PROGESTOGEN: DISADVANTAGES

2009-05-08T12:49:28+0000">May 8, 2009 – 12:49 pm

The other disadvantage of progestogen is that it may negate some of the advantages of oestrogen in preventing disease of the arteries. Oestrogen appears to reduce fats and cholesterols that circulate in the blood, and progestogen may increase them. So, as long as you need to take progestogen, you might not be getting the lowered risk of heart attack and stroke that you would get from oestrogen on its own. Encouraging news is that the newer forms of progestogens have only minor effects on blood fats.

By contrast, small quantities of progestogen help to prevent osteoporosis. There is also a possibility that it might slightly decrease your chance of developing breast cancer, but as some research has suggested otherwise it is difficult to be sure.

In conclusion, if you still have a uterus, the form of HRT you take must contain a progestogen, but with any luck the new non-oral low-dose varieties will reduce the side-effects, new progestogens may overcome many of the present disadvantages, and the future of no-bleed HRT looks hopeful.

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HYSTERECTOMY: ENDOMETRIAL ABLATION AND RESECTION (PART 2)

2009-05-08T09:58:35+0000">May 8, 2009 – 9:58 am

Endometrial resection and ablation were introduced in the late 1970s in the US and are now routine procedures in many hospitals. Many tens of thousands of the procedures are performed worldwide each year. The speed with which the techniques have been taken up by medicine has surprised and shocked many people who say that fundamental questions about their safety, effectiveness and long-term consequences have not been resolved.

Information about the suitability of different groups of women for these procedures is scant. The available evidence suggests that women with a normal sized uterus or those who are on post-menopausal hormone therapy tend to do well, while those with a uterus that is enlarged by fibroids, markedly retroverted (tilted backwards) or who have severe adenomyosis or endometriosis may be unsuitable. Women at risk from a general anaesthetic — such as women who are very overweight, and those with chronic liver, kidney or heart disease — may prefer the option of an endometrial resection or ablation because it is possible to do either under local anaesthesia. Selection of women most likely to benefit from the procedure is extremely important and obviously influences the outcome for them. In this regard, the visualisation of the reproductive organs using ultrasound can be especially helpful in deciding the appropriateness of these procedures.

Endometrial ablation and resection are not risk-free but complication rates appear to be lower than for hysterectomy. Complications include infection (affecting one in every 100 women having the procedure), bleeding (less than one per 100), damage to the bowel or other pelvic structures including major blood vessels (one to two women in every 100 suffers a perforated organ or blood vessel), and fluid overload (one to two per 100).u Studies to date suggest that about two women in every 10 000 having the procedure die as a result of it.

Studies comparing endometrial ablation or resection with abdominal hysterectomy suggest that the former offers benefits in terms of post-operative pain, hospital stay, convalescence, risks and financial cost. Satisfaction among women after having a hysterectomy seems, however, to be significantly higher than among those whose endometrium has been removed (94% compared with 85% in the Maine studies referred to earlier in this chapter). This may reflect the ‘failure rate’ of endometrial resection or ablation — women who are hoping that their bleeding problems will resolve are likely to feel dissatisfied with the procedure even if they have been warned in advance that it is not a universal success. It might also suggest that the procedure is being oversold or that patient selection is not as good as it could be.

Endometrial resection or ablation is probably the treatment of choice for women who want short-term relief from bleeding problems, and who are keen to minimise the risk of complications, the financial cost of treatment and the time off work. Hysterectomy is probably a better option for women wanting certain and complete relief from bleeding problems. It may also be the preferred option of women with an increased risk of endometrial cancer, which includes women with a family history of the disease, those with polycystic ovaries, those who use oestrogen on its own without added progestogen, and women who are obese or who have diabetes.

Cost is probably one of the major reasons for the rapid uptake of these procedures. In a recent Australian survey the cost of endometrial resection was estimated at $ 1500, which is less than half the cost of an abdominal hysterectomy.12 The cost of endometrial ablation was about $2200 to $2500 depending on the type of equipment used. The relative cost advantage of these techniques over hysterectomy may, however, be eroded if re-treatment and later hysterectomies occur more often than has been reported to date.

