Womens Health

Women's Health Newsletters 8/21/05 - 10/30/05



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********** Health Newsletter ***********
           September 4,  2005
Biweekly from BackupMD on the Net

1. Radiological treatment of fibroids
2. Quality of care and longevity of the elderly
3. Reader submitted Q&A - Bleeding and uterine polyps
4. Cell phone use and auto accidents
5. Health tip to share - Exercise is a treatment for pain
6. Humor is healthy

1. Radiological treatment of fibroids

Uterine fibroids are a benign growth of muscle 
cells that form small to large lumps in the 
uterine wall. When they are small, they do not 
cause any problems but if they enlarge beyond the 
size of an inch or two, they can cause health 
symptoms such as constant bladder pressure, 
weightiness or bloating of the lower abdomen, 
constant low back pain, abnormal uterine bleeding 
problems and occasionally sharp pains in the 
pelvis. Fibroids can get as big as volleyballs if 
you let them and ones that are the size of 
baseballs are more common than most people think. 
Up to 25% of all women reaching menopause may have 
some fibroids present in the uterus. they tend to 
get much smaller after menopause. 

When fibroids start producing constant symptoms or 
they become as large as a 3 month pregnancy size 
or more, then many physicians recommend 
hysterectomy if childbearing is completed. If 
childbearing is not completed, surgery to remove 
individual fibroids (myomectomy) may be performed 
if the fibroid(s) is felt to be interfering with 
becoming pregnant or carrying a pregnancy. 

Recently radiological techniques have improved so 
that by catheterizing an artery in the groin, 
particles can be injected into the arteries of the 
fibroids so that the blood supply is cut off. 
Gradually those benign muscle lumps dissolve and 
become significantly smaller or go away entirely. 
This procedure is called uterine artery 
embolization (UAE). 

The report below is about a registry for cases of 
uterine artery embolization for fibroids and they 
report their experience. The major complication 
rates are slightly lower than that for hysterectomy 
(0.66%), although they are not zero. Postoperatively, 
there can be some prolonged pain problems but the 
incidence of pain is still much less than having a 
large abdominal incision from a hysterectomy. 
About 5% of patients having UAE may need 
readmission for pain or other problems after 
discharge from the hospital but these are not 
major complications. Only about 1% required any 
surgical intervention for post UAE complications. 

This procedure, uterine artery embolization, 
should be strongly considered as an alternative to 
hysterectomy for symptomatic uterine fibroids. 

Radiological treatment of fibroids

2. Quality of care and longevity of the elderly

As we get older, most people develop some sort of 
medical problems for which they seek health care 
on a regular basis. Individuals over the age of 65 
are usually under the regular care of a physician 
for one reason or another. A recent study 
conducted at two managed health care organizations 
in California looked at quality of care indicators 
in the health care received by medically high risk 
patients 65 years of age or older living in their 
communities (not in nursing homes). They looked at 
over 200 quality of care measures such as how 
often patients received certain tests or 
treatments depending upon their health problems. 
The premise was that a high quality content of 
health care should predict how long people live. 
You would think this is a "no brainer" that does 
not need to be studied, but the evidence has not 
been here-to-for conclusive as far as living 
longer goes. 

The investigators found that in 372 vulnerable 
elderly patients, when care did not meet the 
quality standards they were looking at, patients 
were more likely to die during the 3 years of 
follow-up. Actually the first year and a half the 
death rate did not increase much, but in the 
second year and a half of the 3 year study the 
death rate did increase. 

I conclude from this study that quality medical 
care not only improves how we live with our 
diseases, but that good, medically-proved 
decisions are effective in prolonging the life of 
high risk elderly individuals. It will be 
interesting as they continue the study, to see how 
long good medical care can contribute to survival. 
The important point is to keep seeking out high 
quality medical care and follow that advice. 

Quality of care and longevity of the elderly

3. Reader submitted Q&A - Bleeding and uterine polyps
"I have been taking Ovcon-50(R) continually for 3 
years... Last year I started bleeding heavy. I had 
2 polyps removed. Two months later I started 
bleeding again after the doctor tried different 
remedies. He saw a polyp again and I had another D 
and C. Now after 4 months I am spotting again... 
What is going on? I am 43 years old. How will I 
know if I am going thru the change if I am on the 
pill continually (due to Polycystic ovarian 
syndrome)?" - anonymous. 

