Health News

The newly recognised implants are often called atypical implants but they are probably younger implants which, as yet, have very little old blood deposited in them.

Atypical implants are usually very small and are sometimes difficult to see. They may occur alone or in clusters and may be clear, white, yellow, orange or red in colour.

Microscopic endometriosis-In the early stages of endometriosis the implants may be too small to be seen without the use of a microscope. This type of endometriosis is often referred to as microscopic endometriosis.

Endometriomas-Endometrial cysts on the ovary are also known as endometriomas. They are usually less than two or three centimetres in diameter but occasionally may be 10 or more centimetres in diameter. They may be embedded in the ovary itself or they may lie on its surface. They are sometimes referred to as ‘chocolate cysts’ because they contain old dark blood which often has the appearance and consistency of melted chocolate.

Adhesions-Adhesions are bands of tissue which bind or matt together organs of the pelvic cavity and they may be formed as a result of endometriosis. They may have the appearance of sticky toffee which has been stretched from one organ to another.

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The term comes up again and again in books about herbal remedies, but what exactly is a tincture? While the herbs in decoctions and infusions are boiled or steeped in boiling water, tinctures are fluid herbal extracts prepared when the active ingredient of a herb cannot be heated and is not water soluble.

Although not widely available in shops, tinctures are favoured by professional herbalists because they are highly concentrated and long lasting, being made with a base of alcohol. The chopped herb is placed in a 40-50% alcoholic spirit and left in a warm place to steep. After a couple of weeks, the alcohol containing the herbal extract is decanted and stored in dark glass.

The required doses and dilutions of tinctures vary greatly from as little as a few drops to 20 mls at a time. Because of the concentrations involved, great care should be taken to follow the herbalist’s instructions which are usually written on the bottle.

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If Gabrielle is convinced that St John’s Wort has helped her depression, for Frieda, a 77-year-old concert pianist, the jury is still out on the matter. Her psychiatrist, Dr Thomas Wehr, is more certain that it has helped with the quality of her sleep at night and wakefulness during the day.

Born in Hungary, Frieda was a child prodigy who learned to play the piano at age two-and-a-half while still in nappies. Seventy-five years later she is still playing the piano, currently in an upscale department store, where she is so popular that families have written to the store management telling them what a treasure they have in her. Not only does she play standard classical and popular music, but also entertains the children with theme songs from their favourite TV programmes. To all outward appearances Frieda is a cheerful person and few would suspect that she is depressed. T am a gay depressive, and I don’t mean in the sexual sense of the word,’ she declares with the dramatic flair one would expect from a concert pianist.

What most people do not know is that Frieda no longer enjoys the many things that used to delight and enchant her. She has withdrawn from people and has not finished reading a book nor been to a concert performance for the past three years. Life feels very difficult. She is pressed for money and everything seems like an effort. Her thoughts often turn to gloomy themes and she is beset by all sorts of imaginary fears. For example, on her recent visit to her GP she worried that she would get lost or trip in his surgery. Even worse, she dwells at times on thoughts of taking an overdose of medications and being done with her suffering once and for all.

Frieda’s history with anti-depressants is an unhappy one. She compares herself to an overweight person who has tried a number of diets but has ended up heavier than she was at the beginning. She feels that every anti-depressant she has tried has left her worse off than she was before. She claims to be the first person to give ‘a bad report on Prozac’. She can’t remember what the problems were with Lustral and Wellbutrin, both of which she tried with untoward effects. She believes Efexor caused ‘brain activity while I was asleep – terrifying dreams’ that disturbed her nights and left her exhausted during the day.

When St John’s Wort began to garner attention in the media, Frieda read up on it in a book of herbs and decided to try it. Frieda discontinued the Efexor and after 10 days shifted to St John’s Wort. This is the first anti-depressant she has ever taken that has not troubled her with side-effects. She is highly circumspect about the reason for her improved sleep and energy level, wondering whether it might be due exclusively to being off Efexor as opposed to an effect of the herbal anti-depressant. Her psychiatrist has recommended that she increase the dosage to see whether the improvement continues. In the meanwhile her suicidal ideas have left her and she is guardedly optimistic that further positive developments may follow.

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Francine Phillips was a graduate student who had been periodically depressed and fatigued since high school. Basically intelligent and capable, she often had periods in which she could not perform even simple tasks. She also suffered from obesity.

