Womens Health

Women's Health Newsletters 5/4/03- 7/13/03



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****** Woman's Health Newsletter *******
              May 4,  2003
Biweekly from BackupMD on the Net

1. How common are uterine fibroids
2. Body piercing incidence and risks 
3. Reader submitted Q&A - Perimenopause
4. Oral contraceptives and voice quality
5. Health tip to share - Nail splitting
6. Humor is healthy

The next newsletter will be in two weeks.

1. How common are uterine fibroids

Whenever a woman has any pelvic discomfort or 
abnormal menstrual bleeding, there is a tendency 
for physicians to order immediately order pelvic 
ultrasound imaging studies even though the pelvic 
exam may be normal. The ultrasound is more 
sensitive in finding pelvic anatomical 
abnormalities than a physician's standard bimanual 
pelvic exam. Often the ultrasound is so sensitive 
that it picks up minor abnormal findings that are 
not really causing symptoms. 

There can be so many "abnormal" but insignificant 
findings that these findings are often wrongly 
"blamed for the symptoms. This is often true of 
cystic areas in the ovaries that are merely normal 
ovarian follicles but are labelled as "ovarian 
cysts" by the radiologist. Small fibroids (smooth 
muscle growths of the uterus) are another common 
finding on ultrasound that are often incidental 
and not the cause of pain or bleeding which the 
doctor is looking for. 

If fibroids in the uterus were uncommon, then it 
might be more likely that if they are found they 
might be causing symptoms. However, fibroids under 
2 inches in diameter are very common in the uterus 
so it makes sense that many ultrasound studies are 
going to find them and mislead both the woman and 
the doctor into thinking that they are the cause 
of symptoms. 

How common are fibroids as detected by pelvic 
ultrasound? One recent study using pelvic 
ultrasound in asymptomatic women in the U.S. aged 
35-49 found that over 50% of women who did not 
have a previous diagnosis of fibroids did have 
fibroids on ultrasound exam. This study estimated 
the cumulative incidence of fibroids by age 50 was 
over 80% in black women and over 70% in white 
women. Thus the answer is that fibroids are very 
common. They are slightly more common and occur 
earlier in black women. 

The bottom line is to not always blame a fibroid 
or let yourself be treated with a medical 
procedure for a fibroid just because an ultrasound 
report indicates a fibroid is present. Discuss 
carefully with the doctor as to whether the 
fibroid is likely playing a role in whatever 
symptoms you might have. 

Incidence of Fibroids 

2. Body piercing incidence and risks

Body art that includes tattoos and skin piercings 
for rings other than those in ear lobes is quite 
common today. One study of college students 
indicated that over half of women and almost half 
(42%) of men admitted to having various parts of 
their bodies pierced. These included lips, 
tongues, eyebrows, nose, nipples, navels and 

About one in seven students reported that they had 
complications such as bleeding, infection and 
local trauma. Surprisingly, none of them reported 
viral infections such as hepatitis and HIV. About 
a quarter of both men and women indicated they had 
tattoos but again none reported complications from 

Other studies have indicated that both body 
piercing and tattooing are risk factors for viral 
hepatitis both B and C. The authors of the article 
below recommend single use instruments (i.e. 
sterilized but disposable) be used if you want to 
have a tattoo or body piercing. They also 
recommend that people who perform the piercing or 
tattooing be vaccinated for hepatitis B. 

There is about a 10% incidence of bacterial 
infection and another 10% incidence of local 
tissue trauma or bleeding with piercings so be 
careful when having it done. 

Body piercing

3. Reader submitted Q&A - Perimenopause

"Are there specific signs that indicate whether or 
not a woman going through perimenopause is 
actually entering menopause?  Why does breast 
tenderness occur at this time and when does it 
end?" - Anonymous 

Perimenopause is a period of time, usually about 
4-5 years, before total cessation of ovarian 
function. Because ovarian follicle development 
during this time  is not quite as normal as it is 
earlier with respect to the amount and timing of 
estrogen and progesterone secretion, menopause-
type symptoms can occur during this period. 

Normal menopause symptoms vary from woman to woman 
but generally include hot flashes, night sweats, 
sleep difficulties and vaginal dryness. 
Additionally, because a perimenopausal woman is 
still having menstrual bleeding, the bleeding 
pattern can be irregular with either skipping 
menses or extra or prolonged, heavy menses. 

I am not aware that breast tenderness is a 
perimenopausal symptom. Rather it is more likely 
to just be an age progression of fibrocystic 
breast change. You have to be very careful of any 
caffeine intake which makes breast pain worse. 

Other than symptoms, the only objective way I know 
to suspect perimenopause is to measure FSH 
(follicle stimulating hormone) levels. Values of 
10-25 IU/ml are very suspicious for perimenopause 
unless it is drawn in midcycle while you are 
ovulating. Therefore, drawing a blood (serum) FSH 
level within about a week of the start of a menses 
and finding a value of over 10 IU/ml is a fairly 
good indication you are in the perimenopause. 

Estrogen levels do not seem to be reliable because 
the range of normal is so wide. 

Perimenopause ends when the ovaries (and menses) 
stop altogether. Average age is about 50 but it 
can often be as much as 56-57. 

Doctors often prescribe very low dose oral 
contraceptive pills during the perimenopause to 
even out the natural hormonal fluctuations. These 
are only used in women who are non-smokers and 
have not had thrombosis problems on the pills. 

4. Oral contraceptives and voice quality

Not being a singer, I was unaware of the rumor 
that high dose birth control pills caused an 
instability of the tonal range of the voice. Of 
course it had not been studied scientifically 
because there were not complaints of this problem 
among women patients. 

One study done in Israel in 2002 looked at women 
taking and not taking birth control pills and 
performed acoustic analyses on recordings of vowel 
pronunciations over a 40 day period. They found 
that the jitter and shimmer values of the pill 
group were significantly lower than those of the 
natural group although there was no difference in 
the  F0, amplitude, and harmonic-to-noise ratio. 

