%A %B %e%q, %Y
%A %B %e%q, %Y
%A %B %e%q, %Y
%A %B %e%q, %Y
%A %B %e%q, %Y
%A %B %e%q, %Y
A heart murmur is a noise heard in addition to the normal heartbeats.
The commonest cause of a murmur in children is an ‘innocent murmur’, which is the result of turbulence or vibration when the blood flows through the heart valves. This can occur, for example, when the child has a fever. The child’s heart is normal, and the murmur usually disappears with time.
Other heart murmurs can signify heart disease, which can either be present from birth (congenital) or acquired later in life. These murmurs are usually caused by aberrant blood flow through a hole in the wall between the heart chambers, or through faulty valves.
A child who has an innocent murmur will have absolutely no symptoms of heart disease. The child is perfectly normal. A child who has a significant murmur, will usually have characteristic symptoms related to heart disease. These may include breathlessness and blueness of the lips and of the fingers and toes. With some congenital abnormalities of the heart, these symptoms may appear immediately or soon after birth.
If there is any uncertainty about the significance of your child’s murmur, your doctor may order an ECG and a chest X-ray. Referral to a paediatric cardiologist may be advised, and an echocardiogram, which is an ultrasound of the heart, may be performed.
A child with an innocent murmur does not require any treatment. On the other hand, a child with heart- disease invariably requires some form of treatment, which can range from medication to surgery, depending on the nature and severity of the disorder.
The management of heart problems in children is a highly specialised field of medicine. Your family doctor can provide you with further information at your request.
%A %B %e%q, %Y
“We were sitting in your waiting room and got to talking with this older couple who said they were in your super marital sex program. They said they were your oldest couple.” The young wife was reviewing the first visit to the clinic and her husband was nodding.
“They told us about the tests and the recommendations. They said something about a posture of the future. You know us. We thought that maybe that would get us pregnant, but they just wouldn’t tell us. They laughed and said we would have to find out for ourselves. When your secretary came to get them, they turned to us and the husband said, ‘We love it. You’ll find it. But first, try these juggling bags. Dr. Pearsall gave them to us. They work like magic’ ”
“Well,” she continued, “we persons in fertility will try anything. We would stand on our heads if it would work. We took those things home and laughed like crazy. We got so daffy at home that we got carried away. We had sex on the wrong night. We had never—I mean never—done that. Some weeks later, we got pregnant. When we came to your office to see you, we met the same people. I gave him the bags back and told him that they worked. He laughed and took his wife’s hand. “Do you think we should juggle tonight? Two seventy-year-olds might just juggle themselves more than they could handle.”
Removing the burden of fear, pressure, and misunderstanding that can accompany health problems is the first step to protecting your sexual rights. To review this issue, try the next opportunity.
Starting at approximately three weeks of development in the uterus, if there is an X/broken-X (Y) chromosome pattern with one of the X chromosomes missing its lower right leg, a male will develop in relationship to the presence of testosterone. Overstating the case, we could say that the clitoris grows out to a penis, the ovaries become testicles and drop down into a sac created when the labia grow together. You have discovered the line where the scrotum grew together, the line called the penoscrotal raphe, the R area of sensitivity along the scrotom up the penis to the frenulum.
This theory of “male from female” is called “inductor” theory in that the male is induced by androgens and MIS, Mullerian Inhibiting Substance, which causes certain female formations to disappear in utero. Early female development is not dependent on hormones; it is autonomous. Mary Jane Sherfey proposed this idea in her book The Nature and Evolution of Female Sexuality. While not totally accurate and in many ways incomplete, the earlier Freudian notion of male superiority or “penis envy” is further from neurophysiological accuracy than inductor theory.
Of course, masculinity and femininity are not mutually exclusive developmental axes. You can be less feminine in terms of society’s criteria without being more masculine, and you can be more feminine without being less masculine. I had the husbands and wives point to areas on the following lines to show, how they felt about their own gender orientation and share these feelings with one another.
FEMALENESS a little very much
Throughout life, even throughout the day, people vary on both axes. It is a mistake to ascribe a natural superiority in sexual function to either gender’s sexual response.
Let go of fear. There is nothing in this world worth fearing about. This is not simply my belief. I know. To fear is one of the worst things you can do to your mind. All logical reasoning, not to mention the connection to your higher mind is completely blocked. People know about it, and some of them use fear techniques to take advantage of others. Look around. The field of medicine prospers by promoting the fear of disease. If they succeed, you fear disease, even if you don’t have any, and this feeling actually replaces the feeling of well being! Instead of enjoying your perfect health and being happy, you worry! Fear blocks your thinking, and in this state you are easy to control by others, who know it and want to take advantage of it. The technique of fear is frequently used by government and religious leaders as a tool to control people. Let go of fear. It blocks your mind. Never use the technique of fear to control children. Use explanation, examples and reasoning instead.
Eliminate feelings of anger, hate and anxiety. – they also block your mind at all levels, preventing the natural state of well being and spiritual development.
Forgive everyone and everything. Hate and resentment also clog your mind. By nourishing hatred and resentment you cannot gain anything except the same things from others. On the other hand, forgiveness and tolerance could give you a key to gaining respect and love.
Do not think of harming anyone or anything. Think of others the way you would like others to think about you.
%A %B %e%q, %Y
But it can cause deformity, disfigurement, paralysis and misery. A variety of drugs can control and cure the disease. Dapsone is widely used, and can eliminate the infectivity of an individual after a few months.
Treatment may need to be continued for many years.
Rifampicin, an antibiotic, also used to treat ÒÂ, has recently been shown to be effective in curing the disease and may render the person non-infective in a matter of weeks.
And those with the lepromatous form can return to their community once the drugs have rendered them non-infectious.
A new vaccine has been developed in Britain and proved successful in the laboratory.
Field trials will soon take place, but it may take 10 years of use before accurate knowledge of its effectiveness is available.
There are few pleasures left in life which have not at some time or another been accused of being dangerous for our health.
Cancer of the bowel is one of the most common forms of cancer in both men and women.
Most cancers of the bowel occur in the rectum or in the lowest portion of the large bowel just above the rectum.
It appears that these cancers are increasing.
As more people are surviving the infections of childhood and early life they are living to an age at which cancer has always been common.