Not much is known about what causes uterine 
polyps. Whether or not hormone therapy in general 
or the specific type of hormone therapy plays a 
role is uncertain. In women who do have 
symptomatic uterine polyps, about 30% of the time 
there is recurrence or persistence of the polyps. 
I suspect you fall in that category. Currently the 
standard treatment for uterine (endometrial) 
polyps causing bleeding problems is an office or  
outpatient surgical procedure called hysteroscopy 
and D and C (dilatation and curettage). 

Hysteroscopy is looking into the uterus with a 
tiny scope so the doctor can see if any polyps are 
present before scraping the lining of the uterus 
with the D and C part of the procedure. Before the 
hysteroscope was used, D and Cs were done blindly 
in the hopes that all polyps would be removed just 
by a thorough, systematic scraping of the lining. 
However when studies were performed of 
hysterectomies immediately after D and Cs, we 
found that many polyps had been missed. Even with 
hysteroscopy it is still possible to "miss" 
existing polyps but it is a much lower frequency 
than before. 

The reason I mention this at all is because there 
are still some physicians performing D and Cs 
without doing a hysteroscopy immediately 
preceding. You did not mention a hysteroscopy with 
your D and C although I would guess that 85-90% of 
physicians are doing that. You did mention that he 
"saw a polyp" so probably he is performing a 
hysteroscopy but you might ask your physician if 
that was done with both of your D and Cs. If it 
was, then your problem is more of recurrence than 
of persistence of endometrial polyps. If that is 
the case, switching you to a lower estrogen pill 
than the Ovcon-50 might help prevent some of the 
recurrent polyps. Estrogens are felt to stimulate 
the growth of polyps. A 20 microgram pill rather 
than a 50 microgram pill should still control your 
bleeding if the progestin component is a strong 
one (e.g., Loestrin 1/20) 

The question about recognizing menopause while you 
are taking continuous oral contraceptive pills is 
a good one. Normally the hormones in the pills 
prevent you from having both perimenopausal 
symptoms as well as menopausal symptoms such as 
hot flashes, vaginal dryness and sleep 
difficulties. The only way to know about menopause 
is to periodically stop the oral contraceptives 
and see if you get hot flashes. Also, a blood test 
for follicle stimulating hormone (FSH) can be 
ordered by the doctor and if it is elevated above 
30 mIU/ml, then you are in the menopause. Average 
age of menopause is about 50-51 years old so you 
will probably still be on the continuous oral 
contraceptives until the 50's. 

4. Cell phone use and auto accidents

Most of us have heard by now that cell phone use 
while driving a car can be dangerous and lead to 
accidents. In one study in the U.S., at any time 
of the day up to 5% of people driving cars are 
using a hand-held telephone. Most studies looking 
at this have been conducted with small numbers of 
volunteers. Those studies have found phone use 
while driving: 

impairs reaction time
affects the variability of lane position and speed
adversely affects following distance and 
  situational awareness 

In a recent Australian study listed below, they 
looked at 456 drivers aged 17 years or more who 
owned or used mobile phones and had been involved 
in motor vehicle accidents resulting in hospital 
admissions. The driver's use of mobile phone at 
the time of crash and on trips at the same time of 
day in the week before the crash were recorded by 
interviews with the drivers as well as phone 
company's records of phone use. 

It turned out that using a mobile phone within 10 
minutes of a crash was associated with up to a 4 
times increased risk of an accident. Interestingly 
enough, the increased risk was still present 
whether the driver used a hand held mobile phone 
or a hands-free phone. In other words, it is more 
the distraction of the attention and thought 
process from speaking on the phone than it is the 
physical handling of the phone itself that leads 
to impaired driving. 

Cell phone use and auto accidents

5. Health tip to share - Exercise is a treatment for pain

Years ago if you were in pain, the treatment 
dictum was "to take it easy". In other words 
decrease your physical activity. However, it has 
now been shown that exercise is an excellent 
treatment for pain. Exercise releases pain numbing 
substances (endorphins), strengthens muscles that 
make painful joints more stable and less likely to 
produce pain, helps you to sleep better, improves 
mood, keeps muscles flexible and less likely to be 
injured and boosts your energy level. Check with 
your doctor to see if exercise is right for your 
specific pain problem and if it is, get on an 
exercise program to eventually ease the pain. You 
will get over the pain quicker with exercise. - 

6. Humor is healthy
"Wedding Advice"

At my granddaughter's wedding, the DJ polled the 
guests to see who had been married longest. It 
turned out to be my husband and I who had been. 