In their follow-up study reported recently they 
concluded that "specifically, amplitude and 
frequency variations between successive vocal 
cycles were smaller in women using oral 
contraceptives in comparison with the control 
group (.24 dB versus.37 dB and 0.86% versus 1.27% 
for amplitude and frequency variations, 

I am not sure if these are meaningful differences 
but would have to conclude that low dose birth 
control pills would not worsen voice variability 
in women who depend upon a consistent voice tone 
quality for a living and they may even make the 
voice quality more consistent. 

Do oral contraceptives improve vocal quality?

5. Health tip to share - Fingernail splitting

"Regarding the problem with splitting nails in the 
April 20 Newsletter, I had this problem and my 
doctor said to use "Hard As Hoof" cream. It 
stopped my problem within three weeks. I applied 
it several times a day and every time I washed my 
hands. It strengthened the nails and softened the 
"I am a 73 year old male and all ten of my finger 
nails were splitting to some degree but the worst 
were the thumbs. This product is available in the 
handcare products area of most drug or cosmetics 
stores." - IR

6. Humor is healthy

"Birthday/Anniversary Card"

A gentleman entered a stationery store and asked 
the clerk for a birthday/anniversary card. 

The clerk replied, "We have birthday cards and
we have anniversary cards. Why not take one
of each?"

The man said, "You don't understand. I need
a card that covers BOTH events! 

You see,
we're celebrating the fifth anniversary of my
wife's thirty-fourth birthday..."

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

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****** Woman's Health Newsletter *******
                 May 18,  2003
Biweekly from BackupMD on the Net

1. Peanut allergy from skin cream
2. Internet and email use for health care
3. Reader submitted Q&A - Perimenopause Weight gain
4. Acetaminophen for high altitude headaches
5. Health tip to share - Communication with physicians
6. Humor is healthy

1. Peanut allergy from skin cream

Peanut allergies can develop at a very early age. 
In a child, the allergy can present anywhere from 
a mild rash to a life-threatening allergic 
response to ingested foods containing any peanut 
products. It is estimated that one in 150 adults 
has a peanut allergy and children who are thought 
to "outgrow" an allergy to peanuts can have it 
reemerge as adults. 

Other than a family history of peanut allergy or 
recurrent, itchy skin rashes (atopy), there are no 
known risk factors that can predict who will 
develop or manifest these allergies. A recent 
study from London looked at almost 50 children 
with confirmed peanut allergies and compared them 
with a group of control children to see if they 
could find any other risk factors to predict it. 

They found that a history of use of soy milk or 
soy formula as infants, rash over joints and skin 
creases and oozing, crusted rash were independent 
risk factors for peanut allergy. In addition,  
there was a significant independent relation of 
peanut allergy with the use of skin preparations 
containing peanut oil. 

The investigators postulate that use of skin 
creams and other products on children that have 
peanut oil in them may have caused the allergic 
sensitization to peanuts when the creams were 
absorbed into the blood stream through damaged 
skin. This may or may not be the cause of peanut 
allergy but it warrants caution in using any 
peanut oil containing skin products in children. 

Factors associated with the development of peanut allergy in childhood

2. Internet and email use for health care

Readers of this newsletter are no strangers to 
obtaining health information over the Internet. 
Nationally, however, it is not clear how many 
people use the Internet for health information 
that actually alters their utilization of doctor's 
visits, lab studies, pharmacy use and 
hospitalizations. Surveys indicate many people 
look up health information on the net but no one 
knows whether it really saves (or even increases) 
any medical expenses. 

The following article in the Journal of the 
American Medical Association (JAMA) reports a 
survey conducted in 2002 of over 4700 individuals 
21 years of age and older who were self-reported 
Internet users. They found very little impact of 
the Internet on the utilization of standard health 
care facilities. Almost 95% said that Internet use 
had no effect on the number of physician visits 
they had nor did it have any effect on the number 
of medical office telephone contacts. Only about 
5% reported use of the Internet to obtain 
prescriptions or purchase pharmaceutical products 
and about the same amount indicated they had ever 
used email to communicate with a physician. 

This has been somewhat surprising since physicians 
have long been told that almost 80% of office 
visits are predominantly for medical information. 
I would have thought that the massive volume of 
medical and health information on the Net would 
perhaps decrease the number of doctor's visits but 
maybe it just seems to make individuals better 
informed medically without eliminating any 
doctor's visits. 

At BackupMD we have offered medical educational 
consults by email since 1998 but there are many 
barriers to utilization of this type of service. 
Insurance companies have been slow to reimburse 
adequately for such Internet health visits and 
many people would still rather take off a quarter 
or half day of work for a doctor's visit just so 
they do not have out-of pocket expenses. 
Physician's trade groups such as state medical 
associations and licensure boards prohibit health 
visits by email unless it is between an existing 
patient and the doctor who has previously 
performed a physical exam and established a 
doctor-patient relationship by a physical office 

In a way, these are good rules that prevent 
quackery medicine from being practiced over the 
Internet but the rules also block legitimate 
access to 2nd opinions for questions that do not 
require a physical exam or additional laboratory 
or radiological studies. It really remains to be 
seen if the Internet can significantly alter (and 
hopefully improve) health care over the long run. 

Internet and email use for health care

3. Reader submitted Q&A - Perimenopause Weight gain

"Will eating 2 oranges a day make me gain weight? 
How about birth control pills taken for a year for 
premenopause? I'm pretty sure one or the other has 
made me gain weight." -  Susan 

Both of them have probably contributed to your 
weight gain. 

Oranges are rich in vitamin C, beta carotene and 
fiber and contain about 60-70 calories per average 
size fruit. They will not cause you to gain weight 
unless they are in addition to what you normally 
eat when you do not gain weight. An extra 130 
calories, per day, however, would increase your 
weight by one pound every 28 days or about 13 
pounds in a year. If you put on more than 13 
pounds this year then it is not just from eating 
the oranges. 

Birth control pills can also increase weight by 
stimulating the appetite. They do not cause you to 
burn calories slower or slow metabolism but rather 
just make you eat more calories especially in 
snacks. This effect is thought to be due to the 
progestin component of oral contraceptives in that 
it may lower your blood sugar making you hungrier. 
It can cause carbohydrate cravings which seem to 
initially appease the low blood sugar but very 
quickly you go back to having low blood sugar (and 
snacking again) because the progestin is 
associated with insulin resistance. This means 
your circulating insulin is elevated slightly 
which quickly lowers the blood sugar after the 
simple sugar snack. 

