Womens Health

Women's Health Newsletters 6/27/04 - 9/5/04



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********** Health Newsletter ***********
              June 27,  2004
Biweekly from BackupMD on the Net

1. Allergy skin tests for diagnosis
2. Liposuction and fat's health risk
3. Reader submitted Q&A - Frequent UTI's
4. First aid and treatment of minor burns
5. Health tip to share - International Travel
6. Humor is healthy

1. Allergy skin tests for diagnosis

Allergy testing, whether it is for contact, food 
or inhalational allergies, can be fairly complex. 
The most accurate, but not the easiest testing is 
to have allergy skin tests performed, usually by 
someone who specializes in allergy testing. 

Using the skin test method, the allergist usually 
puts drops of liquid containing the specific 
allergen (such as pollen, mold, wheat, antibiotic 
etc.) on the skin. Commonly this is done on the 
back. Then a small little lancet or needle is used 
to "prick the skin" so that the body's immune 
system is exposed to the allergen. 

If the body is immune to the substance being 
tested, a chemical called histamine is released 
around the area of the skin prick and swelling or 
a bump takes place within the next day or two. 
This means the body is allergic to that substance. 
Actually a small amount of a histamine containing 
liquid is used as a positive control. If your 
immune system is suppressed which makes the 
testing inaccurate, then this positive control 
will not react. If you are taking an anti-
histamine medication then you cannot have the skin 
testing performed. For a negative control, just 
sterile water or saline is used in the pin prick 
test. Some people have very sensitive skin and 
will react to almost everything but it is not a 
true allergic reaction. 

Skin allergy testing is used because it is very 
accurate. Blood tests can also be used but 
sometimes they will show positive when the body 
does not really react that much to cause symptoms. 
Also, many people do not like the reactions they 
get especially if they have many allergies. 

Blood tests can be used instead of skin prick 
testing. They measure immunoglobulins such as IGE, 
IGA and IGG which govern immediate, intermediate 
and delayed reactions respectively. Most 
inhalational allergies tend to be immediate while 
most food allergies tend to be intermediate or 
delayed, therefore  requiring at least two tests 
to be absolutely sure about allergic causes. 
Still, drawing a blood test or two is some times 
easier for many people than having the skin prick 
tests. The blood tests are especially recommended 
for those who have skin conditions such as 
psoriasis or eczema over much of the body which 
precludes the skin prick testing. Blood tests may 
also be better to test multiple different 
substances to narrow down the list before skin 

Allergy skin tests for diagnosis

2. Liposuction and fat's health risk

Most people are aware that excess fat, obesity, is 
associated with adverse health effects such as 
abnormal glucose tolerance and diabetes, increased 
cholesterol and heart attacks and high blood 
pressure and strokes. Exactly what about being 
obese causes this is not exactly known but weight 
loss very often corrects or reverses these health 

You might wonder if it is the presence of the 
volume of fat cells in the body that causes these 
health problems. If so, removing the fat 
surgically by a technique such as liposuction 
might be expected to improve health by lowering 
cholesterol or improving insulin resistance which 
is associated with adult onset (Type 2 diabetes). 

A recent study by a plastic surgeon, Samuel Klein 
MD in St. Louis and his colleagues, looked at 15 
very obese women who had on the average 22 pounds 
of fat removed from the abdomen by liposuction. 
They measured before and after blood studies and 
could not find any improvement in the health risk 
factors such as cholesterol, blood sugar, insulin 
resistance or blood pressure following the 

This would suggest that it is not the fat cells 
per se that govern the health risks, but rather 
the dietary weight loss process itself that 
reverses some health problems. The mental model I 
use to view this process is simply that excess 
substances such as fats, refined sugar and other 
substances in food we eat act as toxins to produce 
many of these adverse health effects. If we take 
in smaller amounts of these, the health problems 
can go away; if we continue to take in more than 
our body can handle, these conditions develop or 
progress. Of course all of this process is also 
strongly governed by our genetic make-up in that 
some people can handle more of excess toxins and 
do ok while others are very sensitive even to 
small amounts of these toxins because of the genes 
they inherited. 

The bottom line is that one can only expect 
liposuction to help cosmetically and not 
medically. Negative calorie and other toxic intake 
balance is needed to improve these health risks 
associated with obesity. 

Liposuction and fat's health risk

3. Reader submitted Q&A - Frequent UTI's 

I am 38 years of age, and I just had a 
hysterectomy.  I have for the last 2 years have 
had several UTI's, and now I have a severe kidney 
infection, and I am on cephalexen, I was on Tequin 
also, but could not tolerate it, I only drink 
water and cranberry juice's, what else can I do?  
I am on. Celebrex, Aciphex, Estrace, Synthroid, 
Wellbutrin, Lexapro, ultram for my kidney pain." - 

Since your are taking Estrace(R) (estradiol), it 
sounds as if you are menopausal, probably because 
of removal of the ovaries at the time of 
hysterectomy or because they stopped working after 
the surgical shock. The reason this may be 
important is that low estrogen after menopause 
often contributes to frequent urinary tract 
infections or to symptoms such as burning with 
urination that are interpreted by you as possible 
UTIs. Without estrogen, the skin lining the inside 
of the urethra is not as plush so it does not shut 
as tight to prevent bacteria from the vagina and 
rectum from getting into the bladder. Also, low 
estrogen makes the skin around the vaginal opening 
very thin and when urine hits it, it may cause a 
burning sensation with urination that is 
interpreted as a UTI. 

If your infection has gone all the way up into the 
kidneys (pyleonephritis) then it not only needs to 
be treated acutely with antibiotics, but you may 
also need to take some prophylactic antibiotics 
such as nitrofurantoin (Macrodantin(R)) or sulfa 
on a reduced schedule after the kidney infection 
has been treated to prevent new urinary tract 
infections. Taking cranberry pills or cranberry 
juice can help prevent recurrent infections but 
sometimes you may require prescribed antibiotics 
to prevent the infections. 

Topical estrogen cream may also help your symptoms 
and you will need to ask your doctor about that. 
Your physician can check a blood level of the 
estradiol (Estrace(R)) to see if you are absorbing 
enough from the stomach. If not, you can take more 
with a higher pill dose or use estradiol vaginal 
cream to improve that skin. 

