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.
*136\186\4*
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.
*10\198\4*
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.
*9\174\4*
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.
*35\57\2*
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.
*87\75\2*
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.
*26\188\2*
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.]
*47\142\2*
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.
Home care
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.
Precautions
• If your child repeatedly develops ingrown toenails check his or her shoes; they may be too small or too pointed.
• 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.
Medical treatment
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.
*133/84/5*
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.
• Pregnancy causes ankle swelling as a result of the pressure of the heavy uterus on the pelvic veins, which reduces their ability to collect fluid from the legs.
• 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.
*151/72/5*
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.
Adjuvant therapy
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.
*66/39/5*
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