The only way to get around the insulin resistance 
effect of progestin that some women have is to 
avoid all simple carbohydrates using an Atkins 
type diet. Taking in predominantly proteins, fats 
and complex carbohydrates provides a substrate for 
the insulin so you do not get low blood sugar and 
stimulate your appetite. Oranges have a very high 
simple sugar content (glycemic index) which 
aggravates the problem rather than helping it. 

The only medical condition that slows metabolism 
is hypothyroidism. You may want to have your TSH 
checked since women have an increased incidence of 
hypothyroidism near the menopause. OTherwise it is 
calories-in versus calories-out that governs 
weight gain or loss. 

4. Acetaminophen for high altitude headaches

At higher altitudes there is a lower amount of 
oxygen in the air and many people suffer headaches 
know as mountain sickness. Nausea often 
accompanies the headaches and each year over 7 
million people visit, ski or hike into altitudes 
over 6500 feet where acute mountain sickness may 
be severe enough to limit activity. 

Traditionally ibuprofen (Advil(R)) has been the 
main medication used for skiers and hikers to 
treat the headaches until the body becomes 
accustomed to the lower oxygen levels. This 
article reports that acetaminophen (eg., 
Tylenol(R)) is just as effective for the headaches 
and it does not aggravate the nausea as ibuprofen 

While not an earth-shaking medical discovery, this 
reminds us to take precautions and perhaps carry a 
small bottle of acetaminophen when visiting Mt 
Mitchell in the East or the Rockies in Colorado or 
other mountains over 6000 feet. The author also 
reminds us that when we are in high altitudes, we 
should not continue to ascend if we develop 
symptoms such as worsening headaches, shortness of 
breath and confusion. 

Acetaminophen Fights High-Altitude Headaches

5. Health tip to share - Communication with physicians

"Physician and patient communication: Patients 
should always have written questions to ask 
physicians after any procedure or testing ordered, 
and prescriptions.  Educate yourself concerning 
your health.  If you find the physician is not 
willing to allow time to talk to you in more 
detail, I would suggest that you find another 
physician that will.  How will you know if other 
physicians in a particular area allow more time 
for patients? Ask around and explain your 
concerns; then most patients have a sound feel for 
physicians who are not troubled by patients asking 
questions and obtaining information so that you 
can be more informed and have a better 
understanding about your health." - Kelly 

6. Humor is healthy

"Effective Communication"

A widow, recently married to a widower, was 
accosted by a friend who laughingly remarked, "I 
suppose, like all men who have been married 
before, your husband sometimes talks about his 
first wife?" 

"Oh, not any more," the other woman replied.

"What stopped him?" asked the first.

"I started talking about my next husband,"
replied the second woman.

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

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****** Woman's Health Newsletter *******
              June 1, 2003
Biweekly from BackupMD on the Net

1. Rectal cancer and hospital treatment
2. Food allergies
3. Reader submitted Q&A - Dark under eye circles
4. Iron supplementation for fatigue
5. Health tip to share - Prevent tennis elbow
6. Humor is healthy

1. Rectal cancer and hospital treatment

The rectum is the area of the bowel that extends 
from the anus on the outside for a distance of 
about 4 inches (10 cm) into the bowel where it 
continues as the sigmoid colon. It is the area 
responsible for eliminating stool (defecation) and 
any gas that collects in the bowel tract. In 
women, the rectum lies just below the vagina and 
in men just below the prostate gland. 

Rectal cancer usually occurs after age 50. It is 
often lumped together with colon cancer (from the 
bowel tract higher up), but it can present 
differently from colon cancer. Rectal cancer may 
present more often with bright red rectal bleeding 
that is present even when not passing a stool. 
While hemorrhoids often produce bright red 
bleeding, they do so usually when you have a bowel 
movement. Rectal cancer, however, can cause 
bleeding in between bowel movements. A narrowing 
of the caliber (diameter) of the stool can also be 
a sign of rectal cancer. Other symptoms include a 
change in bowel movement pattern, lower abdominal 
bloating and even bowel obstruction with acute 
nausea and vomiting but these symptoms are also 
common to colon cancer higher up in the bowel 

Surgery to treat rectal cancer almost always 
includes a colostomy in which the colon is cut 
away from the rectum and the anus muscles that 
control defecation. The colon is then brought 
through the abdominal skin so that a bag needs to 
be attached to that skin to collect stool. The bag 
is needed since there is no muscle control from 
the rectum. 

One study looked at over 7000 patients with stage 
1-3 rectal cancer who had to have a colostomy as 
part of their treatment. They found that both the 
30 day (postoperative) survival from the surgery 
and the 2 year survival from the cancer were 
highest in the hospitals that did the highest 
volume of surgery for rectal carcinoma. The 
highest quartile (25%) surgical volume hospitals 
had a 30 day survival of 98.4% versus a 95.2% in 
the lowest quartile volume hospitals. The 2 year 
survival was 83.7% versus 76.6% in the highest 
versus the lowest volume hospitals. 

These findings suggest that a high volume of 
procedures may be beneficial in obtaining better 
operative and longer term cancer survival. This 
"volume/experience relationship has also been 
found with other surgical procedures and 
treatments and should be taken into account when 
seeking treatment for major medical problems. 

Rectal cancer and hospital treatment

2. Food allergies

Food intolerance and food allergies are NOT the 
same. A food allergy that stimulates the immune 
system to cause a serious reaction such as: 

hives, itching or skin rash 
swelling of the lips, face, tongue and throat, or 
   other parts of the body 
wheezing, nasal congestion or trouble breathing 
dizziness, lightheadedness or fainting 

is much more serious than a food that your body 
may be directly sensitive to resulting in nausea, 
vomiting, cramping and diarrhea. 

