cut is thoroughly cleaned with soap 
and water. One of our nurse readers reminds 
us that cuts can get infected if they are not 
properly cleansed before applying superglue or 
skin glue. She has seen a bad staphlococcus skin 
infection when there was not good cleansing before 
applying skin glue. "


7. Humor is healthy
Post-op Orders Unclear

A gynecologic surgical patient was discharged from 
the hospital and given my usual post-op 

That night she called wanting to know when her 
mother could visit?  

"Any time," I replied, "Why do you ask?"

She rustled some papers. "It says here in your 
instruction sheet," she continued, 

"No relations 'til after your post-op checkup." 

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

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***** Woman's Diagnostic Cyber Newsletter *****
                September 24, 2000
This week from Woman's Diagnostic Cyber

1. Anxiety or stress or are they different?
2. Black women's health 
3. Reader submitted Q&A - Large ovarian mass
4. Get medical abstracts by email
5. What if your husband has low sexual desire?
6. Health tip to share - Pau d'Arco herb for yeast
7. 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. Anxiety or stress or are they different?
Anxiety is the set of symptoms or state of mind 
that results from stress or from your perception 
of events and their meanings. The exact meaning of 
the term "anxiety" can vary quite much among 
mental health professionals as this article from 
Mayohealth.org points out. 

Mental health professionals like to categorize 
anxiety conditions into different groups because 
they feel the treatment may vary among those 
groups. Their terms for commonly seen conditions 
may include: 

generalized anxiety disorder
panic disorder
obsessive-compulsive disorder
post-traumatic Stress disorder
and many others

You may just feel the anxiety symptoms and not be 
concerned about splitting hairs over what to call 
it. Those mood symptoms can include: 

overwhelming worry
a nagging uneasiness about your future. 

Physical symptoms can include:

rapid heartbeat
relentless fatigue

Anxiety states can also be mixed with depression 
states and the anxiety symptoms can also go away 
as that depression gets treated. You can see why 
it might be important to get an accurate 
diagnosis. Don't be afraid to visit a psychiatrist 
or licensed psychologist. 

Anxiety and stress symptoms

2. Black women's health
African-American women have most of the same 
health concerns that any woman has. There are a 
few conditions, however, that are more frequent in 
women of African extraction such as: 

g6PD enzyme deficiency

as a few examples. But some of the articles that 
are also included at blackwomenshealth.com are 
about spiritual and mental health subjects and look 
very interesting. These issues can affect a woman's 
health and the articles are well worth looking at. 

Accepting Who You Are
Choosing to Love
Domestic Violence
First Date
Healing Without Hate
Mental Health
Overcoming Obstacles
Self Esteem
Improving Your Success
Where are the good men?
Teenage Sex & Pregnancy

Black women's health dotcom

3. Reader submitted Q&A - Large ovarian mass
"A cat scan was performed as a result of what I 
believed was a hernia due to an injury. The scan 
revealed two pelvic masses, one on the right 8.5 x 
10.3 cm, spherical-shaped mass of water density, 
fluid density. A second, similar structure, 3 cm 
is on the left near the left ureteral vesical 
junction. Possible ovarian origin. The larger mass 
is midline, exact origin undetermined, but appears 
cephalic in location." 

"While the report is encouraging, medical reports 
state that masses of this size are uncommon in 
postmenopausal women and are suspect.  What is 
your opinion? The pain is still in the small point 
area of the appendix and  the appendix scar and 
where I felt a strain from the injury when I 
lifted a heavy box. I am 72 years old." 


In asking for an opinion I would guess you are 
asking what is the chance that this mass 
represents a malignancy. Since the mass has 
occurred after menopause and after age 55, the 
chance of any ovarian mass being malignant is 
about 35%. The fact that there is no fluid present 
and the cysts are singular is a good sign and 
lowers the chance of malignancy on an ultrasound 
basis to about 10%. 

Based on age and ultrasound which is all you gave 
us, the chance of malignancy is about 20-25%. I 
hope the surgery turns out well. 

For a discussion of evaluating whether an ovarian 
mass might be malignant, see our updated article 

Can this ovarian mass be malignant?

4. Get medical abstracts by email
The medical jargon in scientific articles from 
PubMed at the National Library of Medicine can be 
a barrier for many people interested in the latest 
medical findings about a given disease. There are 
some women who have enough of a background to 
understand medical abstracts and who may want to 
hear the latest evidence on a personal or family 
medical affliction. 

Medfetch.com offers a weekly email to you of up to 
20 of the most recent medical citations about a 
subject you choose. This could be a great way to 
keep up with the latest about an unusual disease 
or what therapies are being tried for a refractory 

You do not need to be a medical professional to 
sign up for this service. 

