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Women's Health Newsletters 3/10/02 - 5/19/02



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****** Woman's Diagnostic Cyber Newsletter *******
                March 10, 2002
Biweekly from Woman's Diagnostic Cyber

1. Do something about your fatigue 
2. Skin boils - the different types
3. Reader submitted Q&A - Urine odors
4. Chance of developing hypertension in your lifetime
5. Cysts in the liver found on ultrasound
6. Health tip to share - Food cutting boards
7. Humor is healthy

If you change your email address, don't forget to
re subscribe using the new address.

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

The next newsletter will be in two weeks.

1.  Do something about your fatigue 
Complaints of being tired all of the time or 
having a lack of energy are heard commonly by 
physicians. In fact I can assure you that 
physicians are frustrated by the lack of an easy 
fix for this problem. The causes are often 
multiple and almost always the treatment requires 
a major lifestyle change on the part of the person 
who is so tired. Lifestyle changes such as weight 
loss, stress reduction and good fitness and sleep 
habits are not something the physician has any 
control over. They can only recommend and it is up 
to the patient to figure out what changes work 
best for them. 

There are some medical conditions associated with 
fatigue that recurs day in and day out. Anemia 
(low red blood cell count), hypothyroidism, and 
active infections such as hepatitis, Epstein-Barr 
virus and others can be a cause. Cancer and other 
chronic medical conditions such as chronic 
fatigue syndrome can also be a cause as well as 
medication side effects. Usually a blood 
chemistry, a complete blood count, a thyroid test 
(TSH) and a good physical exam can rule out most 
of these causes. Unfortunately only about 1 out of 
20 patients complaining of continuous fatigue will 
have non-lifestyle, medical problems causing it. 
Another one or two have fatigue as a side effect 
from  medicine(s) they are taking. Anti-
depressants and anti-hypertensives are notorious 
for this. 

The other 17 out of 20 people have too much 
stress, too much weight, too little sleep or are 
too far out of good physical shape.  When a doctor 
communicates that one or more of these problems 
may be playing a role as a cause of fatigue, I 
would guess that almost a third of women will be 
skeptical and just assume the doctor did not 
really try very hard to find the cause. Perhaps 
another third will take the doctor seriously and 
try  to make the difficult changes needed to 
restore their daily energy. The other third of 
women realize how life style contributes to the 
problem but either feel helpless to change it or 
they try change and become discouraged very early 

The doctor's dilemma is the lack of an easy 
treatment for stress reduction, weight loss or 
sleep disorders. Most physicians never learned how 
to instruct and monitor patients for those 
problems when they went through medical training. 
They only learned to prescribe medicines which may 
reduce the symptoms but never really address the 
long term solution. On your part, you will 
probably not be able to rely on much physician 
help if trying to reduce stress, lose weight or 
improve sleep. You will need to be your own 
detective to learn how to tackle these problems 
and get your living habits back on track so you 
will feel better on a daily basis. 

 Do something about your fatigue
2. Skin boils - the different types

Any infection deep in the skin elicits the body's 
response to wall off the infected area. This 
causes redness, soreness and swelling around the 
infection and as pressure from dead material 
builds up in the infected compartment, it seeks to 
break out to relieve the pressure. The path of 
least resistance is to go to the surface of the 
skin where it forms a "whitehead" and subsequently 
breaks through the skin and drains. Many call this 
a skin boil. 

Actually there can be different types of deep skin 
infections like this. They might be started by 
ingrown hairs, a foreign body or just plugged up 
skin ducts. When there is only one or a couple of 
areas infected, they are usually referred to as 
furuncles or carbuncles. This skin abscess is 
almost always caused by the Staph. Aureus 
bacteria. Once drainage of the pus takes place, 
the body can heal the area on its own even without 

Another type of skin boil is one that uniquely 
occurs in the skin near the base of your spinal 
cord in back. It is called a pilonidal cyst and it 
often starts at the top of the crease in the 
buttock after sitting for long periods of time. 
This boil tends to keep recurring periodically 
because its origin is in a deep skin cave-like 
crevice that may be present from birth and has a 
narrow opening which can easily be plugged off if 
the skin around it swells at all. Sometimes a 
pilonidal cyst has to be surgically drained 
because the skin lining has very small spider-like 
projections into deeper skin and those areas can 
continually be "plugged off" causing frequently 
recurrent abscesses. 

Skin abscesses unique to the armpit (axilla) areas 
or the groin and perineal areas are often due to a 
process called hidradenitis suppurativa. This is a 
chronic recurrent infection of sweat glands in 
those areas. Because sweat glands are so 
extensively present in skin, it is almost 
impossible to cure the recurrences by just 
surgical drainage or excision. 

Finally, the most common type of recurrent skin 
boils are due to cystic acne. This occurs mostly 
on the face, neck and back. Acne is also an 
infection of the sweat glands and hair follicles. 
The duct of the gland or hair follicle becomes 
plugged up with dead skin cell material and if any 
skin bacteria are trapped behind the plugged duct, 
they grow into an abscess that needs to drain 
through the skin. If acne or any boil is squeezed 
so that the infected material breaks through the 
cavity deeper into the skin, extensive further 
abscess formation can take place with a much wider 
area of skin involvement and eventual scarring. 

The main treatment of any boil is heat to soften 
the skin over the boil and promote drainage 
through the skin surface and not deeper into skin 
structures. Antibiotics are often not needed at 
all; the critical treatment is drainage of the 
abscess material. 

Skin boils - the different types

3. Reader submitted Q&A - Urine odors
"I find that when I urinate that there is an odor 
that lingers in the bathroom. I babysit and the 
children have complained that I stink. I have 
asked my doctor if possibly it could be some of my 
medications. They seem to ignore my statement. 
What can I do to correct problem. I don't know if 
the odor is from there or my vagina." 

"I am 62 and have asthma. Medications include: 
aspirin, Allegra(R), Singular(R), Verapamil(), 
Hyzar(R), Synthyroid(R), Servent(R), Flovent(R), 
Relafen(R), and a breathing machine when needed.  
I am always wet or moist in the vaginal area. 
I am overweight." - H 

I know this is a difficult question for you to 
ask, but one that is of concern for many women. 
Odor that is evident with urination can have its 
origins from basically two sources: bacteria that 
produce odorous chemicals as they metabolize and 
proliferate and chemical substances that are 
excreted in our sweat and urine. 