Food intolerance may be due to the lack of an 
enzyme such as lactose which results in many 
people having a problem drinking or eating milk or 
milk products without becoming bloated, with 
cramping, diarrhea and excess gas. Sometimes food 
may contain a toxin from bacteria that causes you 
to react adversely. This does not mean that you 
cannot ever eat that food again; it just means you 
should not eat that food when it is contaminated 
again. Mushrooms, rhubarb, and spoiled tuna or 
other fish are foods more likely to be come 
contaminated with toxins. It can be very difficult 
to differentiate an intolerance to the food itself 
or to a substance or ingredient used in the 
preparation of the food. This is especially true 
of foods containing lactose, wheat or sulfites. 

On the other hand, if you are truly allergic to a 
food such as: 

cow's milk 
tree nuts 

even a small amount could give you a serious 
health reaction. 

If you suspect that any food is causing you a 
serious allergic response, be sure to see an 
allergist to have it diagnosed thoroughly. Skin 
tests for allergies are considered the best way to 
diagnose an immune response but sometimes you may 
have much less of a reaction by just having a 
blood test known as an in-vitro allergen-specific 
IgE antibody test. There are home tests using a 
drop or two of blood from a finger stick which 
check IgE allergic sensitivities. 

Food allergies

3. Reader submitted Q&A - Dark under eye circles

"Are there any procedures that will permanently 
remove dark, under eye circles which are 

"I developed under eye circles when I went through 
puberty (around age 12)  I've used concealer to 
cover them, but I'm hoping in the modern age of 
medicine that there is some type of procedure that 
can lighten the skin under the eye.  I've seen 
those extreme make-overs on TV, but no one has had 
my problem.  I'm too young for a face-lift (I'm 
25) and I've heard that lasers are good for 
removing wrinkles only." - MCM 

There are several types of conditions causing dark 
circles under the eyes: 

1) increased pigmentation of the skin due to 
genetic background, chronic inflammation from the 
sun, treatment with Retin A, allergies, estrogens 
or any type of chronic skin irritation in the area 
below the eye. 

2) increased fine blood vessels just below the 
skin either from chronic skin inflammation or from 
the lack of fat under the skin so that just the 
blood vessels are visable.  

3) increased fat deposition in the skin (bags) 
causing a bulge below the eye that throws a shadow 
which further darkens the skin. 

Since you developed the dark circles at age 12, 
pubertal estrogen probably caused increased under 
eye skin pigmentation to which you were 
genetically predisposed, I would suspect that you 
fall in the number 1 group above. In this case 
there are sometimes depigmentation creams such as 
hydroquinone that you can get from the 
dermatologist. It is a good option as it can 
lighten the skin if that is the problem.  
Hydroquinone or Kojic acid is often used in ethnic 
and Caucasian patients to lighten the skin before 
laser treatments, peels, etc. Lasers are not only 
used to remove wrinkles; they can be used to 
remove pigment from the skin and both 
dermatologists and plastic surgeons may use them. 

It is also possible that you may have too much fat 
in the under eye skin (bags) or even too little 
fat (sunken eyes) allowing the blood vessels to 
darken the skin. If this is a contributing factor, 
you may need to see a plastic surgeon for suction 
of the fat out of the skin, or even for adding fat 
cells back to the under eye skin. You probably 
would not need a face lift at all at your age but 
the eyes may get a long lasting "eyelift" if the 
appropriate procedure is performed now. 

If you had not said that the problem started as 
early in life as it did, I would suggest you also 
look for iron deficiency anemia, sleep deprivation 
(or even excess), and vitamin and mineral 
deficiencies as well since any of them could be a 
cause of dark under eye circles. 

At your age, I would spend the money at this time 
to seek out two different medical opinions. I 
would schedule to see a local dermatologist and a 
local plastic surgeon to see what they say the 
cause is and what treatment they suggest. Do not 
accept any treatment until you have seen both of 
them for their suggestions. 

4. Iron supplementation for fatigue

Low blood count or anemia, is most commonly caused 
in women by excessive menstrual bleeding. The body 
cannot replace blood very fast if body iron stores 
are low. This leads to a special type of anemia 
called iron deficiency anemia. A low blood count 
for reproductive age women is a hematocrit of less 
than 37% and a hemoglobin measurement of less than 
12 gm%. Fatigue is the main symptom of iron 
deficiency anemia. 

Fatigue is also a common complaint among women, 
even ones who do not have any anemia. From 14-27% 
of the population will admit to fatigue as a 
symptom at any one time, however only 1-2% of the 
population will seek help for this. One European 
study found that up to 20% of women had a low 
serum ferritin concentration but only 4% of those 
women had a true iron deficiency anemia. In other 
words their iron levels were on the low side but 
their bodies were still able to keep up the blood 
counts to normal levels. 

Previously there had been no evidence that fatigue 
is associated with iron deficiency unless anemia 
was present. Some investigators in Switzerland 
however looked at a group of over 100 women who 
consulted doctors for fatigue but were not anemic 
and did not have other conditions that would 
explain the fatigue. In other words they had 
unexplained fatigue. Over 85% of them had low 
serum ferritin levels (less than 50 µg/l). The 
investigators gave half of the women iron 
supplements and the other half placebo pills. They 
found a significant decrease in measurements of 
fatigue in the group who received iron 

This study suggests that when fatigue is a 
problem, doctors should check (and you should 
request) a serum ferritin level to see if iron 
supplementation may be indicated. 

Iron supplementation for fatigue

5. Health tip to share - Prevent tennis elbow
The pain of tennis elbow is on or around the bony 
prominence felt on the outside of the elbow. Pain 
may radiate down the arm. Gripping or extending 
the wrist or arm further increases the pain. 

The pain is actually caused by tiny tears in the 
tendons in your forearms that were produced by 
overuse of the muscle in the first place. 
Continued muscle overuse can prevent the tears 
from healing and produce further pain as the 
tendons become inflamed. 

In addition to tennis, other activities that can 
cause tennis elbow include everything from raking 
leaves, weed eating and repetitive hammering to 
rowing or even painting. 

The best treatment is to simply stop whatever 
activity you believe is causing the pain and give 
your tendons some time to heal. It may take 3-6 
months to totally heal and you may have to 
discontinue tennis, yard work, hammering or 
whatever until then. 