MedFetch - abstracts by email

5. What if your husband has low sexual desire?
Many women complain about low libido but what if 
your husband seems not to want to have sex? After 
the initial years of a relationship pass, it is 
not uncommon for one partner to have a different 
baseline level of sexual desire. How do you handle 

Cynthia Lief Ruberg, MSEd, LPCC, NCC, CFT is a 
licensed counsellor and family therapist who has 
some suggestions for couples in which the husband 
seems to have a low interest level in sex. You 
have to try to get both your interest levels more 
in sync and it takes talking to do that. 

You need to find out what are his sexual 
expectations, what are his turn offs and turn ons, 
is he angry, fatigued, does he feel depressed, 
etc. Is he very task oriented (e.g., computers) 
and has difficulty putting things aside to allow 
himself to "make time for play." If so you may 
need to talk to him about scheduling time to be 
together for dating and lovemaking. To put time on 
the calendar for this activity may seem 
exasperating but it can succeed to replace those 
other "important" work tasks. 

If you suspect there are other issues such as an 
affair, you may both need to seek counselling. If 
medications are an issue, he needs to mention this 
to his doctor and not be embarrassed. 

Low male sexual desire

6. Health tip to share - Pau d'Arco herb for yeast
"One way I have learned to treat recurrent yeast 
infections is by using an herb called "Pau 
d'Arco".  This herb is lethal to fungus and 
usually keeps it from coming back if taken 
regularly. it is also beneficial against 

"The brand I use is "Nature's Way" and is about 
$7.99 per bottle 100 capsules at 1.01g each along 
with calcium. Directions say to use 2 capsules 
twice daily, I use 1 capsule twice daily for 
prevention.  When I first notice symptoms, I use 
about 3 capsules 3 times daily until it is cleared 
up, It usually takes only a couple of days. 


[editor note - Pau d'Arco is an herbal preparation 
from the inner bark of a South American tree, see: 

Pau d'Arco herb]

7. Humor is healthy

Two little boys go into the grocery store. One is 
nine, the other four. 

The nine-year old grabs a box of tampons from the 
shelf and carries it to the register for check-

The cashier asks, "Oh, these must be for your Mom, 

The nine-year old shakes his head and replies, 
Nope, not for my Mom." 

Cashier: "Well, they must be for your sister 

Nine-year old: "Nope, not for my sister either."

Cashier, curious now: "If they're not for your Mom 
and not for your sister, who  are they for?" 

The nine-year old says, "They're for my four-year 
old brother." 

Surprised, the cashier asks, "For your little brother 
right here?" 

Nine year old explains: "Well, yeah! 

They say on TV if you wear one of these, you can 
swim or ride a bike, and my little brother needs 
them because he can't do either!" 

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

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***** Woman's Diagnostic Cyber Newsletter *****
                October 1, 2000
This week from Woman's Diagnostic Cyber
1. Losing motivation for your fitness routine?
2. Do adhesions cause abdominal pain?
3. Reader submitted Q&A - Iodine allergy
4. Varicose veins - surgery and sclerotherapy
5. Caregiver guide to coronary artery disease
6. Health tip to share - Painful intercourse
7. 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. Losing motivation for your fitness routine?
Week after week and month after month, it can be 
difficult to maintain your motivation for whatever 
fitness routine, sport or exercise you know you 
should keep up with. Your spousal support may 
slacken or obligated business/social functions 
seem to corrupt your eating plan. How do you keep 
it up? 

Asimba.com, a fitness web site, has many sections 
about what experts suggest for nutrition, various 
sports, injury prevention or treatment, fitness 
and a unique FAQ section on motivation. 

"I've been working out regularly for the last five 
years. However there are times when I don't 
work... " 
"I always fail at being motivated, yet when I look 
at myself in the mirror, I am so disturbed at 
what... " 
"I would like to start an exercise program that 
fits my busy and unpredictable work schedule. I 
"I want to start losing weight and getting 
healthier but every time i try to i just keep on 
eating ru... "  

"Hi there, I am a 28 year old female and I have 
been trying to lose weight but I always seem to 

"What are the best ways to stay motivated without 
spousal support - or better yet, how can one 
This time of year my husband and I are inundated 
with invitations to parties and dinners at 
friends'... " 

Fitness goals such as physical activity for 10-15 
minutes 3 times a day, for 30 minutes a day, 10 
sit ups a day or walking up 3 flights of stairs 3 
times a day are much easier to meet than more 
nebulous goals such as looking better in the hips 
or losing weight fast enough. The latter goals 
will more often discourage you than a set routine 
to accomplish. If you have trouble maintaining the 
activity sessions you need for good health, you 
might want to look at, "Ask the Asimba
Experts" and then look under the FAQs for motivation: 

Fitness motivation

2. Do adhesions cause abdominal pain?
Adhesions are difficult conceptually for someone 
who is not a surgeon to understand. After any 
abdominal or pelvic surgery, the normal organs 
such as the bowel, omentum, faloppian tubes, 
ovaries, or uterus may stick together when  
normally they slide across the surfaces of each 
other without pulling on each other. Surgery often 
makes some of those surfaces sticky so that 
fibrous bands form between them. This causes 
pulling on one or more of the organ surfaces when 
natural movement occurs. 

