If you had a premature menopause, especially as the result of the removal of both ovaries, and either can’t or won’t take HRT, then you should take steps to reduce your chances of getting osteoporosis. The two main medical treatments currently available for osteoporosis that don’t involve oestrogen are calcitonin and etidronate.

Etidronate. Marketed as Didronel PMO, this is a breakthrough in the non-hormonal treatment of osteoporosis of the spine. It, too, appears to work by reducing the activity of die osteoclasts, and trials show it can lead to a small increase in bone mass and to a reduced risk of fracture. It is taken on a cyclical basis: 14 days of etidronate, followed by 76 days of calcium supplements. Etidronate is not the right treatment for everyone, and because it has not been available under general prescription for very long, many GPs are rather uncertain about which patients it is most suitable for, but if you send an s.a.e. to the National Osteoporosis Society, they will be able to give you (or your doctor) more information.

*70\42\4*

Fluid is sometimes used in the pelvis before a hysteroscopy to separate the abdominal organs. Could you explain why fluid is used instead of gas and the reasons why one or the other may be used? Do they have any adverse effects?

The procedure of hysteroscopy can be used for diagnosis or treatment, but in either case the uterus must be filled with something so that there is space for the hysteroscope to move about. The materials most commonly used to achieve this are carbon dioxide gas, or fluids such as glycine, dextrose, sorbitol/mannitol, saline and dextran.

Carbon dioxide has been found to be particularly useful for diagnostic hysteroscopy, but it has limited usefulness during surgery because blood causes the formation of bubbles that obscure the view. Consequently carbon dioxide gas tends to be reserved for diagnosing the cause of a problem, while fluid is the norm when hysteroscopic surgery is performed.

Occasionally the fluid or the gas is absorbed into the bloodstream, causing significant problems including an electrical imbalance of the body fluids, fluid overload, or swelling in the lungs or brain. There are several effective methods to prevent complications associated with the absorption of gas or fluid, the most important of which is for the medical team to keep a meticulous record of the amount of material instilled in the uterus and recovered from it.

Who should I see about heavy and prolonged bleeding around the time of menopause?

It would be a good idea to see a gynaecologist as heavy and prolonged bleeding near the time of menopause may be due to cancer. This possibility must be excluded before you embark on treatments such as drug therapy, endometrial resection or hysterectomy.

*83\198\4*

The power of suggestion. Whilst in the hypnotic state, the person’s awareness is narrowed but is heightened and sharpened. So the suggestions of the hypnotist are totally received with minimal rejection. There are some very good hypnotic subjects who can go into a very deep hypnotic state. They can see imagined objects suggested to them or they can abolish the perception of pain if the appropriate suggestion is given. Hence hypnosis has been used in the management of chronic pain. The suggestion can also be made to change certain behaviours, and this has been used successfully to treat people who wish to give up smoking. The suggestion that the person can relax easily at night re-establishes confidence in sleeping and is very useful in some cases of insomnia.

Memory and age regression. Another most interesting feature of hypnosis is its influence on memory. People under hypnosis can remember things that they cannot remember whilst in the fully awake state. They can be taken back in time, to relive a period when they were much younger, this is called age regression.

Post-hypnotic suggestion. This is another unique phenomenon in hypnosis. Whilst under hypnosis, it is possible to suggest to the person that after he wakes up from the present trance he will perform a task such as blowing his nose when the hypnotist gives a pre-arranged signal. The person is then awakened from hypnosis, and may have apparently forgotten what went on whilst under hypnosis. After a while, conversations unrelated to hypnosis take place; then the hypnotist, without warning, claps his hands, which is the pre-arranged signal in this case. The person, seeing the signal, starts to have an irresistable urge to blow his nose. He may make some excuse that his nose is itchy and then blow his nose. Most people feel uncomfortable until the posthypnotic suggestion is carried out.

*85\174\4*

In ordinary circumstances pain hurts. Because it hurts we react to it. We therefore rarely experience pain in pure form.

I have warned you that some of these ideas are at first a little hard to accept. This idea is basic to our management of pain, so please go along with me.

You can actually prove this easily enough. Take a pin and stick it lightly into your forearm. It hurts, you screw up your face and perhaps say “Ow” under your breath. You would tell me that the painful stimulus hurts, and you react to it. This is not quite true. I do not think that there is a time sequence to these two events—the hurting and the reaction to it. I think they occur together, or the reacting may in fact precede the hurting. This is also easy to prove. Now decide to yourself that you will stick the pin in yourself again, but this time you will not in any way react to it. Make sure your face muscles are calm and easy. Now stick in the pin. Yes, you feel it. But this time there is no hurt. If we do not react to it, there is little or no hurt in the painful stimulus. At the same time we feel it. The sensation that we feel in these circumstances is some approach to pain in pure form.