Some women have other causes for having frequent 
urine or kidney infections. Kidney or bladder 
stones, bladder polyps or other inflammation of 
the bladder can lead to kidney infections. I would 
say that if you get another kidney infection after 
your estrogen status is corrected, then you may 
need to have a kidney X-ray (intravenous pyleogram 
IVP) and a cystoscopy (looking into the bladder 
with a scope) in order to make sure there are not 
stones, polyps or even an early cancer of the 

4. First aid and treatment of minor burns

Certain principles have evolved over recent years 
of how to treat burn injuries so that the chance 
of infection is minimized and an improved chance 
of having a reasonable cosmetic outcome when the 
burn is healed. Over 90% of burns are minor and 
will heal with minimal treatment. 

The main first aid principles for burns are:

1) stop the process causing the burn (eg. flame, 
chemical, electrical) 
2) cool the burned tissue 
3) get pain relief 
4) cover the burned area 

Immediately after the burning process is 
stopped, do not try to remove any adherent 
material such as burned nylon clothing, tar or any 
other substance. If clothing is not adherent to 
the skin it should be removed to prevent further 
heat transfer to the skin. 

Within less than 20 minutes from the time of the 
burn, the skin should be cooled down to prevent 
progression of burn damage. You should NOT use 
ice; ice can cause blood vessels to constrict to 
the extent that it causes further damage to the 
skin. Just use tepid tap water (drinkable water). 
Immerse or keep applying water over the burn for 
at least 20 minutes. 

You may need some narcotic pain medicines from 
your local physician but if the pain can be 
controlled with non steroidal anti inflammatory 
drugs NSAIDs (ibuprofen, naproxen), be sure to 
take them on a regular basis until most of the 
pain is improved. The anti inflammatory action is 
needed as much as the pain relief. 

While there are special bandage coverings for 
burns, the best covering is the polyvinyl chloride 
cling wrap (e.g., Saran Wrap(R), Glad Wrap(R)). It 
is essentially sterile if you remove the first 
inch or two from the roll. The wrap is pliable and 
does not adhere to the burned skin surface. Also 
you can see through it to assess how the damaged 
skin is doing. Topical creams or ointments are 
avoided at this time so you can keep an eye on the 
burned skin. 

Partial thickness burns (some skin remaining, no 
fat or muscle tissue exposed) that are less than 
about 12 inches in diameter in adults or about 6 
inches in diameter in children can be managed 
without hospitalization. Full thickness burns of 
much more than an inch or so will also require 
hospitalization. If there is any doubt about this, 
be sure to see an emergency physician. 

The cling wrap dressing should be changed every 24 
hours for the first two or three days and then 
every 3 days. The burn should be washed with just 
a mild antibacterial soap (a very small amount) 
and water. Antibiotics or antibiotic creams are 
not usually necessary. If the burn is more than 2-
3 inches in size, be sure to let the doctor look 
at it and monitor the healing process. 

Key points in the primary care of burns are: 

 Initial first aid can influence final cosmetic 

 Cooling with tepid tap water is one of the most 
important first aid measures 

 Routine use of antibiotics should be 

 Simple dressings suffice  

 Aseptic technique should be used for dressing 

 If in doubt, seek advice from your doctor or a 
regional burn unit or plastic surgery department 

First aid and treatment of minor burns

5. Health tip to share - Travel health risks

About 10% of the population living in the U.S. was 
born outside the U.S. This group tends to account 
for a high proportion of international travel 
because of visiting friends and relatives. They 
also account for a high proportion of travel 
related illness. It is extremely important for 
immigrants and others who travel to have their 
health related vaccinations as well as 
prophylactic medicines (e.g., for malaria 
prevention). They should not assume their health 
risk is low just because they were born in a 
country. Be sure to look at the 
Center for Disease Control (CDC) Traveler's Health 
web site if you are taking an 
international trip - FRJ 

6. Humor is healthy

"Signs Found In Kitchens"

1. Kitchen closed - - this chick has had it! 

2. Martha Stewart doesn't live here!! 

3. I'm creative; you can't expect me to be neat 

4. So this isn't Home Sweet Home... Adjust!

5. Ring Bell for Maid Service...If no answer do it 

6. I clean house every other day.... Today is the 
other day! 

7. If you write in the dust, please don't date it! 

8. I would cook dinner but I can't find the can 

9. My house was clean last week, too bad you 
missed it! 

10. A clean kitchen is the sign of a wasted life.


12. I came, I saw, I decided to order take out.

13. If you don't like my standards of 
cooking...lower your standards. 

14. A messy kitchen is a happy kitchen, and this 
kitchen is delirious. 

15. If we are what we eat, then I'm easy, fast, 
and cheap. 

16. A balanced diet is a cookie in each hand.

17. Thou shalt not weigh more than thy 

18. A clean house is a sign of a misspent life.

19. My next house will have no kitchen --- just 
vending machines. 

20. I'm the MOMMY, That's why! 

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

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********** Health Newsletter ***********
              July 11,  2004
Biweekly from BackupMD on the Net

1. Carbs, low carbs and confusion
2. Post menopausal use of soy protein - does it help?
3. Reader submitted Q&A - Grapefruit juice and drugs
4. Repeat C-Section vs vaginal birth after C/S
5. Health tip to share - Maca root for breast pain
6. Humor is healthy

1. Carbs, low carbs and confusion

Most of the food and restaurant marketers have 
joined the low carbohydrate bandwagon and created 
several new, but confusing, terms. "Carb-
friendly", "carb-fit", "carb-wise", and "net 
carbs" are just a few of these coined terms. Many 
uninformed consumers may get the idea that any 
carbohydrates are "bad", just as any "fats" are 
bad for your nutrition. If someone declares 
proteins as bad for your diet, we will have 
nothing left but water. 