General surgeons tend to ignore adhesions as a 
cause of pain, whereas gynecologic surgeons have 
the experience that adhesions often, but not 
always, cause pain. Imaging studies such as CAT 
scans, ultrasounds and MRI's do not show adhesions 
so until the time of actual surgery, a doctor can 
only guess that adhesions may be present and may 
be a cause of pain. 

The following article about adhesions may be 
interesting to those who are skeptical about these 
controversial causes of pelvic pain. 

Surgical adhesions and pain 

3. Reader submitted Q&A - Iodine allergy
"I am highly allergic to iodine. During surgery 
recently one of the medical attendants told me if 
I was allergic to iodine I must be allergic to 
crab and lobster. I actually years ago had a 
reaction to crab. Are there any other things I 
should be wary of?" 


Actually there is not a relationship between 
iodine and shellfish allergies. Fish allergies are 
a response to proteins in the shellfish or fish 
and not to the iodine. Sometimes, the allergic 
response is actually to a parasite that 
contaminates the fish meat and not to the fish 
protein itself. 

If you wonder about other seafoods, whether you 
can eat iodized salt and more about these 
allergies, see our article at: 

Does Iodine Allergy Mean a Shellfish Allergy Too?

4. Varicose veins - surgery and sclerotherapy
Most varicose veins are caused by leaky valves of 
the leg veins located behind the knee or in the 
groin. The venous blood then backs up and distends 
the veins causing a bluish, tortuous cord just 
under the skin of the leg. 

Painful, sore throbbing veins, a history of blood 
clots in the leg veins or just plain cosmetic 
concerns can be reason enough to have these veins 
fixed. Traditional treatment is surgical. Either 
tying off the superficial skin veins so the blood 
does not back up into them or stripping the 
superficial skin veins that have faulty valves is 
the most common treatment. 

Other treatment over the years has included 
injecting the veins with a sclerosing chemical 
that makes the vein totally seal shut. Sclerosing 
has a high recurrence rate of varicosities because 
it does not correct the leaky valve problem. It is 
not used much because of this but sometimes it is 
extensively used on the small spider veins of the 
legs primarily for cosmetic purposes. 

For a good discussion see the site at:

Varicose veins

5. Caregiver guide to coronary artery disease
Women who function as caregivers for an elderly 
parent or a spouse or child with a chronic disease 
have special needs themselves. Carethere.com is a 
support site for such caregivers. 

It offers many resources for keeping medical 
records, medication and allergy lists, healthcare 
and physician contacts, checking drug interactions 
and libraries about chronic diseases that are 
invaluable when taking care of someone with a 
chronic illness. 

The section on coronary artery disease looks 
especially helpful. It goes over all of the 
modifiable risk factors such as hypertension, 
cholesterol levels, smoking, diabetes and obesity 
giving you information you can use to help your 
care receiver minimize the worsening of heart 
problems. It also gives you tips as a caregiver 
such as: 

Stop smoking. If you smoke, it will be even more 
difficult for your loved one to quit.  

Become more active. Exercise is more enjoyable 
when it is a shared activity. Take walks together. 

Makes changes in the family diet. 

If you are overweight, changes to your diet and 
activity will be easier when they are shared with 
your loved one. 

Avoid taking responsibility for the other's 
behavior but most of all, avoid being critical. 

Finally, it covers the signs and symptoms of 
coronary heart disease such as stable and unstable 
angina and heart attacks, Be sure to look at: 

Coronary artery disease for caregivers

6. Health tip to share - Painful intercourse
How I eliminated painful intercourse:

Until 3 years ago, I had never experienced pain-
free intercourse. Things only got worse after the 
birth of my daughter.  I tore during delivery and 
the resulting scar increased the pain.  I had two 
distinct pains.  One I knew was due to 
endometriosis.  Two surgeries gave me no relief.  
I was finally referred to a physical therapist.  
She is schooled in a specific type of therapy 
called "myofascial release."  This focuses on 
tissue mobility rather than muscle mobility.  For 
painful intercourse, she focuses on the pelvic 
floor.  She actually does internal work.  Through 
pressure on the tissues that are contracted, she 
is able to get them to release.  This increases 
mobility in the whole pelvic area but specifically 
in the vagina. After several months of treatment, 
I began to have pain-free intercourse. 