Bacteria that cause odor are either on the skin of 
the perineum, where it stays moist, and bacteria 
in the vagina that are not normally there but that 
are causing chemical reactions with the vaginal 
secretions. Contrary to what you might think, 
urine that smells is almost never due to a 
bacterial urinary tract infection but rather it is 
due to the chemicals from food metabolism as 
previously stated. Your doctor should be able to 
perform a vaginal exam to check for bacterial 
infection such as an atrophic vaginitis or a 
bacterial vaginosis. If either of those are 
present, they need to be treated. 

A common cause of perineal odor is from skin 
bacteria that grow in the moist folds of skin. The 
only way to combat this is to frequently keep the 
skin folds exposed to air and keep them dry. It is 
strains of bacteria that do not need oxygen to 
grow (anerobic bacteria) that usually produce the 
strongest odor. By "air drying" the skin folds you 
introduce oxygen which impedes growth of these 
bacteria as well as it removes moisture needed for 
their growth. If you are overweight and sweat a 
lot, you will have to take breaks in privacy where 
you lie down or sit with your legs very wide apart 
and with no underwear, until the skin dries out. 
Doing this several times a day may significantly 
help this problem and certainly you should try to  
air dry right after voiding each time. 

I am not aware that any of your medicines would 
cause a skin odor but it certainly is possible 
because most prescription medicines are not 
naturally occurring human chemicals. Ampicillin is 
a compound that causes an asparagus type smell to 
the urine so the question you ask about medicines 
causing some of this is a very good one. You will 
have to work very closely with your doctor as far 
as trying to go without a medicine for 3-4 days to 
see if it makes a difference in the odor. I am not 
sure I would recommend this until you look more at 
skin bacteria in a constantly moist environment as 
the main cause. 

There are some metabolic diseases such as diabetes 
and liver cirrhosis that can be associated with an 
increased body acetone or amine odor. Your doctor 
should be able to easily check you out for those. 
There is also a metabolic condition called 
trimethylaminuria in which your body abnormally 
secretes an odorous chemical in the sweat and 
urine that comes from bowel bacteria breakdown of 
food products such as eggs, fish, soy, and liver. 
Total elimination of these foods from your diet 
for about 2 weeks would be recommended to see if 
it makes a difference. 

Finally, you did not mention that you noticed the 
odor as strongly as the children. As aging takes 
place, sometimes our own sense of smell declines 
or we become very used to an odor since we live 
with it all the time. You will need to be your own 
detective about his to see if a decreased sense of 
smell on your part can be playing a role in not 
recognizing the problem soon enough to prevent a 
concentrating odor. 

Some additional tips for body odor control:

have a daily aerobic workout before going to work 
- this can help dissipate sweat gland compounds 
and then bath or shower before work to remove as 
much skin bacteria as possible - this will help 
daytime odors 
avoid seafood, soy, liver and egg yolks as well as 
pungent vegetables such as onions, garlic 
asparagus etc., for awhile to see if this makes 
any difference 

minimize stress and any sweating at work if 
possible - if you feel you have excessive 
sweating, ask your doctor about medications to 
help this. 

keep the perineal area clean and dry especially in 
the skin folds 

Perineal odor

4. Chance of developing hypertension in your lifetime

As a person ages, it is common for their blood 
pressure to rise. In fact it used to be taught to 
physicians that the systolic pressure (140 in a 
140/90 blood pressure measurement) was naturally 
100 plus your age when you got to 50 or older. 
This is not true, but for many years it was a 
rule-of-thumb based upon the premise that most 
older individuals developed higher blood 
pressures. The lower number in the blood pressure 
(diastolic, 90 in the 140/90 measurement) should 
not rise as much with age, however. 

Stage 1 hypertension is defined as a blood 
pressure of 140/90 mm Hg or over and Stage 2 
hypertension is a blood pressure of 160/100 or 
more. The study below looked at data from the 
large Framingham Heart Study. They looked at 
individuals who started the study between the ages 
of 55 and 65 and had no evidence of hypertension. 
After following them to see if their blood 
pressure went up as they aged, the authors 
calculated that the residual lifetime risk for 
developing stage 1 or greater hypertension for 
study participants was 90%. It was not more or 
less frequent for women than men. Approximately 
40% of study participants developed stage 2 

While you might think this is just an aging 
phenomenon, the encouraging news is that the 
frequency of stage 2 hypertension has actually 
decreased in recent years. This means it is a 
disease process and not just a natural physiologic 
progression because some individuals are managing 
to prevent the age progression. About 60% of both 
men and women received anti-hypertensive 
medication at sometime in their life. This 
indicates that many people either try to treat the 
high blood pressure with only lifestyle 
modification or perhaps they or their doctors do 
not think the pressure was elevated enough to 
begin medical treatment. 

Chance of developing hypertension in your lifetime

5. Cysts in the liver found on ultrasound

With all of our modern medical imaging 
technologies such as ultrasound, CAT scans and 
MRIs, more and more often we come across an 
abnormal x-ray finding that surprises us. An 
imaging report such as cysts in the liver is not 
uncommon at all. Before such powerful x-ray 
techniques ere available, liver cysts were only 
discovered when they were quite big and causing 
symptoms just from their size alone. Now we know 
that liver cysts can often occur on their own, not 
produce any symptoms, and be left alone without 
any problem. 

Many liver cysts are present from birth as the 
result of the developmental process when the liver 
was being first formed. There may just be one or 
two cysts or multiple cysts called a polycystic 
liver condition. Sometimes the liver cysts can be 
the result of infection by parasites although the 
radiologist should have been able to tell that. 
Cystic tumors and abscesses are also possible 
causes of liver cysts but again, the radiologist 
should be able to tell if those are possibilities. 
Most of the time the report just indicates simple 
cysts(s) of the liver and it is assumed that they 
are of the simple cyst, congenital origin and do 
not need any treatment. 

Occasionally liver cysts can become very large and 
cause pain in the right abdomen just below the 
ribs or even pain with taking a deep breath. When 
these simple cysts become big and cause symptoms, 
the most common treatment is surgical. It may 
involve use of the laparoscope to remove the top 
of the cyst or the surgery could be more major and 
require a large abdominal incision. 