The premise behind low carbohydrate diets is that 
the body's insulin blood level will not be raised 
as high; high insulin prevents fat in our body 
from being burned. Actually low carbohydrate diets 
do not produce any greater weight loss in the long 
run than do other types of diets such as low fat 
or a weight-watchers balanced diet. Some people 
may lose more weight initially but it appears that 
all diets boil down to calories in versus calories 
out and your choice of diet should be whatever one 
you can stick to by eating a reduced amount of 

"Low-carb" cookies, cakes etc., are not healthy 
for you since they usually contain higher fats and 
still plenty of calories. "Carb-friendly" beers 
are in that same ridiculous category. The concept 
of "net carbs" tries to subtract out fiber (which 
is good for you) and also glycerin and sugar 
alcohols from the total carbohydrates. The "good 
carbohydrates" still count as calories, however, 
so it may just be fooling you to think the food is 
healthier because the "net carbs" calculate out 

Glycemic index is another confusing term. This 
refers to the ability of the food to raise the 
blood sugar quickly. Low glycemic foods are the 
basis for the Sugar Busters Diet. Actually this is 
quit a tricky term also because the body's 
response depends not only on the glycemic index 
but also upon the glycemic load of the food. For 
example carrots raise the blood sugar quickly but 
the normal number of calories or glycemic load in 
a typical serving of carrots is quite low and 
therefore not considered bad for you by most 

The following article at MayoClinic.com will be 
interesting for you if you find these terms 
confusing or even if you put much stock in the 
terms at all. 

Carbs, low carbs and confusion

2. Post menopausal use of soy protein - does it help?

Many post menopausal women have switched from 
hormone or estrogen replacement therapy to soy-
based food products that have estrogenic-like 
plant proteins (usually isoflavones) in them. The 
hope is to obtain some of the health benefits of 
estrogen without the adverse effects of 
prescription medications. Some women take the soy 
products merely for help in controlling hot 
flashes. There is some evidence that isoflavones 
may lessen hot flashes in some women although they 
do not do it as well as estrogen. 

But what about the other beneficial effects of 
estrogen such as that on bone deposition, lowering 
lipids and even improving "brain fogging" 
(cognitive function)? Do the soy proteins provide 
any of those benefits as estrogen does? 
Investigators in the Netherlands looked at this in 
over 175 women followed for a year. Half were 
given a measured soy supplement as a powder and 
the other half were given a cow's milk protein 
powder as the control group. The investigators 
measured cognitive function (verbal and math 
skills, memory etc.), bone mineral density of the 
spine and hip, and lipid (cholesterol) profiles. 

After a year of taking either the soy protein 
powder or the milk protein powder, women had 
repeat measurements performed. Investigators found 
that there was no significant difference in any of 
the tests between the soy group and the milk 
protein group. Cognitive function, bone mineral 
density, or plasma lipids did not differ 
significantly between the groups after a year. 

While I am not sure that cow's milk protein is 
really placebo medication, this study would seem 
to indicate that if a woman was not gaining a 
benefit of decreased hot flashes by taking soy 
protein supplements, then there is no real point 
in taking any extra soy supplements at all. The 
soy isoflavones do not help the vaginal dryness of 
menopause either. 

Post menopausal use of soy protein 

3. Reader submitted Q&A - Grapefruit juice and drugs
" In the past I have read the grapefruit juice is 
not a good thing to drink when taking certain 
prescription drugs but do not remember what drugs.  
Can you please advise?" - Bonnie 

This is a question we receive periodically but the 
last time we answered it was back in 2001. There 
have been some new developments about the genetics 
of the cytochrome P-450 enzyme system that 
grapefruit juice affects so it may be worth 
reviewing it again. 

The bad news is that grapefruit juice CAN alter 
the absorption of some medicines. The good news is 
that you can get around this interaction and most 
of the time do not need to worry about drinking 
grapefruit juice or eating grapefruit on your diet 
as long as you follow a few simple rules. 

There is an enzyme in the bowel and liver called 
cytochrome P-450 (CYP) that is very important in 
metabolizing food and medicine ingested by mouth. 
Cytochrome P450 is a microstructure in our body's 
cells that is responsible for creating the enzymes 
that process (activate or deactivate) chemicals of 
all kinds within our bodies. The enzyme changes 
the base food or drug compound by adding small 
chemical groups to the molecule. Sometimes these 
changed compounds are absorbed from the stomach 
more easily; sometimes the change inhibits 
absorption. CYP can change the drug to a more 
potent form as far as medical action and at other 
times it will deactivate it and change it to a 
less active compound. In other words, any 
substance that stimulates CYP or inhibits CYP can 
make ingested substances more active in its 
medical effects and side effects or less active, 
less potent. 

Grapefruit juice is one substance that has been 
found to inhibit the CYP enzyme system. It does 
this much more than other citrus juices like 
orange juice. Grapefruit juice is not the only 
compound that inhibits CYP. Even red wine or St 
John's Wort, among others, have been shown to 
affect this system. There are undoubtedly many 
other food and drug substances that have the same 
CYP effect but we just do not know about at the 
present time. Inhibition of CYP often results in 
HIGHER BLOOD LEVELS of a drug because inhibited 
drug absorption means that the liver, which often 
breaks down the drug, does not get the first 
chance to inactivate the drug before it has its 
medical effect. 

Probably even more important than grapefruit's 
affect on the CYP enzyme system is what is your 
genetic make up. It has been shown that many 
people have genetic variations that affect this 
system just as grapefruit does. Approximately half 
of all Americans have genetic defects that affect 
how they process certain drugs through the CYP 
mechanism. There are four different genetic 
baseline types of metabolizers, and we all fall 
into one of the categories for the variable 
pathways in Cytochrome P450. 

Genetically you can be:

1) Normal metabolizer - likely to have the desired 
effect from a standard dose of the drug 

2) Slow (intermediate) metabolizer - do not need 
as high a dose of the drug to get the desired 

3) Poor metabolizer - likely to have significant 
side effects from a standard dose because the drug 
accumulates in your system 4) Extensive 
metabolizer - your system works at triple speed 
and overtime so that you require a higher dose to 
have the desired drug effect 

These above birth variations are probably much 
more important than ingesting grapefruit or any 
other substance that affects the system. There are 
now home genetic tests you can get to see what 
type of metabolizer you are as well as lists of 
drugs known to be affected by the CYP system. 

DNA Drug Reaction Profiles

Most of the drugs that I could find that have been 
tested, are INCREASED in the blood by about 0-50% 
if they are taken with a glass of grapefruit 
juice. While decreased blood levels can happen 
too, almost every agent was actually increased. 
And when it was, it was increased about 50%. I 
could not find testing that indicated how long 
after ingesting grapefruit juice the altered 
absorption levels lasted. It is likely that the 
effect is short lived, under 60 minutes. 