Anti-inflammatory medications such as ibuprofen or 
naproxen may help reduce the pain and 
inflammation. In time, the pain should subside and 
you should be able to return to your normal 
activities. If, however, the pain seems to be 
staying the same or worsening two to three weeks 
after discontinuing the activity, you may want to 
consult a doctor. 

6. Humor is healthy
"How To Know You're Growing Older"

-Everything hurts and what doesn't hurt, doesn't 

-The gleam in your eyes is from the sun hitting 
your bifocals. 

-You feel like the morning after, and you haven't 
been anywhere. 

-Your little black book contains only names ending 
in M.D. 

-You get winded playing chess. 

-Your children begin to look middle aged. 

-You finally reach the top of the ladder, and find 
it leaning against the wrong wall. 

-You join a health club and don't go. 

-You decide to procrastinate but then never get 
around to it. 

-Your mind makes contracts your body can't meet. 

-You need glasses... to find your teeth.

-A dripping faucet causes an uncontrollable 
bladder urge. 

-You know all the answers, but nobody asks you the 

-You look forward to a dull evening.

-You walk with your head held high trying to get 
use to your bifocals. 

-Your favorite part of the newspaper is "25 Years 
Ago Today." 

-You turn out the light for economic rather than 
romantic reasons. 

-You sit in a rocking chair and can't make it go. 

-Your knees buckle and your belt won't. 

-You regret all those mistakes resisting 

-You stop looking forward to your next birthday. 

-After painting the town red, you have to take a 
long rest before applying a second coat. 

-Dialing long distance wears you out. 

-You're startled the first time you are addressed 
as "Old Timer." 

-You remember today that yesterday was your 
wedding anniversary. 

-You just can't stand people who are intolerant. 

-You burn the midnight oil after 9 p.m.. 

-Your back goes out more than you do. 

-A fortune teller offers to read your face. 

-You get exercise acting as a pallbearer for your 
friends who exercise. 

-You have too much room in the house and not 
enough in the medicine cabinet. 

-Your sink your teeth into a steak and they stay 

-You go to the beauty shop so they can touch up 
those gray hairs...on your chin. 

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

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****** Woman's Health Newsletter *******
              June 15,  2003
Biweekly from BackupMD on the Net

1. Laser resurfacing - one way to treat wrinkles
2. High iron intake and Parkinson's disease risk
3. Reader submitted Q&A - Celiac disease
4. Stool incontinence after delivery
5. Health tip to share - Pedicures
6. Humor is healthy

1. Laser resurfacing - one way to treat wrinkles

As we and our skin age, the tautness that prevents 
wrinkles no longer holds our skin smooth. The 
tautness is due to fiber-like proteins called 
collagen and elastin. We also lose the underlying 
layer of fat in the skin and both of these 
processes together result in skin wrinkles. 

A recent laser procedure called laser resurfacing, 
has been used to remove the aged or sun-damaged 
outer layers of skin to allow younger skin (with 
its new elastin and collagen) to grow in its 
place. You may want to know if laser resurfacing 
is safe for you. 

Destroying the outer layer of skin to promote new 
growth underneath is not a recent concept. 
Dermatologists have been performing chemical skin 
peels and mechanical dermabrasions for years. The 
laser, however, is a tool that allows a more 
precise skin depth control than the other 
techniques. This is mostly an office procedure in 
which an area of skin is numbed with a local 
anesthetic and the laser is used to evaporate 
(burn off) a microscopic layer of the outer skin. 
The procedure may take from a few minutes to 
several hours depending upon how extensive a skin 
area must be treated. 

After the procedure, the skin appears red or pink 
and a with a little crust of dried secretions. You 
can have mild swelling and skin discomfort much 
like a sunburn sensation. The skin takes about 1-2 
weeks to heal although it may stay red or pink for 
up to 6 months. During this time you must avoid 
sun exposure. 

If you think you might be interested in the 
procedure which also can be used to remove scars 
and skin pigmentation spots, see the article at 
Mayo Clinic.com for more information about its 
advantages and the complications and risks 

2. High iron intake and Parkinson disease risk

Investigators from Seattle, Washington, looking 
for dietary associations, collected food frequency 
questionnaires from over 250 individuals with 
Parkinson disease. They were looking for links 
with vitamin B, anti-oxidants and fat intake which 
had previously been suspected as associated with 
Parkinson disease. They did not find any of those 

They did, however, find that a higher than average 
iron intake and manganese intake, coupled with one 
or more multivitamins or iron supplements each day 
was about 2 times more likely to be associated 
with Parkinson disease than those individuals with 
low intake of these substances. 

Now it is important for you to know that in 
Parkinson disease patients there is an increased 
deposition of iron pigments in a certain brain 
area that has been know for a long time. But other 
investigators have looked for dietary iron 
relationships and not found an association. They 
have postulated that it is not abnormal iron 
intake but rather a metabolic defect in iron 
metabolism that results in abnormal brain tissue 

There are conflicting results about iron and now 
manganese and their relationship to Parkinson 
disease. This report adds to the conflicting 
results. While we do not know the answers, I think 
we should be cautioned about taking any 
supplements that our bodies are not really 
deficient in. 

High iron intake related to Parkinson disease risk

3. Reader submitted Q&A - Celiac disease
"Could you please tell me about Celiac Disease.  
My GI specialist told me that people with Polish 
ancestry could have this disease. I am 56 years 
old, Jewish/Polish background.  I am currently 
having coughing spells every morning.  Also, I 
have heartburn." - ssc 

Celiac disease is a condition of diarrhea, weight 
loss and malnutrition among other symptoms that is 
caused by a genetic sensitivity to gluten in the 
diet that destroys cells that line the bowel 
tract. Gluten is found in  barley, oat, rye, wheat 
and other grains.  In people with celiac disease, 
gluten sets off an autoimmune reaction that 
attacks the body's own gastrointestinal lining 

While not everyone with celiac disease has severe 
symptoms of diarrhea, I am not sure that heartburn 
and coughing spells result from celiac disease. 
Coughing spells are more likely to be due to the 
heartburn. On the other hand, your GI specialist 
is aware of this and if he/she thinks your 
symptoms warrant testing for celiac disease, then 
you should go ahead. 