She herself suspected that “sugar” was the cause of her problem (most people do not differentiate between the various forms of sugar). She believed, as well, that part of her weight problem was caused by fluid retention. She reported feeling swollen after eating a heavy meal. She said that she could gain three or four pounds in a day, but that she could also lose ten pounds on a crash diet. Miss Phillips also suspected that she was allergic to certain kinds of water and reported abdominal bloating whenever she drank tap water.

When she was treated in the Ecology Unit, her depression became worse before it gradually lessened. At the end of the fast period, she felt well. She was then tested on various waters, and she did, in fact, react to several of them, including chlorinated city water.

Her own suspicions about foods were largely correct. She reacted with depression, headache, or fatigue to corn and corn sugar and also to cane sugar, as well as to tea and coffee. She also had lesser reactions to onions, acorn squash, walnuts, lettuce, potatoes, chocolate, and honey.

She also reacted to some foods tolerated in their organic form when she was fed them in their commercial, supermarket form. This was taken as a positive test for chemical susceptibility.

Miss Phillips’ case was not very advanced, and her depression was rated at a minus-three level. With careful control of food intake and avoidance of environmental chemicals, she has been able to lead a happier life and pursue her studies without interruption.

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After flying east or west over several time zones, most people do not overcome the “jet lag” for several days. Out of step with their environment, they feel the urge to eat and sleep on the schedule they followed at home. Since traveling the same distance north and south involves no time zone change, there is no jet lag.

This is not only because of a difference in the person’s sleeping pattern, but also because it changes the time of day when the hormones in the body, such as adrenalin and thyroid, are most plentiful. Hormone production cannot change suddenly and can only adjust by about one hour a day, as we pointed out in the article “Shift Work and Hormones” under the heading Hormones. Since hormone blood levels can’t peak in synchrony with the changed hours of the traveler, the person experiences jet lag.

Surprisingly, more time is needed to overcome jet lag after an eastward journey than after an equally long journey westward. This “directional asymmetry,” according to the British Medical Journal (284:144), is due to the fact that traveling westwards results in a longer day than usual during the journey, whereas traveling eastwards shortens the day. The human body, research has shown, prefers a long day to a short one. People living without clocks and in a building without windows naturally adopt a sleep-wake cycle of 25 hours or longer in preference to the 24-hour day.

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Symptoms: Swelling and tenderness of lymph glands (a sign of illness); unusual swelling, pain, and redness of the skin (a sign of infected glands).

Home care: In the case of mild swelling, identify and treat the disease or infection responsible.

Infected glands require medical attention.

Precautions

-    Infants have limited immunity to disease; swollen glands in an infant should be examined by a doctor.

-    Consult the doctor if a lymph node continues to increase in size and tenderness, or if the overlying skin becomes red.

-    When your child turns his or her head, you may notice lymph nodes the size of a pea or smaller in the sides of the neck; these nodes are normal.

-    Swollen lymph nodes in many areas of the body usually indicate a general illness or widespread infection.

The term swollen glands is often used to refer to swelling of the lymph nodes. Lymph nodes are sometimes called lymph glands, although they are not true glands. Lymph nodes are widely distributed throughout the body, and in their normal state are 2 to 4 millimeters in size.

Many lymph nodes lie just beneath the skin. These lymph nodes are located in front of the ears, behind the ears, at the base of the skull, under the chin, down the sides of the neck, in the armpits, in the folds of the elbows, and above and below the creases in the groin. Lymph nodes are also found within the chest and abdomen, but these lie too deeply within the body to be felt.

All lymph nodes lie along thin-walled tubes called lymphatic vessels. These vessels resemble and roughly follow the course of the veins in the body. They do not contain blood, however. These vessels carry thin, clear, slightly sticky liquid called lymph, which resembles the clear, watery fluid that oozes from a scrape or that forms within a blister caused by rubbing.

Lymph nodes are important in helping the body fight infections and disease. When lymph nodes become swollen and mildly tender, it is a sign that they are fighting an illness or infection. The lymph nodes of the entire body may be swollen, or nodes may be swollen only in one area of the body.

When all the lymph nodes or the nodes in many areas are swollen, this usually indicates a general illness or widespread infection affecting the body.