A recent article in the popular science magazine New Scientist emphasised that doctors who perform endometrial resection or ablation are on a learning curve. To produce good results they need to be experienced in the technique of hysteroscopy and to have served an apprenticeship in hysteroscopic surgery under a knowledgable supervisor. ‘Reports from surgeons suggest that serious complications are most likely to occur while the gynaecologist is still on the ‘learning curve’, which can last for anything between 10 and 80 operations,’ the article said. ‘Studies have shown that 50% of perforations of the womb take place in the first five operations a surgeon carries out.’ It is important to find out where on this learning curve your surgeon is before agreeing to any procedure.

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DID WE SLEEP?

2009-05-08T09:32:54+0000">May 8, 2009 – 9:32 am

But everyone seems to know that they have slept, even though there is a blank in the memory during NREM sleep. How do we know that we have slept? We depend on two cues:

* Dreams, which are an inside cue

* The clock, which is an outside cue

When we wake from our dreams, we can recall the contents of the dream and we know that the dream is part of our normal sleep. Hence we are convinced that we have in fact slept There are people who need to recall that they have dreamt before they are convinced that they have slept Without dreams as a marker in the blank space in the NREM sleep, we are unable to give an account of what follows after the thought of ‘the wonderful lunch’.

The other cue is the clock. We look at the clock before we go to bed; it is 10.30 p.m. at night. We may wake up and go to the toilet, it is 2 a.m. When we wake up again and look at the clock it is 7 a.m. in the morning. Hence we are convinced that we must have slept about eight hours. Have you ever had the experience of the clock, for some mechanical reason, stopping at 6 a.m. in the morning, letting you believe that there was still an hour to sleep before your normal wake-up time. You go back to sleep, and later discover that the clock never went to 7 a.m.; the clock was not working! Too late, it was already 9 a.m. At night we are depending on the clock as an external cue, for during the NREM sleep our mind is blank.

A number of people constantly complain of chronic insomnia and always seek treatment. When they are placed in the sleep laboratory, however, the EEG and other recordings all confirm that they have been sleeping soundly. Yet, when they wake up, they insist that they have not slept at all. These people cannot remember any dreams, and hence they do not have the inside cue to convince themselves that they have in fact been sleeping.

Most of us believe that we do in fact sleep. But this belief is not easily held in the absence of the dream experience or a visible clock. Those people who believe they do not sleep at night do so because they cannot experience sleep itself. All they can experience is the distress they feel while awake. The blank period of NREM sleep is very important in understanding insomnia and in overcoming it. People who suffer from insomnia nearly always underestimate the amount of sleep they really have. This is because the individual’s own view of how much sleep he has is always inaccurate, as no one can recall how much NREM sleep he actually has.

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THE SELF-MANAGEMENT OF ANXIETY: THINGS TO REMEMBER-RELAXING MENTAL EXERCISES ARE NOT DIFFICULT

2009-04-29T10:23:12+0000">April 29, 2009 – 10:23 am

I am going to spend some time in describing the relaxing mental exercises. Do not be put off by this. The exercises are not difficult. In fact they are very simple, and it is their simplicity that necessitates this rather detailed description because it is easy to go wrong from sheer inattention.

Those who are unimaginative might find an initial difficulty in accepting the idea of doing mental exercises. It may seem rather strange to them. But we all accept the connection between physical exercises and physical health, so let us try to accept the idea of mental exercises for mental health. Actually the idea of mental exercises is not as foreign to us as we may at first think. At school each of us have done arithmetic and algebra. Doings sums is itself a mental exercise the purpose of which is to help develop the intellectual powers of our mind. Some people practise meditative and religious mental exercises to develop the spiritual aspects of the mind. Our relaxing mental exercises aim to develop yet another aspect of the mind—the emotional.

Those who are rather lacking in ordinary determination have sometimes complained of difficulty in actually doing the exercises. They are usually people who want a thing done for them rather than to do it themselves.

A very successful businessman well past middle age came to see me because he had developed a distressing compulsion about checking over people’s names. He was normally a robust, good-natured, jovial man, but had recently become tense, anxious, and depressed.

He had worked hard, and had been successful. Over the last few years he had grown to overindulge himself. He ate too much and drank too much. He liked the theatre and television and the company of his friends. In short he was living for pleasure, and had lost the

self-discipline which had characterized Ms earlier life. This man would do the exercises very well in my consulting room when I was there to supervise him. But there was always some trivial reason why he had not practised at home. He settled down very well finally, but only because I continually kept him up to the mark. As you read this, please remember that this type of supervision should not be necessary.

