Health news blog

A definite diagnosis of endometriosis is one made when a gynaecologist has actually observed endometrial implants or cysts in your pelvic cavity during a laparoscopy (a minor surgical operation using a laparoscope) or, occasionally, a laparotomy (major abdominal surgery).

In general, a laparoscopy is the preferred method of diagnosing endometriosis because it is a simpler and shorter operation and the use of the laparoscope enables better detection of small implants as it magnifies them to several times their actual size.

Classical endometrial implants and cysts can usually be easily recognised and diagnosed by a gynaecologist during a laparoscopy. However, atypical implants and microscopic endometriosis can be missed if the gynaecologist relies only on a visual impression. An increasing number of gynaecologists are using biopsies to diagnose endometriosis in doubtful cases. This involves removing a sample of tissue, known as a biopsy, from any area that the gynaecologist thinks may be the site of an endometrial implant for examination and diagnosis under a microscope.

A definite diagnosis is extremely important as it enables an accurate assessment of the severity and extent of the disease to be made and provides a guide as to the likely effect of the condition on your fertility. This is essential information if you are to think about and make informed decisions regarding the management of your endometriosis.

The Commonwealth Department of Community Services and Health, which administers the Pharmaceutical Benefits Scheme, will not subsidise the cost of some of the drugs used in the treatment of endometriosis unless a definite diagnosis has been made.

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It stands to reason that being at all overweight is not going to help your sciatica or back problems one bit. As we’ve seen, the spine’s design is such that it all too often has difficulty in coping with even the normal, ordinary demands put upon it through everyday living. If the burden it has to bear becomes even greater because you’re overweight, then it’s obviously more likely that something is going to give sooner or later.

There’s an additional point to take into account: most overweight people carry their extra pounds in the abdomen area, the hips and the thighs. Extra weight in the abdomen is particularly bad news for back sufferers because its presence not only puts extra strain upon the spine while you’re erect – such as standing or walking – but even when you’re sitting. And, of course, bending over or lifting anything creates even greater demands upon the spine when there’s excess baggage hanging out in front of it.

Keeping your weight down to a reasonable level can make a major difference in both preventing and easing back problems and sciatica. What’s more, of course, keeping to a healthy weight will also pay rich dividends in other health benefits. Additionally, many of the exercises that are so important to maintaining a flexible and trouble-free spine will be a great deal easier to do if you’re not carrying too many extra pounds- and a lot more fun, too! It’s a fact that the overweight – the very people who would perhaps gain the greatest benefits from frequent and regular exercising – are often those who exercise the least, part of the reason for this obviously being that exercising is all that much harder and therefore less appealing for them. This lack of exercising often imposes a double penalty upon the back: firstly, it is likely to contribute to the putting on of ever more extra weight; secondly, because the back muscles are not exercised, they’re likely to be in poor condition, lacking strength and flexibility, providing less efficient support for the back and the spine as a whole.

Faced with an obese patient with recurrent sciatica or other back problems for which no other obvious treatment is indicated, doctors will often recommend a weight-loss programme. Good though that advice is, most doctors unfortunately do not have the time to provide specific guidelines about how best to shed the pounds. Following are some of the things your doctor might suggest if he had the time.

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As you can imagine, with all the symptoms I have just listed, including a grim and bleak view of your present situation and future prospects, a depressed person may easily reach the conclusion – or entertain the possibility – that life is not worth living. This symptom of depression, known to the clinician as suicidal ideation, is a very troublesome one. If you are experiencing any such ideas, please do yourself and everyone who cares about you a great favour and consult a doctor without delay. Depression is a condition where hope is in short supply and one way to get an infusion of hope is to reach out to those who may be able to guide you out of the dark place. Your GP is a logical first port of call in such an attempt to reach out. But if, for any reason, it is difficult for you to talk to your doctor about the problem, tell someone – a family member, friend, or even someone on a crisis hot line. Suicidal ideation is not a symptom that anyone ought to have to suffer alone.

As depression deepens, suicidal ideation may progress to passive suicidal longings, which may be accompanied by lack of self-care or carelessness. A depressed woman may feel a lump in her breast while taking a shower and may say to herself, ‘So what if it’s cancer? It would probably be all for the best anyway’ Another depressed person might cross the road carelessly and, in the back of his mind, be thinking, ‘Well, if I get run over, what loss will that be to anyone?’