The second pain I experienced was a burning 
sensation.  Again, I thought this was how sex was 
to be for me.  At a routine annual exam with a new 
doctor, she touched a spot with a q-tip and I 
experienced the burning. The opening of my vagina 
was red and irritated.  She diagnosed me with 
vulvar vestibulitis.  She instructed me to use no 
soap while bathing for several weeks and gave me a 
cream to use for two weeks (I don't recall it's 
name). After that the problem was solved.  But I 
have been told never to use any soap other Dove 
for Sensitive Skin.  I can't use any bubbles, oils 
or salts in a bath.  Also, if lubrication is 
needed during intercourse, I am to use plain 
vegetable oil.  Apparently most commercial 
lubricants contain alcohol and other ingredients 
that can really irritate. 

A great side-effect of no pain is a significantly 
increased libido.  I also feel like a normal 


7. Humor is healthy
Subject: Women's Words of Wisdom

The hardest years in life are those between ten 
and seventy. 
    -Helen Hayes (at 73)

I refuse to think of them as chin hairs.  I think 
of them as stray eyebrows. 
    -Janette Barber

Who ever thought up the word "Mammogram"?  Every 
time I hear it, I think I'm supposed to put my 
breast in an envelope and send it to someone. 
    -Jan King

A few weeks after my surgery, I went out to play 
catch with my golden retriever.  When I bent over 
to pick up the ball, my prosthesis fell out. The 
dog snatched it, and I found myself chasing him 
down the road yelling, "Hey, come back here with 
my breast!" 
    -Linda Ellerbee

Things are going to get a lot worse before they 
get worse. 
    -Lily Tomlin

You know the hardest thing about having cerebral 
palsy and being a woman? It's plucking your 
eyebrows.  That's how I originally got pierced 
    -Geri Jewell

A male gynecologist is like an auto mechanic who 
never owned a car. 
    -Carrie Snow

Laugh and the world laughs with you.  Cry and you 
cry with your girlfriends. 
    -Laurie Kuslansky

My second favorite household chore is ironing.  My 
first being hitting my head on the top bunk bed 
until I faint. 
    -Erma Brombeck

Old age ain't no place for sissies.
    -Bette Davis 

A man's got to do what a man's got to do.  A woman 
must do what he can't. 
    -Rhonda Hansome

The phrase "working mother" is redundant. 
    -Jane Sellman

Every time I close the door on reality it comes in 
through the windows. 
    -Jennifer Unlimited

Whatever women must do they must do twice as well 
as men to be thought half as good.  Luckily, this 
is not difficult. 
    -Charlotte Whitton

Thirty-five is when you finally get your head 
together and your body starts falling apart. 
    -Caryn Leschen

When I was young, I was put in a school for 
retarded kids for two years before they realized I 
actually had a hearing loss... and they called ME 
    -Kathy Buckley

I try to take one day at a time, but sometimes 
several days attack me at once. 
    -Jennifer Unlimited

If you can't be a good example, then you'll just 
have to be a horrible warning. 
    -Catherine Aird

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

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***** Woman's Diagnostic Cyber Newsletter *****
               October 8, 2000
This week from Woman's Diagnostic Cyber

1. Lead present in calcium supplements
2. Monthly birth control shot is approved by FDA
3. Reader submitted Q&A-Continuous bleeding on OCPs
4. If you witness an epileptic seizure
5. Ringing in ears (tinnitus) affects many
6. Health tip to share - treating a boil
7. 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. Lead present in calcium supplements
Too much lead in the body can lead to anemia as 
well as vomiting, diarrhea, abdominal pain, lack 
of appetite, irritability, listlessness, hysteria 
or convulsions. Excess lead in the environment 
used to come from gasoline but that is fairly well 
under control. Now investigators are having us 
watch how much lead might be in different 
supplements and foods we ingest. 

This article below looked at calcium carbonate 
supplements available both with and without 
prescription to see what the lead levels in them 
were. There have been previous reports of lead in 
calcium supplements made from dolomite and 
bone meal. They found that 8 of the 21 samples 
contained lead. Although not at dangerous levels, 
the amounts were still higher than desirable. 
Both natural and refined products had lead. 