Women will be glad to know that the estrogen 
(ethinyl estradiol) in birth control pills is not 
decreased by grapefruit juice but rather increased 
by 37%.  The estrogen often used for menopausal 
replacement, 17 beta-estradiol, is also altered 
somewhat in its absorption by grapefruit juice. 
Estrone (a weaker estradiol metabolite) levels are 
increased after taking estradiol with grapefruit 
juice but estradiol itself is not increased. 

For the most part, the differences in active drug 
levels with or without grapefruit juice are not 
very great and probably less important than your 
genetics or body weight in determining medical 
effect. However, with a drug that has a narrow 
range between adequate treatment of a medical 
problem and toxicity producing side effects, then 
this amount of interaction can make a difference. 
Chemotherapy agents or blood thinners (e.g., 
Coumadin) would be  instances where the different 
levels could produce very undesirable side 
effects. Anti-depressants and anti-anxiety agents 
are another class of drugs that grapefruit juice 
could affect. On the other hand, if you were not 
seeing a therapeutic effect from a medication, 
taking it with grapefruit theoretically might help 
(eg. low dose estrogens for hot flashes). 

Finally, the wisest course of action with regard 
to eating grapefruit or drinking grapefruit juice,  
however, would be to follow these simple rules: 

Take most medicines at least 30 minutes before or 
60 minutes after you ingest the grapefruit. Take 
them with water or orange juice if you have to (OJ 
has some effect but much less than grapefruit 

If you are having side effects from the drugs you 
take, avoid grapefruit for at least 6-8 hours or 
altogether and check with the doctor to see if 
drug dose adjustment is possible or for genetic 
testing for your DNA metabolizer type. 

If you are taking any cancer chemotherapy drugs or 
blood thinners, check with your doctor about all 
substances which may alter their absorption or 
blood levels. 

4. Repeat C-Section vs vaginal birth after C/S

For about the last 20 years, physicians have been 
encouraging women who had a previous Cesarean 
birth to attempt vaginal delivery with a 
subsequent pregnancy rather than having an 
automatic, repeat Cesarean section. In the last 5 
years, however, there has been a trend back to 
recommending repeat Cesarean section (RCS) rather 
than vaginal birth after Cesarean (VBAC) because 
of the fear of a small increase in uterine rupture 
before delivery. Uterine rupture can result in 
hysterectomy, fetal death and even a possibility 
of a mother dying. 

The following article in the British Medical 
Journal looked comprehensively at all of the 
medical scientific studies in the literature to 
see how high these risks are when considering VBAC 
versus RCS. The investigators found the following: 

the additional risk of uterine rupture from VBAC 
  is 0.3% (range 1-5/1000) 

the additional risk of a baby dying from VBAC is 
  about 1.4 per 10,000 trials of labor (range 0-

the additional risk of a hysterectomy was 3.4 per 
  10,000 trials of labor (range 0-1.2 per 1000) 

it would take 370 (213 to 1370) elective caesarean 
  deliveries (RCS)  to be performed to prevent one 
  symptomatic uterine rupture. 

it would take 7142 elective repeat cesareans (RCS) 
  to prevent one rupture-related perinatal death 

it would take 2941 elective repeat cesareans (RCS) 
  to prevent one rupture-related hysterectomy 
The numbers generated by this study are the best 
estimates we currently have when describing the 
relative risk of VBAC versus Repeat CS although 
they do not include the risk of maternal problems 
with RCS versus vaginal delivery such as 
infection, blood clots, transfusions etc. Those 
risks should also be taken into account. 

Repeat C-Section vs vaginal birth after C/S

5. Health tip to share - Maca root for breast pain
"I am 51 years old and have battled fibrocystic 
breasts for about 10 years. My new gynecologist 
(my old gynecologist died a few years ago) 
mercilessly ordered a mammogram last week while my 
lumpy breasts were acutely tender and swollen.  
Over the years,  I have had some success with 
vitamin E and evening primrose oil, and totally 
abstain from caffeine, but now continue to have 
frequent bouts of enlarged lumps and soreness."  

"This morning,  I tried one dose of Maca 300 mg 
(Peruvian maca root), and within a few hours 
noticed a decrease in the tenderness.  I 
hesitantly took another dose of 300 mg  eight 
hours later resulting in a DRAMATIC diminishment 
of the fibrocystic lumps.   I need to read more 
about how to take this Maca, and I understand that 
it shouldn't be taken every day.  So far, I have 
obtained such relief.  Wish that I had known about 
this before I had the mammogram." - M.H.       

6. Humor is healthy

"But I Never Forget A Face!"

An elderly widow and widower were dating for about 
five years.  The man finally decided to ask her to 
marry. She immediately said "yes." 

The next morning when he awoke, he couldn't 
remember what her answer was!  "Was she happy?  I 
think so, wait, no, she looked at me funny..." 

After about an hour of trying to remember to no 
avail, he got on the telephone and gave her a 
call.  Embarrassed, he admitted that he didn't 
remember her answer to the marriage proposal. 

"Oh", she said, "I'm so glad you called.  I 
remembered saying 'yes' to someone, but I couldn't 
remember who it was." 

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

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********** Health Newsletter ***********
              July 25,  2004
Biweekly from BackupMD on the Net

1. Herbal supplements and flare up of auto immune disease
2. Doctors are often unaware of prescription costs
3. Reader submitted Q&A - Sun sensitivity of meds
4. Hyperpigmented liver skin spots
5. Health tip to share - Resveratrol
6. Humor is healthy
The next newsletter will be in two weeks.

1. Herbal supplements and autoimmune disease flare up

Some herbal preparations are used for supposed 
immune system stimulation. Echinacea is the best 
known one but also some of the algae (Spirulina 
platensis) are thought to do the same thing and 
are sold as such. People use them to prevent colds 
and viral flu thinking that if your immune system 
is boosted it will help prevent or ameliorate an 
infection. So far none of those benefits have been 
proven in controlled human clinical medical trials 
and echinacea at least had been shown NOT to be 
beneficial for cold prevention. 