The test for celiac disease is a blood test that 
looks for IgA antibodies against tissue 
transglutaminase (tTG) which is found in the bowel 
lining. It is important to understand that people 
can have a food intolerance to gluten but not 
necessarily have celiac disease. If you have a 
food allergy test that is positive for glutens, 
you should then have a specific test for celiac 

As far as the genetics goes, people of Jewish 
background have a higher incidence of celiac 
disease. Therefore the bottom line is that even 
though your symptoms do not suggest celiac 
disease, you should probably have testing because 
your GI doctor recommends it. 

4. Stool incontinence after delivery

We have previously discussed accidental loss of 
stool and gas from the rectum known as anal 
incontinence. One of the causes is labor and 
delivery. It used to be thought that this was an 
uncommon occurrence after delivery. Now with 
careful questioning we find that it happens more 
often than expected. It can even take place even 
though a cesarean section was performed. It can 
happen with or without an episiotomy and with a 
forceps vaginal delivery or even without it. 

Investigators at the University of Oregon gave 
questionnaires to postpartum women at their 6 week 
postpartum visit. They found that the frequency of 
at least one fecal incontinence symptom postpartum 
was 38%. Of that group, 24% of women reported 
incontinence of gas and 10% incontinence 
of stool. Size of baby did not make a difference 
nor the number of past babies but women who had 
any perineal lacerations had a greater chance of 
having incontinence symptoms. 

We know from other studies that the incontinence 
of stool tends to go away (down to about 1%) at 9 
months to a year after delivery. Infrequent but 
occasional unintended passage of gas per rectum 
can still occur up to  25% of the time but 
decreases over time. 

It is important for all women who become pregnant 
to know that this can happen after delivery. In 
fact it can happen with or without an episiotomy 
and with or without a cesarean section; although 
admittedly it happens much less with a cesarean 

Stool incontinence after delivery

5. Health tip to share - Pedicures

An infection of the legs with boil-like sores 
caused by a mycobacterium has been associated with 
pedicures. Over 100 patrons of a nail salon in 
California acquired this infection in their legs 
as a result of exposure to foot baths contaminated 
with Mycobacterium fortuitum. 

Mycobacterium infection from pedicures

6. Humor is healthy

"Romeo and Juliet - Txt Version"

 --------- Act 1 ---------
Romeo : R u awake? Want 2 chat?
Juliet: O Rom. Where4 art thou?
Romeo:  Outside yr window.
Juliet: Stalker!
Romeo:  Had 2 come. feeling jiggy.
Juliet: B careful. My family h8 u.
Romeo:  Tell me about it. What about u?
Juliet: I'm up for marriage if u are..Is that a bit
Romeo:  No. Yes. No. Oh, doesn't matter, 2moro
         at 9?
Juliet: Luv U xxxx
Romeo:  CU then xxxx
---------- Act 2 ---------
Friar:  Do u?
Juliet: I do
Romeo:  I do
---------- Act 3 ---------
Juliet: Come bck 2 bed. It's the nightingale
         not the lark.
Romeo:  OK
Juliet: !!! I ws wrong !!!. It's the lark. U gotta
         go. Or die.
Romeo:  Damn. I shouldn't hv wasted Tybalt &
         gt banished.
Juliet: When CU again?
Romeo:  Soon. Promise. Dry sorrow drinks our
         blood. Adieu.
Juliet: Miss u big time.

--------- Act 4 ---------
Nurse:  Yr mum says u have 2 marry Paris!!
Juliet: No way. Yuk yuk yuk. Anyway, am
         married 2 Rom.
--------- Act 5 ---------
Friar:  Really? O no. U wl have 2 take potion
         that makes u look dead.
Juliet: Gr8.
--------- Act 6 ---------
Romeo:  J-why r u not returning my texts?
Romeo:  RUOK? Am abroad but phone still
Romeo:  TEXT ME!
Batty:  Bad news. J dead. Sorry m8.
--------- Act 7 ---------
Romeo:  J-wish u wr able 2 read this...am now
         poisoning & and climbing in yr grave.
         LUV U Ju xxxx
--------- Act 8 ---------
Juliet: R-got yr text! Am alive! Ws faking it!
         Where RU? Oh...
Friar:  V bad situation.
Juliet: Nightmare. LUVU2. Always. Dagger. Ow!!!


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

Back to top

****** Woman's Health Newsletter *******
              June 29,  2003
Biweekly from BackupMD on the Net

1. Bone health in women with breast cancer 
2. Laboratory blood tests to predict heart risk 
3. Reader submitted Q&A - Vitamin E for cuts/scrapes 
4. Major depressive disorder - How common? 
5. Health tip to share - Chitosan diet supplement 
6. Humor is healthy 

1. Bone health in women with breast cancer

Women with breast cancer frequently receive 
chemotherapy which can cause early menopause if 
they have not yet stopped menstruating. If they 
are postmenopausal, estrogen replacement therapy, 
which is very good for blocking osteoporosis, is 
withheld by many physicians. This makes breast 
cancer survivors at additional risk for 
osteoporotic bone thinning and breakage. 

Although this long term risk is well known by 
physicians, very few women (5%) are counselled by 
their cancer specialists about diet modification 
and supplements to maintain bone health. 
Additionally, many of the women cut down their 
intake of milk and milk products without 
compensating by taking additional calcium. 

Calcium (1000-1500 mg a day) with or without any 
vitamin D supplement can substantially help 
prevent osteoporosis. It is important for women 
who have been treated for breast cancer be 
reminded to at least take calcium supplements. It 
is also important at some time around the 
diagnosis and treatment phases to have a baseline 
bone densitometry performed in order to document 
to what degree bone mineral density changes in the 

Breast cancer patients "risking bone health"

2. Laboratory blood tests to predict heart risk

The traditional risk factors that predict heart 
disease are high blood pressure, high cholesterol, 
smoking, diabetes and lack of exercise. However 
even the above factors do not identify all 
individuals who develop heart disease. Recently, 
doctors have found that there are other blood 
tests that can be predictive of whether one 
develops heart disease or not: 

C-reactive protein 
Lipoprotein (a) 

Not all doctors check for these substances but 
some feel it is very useful for you to know if you 
have abnormal levels of these above blood 

C-reactive protein is produced in the liver and is 
an inflammatory marker. Elevation can be due to 
many immune or inflammatory conditions, so it is 
important to not use it alone as a test for 
cardiovascular disease. In women with normal 
cholesterol, elevated levels predict as much as a 
7 times increased risk. 

