Directory of health resources for healthcare professionals.

Skin. Skin is the largest organ in our body. We tend to underestimate its function in the metabolism process and in particular its excretion capacity. When we sweat, glands in our skin expel toxic waste, which usually does not smell nice. We should clean the skin from such waste, because it clogs the skin, reducing its capacity to excrete more toxins. However, we should be careful which cleaning agents (solvents !) we use, because the skin also has the ability to absorb substances into our body. Techniques to accelerate skin excretion (sweating) are for example the sauna and moderate exercise

Bowel. By weight, most of the solid waste leaves our body here. So any improvement in the rate of detoxification should definitely start here. Colonic or even a simple enema can relieve your body from many kilograms of toxic waste, you should not be attached to at all.

Urinary system. Most of the liquid or water soluble waste leaves our body through the urinary system. How can we improve here ? Drinking a lot (2-5 litres) of pure water a day will make a great impact on the fluid exchange processes in our body, enabling improved flushing of unwanted waste. After all, our body is 75% water and our brain is 90% water. Pure water (in contrast to water polluted with chlorine, fluoride pesticides and other nasties) is necessary to the process of proper fluid exchange.

*23\96\8*

Widespread spraying with insecticides and draining of swamps did bring the mosquito population under control but resistance to the insecticides has developed and, in many countries, economic and political factors have led to abandonment of eradication campaigns.

We can consider that all Africa, much of Asia and parts of the Pacific and Latin America are affected.

In Australia, more than 600 cases a year are now reported and most of these have been acquired in the Pacific area.

On a global scene, you can understand the enormity of this problem when there are over 300 million people throughout the world suffering from malaria and it kills over a million children each year in Africa alone.

Where malaria is endemic (occurring widely throughout the community) it leads to great loss of life and chronic infection saps the strength of the population.

Australians who now travel widely in Papua New Guinea and South-East Asia may acquire the infection abroad and only show symptoms on their return.

*491/71/1*

This produces what is known as a “hammer toe.”

A corn is also prone to develop on the top of the toe from pressure of the shoe.

In the early stages of hallux valgus, where the bunion is present but not painful, relief may be obtained by wearing comfortable, wide-toed shoes, and sometimes by inserting a rubber wedge between the first and second toe to help preserve the normal alignment.

Operations should not be performed for purely cosmetic reasons as most people are not happy with the result.

But when the pain is severe the results of operation are excellent, and most accept the slight deformity which results and it still looks much better than the ugly deformity of the hallux valgus, bunion, hammer toe complex.

In operation the bunion or bursa is removed and any overgrowth of the bone or joint is shaved off.

The base of the first bone of the big toe is removed so that the toe is shortened and a false joint made.

This normally results in loss of control of movement of the toe, but no loss of stability.

If there is a hammer toe deformity as well, this is usually corrected by “filleting” or removing one of the small bones of the toe, or by shortening one bone and shaving its end to make it a spike and driving it into the head of the other phalanx, thus rendering the whole toe shorter and straighter, and the joint is removed.

These procedures usually involve less than a week in hospital but it may take two or three months for the person to walk comfortably, although return to work is usually possible in three weeks.

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Herbs are not simple spice* and should be treated with exceptional wisdom and respect. Medicinal herbal cures and treatments are as old as the first amateur botanist who most likely discovered the effects of plants quite by accident. A respectable percentage of modem drugs are made from plants, or were made from plants, before they were artificially reproduced. Penicillin and belladonna are two such drugs; Valium, the tranquilizer, may have had its roots in valerian, an herb known for its identical effect. How safe, then, arc herbs for the woman with endometriosis?

Abigail Rist, a registered nurse and registered acupuncturist with a specialty of herbalism, who has worked with midwives and treated many women with menstrual disorders, believes that sufferers of endometriosis may gain some benefits from a number of herbal remedies. She follows the Chinese school of thought, viewing disease as imbalances of female (yin) and male (yang) energies, heat and cold, expansion and contraction. The herbal teas or tinctures she recommends arc based on these evaluations.

Since this system of medicine does not specify the disease precisely, “endometriosis is diagnosed and treated by its more irritating symptoms,” Ms. Rist told me. “In this sense, endometriosis is a tightening and over cooling of what is called ‘the lower burner,’ or urogenital area. For this area, we prepare an herbal remedy to replenish heat (or yang) and reestablish a balance, in another example, it’s as if you have a fever or sore throat, accompanied by thirst. The remedy prescribed will bring down body heat, soothe the rawness of the throat, and help quench thirst. Dandelion tea, for example, induces these qualities. The same will be done for endometriosis.”