When nodes are swollen only in one location, this is a sign of an infection in the area of the body guarded by those nodes. Swollen glands in one area might be caused by a variety of local infections. The appearance of red streaks under the skin (which typically precede blood poisoning) is caused by infection traveling along the lymphatic vessels in that area.

In some cases an infection may become too severe for the lymph nodes to handle. In such a case, the lymph node itself may become infected.

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Are statins beneficial for older people?

For a start it is controversial whether high cholesterol is a problem in people over 70 years of age. A study called “Cholesterol and mortality: 30 years of follow-up from the Framingham study” was published in the Journal of the American Medical Association in 1987. Cholesterol levels were measured in 1959 men and 2415 women aged between 31 and 65 years of age, who were free of cardiovascular disease and cancer. You may be shocked to know that the study showed there was no increased death rate in people with high cholesterol over the age of 50. So if you make it to 50 years of age, you are not more likely to die of a heart attack if you have high cholesterol than people who have normal or low cholesterol, according to this study. In the study there was a direct association between low levels of cholesterol and increased death.

Researchers at the San Diego School of Medicine found that high cholesterol in people over 75 years of age is protective, instead of harmful. They also stated that low cholesterol is a risk factor for heart arrhythmias, or heart rhythm irregularities. A study in the European Heart Journal recruited 595 people with coronary heart disease who had a total cholesterol level of 4.1mmol/L or less; they were compared with a group of 10 968 people with heart disease who had a cholesterol level above 4.1mmol/L. The study found that the risk of cardiac death was the same in both groups. Therefore, there was no protective benefit to having a low cholesterol level. The study found that “the most frequent cause of non-cardiac death associated with low total cholesterol was cancer”. What is the point of worrying about getting your cholesterol down when it won’t help you to live any longer? Elderly patients are more susceptible to side effects caused by statin drugs. One reason for this is that older people are more likely to take several medications, making drug interactions more likely to happen. Statin induced muscle soreness (myopathy) is more common as we get older, the more other medications we take, the more other diseases we have, and during postoperative periods. All of these factors are more prevalent in the elderly. Muscle pain makes people less likely to exercise; therefore they miss out on the cardiovascular benefits it provides.

Statins without a prescription

In 2004 a low dose version of the cholesterol lowering drug Zocor became available without a prescription in the UK. The theory behind this move was to make statins more widely available to the public, in order to prevent heart disease in at risk individuals. Dr John Reckless, chairman of Heart UK believes statins are safer than aspirin, and “rather more people do need statins than are currently getting them”.

Statins can of course have serious side effects, and this move will place an unnecessarily high number of people at risk. They should never be used by pregnant women because they can cause limb defects. Professor Tom Sanders is a nutritionist at King’s College, London, and nutrition director for Heart UK. According to Professor Sanders, “At the age of 40, your risk of having a heart attack is below one in 1, 000, so any reduction is really quite miniscule in terms of benefit”. Unfortunately, being able to buy Zocor over the counter reinforces the idea that we can eat what we like and never exercise, and a pill will undo the damage.

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Tubal sterilisation

This permanent method of contraception is ideal for the woman who definitely does not want to have any more children. The method involves some kind of interference with the fallopian tubes so that the eggs can no longer pass down into the uterus. There are five main types of procedure and almost all involve the removal of part of the tubes. The success rate is very high (with failure in only 4 in 1,000 cases).

Advantages

• It is permanent-no more worry about unwanted conceptions.

• It is virtually 100 per cent effective.

• It probably has no generalized effects on the woman’s body-none have yet been recognized.

Disadvantages

• It means having an operation and there are dangers in this, albeit few. There is a small surgical complication rate (even in expert hands) but almost all of these get better quickly.

• It is irreversible to all intents and purposes, so you can’t change your mind.

• It can result in heavy or irregular periods in some women and some have PMT for the first time ever.

Morning-after methods

Most people know of the morning-after Pill but there is also the post-coital IUD. Both are forms of very early abortion.

The morning-after Pill must be taken within seventy-two hours of intercourse and contains large doses of hormones. Fitting a coil (IUD) within five days of the unprotected intercourse is an alternative. These methods are only suitable for emergencies and are not used as routine forms of contraception.

Advantages

• They can be used in emergencies to ward off the possible consequences of a ‘mistake’ (i.e. unprotected intercourse). The IUD goes on to act as an on-going contraceptive.