Research, so far, has concentrated on four items of our diet — meat, fat, fibre and alcohol.
There are several studies that show that a high meat diet is one of the causes of the increase in bowel cancer.
Yet, some other studies seem to conflict with this. How a high meat diet can cause cancer, if it does, is as yet unknown.
In the same way, the case against a high amount of fat in the diet as a cause of cancer is equivocal.
%A %B %e%q, %Y
Alternate therapies oiler many possible avenues for alleviating the many problems associated with endometriosis. Uppermost among the benefits of these therapies, such as acupuncture, herbal preparations, yoga and other relaxation techniques, may be temporary relief from chronic pain. These medically unorthodox therapies appeal to those women with endometriosis who do not like taking prescription drugs or for those who like to supplement medications with pain-control techniques.
In the last fifteen years or so, there has been greater interest in investigating pain control through behavior modification, self-hypnosis, biofeedback, imaging, arid stress management techniques, for the endometriosis sufferer, especially the woman who has severe and chronic pain, such a program can guide her toward feeling more in charge of her body and her life. A good pain-control program will address the psychological as well as physiological realities of the disease. A number of pain clinics across the country are affiliated with medical centers, such as the Pain Management Center at UCLA in California, which operates an outpatient Pelvic Pain Program. Other clinics may be privately run. Finding a pain-control program is a matter of asking your doctor or inquiring at a large hospital or medical association.
A good measure of satisfaction comes from having some success with these alternate techniques, since many of them depend on your commitment to them in time, energy, and a sense of purpose. Unlike conventional medical therapies, they can be something of a challenge in this regard, but they are fascinating nonetheless. When you learn how to control pain without painkilling drugs, you will understand more about who you arc, while having as well the adventure of mastering a new discipline, such as behavior modification, meditation, or yoga.
Many of what are now considered alternate therapies were once the only source of practical medical treatments. They coexist now with supersophisticated surgical techniques (such as laser) and the nearly perfected drugs for treating endometriosis (such as the gonadotropinreleasing hormones, or GnRH). They remain popular, if not without an aspect of controversy attached to whether or not they work.
Both hair and nails are derived from the epidermis, and both consist of the same dead tissue—the protein, keratin. Because of their derivation from the epidermis it is not surprising that diseases affecting the skin may affect the hair and nails as well. In addition, there are a number of disorders which are peculiar to the hair (including the scalp) and nails.
Hirsutism, or increased growth of facial and body hair, is a common complaint amongst women attending endocrinology, gynaecology and dermatology clinics. The presence of fine vellus fuzz on the upper lip and chin is very common in women of all races. After the menopause this vellus hair is frequently accentuated by darker terminal hairs, which may appear interspersed among the finer hairs. There is considerable racial variation as regards hirsutism, with women of southern or eastern European extraction being more prone to excess hair, and women of Asian extraction —particularly the Japanese-being rarely affected. Often there is also a familial tendency to hirsutism.
When women are affected in those areas of the body which normally only develop hair in males, and particularly if this is associated with menstrual abnormalities, deepening of the voice, and frontal scalp recession, then there is most likely to be a correctable hormonal cause for this. Hormonal factors causing excessive hair growth include excessive male hormone production from either the adrenal glands, the pituitary gland, or certain rare ovarian tumours. Occasionally some drugs may be implicated—for example dilantin, streptomycin, penicillamine, diazoxide, psoralens, and corticosteroids. Most women however show no clinical evidence of an endocrine disease or hormone abnormality, and this finding can of course by confirmed with appropriate blood and urine tests. If there is any doubt, these tests should be performed after medical assessment has been sought. In those cases of hirsutism where no abnormalities are suggested or found, the cause is probably excessive sensitivity of the hair follicles to the normal quantities of circulating male hormones, or the manufacture of excessive quantities of male hormones within the skin itself. Stress is also thought to be able to cause excess hair production by stimulating the overproduction of male hormones via the pituitary gland, which has a close relationship with the brain.
Excess hair, particularly facial, has always been thought of as an undesirable characteristic in women; although in men, for some reason, it is thought to denote virility! Witches are frequently illustrated with hair on the nose or chin. Grafitti often shows girls with moustaches, and so forth. Consequently many women become psychologically upset by being hirsute. This commonly results in such feelings as irritability, frigidity, masculine trends, and impaired sexuality. As a result, treatment is frequently sought. Here again, we have a situation likely to be exploited: these unfortunate women are very susceptible to the promises of complete and permanent hair removal. From the number of establishments advertising the myth of permanent hair removal, one can get some idea of how many women must be seeking the hairless face. The actual incidence of hirsutism is impossible to assess. However a survey of women students in Wales, in which the women were actually examined and questioned, showed that over one quarter had terminal hair on the face, and that in about 5 per cent of cases it was considered disfiguring.
Diets in most books and magazines advocate energy restriction. Some, such as ‘The Complete F-Plan Diet’ and The Pritikin Program’, are based on credible information, incorporating a high-carbohydrate/fibre, low-fat eating plan, although they tend to be extreme and may be difficult to sustain for a lifetime. Less reasonable but readily available diets that either exclude foods or are based on unsupported claims include:
The Israeli Army diet. This is an eight-day cyclical diet (four by two days) of apples, cheese, chicken, then salad, that has nothing to do with the Israeli Army. It is low energy, nutritionally inadequate, unsound and boring.
The Mayo Clinic diet. This has occurred in various forms, all capitalising on the good name of the Mayo Medical Clinic in the United States. One of the many forms of this diet requires the dieter to eat lots of eggs, in the belief that the energy used to digest them is more than the energy provided. The Mayo Clinic has disowned this diet. Other diets have also used this premise that the energy used to digest and utilise a food will be greater than that provided by the food. This is NOT supported by research but has not stopped people creating many diets, inducting the celery diet and negative calories diet.
The Beverley Hills Diet’. The film stars in Hollywood who gave credence to this diet certainly had no idea of nutrition and neither did its author. It talked of fat-dissolving fruits, and how some other foods were not digested by the body but were trapped as fat. It is a dangerous diet: inadequate, unsound and contrary to any research.
