HORMONAL REPLACEMENT THERAPY: GETTING THE DOSAGE RIGHT

There is such a wide range of dosages available that your doctor should be able to adjust your prescribed dose to your symptoms. If your symptoms are mild, you will start on a low dose; if they are severe you will start on a higher dose. (The further you are from the menopause, the more likely you are to get side-effects in the early days of taking oestrogen, so a low dose would probably be prescribed for you initially.) If the low dose is not getting rid of the symptoms, ask your doctor if he can give you a higher dose; if the higher dose is producing unpleasant side-effects, ask for a lower dose. Women who have had a hysterectomy or oophorectomy will usually be started on a higher dose, as their symptoms will probably be more severe than women passing through a natural menopause.

If you have severe symptoms of breast tenderness, nipple sensitivity, leg cramps, continuing weight gain and feelings of nausea, you might feel better on a lower dose of oestrogen. If you develop acne, bloatedness, disturbances of your digestive system, a drop in libido, breast discomfort, and feelings of pre-menstrual irritability, then you might feel better on a lower dose of progestogen. However, before you rush off to the doctor, be prepared to stick with your initial treatment for two or three months, unless the HRT is giving you really awful side-effects; in most cases they diminish considerably, and often go completely after a few months.

Women who start HRT before their periods stop completely may find it takes longer to get the dosage exactly right This is because if you are still having natural periods, then you are still producing some oestrogen, even though its falling levels may be causing hot flushes, night sweats and all the rest If you take extra oestrogen in the form of HRT, don’t be surprised if you suffer some of the effects of this extra dose. Also, as your own level of oestrogen falls steadily, your HRT dose may need gradually to be increased in order to compensate.

The other group of women who may initially suffer side-effects from higher doses of oestrogen (tender breasts, for example) are those who are many years past the menopause and haven’t produced much oestrogen of their own for a very long time. If this happens to you, your doctor may suggest that you start on a lower dose, and then progress to a higher dose when your body has adjusted to the oestrogen. Alternatively, it may help if you take the HRT on alternate days to start with. You may also find that evening primrose capsules bring relief for breast tenderness.

As well as adjusting the dosage to menopausal symptoms, your doctor will want to consider whether you are at risk of osteoporosis or arterial disease. If you are, he will probably suggest starring at a medium or high dose, as the low dose may not give enough protection for some women.

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LAPAROSCOPICALLY ASSISTED HYSTERECTOMY

Surgeons gain access to, and remove, one or more of the reproductive organs in a number of ways. This is the basis for another method of classifying hysterectomy.

In recent years, another technique has been developed that combines elements of both the abdominal and vaginal approaches. It entails using the laparoscope, described in chapter 3, to gain access to the abdomen through several small (about 1 cm) pelvic incisions. The laparoscopic view of the inside of the abdomen is transmitted to a video screen and the surgeon manipulates cutting, burning or laser instruments within the pelvis according to what is seen on the screen. Direct vision laparoscopy tends to be used only when perception of depth is unclear, otherwise all surgery is performed while watching the screen.

After detaching the uterus and any other organs to be removed with diathermy, and closing blood vessels and realigning tissues using staples or sutures, the surgeon makes an incision near the top of the vagina where it meets the cervix. The unwanted tissue is then extracted through the opening in the vagina. This technique is called laparoscopically assisted hysterectomy or laparova-ginal hysterectomy. It has now been carried out on hundreds of women who would otherwise have had an abdominal hysterectomy. Laparoscopically assisted hysterectomy requires special equipment and a team of doctors and nurses skilled in gynaecological laparoscopy. It is considered to be suitable when:

• fibroids are of intermediate size

• endometriosis is a major reason for the surgery

• a reduced recovery period is important

• there is an early stage endometrial cancer and the ovaries are to be removed.

Margaret had a laparoscopically assisted hysterectomy instead of an abdominal or vaginal hysterectomy largely because of business pressures. A senior staff member of a company involved in a takeover bid, she was appreciative of the shorter hospital stay (one to four days instead of seven to ten days) and the reduced period of convalescence (one to four weeks instead of up to two or more months). After her convalescence it took her another few months to regain total well-being, but nevertheless she was able to contribute meaningfully at a critical time in her company’s business operations.

