Womens Health

Women's Health Newsletters 5/29/05 - 8/7/05



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********** Health Newsletter ***********
              May 29, 2005
Biweekly from BackupMD on the Net

1. Keeping mosquitoes at bay
2. Spinal fusion not more effective for low back pain
3. Reader submitted Q&A - Hysterectomy for prolapse
4. Hair dyes not associated with cancer
5. Health tip to share - Dried apricots for constipation
6. Humor is healthy

1. Keeping mosquitoes at bay

Mosquito and tick-borne illnesses will flair up 
again as summer approaches. Recently, the Center 
for Disease Control (CDC) said that insect 
repellents containing the chemical picaridin (oil 
of lemon eucalyptus) offer comparable protection 
from mosquitoes as do DEET containing products 
when used in similar concentrations. Also 
picaridin containing sprays do not have the same 
intensive odor that DEET products do. Some people 
are very sensitive to DEET odor. On the other hand 
DEET may be more effective in preventing deer 
ticks from sensing a human meal. Picaridin is 
currently being tested for its effectiveness 
against deer ticks. 

Oil of lemon eucalyptus is a natural ingredient 
that offers long acting repellent attributes. Some 
of the shorter acting natural repellents 
containing plant-based oils such as oil of 
geranium, cedar, lemon grass, soy or citronella 
may offer limited protection also. As with any 
chemical to be applied to the skin, some common 
sense tips for safety are appropriate. The experts 
at MayoClinic.com offer the following suggestions 
for safe insect repellent use: 

Do not use products containing oil of lemon 
eucalyptus for kids younger than age 3 

Do not use insect repellent of any type before age 
2 months 

For newborns, cover the stroller or playpen with 
mosquito netting 

Choose the right concentration - A lighter 
repellent for the playground or a walk through the 
neighborhood; a stronger concentration out in the 
woods or a swampy area. 

Be cautious with combination products, such as 
those containing both sunscreen and insect 
repellent; it is better to use those products 

Don't use repellents under clothing or over cuts, 
scrapes or sunburned skin. Avoid the eyes and 
Don't let kids apply their own repellent. They are 
likely to go overboard with the amount used 

Wash off repellent when it's no longer needed

If your skin breaks out from the repellent, wash 
the chemical off immediately with mild soap and 

If you do get an insect or mosquito bite, scrape 
off the stinger with the edge of a credit card or 
knife. Apply 0.5% or 1% percent hydrocortisone 
cream, calamine lotion or a baking soda paste to 
the bite or sting several times a day until your 
itching symptoms subside. 

Keeping mosquitoes at bay

2.  Spinal fusion not more effective for low back pain

Chronic low back pain is a common medical problem. 
It is usually treated non surgically with 
exercises, physical therapy and non steroidal pain 
medications. Occasionally when these conservative 
measures do not result in significant pain 
reduction, spinal fusion surgery to immobilize 
several spinal vertebrae against any movement is 
performed. The premise is that the low back pain 
is produced from movement of the vertebrae against 
the disks and bony surfaces of the spinal disk 
joints and if the vertebrae are splinted against 
movement, pain will be reduced. 

It used to be that not many spinal fusions were 
performed but because of a recent increase in 
these surgeries, a study was launched in the UK at 
15 secondary care orthopedic and rehabilitation 
centers. This study compared over 300 participants 
with low back pain who were refractory to 
conservative measures. Half of the group underwent 
lumbar spine fusion and half underwent an 
intensive rehabilitation program based on 
principles of cognitive behavior therapy. The 
investigators followed the patients for two years 
and measured their ability to walk and their 
disability in performing daily tasks. 

Both groups, the spinal fusion group and the 
physical rehabilitation group, had reduced 
disability at the end of the two years. They also 
had the same ability to walk. The authors 
concluded that there was very little difference 
between the two groups. In other words the surgery 
group really did not do very much better than the 
non surgery group. Therefore the risk and 
additional cost of surgery needs to be considered. 
"No clear evidence emerged that primary spinal 
fusion surgery was any more beneficial than 
intensive rehabilitation." 

Spinal fusion not more effective for low back pain

3. Reader submitted Q&A - Hysterectomy for prolapse
"I have become very confused and frustrated after 
reading ALL of the material and talking to various 
MD's on hysterectomies.  You would have to be a 
rocket scientist to figure out the best 
appropriate option. 

I am 73, healthy, never been in the hospital 
except for three childbirths.  I have a stage 4 
uterine prolapse (outside) with no symptoms except 
for a 'dragging' feeling.  I guess I should have 
something done.  Gynecologist warned I could get 
renal failure with no symptoms if left untreated.  

At first, a colpolesis(sp?) was suggested.  I said 
no.  Then, I have heard that abdominal surgery is 
better than vaginal - more permanent and usually 
ends up being a better job, etc.  Still, it's 
riskier.  I exercise a lot so my concern is that 
if I have the vaginal type, I will be restricted.  
Any comments, advice???" - Mary 

The reason you are having difficulty determining a 
surgical option for treating total uterine 
prolapse is because there are many different 
trade-offs and success rates with the different 
procedures that doctors use. 

A colpocleisis is performed vaginally and the 
uterus is not removed. It is pushed back up into 
the vagina and the vaginal wall is sewn together 
along the length of the vagina. The vagina being 
sewn together holds the uterus back so it does not 
keep falling out of the vagina. This procedure is 
about 85% successful in the long run. The main 
disadvantage is that a woman can no longer have 
vaginal intercourse. Also if you are very active, 
you still have the weight of the uterus bearing 
down on the vaginal closure and may have a higher 
surgical failure rate. 

Abdominal procedures usually remove the cervix and 
uterus and then the vagina is suspended to 
ligaments that attach firmly to the pelvic bone. 
Removing the uterus seems result in less doctor's 
visits in the long run although it does not have 
to be performed at the time of an abdominal 
suspension procedure. An abdominal hysterectomy 
with suspension is usually quite successful in the 
range of 85-90%. It is just as safe if not safer 
than a vaginal surgical procedure but the main 
disadvantage is that it takes about 4 weeks longer 
to recover from an abdominal incision than from a 
vaginal procedure. 