The DJ asked us, "What advice would you give to 
the newly-married couple?" 

I said, "The three most important words in a 
marriage are, 'You're probably right.'" 

Everyone then looked at my husband.  He said,
"She's probably right."

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

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********** Health Newsletter ***********
              September 18,  2005
From BackupMD on the Net

1. Cancer-related causes of mouth sores
2. Belching, bloating and intestinal gas
3. Reader submitted Q&A - Laparoscopic surgery for prolapse
4. Green onions and a hepatitis outbreak
5. Health tip to share - Shin splints
6. Humor is healthy
1. Cancer-related causes of mouth sores

Many cancer chemotherapeutic agents cause mouth 
sores which can be painful and distressing. The 
sores can be so bad as to interrupt treatment. The 
ulcers that form can be on the inside of the 
mouth, on the gums and even the tongue and lips. 
Even bone marrow and stem cell transplants can 
produce ulcers as well as radiation therapy to the 
head and neck. 

Some people are more susceptible than others to 
developing mouth ulcers from cancer treatment. 
Younger patients, those with preexisting gum or 
dental disease, people who do not brush or floss 
regularly and those on certain predisposing 
medications such as pain medicines or anti-

There are some things that can be done if 
chemotherapy is anticipated: 

get a dental check-up
take care of your teeth
stop smoking
eat a well-balanced diet for vitamins
drink plenty of water

These above suggestions from Mayo Clinic may help 
protect from cancer treatment related ulcers. 

Once ulcers occur, the treatments are limited. If 
you are taking 5-FU (fluorouracil), swishing ice 
chips in your mouth for the first half-hour of 
treatment may limit the amount of the drug that 
reaches your mouth, reducing the risk of mouth 
sores. Mouth wash preparations such as Ulcer ease(R) 
can help relieve the pain of the ulcers. 
Palifermin (Kepivance) is a prescription medicine 
that stimulates the growth of cells on the surface 
of the mouth, but it is only approved in people 
with leukemia and lymphoma who receive bone marrow 
transplants. Low-energy laser therapy may be used 
to stimulate cell growth in the mouth but it 
requires expensive equipment and specialized 

Cancer-related causes of mouth sores

2. Belching, bloating and intestinal gas

Belching, bloating and intestinal gas are 
certainly normal physiologic functions. When the 
amounts become excessive, however. they cam make 
one quite uncomfortable as well as embarrassed. 
What defines excessive varies substantially from 
person to person. When these symptoms become 
bothersome, there are some things that can be 

Since belching is the body's way of getting rid of 
excess air in the stomach, excess air swallowing 
needs to be avoided. Chew food carefully and eat 
slowly. Avoid carbonated beverages that release 
carbon dioxide in the stomach. Both smoking and 
chewing gum or candy make you swallow air so these 
should be avoided. Poor fitting dentures may also 
result in increased stomach air. 

Bloating happens when the air remains trapped in 
the stomach or goes down into the small intestine. 
Most of the time food causes this. Vegetables like 
broccoli, any type of beans, cabbage, and salads 
are the most common culprits. 

Increased bowel gas is still part of the same 
problem when the air passes into the large bowel 
or when it is produced by incompletely digested 
food that is further broken down by colon 
bacteria. Stress can make the bowel move 
undigested food too quickly from the small 
intestine where it is supposed to be totally 
digested to the large intestine.  Constipation 
makes the problem even worse because normally 
insoluble fiber is fermented by large bowel 
bacteria resulting in even more flatulence. 

People who have lactose intolerance or irritable 
bowel syndrome (IBS) also have a problem with 
excess intestinal gas. It may be important to make 
these diagnoses before just assuming the increased 
gas problem is to be treated only with diet and 
behavior modification. 

Over-the counter products such as Mylanta(R) or 
Gas-X(R) containing simethicone can break up the 
bubbles in gas. While these do not address the 
original problem of air swallowing, dietary 
intolerances or increased bowel motility due to 
stress, they can still reduce symptoms markedly 
and are worth a try while correcting the base 

Belching , bloating and intestinal gas

3. Reader submitted Q&A - Laparoscopic surgery for prolapse
"What is your opinion of laparoscopic surgery for 
pelvic floor displacement where bladder and 
ligaments need readjustment (dropped)?" - M.J. 