There is some evidence that laparoscopically assisted hysterectomy has a lower complication rate than either vaginal or abdominal hysterectomy, although this claim has been disputed and the results of clinical trials are awaited with interest. The operation takes somewhat longer to carry out than the other types of hysterectomy (one to two hours on average, although the French have reduced their operating time to less than an hour, compared with thirty minutes to an hour for an abdominal hysterectomy) and requires more costly instruments.

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BIOLOGICAL CLOCK: ORCADIAN RHYTHM

Have you noticed that, even without looking at a watch, we usually wake up at about the same time every morning and feel sleepy and go to bed nearly the same time each night? We do not need to know the time to do all these things. Somehow our body knows the time, as if we have a clock inside. This internal clock is called the biological clock.

It is well known that all living things have a biological clock within them. This is because we live on a planet that rotates once every 24 hours, such that a period of light is followed by a period of darkness within every 24 hour cycle. Our sleep patterns, body temperature, hormonal excretion, body metabolism, and other biological functions fluctuate within this cycle as day becomes night and night becomes day. The biological clock governs our body rhythm repeatedly every day, and this rhythm is known as the arcadian rhythm. Orcadian is a Latin word meaning ‘about a day’.

This circadian rhythm is endogenous and is as if governed by an internal clock which is situated inside our brain. The body functions such as sleep patterns, body temperature, etc. appear to follow this internal clock. This body clock is quite robust and possesses a certain amount of durable inertia, and resetting of this clock may take from a few days to a week to complete. This is illustrated by the interesting case of the fiddler crab.

Scientists have noticed that the fiddler crab of North America changes colour according to whether it is night or day. These crabs are flown by air from New York on the east coast to California on the west coast. Because our earth rotates towards the east, New York on the east coast sees the sunrise many hours earlier than California. When the crabs first arrive in California they continue to change colour as if they were still back in New York; they have

not yet adjusted to the new timing of day and night in California. But after about ft week the crabs adjust to the local time in California and change colour according to this new local time. Obviously the crabs do not wear watches. Their biological clock is gradually reset to the new timing of daylight in California.

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HOW TO DO THE EXERCISES FOR SELF-MANAGEMENT OF ANXIETY: DIFFICULTIES IN ATTAINING RELAXATION OF THE MIND

It is extraordinary how people tend to give up even before they have started. “Relaxing the body, yes, I can do that; but relaxing my mind, that is impossible; that is why I have come to you.” I hear this almost daily. Yet experience has shown that anyone who can achieve physical relaxation can likewise attain the sensation of relaxation of his mind, if he will only try—and try in the right way.

A common difficulty is that our thoughts seem to become too active. We keep thinking of the problems of the day. All the small inconsequential things of our business keep running through our mind. In an effort to stop it, we consciously turn our thoughts to our home. But the same thing happens again, and we become exasperated by the flow of unwanted thoughts. This particular difficulty is more common in people who have well-developed obsessive traits in their personality. The main problem is the rather vivid awareness of these thoughts, the way they intrude into our consciousness and the way they disturb us. We cope with this difficulty simply by giving our thoughts full rein, as it were, and letting them wander where they will without us worrying about them. We do this in a way similar to what happens in our moments of reverie. In it we are idle, and we daydream. Our thoughts wander far and wide; but it does not disturb us, and we still remain completely relaxed in our mind. This is the approach to the difficulty of active thoughts while we are first trying to relax. We just let the thoughts go. There is no tension. We let them go easily, just where they like, and it does not worry us.

There is another approach to this same problem which is also a help. As we do our exercises we have to maintain the physical reaction of our body. We do this by thinking of different parts of our body in turn, and making sure that each is relaxed.

I can feel my legs relaxed, both of them relaxed.—My body, it is relaxed, and I just feel the weight of it.—My arms relaxed, my face smooth, my jaw loose, the muscles around my eyes relaxed, my forehead relaxed deeply.