Vaginal procedures offer a quicker recovery but 
about a 10% lower success rate overall. You would 
be restricted from impact exercise activity and 
lifting over 10 pounds with either a vaginal 
procedure or an abdominal procedure for at least 3 
months. You should consider, however, permanently 
avoiding any physical activity that increases 
intraabdominal pressure for extended periods of 
time in order to guarantee the highest chance of 
success from any prolapse surgery. 

Probably more important to the success of the 
procedure is the experience of the surgeon 
performing it. Most surgeons end up using one 
approach for most of their cases even though 
technically they can perform either vaginal or 
abdominal surgery. They have learned over the 
years that in their hands, they can maximize the 
success and minimize the complications by becoming 
very experienced at one approach over the other. 

My suggestion is that you should consider having 
the uterus removed since you are very active 
physically. As to whether you have the surgery 
performed abdominally or vaginally, I would just 
find an experienced prolapse surgeon and go with 
whatever approach they favor. Personally, I favor 
the abdominal approach for someone who is 
relatively healthy and active. 

4. Hair dyes not associated with cancer

From time to time, hair dyes are alleged to cause 
cancer in epidemiological studies. While these 
claims produce alarming news, they are also 
controversial. To try to answer  questions as to 
whether hair dyes could be carcinogenic, 
scientists have reviewed the evidence of past 
studies in medical journals. Investigators from 
Canada looked at 79 literature studies for the 
effect of extensive hair dye use (>200 lifetime 
episodes of dye use) and any effect on bladder 
cancer, breast cancer, leukemias/lymphomas and 
cancers of other sites. 

Basically, they "did not find strong evidence of a 
marked increase in the risk of cancer among 
personal hair dye users. Some aspects related to 
hematopoietic cancer (leukemia/lymphomas and other 
cancers that have shown evidence of increased risk 
in 1 or 2 studies should be investigated further." 
2 specific studies needs to be followed up." 

Hair dyes not associated with cancer

5. Health tip to share - Dried apricots for constipation
"A small bag of dried apricots will cure 
constipation - quickly!  Very quickly! I purchased 
a small bag of dried apricots to alleviate my 
sweet tooth.  I did not realize the consequences 
it would have on my bowels.  Needless to say that 
unless I ever get constipated, I will not eat 
dried apricots again." - Pat 

6. Humor is healthy

"Funeral Procession"

A woman was leaving a convenience store with her 
morning coffee when she noticed a most unusual 
funeral procession approaching the nearby 

A long black hearse was followed by a second long 
black hearse about 50 feet behind the first one. 
Behind the second hearse was a solitary woman 
walking a pit bull on a leash. Behind her, a short 
distance back, were about 200 women walking single 

The woman was so curious that she respectfully 
approached the woman walking the dog and said, "I 
am so sorry for your loss, and I know now is a bad 
time to disturb you, but I have never seen a 
funeral like this. Whose funeral is it?" 

"My husband's." 

"What happened to him?"

The woman replied, "My dog attacked and killed 

She inquired further, "Well, who is in the second 

The woman answered, "My mother-in-law. She was 
trying to help my husband when the dog turned on 

A poignant and thoughtful moment of silence passed 
between the two women. 

"Can I borrow the dog?"

"Get in line."

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

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********** Health Newsletter ***********
              June 12,  2005
Biweekly from BackupMD on the Net

1. To avoid malpractice claims, physicians order excess tests
2. Cancer survival rates - What do they mean?
3. Reader submitted Q&A - Cholesterol levels
4. Low dose aspirin not beneficial for those over 70
5. Health tip to share - Patient assistance programs
6. Humor is healthy
The next newsletter will be in two weeks.

1. To avoid malpractice claims, physicians order excess tests

Many physicians practice defensive medicine. They 
are afraid to miss a rare or uncommon diagnosis 
because they might be sued for malpractice. Of all 
medical malpractice suits filed, over 25% allege 
failure to diagnose a condition, often a cancer. 

The big question is, "how much defensive medicine 
is being practiced?" and "how much does it cost or 
raise prices." A recent survey was performed and 
reported in the Journal of the American Medical 
Association (JAMA). Physicians in 6 specialties at 
high risk of litigation, emergency medicine, 
general surgery, orthopedic surgery, neurosurgery, 
obstetrics/gynecology, and radiology were given 
questionnaires. The authors looked at the number of 
physicians in each specialty who reported changes 
in their behavior or scope of practice because of 
medical malpractice concerns. 

This study was conducted in Pennsylvania and over 
800 physicians responded to the survey. Over 90% 
of physicians reported practicing defensive 
medicine. The results were as follows: 

"Assurance behavior such as ordering tests, 
performing diagnostic procedures, and referring 
patients for consultation, was very common (92%). 
Among practitioners of defensive medicine who 
detailed their most recent defensive act, 43% 
reported using imaging technology in clinically 
unnecessary circumstances. Avoidance of procedures 
and patients that were perceived to elevate the 
probability of litigation was also widespread. 
Forty-two percent of respondents reported that 
they had taken steps to restrict their practice in 
the previous 3 years, including eliminating 
procedures prone to complications, such as trauma 
surgery, and avoiding patients who had complex 
medical problems or were perceived as litigious. 
Defensive practice correlated strongly with 
respondents' lack of confidence in their liability 
insurance and perceived burden of insurance 

Well what does this mean to you, the medical 
consumer? On the one hand, doctors are ordering 
you to undergo more tests than they think are 
medically necessary just to assure you that there 
is not a hidden medical condition or disease. If 
you are a nervous person who needs certainty that 
you do not have a serious disease, then this 
behavior should be reassuring to you. If, however, 
the costs of a test and the risks of undergoing a 
diagnostic procedure or obtaining a false positive 
result concern you, then you may want to pin your 
doctor down as to how likely that test is going to 
be helpful. Let him or her know that if it is 
being ordered just to reassure you and he/she does 
not really think the test is that necessary, you 
may be willing to wait awhile to see how the 
symptoms change before having the study. 

Secondly, if the doctor perceives you as litigious 
(likely to sue for any undesired outcome), then 
you may not get recommended certain procedures 
such as surgery that you medically need. Also, if 
you are high risk medically, doctors may also 
avoid recommending necessary surgery. 

