Health and medical information

All of the major nutrients—carbohydrate, fat, protein and alcohol— can ultimately regenerate ATP as needed to fuel the body. However, this occurs through different metabolic pathways. Basically, when immediate energy is called for to create movement, especially sudden movement, stored ATP and creatine phosphate (CP) in the muscle are used. Using the money analogy, this could be equated to cash. There’s no conversion needed here, and the transaction is quick. Energy is supplied for up to 10 seconds and a period of 1-2 minutes is all that is needed to replenish supplies. The whole process is carried out without oxygen (an aerobically). The type of activity which uses this form of energy is short, sharp bursts of ‘power’ type activity such as short sprints or weight lifting. Because fat is not immediately implicated in the system, there is little role for this type of exercise in fat burning, at least in the short term.

Myth-information. Sit-ups to reduce abdominal fatness will result only in a “tight’ fat waist instead of a ‘loose’ fat waist. Sit-ups can tone muscle but will have little effect on the subcutaneous fat overlaying this muscle.

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Endometriosis is the growth of tissue resembling the endometrium in parts of the pelvis where it is not usually seen. This ’stray’ tissue grows in an estimated 1-6% of women. It occurs on the ovaries, Fallopian tubes, the outside of the uterus or its supporting ligaments, the bowel, bladder or vagina.6 It occurs in about one in five women with fertility problems, suggesting a significant role in infertility. The tissue behaves like the endometrium in some respects, bleeding at the same time as the usual menstrual period. If the blood cannot easily escape from the body, it may cause irritation or pain and may develop into blood-filled cysts.

Sometimes endometriosis only lasts for a few cycles, but it may also continue throughout reproductive life, getting worse as women enter their thirties and forties. The behaviour of endometriosis in pregnancy is highly variable and it rarely disappears permanently after pregnancy. Published reports indicate that some women continue to have problems due to endometriosis after menopause. It can limit bending, stretching, standing and taking exercise, especially on days of menstrual bleeding. Although it is also associated with infertility, many women with endometriosis become pregnant without difficulty.

Endometriosis is regarded as the most common cause of chronic pain in women aged from fifteen to fifty-five years. This pain is nearly always cyclical, that is, it tends to occur at about the same time in most menstrual cycles. It may be experienced by a woman when she ovulates, menstruates or is about to menstruate. It may also occur when she has sexual intercourse, urinates or passes a bowel motion. It sometimes causes spotting between periods. Although it has much in common with period pain it does not respond to medications, such as anti-prostaglandins, found helpful in that disorder. When Laura sought advice from her doctor about chronic pelvic pain, a number of factors in her history suggested a diagnosis of endometriosis. These included a history of painful periods which had worsened with age, short menstrual cycles with a relatively large number of days of bleeding, and a family history of pelvic pain among her female relatives. Despite this suggestive evidence, Laura’s doctor advised her that the diagnosis required a laparoscope entailing a visual inspection of her abdominal organs. He said a number of other procedures might assist in arriving at a diagnosis but he preferred not to perform a biopsy of suspected lesions, a vaginal ultrasound and blood tests until he did the laparoscopy. In fact, the laparoscopy was sufficient to reveal the endometriosis and he and Laura discussed a number of possible treatments, including drug treatment and surgical removal.

The diagnosis of endometriosis usually relies on a laparoscopic examination, a procedure that enables a doctor to examine the contents of the abdomen without making a big opening in. Instead several small incisions are made and a long thin tube specially equipped with thin glass fibres is inserted through one of the incisions. Light travels along the fibres to ’spotlight’ internal organs and a periscope-type attachment allows the doctor to see into the abdomen and pelvis. Other instruments used with the laparoscope (hence the need for the other incisions) enable the doctor to make photographic records of the inside of the abdomen, obtain samples (biopsies) of tissue for laboratory analysis and remove abnormal tissue. Using this technique, doctors have learned that the appearance of endometriosis varies markedly. Younger women tend to have clear growths or red lesions, whereas the lesions of older patients tend to be black or yellow-white.

Various theories have been advanced about why endometriosis occurs, but these are hotly disputed. Suffice it to say that no one yet knows if some women are born with a tendency to develop it or if endometrial-type tissue spreads in the body due to some unusual abdominal structure or function.