Cysts in the liver found on ultrasound

6. Health tip to share - Food cutting boards

While experts agree that an ideal type of cutting 
board for food preparation would be non porous and 
easy to clean, the word is not in on whether 
plastic, wood, ceramic or glass are the safest. 
All of them depend upon cleaning in between uses, 
especially when meat or poultry is cut on the 
board. You need to wash the cutting board after 
cutting meat on it before using it for vegetables 
or fruits. 

If the board cannot be washed in between types of 
foods, a chlorine bleach solution, 2 teaspoons 
(10ml) of liquid chlorine to a quart of water, 
should be used to wash the board or use a 
commercial antibacterial cleanser. If you use a 
wood board to cut, be sure to make up a bleach 
solution to soak the board after every use. - FRJ 

Cross contamination from cutting boards

If you have discovered ways of coping with a 
disease or condition and it works for you, please 
share it with us: 

Health tip suggestion form

7. Humor is healthy

"ER Visit"

I am five feet, three inches tall and pleasingly 
plump. After I had a minor accident, my mother 
accompanied me to the emergency room. The triage 
nurse asked for my height and weight, and I 
blurted out, "Five-foot-eight, 125 pounds." 

While the nurse pondered over this information, my 
mother leaned over to me. 

"Sweetheart," she gently chided, 

"This is not the Internet." 

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

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****** Woman's Diagnostic Cyber Newsletter *******
                March 24, 2002
Biweekly from Woman's Diagnostic Cyber

1. What is a heart arrhythmia?  
2. Pregnancy at an older age
3. Reader submitted Q&A - What estrogens for menopause
4. Low birth weight infants from infertility treatments
5. About prostate cancer
6. Health tip to share - Breast cancer without lumps
7. Humor is healthy

If you change your email address, don't forget to
re subscribe using the new address.

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

The next newsletter will be in two weeks.

1. What is a heart arrhythmia?  
The electrical system that controls our heart rate 
is an amazingly precise system. It accommodates 
our different emotions and physical activities 24 
hours a day, 7 days a week for over 70 years, on 
the average, without failure. Sometimes the 
conduction system can develop abnormal electrical 
activity and when it does, that is known as a 
heart arrhythmia. 

If you want to understand arrhythmias, you must 
understand the normal conduction pathway. Blood 
comes into the heart in the right upper chamber 
(atrium). It is pumped down to the right lower 
chamber (right ventricle) and then out to the 
lungs to receive more oxygen. This oxygenated 
blood returns from the lungs to the left upper 
chamber (left atrium) and then is pumped to the 
left lower ventricle for distribution to the rest 
of the body. The pacemaker of the heart is located 
near the top of the right atrium and is called the 
sino-atrial node. 

The electrical impulse to trigger the heartbeat 
essentially starts at the sino-atrial node in the 
right atrium and spreads over the both upper 
chambers. As the impulse spreads over to the lower 
chambers, it crosses a specialized electrical  
conduction tissue called the septum. The tissue 
there takes the electrical signal from the top 
chamber, slows its progression down slightly, and 
then passes it on to specialized fibers that 
transmit the impulse across the ventricle chambers 
to signal these muscles to contract and pump blood 
to the lungs (right) and rest of the body (left). 
The slowing down of the first impulses allows the 
atria to contact first and then fractions of a 
second later, for the ventricles to contract. 

Whenever this normal sequence of electrical 
conduction is disrupted, an arrhythmia occurs. It 
can be due to extra electrical impulses starting 
at locations other than the sino-atrial node 
(premature atrial or premature ventricular 
contractions, atrial tachycardia or ventricular 
tachycardia)  or it can be due to poor conduction 
along the pathway which blocks some or all of the 
impulses from initiating a heart muscle 
contraction (partial or complete heart block). 
Sometimes the tissue that is supposed to slow down 
the impulse is abnormal or there is an electrical 
pathway around it (Wolf-Parkinson-White syndrome). 
There may even be a block of any starting impulses 
from the node or a complete block of any impulses 
being transmitted to the ventricles. 

Some arrhythmias are caused by damage to the 
normal heart muscle such as that from a heart 
attack. Most abnormal heart rates however are just 
due to these abnormal electrical impulses that we 
do not understand. Any arrhythmia that alters 
normal blood pumping action enough can be life 
threatening, although most times a common 
arrhythmia such as premature ventricular 
contractions (PVCs) gives no problems at all 
except an occasional awareness of a "pounding 

Symptoms to look for that may indicate a heart 
arrhythmia are: 

a pounding heart rate or pulse, 
shortness of breath, 
chest discomfort or pain

Since these same symptoms can be caused by other 
conditions, a physician should be consulted to 
detect if the heart is likely to be the source of 
these symptoms. Sometimes a 24 hour EKG type of 
heart monitoring is needed to pick up the abnormal 
rhythm if it does not occur all of the time. 

2.  Pregnancy at an older age
How old is too old for pregnancy? While the ideal 
pregnancy outcome is for women who deliver between 
ages 15 and 30, many  women delay childbearing 
until after 30. Pregnancies in the 40's are not 
that uncommon either and rarely, there are 
pregnancies in the early 50's. Pregnancy at a 
later age has some more risks to it but for the 
most part they are not excessive risks. 

With age comes a higher incidence of uterine 
fibroids. These can decrease the chance of 
conception but if a woman does become pregnant 
with fibroids in the uterus, growth of the baby 
must be closely watched. High blood pressure is 
more common with advancing maternal age as well. 
Perhaps one of the worst daily reminders of being 
pregnant after 35 or 40 is just the general bony 
and muscular aches and pains that occur more often 
during the antepartum course. 

The mother over 40 has a much higher rate of 
cesarean section due to poor labor, fetal distress 
and abnormal presentation problems (the baby is 
not directly head first). Even a greater chance of 
having a baby with a birth defect is a standard 
risk for the older mother. This risk can be 
discovered mostly by an amniocentesis procedure 
which involves a needle stick to the abdomen of 
the mother to draw off fluid from the baby's bag 
of waters. So this adds another hassle to the 
older mother's pregnancy because it is recommended 
for any mom who will be over the age of 35 when 
she delivers. 

All of these problems add up for the mother who 
becomes pregnant after 35 but they are not 
surmountable problems and they do not raise the 
risk so high that a woman should be talked out of 
becoming pregnant if she really wants to. 