Using this reasoning, the overcooling effects of endometriosis would need to be treated or counteracted with warmth. The herbs used would tonify the blood, stimulate and warm the organs. “In traditional Chinese medicine,” Ms. Rise continued, “doctors attribute the function and regulation of some aspects of the blood to the liver and spleen. If a woman has dark clots during menstruation, it is attributed to an imbalance of the liver. If a woman has lighter red blood but profuse bleeding, this would be related to an imbalance of the spleen. The herbs prescribed would be “tissue specific,’ that is. herbs with some affinity to each organ which can, if possible, influence and regulate its function.”

There are teas and tinctures that Ms. Rist recommends. The white peony has specific liver action, so it will actually decrease abdominal tightness and pain. The peony, which may be either dry-roasted or cured, depending on what the herbalist decides for each case, is often one of four other herbs blended in a concoction and prepared to be taken as tea. “Its nature is to be cooling,” says Ms. Rist, “so when it enters the spleen and liver channels, it can tonify the blood. The herbs can also help stop pain by relaxing the tendons and tissues.”

Another popularly used herb is dong quai, considered a “female” root plant, the way that ginseng it assigned male properties. Dong quai is found in many “female trouble” herb blends that are commercially made and distributed to hearth food stores. It is a cured root that, says Ms. Rist, “is thought to help establish an endocrine balance, increasing tissue sensitivity to estrogen and helps with ending menstrual cramps and pelvic congestion.”

Another tea suggested by this herbalist is raspberry tea, handed down as a remedy from grandmother’s rime to its use by present-day midwives. It is reputed to help relax muscles and dilate the cervix. Other teas that are toning or can help reduce inflammation or relieve pain arc rosemary tea, licorice tea, chamomile, and witch hazel tea.

*61\43\4*

There are a number of relatively minor disorders of the nails and the surrounding skin. These are fairly common in the community, and for this reason will be mentioned. Most of the more major disorders are fortunately less common, so only some of these will be discussed.

Fungal infections of the nail are also a reasonably common problem. Several fungi may be involved, including the common tinea fungus responsible for ‘athletes foot’. Initially the infected nail is merely discoloured at the end, but as the infection spreads, it may become softened, fragile, and later thickened.

Eventually the nails will separate and lift off, or become grossly distorted. Most commonly, the toenails are the ones affected.

Unfortunately surface applications are rarely sufficient to remedy the situation, nor is removing the affected nail. The most effective treatment is regular clipping of the nail, plus the taking of specific anti-fungal tablets. Because of a toenail’s slow rate of growth, and the necessity to take the medication for the entire growth period of the nail, this treatment may be required for anything between 6-18 months.

An ingrown toenail forms when the edge of the nail penetrates the adjoining soft tissue. The first symptoms are redness and pain, followed by swelling and a discharge. Secondary infection then frequently occurs. The most common causes of this problem are ill-fitting shoes, nails that have been cut too short, excessive curvature of the nail, and flat feet. The first three of these problems may be avoided by wearing adequately wide and long shoes, as well as by cutting the nails straight across and not too short. Mild cases may be treated with wet dressings and packing sterile cotton wool under the affected edge of the nail. Antibiotics may also be necessary. Severe cases may require an operation.

A corn is a cone-shaped overgrowth of hard skin with a central core. Corns usually occur over bony prominences, such as toe joints, or between the toes. They are a result of chronic pressure or rubbing for long periods. Poorly fitting shoes are the most common cause, but arthritis, improperly positioned toes or bony spurs may also be involved. Prevention requires shoes to fit properly and, occasionally, mechanical devices to position the toes correctly. Otherwise the corn may be padded over or gradually pared down. The latter may be done with either a salicylic acid paste or the help of a podiatrist. If there is an underlying bony spur, then an orthopaedic surgeon may have to deal with it.

Psoriasis frequently affects the nails, resulting in deformities which may precede all other manifestations of the disease. Although the nails may occasionally be the only part of the body affected, in most cases of psoriasis, the symptoms are much more widespread. Almost all patients with psoriasis find their nails are affected at some time during the course of their disease. This, however, may be quite transient. The character istic changes are fine thimble-like pitting, lifting, discolouration, and gross thickening of the nails. Treatment of nail psoriasis is most unsatisfactory. Some cases clear spontaneously, whereas others respond to rather painful cortisone injections into the nail-fold.

Eczema or dermatitis affecting the hands will often affect the nail as well. The usual symptoms are transverse ridging, coarse pitting, discolouration, and eventually marked deformity of the nail. This will all correct itself once the eczema or dermatitis is controlled.

*88\44\4*

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.

*140\186\4*

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.

*14\198\4*

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.

*14\174\4*

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.

*39\57\2*

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.

*91\75\2*