Early studies of about 5 years ago comparing 
laparoscopic procedures for prolapse and stress 
incontinence were only slightly less effective 
than "open" procedures resulting in an abdominal 
and/or vaginal incision. Studies in the last year 
or two, however, show about the same results when 
performed by surgeons who have had moderate 
experience in these techniques. The advantages of 
laparoscopic surgery include small incisions and 
less recovery time although you have to be very 
cautious about too much post operative activity 
too soon. That can tear out some of the results 
before total healing occurs. 

The best rule-of-thumb to follow when considering 
surgery by various techniques is to be willing to 
have whatever procedure your surgeon has performed 
the most of. There is no substitute for 
experience. Extensive experience will almost 
universally produce the least complications and 
the best success rate. 

Personally, I still prefer the "open" procedures 
just because that is where my experience lies. 
They give a very good success rate with minimal 
complications. It usually takes performing in the 
range of about 100 procedures to develop a routine 
that optimizes the intended results of the 
procedure while minimizing any risk. Recovery time 
of laparoscopic procedures versus "open" 
procedures has been shown to be about 2-3 weeks 
less. That's not as much difference as you would 

4. Green onions and a hepatitis outbreak

While food poisoning is the worry that most people 
have about eating out in restaurants frequently, 
one of the more worrisome foodborne diseases is 
hepatitis A. This can come not only from kitchen 
workers who are infected but also from foods that 
are contaminated and improperly washed. You 
probably remember the 2003 incident in 
Pennsylvania where over 600 people who had eaten 
in the same restaurant were infected by hepatitis 
A which was subsequently traced to contaminated 
green onions from Mexico used in large salsa 
batches and other menu items. Three people died 
and 124 were hospitalized. 

Symptoms of hepatitis A include:

a short, mild, flu-like illness 
nausea and vomiting 
loss of appetite 
weight loss 
jaundice (yellow skin and whites of eyes, darker 
   yellow urine and pale stools) 
itchy skin. 

A person can be exposed and have no symptoms at 
all or develop a severe inflammation of the liver. 
He or she can even be a carrier for a short while. 
Most hepatitis A symptoms improve after a few 
weeks, although some people can feel tired for 
months after the infection. 

The best treatment is prevention which is carried 
out by immunization. Current Center for Disease 
Control recommendations for Hepatitis A 
immunization are for: 

Travelers to areas with increased rates of hepatitis A  
Men who have sex with men 
Injecting and non-injecting drug users 
Persons with clotting-factor disorders (e.g. hemophilia) 
Persons with chronic liver disease 
Children living in areas with increased rates of 
   hepatitis A 

Actually, I would suggest that everyone be 
immunized for hepatitis A (viral hepatitis), not 
just high risk people. I think there are too many 
possible foodborne exposures for most people who 
eat food that someone else has prepped. You can 
usually get a vaccination either at your doctor's 
office (general practitioner), or at your local 
health department. 

Green onions and a hepatitis outbreak

5. Health tip to share - Shin splints

Shin splints is a condition in which there is a 
sharp, searing type of pain along the bone of your 
lower leg. It can be caused by inflammation or 
injury to the shin muscles. 

The Calgary Health Region of Canada offers these 
self-care tips: 

Rest the affected leg as much as possible.

Substitute non-weight bearing exercises, such as 
swimming, for your usual workout until the pain 
has gone. 

Do daily calf muscle and Achilles tendon stretches 
but avoid stretching the shin muscles. 

Apply ice to the inflamed area.

Wrap your lower leg with a tensor bandage to 
provide support. 

Elevate the lower leg above the level of your 
heart as often as possible. 

The pain from shin splints can last from several 
days to a week, but it may become chronic if you 
do not allow enough time for the muscles to heal. 

6. Humor is healthy

"Crossing The River"

Three men were hiking through a forest when they 
came upon a large, raging violent river.  Needing 
to get on the other side, the first man prayed, 
"Lord, please give me the strength to cross the 

Poof! Lord gave him big arms and strong legs and 
he was able to swim across in about 2 hours, 
having almost drowned twice. 

After witnessing that, the second man prayed, 
"Lord, please give me strength and the tools to 
cross the river." 

Poof! Lord gave him a rowboat and strong arms and 
strong legs and he was able to row across in about 
an hour after almost capsizing once. 

Seeing what happened to the first two men, the 
third man prayed, "Lord, please give me the 
strength, the tools and the intelligence to cross 
this river." 

Poof! He was turned into a woman. She checked the 
map, hiked one hundred yards up stream and walked 
across the bridge. 