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How much sleep is really enough? The sleep deprivation studies suggest a minimum of perhaps two hours a day. Psychological studies show that it depends on whether we are larks or owls, or a bit of both. Statistically, it is reported that most healthy adults sleep 15 hours a day.

It is now known that how much we sleep each night may be determined by our genes. Studies of identical twins, who share the same genes, reveal that their sleep is similar in quality and quantity even if they live in different environments for years. We can be trained to sleep a shorter number of hours each night, but it appears that we revert to our former number of hours of sleep when the training is over.

It has also been shown that longer sleepers who sleep more than ten hours each night may not be the healthiest group of people. The American Cancer Society carried out a six year survey which showed that the death rate of these long sleepers was nearly double that of those who sleep between seven and eight hours each night The reverse is also true for short sleepers who claim they sleep less than four hours each night; their death rate is two-and-a-half-times that of average sleepers. At present the exact relationship between sleep and health remains a mystery.

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Aggression may be dealt with in various ways. It may simply be dissipated. We see this in simple form when a child is thwarted by his parents. His aggression is aroused, but he cannot give it direct expression or he will be punished. He is not mature enough to sublimate it. His aggression is just dissipated in his behaviour. He stamps about, handles his toys roughly and expresses an aggressive attitude to those about him. In a more sophisticated way in adult life we dissipate our aggression by playing games or by watching sports in which we identify ourselves with the players and experience their emotions.

Aggression can also be displaced, so that our aggressive impulses toward one person or situation are vented on some completely innocent party. The husband is frustrated at work by his boss. His aggression is aroused. He cannot give it direct expression, but on reaching home he blows up and vents it on his unsuspecting wife. Aggression can also be controlled by act of will. In fact, learning to control aggression is one of the most important experiences of childhood and adolescence. But this control, and the awareness of the necessity for it, creates a further stress, and the individual is tense and anxious as a result of it.

The person who is controlling a good deal of aggression is vulnerable to minor additional stresses. This is an important factor in the cause of bad temper. Father tolerates the bickering of the children for a long time, then he suddenly blows up and punishes them more severely than he intended.

An intelligent adult man with a good work record came to see me, saying that he was becoming increasingly on edge so that he was likely to blow up with his wife and family at the least provocation. He had not realized that anything was wrong with himself until a few days previously. He had burst into a temper with his wife, and in the heat of his rage had thrown to the ground the watch which she had given him for his birthday. He then jumped on it until it was broken to pieces. He was humiliated and alarmed that he could have done such a thing.

With further discussion it became clear that he had been becoming more and more tense as a result of increasing pressures at work.

He went about practising the relaxing exercises with real determination. His wife was understanding, and her support did much to relieve his sense of humiliation. She wrote to me some weeks later, saying that he was still doing the same amount of work, but things had never been better.

Many of us, perhaps all of us, have particular topics on which we are especially vulnerable. In these areas we are easily hurt, and our aggression is likely to flare up.

A man in his middle fifties held a responsible executive position, which he filled with reasonable ease and without any sign of undue aggression. He had always been extremely attached to his mother, so much so that it had been a constant source of conflict between him and his wife. The mother had died about a year previously, but instead of being better as one might have expected, things between the husband and wife were so much the worse. The wife had innocently suggested that he put away some of his mother’s personal belongings. He had flown into a blind rage and struck her.

He was encouraged to do the relaxing exercises, and at the same time to concentrate on calm and understanding thoughts about his mother and wife. When I last saw him he was still a little touchy about his mother, but much easier than previously.

Aggression need not be such a destructive force. The same impulse that drives us to feel like punching someone in the nose can be diverted, and used to drive us on in whatever enterprise our life situation places us. By this drive we achieve goals in commerce, industry, and science. In a more personal way we obtain the drive to. seek things out and to understand, both the material aspects of life and the abstract, in art and beauty.

Anxiety is the price we pay when our victory over our aggression is incomplete. But the reader who is seeking relief from mental tension is reminded that the struggle for inner control is not won by a fixed-jaw-and-clenched-fists attempt to discipline oneself at all costs. In this way we may manage to hold our aggression in check, and to stop it from breaking forth, but the effort of holding it in creates tension to the limit of our control. So, we must aim to establish a pattern of life in which our overt aggression is not easily aroused. We can do this by understanding the factors involved, by using our native aggression in creative fashion and by practising our relaxing mental exercises. These three approaches are not separate entities but are a unity in themselves. Understanding, creative use of aggression, and ease of mind are one. This integration is to be our aim.