One might ask the opposite question, i.e., if some 
herbal products really did stimulate the immune 
system, could those products worsen medical 
conditions which are autoimmune (the body is 
allergic to itself) in origin? 

Again, no good clinical trials have been performed 
but a recent Archives of Dermatology article 
reported three patients that had flare ups of 
their autoimmune diseases. Two had flaring of the 
skin condition pemphigus vulgaris after ingesting 
Echinacea and the alga Spirulina platensis. One 
patient had a flare of dermatomyositis after 
ingesting a supplement containing the algae 
Spirulina platensis and Aphanizomenon flos-aquae. 

While it is too early to postulate direct cause 
and effect, I would caution individuals with 
autoimmune conditions to avoid any supplements 
containing algae (Spirulina platensis) as well as 
to consider avoiding Echinacea or any other 
supplement touted as an immune stimulant. 

Herbal supplements and flare up of autoimmune disease

2. Doctors are often unaware of prescription costs 
Since about the 1950's, physicians no longer 
dispense many or any prescription medicines from 
their offices. It has been discouraged by medical 
societies who feel there can be a major conflict 
of interest if a physician profits from the sale 
of something he or she recommends to the patient. 
This makes good sense in a way but it has also 
caused physicians to lose track of how much 
medications cost at the pharmacy. 

In this study below from family practitioners in 
Iowa, doctors were asked how much they thought 
certain medicines cost. They did not need to guess 
exactly but just get it within a $10.00 range from 
$0.01 to $80.00. They gave estimates for each of 
50 medications that they might prescribe. 

Of 178 physicians who responded, only 23% guessed 
the medicine price within a $10 range correctly. 
Over 2/3's of the physician guesses were 
underestimated. When the drugs were divided by 
whether they were brand names or generic, the 
estimates were even worse. Doctors 90% of the time 
underestimated brand name drug costs and 90% of 
the time they overestimated generic drug costs. 

These errors in estimates will result in higher 
drug costs overall because the less expensive 
drugs (generic) will be used less often than they 
should and the more expensive drugs (brand name) 
will be prescribed more than they should. 

Be sure to ask your doctor about the availability 
of generic meds for your prescription. 

Doctors are often unaware of prescription costs

3. Reader submitted Q&A - Sun sensitivity

"I am on high blood pressure medication 
(Avalide(R)) and was wondering why the warning 
label says to stay out of the sun for prolonged 
periods of time and to wear a sunscreen? What 
would the harmful effects be while taking this 
medication?" -  Michelle 

Avalide(R) is a medication that can change the 
sensitivity of your skin to the sun's ultra violet 
rays. In other words, you will sunburn quicker 
when your blood levels of Avalide (irbesartan) are 
high. For this reason, you should Use a sunscreen 
and wear protective clothing when exposure to the 
sun is unavoidable. The sun exposure time to burn 
can be cut almost in half. 

Skin will redden or burn from the sun or tanning 
lamp easier with any photosensitizing agent. The 
list of drugs causing increased photosensitivity 
is too long to list here. it includes many 
prescription and over-the-counter medications 
including hormones, oral contraceptives and even 

For any specific photosensitizing medication, it 
is difficult to estimate by how much your time to 
burn in the sun is reduced. Some of the 
medications such as Accutane are extremely 
sensitizing while others such as ibuprofen are 
less so. It is best to use the 50% rule-of-thumb 
until you know for sure. 

On the other hand, with today's knowledge about 
sun damage, you should never be outside in direct 
sun for more than about 15 minutes without using 
sunscreen that protects against all ultraviolet 
rays; unless you like the wrinkled, leathery look. 
Using a protectorant with a factor of SPF 30 
should be routine if you are on any 
photosensitizing medications and even then, 
confining time in direct sun to less than an hour 
would be wise. 

4. Hyperpigmented liver skin spots

When you were young, you probably did not know 
that sun exposure was eventually going to cause 
"liver" spots on your skin when you age. Its too 
late now to prevent them, so what do you do when 
they come? Basically you can leave them alone or 
bleach them. 

Dark skin spots are caused by an excess of a skin 
pigment called melanin. Sometimes the cause is 
genetic such as in the case of freckles. At other 
times skin injury such as that from acne, surgery 
or other trauma can cause increased pigmentation. 
Big blotchy areas of skin darkening are called 
melasma and are often due to pregnancy hormones or 
birth control pills along with sun exposure. 

Prescription creams used to lighten the skin 
contain hydroquinone. This is a skin bleach which 
lightens and fades darkened skin patches by 
slowing down the production of melanin so those 
dark spots gradually fade to match normal skin 
coloration. When a doctor writes a prescription 
for a skin bleach, it contains about two times the 
amount of hydroquinone (4%), the active 
ingredient, as over-the-counter skin bleaches 
(2%).  Of note is that in Canada and via Internet 
you may purchase 4% hydroquinone cream without a 

In more severe cases prescription creams with 
tretinoin and a cortisone cream are added. These 
are somewhat irritating to sensitive skin and will 
take 3-6 months to produce improvement. It is 
important to also note that as little as 10 
minutes in the sun without UV blockers can reverse 
months of using these creams. 

Hyperpigmented liver skin spots

5. Health tip to share - Resveratrol
The compound that makes red wine healthy is called 
resveratrol. It not only improves cholesterol 
profiles but in studies in which it is given to 
animals, it prolongs their life span. Resveratrol 
is not only found in red wine but also red grapes, 
red grape juice and also in grape root 
supplements. If you are not a wine drinker or do 
not want the calories of grapes or grape juice, 
check with your local health food store for grape 
root supplement or even just a resveratrol 

6. Humor is healthy

"Living In The 00s"

You know you're living in the 00s when: 

1. You try to enter your password on the 

2. You haven't played solitaire with real cards in 

3. You have a list of 15 phone numbers to reach 
your family of three. 

4. You e-mail your mate who works at the desk next 
to you. 

5. Your reason for not staying in touch with 
friends is that they do not have e-mail addresses. 

6. When you go home after a long day at work you 
still answer the phone in a business manner. 

7. When you make phone calls from home, you 
accidentally insert a "9" to get an outside line. 

8. Your company's welcome sign is attached with 

9. Even though you've sat at the same desk for 4 
years you have worked for 3 different companies. 

10. Your CV is on a disk in your pocket. 

11. You learn about your redundancy on the 11 
o'clock news. 

12. Your biggest loss from a system crash was when 
you lost all of your best jokes. 

13. Your supervisor doesn't have the ability to do 
your job. 

14. Contractors outnumber permanent staff and are 
more likely to get long-service awards. 

15. Board members salaries are higher than all the 
Third World countries annual budgets combined. 

16. Interviewees, despite not having the relevant 
knowledge or experience, terminate the interview 
when told of the starting salary. 