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

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********** Health Newsletter ***********
              October 16,  2005
From BackupMD on the Net

1. Alcohol use and breast cancer
2. What should your cholesterol be?
3. Reader submitted Q&A - Dermatographism 
4. Fingernails - Keep them healthy and strong 
5. Health tip to share - Cinnamon tea and bladder 
6. Humor is healthy
1. Alcohol use and breast cancer
Many studies have shown a relationship between 
high alcohol consumption (about 3 or more drinks a 
day) and breast cancer. The effect is not a great 
one but high alcohol use increases the risk for 
breast cancer by about 40%. How exactly alcohol 
raises the risk for breast cancer is not clear and 
most scientists do not postulate that it is the 
alcohol itself that causes cancer but rather 
byproducts of alcohol or dietary changes that go 
along with higher alcohol consumption. 

Folic acid (vitamin B6) that comes mostly from 
green leafy vegetables has been shown to be low in 
those who consume larger amounts of alcohol and 
develop breast cancer. A recent study in Australia 
looked at the folic acid and alcohol consumption 
in over 22,000 women and analyzed their risk for 
breast cancer as correlated with their self 
reported alcohol and folic acid consumption. They 
found than expected higher incidence of breast 
cancer in women who consumed about 3 or more 
drinks a day (over 40 grams of 100% alcohol) but 
if that person also consumed 400 ugm a day of 
folic acid, then they did not have the increased 
cancer incidence. In other words, somehow folic 
acid was protective of the alcohol relationship 
with breast cancer. 

This study does not show that woman who drinks 
alcohol can take folic acid supplementation to 
prevent breast cancer but it does strengthens the 
evidence that an adequate dietary intake of folate 
may afford some protection against the increased 
risk of breast cancer associated with alcohol 

Alcohol use and breast cancer

2. What should your cholesterol be?
As you may have realized, there is a big national, 
medical push to have people lower their blood 
cholesterol levels presumably to reduce their 
incidence of heart attacks and strokes. This is 
especially true for people who are at high risk 
for heart disease such as having a positive family 
history of cardiovascular events at ages less than 
50, having diabetes mellitus, smoking, having high 
blood pressure or having already had a history of 
a heart attack or stroke. Most people, however, do 
not fall into this category. Most people who are 
not at high risk are fine if their: 

Total cholesterol is below 200 mg/dl,
LDL cholesterol is below 160 mg/dl,
HDL cholesterol is above 40 mg/dl,
triglycerides are below 200 mg/dl

If you are normal risk for cardiovascular events, 
there is not much of a benefit to lowering 
cholesterol below the above levels; however if you 
are in a high risk group or have already had a 
cardiovascular problem, then studies from statin 
therapy trials indicate that lower levels may 
reduce your risk. Although I am not sure it is the 
cholesterol level itself that predicts risk or 
another mechanism of statins such as lowering 
platelets, LDL levels below 100 mg/dl and HDL 
levels above 60 mg/dl by taking statins will make 
your risk even lower.  

The following tables from the National Heart, 
Lung, and Blood Institute offer general guideline 
categories. At home cholesterol 
profiles are available. 

Total cholesterol
Below 200 mg/dL Desirable
200-239 mg/dL Borderline high
240 mg/dL and above High 

LDL cholesterol
Below 100 mg/dL Optimal
100-129 mg/dL Near optimal
130-159 mg/dL Borderline high
160-189 mg/dL High
190 mg/dL and above Very high 

HDL cholesterol
Below 40 mg/dL Bad
40-59 mg/dL Better
60 mg/dL and above Best 

Below 150 mg/dL Desirable
150-199 mg/dL Borderline high
200-499 mg/dL High
500 or above Very high 

What should your cholesterol be?

3. Reader submitted Q&A - Dermatographism 
"What can you tell me about dermographism and the 
different treatment options. Are there any 
dermatologists that specialize more in this area? 
I am 43 years old with a mid-life onset of 
allergies. I went to my family doctor with very 
itchy skin. He told me that I have dermographism 
triggered by an allergic reaction. He feels it 
will go away as the allergy calms. I called my 
derm (I also have controlled rosecea) and the 
nurse practioner said she didn't think that was 
true, although she did not see me." - Darlene 

Dermatographism is a condition in which physical 
pressure on the skin, such as lightly writing your 
initials on your skin, produces a histamine 
response (urticaria) in the skin. The histamine 
release in turn causes redness and swelling so 
that the initials appear on the skin as big red 
wheals. It lasts on the skin for a variable amount 
of time. This condition is an allergic response in 
skin that has been sensitized by some allergen 
although often we do not know what specific 
allergen. Most of the time it goes away in about 3 
weeks as long as you are not continuously exposed 
to that allergen. 