It is important that we fully understand this, and know it to be true; so repeat the little experiment on yourself, and also do it to a friend.

We must conclude that pain is not an unbearable sensation, provided that we do not react to it. This is true of much more severe pain than a pinprick.

*107\57\2*

Q. Okay, let us start with the x-ray examination. The patient is referred to the radiologist for this. What takes place?

A. When making the appointment, the patient is given instructions, and it is essential these be carried out exactly. Usually, not eating food or drinking fluids for a certain number of hours before the examination is recommended. Unless this is strictly adhered to, it could ruin the pictures, and so negate the value of the test. Sticking to the recommendations is essential.

Q. How does the barium come into the picture?

A. When you arrive for the test you will be given a glass of fluid which has been flavoured to mask the otherwise rather unpleasant taste of the barium. It doesn’t taste too bad, although many still complain. Really it is a small price to pay for a correct diagnosis. The barium enters the stomach, duodenum and bowel, and coats the lining with particles which accurately show their outline during the x-ray examination. The doctor may also give you a tablet to take which gives a feeling of fullness, but this is also important to make the pictures much clearer. It should not be burped up.

Q. Is the examination painful?

A. Fortunately, it does not hurt, for you cannot feel the x-rays going through the body. You will be placed in numerous positions, usually lying on an examination table which isn’t too comfy. You may be tilted from a standing to lying position, and turned this way and that, on one side then the other, and asked to hold your breath whilst he pushes his buttons. The tummy might be pressed.

You may be given an injection to ease down stomach movements. This may make you see double for a short time, and is worth knowing about beforehand, for it is better to have somebody present to drive you home later in case there are temporary difficulties.

Q. Does it take very long?

A. The whole examination takes about 10 to 15 minutes. You are awake the whole time, and will probably be given verbal instructions to follow. Try and co-operate as much as possible for this helps the radiologist arrive at a correct diagnosis. In some offices you may be able to see what is going on, for television screens are now widely used, and you can actually see your own inside in glorious black-and-white (sorry, no colour yet) on the screen. The doctor usually takes a series of pictures which will demonstrate the ulcer in various positions. Also, if there is any other pathology present, such as a hiatus hernia, or growth — hopefully not, but one may be present in the stomach, often with few if any symptoms.

Q. How does the patient feel afterwards?

A. After the examination there are very few if any unpleasant effects. Occasionally the injection (if given) may cause blurring of the vision for a while, but this soon passes off. Constipation is common for a day or two due to the barium, and a laxative may be recommended. A mild one is best, or bran with breakfast for several days, or prunes, or raisins and figs can often do a better job than artificial medications. Today, there is a swing away from laxatives.

Q. Are these examinations safe for pregnant women?

A. Today, great care is taken to avoid x-rays as far as possible during pregnancy, for it is believed the rays may be harmful to the developing baby. So, this diagnostic test may be delayed until after the baby is born, unless it is urgent. In any case, with women in the reproductive age groups, the ‘Ten Day Rule’ is now widely applied.

This says that x-rays are carried out only in the ten day interval immediately following the start of a normal menstrual period.

During this time the woman is not likely to be pregnant, for ovulation has not occurred. After this interval of course, ovulation and possible pregnancy is a chance, and is a risk better avoided. This of course applies to women who are not taking active contraceptive measures. In any case, efforts to avoid exposure of the reproductive organs may be made.

Q. Are x-rays always accurate, and do they always diagnose ulcers or are they sometimes missed? I have heard all kinds of stories.

A. One must remember that x-rays are only shadows, and despite the skill of the radiologist and his experience, ulcers may be missed. It is claimed that these examinations will correctly pick up 70-80% of peptic ulcers. Some claim the figure is higher, some lower. If it is a definite ‘positive’, then the ulcer is certainly present. If it is ‘negative’, and symptoms are present, then an error is possible. The doctors always do their best, but some cases are very difficult, especially if the ulcer is small and very shallow.

Q. What happens after this examination?

A. The results are delivered back to your doctor, and in due course you contact him again, and he goes over the results in detail. If you have an ulcer, treatment will follow.

Q. What about the other form of investigation you mentioned?

A. Endoscopy today is very widely carried out, and some doctors prefer this to start with, eliminating the x-rays. On the other hand, some doctors prefer it as an adjunct and have both performed. In my opinion, as x-rays are known to have possible harmful effects in some people, and are inadvisable in pregnant women, the endoscope is often quicker, more accurate and a better form of investigation.

*10\61\2*

As explained in the previous chapter, sciatica – whether or not it is also marked at times by pain or aches in the lower back – can stem from a wide variety of underlying problems, some of them potentially serious, others less so. However, no matter what your health problem may be, the first step towards a cure is, of course, to have it properly diagnosed.