The recommendations include:

be sure to look at the calcium carbonate label to 
   see if it has been tested for lead 
types of calcium other than carbonate form are 
   less likely to contain lead 

Also look at the editorial that is listed as a 
link below the article. This points out that the 
levels of lead found are not high at all. A 
"luncheon of mixed salad greens and a glass of 
Chardonnay will contain from 10 to more than 50 
times as much lead as could be ingested in a 
typical calcium supplement tablet." Therefore we 
have to put it in perspective. The amount of lead 
in calcium supplements are not at concerning 

2. Monthly birth control shot is approved by FDA
The FDA has approved a monthly shot for birth 
control that should be available on the market 
within the next 3-4 months. It is meant to compete 
with DepoProvera which is an every 3 month shot. 
Unlike DepoProvera, however, women using the new 
shot, Lunelle, will still have a monthly menstrual 

Also different than DepoProvera is the fact that 
return to ovulation is much quicker, 2-4 months. 
This means that a woman trying to conceive is much 
more likely to than if she uses DepoProvera which 
can often result in no ovulation for as much as 18 
months after stopping. 

Monthly birth control shot approved

The Lunelle contraceptive  may have more 
break through bleeding than regular pills, however.

Article comparing Lunelle and OrthoNovum 777

3. Reader submitted Q&A - Continuous bleeding on OCPs
"I started taking Ortho-Tricyclen® about 2 
years ago.  I would have my normal period for 5-7 
days, and then the following year I started 
continual bleeding for 2-4 weeks out of each month 
in addition to my normal week period.  Last year, 
I had my period for five weeks straight, and was 
rushed to the hospital, where I was put on highest 
estrogen pill (beige w/ butterflies) and taken off 
Ortho-Tricyclen® , until about 8 months ago.  
I experienced the same irregular bleeding with 
this pill, so they put me on the lowest estrogen 
pill for the next several months.  No results from 
this pill either, they next tried Depo. 

I've been on Depo since then, and have experienced 
continual bleeding for 9 months, until recently I 
was put on another low dose pill  (could be Ortho 
Novum 777®, not sure), while still on Depo.  
The bleeding stopped within a day after taking the 
pill.  I don't know wheither to get off Depo or 
the pill?  My doctors can't tell me what's wrong, 
and I am getting no answers where ever I go.  I 
have a history of cancer in my family, and am 
afraid that this might be a factor?  Please help 
me out with any answers, suggestions, or advice. 


The continuous bleeding in this situation is very 
likely to be due to low estrogen levels. Estrogen 
is needed to repair blood vessels and grow 
supporting tissue around them after each menses. 
The progestin in pills or in DepoProvera 
injections can block this growth and result in 
prolonged bleeding. To get around this, you will 
need to take added estrogen or a pill with a 
higher estrogen level and a less potent progestin. 

To see how this comes about and for further 
discussion, see our article at: 

Continuous bleeding on birth control

4. If you witness an epileptic seizure
Witnessing an epileptic seizure can be almost as 
upsetting as having one. A person may have 
uncontrollable spasms of the head, arms, legs and 
trunk of the body with loss of bowel or urine 
control or it may just present as a fixed stare, 
an apparent doze or just drooling from the mouth. 

Seizures are self-limited and are usually over in 
2-3 minutes. You really should not try to hold a 
person's tongue  or try to put anything in the 
mouth. The best you can do is to protect the 
person's head or body from injury by moving 
furniture or placing some padding under the head. 
DO NOT try to restrain someone having a seizure. 
Just let it run its course. 

First aid for an epileptic seizure is a skill 
everyone should have. See the first aid tips at: 

First aid for epilepsy

5. Ringing in ears (tinnitus) affects many
Noise in the ears (when there really is no 
external noise) such as ringing, hissing, roaring 
or clicking may affect as many as 1 out of 8 
people at sometime in their lives. It is a very 
annoying condition whose cause is not clear. There 
are known factors that worsen the noise such as: 

noise exposure
wax build-up in the ear canal 
certain medications
ear or sinus infections
heart disease
and other trauma and tumors

There are treatments available for this and 
sufferers may want to see an Ear, Nose and Throat 
(ENT) specialist. 
6. Health tip to share - treating a boil
A boil (also called a furuncle) is a deep skin 
infection that develops from an infected hair 
follicle. It can appear on any skin area including 
the vulva. It often appears as a red, warm, 
painful, pus-containing bump under the skin. DO 
NOT squeeze a boil to make it drain. This can 
cause it to break under the skin and spread even 
more extensively and painfully. Apply a hot 
compress for 10 minutes several times a day. This 
should make it rupture and drain within a day or 
two. Very rarely are antibiotics needed to treat a 


7. Humor is healthy
When our second child was on the way, my wife and I
attended a pre-birth class aimed at couples who had
already had at least one child. The instructor
raised the issue of breaking the news to the older
child. It went like this:
"Some parents," she said, "tell the older child, 
'We love you so much we decided to bring another 
child into this family.' 