If you or a woman you know wants a pregnancy but 
is afraid her age is a barrier, please suggest 
seeing a physician who can explain the magnitude 
(or lack of great magnitude) of what she might 

Pregnancy at an older age

The Complete Guide to Pregnancy After 30

3. Reader submitted Q&A - What estrogens for menopause
Two questions this week have a similar thread.

"This is a general question. Is taking Estroven 
(R) (sold over the counter at pharmacies) harmful 
in anyway?  This is a natural soy plus vitamin B6, 
E, black cohosh, Kava Kava etc. product.  Can 
women without menopausal symptoms take this 
product?" - Kay 

"Aside from contraception, what medical 
indications would lead you to prescribe a non-
human hormone (Premarin(R), Provera(R), ...) in 
preference to a human estrogen or progesterone?" - 

To the best of my knowledge and from what I could 
find in the scientific literature, Estroven (R) is 
not harmful if taken at the suggested dose of one 
capsule per day. The only thing you have to 
remember is that there is only a small amount of 
calcium in it (150 mg or about 10% of what is 
recommended per day if you are not taking 
estrogens in the menopause). So if you are using 
it for your total calcium source then it would be 
harmful by omission. The isoflavones in it from 
the soy content should be helpful with hot flashes 
and they may help slow down bone loss after the 
menopause also. The black cohosh component is 
probably not effective one way or the other but it 
is not harmful. 

There are several different Estroven(R) products 
as you may know. The original formulation for 
menopause, one for memory and concentration, one 
for bone density, one for mood and one for PMS. 
They are all combinations of different herbs and 
do not have the same amount of isoflavones (plant 
estrogens) in them as the original formulation. I 
do not think from their components they are 
harmful. The one for mood has St John's Wort in it 
and there are always some cautions about taking it 
with prescribed mood medications containing 
monoamine oxidase inhibitors, but this has not 
turned out to be a real problem at the doses used 
that I know of. 

You can take it even if you are not menopausal. 
The estrogenic plant components (isoflavones) are 
not very potent at all and since they do not 
stimulate the uterine lining to any great degree, 
they should not cause a problem at all. They 
actually may help some perimenopausal hot flashes.

Like many herbal and plant remedies, the safety 
profile for Estroven(R) should be much better than 
many prescribed medications. The efficacy is less, 
but that is the trade-off people make. Within 
prescribed estrogens, the conjugated equine 
estrogens (Premarin(R)) have some similarities to 
herbal medications in that they are composed of 
multiple different estrogenic substances in small 
amounts. There are over 10 different estrogenic 
compounds in Premarin(R) and over twice as many 
other chemicals, some of which have been shown to 
have a beneficial effect on the heart and other 
systems. The aggregate of these 30+ compounds 
are like herbal medicines that are safe because of 
such small doses of one or a few components that 
might give an adverse effect but a synergistic 
beneficial effect among the rest of them to 
produce a clinically beneficial effect. 

Even when compared to generic conjugated 
estrogens, there is a slower, time release 
characteristic of the original equine estrogens 
(Premarin(R)) than with the synthetic conjugated 
estrogens. The main cardioprotective effects of 
Premarin may be due to one particular component 
that seems even better than pure estradiol 
(natural estrogen) as far as its effect at 
dilating coronary blood vessels. 

Premarin was approved for use in the late 1940's 
and we have a much more extensive scientific 
experience than we do with the natural estrogens 
(estradiol) which were used in large scale studies 
mainly in Europe. The studies showing lower colon 
cancer incidence and lower Alzheimer's disease 
incidence was mainly collected from conjugated 
estrogen users and not from women using estradiol. 
In fact in animal studies looking at the 
protective effect of estrogens on the nervous 
system, the conjugated estrogens had a much more 
protective effect (3+) than did "natural estrogen" 

Natural estrogen and progesterone have had a 
history of being quite variably absorbed from the 
stomach, thus producing lower levels in some women 
than in others. Now that they have been processed 
to be "micronized" they absorb in oral form much 
better but there still can be more variability 
among different woman. For while it looked as if 
there was a higher incidence of breast cancer 
associated with estrogens in Europe (where they 
predominantly use estradiol) than in the U.S.  
where conjugated equine estrogens have the largest 
share of the market. I could not confirm this with 
the scientific studies I found, but I still worry 
about it. 

So to answer your question about when would I 
prescribe any "non-human" hormone other than  
natural estradiol and progesterone, my answer is 
'when first prescribing hormone replacement in a 
woman who has not had it previously'. The first 
rule of medicine is to do no harm and the 
conjugated equine estrogens still have the best 
safety profile and clinical evidence of a long 
term benefit in heart, colon cancer and 
Alzheimer's. Estradiol is certainly as good in the 
bone and hot flash studies as well as for vaginal 
and skin atrophy. I do switch to estradiol when 
women are having difficulty getting on the right  
dose for hot flash and mood problems. It is much 
better for measuring blood levels than with use of 
conjugated equine estrogens. I also use estradiol 
when money is a problem. Generic estradiol (but 
not progesterone) is very inexpensive compared to 
Premarin(R). I also will use it if a woman just 
objects to conjugated estrogens because of what 
she has heard and believes. 

I would guess that this is not the answer you 
expected to hear but having followed this 
literature for over 30 years now, my first choice 
to prescribe would be conjugated estrogens. with 
the other estrogen products being a second choice 
under various circumstances. I would guess my 
thoughts are the same as the majority of 
gynecologists prescribing estrogen replacement and 
is the same reason why women seek so many non 
prescription hormone replacement treatments. The 
popular news media has done women a great 
disservice by selective reporting in my opinion. 

4. Low birth weight infants from infertility treatments
Women who undergo infertility treatments such as 
ovulation induction, in vitro fertilization and 
other advanced reproductive technologies always 
have a higher risk of twin and higher multiple 
pregnancies such as triplets, quads etc. Because 
multiple pregnancies often result in premature, 
low birth weight infants, women undergoing these 
treatments are at higher risk of having premature, 
low birth weight (below 5 1/2 lbs/2500 kg) babies. 
It has not been clear, however if the risk is only 
due to multiple pregnancies or whether singleton 
pregnancies are also at the same risk for lower 
birth weights. 