Homocysteine is an amino acid building block of 
foods. Sometimes an excess of homocysteine in the 
blood can predict heart problems and strokes even 
in the absence of other risk factors. The doctor 
may want to know these levels especially if you 
are a smoker but do not have any other typical 
risk factors. 

Fibrinogen is a blood protein that is involved in 
the blood clotting process. Smoking, estrogen and 
heredity can elevate fibrinogen. Doctors would 
want you to stop smoking, alter your lifestyle and 
to alter some of your medications in order to 
lower blood fibrinogen. 

Lipoprotein (a) is a blood fat. It is a low 
density cholesterol molecule that is attached to 
another blood protein. It is often elevated 
genetically. Those who have relatives who 
developed or died from heart disease before the 
age of 50 should be tested to see if their blood 
levels are elevated. 

While none of these blood test should be 
considered more important than the traditional 
risk factors, they may be indicators that provide 
more motivation for changing lifestyle and habits. 
They can then be used to monitor how well those 
changes are reducing risk. 

3. Reader submitted Q&A - Vitamin E for cuts/scrapes

"I use the fluid inside a vitamin E capsule to 
heal wounds and it speeds up the healing 
wonderfully.  I wonder if it is safe to use it for 
all the cuts and scrapes my little granddaughters 
get.  Since they are 10 years old and under I 
wonder if it is too strong for their systems." - 

For many years there have been rumors and home 
remedies advocating topical vitamin E to promote 
wound healing. Only recently have scientific 
studies actually been conducted testing topical 
vitamin E gels and ointments versus placebos. 
Unfortunately the studies have not only shown that 
topical vitamin E is no more effective than 
placebo at wound healing, but also that there is a 
skin hypersensitivity reaction to vitamin E 
products in about 15-30% of patients. Thus, I 
would not advise using the vitamin E capsules on 
fresh cuts and scrapes. 

There is some evidence that once a thickened scar 
or keloid scar has formed that vitamin E gels may 
promote a better appearance (thinning of the 
scar). This is different though than any positive 
effect on original wound healing. 

Now, you may ask why your experience (and others) 
has been positive on wound healing using topical 
vitamin E in oil. The primary factor that has been 
shown to promote healthy (small) scar healing is 
keeping the scar moist (skin hydration). If the 
skin is kept clean and moist for several weeks, 
scars are minimal. By placing the vitamin E 
capsule oil on the wound you have created that 
moisture barrier which is really what is 
responsible for promoting quick wound healing. 
Scab formation is actually undesirable. 

You may have noticed all of the "healing" and 
"scar preventing" bandages that are available 
commercially. These are based upon keeping a 
moisture barrier on the skin over the scar. In 
fact if you undergo surgery and have any tendency 
for thick scar formation, talk your doctor into 
using one of the transparent gel-like skin 
bandages that are left on for at least a week. 

4. Major depressive disorder

While depression can be experienced by anyone 
occasionally, most of the time it is not prolonged 
more than a few days. When it lasts longer than 
two weeks and takes place most of the day nearly 
every day, it is abnormal. Depression is often 
accompanied by extreme fatigue, loss of pleasure 
in any activity, irritable mood and even 
unintended weight loss or weight gain. 

Major depressive disorder alters one's family or 
work role so that normal daily activities cannot 
take place. It can lead to serious impairment in a 
life. How frequent is this condition? A recent 
national survey was conducted on over 9000 adults 
to find out how common major depressive disorder 
(MDD)is in the general population. 

The prevalence of MDD for a lifetime was 16%, 
i.e., 1 out of each 6 people have at sometime in 
their lives experienced a major depression. For 
any 12 month period, 6-7% of adults experienced 
MDD. The average duration of an episode was 16 
weeks and almost 60% of those with MDD for a 12 
month period had severe or very severe role 
impairment. Only half of the people with MDD 
received any treatment at all but less than half 
of that group had adequate depression treatment. 

Major depression appears to be common and even 
though more depression sufferers are receiving 
treatment, quite a few still are not. 

Major depressive disorder - How common is it?

5. Health tip to share - Chitosan diet supplement

Chitosan is a dietary supplement that has been 
advocated as promoting weight loss. While some 
fats bind to chitosan in the intestine, the number 
of calories in those fats are insignificant. It 
also decreases your absorption of fat soluble 
vitamins A, D, E and K by a small amount. Since 
you can not lose weight with chitosan alone 
without dieting, it is not a supplement for a 
weight loss diet you should take. Chitosan is made 
from a starch (chitin) found in the shells of 
shrimp, crab and other shellfish. 

6. Humor is healthy

Occasionally, people use the term "anal-retentive" 
to refer to obsessive-compulsive personality 
traits (like Jack Nicholson in "As Good As It 
Gets"). We all have some of those traits about a 
few things in our lives. Being obsessive can be 
healthy but here's how to know if it is getting 
out of hand. 

"You may be anal-retentive if..."

1. you eat the M&Ms in color order. 

2. you fold your dirty clothes before putting them 
in the hamper. 

3. you have to have all boxes in the kitchen 
facing the same way and in order by size. 

4. you have all your canned goods organized by 
type, flavor, and use and they're all facing the 

5. all your books, CDs, and movies have to be 
alphabetical order. 

6. you require no less than 230 threads per inch 
on your sheets.  ...and they are tucked so tightly 
that you really could bounce a quarter on them. 

7. you alphabetize your spices.

8. you organize your closet by color, season, and 

9. you flame every person who sent you email 
because the emails weren't spelled correctly or 
grammatically correct. 

10. you remove the tires to wash inside the wheel-
wells of your vehicle. 