Lena’s main problem with fibroids was painful, heavy, dot-laden bleeding which occurred for eight or more days each month. After almost a year of putting up with this, she felt frustrated about the situation and was determined to do something about it. When a friend mentioned the possibility of a hysterectomy, she had strong reservations. She wanted to have a child, and her doctor agreed that a myomectomy (the surgical removal of fibroids from the uterus) was appropriate in her case. This was carried out successfully, leaving her uterus intact. Some years later, by which time Lena had given birth to a child, the fibroids recurred. This time they were even more troublesome causing pain and severe haemorrhoids as well as heavy bleeding. An internal examination revealed that the fibroids were more extensive and intrusive than they had been previously and Lena decided on a hysterectomy.
Before a diagnosis of fibroids is confirmed, other possible reasons for a mass in the abdomen should be excluded; for example, pregnancy or cancer of the cervix, endometrium or ovaries. To rule out pregnancy in a premenopausal woman, a sample of blood or urine is tested and a result obtained within minutes. To exclude cancer, several diagnostic procedures may be necessary. These include a Pap smear; a colposcopy, which entails viewing the cervix with a magnifying instrument called a colposcope, with or without removing a small sample of tissue (a biopsy) for subsequent examination; dilatation and curettage, in which the cervix is stretched or dilated and an instrument is inserted to scrape away most of the uterine lining; an ultrasound examination conducted via the vagina which produces an image of the uterus and other internal structures; and laparoscope a pelvic examination using a laparoscope (a tubular instrument with a light at one end and an eyepiece at the other) inserted through a small incision in the abdominal wall. Before committing to a diagnosis a doctor may also want to exclude other situations in which similar symptoms can occur, such as endometriosis, a pregnancy in a Fallopian tube, irregular placement of the uterus, bladder cancer, and ascites, which is an accumulation of fluid in the abdomen.
Doctors do not usually recommend removing fibroids if they are not causing problems, and it is estimated that this is the situation for most women who have them. In these women, fibroids tend to be diagnosed during a routine check-up, usually causing suspicion because the uterus is larger than expected but there is no evidence of pregnancy. If a doctor feels a firm, irregularly shaped mass when conducting an abdominal examination, the likelihood is that one or more fibroids are present.
When suggestions are made about removing fibroids that are not producing symptoms, this may be because of concerns that their further growth could make later removal difficult, or could result in serious complications by pressing on nearby organs. Of course doctors do not have crystal balls and predicting which patients will experience a worsening of their symptoms requires a good deal of guesswork. If this is the reason given for hysterectomy, it should be closely questioned. It is reasonable to remove symptomless fibroids if they are blocking the cervix, protruding into the uterine cavity or closing off the Fallopian tubes. Recent estimates suggest that fibroids are involved in about one in fifty cases of infertility in Australian couples.
The cause or causes of fibroids are uncertain although it is clear that stimulation of the myometrium by oestrogen promotes their growth and development. When oestrogen levels are high, as occurs during the reproductive years in general and pregnancy in particular, fibroids tend to increase in size. When oestrogen levels fall, for example after menopause, fibroids tend to shrink. During the past decade, further valuable insights have emerged. Studies of large population groups show that fibroids are much more common in women from certain racial groups. Black women in the US, for example, are three to nine times more likely to develop fibroids than comparable White women. Suspicion has fallen on genetic factors and pelvic infections, but it has also been suggested that a predisposition to fibroid formation occurs in obese women with above-average levels of blood glucose and growth hormone. Oestrogen and growth hormone are synergistic, meaning that their combined effect is greater than the effect of either hormone acting alone. Women on the Pill and those who smoke cigarettes seem to be less likely to develop fibroids.
Sleep is a modified innate activity. Young babies sleep for about 16 hours a day, waking up about five to six times in the 24 hours for feeding. This multiphasic sleep pattern may be the innate pattern of sleep. Gradually, as we become older, we learn to sleep more at night and to stay awake more in the day. At about one year of age, we wake up only once or twice at night, but stay awake most of the day. When we reach school age, we go to bed at about 8 p.m. and wake up at about 7 a.m. the next day. When we are adults, most of us sleep for seven to eight hours each night at one stretch. Hence, through learning, we change from a multiphasic pattern to a monophasic pattern of sleep. In some countries there is a sleep in the afternoon called the siesta or midday nap. Sleeping at two different times in the 24 hours is known as a biphasic sleep pattern and is more natural and refreshing than a monophasic pattern since it more closely resembles the innate pattern of multiphasic sleep.
Hence learning a sleep pattern is like toilet training. We learn to sleep at certain times of the night. Our parents expect us to sleep at night, and our teachers expect us to stay awake in class. We are modifying the innate ability to sleep in order to fit in with society, the majority of which shows a monophasic sleep pattern.
Nowadays, with the help of the sleep laboratory, we can demonstrate that there is a recurrent 90 minute sleep cycle, discussed in detail in chapter 5 on Two Kinds of Sleep. Every 90 minutes throughout the 24 hours there is a few minutes of sleepiness which has been called the 90 minute window. During this window we can fall asleep easily if we want to. Can this be a vestige of the innate multiphasic sleep pattern?
Since sleep is a modified activity and we learn to sleep when we are very young, various problems are created. We learn a lot of bad sleeping habits. Bad habits are certain behaviours we pick up and incorporate into our routine.
We watch television in bed, we eat in bed, we stay up late at night, and wake up at all sorts of hours in the morning. Yet we expect to be able to sleep well whenever we want to. If we want to have better sleep, these bad habits have to be unlearned and eliminated.
%A %B %e%q, %Y
COMMON CAUSES OF ANXIETY: PROBLEMS OF EMOTIONAL REMOTENESS AND OF TOO CLOSE RELATIONSHIP AND SEXUAL PLEASURE IN CAUSING PAIN
Because of their different personalities different individuals express their feelings of affection in varying degrees of emotional and physical closeness. The shy and inhibited introvert habitually defends himself by withdrawing from people. In the early stages of marriage he is simply unable to tolerate a very close relationship. If his partner is emotionally freer, and is not sensitive enough to perceive his need for emotional distance, she may produce extreme tension in the introvert by trying to come too close either emotionally or physically. On the other hand, if the introvert’s partner allows their relationship to develop slowly and easily, he will mature and come to make freer patterns of response which at first would have been quite impossible.