This study below looked at over 42,000 infants 
born to women who received infertility treatments. 
They compared those children to over 3 million 
children born in the U.S. in 1997. The expected 
low birthrate rate was about 7.2% in the general 
population. In women undergoing infertility 
treatment, the low birth rate in singleton 
pregnancies was 13.1% which is almost twice as 

This is not a reason for a woman to avoid 
infertility treatment but it is one of those 
factors that should be taken into account. Women 
who are just very anxious to start fertility 
treatment before having an adequate trial of 
attempting pregnancy should consider all of the 

Low birthweight infants from infertility treatments

5. About prostate cancer
Men have a high frequency cancer just like breast 
cancer in women. Prostate cancer is the most 
common cancer in men and the second leading cause 
of cancer deaths in men. Actually it is a some 
what slow growing cancer and may be present in 
many men by age 50 and by age 80 one in every two 
men may have prostate cancer cells in their body. 
Men often die with it but not necessarily because 
of it. 

The prostate gland is a walnut sized gland that 
surrounds the tube from the bladder, through the 
penis to the outside. It manufactures semen for 
sperm. Symptoms of prostrate cancer often come 
from the mass effect of a growth that is enlarging 
in the prostate gland and compressing urinary 
tract outflow: 

difficulty urinating
slow urine stream and dribbling
irregular flow of urine stream
urinary urgency both day and night
painful urination
blood in urine
painful ejaculation during sex

Early in the course of prostate cancer there are 
often no symptoms, so to detect it early, 
screening exams are needed. The two major screens 
are the digital rectal exam done by the doctor 
during the physical exam to feel the size and 
shape of the prostate gland through the rectal 
wall, and a blood test called the prostate 
specific antigen (PSA). This antibody test is not 
limited to only prostate cancer; any prostate 
infection, cancer or even just benign enlargement 
can cause an abnormal result. If a man has either 
an elevated PSA test or an abnormal finding on the 
doctor's rectal exam other imaging studies will be 
needed such as ultrasound, MRI, bone scan and then 
a biopsy of the gland itself. 

Cancer of the prostate can be treated well with 
surgery or radiation therapy if it is found early. 
Large tumors often need to be shrunk with hormone 
therapy such as Lupron (R) or other anti-hormone 
medications that block testosterone. The American 
Urological Association and the American College of 
Radiology recommend annual digital rectal exams 
and PSA blood test screening beginning at age 50 
and annual PSA screening beginning at age 40 for 
African-American men and other men with a positive 
family history of prostate cancer. 

When you get your annual mammogram test and 
physician breast exam, remind any men close to you 
that it is their turn to suffer the screening test 
that can save their lives. 

At home prostate cancer screening test
6. Health tip to share - Breast cancer without lumps
Why don't most people know you don't have to have 
a lump to have breast cancer?   My daughter was 
diagnosed with inflammatory breast cancer 4 plus 
years ago .. she continues to do amazingly well.  
With the proper diagnosis and treatment lives can 
be saved. " 

"Just knowing there is more than one type of 
breast cancer and you don't have to have a lump to 
have breast cancer can literally save lives.  
Inflammatory breast cancer is too commonly 
misdiagnosed as mastitis and after ten days the 
patient should have a biopsy.  Public Awareness of 
inflammatory breast cancer and it's symptoms are 
vital not just for the general public but for 
physicians, nurses, technicians, etc. " - M. K. 

If you have discovered ways of coping with a 
disease or condition and it works for you, please 
share it with us: 

Health tip suggestion form

7. Humor is healthy
The following list of phrases and their 
definitions might help you understand the 
mysterious language of science and medicine. When 
you hear the news media interview or quote a 
physician or scientist and they say... it may 

"It has long been known" ...  
I didn't look up the original reference.

"A definite trend is evident" ...  
These data are practically meaningless. 

"While it has not been possible to provide definite answers to the
questions" ...  
An unsuccessful experiment, but I still hope to 
get it published. 

"Three of the samples were chosen for detailed 
study" ...  
The other results didn't make any sense. 

"Typical results are shown" ...  
This is the prettiest graph.

"These results will be in a subsequent report" ...  
I might get around to this sometime. 

"In my experience" ...  

"In case after case" ...  

"In a series of cases" ...  

"It is believed that" ...  
I think.

"It is generally believed that" ...  
A couple of others think so, too.

"Correct within an order of magnitude" ...  

"According to statistical analysis" ...  
Rumor has it.

"A statistically oriented projection of the 
significance of these findings" ...  
A wild guess. 

"A careful analysis of obtainable data" ...  
Three pages of notes were obliterated when I 
knocked over a can of pop. 

"It is clear that much additional work will be 
required before a complete understanding of this 
phenomenon occurs" ...  
I don't understand it. 

"After additional study by my colleagues" ...  
They don't understand it either. 

"Thanks are due to Joe Blotz for assistance with 
the experiment and to Cindy Adams for valuable 
discussions" ...  
Mr. Blotz did the work and Ms. Adams explained to 
me what it meant. 

"A highly significant area for exploratory study"...  
A totally useless topic selected by my committee. 

"It is hoped that this study will stimulate 
further investigation in this field" ...  
I quit. 

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

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****** Woman's Diagnostic Cyber Newsletter *******
                April 7, 2002
Biweekly from Woman's Diagnostic Cyber

1. Pulmonary hypertension-High blood pressure of the lung
2. FDA advisory about Kava Kava herb
3. Reader submitted Q&A -  Aspirin for heart protection
4. Stress reduction techniques
5. At what age should I get a test for colon cancer?
6. Health tip to share - Coffee and high blood pressure
7. Humor is healthy

If you change your email address, don't forget to 
re subscribe using the new address. 

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

The next newsletter will be in two weeks. 

1.  Pulmonary hypertension - High blood pressure of the lung
Not all hypertension is the same. The body has two 
different networks of blood vessels that are under 
different resting tone control. Blood is pumped 
from the heart to the lungs to receive oxygen and 
then back to the heart. From there, blood is 
pumped all over the rest of the body. The blood 
flow to the lungs is a lower pressure system and 
normal systolic ranges are 14-40 mm Hg. This 
compares to a systolic pressure of about 80-135 mm 
Hg in the rest of the body. 

Hypertension is a tightening in the diameter of 
blood vessels somewhat like pinching a water hose 
and restricting the flow of water from the hose 
nozzle. Both types of hypertension make the heart 
pump harder and can lead to heart failure over 
time. While systemic hypertension is most often 
due to atherosclerosis, pulmonary hypertension has 
different causes. 