To avoid malpractice claims, physicians order excess tests

2. Cancer survival rates - What do they mean?
If you or a family member or friend are 
unfortunate enough to be diagnosed with cancer, 
you will hear many terms about your chances of 
survival that may be confusing. The most common 
expression is cancer survival rate. This basically 
tells you the percentage of people with the cancer 
that are alive after a certain time. 

Five year survival rates are typically calculated 
from medical statistics so that if a doctor says 
the 5 year survival rate of Stage 1 breast cancer 
(less than 2 centimeters in size and no lymph node 
spread) is 98%, this means only 2 people out of a 
one hundred will have died from the cancer in 5 
years. It does not necessarily mean that the other 
98 are totally cured of cancer. For example the 7 
year survival rate for Stage 1 breast cancer is 
about 92%. In other words, 6 more people of the 
original 100 are likely to die between years 5 and 
7 from the cancer. This brings up a second term 
you need to know - disease free survival rate. 

Disease free survival rate refers to patients who 
are very likely, but not definitely  "cured" of 
their disease. At least they have no evidence of 
the cancer at the time period being measured. 
These rates depend very much on whether the 
specific cancer is a rapid grower or a slow 
grower. If it is a rapid grower like a ovarian 
cancer in which most people who are not 
successfully treated die within 2-3 years, then a 
statistic such as the 5 year disease- free 
survival will reflect almost entirely those who 
have been completely cured. If the cancer is a 
slower growing tumor, such as prostate cancer in 
men or carcinoid cancer of the bowel in men or 
women, then the 5 year disease-free survival will 
still include many people who have microscopic 
disease but undetectable by current methods. 

Finally, there is a term called progression-free 
survival rate. This is the number of people who 
still have cancer, but the cancer is not growing 
much. This may be due to the cancer being slow 
growing or the treatment being "fairly effective" 
but not necessarily curative. The progression free 
survival rate includes people who may have had 
some success with treatment, but their cancer 
hasn't disappeared completely. 

While many people lump all cancers together as bad 
to have, and they are, doctors make vast 
differentiation among cancers according to the 
survival rates, cure rates and progression-free 
rates. You should make all the effort you can to 
understand about the survival rate of whatever 
cancer is affecting you or your friends or family. 

Cancer survival rates - What do they mean?

3. Reader submitted Q&A - Cholesterol levels
"Question submitted:  I am a 53 yr obese woman 
diagnosed 2 years ago with Type 2 diabetes. With 
Avandia, my glucose is doing fine. But this year 
my cholesterol numbers are elevated. total 
cholesterol 235, HDL 40 and LDL 164. How do you 
feel about statin drugs?  I would like to bring 
down my numbers without taking them, can you 
outline what I need to do? The lady at the health 
foods store sold me some Soy Protein Granules that 
I've begun sprinkling on my oatmeal in the 
morning, she said it's helped a lot of people. Do 
you agree with that or Chinese red yeast?" 

Chinese red yeast rice (Monascus purpureus) has 
the same rare complication that statins have, that 
of muscle destruction (rhabdomyolysis). It is 
quite uncommon but may happen with the same low 
frequency as with statins. For that reason, I do 
not think red yeast rice has any advantage as a 
natural substitute for statins. 

Oatmeal with soy protein is a good dietary 
treatment for elevated cholesterol but its 
effectiveness is in the range of less than 5%. I 
would continue it but not totally count on it to 
do the job. 

In women, a good HDL level above 35 mg/dl (or 45 
mg/dl if you have a family history of heart 
disease), is more significant to predict a lower 
chance of heart disease than is a high total 
cholesterol level or a high LDL (bad cholesterol) 
level. Since you did not indicate that you 
currently have a heart problem, I would guess that 
the diabetes you have is going to contribute much 
more to any future heart disease in you than will 
the elevated total  cholesterol level. Therefore 
the major recommendation to you would be to remove 
all stops to lose at least 15% of your body 

Weight loss is the only factor that someone with 
diabetes can control in order to totally cure 
themselves of this condition. While adult onset 
diabetes does not go away 100% of the time when 
you lose significant weight, it does go away often 
enough that you need to strongly focus on weight 
loss as the single thing you can do to improve 
your health. Weight loss will also lower your 
cholesterol levels. In simple terms cutting 
portions down, cutting out calories is much better 
than adding any cholesterol reducing food 
supplements, even oatmeal. I wish I had a secret 
to share with you on how to lose weight but I do 
not. Weight watchers has one of the best programs 
that doctors recommend but if you choose to do it 
yourself, remember that changing your eating 
habits permanently has to be part of the program. 

4. Low dose aspirin not beneficial for those over 70

Low dose aspirin (a baby aspirin, 80 mg a day) has 
been advocated by many physicians and health 
publications as a possible preventative against 
heart attacks. Aspirin functions as a weak 
anticoagulant (blood thinner) so any blood 
clotting from atherosclerotic plaques in blood 
vessels that produces a myocardial infarction (MI) 
or a thrombotic stroke may be lessened by daily 
aspirin. The only problem is that blood thinning 
of any kind can also cause bleeding in the stomach 
or bowels or bleeding in the small blood vessels 
in the brain (hemorrhagic stroke). 

Recently, investigators in Australia modeled the 
benefits versus the risks of low dose aspirin 
therapy. They used high quality articles in the 
medical literature to make estimates f MI 
reductions and bleeding complications under 
different circumstances and at different ages. 
They found that in men and women over the age of 
70 who did NOT have diagnosed cardiovascular 
disease, the benefits were almost evenly matched 
by the complications. For example in a theoretical 
10,000 women, low dose aspirin may have prevented 
321 ischemic heart attacks and 35 ischemic 
strokes, but it caused 572 major gastrointestinal 
bleeds and 54 hemorrhagic strokes.  

The authors did not feel that the benefits 
outweighted the risks of low dose aspirin therapy 
in people over 70 years old. I agree with them. 

Low dose aspirin not beneficial for those over 70

5. Health tip to share - Patient assistance programs

For people living on a reduced income, e.g., less 
than $19,000 per year if single or less than 
$30,000 a year for a family, there are programs to 
help with the expense of medicines. Many 
pharmaceutical companies have programs to help 
with medications but you have to apply and 
qualify. Until now there has not been a single 
source to go to in order to find out what 
medications might be available. One group 
www.freemedsandsolutions.com has compiled such 
lists and will help people to apply to programs 
for reduced cost or free medications. There is, 
however, a $10 charge for the application fee and 
help in applying. 