Sexual Pleasure in Causing Pain-The sex act evokes a different mental attitude in the man to that in the woman. The man is active and in a way aggressive, while she is essentially passive and accepting. In men, being active and aggressive may become associated with sexual feelings; but in another way aggressive action is associated with fighting and inflicting pain. In this way sexual pleasure may become unconsciously associated with causing pain, a condition known as sadism. The man with mild sadistic tendencies is rough with his sexual partner, and likes to penetrate roughly and deeply as if to hurt her. Conversely the passive and receptive elements in the woman may be associated with the idea of being hurt. She comes to experience sexual pleasure in being caused pain in her sexual relations. This is known as masochism. If the husband has marked sadistic traits, and if the wife is lacking in the corresponding masochistic elements, there will be tension and anxiety. If on the other hand these attitudes are reversed in an unnatural way so that the woman has the sadistic tendencies, then the tension is likely to be so much the greater because it conflicts more acutely with the male personality.
Depression is by its very nature a discouraging condition and the response to anti-depressants in general is often not smooth and linear. Your mood can bob up and down and it may be hard to tell just where you are compared to where you were before you started treatment. In my practice I have used a very simple way to help my patients monitor their mood over time. Just as when you diet it is helpful to weigh yourself regularly so as to see the pattern of response, so it can be very helpful to chart your mood on a daily basis after you start a new type of anti-depressant treatment. And just as when you diet you can gain a pound or two on a particular day, perhaps as a result of water retention, even though you are succeeding in losing weight over the long run, so it is possible to have one or two bad days even though your mood may be better overall. Being able to refer to the chart is helpful in illustrating this overall improvement. Alternatively, if you are not improving, you might be inclined to try and kid yourself that you are. Referring to the chart may reveal this not to be so and prompt you to shift your strategy in finding a different way out of your depression.
%A %B %e%q, %Y
Whatever the ’cause’, most people with epilepsy analyse their day to day lives in an attempt to detect factors which precipitate seizures.
Virtually every conceivable life event may be blamed by some people with epilepsy, who may become overly obsessional about avoiding factors they consider important. For example, a man had each of his two seizures on railway trains. He firmly believes that in some way trains make him have seizures. It is likely that this occurrence is just coincidental, but we cannot be entirely sure that he is wrong!
There are, however, a number of factors which do seem to precipitate seizures in at least some people with epilepsy.
Sleep and lack of sleep-The electroencephalogram (EEG). At this stage, it is only necessary to know that it records the changes in voltage resulting from activity of cerebral nerve cells. The EEGs of people without epilepsy change during the passage from normal wakefulness, through drowsiness, to sleep. Sleep is not constant, as judged by body movements and EEG patterns, throughout the night. At various intervals one pattern of brain waves occur in association with rapid movements of the eyes. Through waking patients at this time we know that it is during this stage of sleep that dreams occur.
The changing electrical activity of the brain during drowsiness and sleep may allow seizure discharges to ‘escape’. Indeed, those analysing EEGs hope that their patients drop off to sleep during the procedure as the possibility of recording an abnormality is considerably enhanced.
Some subjects have all or virtually all the seizures whilst asleep—but they can never be entirely sure that a daytime attack will not occur. A follow-up study of one group of people with ‘nocturnal’ epilepsy showed that about a third had a daytime seizure in the next five years. The effects of depriving people of sleep have also been studied by keeping volunteers continuously awake, or by waking them up every time the EEG showed the pattern of rapid eye movement sleep. In each case EEGs on subsequent undisturbed nights showed that the subjects were catching up on the rapid eye movement sleep they had missed. Deprivation of sleep, therefore, has been shown to alter cerebral electrical activity, and it is not surprising that this is another factor in precipitating seizures. In practical terms, repeatedly staying up late may precipitate seizures in young adults.
Mr J.P. of Michigan writes: “Though I’m only 36 years old, I had suffered for years with arthritis in my knees as a result of a number of old sports injuries. At the restaurant where I work I often have to get things from the walk-in cooler downstairs, sometimes as much as twenty times a day. The frequent stair climbing is bad enough in itself. Add to that the freezing air from the meat cooler, especially on these cold Michigan winter days, and you’ve got a killer combination for arthritis.
“I often had to use a knee brace to help me along. Actually, I began to wonder just how long I would be able to hold on to my job before my knees gave out. Well, thanks to you and CMO my knees are just fine now. So much so, I even packed away my knee brace a couple of months ago.” [Editor's note: Mr J.P. took CMO in February 1996 and has needed no further treatment to this day.]
Mrs. J.L., age 65, of Michigan experienced a sudden onset of arthritic symptoms in her hands, shoulders, and hips. In less than a year her fingers became gnarled and twisted out of shape. She wrote, “I’m in pain all the time. My fingers and hands cramp up as well as my feet and legs.” She sometimes took as much as 40mg of Prednisone and 100 mg of Darvocet, but found them only somewhat helpful. With CMO her fingers straightened so well she sent us before and after pictures. [We regret they're not of publication quality.] Another benefit, her blood pressure dropped from 160/90 to a normal 110/70 – further proof that CMO is an immunomodulator that can normalize a number of different functions within the body. [Editor's note: This normalization of blood pressure is very common in people who take CMO. Specific controlled studies of this effect are being planned.]
Signs and symptoms
The toe becomes red, painful, and tender to the touch. The wound produces a thin, watery pus that works its way under the nail. The tenderness, redness, pain, and swelling gradually get worse, eventually involving one entire side of a toenail. Often the nail becomes partly covered by raw, red tissue and a wet crust.
If you catch it early, you can treat an ingrown toenail successfully by gently cutting out the spur or the ingrown corner of the nail, and then frequently soaking the toe in warm water for long periods. Even if the toe is so tender to the touch that you cannot remove the embedded nail, prolonged soaking in a strong Epsom salts solution (one cup to one liter of water) may cure the condition. Cover the lower foot and toe with a bandage or cloth and soak both foot and bandage thoroughly in the solution. Then cover the dripping foot with plastic wrap or encase the foot in a plastic bag. In this manner the nail can soak for hours with little effort on your part. Because of the delicacy of the nails involved, the ingrown toenail of an infant can often be cured by wiping the area several times a day with rubbing alcohol, and then soaking the toe in clear warm water.
• Teach your child to trim the toenails straight across without leaving sharp spurs that may cause problems.
• An infection near the nail that lasts for more than a few days is probably an ingrown nail.