Disadvantages

• The morning-after Pill can produce quite unpleasant side-effects-usually nausea and vomiting.

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Pneumonia’s a bully. It picks on the very young, the old, and the weak. But like most bullies, it’ll back off if you stand up to it.

Taking it seriously is a good first step. If you’ve written off pneumonia as a has-been of a disease, write it back on. Granted, the advent of antibiotics dethroned it from its pre-1936 status as the nation’s top cause of death. But there’s a lot of fight left in this old killer. Teaming up with influenza, it’s still the sixth leading cause of death in the United States. And the number of pneumonia-caused deaths has actually been on the rise, from less than 55,000 in 1980 to more than 80,000 in 1995.

Pneumonia usually swoops in for the kill after some other disease-say, diabetes, chemotherapy-treated cancer, or heart disease-has weakened you. “Even many who die from ‘old age’ really die of pneumonia,” says Ronald Greeno, M.D., co-director of respiratory therapy and pulmonary function at Good Samaritan Hospital in Los Angeles.

Pneumonia is what they call an infectious pulmonary disease, caused usually either by viruses or (much more seriously) bacteria that overpower your lung’s defenses and take over. Pretty soon, oxygen isn’t getting to your blood the way it should and your cells aren’t working right. That can be fatal.

And while the majority of deaths from flu-derived pneumonia in our antibiotic era are in people over 65, that’s by no means all of them. “The most common bacterial pneumonia- pneumococcal pneumonia, also known as Streptococcus pneumoniae – very often follows a bout of influenza at any age,” says Alfred Munzer, M.D., a pulmonologist at Washington Adventist Hospital in Takoma Park, Maryland, and past president of the American Lung Association. “It is much more likely to be fatal in people who are debilitated or elderly, but it certainly can also be fatal in younger people.”

What hits younger and middle-age men a lot more often than bacterial pneumonia is either viral pneumonia or pneumonia caused by mycoplasmas, which are bugs falling somewhere in between a virus and bacterium. Since these types are rarely lethal and usually won’t land you in the hospital, you hear them referred to as walking pneumonia. Walking is about as much as you’ll feel like doing if you have it.

“You can recognize somebody with viral pneumonia because they usually have a dry, hacking, nonproductive cough combined with a fever,” says Dr. Munzer.

So if you don’t want to be the guy doing the coughing, do your best to follow these tips.

Know the symptoms. Doctors can usually knock out bacterial pneumonia with antibiotics, but hot if you don’t seek treatment. The problem is that the symptoms are often a lot like flu symptoms-fever, cough, chest pains, phlegm.

Another red flag is a cough that comes in violent attacks, which can signal mycoplasma pneumonia. And, says Dr. Munzer, “if you’re bringing up a lot of phlegm and you have a fever, with chest pains that are aggravated by breathing, then you have to start thinking seriously about pneumonia.”

Seek treatment pronto. As with most diseases, early diagnosis and treatment speed your recovery of pneumonia. Getting doctor-shy because you simply assume that you have a bad flu-or the more common and less dangerous viral pneumonia-is a dubious piece of self-diagnosis, according to Dr. Greeno.

Besides, adds Steven Mostow, M.D., professor of medicine at the University of Colorado in Denver and chairman of the American Thoracic Society’s Committee on the Prevention of Pneumonia and Influenza, in New York City, “there are therapies with any number of compounds that will shorten mycoplasma disease dramatically. And you’ll feel a hell of a lot better much more quickly.”

Get vaccinated. Yes, there’s a pneumonia vaccine. And while it won’t fend off every type of pneumonia in existence, it will protect you from the most common bacterial pneumonia, pneumococcal. It’s relatively cheap, it’s covered by Medicare, it’s side effect-free, and it will last you at least 10 years, perhaps a lifetime. And still, sighs Dr. Munzer, “it’s probably the most underutilized of all the vaccines.”

Dr. Munzer adds: “There’s no harm in anybody who’s interested in preventive medicine asking his doctor about taking the vaccine. If you want to take it, you should be encouraged to do so.”

Get a flu shot. The logic is simple. Influenza can lead to pneumonia. So don’t get influenza. “There’s one way to avoid the flu, and that’s to get an annual flu shot,” Dr. Mostow says. “I recommend it even for young, healthy men.”

