Dear Dr. Roach: You recently discussed Pap smears. What is the root meaning of the term? Is it a medical test invented by a Dr. Pap, or an acronym for some long and complex medical term, or a smear taken from a woman’s “pap”?
Answer: “Pap” is for Dr. George Papanicolaou, a Greek-born physician/scientist who worked at Cornell University and the New York Hospital from 1913 to 1961 (I pass his bronze bust every day when I walk into the hospital). He showed in 1928 that cancer of the cervix can be diagnosed early by looking at a sample of cells taken with a swab or brush from the woman’s cervix and smeared on a slide. He had been evaluating the change in the cells at different times of the menstrual cycle, based on the hormone activity. One of his subjects happened to be diagnosed with cervical cancer a few weeks after he obtained the smear, and he was able to subsequently identify the cancer from the cells on the slide. Since then, many women have been able to be treated early, or even before cancer has developed, and his test has extended the length and quality of the lives of millions of women.
History also owes a debt to Dr. Papanicolaou’s wife, Mary. She not only managed his laboratory and household, but she also had sampling of her cervical cells (now called a Pap smear) done every day for 21 years, allowing her husband to clearly see the changes that happen over time.
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Dear Dr. Roach: You recently wrote about some of the benefits and risks of yoga. Would you suggest yoga to someone diagnosed with hypermobility? I’d like to try, but I worry about creating more problems. How do I know if an instructor has enough relevant experience to protect my joints?
Answer: Joint hypermobility syndrome is a hereditary disorder of connective tissue seen in as much as 10 to 20 percent of the population, to some degree. It is related to Marfan syndrome and Ehlers-Danlos syndrome, but unlike those other conditions, the exact mechanism is not understood. People with JHS (often called “double-jointed,” though this is not accurate) routinely get joint sprains and other soft-tissue injuries. Joint dislocations are common, and many people with JHS have stretchy skin that bruises easily. Hernias, flat feet and irritable bowel syndrome are other, more common associated conditions. Pelvic floor weakness — with attendant urinary urgency, frequency and stress incontinence — also is common. About 60 percent of people with JHS have chronic pain; 90 percent have chronic fatigue; and 15 to 20 percent have anxiety.
I am sure many readers are seeing themselves in at least parts of this description but have not been diagnosed. This is common: The diagnosis of JHS is often missed.
Some authorities have recommended against yoga, as stretching can damage joints, and many people with JHS do not realize that they may be injuring themselves due to abnormalities in pain processing. However, I think that with proper precautions, yoga may still be a valuable treatment to improve strength and stability, both important parts of treating this disease.
Rather than relying entirely on your yoga teacher, I would recommend that you seek out a physical and/or occupational therapist with experience in JHS, and learn yourself how to avoid overstretching in yoga class. You certainly should explain your concerns to your instructor.
Some other activities you could try include tai chi, a form of movement that is particularly recommended for people with JHS. Another is Pilates exercise, which was shown in one survey of JHS patients to be one of the most effective treatments for the symptoms of this common but often undiagnosed condition.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.