If an ingrown toenail doesn’t clear up with home treatment, your doctor can remove the embedded piece of nail. If the toe is very painful, the doctor may apply a local anesthetic before removing the ingrown area of the nail. If ingrown toenails occur frequently your doctor may suggest minor surgery to narrow the nail and make in-growing less likely.
%A %B %e%q, %Y
What is it?
The accumulation of tissue fluid in the body. It is most noticeable in the fingers (rings become tight), around the eyes (eyelids look and feel puffy), and in the abdomen (belts become tight). It is a condition that affects millions of women, often around their period times.
About 60 per cent of the body’s weight is water, which is distributed in the various fluids inside and outside the cells. The average person takes in about 2-3 quarts of fluid a day and the body’s balancing mechanisms ensure that the loss through urine, sweat and on the breath keep the total body water steady. A healthy person can handle at least 8 quarts of fluid a day without retaining any but people with heart disease, liver disease, kidney disease and certain hormonal problems retain fluid abnormally. Water is retained in places that offer least resistance, particularly around the eyes or where gravity exerts its main influence (such as around the feet and ankles). If, when you poke your fingertip into a swollen ankle it leaves a depression, you have about 8-9 lb of water too much in your body overall.
Immediately before a period many women, because of their hormonal changes, retain water-sometimes putting on up to a stone in weight. This produces swollen, tender breasts, pelvic pain, headaches, stomach swelling, nervousness, irritability, a feeling of mental dullness, insomnia and poor concentration. Even the eyeballs can swell and make the wearing of contact lenses impossible. During pregnancy ankle swelling is also common.
What causes it?
• Hormone changes in the premenstrual phase of a woman’s cycle.
• Long periods of standing and walking can cause foot and ankle swelling.
• Heart disease (especially heart failure, in which the reduced pumping efficiency of the heart means a smaller blood flow to the kidneys to produce urine).
• Steroid hormones (which cause salt to be retained by the body along with water to dissolve it in). This includes the contraceptive Pill, of course.
• Kidney diseases in which the capability of the kidney to put out normal amounts of urine is impaired.
• Certain allergies cause local fluid retention. This is especially seen in urticaria (hives). The swelling may be generalized, or may affect only the hands, feet and face.
• Too much sodium in the diet. Water always goes hand in hand with sodium so if you eat too much sodium (salt) you will automatically retain too much water.
• Stress and emotional conditions can cause (in men as well as women) too high a production of anti-diuretic hormone which causes the retention of water.
• Very hot weather, especially if humid too, can make some people retain water.
%A %B %e%q, %Y
PRIVATE CARE FOR BREAST CANCER PATIENTS: ABOUT DISCHARGE FROM HOSPITAL, DIFFERENCES AND SIMILARITIES
Discharge from hospital
When you are Discharge from hospital ready to be discharged from hospital, the ward receptionist will ask you to pay any outstanding charges such as those not covered by the hospitalization charge. Before you leave you will be given any medical items you may need from the hospital pharmacy.
Although adjuvant treatments for breast diseases, such as radiotherapy and chemotherapy, can be undertaken in private care, not all private hospitals have the facilities to carry these out. For example, very few can offer on-site radiotherapy, and this treatment is likely to be given at an NHS centre.
Differences and similarities
The main aim of the staff of any private hospital is the same as that in an NHS hospital – to make your stay as pleasant and as comfortable as possible. Because the staffing ratio is higher in private hospitals, more emphasis can be placed on privacy and comfort.
The consultant surgeons and anesthetists almost always work in an NHS hospital as well as in a private hospital, so you will receive the same expertise and skill under both systems. However, in an NHS hospital you may not actually be operated on by the consultant surgeon who heads the surgical team and, indeed, you may not see the consultant at all during your stay.
Private hospitals arrange their operating lists differently from NHS hospitals. The NHS hospitals have ‘sessional bookings’ for their operating theatres. This means a particular day is set aside at regular intervals for a specialist in one type of surgery to perform operations. In private hospitals, the consultants can book the use of an operating theatre (and the assistance of the staff who work in it) on any day, at any time that suits them. Therefore, your operation can take place privately with minimum delay, and at a time that is convenient to you and your consultant.
It is also possible, even if you are already on an NHS waiting list, to tell your GP or consultant at any time that you would like to change to private care. If the consultant you have already seen under the NHS does not have a private practice, you can ask to be put in touch with a consultant who can see you privately.
Although some private hospitals may have their own breast care nurses, the majority do not. However, if you would like to talk to a breast care nurse, the hospital should be able to arrange this. Bearing in mind how important the role of these specialist nurses has been recognized to be, it may be a good idea to request this service. The same applies to counseling services, which will probably be made available if you request them.
There are several reasons why, if they can, some women choose to have their operations done privately, either paid for by private health insurance or from their own pockets. Some find it much more convenient to be able to have a say in when their operation is to take place. The NHS, under which the majority of people are treated, naturally has longer waiting lists. If time is an important factor for you, you may be happy to pay to have your operation done at a time that you find convenient.
Some people simply prefer the smaller, more intimate setting they are likely to find in a private hospital. Private hospitals rarely deal with accidents and emergency treatment; the operations carried out in them are normally planned, at least a day or two in advance. Therefore, they do not have the bustle of an NHS hospital which has to deal with emergency admissions as well as the routine admissions for non-emergency operations.
Precisely what will happen when you have your laparotomy will depend to some degree on what sort of surgery you are having, the practices of your gynecologist and the practices of the hospital. What follows should only be used as a guide.
You will probably be in hospital for about five to seven days if you are having a conservative laparotomy, or seven to ten days if you are having a hysterectomy.
You will usually be admitted to the hospital the day before the operation. After you have gone through the formalities of being admitted to the ward someone will probably take your medical history. A nurse will take and record your temperature, pulse, breathing rate and blood pressure. An electrocardiogram and blood and urine tests may be taken, particularly if you are having a hysterectomy. Your pubic hair and the lower part of your abdomen will usually be shaved and you may be given a suppository if you have not opened your bowels that day.
A physiotherapist may visit you and teach you some breathing and foot and leg exercises to do after the operation, especially if you are a smoker, an asthmatic or prone to chest infections.
The anesthetist will visit you to discuss the operation and ask you about any allergies and previous problems that you may have had with a general anesthetic, such as nausea.