Take your time. If you rush your recovery, you run the risk of a relapse. Remember, it takes longer to recover at age 45 than it does at age 25. And some walking pneumonias, such as mycoplasma, leave you weak for many weeks. Rest, after all, is the cure for walking pneumonia, says Dr. Munzer. So stop walking. Take a load off.

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Bulimia may arise from anorexia; half or more of bulimics have a history of self-starvation. A traumatic event, such as a severe loss or change, may trigger the bulimic cycle. So too can an episode of dieting.

Binge eating is pretty common. Between 60 and 80 percent of American women report that they binge once in a while. Another 10 to 20 percent have weekly binge episodes. With statistics like these, we have to conclude that the occasional act of eating a lot of food in a short time is actually normal. Making a diagnosis of bulimia requires much more than that the person experiences an occasional binge.

As we have seen, different events can trigger increased bingeing. There may be a change in the chemical balance in the brain. We know that such changes occur in some types of depression and lead to the symptom of increased eating.

Psychologically, someone may use bingeing to control unpleasant or overwhelming feelings. Bingeing shifts one’s mental focus. Eating a pound of cookies makes it easier to tolerate the anger one feels when denied a raise, for example. But bingeing then stirs up feelings of shame and inadequacy: “I shouldn’t have done that.” The binger thus takes the anger she feels toward her boss and redirects it toward herself. Eating also represents an act of revenge against the world; the binger knows she is doing something both forbidden and gratifying.

The intense sensory pleasure of (over)eating removes-or at least covers up-anxiety, such as dread of an upcoming school examination. Bingeing thus relieves tension in the same way as drugs or alcohol. Furthermore, bingeing produces chemical changes in the brain, changes that may have some direct anxiety-reducing effect.

Loss of control during a binge leads to self-disgust. Strangely, that self-disgust may also serve to reduce anxiety. Before the binge, the woman is haunted by the thought: “I may fail.” Afterward, though, a new thought dominates: “I have already failed.” Her burden is lifted; now she has little left to lose.

Bingeing also provides a familiar and dependable mental state, an escape from the emotional roller coaster. Many patients tell me they originally needed such an escape because of their chaotic family situation-for example, because the father came home drunk and abusive night after night. Others report that a binge provides “company” during times of painful loneliness.

Purging (vomiting, laxative abuse) or excessive exercise also has psychological meaning. Purging acts as “damage control”- a way of canceling out excessive calories. It also offers a way for the “child” part of the personality to return the good graces of the “parent” part by accepting punishment for being naughty.

Purging lets a woman think, “I can do something bad but it doesn’t really count.” In some patients, this thought comes to dominate the pattern-in other words, purging, not bingeing, becomes the goal. At first a woman may purge to “cancel out” her binge. Over time, however, she finds she must binge in order to purge. Calories are seen as “bad”; therefore, the emptiness produced by vomiting or laxative abuse is “good.” Purging restores control to a life that feels out of control.

Often a bulimic sees her “discovery” of purging as a positive thing. At first it makes her feel calmer or better able to cope with stress. She may even feel happy because she loses some weight in the early stages of her illness. Such weight loss, however, is unstable. The metabolic and nutritional chaos that comes with bulimia usually leads to more bingeing, which in turn may lead to weight gain. (Even when someone vomits immediately, the body retains as much as 25 percent of the calories contained in the meal.) Moreover, many bulimics interpret purging as “permission” to engage in more bingeing.

Bulimics keep their binge-purge habits secret because they feel ashamed. What may initially have begun as a response to upsetting feelings now produces upsetting feelings. The pattern becomes a habit. Thoughts and feelings about bingeing and purging occupy more and more of the patient’s time. In fact, she may structure her entire day around her habit. Some make an after-work ritual out of buying binge food, eating it, and purging. As with drug abuse, such devotion to ritual may increase the patient’s isolation from other people and keep her from taking part in a more normal social life. This in turn leaves her with more empty time on her hands; usually she fills that time with even more bingeing and purging. If something happens to prevent her from indulging her habit—social obligations, work pressure—she grows increasingly anxious.

In severe cases, a bulimic purges so frequently that the mere feeling of having food in her stomach produces the overwhelming desire to get rid of it. Similarly, anxiety caused by the very act of eating may be severe enough to promote purging. Frequently, the bulimic tries to distract herself as she eats by reading, watching TV, and so on. Doing so just makes it easier to eat large amounts without being aware of it.

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