6. Humor is healthy

"Great Truths About Life That Little Children Have 

1. No matter how hard you try, you can't baptize 

2. When your mom is mad at your dad, don't let her 
brush your hair. 

3. If your sister hits you, don't hit back. They 
always catch the second person. 

4. Never ask your 3 year-old brother to hold a 

5. You can't trust dogs to watch your food. 

6. Reading what people write on desks can teach 
you a lot. 

7. Don't sneeze when someone is cutting your hair. 

8. Puppies still have bad breath even after eating 
a breath mint. 

9. Never hold a vacuum and a cat at the same time. 

10. School lunches stick to the wall. 

11. You can't hide a piece of broccoli in a glass 
of milk. 

12. Don't wear polka-dot underwear under white 
shorts -no matter how cute the underwear is. 

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

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********** Health Newsletter ***********
              June 26,  2005
Biweekly from BackupMD on the Net

1. How does cancer treatment affect libido?
2. Fish oil supplementation and heart rhythm
3. Reader submitted Q&A - Shellfish allergy
4. PMS and vitamin D, calcium intake
5. Health tip to share - Nausea from chemotherapy
6. Humor is healthy
The next newsletter will be in two weeks.

1. How does cancer treatment affect libido?

It is not uncommon for sexual desire to decrease 
or become absent when one is undergoing treatment 
for cancer. Sometimes the causes are physical, 
sometimes mental and often times both. Losing 
interest in sexual intimacy, even just kissing or 
cuddling causes strain between partners. It is a 
very important time for good communication to 
determine just exactly what the problem is. 

Of course any cancer treatment affecting the 
genital organs such as vulva, cervix, uterine or 
ovarian cancer in women or prostate, penile or 
testicular cancer in men is going to produce 
physical changes that decrease libido. Any 
treatment causing menopause in women also may 
decrease  libido by producing vaginal pain from 
dryness. Radiation therapy can produce extreme 
fatigue which in turn affects sexual desire. 

In addition to physical changes, emotional changes 
are also associated with cancer treatment. Some 
people may feel guilty that sex caused a cancer or 
that having sex may cause a spread of cancer to 
your partner. Neither of these are true. Sex does 
not cause cancer nor is cancer contagious. Even 
the often sexually transmitted human papilloma 
virus (HPV) which can play a role in setting the 
background for cervical cancer occurence is not a 
sole cause of cancer. Most people with HPV 
infection never develop any cancer at all. 

Depression over the future is a major concern. It 
is an emotional component among cancer treatment 
and cancer survivor individuals that affects 
sexual desire. Heightened self-consciousness about 
appearance is another emotion that can interfere 
with libido. Loss of your hair from taking 
chemotherapy, the loss of a limb, breast, or 
testicle, scars from surgery, and ostomies can 
make you feel less attractive and concerned that 
your partner will not find you attractive either. 
Truthfully, most partners are not as concerned 
about these changes as you are. 

Perhaps the major impact on libido when undergoing 
cancer treatment is the stress and anxiety of all 
the decisions that need to be made and the stress 
of making significant changes to your daily living 
activities while taking treatment. Stress 
decreases libido even if you are not undergoing 
cancer treatment. Stress causes you not to be 
relaxed and sexual intimacy requires some degree 
of relaxation or a least freedom from worrying 
about multiple issues while trying to engage in 

Most couples probably have not spent much time 
discussing sex before a cancer diagnosis and 
adding cancer to the mix makes it all the more 
difficult. However, the only real answer to this 
problem is communication. You need to talk with 
your partner as well as the doctors and nurses on 
the health care team. Discussions with other 
individuals undergoing cancer treatment can also 
be very helpful. You may need to change your 
definition of sexual intimacy for a while. Look 
for ways of being intimate without having vaginal 

How does cancer treatment affect libido?

2.  Fish oil supplementation and heart rhythm

Fish oils are rich in omega-3 polyunsaturated 
fatty acids (PUFAs) and have been thought to play 
a role in decreasing heart disease. It is not 
certain if the mechanism is by decreasing 
cholesterol levels or possibly by having an anti-
arrhythmic effect. The PUFAs are associated with a 
decrease in sudden cardiac death so one of the 
premises of PUFAs blocking heart arrhythmia was 
tested by a group from Oregon. They conducted a 
randomized clinical trial of giving fish oil PUFAs 
or placebos to patients who already had 
arrhythmias. They wanted to see if the fish oils 
decreased the episodes of heart arrhythmias that 
those patients already experienced. 

In the group of patients who had an implantable 
cardioverter defibrillator (ICD) and a recent 
episode of sustained ventricular tachycardia or 
ventricular fibrillation, taking omega-3 
polyunsaturated fatty acids resulted in more 
episodes of arrhythmias. In other words it may 
have caused arrhythmias more than it prevented 
them. It seems we have to look for a different 
reason as to why fish oil may reduce acute cardiac 

Fish oil supplementation and heart rhythm

3. Reader submitted Q&A - Shellfish allergy

"I read an interesting submission regarding 
shellfish allergy in possible relation to salt.  I 
have had anaphylactoid-like reactions from 
childhood spaced by years, to stewed jumbo shrimp 
(my throat swelled at around 7 yrs), and crab (my 
tongue swelled and darkened, a few years later).  
Now, I find that salty broth/stew will cause my 
throat to swell in the same way as lobster bisque, 
crab meat and corn soup, salmon stew, and sometimes 
shrimp.  While these are all very infrequent 
reactions, I am very afraid of ingesting too much 
salt.  I thought it was the iodine which maybe the 
salt had in common with the fish (as such I was 
avoiding iodized salt), but I have come to believe 
it may in fact be sea salt in particular which is 
the problem, since it gives me the same closed 
throat reaction as cooked shellfish.  Is this 
possible, or rare?  How do I read more on this?  
Also, are raw shellfish or shellfish cooked 
plainly possible even more threatening for this 
reason! I am 44 y.o. and generally healthy, recent 
celiac disease diagnosis, plus separate allergy 
diagnosis to eggs, corn, beef, soy, and wheat!" - 

Food allergies are a complicated business. The 
body has several different ways of producing an 
immune response. The most dangerous allergies are 
mediated by IgE antibodies and are probably what 
you describe as your shellfish and fish allergy. 
The allergic response is usually to a protein in 
the shellfish or even to a parasite contaminant; 
it is not to iodine. See our article about 
shellfish and iodine allergies at: 
/ngen22.htm . Most people 
are familiar with the immediate-onset food 
allergies caused by IgE mediated immune reactions 
such as those that children have to milk, nuts, 
peanuts, eggs, shellfish etc. These are severe 
reactions bringing on severe stomach reactions, 
cramping, diarrhea, skin rashes, hives, swelling, 
wheezing or even anaphylactic shock. The reactions 
usually occur within 2 hours of eating. 