Some time before your operation you will be given a consent form to sign so that you can give your permission to undergoing the operation. You may have previously signed the consent form when you discussed the operation with your gynecologist during an earlier visit.
At bedtime you may be offered a sleeping tablet to help you sleep in the unfamiliar hospital ward. It is important to have a good night’s sleep before your operation so it is advisable to take the sleeping tablet if it is offered.
You will not be allowed to have any food or drink for at least six hours before the operation. Shortly before the operation you will be asked to shower and put on a gown and you will be asked to empty your bladder. About an hour before you are due to go to the operating theatre you will probably be given an injection, known as a pre-med or a pre-medication, which will probably make you feel relaxed and sleepy and make your mouth dry.
If you are apprehensive about your surgery you may like to ask if you can have your partner or a friend or a close relative come to stay with you for the hour or two before you go into theatre.
Immediately before the operation you will be taken to the operating theatre. In the operating theatre an intravenous drip will be inserted into your arm and you will be given the general anesthetic. After you have lost consciousness a tube will be placed in your throat and connected to a machine that breathes for you.
A tube known as a catheter may be inserted into your bladder to drain the urine.
A horizontal cut about ten centimeters in length will usually be made across the abdomen along the pubic hairline. Sometimes the cut will be made vertically between the middle of the pubic hairline and the navel, particularly if you have previously had a vertical cut or if bowel surgery is likely.
The gynecologist will then thoroughly inspect the pelvic cavity for any signs of endometriosis, adhesions and other damage so that she or he can plan the operation and decide which procedures need to be carried out.
When the surgery has been completed the gynecologist will stitch up the wound and the tube in your throat will be removed. You will then be taken to the recovery room for about half an hour before being taken back to your bed in the ward.
In anorexia, the first goals are to stop the patient from starving and to reverse her weight loss. Only then can we work on the emotional problems that led to the disorder in the first place.
Another goal is to show her how to reduce anxiety, not just about weight gain, but about food and eating as well. For an anorexic, who also binges and purges, an additional goal is to stop her bulimic behavior. Although some of the methods described below are for inpatient treatment, they can also be adapted for use with outpatients.
As in bulimia, there are three phases of behavioral treatment. First is the evaluation. During this time we conduct medical tests and get to know the patient. We draw up the treatment contract, which spells out the goals for weight gain and which both the patient and her parents sign. In this early phase, we tell the patient she must maintain at least the same weight she had when she was admitted. Otherwise she will be confined to her bed to save precious calories.
Once things have settled down we move into the next phase, during which we work toward the goal of bringing her weight back up to a healthier level. The contract specifies this target range, which is not subject to further negotiation because it is based on what we believe will be physically healthy for the patient.
We monitor the patient’s progress by weighing her daily. To get the most accurate reading, we weigh her in the morning, before breakfast and after she has gone to the bathroom. She wears only a robe. If knowing her weight will make her anxious, she faces away from the scale. We reward her for actual weight gain, rather than for her eating behavior during meals. The reason for focusing on weight rather than eating behavior is that the patient may give the appearance of eating all she is being served but may be getting rid of the food when no one is looking.
Our usual inpatient contract asks that the patient gain one half-pound a day. Such a goal is both reasonable and safe. Gaining weight too fast can cause edema or cardiac failure. If the patient reaches this goal, and is in no medical danger, she earns full privileges, such as complete recreation and visiting privileges. A gain of between a quarter and half a pound means only partial privileges. No gain-back to bed. This isn’t a punishment-bed is simply the safest place for a starving person to be. We also negotiate other incentives for weight gain at various points along the way: new clothes or records, special trips outside the hospital, and so on.
Gaining weight requires more calories than simply maintaining weight. Patients gradually work up to eating perhaps four thousand calories a day. Since the goal is not to teach someone to eat huge quantities of food or become bulimic, I usually add high-calorie liquid supplements such as Sustecal or Ensure to her normal amount of solid food.
Instead of requiring a specific daily weight gain, some doctors use a graph. A curve on the graph represents what the patient should weigh as time progresses. As long as her weight stays above that line, she earns full privileges. This method has one advantage over a daily weight-gain requirement. Especially during the early phases, a patient’s weight may fluctuate quite a lot, even if she is eating well, due to changes in water balance. A graph can take such fluctuations into account, which may keep the patient from being unfairly penalized.
Critics of the behavioral contract point out that an anorexic needs to develop a sense of self. She must find an identity that doesn’t depend on starvation. The contract, they claim, robs her of the opportunity to grow by imposing on her a mechanistic, prefabricated set of rules.
I disagree. My experience convinces me that many people with eating disorders welcome intervention by others, so long as it is done in a way that genuinely respects their individuality. A contract sets up boundaries and limits. It gives shape and focus to a world that is spinning out of control. The patient knows what to expect and what the consequences of her actions will be. I’m not saying that she necessarily likes those limits. Sometimes one benefit of the contract is to give her something to react to-or against. She finally has a focus for her anger. This in turn might help her to express anger rather than turn it inward. For people with an eating disorder, recognizing and dealing with anger is a good step in the right direction.
In 1987, Fay Hodge stepped onto a scale at a Weight Watchers meeting. It was the first step of a journey in which she would lose 111 pounds and find a tremendous power within herself: the power to choose.
Fay had struggled with her weight since childhood. Like most of us, she was taught to eat everything on her plate. “My grandmother used to say that what I didn’t finish at dinner, she’d scramble into my eggs the next morning,” recalls the Fairfax, Virginia, resident. “She was teasing, but I got the message. My family worked hard to put food on the table. My job was to eat it.”
Unfortunately, the combination of eating too much and exercising too litde quickly took its toll. At age 7, Fay was put on her first diet by her doctor. It didn’t work. Neither did the diets that followed. She just kept gaining. At age 33, she weighed 266 pounds— “I was uncomfortable in my own skin and getting ready to develop another set of stretch marks,” she says.
At the time, a friend of Fay’s was going to Weight Watchers, and she urged Fay to join, too. It was through the organization’s weekly meetings that Fay came to a profound realization: Her weight and her health are the culmination of countless choices that she makes every day.
“I can choose to eat the right foods in the right portions and be successful, or I can choose to eat foods and portions that will cause weight gain,” she explains. “The decision is mine. I’m in control.”