17. Free food left over from meetings is your 
staple diet. 

18. Your supervisor gets a brand-new state-of-the-
art laptop with all the latest features, while you 
have time to go for lunch while yours boots up. 

19. Being sick is defined as you can't walk or 
you're in hospital. 

20. There's no money in the budget for the five 
permanent staff your department desperately needs, 
but they can afford four full-time management 
consultants advising your boss's boss on strategy. 

21. Your relatives and family describe your job as 
"works with computers." 


22. You read this entire list, and kept nodding 
and smiling. 

23. As you read this list, you think about 
forwarding it to your "friends" 

24. It crosses your mind that your jokes group may 
have seen this list already, but you don't have 
time to check so you forward it anyway. 

25. You got this email from a friend that never 
talks to you anymore, except to send you jokes 
from the net. 

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

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********** Health Newsletter ***********
              August 8,  2004
Biweekly from BackupMD on the Net

1. Smoking cessation and elective surgery
2. Headaches
3. Reader submitted Q&A - Perimenopause
4. Plantar warts
5. Health tip to share - Ayurveda precaution
6. Humor is healthy
The next newsletter will be in two weeks.

1. Smoking cessation and elective surgery
Smokers are at increased risk for many health 
conditions but most people do not realize that 
smokers undergoing elective surgery are at much 
higher risks for complications. Lung infections 
such as pneumonia are increased and Wound 
infection rates go up by a factor of 3-8 times. It 
has even been shown by a randomized study that 
smoking cessation prior to surgery such as 
artificial hip replacement can reduce wound 
infection from 27% to zero. 

Reducing the amount of smoking does not help; it 
needs to be total smoking cessation. And the time 
period of smoking cessation before surgery 
probably needs to be about 6 weeks although a 
significant reduction can be seen with a cessation 
period of 4 weeks. 

Wound infection can be quite serious. It is not 
just a matter of taking antibiotics and opening 
the surgical incision to drain pus. Sometimes the 
deeper tissue can be disrupted so that with an 
abdominal wound, for instance, the bowels can come 
through the open incision (evisceration). With 
orthopedic surgery, chronic bone infection can set 
in which may require additional surgery or a very 
long, protracted course of intravenous 

Doctors often forget to tell patients about 
stopping smoking so it is up to you to be aware of 
this relationship either for yourself or for a 
family member or friend who smokes. 

Smoking cessation and elective surgery

2. Headaches
Headaches are often treated by others as a non 
serious health problem. Chronic headaches is not 
looked upon as a serious medical condition and yet 
it is one of the most common causes for 
absenteeism from work or school. About 4-5% of 
individuals have headaches more days than not so 
this is a major population problem. 

About 80% of headaches are categorized as tension 
headaches. Most of these are treated with over-
the-counter pain relievers.  They are often 
aggravated by caffeine abuse and sleep 
deprivation. Another group of headaches which 
numbers almost 20% is the category of vascular 
headaches. These include migraine and cluster 
headaches. They are often misdiagnosed or under 
diagnosed. A class of drugs called triptans are 
the most commonly used for these although 
sometimes the headaches will respond to  the 
recommended 1st round treatment combination drug 
of acetaminophen, aspirin and caffeine (eg 
Excedrin Migraine(R)) especially for mild or 
moderate vascular headaches. 

Women are much more susceptible to migraines while 
males get cluster headaches predominantly. A 
cluster headache is very severe and usually 
centered around one eye. Cluster headaches occur 
in a series or bunch, several in a day for 2-4 
months before going away.       


3. Reader submitted Q&A - Perimenopause bleeding
"I was wondering if it is normal for women who are 
going through menopause to stain lightly, but 
without a stop between periods. I had a period, 
which lasted five days, (unusually short for me; 
it usually lasts 6 to 7 days.) and about a week 
later, I started to have a full period, dark red 
blood, and all. It continues to stain very 
lightly; but it doesn't go away. I am going to be 
48 soon, and this year I have started menopause. I 
have not taken anything at all for the regulation 
of my periods. How long does this process of 
irregularity last ultimately?" - Carole 

Menopause is defined as the condition of having 
had no menses for one year. It signifies the 
inability of the ovary to ovulate eggs having 
totally exhausted its supply. In the time period 
running up to complete cessation of menses, more 
and more of the menstrual cycles are anovulatory. 
In other words, an egg is not ovulated each month 
and that may go on to cause abnormal bleeding 
patterns. This time period is called the 

I would say from what you describe that you are in 
the time period of the perimenopause. You have not 
yet become fully menopausal, i.e., stopped 
ovulation altogether. The irregular bleeding you 
are experiencing is normal for this time period 
although women manifest many different specific 
abnormal bleeding patterns. The real dilemma for 
doctors is that while the abnormal bleeding can be 
due to perimenopause hormonal fluctuations, 
endometrial cancer, endometrial pre malignancy 
(hyperplasia),  polyps or fibroids can also cause 
these bleeding patterns. Thus when do you assume 
the abnormal bleeding is physiologic and hormonal 
and when do you assume it could be due to an 
anatomical abnormality? Basically if you have 3 
abnormal cycles in a row, then the doctor should 
consider doing an endometrial biopsy just to make 
sure there is not a possible malignancy inside the 

How long can this pattern last before full 
menopause you ask? Basically it can be anywhere 
from about 2-8 years but the average is about 4 
years. That is about how long you can expect this 
to last. The average age of onset of these 
abnormal periods is about 47.5 years of age. Only 
about 10% of women have an abrupt cessation of 
menses at menopause without having any preceding 
abnormal menses. 