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Alcohol itself often complicates the treatment of depression. Although depressed people often report a pleasant buzz after using alcohol, in my experience they often pay for this buzz heavily in the days that follow. This delayed effect is often difficult to discern. If your mood is bad to start with and it feels worse on certain days, there are any number of good reasons to explain the mood worsening. The two or three drinks you had last night or the night before are by now a distant memory and hardly seem to be likely culprits. But careful observation in many patients has shown that once the alcohol is stopped, mood control is often much smoother and better. Now, if you enjoy having several drinks of an evening I hardly expect these mild observations of mine to persuade you to stop doing so, but it’s worth thinking about it. If you’re keeping the mood log I mentioned above, you might note when you drink (including the number and type of drinks you have) and see whether you can detect an impact of the drinks on your mood over the ensuing days.

Quite apart from the potential problem of drinking alcohol if you happen to suffer from depression is the question of whether you can safely drink alcohol if you are on St John’s Wort. The answer is that there is no known negative interaction between St John’s Wort and alcohol. Even so, I always suggest that my patients go easy on the alcohol if they are on any anti-depressant (no more than one or two lagers or glasses of wine or one glass of spirits is what I usually recommend). After all, if these drugs are all working on the brain, it would be strange if they did not affect each other’s actions in one way or another.

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Some chemical compounds are so powerful that they will cause seizures in most of those exposed. War gas which has actually been used in some units to induce seizures in those with severe depression as an alternative to electroconvulsive therapy. In this case the seizure is the required effect, but in all other instances seizures complicating drug therapy are very much an unwanted effect.

Antidepressant drugs of the tricyclic group, including amitryptiline (for example, Tryptizol, Saroten, Domical) and nortryptyline (for example, Allegron, Aventyl) are amongst those which clearly lower the convulsive threshold and precipitate seizures. Other offenders include phenothiazines, isoniazid, and high doses of penicillin. Excessive doses of insulin precipitate seizures through hypoglycaemia (low blood sugar). Any of these drugs may precipitate a first seizure or exacerbate established epilepsy.

Other drugs may precipitate seizures in those with epilepsy on anti-epileptic medication by interfering with the metabolism of these drugs.

Finally, it should be remembered that withdrawal of some drugs, particularly barbiturates, may precipitate seizures.

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Mrs DH, of Gloucester, England wrote…..”I suffered very badly from osteoarthritis of the lower spine with pain at times so bad I did not wish to go on. After completing the course I can only say that my life is completely turned around. I am so mobile and free from pain it feels like a miracle. I hope this letter will in some way convey the gratitude I feel for having my life back again.”

Mrs C, Surrey, England…..“Before taking the [CMO] I had a problem with BPH, which has improved within a fortnight. I also had a problem with leg cramps from a sciatic nerve injury about 10 years ago. Nothing seemed to work, however after a few days of taking CMO the cramps almost completely went and I can sit cross legged for one hour plus.”

Mrs M M, Derbyshire, England. “I have nearly finished my first tub [of CMO], and I can tell you that already they are doing me the power of good, it is a miracle. I can now walk without having to use my stick. I am going to order my second bottle and I will keep you posted of my progress.”

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Symptom

Yellow tinge to the skin and the whites of the eyes

Home care

Watch your newborn baby closely for signs of jaundice in the first week after the baby goes home from the hospital.

Inform the doctor if you suspect jaundice.

Precautions

-    Many newborns develop a normal jaundice in the first week of life; however, jaundice that develops in the first 24 hours after birth is not normal.

-    If the baby develops jaundice – or jaundice worsens – after the baby comes home, consult your doctor.

-    Consult the doctor immediately if your jaundiced baby is nursing poorly, seems excessively drowsy, or is fevered or irritable.

-    If your baby develops jaundice, follow your doctor’s instructions exactly.

The liver transforms a substance known as bilirubin, released when old blood cells are replaced by new cells, into bile. The bile is then passed into the intestine. When damage to the liver prevents or slows down this process, bilirubin accumulates in the body and jaundice results.