But think about that. 

Ladies, what if your husband came home one day and 
said, 'Honey, I love you so much I decided to 
bring home another wife.'" 
One of the women spoke up immediately. "Does she 

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

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***** Woman's Diagnostic Cyber Newsletter *****
                October 15, 2000
This week from Woman's Diagnostic Cyber

1. Dietary supplements - A guide to their efficacy
2. Hysterectomy or an alternative?
3. Reader submitted Q&A - Surgical menopause
4. Lung treatment for chronic obstructive disease
5. Should healthy adults take a flu vaccine?
6. Health tip to share - Milkweed for warts
7. 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.Dietary supplements - A guide to their efficacy
The Wellness Letter from the University of 
California at Berkeley has established a reputation 
over the years as a reliable source for health 
information that is evidence based. Some of their 
materials are available on the Web and a very 
practical resource is their list of nutritional 
supplements that they have comments on over the 

Whether you are wondering about nutriceuticals 
from aloe vera drink to bilberry to grape seed 
extract to phosphatidylserine to zinc and more, 
they have some quick information about it that may 
help you decide if it should be part of your 
health program. 

Some of the interesting points scattered 
throughout this list are: 

chelated minerals are not absorbed any better than 
non-chelated ones and in fact may be less well 

blue-green algae supplements have no evidence of 
being beneficial and are easily contaminated 

vitamin B12 can help improve mental awareness in 
people over 50 who may absorb less from their 
gastrointestinal tract 

saw palmetto may reduce prostatic hypertrophy in 
men and it has a lower incidence of erectile 
dysfunction than the prescription medicines used 
to treat the hypertrophy. 

Wellness guide to dietary supplements 

2. Hysterectomy or an alternative?
Hysterectomy for nonmalignant gynecologic 
conditions is still a very common procedure. On 
the one hand, many studies indicate that there is 
a high incidence of unnecessary procedures, i.e., 
in many cases there was a lack of adequate 
diagnostic evaluation and failure to try 
alternative treatments before hysterectomy. 

On the other hand, hysterectomy has a higher cure 
rate for most of the problems for which it is used 
such as fibroids, endometriosis, prolapse, chronic 
abnormal uterine bleeding and chronic pelvic pain 
than do the alternative treatments such as 
myomectomy, fibroid embolization, hormonal 
treatment and uterine suspension among others. 

Studies have varied from showing a new occurrence 
of depression (8%), lack of sexual interest (7%), 
and anxiety (6%) after hysterectomy to showing a 
large study showing the majority of women 
demonstrating increased libido, greater frequency 
and intensity of orgasm, and lessening of pain 
during sex following hysterectomy. 

Since 40% of women will have had a hysterectomy, 
it is worth knowing the pros and cons if you have 
not had a hysterectomy. 
3. Reader submitted Q&A - Surgical menopause
"Have there been any studies comparing a "natural" 
menopause to a surgically-induced menopause? Has 
there been any medical consensus that one is more 
advantageous for a woman's health? I am 51 and 
still having regular menstrual periods. Thanks!" 

There is a much more sudden dropping of estrogen 
and testosterone levels with surgical removal of 
the ovaries in a premenopausal woman than there is 
with a natural menopause. For about 5 years prior 
to natural menopause, hormone levels start 
declining. Then estrogen jumps down and everything 
levels off by about two years after menopause. 

Other than the sudden hormonal changes, it is not 
clear whether natural or surgical menopause  has 
much effect on the long term aging process. It 
seems to depend upon whether ERT or HRT is used 
rather than the type of menopause. There are not 
many studies about this, however, so most of the 
evidence is indirect. We discuss it at: 

Natural vs surgical menopause

4. Lung treatment for chronic obstructive disease
Pulmonary rehabilitation can help people with 
chronic lung disease control their shortness of 
breath, coughing or mucous production symptoms and 
improve their day-to-day functioning. The program 
combines exercise training with behavioral and 
educational programs. 

This patient guide from the American College of 
Chest Physicians and American Association of 
Cardiovascular and Pulmonary Rehabilitation 
outlines the concept of lung rehab. 

Lower body training focuses on leg muscles for 
walking or climbing stairs. Upper body training 
helps with day to day tasks of lifting, cleaning 
and cooking functions so that less oxygen is 
consumed and thus there is less worry about 
breathing function. 