4. Plantar warts
Plantar warts are skin growths on the bottom of 
the feet caused by a virus. The skin growths can 
push up into the sole or toes when you walk 
causing a moderate amount of pain. The virus is 
usually contracted in shower rooms and up to 10% 
of teenagers will have had plantar warts at 

Ultimately the warts go away as the body's immune 
system fights off the virus. It may take months to 
a year or more but eventually they disappear. They 
need treatment if they become too painful and 
interfere with normal activities. 

Salicylic acid patches from the local pharmacy can 
be used to soften the warts and a pumice stone can 
be used to rub away some of the protruding skin. 
You must keep the feet very clean and dry so that 
the warts do not spread. If the salicylic acid 
patches do not work, you might want to see a 
dermatologist. The dermatologist may freeze the 
warts with liquid nitrogen and then scrape the 
excess tissue off as the skin cells die from being 

Plantar warts

5. Health tip to share - Ayurveda precaution
Most lead poisoning among U.S. adults results from 
occupational exposure, but it can also occur from 
use of traditional or folk remedies. Ayurveda is a 
traditional form of medicine practiced in India 
and other South Asian countries. Ayurvedic 
medications can contain herbs, minerals, metals, 
or animal products and are made in standardized 
and nonstandardized formulations. During 2000-
2003, a total of 12 cases of lead poisoning among 
adults in five states associated with ayurvedic 
medications or remedies were reported to the 
Center for Disease Control. 

6. Humor is healthy
"Best Excuses If You Get Caught Sleeping In Your 

1. "They told me at the blood bank this might 

2. "This is just a 15-minute power nap like they 
raved about in that time-management course you 
sent me to." 

3. "I was working smarter-not harder." 

4. "Whew! I musta left the top off the liquid 

5. "Oh, I wasn't sleeping! I was meditating on our 
mission statement and envisioning a new paradigm!" 

6. "This is one of the seven habits of highly 
effective people!" 

7. "I was testing the keyboard for drool-

8. "I was trying to remember where that difficult 
"Z" Key was, and now it is indelibly imprinted on 
my brain, or at least my forehead." 

9. "I'm in the management training program." 

10. "I'm actually doing a "Stress Level 
Elimination Exercise Plan" (SLEEP) I learned at 
the last mandatory seminar you made me attend." 

11. "This is in exchange for the six hours last 
night when I dreamed about work!" 

12. "I was doing a highly specific Yoga exercise 
to relieve work-related stress. Do you 
discriminate against people who practice Yoga?" 

13. "Darn! Why did you interrupt me? I had almost 
figured out a solution to our biggest problem." 

14. "Uh, hey, whaddaya expect... the coffee 
machine is broken..." 

15. "Someone must've put decaf in the wrong pot." 

16. "Boy, that cold medicine I took last night 
just won't wear off!" 

17. "Ah, the unique and unpredictable circadian 
rhythms of the workaholic!" 

18. "I wasn't sleeping. I was trying to pick up my 
contact lens without my hands." 

19. "The mailman flipped out and pulled a gun so I 
was playing dead to avoid getting shot." 

20. "Geez, I thought you (the boss) were gone for 
the day." 

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

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******** Health Newsletter ***********
              August 22,  2004
Biweekly from BackupMD on the Net

1. Fear of social situations
2. Listeriosis bacterial exposure 
3. Reader submitted Q&A - Heartburn in pregnancy
4. Depression in teenagers
5. Health tip to share - Plantar Warts
6. Humor is healthy
The next newsletter will be in two weeks.

1. Fear of social situations

Meeting someone new or having to give a short 
speech can produce anxiety or "butterflies" in 
almost anyone, That is normal. Some people, 
however, fear social situations so much that they 
avoid jobs, activities or events even though they 
would find those things enjoyable were it not for 
having to expose oneself to others who might be 
critical. This avoidance becomes so severe that it 
is called a phobia. "Social phobia can severely 
limit dating, academic achievement and career 

For those with social phobia, sometimes called 
social anxiety disorder, common, everyday 
experiences can be a source of extreme stress: 

Using a public restroom or telephone 

Returning items to a store 

Interacting with strangers or with people of the 
opposite sex 

Writing in front of others 

Making eye contact
Entering a room in which people are already seated 
Ordering food in a restaurant
Being introduced to strangers

The treatment for this problem is both counselling 
as well as anti-anxiety medications. The important 
point is to recognize that this is a behavioral 
condition that needs treatment. It often starts 
during childhood or adolescence and will persist 
most of one's adult life unless some cognitive 
counselling takes place. Medications can improve 
the symptoms but only counselling and rarely, a 
self-help approach will permanently lessen or 
abate the symptoms. You or someone you know with 
this problem should not suffer in private. 

For self-help suggestions, see this article at 
Mayo Clinic's web site. 

Fear of social situations

2.  Listeriosis bacterial exposure
Listeriosis is a very serious, food borne public 
health infection which is probably under 
recognized by the general population. Symptoms can 
be mild or severe including headache, stiff neck, 
confusion, loss of balance, or even convulsions. 
Many times, especially in pregnancy, it presents as 
only mild flu-like symptoms. A listeria infection 
can cause stillbirths, however so it is very 
serious for the unborn baby. 

Anyone who has a suppressed immune system such as 
the elderly, newborns, someone on steroids, those 
with HIV, cancer or who are on chemotherapy are at 
more risk for the serious consequences of the 
disease. About 2500 people annually become 
infected and about 20% of those people die from 
the infection or its complications. 

Listeria comes from contaminated soil and water 
and can be present on vegetables, meat or 
unpasteurized milk and cheeses. Animals can carry 
the bacterium without appearing ill and can 
contaminate foods of animal origin such as meats 
and dairy products. The listeria bacterium has 
been found in a variety of raw foods, such as 
uncooked meats and vegetables, as well as in 
processed foods that become contaminated after 
processing, such as soft cheeses and cold cuts at 
the deli counter. 