Drugs like fenfluramine (part of the Phen-fen for 
dieting) or cocaine can cause the lung vessels to 
constrict. Emphysema is a common cause for 
pulmonary hypertension and chronic liver disease 
(cirrhosis), AIDS, sickle cell anemia, and 
connective tissue diseases such as scleroderma and 
lupus are other conditions that can cause this.  
About 10% of the time there is a genetic 
disposition to pulmonary hypertension. Sometimes 
we just do not know what causes high blood pressure 
of these blood vessels going to the lung - we call 
that primary pulmonary hypertension. If we do know 
the cause it is called secondary pulmonary 

Symptoms of pulmonary hypertension are mainly 
those of heart failure: 

shortness of breath
difficulty breathing with exercise
racing pulse of increased heart rate
swelling of the legs or feet
a bluish color to your lips and skin 

Thus, this is a situation where you can have 
problems of heart failure even though your regular 
blood pressure measured in the arm has always 
been normal. Be sure to see your physician if you 
are at all concerned about the above symptoms. 

Pulmonary hypertension

2.  FDA advisory about Kava Kava herb

You may have heard about the warning issued by the 
FDA about the herbal supplement, Kava kava. This 
herb has traditionally been used to promote 
relaxation and induce sleep or to relieve stress 
and anxiety. Apparently there have been instances 
of liver toxicity  associated with using it. Those 
instances are rare but they have caused deaths. 

There have been about 25 reports internationally 
of liver toxicity, some even requiring liver 
transplants. There has only been one episode 
reported in the U.S. but the FDA has still given a 
warning just in case this turns out to be a real 
complication. Some other countries have taken 
action ranging from consumer warnings about the  
risks of kava use to removing kava-containing 
products from being sold at retail. 

Although this seems to be a rare occurrence, any 
woman with liver disease such as past hepatitis, 
cirrhosis or taking prescription drugs known to 
have liver toxicity would be best to avoid taking 
kava until we know more. Also anyone with any 
adverse effects thought to associated with taking 
kava kava should report these events to the FDA 

FDA Medwatch

FDA advisory about Kava Kava herb

3. Reader submitted Q&A -  Aspirin for heart protection
"Should women take one baby aspirin daily?"

"I am 50; complete hysterectomy 1 year ago; take 
Celebrex(R) daily; have mitral valve prolapse - no 
treatment.  My doctor prescribed that I take one 
baby aspirin daily, which I do, but I am beginning 
to feel uncomfortable about it. I have read that 
it increases the chance of stroke through 
bleeding, and the dose has not been proven to be 
beneficial to women." - ST 

Aspirin is a platelet inhibitor, the blood 
component that causes clotting if there is blood 
vessel injury. It has been used after heart 
attacks and strokes to prevent consequences of the 
attack or to prevent a second heart attack or 
stroke. It has also been used to prevent new heart 
attacks in men who have never had a previous 
heart problem. There are some pros and cons about 
aspirin's use in this manner. 

Your reading has been right on target and the 
answers are not yet clear. Almost all of the 
studies have been carried out with men as the 
subjects and proven beneficial in those men, ages 
45 - 70  who are at low risk for coronary events. 
The studies show a reduction of about 20 - 30% in 
the rate of non-death producing heart attacks. In 
other words, taking aspirin does not prevent 
deaths but it will reduce the number of total 
attacks. For men who already had high blood 
pressure, this treatment did not have a positive 
or negative effect. 

As to the dose of aspirin used in the studies, 
anywhere from 50 mg to more than a full aspirin 
tablet (325 mg) have been used. So the lowest 
effective dose is not yet clear and we know that 
as you increase aspirin ingested, the bleeding 
problems may also increase. This makes us worry 
about possible brain attacks (strokes) from any of 
the doses, but especially the higher doses. That 
is why doctors have settled on the lower 80 mg 
aspirin dose or what has been called a "baby 

The overall incidence of strokes in men at low 
risk did not go down as the heart attacks went 
down. It was expected that the incidence of blood 
clot (thrombotic) strokes would go down if heart 
attacks went down because the mechanisms of 
clotting should be similar but there were some 
more bleeding (hemorrhagic) strokes that offset  
the thrombotic strokes so the overall incidence 
did not go down. That is where you heard that 
hemorrhagic strokes increased on aspirin but you 
really can't go by that because one merely 
balanced the other. I believe the consensus now is 
that the baby aspirin reduces non-fatal heart 
attacks by about 25% and does not increase or 
decrease the overall incidence of strokes in men 
who are at low risk for heart problems. 

Women tend to be about 10 years later than men in 
starting their heart attacks so it has been 
recommended as a cardiac event preventative in 
women over age 50 who are not already at high risk 
for heart problems. The truth is we will not know 
if it works in women until completion of the 
Women's Health Study in 2004 which is testing low 
dose aspirin and vitamin E for cardiac protection 
in a randomized, controlled trial.

Before you decide whether or not to continue 
taking the baby aspirin a day (or every other 
day as the Women's Health Study is doing), keep in 
mind that while aspirin may reduce the cardiac 
events by about 25%, a Mediterranean diet 
consisting of olive oil, pasta, fruits, 
vegetables, fish, and wine, is also associated 
with a low rate of cardiovascular events (over 35% 
reduction).  There are probably many healthy 
habits that can reduce your risk for heart attacks 
just as much as an aspirin can. 

4. Stress reduction techniques
Stress and anxiety can cause medical problems if 
left unchecked. It is essential to learn how to 
reduce stress for your own long term health. 

There are basically two ways to attack stress. One 
way is to identify exactly what is the trigger 
that causes stress and change your thought process 
to minimize your own emotional reactions to the 
trigger. This is extremely difficult to do on your 
own because it takes a constant effort and insight 
as to what your emotional thought process really 

The second stress attack method is to use anti-stress 
techniques to relax your mind and the body's 
physiological response to that stress. This is 
very successful as a stress buster and anyone can 
do it. While stress relaxation only treats the 
symptoms and not the cure, it is a very useful 
tool in our everyday lives. 

The preface to any relaxation technique is to 
reduce your mental load "to do" list. Most of us 
get aggravated by overloading ourselves with tasks 
and errands. Make a written list for the day and 
then eliminate those tasks you don't absolutely 
have to do. Just put the essentials on the list. 
Secondly, you need to create a good ambience for 
stress relaxation. Quiet spaces, soft music, 
outdoor light or cozy corners help set the stage. 