In some cases dermatographism continues as a 
chronic urticarial response. At that point, where 
it seems not to go away after a month or so, 
treatment with a combination of an antihistamine 
and an H2 antagonist, e.g. chlorpheniramine 
(Aller-Chlor®, Chlor-Trimeton® Allergy, 
Teldrin®) and cimetidine (Tagamet®), appears to 
be effective. You should see your dermatologist or 
family doctor to get that. 

I do not know that any dermatologists specialize 
in that area. You may need to see an allergist for 
some skin testing if this is a chronic problem. 
You will also have to be your own detective to try 
to see if there is anything new in your 
environment that you may be allergic to. Skin 
lotions, soaps, any chemicals applied to the skin, 
exposure to toxic chemicals, food allergies, 
dietary supplements, new medicines, sun exposure 
etc., can all be culprits in producing this. 
Sometimes you may never find out the allergic 
stimulant and just have to manage it as best you 

4. Fingernails - Keep them healthy and strong
Weak or brittle fingernails, fingernail fungus or 
infection of the skin around the fingernail are 
problems that can plague you for a long time and 
the fixes are not always obvious. Sometimes the 
more you care for your fingernails the more 
problems you have because of the strong chemicals 
used in polish, polish remover, or infections from 
manicurists who do not sterilize their equipment 
after each use. 

Some of the following tips are given from Mayo 
Clinic for strengthening brittle nails so they do 
not split or break and become infected or 

1. Keep fingernails short
2. Trim brittle nails after a bath or a 15-minute 
   hand-soak in bath oil. 
3. Apply a moisturizer each time you wash your 
4. If the nails are brittle, moisturize nails and 
   cuticles at bedtime. 
5. You may apply a nail hardener, but avoid 
   products containing toluene, sulfonamide or 
   formaldehyde which can inflame the surrounding 
6. Don't use nail polish remover more than twice a 
   month and use a non-acetone remover 
7. Repair nail splits or tears with nail glue or 
   clear polish. 

If you develop an infection of the skin around the 
nail, frequently soak the nail in a mild 
antibacterial soap about three times a day. You 
may apply an antibacterial ointment on the skin 
like Neosporin(R) after the soaking. Use gloves 
when washing dirty dishes or any outside work like 
gardening. You do not want to get any foreign 
bacteria or fungus invading the skin around the 

Fungus infections of the fingernails are much less 
common than of the toenails but they can happen. 
Be sure to see your doctor or podiatrist for anti-
fungal treatment. Topical treatment like Tineacide(R)
is less effective than taken oral anti-fungal 
medicines but sometimes if diligently used, it can 

Be sure to take care of your nails. Nail problems 
often reflect other conditions that need to be 

Fingernails - Keep them healthy and strong

5. Health tip to share - Cinnamon tea and bladder 
"After reading about the many benefits of  
cinnamon,  I began drinking  my own version of 
cinnamon tea:  heat a mug almost filled with  
water heated in the microwave,  then add and stir 
one-quarter teaspoon of ground cinnamon.  I then 
add a little hazelnut-flavored coffee creamer.   
It tastes wonderful.    

About a week after daily drinking this tea,  it 
seemed that my trivial and sometimes annoying 
cystitis problems vanished. I had forgotten that 
the cinnamon also has some anti-microbial 
properties, and seems, for now, to be helping me." 
- Maggie 

6. Humor is healthy
Dear Tech Support:
Last year I upgraded from Boyfriend 5.0 to Husband 
1.0 and noticed a distinct slowdown in the overall 
performance, particularly in the flower and 
jewelry applications, which operated flawlessly 
under Boyfriend 5.0. 
In addition, Husband 1.0 uninstalled many other 
valuable programs,such as Romance 9.5 and Personal 
Attention 6.5, and then installed undesirable 
programs such as NFL 5.0, NHL 4.3, MLB 3.0, and 
NBA 3.6. 
Conversation 8.0 no longer runs, and Housecleaning 
2.6 simply crashes the system. I've tried running 
Nagging 5.3 to fix these problems, to no avail. 
What can I do? 
Dear Desperate:
First, keep in mind that Boyfriend 5.0 is an 
Entertainment Package,while Husband 1.0 is an 
Operating System. Try to enter the command: 
"C:/ITHOUGHTYOULOVEDME" to download Tears 6.2, 
which should automatically install Guilt 3.0. If 
that application works as designed, Husband 1.0 
should then automatically run the applications 
Jewelry 2.0 and Flowers 3.5. 
Remember, though, that overuse of the above 
application can cause Husband 1.0 to default to 
Grumpy Silence 2.5, Happy Hour 7.0, or Beer 
6.1.Beer 6.1 is a very bad program that will 
create Snoring Loudly 10.8. Whatever you do: DO 
NOT install Mother-in- Law 1.0 or reinstall 
another Boyfriend program. These are not supported 
applications and will crash Husband 1.0. In 
summary, Husband 1.0 is a great program, but it 
does have limited memory and cannot learn new 
applications quickly. 
You might consider buying additional software to 
improve memory and performance. I personally 
recommend Hot Food 3.0 and Lingerie 7.7. 
Good Luck,
Tech Support