Sixty percent of full-term infants and 80 percent of premature babies develop a normal jaundice during the first week of life. This occurs because of the rapid destruction of the excess number of red blood cells with which all healthy babies are born. The jaundice usually begins in the second or third day of life and disappears between the fifth and tenth day. With rare exceptions, this jaundice is harmless. Its major importance is the difficulty distinguishing it from abnormal jaundice.

The two most frequent causes of abnormal jaundice in the newborn are blood poisoning and erythroblastosis fetalis. Blood poisoning, a generalized infection caused by bacteria or viruses, causes jaundice in the newborn by destroying red blood cells and injuring the liver. Erythroblastosis fetalis is due to an incompatibility between the child’s blood and that of the mother. The mismatch may be in the Rh factor (for example, when the mother is Rh-negative but the infant is Rh-positive), in the ABO factors (when the mother’s blood is type Î but the baby’s is type A or B), or in rarer blood factors. Because of the incompatibility, the mother’s blood forms antibodies (protective substances that form to fight off disease or anything the body interprets as an attacking organism). These antibodies rapidly destroy the infant’s red blood cells.

Breast-fed newborns may also develop jaundice because a substance in the mother’s milk interferes with the proper function of the baby’s liver. This form of jaundice by itself usually is harmless. There are many other causes of jaundice in the newborn, including certain forms of anaeimia, hepatitis, and German measles, but jaundice due to these causes is rare.

Because either erythroblastosis fetalis or blood poisoning can be fatal to newborn babies if not treated immediately, a doctor’s diagnosis must be made promptly. Other forms of jaundice can also be serious if the bilirubin in the blood exceeds a safe level. If jaundice is suspected, a doctor must monitor the bilirubin level closely.

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What is it?

Glaucoma is an eye disorder in which the eyeball becomes harder and the area of vision is narrowed down. It occurs in about one in 100 people over the age of 40. About 20,000 people are blind as a result of glaucoma in England and Wales alone. It is about ten times as common in close relatives as it is in the general population, and it is not catching. It can be treated, and loss of sight prevented, if it is caught early. Treatment is by eye drops, tablets and operation. Glaucoma usually affects both eyes, though frequently one more than the other.

What causes it?

Watery fluid is normally formed in the eye and then drains back into the bloodstream through a sieve-like area of tissue. If this becomes partly blocked the fluid gets dammed up in the eye and presses on the sight nerve. Parts of this nerve go out of action and this causes a loss of vision around the edge of the field of vision. Eventually, if untreated, only the centre of the field of vision is left, and it can even blind you.

Prevention

• Vitamin Ñ can lower the pressure and stem the disease. Research has shown that healthy people who consume about 1.2 g vitamin Ñ a day tend to have lower pressure inside their eyes than those who consume only 75 mg of the vitamin a day. Take 1 g a day to be sure.

• Thiamine (vitamin Bi) may also help glaucoma sufferers. A recent Californian study found that people with glaucoma usually have lower amounts of thiamine in their blood. A study in Guyana in the 1950s found that East Indians living there who ate a largely vegetarian diet, rich in  vitamins, rarely suffered from glaucoma while their fellow countrymen living on a different diet often developed the disease. This researcher relieved the effects of glaucoma with large injections of thiamine (100 mg a day for ten days) and followed this up with oral supplements.

• Modern medicines prevent the glaucoma from getting worse, even making an operation unnecessary, and saving sight. Possible side-effects of the drops are an increase in urine passed and a tingling in the fingers and toes. They generally work for only a limited time and have to be repeated every six hours or so, though the latest drops last longer and only need to be used twice a day. Tablets boost the effects of the drops and are needed in some patients.

This ‘medical’ treatment may make your eyes a little better and will certainly stop them getting worse. If you take certain tranquillizers or steroid drugs (including the contraceptive pill) you will have to be aware that your glaucoma could get worse and get your optician to measure your eye pressure more frequently than he otherwise would.

• Regular testing of your eyes for glaucoma is a simple and painless procedure which should be done every two years ii there is glaucoma in the family and every three years or so as part of a regular eye check-up for anyone over 40. This enables the condition to be caught early before irreparable damage is done to the eyesight. Screening for glaucoma, especially among ‘at risk’ groups, is an example of preventive medicine at its best. There are about 100,000 people diagnosed as having glaucoma in the UK but it is estimated that there are about 150,000 people who have the disease yet don’t know it. Given that this is a major preventable cause of blindness, as soon as you are diagnosed as having the condition do everything you can to ensure that your close family all have an eye test.