Immediate techniques to handle  stress might 

relaxed breathing
counting to 10
muscle isometrics
facial massage
laughing or crying

End of the day relaxation activities might 

warm bath
warm drink
sit in the sun

Finally, remember to get enough sleep and 
exercise. Finding a daily 30 minutes for some 
physical activity is difficult due to anxiety and 
overloading your daily tasks but if you have no 
time for exercise, that is the time you need it 
the most. You may want to look at this site that 
has some practical tips. 

Stress reduction techniques

5.  At what age should I get a test for colon cancer?

Current screening recommendations are divided into 
those for women and men at low or average risk for 
colon cancer versus different recommendations for 
those at higher risk. Most people are at average 
risk if you do not have a family history of colon 
or rectal cancer, hereditary non polyposis 
colorectal cancer, familial adenomatous polyposis 
or ulcerative colitis. 

While there are different recommendations from 
different agencies and organizations, the essence 
of them are that all low to average risk women 
and men aged 50 or older should be screened for 
colorectal cancer with yearly fecal, occult blood 
testing (FOBT), a flexible sigmoidoscopy every 
five years, or both. 

Fecal occult blood testing involves a smear on a 
piece of special paper of a stool specimen from 
the glove after a rectal exam by the doctor or 
nurse. This is then tested by adding a drop of a 
special dye. A color change indicates blood in the 
stool. Another FOBT method is to drop a dye 
impregnated piece of paper in the toilet after a 
bowel movement and to look for a color change that 
would indicate  blood in the stool.  These at home 
tests are available on the internet or at some 

The flexible sigmoidoscopy test requires you to 
have a bowel prep in which you take laxative 
agents to clean out the stool in your colon and 
rectum. Then in the doctor's office or sometimes 
in the outpatient hospital surgical suite, you are 
given sedation (but not put asleep) and a cord-
like, well-lubricated scope is placed into the 
rectum and threaded up the colon to visualize any 
polyps or cancer areas. 

You are at high risk for colon or rectal cancer if 
you have one or more parents, brothers, sisters or 
children (first degree relatives) with a history of 
colon cancer. If that relative was diagnosed with 
cancer at age 55 or greater, then you should have 
the sigmoidoscopy every 5 years, FOBT testing 
annually or both, STARTING at age 40. If that 
relative was under age 55 when diagnosed, or if 
you have two first degree relatives with 
colorectal cancer, you need to have the complete 
colon exam every 5 years starting at age 40 or 
starting 10 years before the age at which the 
youngest relative was diagnosed with colon cancer. 

Those are some helpful guidelines for preventative 
medicine and screening for colon and rectal 
cancer. But what if you get symptoms? Which 
conditions warrant immediate testing for colon 
cancer? The following circumstances should alert 
you to see your doctor for further testing. 

unexplained iron deficiency anemia
any rectal bleeding of undetermined cause
sudden narrowing of the caliber of bowel movements
anyone with long-standing (> 8 years) chronic 
  ulcerative colitis or Crohn's Colitis 

Colorado guidelines for colon cancer screening

Recommendations for different at risk groups

6. Health tip to share - Coffee and high blood pressure
Coffee drinking can raise the blood pressure 
slightly but on the average, it does so by less 
than 1 mm systolic and 1 mm diastolic. Drinking 
less than 5 cups of regular coffee per day does 
not cause long term hypertension. Caffeine in any 
amount, however, worsens fibrocystic breast 
disease, PMS and just plain stress. 

Coffee and hypertension

If you have discovered ways of coping with a 
disease or condition and it works for you, please 
share it with us: 

Health tip suggestion form

7. Humor is healthy
Inner Strength

If you can start the day without caffeine or pep 

If you can be cheerful, ignoring aches and pains, 

If you can resist complaining and boring people 
with your troubles, 

If you can eat the same food everyday and be 
grateful for it, 

If you can understand when loved ones are too busy 
to give you time, 

If you can overlook when people take things out on 
you when, through no fault of yours, something 
goes wrong, 

If you can take criticism and blame without 

If you can face the world without lies and deceit, 

If you can conquer tension without medical help, 

If you can relax without liquor, 

If you can sleep without the aid of drugs, 


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****** Woman's Diagnostic Cyber Newsletter *******
                April 21, 2002
Biweekly from Woman's Diagnostic Cyber

1. Body piercing and tattoos
2. Diabetes dangers in women
3. Reader submitted Q&A - Rectal pain
4. Postpartum Depression
5. Dementia treatment to improve quality of life
6. Health tip to share - Pill identifier
7. Humor is healthy

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

The next newsletter will be in two weeks.

1.  Body piercing and tattoos
Rings through body parts or dye injected in 
various areas of skin are assaults on our 
protective barriers that can become infected, 
bleed, or even tear. Besides bacterial infection, 
those who get tattoos are at risk for hepatitis C. 
In fact women with tattoos have a 6 times 
increased incidence of hepatitis C. The Red Cross 
will not allow someone recently tattooed to donate 
blood within a year of the tattoo procedure. 

Other infections include HIV, tuberculosis and 
tetanus. These can originate from instruments and 
needles that are not sterilized. Piercing guns for 
earrings and body rings are notorious for 
introducing skin infection since they are not easy 
to sterilize. Also you have to watch out for rings 
and posts that are allergenic. Many irritative 
metals promote infection. Only use stainless steel 
(300 series), gold, niobium, titanium or platinum 
that has been sterilized in the autoclave. 

Some women will pierce their tongue, nipples or 
genitals with the intent of increasing sexual 
pleasure for themselves and their partners.  The 
problem is that bacteria from the other person 
gets in the pierced holes and commonly leads to a 
chronic infection that causes pain and permanent 

If you are going to get a tattoo or have a body 
part pierced, be sure to check out the cleanliness 
of the establishment. The person who does the 
piercing or tattoo art should wear gloves. 
Instruments should be soaked in disinfectants or 
processed in a sterilizer machine (autoclave). 
They should be willing to discuss health and 
safety issues as well as the training they have 

Finally, when you have had enough of body art 
display and want it removed, see this article at 
Mayoclinic.com for tips on removing the tattoo 
with excision, laser surgery. dermabrasion or 

Body piercing and tattoos: More than skin deep

2.  Diabetes dangers in women
Both patients and doctors have a tendency to  
treat diabetes lightly. After all, it is quite 
uncommon for someone to die in insulin shock or a 
high blood sugar crisis. To most people without 
diabetes the condition seems to be only 
associated with complications in the later years 
of life. 