Matters become even more serious when suicidal ideas begin to gel into actual plans, and even more so when actions are taken to put these plans into effect. It might seem unnecessary to say that if someone you know or love should mention suicidal ideas or plans to you, these should always be taken seriously. Unfortunately it is still all too common for people to minimize the seriousness of such communications. The idea that if someone tells you he is considering suicide, he is unlikely to act on it, is a very dangerous myth. Such divulgences should always be heard as a communication of despair, which may or may not involve immediate danger but which always warrants serious attention. At the very least it is an expression of severe mental anguish.

If you think that life is not worth living or have any thoughts or plans to end your life, you are very, very likely to be depressed. Please don’t delay in getting professional help for this problem.

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Automobiles represent an important source of environmental problems. It has been pointed out in the case of Nora Barnes and other patients that some individuals react to even supposedly “harmless” amounts of automotive exhaust fumes (Chaps. 3 and 7). For this reason, the consumer should think ecologically when buying an automobile. There are five basic rules to follow when purchasing a car:

1.    The car should have a valve which turns off the air intake. This is

important, since one may run into unexpected sources of fumes on

the road: a garbage dump, freshly tarred road, airport, driving through

tunnels or unusually heavy traffic.

2.    Choose the car upholstery with forethought. The best kind of upholstery

is leather, although this has become very difficult to find in American cars. The next best choice is rayon, a fabric made from cellulose, itself a wood by-product. Nylon is less objectionable than the newer synthetic fabrics such as vinyl.

3. The car should have push-button windows, to allow the driver to simultaneously raise all the windows when approaching a major source of pollution.

4. All rubber mats should be removed from the floor of the car and the trunk and should be replaced with carpeting, preferably made from natural fibers.

5. The car should be equipped with an activated carbon filter to clean up fumes which have accumulated on the inside. This is particularly important for those who are known to have a moderate-to-severe form of chemical susceptibility. Sources for such filters are given in the Colos book.

In general, one should be most careful when purchasing a car. It should be driven on the highway first, to see if unpleasant health symptoms develop when riding in it. There may be an undetected leak in the exhaust system, and any prepurchase inspection should pay careful attention to this part of the automobile. The car should preferably be tried out on a sunny, warm day, for plastic car upholstery can cause problems when heated. One should never buy a car which is a source of environmental problems or which causes or perpetuates symptoms.

Once a car is purchased, it is necessary and important to keep car fumes out of the living quarters. If there is a choice, avoid a house whose garage is located under or adjacent to the living area. The case of Sister. Francesca, who fell asleep after being exposed to fumes from a still-hot car engine, illustrates the potential for reactions.

Detached garages are best. If the car must be stored in an adjacent garage, it should be allowed to cool completely, away from the house, before it is put away.

In choosing a house site, one should make sure that it is not located too close to any major road or highway, especially one on which busses travel. The direction of the prevailing winds should be taken into account as well. Check to find out if a new highway is planned for the neighborhood. Patients sometimes choose an ideal country spot for building an ecologically sound house, only to wake one morning to the sound of highway-building equipment.

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As more and more people take up wilderness river rafting as a means of getting back to nature, the number of plant poisoning cases has been on the increase. Ingestion of the water hemlock plant (known as Cicuta douglasii), the Western Journal of Medicine (142:637) reports, has recently been responsible for the deaths of several river rafters in Oregon and Idaho.

This plant closely resembles the wild carrot or parsnip. It has large fleshy roots with a smell so strongly suggestive of carrots and celery that people are tempted to taste them.

Unfortunately, however, the water hemlock is one of our most poisonous wild plants and can bring on convulsions, collapse, and death, all within an hour or two after one has taken a small bite of its root.

About the only method of treating hemlock poisoning available in the wilderness is the induction of vomiting, but, without an emetic such as syrup of ipecac, this can be very difficult. Campers, therefore, should always be prepared for such emergencies by carrying a reliable emetic in their packs.

In emergencies, a useful trick that can save lives from poisoning, according to the Journal, is to make up an emetic by mixing a tablespoonful of liquid dish soap in eight ounces of water.

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Heatstroke is a sudden, uncontrolled rise in body temperature. Heatstroke occurs when the body is exposed to excessive heat but cannot replace the body fluids lost through perspiration. If the lost fluids are not replaced, dehydration (depletion of total body fluids) occurs and leads to a decrease in blood volume.