The sequence is then repeated easily and leisurely, starting with the legs again. By this simple means the mind is kept occupied so that other thoughts do not get the chance to intrude and worry us.

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THE ROLE OF NUTRITION IN ARTHRITIS TREATMENT: BALANCED DIET

The worn-out cliche, “the balanced diet,” has been so misused and abused that it no longer has much meaning. The term optimum diet would better signify a diet so well planned and chosen as to assure optimum health.

What is a balanced diet? Is it a diet made up of “four basic foods” as you were taught in grade school? Or is it the “seven basics” as it is sometimes advised? Whichever it is, meat has always been considered the most basic food. We have all been brainwashed for years with the pseudoscientific slogan “high protein—low carbohydrate.” We believe that we should eat as much protein as possible. We are living in an era of the high-protein cult!

When I recently met Dr. Karl-Otto Aly, M.D., the prominent Swedish doctor, upon his return from an extensive lecture tour in the United States and asked him, ‘What is singularly the most memorable impression of your trip?” he had an immediate answer:

“The American high-protein craze! Not only the general public, but even so-called health enthusiasts are so thoroughly brainwashed on the question of protein in their diet, that, to my mind, this point alone may be held responsible to a great degree for the deplorable state of health of the American people.”

*28\176\2*

WHAT ELSE MAY BE USED TO TREAT EPILEPSY?

The use of anti-epileptic drugs is clearly the principal method of treating epilepsy. In those situations where a specific cause for the seizures has been found, then other treatments may be necessary. This will include antibiotics if the cause is meningitis or a cerebral abscess, antiviral drugs for certain types of encephalitis caused by viruses, supplementation of the diet with vitamins or other substances in those rare disorders where there may be a deficiency, and the use of surgery to remove cysts, tumours, or abnormal areas of the brain. Counselling and other specific psychological programmes designed to help modify behaviour may also be required for certain people, including those who drink alcohol to excess, or who use illicit drugs.

Dietary manipulation-There have been a number of attempts to control epileptic seizures by modifying the diet. This arose from the observation many years ago that fasting or starvation seemed to be associated with a reduction in the frequency of seizures. In the fasting state, normal metabolism is altered with the appearance of substances in the blood and urine, called ketones. It is not known how or why ketones are linked with seizure control. Of course, there may be no direct relationship between the two, and the occurrence of the two together may be coincidental. A diet was discovered which produced ketones, but without the child having to be starved. The diet is very rich in fat and oils, which makes it rather unpalatable. Because 70 per cent of the diet is in this fat form (the remaining 30 per cent coming from protein and carbohydrate), extra vitamins and minerals (such as calcium and magnesium) must be given. In spite of all the fat and oil eaten in this diet, there is no change in the blood level of cholesterol which is responsible for causing coronary heart disease. The main disadvantages with this diet are the unpalatability, often unpleasant diarrhoea, and the fact that the diet must be strictly followed. Its use is usually restricted to infants and children with very severe epilepsy (often with the Lennox-Gastaut syndrome). Unfortunately its success is limited and usually short-lived.

A rarely used and less successful diet is oiled the oligoantigenic diet. This entails trying to identify those substances in the diet which may cause an increase in epileptic seizures, and then to exclude them from the diet.

There are few, extremely rare conditions, where the epilepsy is caused by an ‘inborn error of metabolism’. This means that either the body is missing, or is unable to use, a particular substance—usually a vitamin or enzyme, and, as a result the person develops epilepsy, and often other problems (for example, skin rashes, loss of hair, failure to grow). If the missing substance is then given in large doses, then the epilepsy may stop. An example of this is a condition called pyridoxine (vitamin B6)-dependent seizures, which usually begins by affecting babies or infants in the first few days or weeks of life.