11. you collect the little postcards in magazine 
issues... ..for recycling. 

12. every e-mail reply that you send has been 
through a grammar checker... ..and you correct the 
original message. 

13 you're on a "calorie-counting" diet and you 
count the calories in the hot sauce on your "Big 
Beef Burrito Supreme" 

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

Back to top

****** Woman's Health Newsletter *******
              July 13,  2003
Biweekly from BackupMD on the Net

1. Smoking cessation and nicotine patches
2. Spontaneous miscarriage without D and C
3. Reader submitted Q&A - Mastoiditis
4. Maintaining independence as you age
5. Health tip to share - Missing breakfast
6. Humor is healthy

1. Smoking cessation and nicotine patches

Any long term habit such as overeating or smoking 
is difficult to break. We look for pharmacological 
help to assist us to stop the unhealthy habit 
rather than just relying on will power (choice) 
alone. Nicotine patches were supposed to help 
people stop smoking but recent evidence indicates 
they are not very effective. 

Investigators in Great Britain followed up on over 
1500 men and women who had participated in a 
nicotine patch smoking cessation randomized trial 
in 1991-1992. They contacted them in 1999-2000 to 
see how many had stopped smoking for a long time. 

In the original study, 11.2% of the nicotine patch 
group and 7.7% of the placebo group had stopped 
smoking for at least one year.  When they 
rechecked at 8 years, only about half of those who 
had stopped smoking were still abstinent (5% of 
the original study). More importantly, the 
nicotine patch group had a slightly higher rate of 
resuming smoking so that the completely abstinent 
rate at 8 years was less than 1% difference. 

Basically this would indicate that nicotine 
patches may have a slight initial supportive 
effect but that in the long run they are not 
superior to just quitting on your own. Diet pills 
show the same results so we should not be 

Smoking cessation and nicotine patches

2. Spontaneous miscarriage without D and C

It used to be the rule-of-thumb that miscarriages 
were always treated with a D and C or dilatation 
of the cervix and curettage (scraping) of the 
contents of the uterus. This was to primarily 
prevent heavy bleeding and moderate blood loss 
with spontaneous miscarriage. There has been a 
recent trend toward just letting the miscarriage 
take place itself without medical interference. 

In a study conducted in Scandinavia of over 250 
women who sought help for symptoms of miscarriage 
within the 1st 14 weeks of pregnancy and who were 
not having excessive bleeding at the time, 
investigators found that 83% completed the 
miscarriage spontaneously without D&C within one 
week of onset of symptoms. They had an average of 
3.2 days of absenteeism from their daily duties 
and did not have excessive blood loss that lowered 
their blood count. 

This data shows most miscarriages can be managed 
without surgical intervention and the time to 
resolve the miscarriage is not excessive, i.e., up 
to a week. 

Spontaneous miscarriage without D and C

3. Reader submitted Q&A - Mastoiditis

"What are the symptoms, diagnosis, and treatment 
of mastoiditis. I am age-70, blocked left 
Eustachian tube (3 yrs.), Water in right ear 
(bubbles seen from exterior on examination, 
vertigo, (three treatments wearing collar and 
sleeping sitting up), and have problems hearing and 
distinguishing vocal sounds. Noises are very 
disturbing." - Kay 
Mastoiditis is an infection of the mastoid bone of 
the skull, the bone just behind the ear. It 
usually starts from a middle ear infection (acute 
otitis media). The infection spreads from the ear 
to the mastoid bone and the bone becomes filled 
with infection. It used to a leading cause of 
death among children before the days of 
antibiotics. Antibiotics have reduced mastoiditis
from 50% after ear infections down to 0.4%.

Symptoms include:

ear pain
redness of the ear or behind the ear
ear drainage

Examination by a doctor can usually diagnose 
mastoiditis but also an MRI or CAT scan xrays 
may indicate an abnormality in the mastoid 
bone consistent with infection. Bacterial culture 
of ear drainage may indicate what specific 
bacteria is causing the mastoiditis. 

If the mastoiditis remains untreated, brain 
abscess or infection can spread throughout the 
body and hearing loss and destruction of the 
mastoid bone can result. 

Once infection is in the mastoid bone, antibiotics 
do not clear it up very quickly and there may be 
recurrences. It is difficult to get good 
antibiotic blood levels to bone tissue because of 
the relative lack of blood supply to any bone 
tissue. The bone may have to be partially removed 
which is quite a major operation. Also a chronic 
otitis media may need to be drained by incising 
the eardrum (myringotomy) in order to allow 
drainage of bacterial infection. 

This is a serious problem and you may have 
symptoms of mastoiditis so I hope you are seeking 
medical help. You may need to ask for referral to 
an ear, nose and throat (ENT) specialist. 

4. Maintaining independence as you age

"Most people do not necessarily want to live 
longer, they want to live better." They want to 
get around, do what they want to do and manage 
their own affairs. Most adults take their 
independence for granted. It is only when you 
become older that you realize there may come a 
time when you cannot drive, cannot even walk 
around easily and are unable to manage affairs 
such as paying bills or even fixing yourself a 
simple meal. 

Before the time comes when your independence is 
threatened, planning is in order. The major 
problems you want to prevent are: 

Avoid falls - make sure your eyesight is fully 
corrected, lighting is very good, slippery scatter 
rugs are removed. 

Avoid muscle weakness and joint stiffness - 
exercise regularly, maintain good eating habits 
and a healthy weight. 

Plan for a day when you may need daily living 
assistance either in your home or in some other 
care facility. 

Take care of any chronic medical conditions - take 
medicines you absolutely need but no extra 
medications for any minor but tolerable symptoms. 

The most common barriers to independence that I 
see in the elderly are crippling arthritis and 
cataracts.  Non impact exercise and possibly 
glucosamine/chondroitin supplements may help 
prevent some worsening of arthritis and 
ultraviolet sunglass eye protection with outside 
activities may help prevent cataracts. 

5. Health tip to share - Skipping breakfast

Those who skip breakfast are 4.5 times more likely 
to be overweight. On the other hand, individuals 
who are "nibblers" and have 4 or more meals a day 
are much more likely to be thin. - FRJ 

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