With a newfound sense of empowerment, Fay embraced the Weight Watchers principles, eating a wider variety of nutritious foods, monitoring her portion control, and drinking lots of water. She also increased her level of physical activity by walking briskly three or four times a week. And sure enough, the weight came off.
“There is nothing more exciting than discovering a hip bone. I felt like Columbus!” she says. “I was absolutely intrigued that there was a body underneath all of those layers.”
In just 1 year, Fay took off 111 pounds. And she has kept off the weight for 11 years. Today, at age 45, she’s a statuesque 5′ 11″ and a size 12. She was so inspired by her own success that she became a Weight Watchers leader, helping others take the first steps of their own weight-loss journeys.
It’s never too late to lose. When weight gain starts so early in life, it’s all that much harder to realize that there is a thin person in there, just begging to come out. Overweight needn’t be anyone’s destiny. Determination and the realization that you will succeed is the first step. When you start to doubt, just think of Fay.
%A %B %e%q, %Y
? How do I know if I’m getting near my menopause?
The most common sign is irregular bleeding – a light period followed by a couple of heavy ones that go on for much longer than usual. You might also notice that you break out in embarrassing hot flushes for no apparent reason. Uncharacteristic moodiness is also quite common, and so are sleeplessness and difficulties with memory or concentration.
? I had an early puberty at the age of eleven. Will this affect the age at which I go through menopause?
No. The average age of menopause – forty-eight to fifty-three for most Australian women – has changed little over the centuries, while girls now begin their periods at an earlier age than they once did.
? My periods have stopped after several months of irregularity. How long should I wait before having sex without contraception?
You should use a barrier method of contraception such as condoms or a diaphragm until you have not had a period for a year. You can then throw away your contraceptives.
%A %B %e%q, %Y
The effects of oestrogen on the following disorders have been studied in some detail during the past fifty years. The impact of added progestogen is not so well understood.
HRT AND OVARIAN CANCER No consistent link has been demonstrated between HRT and ovarian cancer, but such a link has not been adequately ruled out. There is some evidence of ovarian cancer a substantial time after long-term HRT use. On the other hand, Pill-users (taking similar hormones to those of HRT but at higher doses) seem to be protected somewhat from ovarian cancer. Research in this area is continuing, but as yet no definitive conclusions can be drawn.
WOMEN WITH EXISTING LIVER DISEASE This condition becomes evident from abnormal liver function test results indicating that the liver is having difficulty doing its job of breaking down a wide range of substances. Recommendations regarding HRT for women with liver disease usually hinge on the nature and severity of the problem. In cases of severe active liver disease with abnormal liver function, HRT should be withheld. If the liver disease is mild or has resolved, HRT may be appropriate; in these cases the patch is the preferred way of administering it. This is because it is less demanding on the liver for absorption of hormones to be through the skin than via the stomach. While patches may be suitable for women with mild abnormalities of liver function, remember the reservation expressed at the beginning of this chapter about the lack of long-term research data on patches.
WOMEN WITH UNDIAGNOSED VAGINAL BLEEDING
Until the reason for unexplained vaginal bleeding is diagnosed it is unwise for women to have HRT. The safest course of action is to have the bleeding investigated. This may entail a hysteroscopy and biopsy or curettage.
HORMONE COMBINATIONS AND SINLE DRUG FORMATS: HIGH-DOSE PROGESTOGEN ALONE AND TESTOSTERONE ALONE OR COMBINED WITH OESTROGEN AND PROGESTOGEN
HIGH-DOSE PROGESTOGEN ALONE
For reasons that are unclear, high doses of progestogen alone may prove helpful in relieving the problem of hot flushes if you are one of those women for whom oestrogen has not been recommended (such as those with a personal experience of breast cancer).
Testosterone alone or combined with other hormones may be given to women concerned about their loss of libido when this does not seem to be caused by psychosocial factors or discord with a partner. Testosterone is usually given by implant six-monthly or by injection into muscle tissue every three to six weeks. The dosage by implant is about one-quarter that prescribed for men with libido problems.
It happens to every woman, sooner or later. Parenthood you can choose or not. With menopause there is no choice. It happens to women who are nurses, secretaries, politicians, news readers, nuns, teachers, doctors, sales assistants and senior executives, to women who are unemployed and to retirees. It happens to women with young children – the menopause mums who are still breast-feeding when their periods stop – to women who have no children, to women working in the home and from home, to those accustomed to a low-stress existence and to those who have consistently demanded the highest mental and physical performance of themselves. Some wish it would happen quickly so that they can throw away their contraceptives and menstruation paraphernalia. Others regret the sometimes sudden, and perhaps also premature, end to their fertile years.
We’ve talked about the experience of menopause to countless women, the majority of whom have experienced some signs of change in their body chemistry – hot flushes, headaches, depression, mood swings, sleeplessness. Some are less concerned about these difficulties than about future health problems caused by a possible inherited high risk of heart disease or cancer. Still others have broken a bone soon after menopause and show early signs of reduced bone density (osteoporosis). The questions they ask vary accordingly. Will HRT settle my symptoms? Will it reduce or increase my risk of future disease? Can it stop my existing medical problems getting worse?
We are the first to admit that the women with whom we have discussed the menopause and HRT do not necessarily represent all women. We certainly do not want to stereotype menopause in an excessively negative way. But it is believed that about three out of four women in countries like Australia experience some physical signs associated with menopause, even though only one in four feels she needs medical help to deal with them. Maybe women who don’t seek medical advice consider their symptoms to be unimportant, maybe they have not been told about the kinds of help available, or perhaps they are coping perfectly well regardless.
As your GP will tell you, you can be sure menopause has occurred only when you have had no menstrual bleed for twelve months. Three or so months without a period are not enough: about one in five women near menopause menstruates again after that.
Raise the issue of menopause at any gathering of women, and it is clear that the term has come to mean more than just the end of monthly bleeds. Menopause has become shorthand for the many changes occurring during the transition from regular periods to no periods at all. It is a quick way of summing up hormones in flux, children leaving home or returning, ailing parents needing help, changing relationships with partners, and altered responsibilities in the workplace. An alternative catch-all term for this time of midlife change is the perimenopause.