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ARTHRITIS BEATEN TODAY: CMO AND OTHER AILMENTS-MACULAR DEGENERATION AND DIABETIC RETINOPATHY

Macular degeneration is the leading cause of blindness in persons over 65 years of age in the USA. It starts with a thickening of certain fibres in the eye and deterioration of the capillaries of the blood supply. Detachment of the pigmented layers of the eye may occur eventually. Total blindness or loss of central vision may result.

Diabetic retinopathy is the leading cause of blindness in adults from 20 to 65 years of age in the USA. It involves dilation and bleeding of the veins in the retina which can also lead to retinal detachment.

These ailments are often associated with diabetes, hypertension, sarcoidosis, toxoplasmosis, or syphilis. Corrective surgery, often by laser, is very costly but frequently recommended as the only conventional therapy. Most cases treated with CMO have responded exceptionally well, eliminating the need for surgery.

Just what autoimmune processes, if any, are being affected by CMO in these diseases has yet to be determined. We have so much more to learn about the secret mechanisms of CMO and its broad range of influence on so many ailments.

*81\142\2*

CHILDREN’S HEALTH: PNEUMONIA

Symptoms

Bacterial pneumonia: mild upper respiratory tract infection; high fever; chills; cough; rapid breathing; chest pain.

Viral pneumonia: headache; fatigue; fever; sore throat; severe, dry cough.

Home care:

Viral pneumonia usually clears up on its own.

Bacterial pneumonia requires medical attention.

Precautions

-    Watch for signs of pneumonia in a child whose resistance is lowered by a cold or infection.

-    If a cold suddenly gets worse and is accompanied by high fever, cough, chills, chest pain, or rapid breathing, suspect pneumonia.

-    Flaring of the nostrils, grunting breathing, and pulling in of the chest in an infant are serious and require immediate medical attention.

-    If a child coughs up a discharge tinged with blood, consult a doctor.

Pneumonia is an infection of one or more areas of the lungs. It’s caused by bacteria or viruses. The common bacterial cause of pneumonia is pneumococcus or, less often, streptococcus or staphylococcus. The viral causes include the influenza and parainfluenza viruses, the respiratory syncytial virus, and adenoviruses. Pneumonia also may be caused by mycoplasma organisms.

In order to contract bacterial pneumonia, the child must be exposed to ê at a time when he or she is particularly susceptible. Pneumococci, streptococci, and staphylococci bacteria frequently are present in the nose and throat of a healthy child. Before these organisms can invade the lungs, however, the child’s resistance must be lowered by a cold or some other upper respiratory tract infection. Therefore bacterial pneumonia is not considered to be contagious in the usual sense.

The types of pneumonia that are caused by viruses are known as “walking pneumonias” and are contagious. The incubation period – the time it takes for the symptoms to develop once the child is exposed to the disease – for mycoplasma is one to three weeks; for most viruses it is two to five days.

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ISOPHAN E INSULINS USED IN YOUNG PEOPLE: HUMULIN, ASTRAPHANE AND OTHERS

Humulin NPH (Isophane Insulin NPH)

Humulin NPH has a moderately slow action.

This is a Human Isophane. Humulin NPH may start to have its effect within two hours of the injection (sometimes even before) and has-its maximum effect from between four to twelve hours. Activity fades rapidly after twenty four hours. For some children on small doses, it may provide good coverage of insulin through the whole day, but many children need a small addition of quick acting insulin (Humulin R) to the Humulin NPH to cover the early part of the day. The proportion of quick acting insulin to Humulin NPH will usually be about one to four, but this varies according to how a child responds to the insulin. For many children, the effect of Humulin NPH is not strong enough through the night and it may be necessary to give an evening injection as well.

A hypoglycemic reaction due to Humulin NPH given before breakfast is likely to occur in the late afternoon, but may occur during the night.

Actraphane (Isophane and neutral insulin mixed)

Actraphane is a mixture of Protaphane (70%) and Actrapid (30%). It is mixed as a convenience for those people who may need both a quick and slow acting insulin but who might have difficulties in mixing the two insulins in the syringe themselves.

Its effect may start in one hour and it has a maximum effect from four to fifteen hours with a fading of activity from then to twenty-four hours.