The most common food allergies (70-80% of the 
population) are what are called delayed-onset food 
allergy mediated by IgG antibodies having an onset 
from a couple of hours to several days after 
consuming allergic foods. Delayed-onset food 
allergy/intolerance has been associated with many 
medical conditions including: arthritis, asthma, 
candidiasis, celiac disease, cardiovascular 
complaints, hypertension, epilepsy/seizures, 
sinusitis, skin rashes, weight problems, immune 
deficiencies, migraines, autism, irritable bowel 
syndrome, chronic fatigue, headaches, allergy/hay 
fever, stress, hypoglycemia and fibromyalgia. It 
sounds as if you have had some testing for IgG 
food antibodies and also have some of these 
allergies going on. There are also other types of 
rarer allergies to food mediated by the IgA 
antibody system. 

None of these immunoglobulin mediated allergies 
apply to salt however. Pure salt can cause 
swelling in tissues like the throat but it is not 
an allergic response and there are no allergies to 
pure salt that I know of. After all the body is 
basically made up of a 1% salt solution. It would 
be rare to have any sort of reaction to normal 
amounts of salt other than mild swelling of the 
tissues of the mouth and throat if you ingest a 
high salt concentration. 

On the other hand, could sea salt be contaminated 
with proteins such as the shellfish allergens? I 
think that would be possible since much sea salt 
is derived from just dried ocean water. It is 
conceivable that sea salt has organic proteins 
that are essentially contaminants and could 
possibly produce an allergic response. If I were 
you, I would stick with reputable manufacturer's 
commercial iodized salt in very small amounts and 
stay away from sea salt since there is no way of 
knowing how it has been prepared. I do not know of 
any reading sources for you since this had not 
been studied very well. With your multiple food 
allergies, you will have to stick pretty much to 
foods you have prepared yourself or commercial or 
restaurant foods that you have found to be non 
allergenic and stick with them. 

4. PMS and vitamin D, calcium intake

Premenstrual syndrome refers to a complex of 
physical and mood symptoms that worsen in the one 
to two weeks prior to a woman's menses and 
disappear by the end of a full menstrual flow. 
These symptoms often include fatigue, 
irritability, labile mood, and depression along 
with physical symptoms of bloating, breast 
tenderness, leg swelling and headache among other 
things. There have been a few things shown in good 
clinical trials to reduce the severity of PMS 
symptoms: nonsteroidal anti-inflammatory drugs 
such as naproxen, vitamin B6 at 100 mg a day, 
magnesium oxide at 600 mg a day, and calcium at 
1000 mg a day. 

While medical studies suggest that blood calcium 
and vitamin D levels are lower in women who have 
premenstrual syndrome (PMS) and that calcium 
supplementation may reduce the severity of PMS 
symptoms, we do not know whether any of these 
supplements can prevent the initial development of 
PMS versus just giving some symptom relief once 
you have it. To answer this, investigators who 
were conducting the Nurses’ Health Study II cohort 
looked prospectively at a subset of women aged 27 
to 44 years and free from PMS at baseline entry 
into the study. There were 1057 women who 
developed PMS over 10 years of follow-up and 1968 
women reporting no diagnosis of PMS and no or 
minimal premenstrual symptoms. The investigators 
looked at dietary questionnaires to determine how 
much vitamin D and calcium subjects were ingesting 
on the average throughout the decade. 

In this study, women taking the greatest amount of 
vitamin D and calcium in their diet had a risk 
ratio of 0.7 compared with women taking in the 
lowest amount of vitamin D and calcium. In other 
words, more vitamin D and calcium intake resulted 
in a 30% reduction of developing PMS symptoms. 

A good supplement for PMS prevention would have 
vitamin B6-50mg, vitamin D-200 IU, calcium 500 mg, 
and magnesium oxide 300 mg and you would need to 
take one tablet twice a day. I could not find any 
specific supplement that has this formula in it so 
you may need make it up with more than one pill. 

PMS and vitamin D, calcium intake

5. Health tip to share - Nausea from chemotherapy

"Ginger helps with nausea: I found sucking on 
small sections of crystallized ginger, and 
drinking ginger tea with honey especially helpful 
with nausea related to chemotherapy treatment.  
Another drink I found helpful to the stomach when 
on chemotherapy was about 1/4 tspn. nutmeg + 2-3 
tsp. honey dissolved with 1 tsp. hot water and 
mixed with a glass of fresh cold milk.  These 
remedies are much better for the body than taking 
prescription medications, if the natural products 
ease the problems." V.W. 
6. Humor is healthy

"Good Advice - Rules for Inner Peace"

I am passing this on because it definitely worked 
for me, and we all could use more calm in our 
lives. By following the simple advice I heard on a 
Dr. Phil show, I have finally found inner peace. 

Dr. Phil proclaimed "The way to achieve inner 
peace is to finish all the things you've started." 

So I looked around my house to see all the things 
I started and hadn't finished, and before leaving 
the house this morning, I finished off a bottle of 
Merlot, a bottle of White Zinfandel, a bottle of 
Bailey's, a bottle of Kahlua, a package of Oreos, 
the remainder of both Prozac and Valium 
prescriptions, the rest of the cheesecake, some 
saltines and a box of chocolates. You have no idea 
how freaking good I feel. 

Please pass this on to those you feel are in need
of inner peace!!!

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

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********** Health Newsletter ***********
              July 10,  2005
Biweekly from BackupMD on the Net

1. Circulating male hormone levels and female sexual dysfunction
2. Menstrual cramps in adolescents lessened by B.C. pills
3. Reader submitted Q&A - Pregnancy at age 41
4. Postpartum depression prevention
5. Health tip to share - Tai Chi can prevent falls
6. Humor is healthy

The next newsletter will be in two weeks.