At this point the body has to decide whether to supply the diminished amount of blood to the internal organs or to the skin; since the internal organs take priority, they will receive the blood. At the same time, the body loses its ability to sweat. The situation now becomes critical for two reasons: the body cannot now produce enough sweat, so the evaporation of sweat on the skin cannot cool the body; and the skin is now being deprived of the blood supply that insures that excess heat can be released through the skin. The lack of blood supply to the skin and the inability to sweat together cause the body to overheat.

If it is not treated quickly and correctly, heatstroke can cause permanent brain damage or death. When there is loss of blood volume, which can mean there is not enough blood to circulate through the body, the victim goes into shock. Also, at high temperatures the blood cannot clot properly, and this can result in blood leaking from the vessels into body organs.

Heatstroke most often strikes athletes or other people who do strenuous work in hot weather. People who have had heatstroke once are more likely to suffer another attack if they return to strenuous exercise within a week. Lack of water, excessive sweating, vomiting, or diarrhea all increase the body’s susceptibility to heatstroke.

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Illness, Aging and Genes

Two other suicide hot spots include sickness and old age, which are often, but certainly not always, synonymous. And there also may be a genetic link, experts say.

Men ages 20 to 59 who have been diagnosed with AIDS, for instance, are about 36 times more likely to commit suicide than men of the same age who do not have the disease. Barring diseases such as AIDS, however, the older you get, the greater your chances for getting seriously ill, and the greater your risk for suicide. Medical illness is a direct contributor to suicide in up to 70 percent of all suicide victims older than 60. White men over 50 are especially vulnerable. Though they make up only 10 percent of the population, this volatile group is responsible for a third of all suicides.

Yet doctors have found that, like other suicidal people, those who wish to die while they are ill most often are suffering not from a pain-induced, well-pondered death wish but from clinical depression or alcoholism. When their depression is treated, they usually don’t want to die any longer, according to the AFSP.

Like your height and eye color, suicidal tendencies are unfortunately passed on along family lines. If someone in your family has killed himself, your risk of doing the same increases fourfold.

There are a couple of reasons for this, say AFSP researchers. First, there may be an actual biological-suicidal characteristic that is inherited, such as the inability to process serotonin correctly. Second, families don’t just share genes; they share environments, says Dr. McIntosh. “We live with the same stressful situations. And if you see your parents acting out in a certain way, you’re likely to pick up that behavior, no matter how destructive.”

Following the Signs

Though a few suicides occur out of the blue, 75 percent of people who attempt suicide give some warning to their friends and family, Nock says. You should become familiar with the primary danger signs that signal someone is contemplating suicide, says Nock. They are:

•     Previous suicide attempts. Trying to kill yourself once is one of the best predictors of whether you’ll actually take your life one day. Between 20 percent and 50 percent of people, who kill themselves, have tried before.

•     Talking about death. People who commit suicide often talk about death. Sometimes they say goodbye or act as though they’re going away.

•     Making final arrangements. Suicidal people often go about putting their affairs in order as though they have a terminal illness. They may give away possessions or pay off large debts or mortgages.

•     Showing signs of depression. Be especially concerned if people withdraw from activities they used to enjoy or have changes in sleeping patterns, appetite, weight, energy, or sex drive. These, along with feelings of worthlessness and thoughts of death, are signs of depression.

If you recognize these in yourself or another, check your local listings for a suicide prevention hotline.

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Gold therapy

Gold therapy basically involves the administration of gold salts (so that the gold is in a soluble form) into the system of the patient involved. The mechanism of the anti-arthritic effect has received considerable attention with several theories being put forward. The theories have been based on the bactericidal effect, the suppression of certain enzyme effects, and even the toxic effect of gold. So far the true mechanism is still not known but possibly the inhibiting effect in some enzymes is the most popular theory.

With regard to the effectiveness of gold therapy it was reported that over relatively short periods (about one and a half years) the treatment was quite effective but that a reverse trend occurred after that. The improvement in condition takes place slowly, unlike the therapies described earlier, and it can be necessary for a person to be on treatment for many months.

To complete the gold story the side-effects have to be considered and, once again, these tend to be rather unpleasant. Amongst the side-effects listed for gold are toxicity (it is known to be quite lethal but as it is only administered in small amounts this effect is minimized), dermatitis, loss of hair, mouth ulcers and the seemingly inevitable gastric problems.