Ventilatory muscles that are the ones actually 
involved in breathing, Improvement of these 
muscles may reduce shortness of breath and permit 
more general exercise. All of these training 
programs can help a person with chronic lung 
disease due to smoking, cystic fibrosis, 
bronchiectasis, or neurological diseases. 

5. Should healthy adults take a flu vaccine?
Most recommendations for taking the flu vaccine 
each year are confined to high risk populations, 
people over 65, people with medical conditions, 
and pregnancy. This year, officials are planning 
to recommend it to anyone over 50. In addition 
many low risk persons choose to take the vaccine. 
The study below in the Journal of the American 
Medical Association looks at the experience of two 
years of widespread use of the flu vaccine. 

In one year, 1997-1998, the flu vaccine was 
different from the prevailing viruses and the 
efficacy was only 50%. It did not reduce doctor 
visits or lost workdays. In the 1998-1999 flu 
season, the vaccine and the circulating viruses 
were well-matched and the vaccine was about 86% 
successful. Physician visits and lost work days 
were reduced by 30-40% compared with placebo 

Thus the chance of the vaccine being beneficial 
only occurs in those years in which the vaccine 
and the circulating virus are well matched. In the 
best of years it prevents the flu about 85% of the 
time but only reduces lost work days by a third. 

Flu vaccination for healthy, working adults

6. Health tip to share - Milkweed for warts
"If you have a wart that can't be removed without 
coming back try this. It has been proven to work. 
When milkweeds are up and green just break off a 
piece and before going to bed put the milk of the 
milkweed on wart. Cover real good and blow to dry. 
It is painless and will not leave a scar. Usually 
1 or 2 times is all it takes. Just forget about it 
and next time you look it will be gone."  Rosa 

image of milkweed

7. Humor is healthy
Not exactly medical but ...
A man piloting a hot-air balloon discovers he has 
wandered far off course and is hopelessly lost. He 
descends to a lower altitude and locates a woman 
down on the ground. He lowers the balloon to 
within hearing distance and shouts, 

"Excuse me, can you tell me where I am?" 

The woman below says: "Yes, you're in a hot-air 
balloon, about thirty feet above this field." 

"You must work in information technology," says 
the balloonist. 

"Yes, I do," replies the woman. "And how did you 
know that?" 

"Well," says the balloonist, "what you told me is 
technically correct, but of no use to anyone." 

The woman below says, "You must work in 

"I do," replies the balloonist, "how did you 

"Well," says the woman, "you don't know where you 
are, or where you're going, but you expect my 
immediate help. You're in the same position you 
were before we met, but now it's my fault!" 

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

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****** Woman's Diagnostic Cyber Newsletter *******
                October 22, 2000
This week from Woman's Diagnostic Cyber

1. How often does rectal bleeding mean cancer?
2. Is it a migraine or a tension headache? 
3. Reader submitted Q&A - Weight loss programs
4. Low dose birth control pills for perimenopause
5. Cosmetic enlargement of the lips
6. Health tip to share - MSG may cause problems
7. 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. How often does rectal bleeding mean cancer?
There are two types of rectal bleeding - bright 
red bleeding that you see in the toilet or on 
toilet paper and hidden bleeding (occult) that can 
only be detected by stool tests with special dyes 
that turn positive when small, invisible amounts 
of blood in the stool come in contact with the 

Bright red, visible bleeding can be frightening. 
The first thing that comes to mind is cancer of 
the rectum or colon. Actually the most common 
cause is hemorrhoids  or a local rectal 
irritation. But how often is the bleeding due to 

This study in the British Medical Journal looks at 
the symptom of bright red, visible bleeding and 
determines how often it ends up being due to 
colorectal cancer at the different ages it is 
detected. Overall, 7% of people with rectal 
bleeding had cancer. Under age 50, less than 1% 
had cancer and from ages 50-60 less than 2% of 
people with bleeding had cancer. Over age 60 is 
where a jump in incidence occurred. From 60-70, 
about 10% of bleeders had cancer and over age 70, 
20% had cancer. Thus rectal bleeding becomes an 
ominous sign over age 60. It is especially 
worrisome if accompanied by fatigue and weight 

Another finding was that the absence of rectal 
bleeding is not predictive for the absence of 
cancer. In other words, just because you have not 
had any bleeding does not mean you are free of 
cancer. That is why colorectal cancer screening 
recommendations include procedures like a periodic 
rectal exam, and sigmoidoscopy or colonoscopy over 
the age of 50. 

Rectal bleeding and colorectal cancer

2. Is it a migraine or a tension headache? 
Women who have migraine headaches on a regular or 
semi-regular basis do not need to be told what the 
symptoms of a migraine are. However, many women 
will get tension headaches that are so bad, they 
believe they are having a migraine. The reason to 
know the difference is that migraines respond to 
different medications than those used to treat 
tension headaches. 