1. Circulating male hormone levels and female sexual dysfunction
As you may be aware there have been recent efforts 
by pharmaceutical companies to promote low dose 
testosterone patches for women who have decreased 
sexual libido or arousal levels. The FDA has 
delayed the patches because of concern about the 
long term effect of testosterone on women, 
especially with regard to heart disease. While 
there have been studies showing that testosterone 
supplements for women may increase sexual desire 
and arousal, the basic premise of whether low 
blood levels of circulating male hormones in women 
causes or is even associated with low arousal and 
desire has not been shown in good scientific 

A recent study reported in the Journal of the 
American Medical Association (JAMA) looked at over 
1000 Australian women. They categorized their 
self-reported sexual desire and sexual 
satisfaction levels to see if they were more 
likely to have low serum androgen blood values 
than women without self-reported low sexual desire 
and sexual satisfaction. They measured total and 
free testosterone, androstenedione, and 
dehydroepiandrosterone sulfate (DHEA-S). 

As it turns out, there was no correlation of serum 
testosterone levels or of androstenedione levels 
with degree of sexual arousal and desire. This 
refutes the concept that replacement of low levels 
of blood testosterone in women with testosterone 
patches is curing any deficiency. On the other 
hand there was some correlation of low DHEA-S 
blood levels and degree of sexual desire and 
satisfaction. Perhaps the advocates of DHEA 
supplements have a better argument for replacement 
than testosterone advocates. The authors did point 
out, however, that there were many women with low 
DHEA-s levels who had normal levels of sexual 
desire and arousal. Who knows? 

Circulating male hormone levels and female sexual dysfunction

2. Menstrual cramps in adolescents lessened by B.C. pills

Teenaged girls often suffer from severe menstrual 
cramps. These are not always present in the first 
1/2 to 1 year after menses starts but when the 
ovaries begin to ovulate regularly, cramps often 
appear. The medical term for menstrual cramps is 
dysmenorrhea. Pressure inside the uterus in 
dysmenorrhea has been measured to frequently be 
higher than that of a labor contraction. It is no 
wonder that the cramps can cause loss of time from 
school and other daily activities. 

The first line treatment for severe menstrual 
cramps is non steroidal anti-inflammatory drugs 
(NSAIDS) such as ibuprofen or naproxen. This 
applies not only to adolescents but to women of 
any age with severe menstrual cramps. The NSAIDs 
have to be taken on a regular basis not just when 
cramping occurs. They work by blocking the 
substances that cause the uterine muscle to 
contract. Teens need to be told this in order to 
take the NSAIDs before the cramps cause pain 
otherwise the lack of quick pain relief will make 
them think NSAIDs do not help. 

Another treatment that doctors also use for 
dysmenorrhea is oral contraceptives. Birth control 
pills seem to have a quieting effect on the 
uterine muscle as well as decreasing the amount of 
tissue that is passed during menses. While oral 
contraceptives are thought to be effective, good 
studies have been lacking. 

In a recent study from New York, investigators 
gave low dose oral contraceptives to adolescents 
having menstrual cramps and they found a 
significant reduction in pain scores as well as a 
reduction in pain medicine use. 

The pills do not make the cramps go entirely away 
but they do seem to reduce the symptoms and pain 
medicine use by more than in half. 

Menstrual cramps in adolescents lessened by B.C. pills

3. Reader submitted Q&A - Pregnancy at age 41

"I am 41 years old and I am trying to get pregnant 
by IUI (intrauterine sperm insemination) or IVF 
(in-vitro fertilization).  My concern is I have 
FSH of 5.8 but my estrogen is high. What does this 
mean?  Plus my FSH fluctuates. I have never tried 
a IUI because my doctor is waiting for my FSH to 
be under 9 w/o any drugs and my estrogen to be 
under 60?  I would like to have a full explanation 
of what these exact numbers` mean.  If I use drugs 
to stimulate my follicles I will be using 
Follistim.  Additionally, is it true Clomid should 
not be used with woman in their 40's, I welcome 
your insights and suggestions.  I would like to 
get pregnant as soon as possible." 

If your FSH level is too high and the estrogen 
levels are too high you run the risk of ovarian 
hyperstimulation syndrome when the doctors give 
you medicines (eg., Follistim) to stimulate 
ovulation from the ovaries. Ovarian 
hyperstimulation syndrome expands the ovaries to 
almost bursting point with multiple follicles. In 
some cases it can be fatal. That is why the 
doctors insist that your baseline hormone levels 
before stimulation are low so you are at lower 
risk for this serious complication. 

Over age 40 it is tough to get pregnant. Some 
women do but I assume you have been told the 
chances are not good. Infertility experts will try 
to stimulate the ovaries to give you the best 
chance of getting pregnant but even then the 
chances are still low but expensive. From a 
literature review, it appears that the costs per 
child born greatly increase after the age of 40 
for both intrauterine insemination with mild 
ovarian stimulation and in vitro fertilization 
treatment, while in cases of age 44 and over, 
prognosis is flat zero. 

Over age 40, the IVF success rate (full term 
delivery rate) is about 3.6% in one study.  In 
another study, using a combined clomiphene 
citrate/gonadotrophin protocol for non-assisted 
reproductive technology fertility treatment, 
pregnancy rates varied significantly with patient 
age: 9.3% in women less than 40 years vs. 2.4% in 
women greater or equal to 40  years old. You can 
use Clomid over age 40 but it is not very 

Intrauterine insemination without ovarian 
hyperstimulation for male or cervical factor in 
women aged 40 or over results in a cumulative 
probability of ongoing pregnancy following 3 
cycles of IUI of 28.2% for women under 40 and 0.0% 
for the older group over 40. 

Overall, the chance of becoming pregnant over age 
forty is about 5% or less. I am not sure that it 
is any lower than that without any treatment at 
all. While you are presumably very desirous to get 
pregnant, all the money you spend with ovulation 
stimulation and IUI may only increase your chances 
from 4% to 5% or so. You will need to decide 
yourself if the money is worth it. 