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

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********** Health Newsletter ***********
              November 13,  2005
From BackupMD on the Net

1. Chronic caffeine consumption and hypertension
2. What is the risk of dying from obesity surgery? 
3. Reader submitted Q&A - Gout
4. Cold sores
5. Health tip to share - Ear pain from flying
6. Humor is healthy
1. Chronic caffeine consumption and hypertension

When you have a drink containing caffeine, your 
blood pressure goes up. Acutely like this, 
caffeine can cause a very temporary hypertension. 
The question is whether or not habitual caffeine 
consumption can cause chronic hypertension for 
which you need to be treated for the long term. 

Recently, a group of investigators from Harvard 
Medical School looked at the ongoing Nurse's 
Health Study of over 150,000 nurses since 1990. 
They looked at chronic coffee consumption as well 
as caffeine from other sources such as cola drinks 
to see if women who did not have high blood 
pressure problems at the start of the study but 
who had a high consumption of these caffeine 
containing drinks, developed high blood pressure 
more often than women who did not have a high 
caffeine intake. They did not find a linear 
increase in high blood pressure among women who 
were habitual coffee drinkers, but they did find 
that the more regular and diet colas that a nurse 
drank, the more likely she was to develop high 
blood pressure. The effect was present whether the 
drink was diet or regular cola. 

The authors feel that the role of cola beverages 
in causing hypertension should be studied. 

Chronic caffeine consumption and hypertension

2. What is the risk of dying from obesity surgery? 

Stomach bypass or banding surgery for obese 
patients to lose weight can be risky surgery. 
There is a higher surgical death rate overall than 
with most other elective surgeries. Known as 
bariatric surgery, these types of stomach 
operations have an overall death rate in the range 
of almost 5% within a year of the operation. 
Remember that people who undergo this type of 
surgery are already at a higher risk for death 
just because of the obesity and associated medical 

A recent study using a Medicare database looked at 
how the post-bariatric surgical death rate varied 
by gender and age. They looked at the 30 day, 90 
day and 1 year mortality. Basically, investigators 
found out that men had higher 1 year death rates 
compared to women (7.5% vs 3.7%) and that the 
death rate went up with age. Individuals 65 years 
or older when they had the surgery had an 11.1% 
one year death rate vs 3.9% for all those under 
age 65. Therefore age is quite a risk factor when 
undergoing obesity surgery. 

Keep in mind that those who successfully undergo 
bariatric surgery have significant benefits of 
reduced mortality from the weight loss that takes 

What is the risk of dying from obesity surgery?

3. Reader submitted Q&A - Gout
"I had an attack of gout (according to the doctor) 
but my uric acid level is fine. I am a 55 year old 
woman. What can I do to prevent other attacks?" - 

There are 2 different types of crystals which can 
end up being deposited in the joints and producing 
an arthritis. The most common type is uric acid 
crystal deposit called gout. The other type of 
crystal is calcium pyrophosphate dihydrate which 
produces "pseudogout" or a calcific 

Regular gout is the most common type of crystal-
induced arthritis and while most people with gout 
have elevated blood levels of uric acid, not all 
do. In fact if measured during an acute attack, 
almost half of the people have normal uric acid 
levels. Therefore one possibility is that you may 
have regular gout with normal blood levels of uric 
acid. If this is the case, the goal is still to 
reduce your uric acid blood levels even more in 
order to prevent gout attacks. 