Although you can probably judge fairly accurately whether sciatica is causing your symptoms, the only way to be sure that this is what is troubling you is to consult your doctor. Indeed, you should always seek medical advice if you’re troubled by any kind of health difficulties that are either severe or occur frequently. Although almost everyone would agree with the preceding recommendation, it’s nevertheless a fact that many people do have a great reluctance to seek help from the one quarter most qualified to provide it, their doctor, and will keep on finding reason after reason to postpone making an appointment.

Research into why so many people troubled by chronic symptoms fail to seek the help that’s available found that this reluctance usually derived from one or more of the following reasons:

Many patients postponed or altogether avoided consulting their doctor because they feared the diagnosis would bring bad news.

Many others said they avoided seeking medical help because this would be to acknowledge that their problems were of more than just a temporary nature and unlikely to go away of their own accord.

Sufferers were also put off because they had heard stories of how people with similar-sounding symptoms eventually had to undergo complicated operations.

Should you, too, be someone who is hesitant about seeking medical help, let us look at the objections raised above one by one:

Postponing seeing your doctor because you fear that the news will be bad.

Although a perfectly understandable reaction, this doesn’t, however, serve your own interests best. First of all, the chances are that your doctor will find that your symptoms are evidence of a comparatively minor problem, one that can be cured or treated quite easily. Secondly, in the event that an operation is indicated, then it’s usually best to have this done as soon as possible before your condition deteriorates further.

An unwillingness to acknowledge that your symptoms are going to remain with you unless they are treated.

While most of us, when afflicted by symptoms that although troublesome are not that severe, may play a waiting game in the hope that the problem will go away of its own accord, you mustn’t overdo this. If your symptoms are persistent or recurrent or are severe enough to cause you to be concerned about them, then you owe it to yourself to seek help, even if just for the sake of your own peace of mind.

You ‘re put off from seeing your doctor because of what you \e heard from other people with similar problems.

Two thoughts to keep in mind: first, it’s probable that the stories you heard were embellished in the telling; secondly, though the symptoms sounded similar, that doesn’t mean that they were. Many different diseases can present themselves with remarkably similar symptoms, but the underlying causes – and therefore the treatments available and their rates of success – will vary tremendously.

As you can see from the above, there really are no good or logical reasons to keep on postponing consulting your doctor – and lots of good ones why you should do so just as soon as reasonably convenient! Remember that the sooner you get medical advice the sooner you will learn what exactly is the matter with you, and the sooner you will be getting treatment which will make you feel better.

*8\124\2*

Claimed by enthusiasts as an anti-aging vitamin and as a remedy for most skin disorders, vitamin E is not considered effective for these purposes by most doctors and dietitians. They agree, however, that it helps tissues defend themselves against harmful oxidant “free radicals” that may be one cause of cancer.

However, for that, one needs no more vitamin E than the Recommended Daily Allowance (RDA), which is 10 mg daily for a large man. More than this does harm, and Geriatrics (39#2:69) lists the signs and symptoms that usually result from excessive dosage.

The most serious side effects include: thrombophlebitis (inflammation and tenderness under the skin, with bumps and bruises over the veins), pulmonary embolism (blood clots lodging in the circulation of the lung, causing a dangerous illness, with pain in the chest, shortness of breath and blood spitting), high blood pressure, severe fatigue, and tender enlargement of the breasts. Some more easily seen effects include: chapped lips, sore mouth, blister-like rashes, and very slow healing of wounds. Others are: nausea, diarrhea, intestinal cramps, and night blindness (due to vitamin A deficiency since very large doses of vitamin E antagonize vitamin A).

Since vitamin E capsules containing several times the RDA are on sale, many people must be taking it in dangerously large amounts. The Journal of the American Medical Association (246:129) recently published an article deploring the fashionable habit of taking vitamin E in “megadoses” every day and reported that the author sees many patients with the side effects of overdosage with vitamin E.

Unfortunately, the cause of its bad effects can easily be overlooked since they rarely all appear together or begin until large doses have been taken for many months.

*216\143\2*

Symptoms: headache; fever; sore, red throat; vomiting; abdominal pain; swollen lymph glands in neck; sandpaper rash.

Home care: give aspirin or paracetamol to relieve pain and fever and take the child to the doctor.

Precautions

-    Keep infants away from groups of children, some of whom may be carriers of the strep bacteria.

-    If one child has a strep infection, your other children should receive a throat j culture whether they are sick or not.

-    Even if the child appears to be better, do not discontinue treatment until the child has taken all the medication prescribed by the doctor.

-    A strep infection imparts immunity only to the particular type of bacteria that caused it: there are over 60 types of streptococcus organisms.

Strep throat is a highly contagious infection of the throat, usually caused by the group A strain of beta-hemolytic streptococci bacteria. Although some strep germs do not cause rashes, most types can produce a toxin (poison) that causes the rash that typifies scarlet fever (also commonly called scarlatina). There are at least 60 different types of streptococcus organisms. After an attack of strep throat the individual is immune to further attack from that one type of streptococcus organism only.