4. Postpartum depression prevention

As Tom Cruise and Brook Shield use the media to 
discuss their thoughts on the management of 
postpartum depression, others are looking at what 
studies have been done in order to PREVENT 
postpartum depression. A recent scientific paper 
looked at numerous studies in the medical 
literature to see if there were any successful 
strategies that could be used to prevent or at 
least lessen the likelihood of developing 
postpartum depression. 

In looking at 15 studies that encompassed almost 
770 women, the authors concluded that most 
strategies did not really work well to prevent 
postpartum depression (PPD). The only ones that 
showed a small trend toward significantly 
preventing PPD involved health care professionals 
who singled out women at high risk and followed 
them frequently after delivery. Individual therapy 
was better than group therapy and postpartum 
therapy alone was better than antepartum plus 
postpartum therapy. 

The authors concluded that "diverse psychosocial 
or psychological interventions do not 
significantly reduce the number of women who 
develop postnatal depression". The most promising 
intervention is to provide intensive, professional 
postpartum support. 

Postpartum depression prevention

5. Health tip to share - Tai Chi can prevent falls
In the U.S. it is estimated that 30% of people 
over 65 living in the community fall each year and 
this rises to up to 50 percent for people in long-
term care facilities, such as residential homes. 
One in 10 falls results in a fracture. 

Tai Chi is an ancient Chinese martial art form. It 
consists of a series of slow, gentle, continuous 
movements. In a recent study of Tai Chi in the 
elderly  (average age 28) the participants 
significantly reduced their risks of falling. 
Twenty-nine elderly people took part in a 12-week 
course three times a week, while 30 others were in 
a non-exercise control group. The study found the 
physical fitness of the Tai Chi group showed 
significant improvement, with stronger knee and 
ankle muscles, improved mobility and flexibility 
and better balance. 

6. Humor is healthy

One afternoon a man came home from work to find 
total mayhem in his house. 

His three children were outside, still in their 
pajamas, playing in the mud, with empty food boxes 
and wrappers strewn all around the front yard. 

The door of his wife's car was open, as was the 
front door to the house. 

Proceeding into the entry, he found an even bigger 

A lamp had been knocked over, and the throw rug 
was wadded against one  wall. 

In the front room the TV was loudly blaring a 
cartoon channel, and the  family room was strewn 
with toys and various items of clothing. 

In the  kitchen, dishes filled the sink, breakfast 
food was spilled on the  counter,  dog food was 
spilled on the floor, a broken glass lay under the 
table, and a small pile of sand was spread by the 
back door. He quickly headed up the stairs, 
stepping over toys and more piles of clothes, 
looking for his wife. 

He was worried she may be ill, or that something 
serious had happened. He found her lounging in the 
bedroom, still curled in the bed in her pajamas, 
reading a novel. She looked up at him, smiled, and 
asked how his  day went. He looked at her 
bewildered and asked, "What happened here today?" 

She again smiled and answered, "You know everyday 
when you come home from  work and ask me what in 
the world did I do today?" 

"Yes," was his incredulous reply. 

She answered, "Well, today I didn't do it."

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

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********** Health Newsletter ***********
              July 24,  2005
Biweekly from BackupMD on the Net

1. SSRIs effectiveness for depression rx questioned
2. Ovarian Cysts
3. Reader submitted Q&A - Splenda(R)
4. Negative urinalysis may still benefit from treatment
5. Health tip to share - Baking soda to wash with
6. Humor is healthy
The next newsletter will be in two weeks.

1. SSRIs effectiveness for depression rx questioned

Many medical professionals and patients have 
accepted that selective serotonin re-uptake 
inhibitors (SSRIs) make a difference in treating 
the symptoms of depression. Prescriptions for 
citalopram (Celexa(R)), fluoxetine (Prozac(R)), 
paroxetine (Paxil(R)) and sertraline (Zoloft(R)) 
have increased tremendously in the last decade. 
Unfortunately the data on which recommendations of 
SSRI use for mild or moderate depression are based 
has come into question. 

Investigators in the U.K. point out that even 
though SSRIs reduce the symptoms of depression, 
they only do so by a minimum amount. Scores on 
depression scales were only reduced by less than 2 
out of a possible maximum score of 52. Analysis of 
multiple studies found that SSRIs were only about 
10-17% better than placebos. If you look at the 
data and arguments in the below referenced British 
Medical Journal, you might conclude that SSRIs do 
not make a meaningful difference in mild to 
moderate depression symptoms. 

While you might think that in severe depression, 
SSRIs are more effective, data for that is also 
questionable. Any effect the SSRIs may have may be 
due to a slight sedative effect they have that can 
alter depression rating scores. The authors came 
to the following conclusions: 

1. Recent meta-analyses show selective serotonin 
reuptake inhibitors have no clinically meaningful 
advantage over placebo 

2. Claims that antidepressants are more effective 
in more severe conditions have little evidence to 
support them 

3. Methodological artifacts may account for the 
small degree of superiority shown over placebo 

4. Antidepressants have not been convincingly 
shown to affect the long term outcome of 
depression or suicide rates 

5. Given doubt about their benefits and concern 
about their risks, current recommendations for 
prescribing antidepressants should be reconsidered 

If you or someone you know is on an SSRI 
medication, you should seriously consider talking 
to your doctor as to whether it is really helping 
you enough to be worth the expense as well as the 
risk of side effects. 

SSRIs effectiveness for depression rx questioned

2. Ovarian Cysts 

Ovarian cysts are sometimes misunderstood by both 
patients and doctors alike. In a reproductive age 
woman, an egg is formed each month in the first 
two weeks of the menstrual cycle. It is surrounded 
by a cystic area full of fluid and called a 
follicle. Usually a follicle does not get bigger 
than 1 inch (2.5 cm). At approximately 2 weeks 
after menses and 2 weeks before the next menses, 
the egg extrudes from the follicle (ovulation) and 
the cystic area heals over to become a corpus 
luteum (luteal) cyst. This cyst forms some cells 
which secrete estrogen and progesterone. When 
pregnancy does not occur, the cyst just dissolves 
and goes away. 

Both the follicular cyst and the luteal cyst can 
sometimes go "haywire" and just continue to grow 
and not go away when they should. Eventually they 
both go away  but sometimes they can swell up, 
rupture, bleed or even twist causing moderate pain 
before they go away. Most cysts under 3 cm (1.5 
inches) will gradually regress on their own and do 
not cause any symptoms. Cysts up to 5 cm in size 
(2 inches) almost always regress eventually and 
most doctors do no recommend intervening with 
surgery without giving those cysts 3-4 months to 
dissolve themselves. 