It is also true that the medical profession has rather foisted the “easy way out” on to people by its readiness to prescribe tranquillizing drugs, rather than help the patient to cope with his inner tensions and learn to be relaxed. The relaxing mental exercises are not difficult. They merely require the minimum amount of patience which any new skill demands. If when you first try them, you are tense, don’t give up; instead bear in mind that obviously tense individuals usually get the greatest benefit in the shortest time.

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THE PROGRAM OF BIOLOGICAL TREATMENTS OF ARTHRITIS: DIET

2009-04-29T09:03:08+0000">April 29, 2009 – 9:03 am

Fresh Juices

Although the classic form of fasting is the so-called pure water fast (abstinence from all foods and drinks with the exception of pure water), all the practitioners I interviewed in European clinics, including the champion of therapeutic fasting in modern times, Dr. Otto Buchinger, Jr., use fresh juices, vegetable broths, and herb teas during fasting.

Biologically oriented doctors feel that freshly pressed vegetable and fruit juices, given to the patient during fast, will speed his recovery. This is attributed to the fact that raw vegetable and fruit juices, as well as freshly made vegetable broth, are rich in vitamins, minerals, enzymes, and trace elements, which help to normalize the bodily processes and speed up recovery. At the same time, they are very easily assimilated directly into the bloodstream without putting a strain on the digestive organs.

Juices most frequently used in Sweden are: carrot juice, apple juice, black currant juice, and tomato juice.

Vegetable Broth

Vegetable broth is made by boiling all kinds of available vegetables, but predominantly potatoes, carrots, and celery, chopped to about half-inch pieces, for 30 minutes in a pot of water. (Use only stainless steel, glass, or earthenware utensils.)

Then it is strained and the vegetables are thrown away. The remaining liquid is a highly alkaline, mineral-packed broth, which is considered to be of extraordinary importance in biological arthritis therapy. It combats acidosis or a tendency toward a high acidity in the bloodstream and tissues. It helps to normalize the mineral balance in the tissues, which, according to Dr. Lars-Erik Essen, is of utmost importance for the effectiveness of the fast.

Both vegetable broth and fresh vegetable and fruit juices are concentrated nutrition. Perhaps, it would be more appropriate to call such therapy a liquid diet, rather than a fast.

Herb Teas

AH biological clinics use various herb teas, both during fasting and while on a diet.

The medicinal value of herbs is well known. Herb medicines are the oldest remedy known to man.

The herb teas used in Swedish clinics are usually made from native herbs: rose hips (very rich in vitamin C), peppermint, milfoil, etc. Swedish health food stores are well stocked with dozens of herb teas, many of them combinations of different herbs mixed for specific diseases.

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TESTS IN EPILEPSY: OTHER TESTS

2009-04-28T12:35:57+0000">April 28, 2009 – 12:35 pm

Blood tests are seldom informative in patients with epilepsy but may be useful in the early days of life, when chemical abnormalities may precipitate seizures. A lumbar puncture may be carried out if an infection such as meningitis or encephalitis is suspected as causing epileptic seizures. Occasionally, removal of tissues (biopsy) for microscopic analysis may be helpful in rare causes of epilepsy; the tissues which are biopsied include skin or rectum (as these contain accessible nerve cells) or muscle. The diseases which are being tested for usually have manifestations other than seizures alone.

It is rarely necessary to repeat the EEG or a brain scan in most people with epilepsy. However, there are some exceptions to this general rule. Further EEGs may be helpful if treatment is not as effective as expected, or if, after a period of good seizure control, a patient’s seizures become more frequent. Some doctors recommend that an EEG should be repeated before a patient comes off treatment with anticonvulsants, but there is not much evidence that this helps reach a decision. There is rarely any justification for repeating a brain scan. However, if something suspicious is seen on a CT scan, then an MRI scan could be useful in confirming an abnormality, particularly if surgery for the epilepsy is being considered. Clearly if the epilepsy gets markedly worse, or the patient develops new symptoms such as weakness of a limb or develops new neurological signs, then it is essential to investigate the patient again.

In summary, laboratory investigation of seizures has a limited value. An ordinary EEG may rarely improve the certainty of diagnosis, though it more frequently helps ascertain the type of seizure and so the correct choice of anti-epileptic drug. The much more expensive tape-recorded EEGs and video monitoring of seizures do undoubtedly help discriminate between different types of seizures, and between real and simulated attacks.