But did you know that women have diabetes more 
frequently than men and they are at greater risk 
for diabetes-associated heart disease and 
blindness than men are?  Not all women with 
diabetes develop heart disease but almost half do. 
And women with heart disease die from heart 
attacks more frequently than men do. Whether this 
is because the degree of heart disease is 
underdiagnosed in women or because they just have 
an inherently increased cardiovascular reaction to 
the diabetes compared to men is unknown at 

A major effect of early diabetes is to reduce 
sexual functioning in both men and women. In men, 
the diabetes effects sexual functioning through 
the vascular and local nerve systems making it 
more difficult for men to have an erection. 
Diabetes has a different effect on women's 
sexuality though. For them, sexual health becomes 
impaired more by depression and frustration with 
diabetes treatment than it does by effect on the 
local vascular and nerve system of the genital 
tract. Feeling unhealthy, afraid or unattractive 
causes more sexual dysfunction from diabetes in 
women more than it does in men. 

The answer to this potential health problem is 
early detection and aggressive early treatment 
including weight reduction along with  medications 
to improve sugar tolerance. If you have ever been 
diagnosed with gestational diabetes (sugar 
intolerance during pregnancy) or polycystic 
ovarian syndrome, it is especially important to 
maintain your ideal body weight and frequently 
check for diabetes or pre-diabetes through special 
tests from your physician. 

Diabetes dangers in women

3. Reader submitted Q&A - Rectal pain
"Do you have any information on the disease called 
Levator Ani syndrome?  How can it best be treated?  
Are there any natural supplements that could help 
treat it?  Is there a web site on the disease?" - 
E. T. 

Levator syndrome is a condition in which there are 
muscle spasms in the rectum that produce pain. The 
episodes of spasm may last several seconds or 
many minutes at a time. In severe cases the pain 
can last for hours. The pain is unrelated to 
having a bowel movement and it is more likely to 
be associated with sitting or just occur randomly. 
This problem also goes under other names such as 
proctalgia fugax or coccydynia. 

The pain can easily radiate to front of the pelvis 
where the bladder is, the perineum, buttocks and 
even the legs. Thus it can mimic back, pelvic and 
urologic disease so sometimes the presentation is 
not as straight forward as it seems. To diagnose 
this condition. the doctor needs to perform a 
vaginal and a rectal exam to put pressure on the 
various muscles of the pelvic floor to see where 
the pain is originating from. To see if the tail 
bone (coccyx is a major source of the pain, an 
injection of local anesthetic and steroid into the 
joint of the coccyx and the sacrum may need to be 
performed. Almost instant pain relief from this 
injection would confirm that the coccyx is the 
main source of pain. 

No one knows the cause of the muscle spasms. In 
some cases it has even been proposed that the 
muscles in spasm are the lower colon and not the 
anal sphincter muscle. In that case this would be  
a variant of irritable bowel syndrome. Others 
believe that prolonged sitting on a soft seat that 
puts pressure on the tail bone (coccyx) can be a 
major cause of this problem. 

Treatment is mostly symptomatic for this benign, 
but painful condition. Heat from a sitz bath or a 
mild analgesic pain medicine is used. Sometimes 
muscle relaxants such as Valium (R) or Xanex (R) 
are needed. Anal sphincter massage can also be 
used to reduce the spasm and physical therapy, 
involving a mild electrical stimulation to the 
muscles can be helpful, in decreasing recurrences 
of these spasms. 

I do not know of any natural products that have 
been tested on levator ani syndrome. It would make 
sense, however, to try calcium and magnesium 
supplements which sometimes help muscle spasms in 
general. Peppermint is thought to help bowel 
spasms in general and might also be worth a try. 
It should not be harmful for this at least. 

Finally, I could not find a web site that is 
dedicated primarily to levator syndrome.  It is 
not a common problem so there is not a big 
collection of experience that I know of. The best 
course is probably to find a gastroenterologist, a 
colon and rectal surgeon or a urogynecologist who 
will work with you on trying various approaches to 
this unusual problem. 

4. Postpartum Depression
There is a very good reason to know about 
postpartum mood illness even though you may never 
have a future pregnancy yourself. It is not to 
diagnose your own health that this knowledge is 
important; it is to help relatives or friends. 
When postpartum depression strikes, a woman is 
unable to lift herself out of the depths of 
sadness, lack of energy, or guilt feelings. While 
she may think she can fight it on her own, she 
can't. Control over actions and thoughts is lost 
and she needs someone to look out for her until 
significant time passes. 

Probably 60-80% of women have some degree of 
"postpartum blues" over the several weeks 
following delivery of the baby. For most women 
this period passes without significant long term 
effects or permanent harm to the mother or baby, 
but it does not mean that it is not a painful 
period to experience. Both our culture and 
physicians seem to be unconcerned about postpartum 
blues. Everyone seems to focus only on the 
extreme case in which there is a full blown 
postpartum psychosis that results in a mother 
harming herself or her child. 

Actually there is a category between mild "blues" 
that last for several weeks or so and a full 
psychotic loss of reality. Let us call this 
"postpartum depressive illness" or "chronic 
depressive disorder", realizing it is but a part 
of the collection of postpartum depression that 
also includes "blues" as well as "psychosis". It 
is still poorly defined but is characterized by 
"despondency, tearfulness, feelings of inadequacy, 
guilt, anxiety, irritability and fatigue." 

This postpartum depressive illness  category 
probably comprises about 5-20% of women after 
delivery but it is the group that you can help the 
most just by recognizing that it exists. These 
women rarely seek help on their own. While over 
90% of them realize something is greatly wrong, 
less than 20% report it to a health care provider. 
To understand it, you may want to read this book 
by Marie Osmond: 

Behind the Smile: My Journey Out of Postpartum Depression

What you can do to help is to ask questions of the 
new mother each time you see her: 

What is her energy level?
Has she worried about harming herself or the baby?
Does she feel hopelessness?

If any of these are yes, she needs to see a 
professional right away.
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