A second possibility is that the crystals causing 
your arthritis are the calcium pyrophosphate 
dihydrate crystals seen in pseudogout. The only 
way to know for sure is for the doctor to put a 
needle into an affected joint (usually the big 
toe) that has been numbed up with a local 
anesthetic, and draw off some fluid for crystal 
analysis. You should probably have this done. If 
uric acid crystals are found then prevention of 
further attacks is helped by lowering your uric 
acid levels. If the calcium pyrophosphate 
dihydrate crystals are found then lowering uric 
acid levels will not help. 

Gout - to lower blood uric acid levels:

1) avoid alcohol
2) avoid weight gain and lose weight if possible 
3) drink plenty of fluids to dilute uric acid in the blood stream
4) limit animal protein and avoid high purine 
foods such as red meats, liver, tongue, peas, 
beans, shellfish, clams, mussels, mackerel, 
5) use drugs as the doctor prescribes such as 
anti-inflammatorily, allopurinol (Zyloprim(R), 
Aloprim(R)), probenecid (Benemid) and steroids. 

Pseudogout -

1) always keep well hydrated; dehydration leads to 
crystal deposit 
2) use the anti-arthritis pain medicines and 
steroids prescribed by your doctor 
3) be checked for other conditions such as 
overactive parathyroid gland 
(hyperparathyroidism), too much iron in the body 
(hemochromatosis), hypophosphatasia, an inherited 
metabolic bone disease, low blood levels of 
magnesium (hypomagnesemia), Wilson's disease, an 
inherited disease in which too much copper 
accumulates in the body, osteoarthritis, diabetes 

You will need to work closely with your doctor on 
these things or seek out an arthritis specialist. 

4. Cold sores

Cold sores or fever blisters are breakouts of red 
spots that turn into ulcers on the outside of the 
lips as well as sometimes on the inside of the 
lips or at the corners of the mouth. They are 
different from "canker sores" that occur more on 
the gums, inside of the cheeks and mouth away from 
the lips or under the tongue. Canker sores may run 
in families, but they aren't contagious. Doctors 
don't know what causes canker sores, but they may 
be triggered by stress, poor nutrition, food 
allergies and menstrual periods. 

Cold sores ARE infectious and are caused by the 
herpes simplex virus which is closely related in 
type to the herpes virus that causes genital 
sores. Initially pain or tingling occurs for 1 or 
2 days at the skin site where the ulcer is going 
to break out. Then small, painful, fluid-filled 
blisters appear on a raised red area of your skin. 
More blister/ulcers may beak out for several days 
and they last about 10-14 days. You are most 
contagious when the blisters are breaking open and 
need to be careful not to spread the virus to 
others by touching the area, kissing, sharing 
eating utensils, cups, glasses, towels etc. The 
person exposed to the virus may not have a 
breakout for up to 3 weeks after coming in contact 
with the virus. 

After an initial breakout, the virus lays dormant 
in the nerve cells of the skin and you may get a 
recurrence of the cold sore any time your immune 
system is stressed such as at time of menses, high 
anxiety, fever or even exposure to the sun. Some 
people go on to have fairly regular recurrences of 
sores that break out. Medicine (antivirals) does 
not help shorten the symptoms of an acute breakout 
by much, but may help reduce the frequency of 
recurrent episodes. 

If you do get cold sores, be sure to avoid contact 
with high risk individuals such as infants, people 
with aids or cancer or those who have had organ 
transplants. They can become seriously ill with a 
herpes infection. If you seem to get recurrences, 
contact your doctor for possible antiviral 

Cold sores

5. Health tip to share - Ear pain from flying

"I had severe ear pain when flying for years.  At 
one point I had tubes implanted in my ears to 
relieve the extreme pain.  After one of the tubes 
dislodged, my ear doctor suggested that I use 
Afrin(R) and Sudafed plus "EARPLANES" (a 
specialized pressure adjusting set of earplugs). 
At first I thought it was an ear doctor joke but I 
tried it and now recommend to everyone.  I have 
been pain free for five years, have lessened the 
amount of Afrin(R) and Sudafed(R) I use, and can 
fly without fear of extreme pain. For those who 
think the $5 is too much, the pain isn't that 
bad." - Anonymous 

6. Humor is healthy

"How To Start Your Day With A Positive Outlook" 

1. Open a new file in your PC.

2. Name it "HOUSEWORK"

3. Send it to the RECYCLE BIN

4. Empty the RECYCLE BIN

5. Your PC will ask you, "Are you sure you want to 
delete Housework permanently?" 

6. Answer calmly, "Yes," and press the mouse 
button firmly.... 

7. Feeling better now???

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

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