The last menstrual period for most Australian women occurs between the ages of forty-eight and fifty-three (and can happen quite normally five or so years earlier or later than this). It is less tied to age, however, than at any time in human history due to developments in surgery and cancer treatment. These medical procedures can result in a woman having an artificial menopause (that is, one caused by removal of or damage to the ovaries) from the age of puberty onwards.
For the past 15 years, John had suffered from regular bouts of mouth ulcers. Sometimes these were so painful that he could not eat for several days. Eventually the ulcers would clear up, only to come back again a few weeks later. During a long holiday in Southeast Asia, John’s mouth ulcers were much less of a problem, and this made him wonder if food might be the culprit, because he was eating a very different diet on holiday. Soon after his return, the mouth ulcers began to trouble him again. His doctor suggested that being on holiday, and free from stress, could have effected the cure, but John
pointed out that they had never got better on holiday before. The foods he had eaten very little of in Southeast Asia were bread, milk, butter and cheese, so he decided to try cutting these foods out for a while. There was no improvement, so the doctor suggested that John should also cut out other foods containing wheat, such as biscuits, pastry and pasta. When he did so John’s mouth ulcers improved considerably but did not disappear. The doctor then advised a gluten-free diet, cutting out oats, barley and rye, as well as wheat. On this diet, John has not suffered from mouth ulcers for over two years.
%A %B %e%q, %Y
The question of how much sleep a person really needs has occupied the minds of many clever people who, try as they might, have never arrived at a satisfactory answer. Some say that seven or eight hours sleep are necessary if one wants to be rested and ready for work, while others seem to think that they can manage quite well with four or five hours. Regarding those who sleep fewer hours, it is questionable whether the nerve cells will have sufficient time to become regenerated and whether, in time, some deficiency will become apparent. An unusual failing of strength, shorter attention spans and becoming easily tired are definite indications that one is not getting enough sleep, no matter what kind of theories anyone has on the subject.
When should we sleep and for how many hours? There are many different answers to these two questions and it is better if we ask, not other fellow humans, but nature itself – the most appropriate teacher. Nature sets before us a splendid example in the lively, ever-active world of birds. What can we learn from our feathered friends? When and for how long do those cheerful little singers sleep? Well, we all know the answer, don’t we? They begin their songs at the break of dawn when the average person is wasting the sunny hours of an early spring morning lying asleep in bed. They are already about their business and do not return to rest until the last traces of twilight have gone. For the birds this seems to be a natural and proper way of life and, indeed, primitive man adopted it.
Even if you are healthy you should not expose yourself to the sun’s rays indiscriminately if you want to avoid trouble. You will have to be patient and adjust your body gradually, staying in direct sunlight for only short periods at a time. And another thing: it is much better for you to move around in the sun rather than lie in it passively. Sunbathing in half-shade is far healthier and can even be recommended for the sick.
In low-lying areas the sun has little power in the winter months and more and more people prefer to spend their holidays in the mountains. High up in the mountains amidst the snow and ice it is quite common to see girls and young women in their bathing suits. They hope to get an even better tan in winter through the reflection of the snow than they would in summer. Watching this effort could really be a great comfort to the dark-skinned populations of the earth, especially those among them who strive to look as light-coloured as possible and escape the contempt they think white people might have for them because they are dark!
The milk of a diseased cow must be affected in some way, even though the animal might not be tubercular. This is not difficult to understand because it is the same with humans. If a mother is sick, suffering from mineral and vitamin deficiencies, she will be unable to pass on these vital elements to her baby because she lacks them herself. Only a healthy mother can transmit healthy nutrients.
What do we learn from these considerations? That certain basic principles must be put into practice. We have to go full circle if we want to eradicate any mistakes. We have to provide healthy conditions before we can successfully combat today’s nutritional problems. First, we must see to it that the soil is healthy and provides healthy food for the animals. Then we must make sure that their housing is adequate if we want them to produce safe milk. By observing these requirements we can be more certain of better health for the consumer.
Since natural food is indispensable for good health we can count on its benefits. Even if the vitamin content of cherries is relatively low, it is still important, because it is easily absorbed by the body. Cherries contain 0.05 mg per 100 g (2 oz) of vitamin B. This anti-beriberi substance, also known as thiamine, is good for vascular problems, circulation disorders and heart trouble, as well as for low blood pressure. This makes even small quantities of these vitamins welcome. Another of the Â complex vitamins, known as nicotinamide, which is used in the treatment of pellagra, is also present in cherries at 0.01 mg per 100 g. If a person’s gums often bleed or are inflamed, or the teeth are loose, natural food rich in vitamin Ñ is needed. In this case we should eat unsprayed, fully ripe cherries. Sour cherries contain more vitamin Ñ than the sweet kind, but they have 1 per cent less sugar. In spite of their sour taste, these cherries are alkaline-forming. They contain less sodium than sweet cherries, but in comparison they have more potassium and sulphur, and are very rich in malic and citric acids.
A low-protein diet is of paramount importance in treating all metabolic and digestive disturbances, high blood pressure, arthritis, rheumatism and gout, and should be adopted for some time. Protein is found chiefly in meat, eggs, cheese, milk and milk products, peas, beans and lentils, so vegetarians should reduce the intake of milk products and pulses (legumes). People who have previously enjoyed a mixed diet ought to refrain from eating pork, sausages and cold meats and restrict the diet to veal, beef, lamb and mutton.
Eggs and cheese and dishes prepared from them should also be avoided. But if you must eat eggs, have a limited amount and eat them raw. They can be beaten and added to cooked soup. Since eggs produce a great amount of uric acid, sufferers from arthritis are better off without them. Women troubled by insufficiency of the ovaries may eat raw eggs in moderate quantities.
%A %B %e%q, %Y
What conclusion about the liver can we draw from what has been said above? No doubt we are more aware of the need to protect it and if some disorder should arise, we can treat it properly if we are well informed about the right kind of food to eat. For if we ignore the question of diet, we should not be surprised if deficiencies and weaknesses will not respond to treatment. Furthermore, we must be willing to continue observing the basic requirements of a sensible liver diet even after having achieved a significant improvement in our condition. It must be remembered that the liver, despite having recovered from the disorder, is usually still quite sensitive and not immediately as strong as it was previously. That is why it is advisable to be sensible. After all, it should not be all that difficult to keep up a good habit rather than give it up and have a relapse.