This study in the Annals of Internal Medicine 
looks at what symptoms are the most likely to 
differentiate a migraine headache compared with a 
tension-type headache. They found those key 
symptoms to be: 

nausea associated with the headache
an extreme pain sensitivity to lights
an extreme pain sensitivity to sounds
worsening by physical activity

If your headache doesn't have one or more of these 
symptoms, it probably is NOT a migraine. 

A cluster headache is one that occurs on only one 
side of the head, mostly around the eyes. 

Symptoms of a migraine headache

3. Reader submitted Q&A - Weight loss programs
"Some friends of mine are on the diet program 
Herbalife ®.  They say it is dr. approved and 
it seems to be working for them.  What is your 
opinion of this program?" Anonymous

I cannot tell specifically about the effectiveness 
or safety of this diet program because it has not 
been medically evaluated and published as far as I 
can tell. 

There are some general principles that can be 
applied to all of the trendy weight reduction 
programs. Low carbohydrate diets are more 
effective in producing weight loss than are high 
carbohydrate diets. Prescribed medications that 
have been shown to be medically effective probably 
just help us get the motivation to start a diet 
and possibly to stay on it. They do not seem to 
promote greater weight loss than any equivalent 
calorie reduction plans in which people are highly 
motivated but do not take the medicine. 

Some non prescription drugs and supplements still 
being popularly promoted have been tested and 
found not to be effective. Some have even been 
found to be dangerous. For a discussion of this 
and general principles involved in weight loss 
diets, see our article at: 

Weight loss diets and supplements

4. Low dose birth control pills for perimenopause
One of our recent articles on menopause quoted a 
nice perimenopausal study that measured hormone 
changes leading up to, including and then after 
menopause. It showed how female hormone levels 
such as estrogen and testosterone gradually 
decreased in the 4-5 years prior to actual 
menopause. Women often will have symptoms from 
these changing levels. 

This article below discusses how many women who do 
not smoke or have cancer or vascular problems, end 
up taking low dose birth control pills to control 
abnormal uterine bleeding especially in the late 
40's. The pills also reduce hot flashes and 
prevent some of the bone loss that occurs before 
actual menopause. The low dose pills (containing 
20 mcgms of estrogen) not for everyone, however, 
so be sure to ask your physician about them. 

5. Cosmetic enlargement of the lips
Lips can be made to look fuller by injections of 
different types of materials. If you are 
interested in this, you will need to see a plastic 
surgeon. Basically, lip enhancement can be 
accomplished by injections of your own body fat, 
collagen from your own cells, other humans or 
synthetically made, or tissue grafts. 

Most of the time treatment is performed on an 
outpatient basis and the minor discomfort and 
swelling lasts for only several days. Lip 
stiffness may persist for several weeks. 

If fat is used, there may be some loss of fullness 
over 6 months when the fat is resorbed. The other 
substances can sometimes cause allergic or 
infectious reactions so that is a risk. If you are 
interested, see this article at PersonalMD.com 

Cosmetic enlargement of the lips

6. Health tip to share - MSG may cause problems
"Natural flavors", "spices", these are vague terms 
on food labels that made me suspicious. I found 
out they indicated the presence of MSG (monosodium 
glutamate). And these terms were used so consumers 
would not be turned off. I found out MSG causes 
terrible cysts in my breasts, and many other 
problems for me including anxiety and depression. 
Since I found the list of other names this 
additive falls under I can avoid it." 

"I am so happy now, I want to share the fortune. 
Hope this helps others. Oddly since I rid my 
kitchen of this toxin my son no longer has asthma 
attacks and my husband's migraines are gone!!!!" 


A web site that addresses this:

No MSG .com/ Maryland Chapter

Dr. Russell Blaylock, a neurosurgeon addresses 
this practice (hiding food additives) and the 
risks of this neuro toxin to brain lesions and 
diabetes in a book called: 
Excitotoxins: The Taste That Kills. 

7. Humor is healthy
From Dan Tarditi, DO

A 20 year old young woman came into the hospital 
ER complaining of abdominal pain. The doctors 
evaluated her and found she had a positive 
pregnancy test. After informing her of the 
pregnancy, she was dumbfounded. 

"That's impossible!" she said, "We used birth 

"Did you use condoms or birth control pills?"

"Both!" said the woman. "The only problem was that 
my boyfriend read the birth control pill insert. 
After seeing all the side effects of blood clots 
and bleeding, etc.,  he told me, 

'Honey, all these side effects! I don't want you 
taking these pills. So I'll take them for you.'" 

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

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