Treatment of osteo-arthritis

Drug therapy forms a smaller part in the treatment of osteo- arthritis than in that of rheumatoid arthritis. It is not within the scope of the discussions here to go into therapies that involve the use of splints, surgical appliances, crutches am heat treatment. All of these, together with programmes of balanced physical exercise therapy, are used in the treatment and management of various forms of osteo-arthritis.

Drug therapy and diet are factors which should be î interest to most of us as it will be this area in which we ourselves will be most able to be effective in choice. That die is effective in influencing osteo-arthritis one way or the other is still open to doubt on clinical grounds. However, in trial on the incidence of osteo-arthritis in mice being fed a diet rich in saturated fat, an increased frequency of osteo-arthritis was noted. If some of the saturated fat in the diet was substitute by unsaturated fatty acid, a significant decrease in the incidence of osteo-arthritis resulted. Contrary to common opinion, clinicians do not consider that osteo-arthritis is due to dietary factors causing too much or too little calcium in the bones. Thus, apart from the obvious effect obesity may have on this condition, which could be described as an indirect dietary effect, osteo-arthritis is not considered to be a condition susceptible to nutrition.

In common with rheumatoid arthritis, probably the most widely used drug therapy for osteo-arthritis is aspirin. The analgesic effect would generally be the most active in relieving the pain symptoms of the condition. And inflammatory properties can come into play however where synovial inflammation is occurring. Synovial inflammation means inflammation of the synovial which is a lining membrane in certain types of joints. This membrane is responsible for lining and producing synovial fluid, the lubricating fluid for these joints.

Most other non-steroidal anti-inflammatory drugs, as used for rheumatoid arthritis, are also used for osteo-arthritis. The side-effects are the same for all these preparations. In general, the use of these drugs in the treatment of different conditions usually involves the same side-effects.

Corticosteroid therapy is not favoured as an oral form of treatment for osteo-arthritis due to the comparative lack of efficacy and the risk of serious side effects following long-term administration. Direct injection of corticosteroids into the joints has been used quite widely with successful, though temporary, relief of symptoms in some cases of osteo-arthritis. From personal reports of people who have experienced this type of treatment, however, the injections themselves are rather an unpleasant experience. The adverse effects of corticosteroid therapy by direct injection are not restricted to the injection itself.

Experimental studies have demonstrated that these drugs can have deleterious effects on the joint cartilage which can assist further deterioration of the joint. Also inflammations and joint infections can follow due to injected steroid crystals. As a result of these factors, and its inability to help in severe cases its use is not widely recommended.

Other therapies exist, including a type of radiation treatment and, particularly with arthritis of the hip, surgery. Wonderful results are being achieved with hip, knee and hand replacement surgery nowadays using durable metal or plastic components.

Thus, there are various means of treating arthritic disorders with various degrees of effectiveness and also various degrees of risk from side-effects. Obviously the best treatment is one where there is the maximum effectiveness with the minimum risk of adverse side-effects covering the broadest range of symptoms.

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To-date, no treatment has been developed that is effective for all women with endometriosis because little is known about the causes of the condition. However, many different approaches have been tried.

In general, the treatments aim to relieve the symptoms and, where desired, improve the chances of conception by eradicating as many endometrial implants, cysts and adhesions as possible.

The main options available for the management of endometriosis are:

* observation

* symptomatic management

* hormonal treatment

* surgical treatment

* combined treatment

* alternative therapies

Observation

Observation or a ‘wait-and-see’ approach involves no active treatment. Rather, as the name suggests, it simply involves a period of observation and monitoring. Such an approach should still involve regular visits to your gynecologist to monitor any possible progression of your endometriosis and its symptoms.

Some gynecologists believe that a period of observation is the most appropriate form of management for young women who have minimal endometriosis with no significant symptoms. Others believe that it is inappropriate because they believe endometriosis should be treated as it usually progresses.

A period of observation may be the most appropriate form of management if a woman decides that she does not want to have active treatment, particularly if she has minimal or no symptoms.

Symptomatic management

Symptomatic management for endometriosis involves treating only the symptoms – usually the pain – without attempting to treat the underlying disease.