Some of the known foods to avoid to prevent 
listeriosis are: 

"Do not eat hot dogs, luncheon meats, or deli 
meats, unless they are reheated until steaming 

Avoid getting fluid from hot dog packages on other 
foods, utensils, and food preparation surfaces, 
and wash hands after handling hot dogs, luncheon 
meats, and deli meats. 
Do not eat soft cheeses such as feta, Brie, and 
Camembert, blue-veined cheeses, or Mexican-style 
cheeses such as queso blanco, queso fresco, and 
Panela, unless they have labels that clearly state 
they are made from pasteurized milk. 
Do not eat refrigerated pates or meat spreads. 
Canned or shelf-stable pates and meat spreads may 
be eaten. 
Do not eat refrigerated smoked seafood, unless it 
is contained in a cooked dish, such as a 
casserole. Refrigerated smoked seafood, such as 
salmon, trout, whitefish, cod, tuna or mackerel, 
is most often labeled as "nova-style," "lox," 
"kippered," "smoked," or "jerky." The fish is 
found in the refrigerator section or sold at deli 
counters of grocery stores and delicatessens. 
Canned or shelf-stable smoked seafood may be 

Diagnosis is only by taking a blood culture for 
the specific bacteria, listeria monocytogenes when 
the symptoms are present. Therefore you or the 
doctor has to be highly suspicious in order to  
receive the correct diagnostic test. Treatment is 
with regular antibiotics such as penicillin. 

3. Reader submitted Q&A - Heartburn in late pregnancy

"How do I battle (and win) against acid reflux and 
nausea during late pregnancy? I am in my 34th week 
and at my wits end." - Mary Kay 

Toward the end of pregnancy, the stomach gets 
highly compressed toward the chest because the 
baby is taking up most of the room in the 
abdominal cavity. This makes the stomach capacity 
small and the hormones of pregnancy relax the 
muscles at the top of the stomach so ingested food 
and acid liquid regurgitates or refluxes into the 
lower throat (esophagus) to produce the burning 
sensation of heartburn. 

This gastric reflux is much worse when lying down 
so it is important to always lie down with your 
head still somewhat elevated. A couple of pillows 
under your head and/or some bricks placed under 
the feet of the bed at the head can help produce 
an incline that lessens reflux at night. Of 
course avoid eating or drinking anything within 
about an hour of going to bed. 

When eating or drinking, avoid high acid foods 
such as citrus juices, coffee, colas, tomato based 
products etc. Also try to separate your liquids 
and solids, i.e., don't eat solid food and then 
drink liquids at the same time. Just eat solids, 
wait a while, and then have your liquids. And keep 
the amounts very low because the stomach fills so 
quickly. It is better to eat and drink small 
amounts more frequently than large amounts at 
normal meal times. 

Liquid antacids without much sodium are used to 
neutralize the stomach contents so if reflux 
occurs it does not burn as much. A popular over-
the-counter antacid is the butterscotch-flavored 

Histamine blocking (H2) medications such as 
cimetidine (Tagamet(R)), famotidine (Pepcid(R)), 
nizatidine (Axid(R)), and ranitidine (Zantac(R)) 
which block the secretion of stomach acid, are not 
recommended during pregnancy or lactation but to 
date the evidence shows no adverse effects on the 
baby when H2 blockers are taking during pregnancy. 

4. Depression in teenagers
Teenagers seem to be more prone to major 
depression than adults or a least so it seems. In 
adult depression treatment, many insurance 
companies have decided it is much less expensive 
for them to pay for anti-depressant medications 
such as SSRIs than it is to pay for counselling 
with a psychiatrist or psychologist. Since either 
medication only or counselling only are about 60% 
effective, it makes sense to see if the 
combination of medication and counselling could 
significantly improve the success rate of treating 
major depression. 

A recent U.S. multicenter study examined over 400 
teens ages 12-17 with major depression. They were 
divided into 4 groups, placebo, fluoxetine 
(Prozac(R)) only, CBT only, and CBT plus 
fluoxetine. Response rates were: 

35% - placebo
43% - CBT alone
61% - fluoxetine alone
71% - fluoxetine plus CBT

There had been a question as to whether Prozac 
caused an increased incidence of suicidal thinking 
in teens. In this study, clinically significant 
suicidal thinking, which was present initially in 
29% of the teens at the study beginning, improved 
significantly in all 4 treatment groups. It did 
not improve as much in the Prozac alone and Prozac 
plus CBT group so as such, CBT was more protective 
against suicidal thinking than Prozac. In other 
words, Prozac did not cause suicidal thinking but 
it did not reduce it as much as counselling (CBT). 

Depression in teenagers

5. Health tip to share - Plantar warts

"In your recent Health Newsletter, you offered 
information on treating planters warts.  Planters 
warts can be effectively treated with duct tape.  
Yes, that manly tool - duct tape!  

Cover the wart for 6 days with duct tape.  Remove 
the tape and soak the foot.  Gently scrape the 
wart with a finger nail file and re-cover it with 
new tape the next day.  It does take a few months 
but it really works.  This is how I treated my 
son's warts without using acid or liquid 
nitrogen." - DLW 

6. Humor is healthy
"Things Women Want to Hear, but Never Do"

Wow, I just don't know what to do with this money 
we won in the lottery, so why don't you take it to 
the mall and see if you can find something to buy 
with it. 

Hey, how about inviting your mother to spend the 
summer with us. 

Oh, go ahead and eat that third piece of chocolate 
cream pie. If it's one thing I hate it's skinny 

What luck, they had a special rental rate at the 
video store on romance movies. 

You know, that Pam Anderson just doesn't seem to 
have the brain power that I find so attractive in 
a woman. 

What a break, I won a prize on the radio station....
tickets to either the super bowl or the opening of the
New York Ballet. I got first choice so pack your bags
for New York, we get to go to the ballet!!!

Who wants to play golf when I can get to see how
good the lawn looks when it's freshly mowed.

Shoot, there's nothing on TV but football games.
Let's go furniture shopping.

Man I tell you, nothing feels better than getting all
spruced up in a suit and tie.

I'm getting a little tired of steak on the grill. How
about a nice quiche?

You know, I think I'd really prefer the four-door sedan
to that impractical Corvette.

Golly I think we're lost. Let me find a gas station to ask
for directions.

My golf clubs are only 30 years old. Why don't you use
the money my parents gave us to get something nice
for the house.

If the guys call and want me to go to that new 
sports club with them, tell them I'm busy. I 
really want to get the living room painted 

Sports cars are just such stupid little toys for 
men who have never really grown up. 

If you're looking for me later, I'll be over there 
looking at the home decorating magazines. 

You know, we really don't visit your relatives 

Why don't you relax this weekend. I'll take care 
of the cooking and housework. 

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

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