A hypoglycemic reaction due to Actraphane given before breakfast may occur during the late morning or afternoon.

Mixtard 30:70 (Isophane and neutral insulin mixed)

Mixtard has a combined fast and moderately slow action.

Mixtard is a mixture of Insulatard (70%) and Velosulin (30%). It is mixed as a convenience for those people who may need both a quick and slow acting insulin but who might have difficulties in mixing the two insulins in the syringe themselves. It has a start effect in one hour and a maximum effect from four to eight hours with a fading of activity from then to twenty-four

hours.

A hypoglycemic reaction due to Mixtard given before breakfast may occur during the late morning or afternoon.

Mixtard 50:50 (Isophane and neutral insulin mixed)

Initard has a combined fast and moderately slow action.

Initard is a mixture of Insulatard (50%) and Velosulin (50%). It is mixed as a convenience for those people who may need both a quick and slow acting insulin but who might have difficulties in mixing the two insulins in the syringe themselves. Its effect may start in one hour and it has a maximum effect from four to eight hours with a fading of activity from then to twenty-four hours.

A hypoglycemic reaction due to Initard given before breakfast may occur during the late morning or afternoon.

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SOLUTIONS TO INFERTILITY: PROTECTION AGAINST POULLUTANTS AND CHEMICALS AT HOME

Household pesticides

A number of children have been diagnosed with Charge Syndrome which is characterized by major abnormalities including heart disease. It’s believed that the condition is caused by exposure to pesticides and insecticides during pregnancy. One baby was born with severe handicaps after her mother had been exposed to a cockroach pesticide when she was six weeks pregnant. Another woman gave birth to a handicapped child after exposure to flea insecticide during pregnancy.

Dr Jeff Howell, of South Bank University, has strong concerns about the use of permethrin to treat woodworm. This chemical has been linked to skin and eye irritations but also to birth defects. Home-owners have always been told that the treatment chemicals fall to safe levels eight hours after application. But research carried out by the Faunhofer Institute of Toxicology and Aerosol Research in Germany shows that house dust picks up permethrin and deposits it on food and kitchen surfaces. So you can end up breathing and eating it.

Parents in the UK and USA are suing the manufacturers of a garden pesticide they claim caused eye deformities in babies following use in the early months of pregnancy.

What You Can Do

• Try not to use pesticides in your garden. If this is not possible then make sure you don’t handle any of this stuff in the four months leading up to conception.

• Do not have your home treated for woodworm in those four months either. Do any house treatments before you actually move in so that you are not living, breathing, eating and sleeping in a potentially toxic environment.

• Treat your pets for fleas with natural herbal sprays. They do not kill the fleas but repel them, making them less likely to stay on the animal. There are also other ways of dealing with fleas which can be obtained from the vet. You can feed your cat a substance or put drops on their necks which change the blood so the fleas don’t like the taste. Garlic works the same way. If you crush up garlic tablets into your pet’s feed, this may keep the fleas off.

• Garlic can also be used to deter other insects. A few years ago we had some ants in the kitchen. We opened up some garlic capsules and spread the garlic around the opening the ants seemed to be coming from. Interestingly, the ants would not cross over the ‘garlic’ line and went back down the crack.

Household Chemicals

Decorating your home can be a problem. Solvent-based paints and white spirits release gases into the air and these can stay around for weeks after painting has finished. Apart from causing irritation, these gases can be inhaled and cause dizziness, nausea and headaches. Years ago, paint and furnishings were made from natural products but nowadays they are usually made from chemicals. Unfortunately, there is also a tendency to paint the baby’s room just before it is born so the baby ends up sleeping in a sea of chemicals. In addition, new carpets often contain chemical preservative called formaldehyde which can irritate the mucus linings of the eyes, nose and throat.

What You Can Do

• Decorate at least four months before conception.

• When you redecorate, buy solvent-free paints.

• Minimize the amount of chemicals you use in your home (such as polish, bleach, detergents, air fresheners, etc). Buy more natural and more biodegradable household cleaners, available from health food shops.

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