It usually involves the use of various analgesics or anti-inflammatory drugs if the pain is intermittent, or a range of pain management techniques if the pain is chronic and ongoing.

Symptomatic management may be appropriate if a woman decides not to have treatment or if she has symptoms that have not responded to previous treatments.

Symptomatic management may also be used as an adjunct to conventional or alternative treatments in order to relieve ongoing symptoms.

If you decide to have only symptomatic management you need to be aware that it will not treat your endometriosis in any way and that in fact your endometriosis may progress.

Hormonal treatments

The hormonal treatment of endometriosis uses drugs to treat the condition. In general, hormonal treatments aim to eradicate the endometriosis by suppressing the menstrual cycle and preventing the growth and development of the endometrial implants and cysts.

Surgical treatments

In general, surgery for endometriosis aims to remove as many endometrial implants, cysts, endometriomas and adhesions as possible and to repair any damage caused by the disease. In the case of a hysterectomy, surgery aims to cure the disease by removing the uterus and sometimes the ovaries as well.

Combined treatment

Combined treatment is the use of a course of hormonal treatment before, or after, surgery to enhance the effects of the surgical treatment.

Alternative therapies

A variety of treatments are used by alternative therapists. Each therapist uses a combination of treatments, although the actual treatments used for each individual will usually depend on an assessment of her problems.

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Noted brain experts Richard Wurtman and Judith Wurtman conducted experiments with CCO (carbohydrate-craving obesity) patients. Their work demonstrated how the urge to consume carbohydrates strikes predictably during the late afternoon. But why should this be so? If a person has a disorder that compels her to eat huge quantities of food, why should her appetite be greater at certain times of day? And why is it limited to a certain type of macronutrient? Not all of the answers are in yet. However, some evidence points to the neurotransmitter serotonin-or rather, a defect in serotonin secretion-as one possible source of the problem.

A normal person who feels the urge to eat something sweet might be satisfied with a couple of cookies or a candy bar. In contrast, a carbohydrate craver continues to eat beyond the point of satisfaction. As we learned earlier, serotonin usually acts to suppress eating. The Wurtmans believe that carbohydrate-craving behavior suggests something has gone wrong with the feedback loop that signals the brain when enough food has been taken in.

There’s another level to the problem as well. When asked why they succumbed to such dangerous eating practices, carbohydrate-craving people reported that they weren’t interested in the taste of the food. Instead they ate as a means of fending off tension, anxiety, or mental fatigue. In other words, carbohydrate cravers seem to use food as a kind of self-prescribed regimen of antidepressant therapy. Earlier we saw how carbohydrates lead to increased serotonin levels. Could a defect in the serotonin system be a common link between these disorders?

Knowing that a faulty serotonin system may underlie certain kinds of abnormal eating has led to the use of medications to correct the problem. A chemical called d-fenfluramine, for example, acts as a kind of biological boxing coach. It calls on serotonin to get out there and fight by triggering its release from nerve cells. Then d-fenfluramine prolongs the bout by blocking reabsorption of serotonin back into the cell-in a sense, keeping the boxer from returning to his corner before the fight is over. The popular antidepressant Prozac (fluoxetine) also increases serotonin levels by blocking the reabsorption of serotonin by the nerve cells.

Through this one-two punch, d-fenfluramine helps serotonin do the job it was designed for: control appetite. Use of this and other similar compounds can help some carbohydrate-craving patients enjoy more normal moods and in some cases lose weight. There has also been some success in using these medications for PMS and SAD. Recent research in patients with PMS has also shown that consumption of high-carbohydrate meals (which increases serotonin) can help improve premenstrual depression, tension, and fatigue.

Eating is not just a simple process. A complex network of signals exists between the brain and the rest of the body. Some of these signals arise from within. Others- anything from the amount of daylight outside to a friend’s invitation to go and grab a burger-come from the outside world.

These signals trigger the release of biochemicals that stimulate appetite. The digestive organs respond to what we eat by releasing still more chemical messengers that report to the brain. The brain processes the information and issues orders to stop, continue, or eat something different next time.

Although social cues play a role, eating is largely a self-sustaining physical process. Disruptions can occur at any point in the system. There may be insufficient supplies of a certain brain chemical or a defect in an organ’s ability to respond to a neurotransmitter’s message. Fortunately, our growing knowledge of how physical problems contribute to eating disorders points the way to new and effective biological treatments.

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