CT or MR scanning may give a direct visual demonstration of the structural abnormality causing seizures, though this does not often influence management. Simple blood tests and skull X-rays, though cheap to perform, seldom show a relevant abnormality. With this knowledge, the neurologist will often embark upon few if any investigations. His perspective may be that he is faced with a problem that is common in his practice, and that there are well recognized and effective policies for coping with the matter. A good and kind neurologist will recognize that this professional perspective, based on his knowledge and experience, is not that of his patient, who is frightened and bewildered by the onset of events which he does not understand, but which he feels may have important effects on his life and career.

The technical aspects of the neurological consultation—the history, the differential diagnosis, the examination, any necessary investigation, and prescription of anti-epileptic drug—take

comparatively little time. Most of the consultation should be spent, in our view, in exploring the person’s attitudes and knowledge about epilepsy, and the effect that epilepsy may have on his life, so that practical advice and support can be given. Often this may take more than one consultation. How much of this support should be provided by the neurologist and how much by the family doctor depends upon the personalities of the doctors and the patient, as well as upon the available time. What is disastrous for the patient is if each doctor assumes that the other is coping with these aspects.

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ARTHRITIS BEATEN TODAY: CMO AND OTHER AILMENTS-PROSTATE INFLAMMATION

2009-04-28T11:16:43+0000">April 28, 2009 – 11:16 am

When there’s no infection or cancer involved, it’s called Benign Prostatic Hyperplasia (BPH). The swollen prostate gland puts a lot of pressure on the urinary bladder and reduces its ability to hold normal amounts of urine. The first sign of BPH is the need to urinate very frequently. Often, urinary incontinence follows. BPH may also cause discomfort during sexual activity, reducing the sex drive. The pressure on the seminal vesicles may also block the flow of sperm to the seminal fluid causing the ejaculate to be infertile. Often there are feelings of pressure in the lower abdomen, sometimes accompanied by pain.

Surgery is one option. Medicinal and nutritional therapies can help somewhat, but nothing seems to achieve the simple and dramatic results we often see with CMO. We’ve seen patients’ symptoms disappear in less than a week. And it all happens without the dangers and negative side effects of prescription medications.

Some patients take longer, of course, but once the inflammation is relieved, interest in sexual activity normally returns. This is in such sharp contrast to the impotence which so frequently occurs after surgery. The prostate plays an important role in sexual function. Sexuality is frequently altered or completely destroyed by prostate removal. By contrast, CMO leaves the prostate intact, and there have been many reports that it actually stimulates the sexual drive. A few patients swear that it’s an aphrodisiac and that it has improved their performance as well as their desire. A few doctors have also confirmed such reports.

One man reported relief of his swollen prostate symptoms within a week and that his sexual activity increased from near zero to twice daily. His medical exam confirmed the reduction of prostate inflammation and his cheerful attitude confirmed the other. Those results are quite common with CMO.

Another man who found relief from his prostate inflammation also reported finding sex to be a totally new and pleasurably exciting experience. He wants to explore the possibility of using CMO in small doses on a continuing basis to see if his heightened pleasures persist. So far, so good — but we must await the long term results before reaching any conclusions.

Sometimes prostate inflammation is caused by bacterial or viral infections. That’s called prostatitis and should not be treated with CMO alone. Antibiotics or antivirals should be used as well to defeat the infecting organisms. CMO can help with the inflammation, but the medicines are necessary for infections.

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CHILDREN’S NEPHRITIS: SYMPTOMS, HOME CARE, PRECAUTION AND TREATMENT

2009-04-28T09:48:06+0000">April 28, 2009 – 9:48 am

Signs and symptoms

In most cases, the first sign of nephritis is the child’s producing urine that is a smoky color or brownish-red and tinged with blood. The child may have puffy eyes and run a fever of 38.3°C to 38.9°C for several days. In severe cases, the illness produces high fever, headache, vomiting, high blood pressure, and convulsions; urination ceases almost completely, and the urine the child does produce contains a lot of blood. An analysis of urine will confirm the diagnosis. Positive cultures of nose and throat secretions for the strep bacteria support the diagnosis.

Home care

As mentioned earlier, most cases of nephritis are mild and don’t attract attention or require treatment. If the symptoms are severe enough to be recognized, however, do not attempt home treatment; the child should see a doctor.