This normal physiologic process becomes 
complicated when a woman has an imaging study such 
as an ultrasound or CAT scan for abdominal pain 
and a "cystic area" in the ovary is detected. If 
it is reported by the radiologist as a cyst, many 
patients will assume their pain is coming from the 
cyst as opposed to the cyst being just an 
incidental finding. I wish the radiology 
technicians would not mention any cystic areas to 
the patient that are less than 3 cm because if 
they do, a patient  begins to believe that 
something has to "be done" about that ovarian 

Sometimes other cysts can form in the ovary that 
do not come and go with the monthly menstrual 
cycle. Endometriotic cysts (endometriomas) and 
benign ovarian tumors like cystadenomas or 
dermoids can form in the ovary. Endometriosis can 
cause pain whereas the other ovarian tumors 
generally do not. 

When cysts other than endometriomas cause moderate 
pain, they usually do so rather acutely such as 
when they rupture, bleed or twist. If you get a 
sudden onset of lower abdominal pain then you need 
to be evaluated for a cyst. Also if you get sudden 
onset of pain and nausea and vomiting, that may 
represent a twisted cyst. 

If you have a ruptured cyst or bleeding into a 
cyst (some call it a bruised ovary), the pelvic 
pain may take as long a 3-4 months to totally go 
away. At other times the pain is incapacitating 
enough that emergency surgery has to be performed. 

3. Reader submitted Q&A - Splenda(R)

"I recently received an email entitled  "Splenda  
A Poisonous Clorocarbon"..... I would like your 
opinion on this. Do you agree it is lethal? Or do 
you recommend it to your patients? I am a 53 yr 
old female with Type 2 Diabetes and am also 
obese." - DF 

I do not consider Splenda(R) lethal or even harmful. 
That is the short answer. 

Splenda is made from regular sugar (sucrose). In 3 
places on the molecule, chlorine (Cl-like the Cl 
in NaCl table salt) is substituted for the OH 
molecules (like the OH in water-HOH). This makes a 
new molecule called sucralose which tastes sweet 
like sugar but is not metabolized to calories like 
sugar. There have been hundreds of animal studies 
indicating that it is very safe and about half a 
dozen randomized controlled human studies with no 
adverse effects. I am not aware of any adverse 
effects of sucralose other than somewhat 
unsubstantiated claims on Internet web sites.  

All of the artificial sweeteners (acesulfame-K, 
aspartame, neotame, saccharin, sucralose) have at 
sometime or another been subjected to circulating 
rumors that they are toxic or they produce cancer 
or some other medical problem. Epidemiological 
studies in humans did not find the bladder cancer-
inducing effects of saccharin and cyclamate that 
had been reported from animal studies in rats. The 
Nutrasweet (aspartame) rumors I occasionally hear 
about do not have any  substantiated studies 
showing adverse affects. Some initial concerns 
about Splenda because of animal studies about 
brain tumors and a decreased seizure threshold 
with epilepsy, have not been observed at all with 
humans. Remember even Tylenol is dangerous in 

Still, I have family members who swear up and down 
that aspartame causes medical problems even though 
I keep showing them that no data exists for such 
claims. Therefore I have no reservations about 
people consuming Splenda or other artificial 
sweeteners. They do reduce your calorie intake and 
effect on raising blood sugar compared to the same 
food or drink with plain sugar in it. The American 
Dietetic Association considers Splenda safe. They 
state that "consumers can safely enjoy a range of 
nutritive and non nutritive sweeteners when 
consumed in a diet that is guided by current 
federal nutrition recommendations." 

4. Negative urinalysis may still benefit from treatment

Urinary tract infections are not uncommon, 
especially in women. Symptoms include burning on 
urination, urinary frequency during the day as 
well as having to get up from sleep to void and 
lower abdominal midline pain or discomfort. When a 
woman goes to the doctor with a suspicion of 
having a urinary tract infection, the common 
doctor's office laboratory tests are: 

1) using a dip strip to check for bacterial 
infection chemical problems abnormalities in the 
urine such as leukocytes and nitrites 

2) performing a microscopic analysis of the urine 
looking for red blood cells and white blood cells 

3) sending the urine for a bacterial culture 

The dip strip is the most commonly used method of 
detection because it is the least expensive and 
about 85% accurate in picking up an infection. The 
question the doctor has to answer is what if the 
dip strip is negative but you still have symptoms, 
should the doctor still prescribe antibiotics even 
if the test is negative? 

A recent study in New Zealand looked at women aged 
16-50 years presenting with possible urinary tract 
symptoms but in whom a dipstick test of midstream 
urine was negative for both nitrites and 
leukocytes. Half of the women were given 
trimethoprim 300 mg daily (a sulfa-based 
antibiotic for three days or a placebo. They then 
measured how many days it took for the burning 
urination to resolve as well as the other 

At the end of seven days of treatment, only 10% of 
the women taking the antibiotic still had burning 
on urination while 40% of the women who had taken 
placebo still had burning. 

These findings would imply that women should be 
treated for any symptoms of urinary tract 
infection even if the dip strip is negative. 
Remember these findings the next time you have any 
urinary symptoms and go to the doctor. 

Negative urinalysis may still benefit from treatment

5. Health tip to share

"I have found that using baking soda in the shower 
is great for washing all the 'stinky parts' of the 
body.  A hand held shower is probably necessary.  
Baking soda gently exfoliates and is gentle enough 
for the genital area (all the way) to the more 
oily, 'fragrant' areas of the rear." DIY 

6. Humor is healthy

11 People On A Rope"

Eleven people were hanging on a rope under a 
helicopter, ten men and one woman. The rope was 
not strong enough to carry them all, so they 
decided that one has to leave, because otherwise 
they are all going to fall. 

They were not able to name that person, until the 
woman held a very touching speech. She said that 
she will voluntarily let go of the rope, because 
as a woman she is used to giving up everything for 
her husband and kids, or for men in general, and 
was used to always making sacrifices with little 
in return. 

As soon as she finished her speech, all the men 
started clapping their hands....... 

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

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