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Sarah is 36 years old, married, with two children aged 11 and 12.

Two and a half years ago, she was relaxing after a bath when she felt a lump in the upper part of her breast. Although she was not very concerned about it, she went to see her doctor the following day. Sarah’s G.P agreed that the lump was probably nothing to worry about, and was likely to be related to the fact that her period was soon due. She suggested Sarah return a week later. As the lump was still there the following week, Sarah was referred to a consultant.

There was some delay in arranging an appointment with the consultant, and Sarah was eventually seen by a hospital doctor about 4 weeks later. The doctor did a needle biopsy to remove some cells from the lump, and Sarah returned the following week for the results of this test. Unfortunately, the biopsy had failed to provide any conclusive evidence about the nature of the lump, apart from indicating that it was not a cyst and contained no fluid. Another needle biopsy was done and another appointment made for the following week. This time she saw the consultant, who told her that the second needle biopsy had also failed to provide any useful information. He then did a Tru-Cut biopsy to remove a piece of tissue from the lump. Sarah was due to return to the hospital to receive the results of this biopsy a week later, but in the meantime the consultant rang her to suggest that she should take a suitcase with her to her next appointment as, whatever the results of the biopsy, he felt that the lump should be removed.

It was only then that Sarah began to feel concerned about the possibility that the lump could be cancer.

At her next clinic visit, Sarah and her husband learned that the tissue biopsy had revealed cancer, and the consultant asked if she would like to go home for a few days to consider whether she would prefer to have a lumpectomy or a mastectomy. He himself was in favour of a mastectomy, and they all agreed that she should have this operation the following day.

The breast care nurse took Sarah and her husband to the ward and explained to them what was going to happen.

The next morning, Sarah’s breast was removed, together with several lymph glands from under her arm. The lump was between 2 and 3 cm in width (about 1 inch). She was in hospital for about 4 days, and before she left she was fitted by the breast care nurse with a temporary soft prosthesis to put in her bra. While she was in hospital, a physiotherapist also showed her how to do some exercises to help her regain the movement in her arm.

She felt shocked and exhausted for the first few days she was at home. Her wound was quite painful for several days, but regular painkillers helped. She was given sleeping tablets which she took for the next 10 nights, while awaiting her follow-up appointment with the consultant. When she returned to the clinic, she was told there had been no evidence of spread of the cancer beyond her breast, and she would not need to have further treatment.

About 10 days after her operation, the stitches were removed from Sarah’s wound at her local health centre, and 4 weeks after her mastectomy, she was fitted with a permanent external silicone prosthesis.

A few weeks later, having watched a television programme about cancer, Sarah developed a fear of her breast cancer recurring. During the next few months she had a bone scan after developing back ache and headaches, as well as a variety of other tests to investigate the causes of various aches and pains. About 3 months after her operation, she started having dizzy spells and her doctor, who felt that anxiety could be the cause of some of Sarah’s problems, started her on anti-depressants. She continued taking the anti-depressants for about a year, gradually stopping when she felt better able to cope.

Sarah had a great deal of support from her breast care nurse, as well as from her GP and consultant, all of whom took her worries seriously. She also saw a counselor for a while when her anxiety was becoming difficult for her to deal with. However, for 18 months after her operation, every ache or pain Sarah suffered added to her terror of the cancer returning. She feels that it has taken her about two and a half years to recover completely psychologically, although it was only about 4 to 6 weeks before she had recovered physically from the operation. She now feels able to live her life without constantly thinking about what she will do if the cancer recurs, and has decided to face any problems if and when they arise.

Her breast care nurse arranged for pockets to be sewn into her bras (and her swimsuit) following an embarrassing experience at her daughter’s sports day. She did try an adhesive prosthesis, but found the strips that stick to the skin, and to which the prosthesis itself attaches, uncomfortable.

Sarah returned to her consultant for check-ups every 3 months to begin with, and then every 6 and she will now see him once a year. She wishes that there was some test that could be done so that she could be told categorically that there is no more cancer in her body, but realizes that this is not possible. Since her operation, she examines herself regularly to check for any breast abnormality.

Sarah and her husband have not told their children that she has had breast cancer, only that she had to have a lump removed from her breast. They will do so when they feel their daughters are old enough to cope with this knowledge.

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