Precaution

You should be aware that nephritis most often follows strep impetigo and can follow a strep throat whether or not the strep throat has been treated with antibiotics.

Medical treatment

In a case of suspected nephritis the doctor will examine the child thoroughly and take the child’s blood pressure. The doctor may take a throat culture to identify a strep infection, and order urine and blood tests. If the child does have nephritis the doctor will usually prescribe penicillin or erythromycin for ten days. The doctor will monitor the child’s blood and urine until they are normal again. The child should stay in bed only during the acute phase of the disease. A severe case may require the child to be hospitalized for observation and treatment of high blood pressure or convulsions. In some cases the doctor will prescribe continued medication, sometimes for several months both while the child is recovering and afterward.

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DIABETES IN YOUNG PEOPLE: CONTROLLING DIABETES

2009-04-23T08:04:48+0000">April 23, 2009 – 8:04 am

If the insulin or the diet was not properly adjusted, the child would probably feel sick or not grow properly. We do not want this to happen. We want to know if the diabetes is getting out of control before he feels the bad effects of this. We can do this by measuring the level of glucose in the blood.

The body needs a certain amount of glucose circulating in the blood at all times: not too much and not too little.

If there is too much (as when diabetes is not well controlled) it may lead to ill-health, but if there is too little the body – particularly the brain – may suffer from inadequate glucose energy. So by measuring the level of glucose in the blood we can check whether treatment for diabetes is just right or whether it needs adjustment.

The level of glucose in the blood of young people with diabetes on insulin treatment can vary a lot during the day, so we may need to check this at various times of day.

If levels of glucose in the blood rise too high, we may need to increase the insulin dose or perhaps check that the diet was correct. If the level of glucose in the blood is too low we may need to reduce the dose of insulin or have more food. Thus these tests help to adjust insulin and diet to keep good control of diabetes.

When a child develops an infection or other illness (such as a cold or flu) the level of glucose in the blood may rise, and we may need to increase the insulin dose for a few days while he is sick. This helps the child get over the illness quickly.

If there is too much glucose in the blood it spills out into the urine, we can test for this also. Some children prefer to test their urine rather than their blood. Urine tests are not as reliable or informative as blood tests, but they can provide a useful guide.

If we find glucose in the urine it suggests there was too much in the blood. As glucose levels in blood do rise at times, particularly after meals, it may be hard to avoid small amounts of sugar appearing in the urine from time to time.

If the urine contains no glucose (no glucose has spilled out into the urine, so the blood glucose levels were not too high) this may be a sign of really good control, but we need to be on the lookout for hypos.

The child with diabetes is asked to do things in controlling his diabetes that may seem boring or irritating. He should remember however that the treatment of diet and insulin and the tests and regular check-ups are designed, not only to keep him feeling well from day to day, but to help him grow normally, and to help protect his health when he grows up.

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FERTILITY: HOMEOPATHY AND ACUPUNCTURE AS COMPLEMENTARY MEDICAL APPROACHES

2009-04-23T07:18:43+0000">April 23, 2009 – 7:18 am

Homeopathy

The word homeopathy comes from the Greek words homos (meaning ‘same’) and pathos (meaning ‘suffering’). In homeopathy different people suffering from the same problem can be given different remedies because each person is treated according to their individual constitution. Pulsatilla is often given for women with no periods or irregular periods.148 General remedies recommended for male infertility could include lycopodium, argentum nitricum and selenium metallicum. Because infertility is multifactorial, it is better to consult a qualified homeopath so that the treatment is individualized. Specific help could be given for endometriosis, fibroids, cysts and other complaints.

Acupuncture

Acupuncture can also be used alongside the other recommendations to help increase fertility. It is an ancient system of Chinese medicine that dates back some 2,000 years and is based on the concept of Qi (pronounced ‘chee’) which is the body’s energy. The acupuncturist aims to balance this flow of Qi along pathways called meridians. Acupuncture has proved particularly successful in boosting the fertility of older women who want to get pregnant. Chinese herbs may also be given with acupuncture, and an interesting study on infertile women at Qian Fo Shan Hospital in Jinan, China, showed a pregnancy rate within two years of 70 per cent for those given acupuncture, 52.7 per cent with herbs and 46.7 per cent with conventional drugs. Acupuncture can be especially useful for correcting hormonal imbalances and problems such as fibroids and endometriosis.

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