A streptococcal infection can be serious. Among its complications are rheumatic fever, nephritis (inflammation of the kidneys), middle ear infection, sinusitis, pneumonia, and transient (temporary) arthritis.

The incubation period (the time it takes for symptoms to develop once the child has been exposed to the bacteria) of strep throat is two to five days, and the disease is passed from child to child by means of the throat or nasal secretions of an infected person. It may also be spread by a carrier who has no symptoms of the illness. (A carrier is a person who harbors the disease-causing organism and can pass it on to others, but does not get sick him-or herself.) At times, as many as half the children in any one area may be carriers of the disease.

*203/84/5*

A patch test is performed if a careful history (based on the site of the lesion) offers a clue to the offending agent. The gauze used in testing (which is soaked in the suspected material) is left on the skin for forty-eight to seventy-two hours.

The causes of contact dermatitis include the following materials:

Soaps and detergents: May irritate the hands, fingers, or wrists.

Plants: May touch the hands, forearms, ankles, etc. and create an itch usually followed by a secondary bacterial infection. (Examples include poison ivy, poison sumac, English ivy, and philodendron, as well as such plant derivatives as Japanese lacquer and cashew nutshell oil.)

Textiles: May cause contact allergy where the pressure of the clothing is greatest, such as under a hat band.

Jewelry: May cause contact dermatitis on earlobes, neck, and wrists.

Cosmetics: May cause contact dermatitis on eyelids, ears, fingers, etc. If the dermatitis is present in the scalp, the cause may be scalp lotions, hair tonics, hair dyes, or shampoos; if it is on the eyelids, the cause may be mascaras and eyebrow pencils; if it is in the armpits, the cause may be deodorants.

*31/99/5*

Caffeine

Caffeine is a stimulant and could therefore be classed as a ‘drug’. It has an adverse effect on fertility but it can also cause problems once a woman is pregnant.

In a study of 2967 pregnant women, carried out by the Department of Epidemiology and Public Health at Yale University School of Medicine, the researchers found that drinking three or more cups of tea or coffee a day was associated with an increased risk of miscarriage. Other research has shown that caffeine during pregnancy can increase the probability of chromosomal abnormality which could lead to a miscarriage.

Since 1980 the US Food and Drug Administration has advised pregnant women to minimize their caffeine intake, citing the dangers of possible miscarriages or having a mentally retarded baby. Some studies suggest that there is a doubly increased risk of foetal loss when as little as one to three cups of coffee are consumed a day. So the logical advice is to err on the side of caution and avoid caffeine altogether, especially if you have a history of recurrent miscarriages.

Even decaffeinated coffee has been linked to an increased risk of miscarriage, since there is still some caffeine left even after decaffeination. Moreover, decaffeinated coffee contains, two other stimulants, theobromine and theophylline, which are not removed when the coffee is decaffeinated. Also most decaffeinated coffee has been decaffeinated by a chemical which can remain in the product.

An important point to remember is that caffeine comes in many other forms besides tea and coffee. It is there in colas and other soft drinks, as well as chocolate and pain-relieving medication, such as headache remedies.

Selenium Deficiency

Selenium is a powerful antioxidant which may help prevent DNA damage. Researchers have found that those women who miscarry have low levels of selenium in their blood compared to women who don’t miscarry.

Radiation

Visual Display Units (VDUs) on computers emit non-ionizing radiation, as indeed do microwaves, televisions, electric blankets, mobile phones and other electrical appliances. A number of studies have looked at the effects on women who work in front of computers, but the results are not conclusive.

Concerns about VDUs originated in Canada. In 1980, it was reported that a large number of birth defects were present in one group of VDU operators. Another study in 1984 showed that, out of 55 pregnancies of VDU users, 14.5 per cent ended in miscarriage, as compared to 5.3 per cent in non-VDU users. A further 22 per cent of the pregnancies had resulted in a malformation, compared to 11 per cent in non-VDU user. And 6.7 per cent had suffered a stillbirth, as compared to only 1 per cent in the other group. The Royal College of Obstetricians and Gynecologists in the UK suggests that VDUs are not a hazard.

With the evidence as it stands at present, I personally feel it is sensible to limit time on VDUs during pregnancy. This is not only because of the possibility of unknown risk factors but also because working for long, uninterrupted periods in front of VDUs is stressful and can cause other symptoms such as headaches, nausea, fatigue, insomnia and menstrual disturbances. There is good evidence to show that stress in some women can stop them ovulating, and may also have adverse effects during pregnancy.

If a woman is going for an X-ray she is usually asked to do it in the first half of the cycle so that she cannot be pregnant without knowing it.

*105/73/5*