Health News and Information

You may be in the position of being able to pay to have your operation done privately. The Bookings Manager at a private hospital will be able to give you an idea of the cost involved. Some private hospitals run a service known as Fixed Price Care: a price can be quoted to you before you enter hospital which covers the cost of your operation and a variety of other hospitalization costs. You should always ask to have the quotation in writing before you enter hospital, with a written note of everything it covers. At some hospitals, the fixed price will include accommodation, nursing, meals, drugs, dressings, operating theatre fees, X-rays etc.; at others only some of these are included. Once you have a quotation, you should not have to worry about any hidden costs that you had not accounted for. However, the price quoted to you by the hospital may not include the fees of the consultant surgeon or consultant anesthetist, and you may have to ask your consultant for a note of these.

With Fixed Price Care, all the hospitalization costs included by that particular hospital are covered should you need to stay longer than expected in hospital (usually up to a maximum of 28 days) as a direct result of complications arising from your original reason for admission. In other words, if you develop some problem while in hospital that is unrelated to the breast disorder which led to your need for your operation, the price you have been quoted will not cover treatment to deal with this. If, on the other hand, you should have a complication as a direct result of the breast disorder or of the operation to treat it, and your consultant decides to keep you in hospital for longer than originally planned, all the costs that arise from your stay and are included in the hospital’s fixed price (again, with the possible exception of consultants’ fees) will be covered. At some hospitals, the quoted price will also cover your treatment should you have to be re-admitted due to a complication related to your original operation and arising within a limited period of time after your original discharge.

The only extra charges that you will have to pay to the hospital will probably include those for telephone calls, any alcohol if you have this with your meals, food provided for .your visitors, personal laundry done by the hospital, hairdressing, and for any similar items such as you would have to pay for in a hotel. It is usually possible for a visitor to eat meals with you in your room, and for tea and snacks to be ordered for visitors during the day. (You will also have to pay these extra charges before you leave the hospital if you are being treated under private health insurance.)

It is important therefore that you ask in advance for written confirmation of the price you will have to pay for your stay in hospital and what is included in the quotation. If the hospital does not have a Fixed Price Care or similar system, make sure that all possible costs are listed.

*63/39/5*

Laparoscopic surgery for endometriosis is any surgery that attempts to remove or destroy endometrial implants, cysts and adhesions during a laparoscopy.

Laparoscopy was originally only used as a means of diagnosing endometriosis but over the years it has been used increasingly as a way of surgically treating the condition. It is now common for some laparoscopic surgery to be performed at the time of a diagnostic laparoscopy – assuming the woman agrees and laparoscopic treatment is appropriate.

In the early days of laparoscopic surgery only simple procedures were performed but as experience with the technique has increased surgeons have treated increasingly severe cases and performed more complex procedures. The complexity of the procedures that your gynecologist will attempt will depend on his or her level of training and experience.

Who is suitable for laparoscopic surgery?

Laparoscopic surgery is generally only suitable for women with minimal or mild endometriosis, though in some cases it may also be appropriate for women with moderate disease.

Things to discuss before laparoscopic surgery

Before your operation you should discuss with your gynecologist what he intends to do during the operation and what should be done if more extensive surgery is necessary.

What happens with laparoscopic surgery?

The basic routine for laparoscopic surgery is the same as that described for a diagnostic laparoscopy except that in addition to inspecting the pelvic organs, one or more of the treatment procedures outlined below will be performed.

Procedures that may be performed include the removal or destruction of superficial implants and small cysts, the removal of adhesions, the removal or destruction of endometriomas and the removal of an ovary. Few gynecologists are able to perform the latter two procedures but it is possible that in the future more surgeons will be able to do so.

Any superficial implants and small cysts on the peritoneum and ovary will usually be destroyed by cauterization. Cauterization involves the use of a heat source or electrical current to destroy or ‘burn’ the implants or cysts. As the depth of the burn cannot be precisely controlled cauterization is not used if there is any danger of damaging any important underlying organs, such as the fallopian tubes, bowel or bladder. It is not always possible to destroy all the implants and cysts present. Larger cysts may be removed by cutting them out.

Adhesions can be removed by cutting or cauterization but again it may not be possible to remove all the adhesions present.

Effectiveness of laparoscopic surgery

Laparoscopic surgery has several advantages over conservative laparotomy because being minor surgery as opposed to major surgery it is associated with fewer risks and complications, causes less discomfort and has a shorter recovery period. It can also readily be done at the time of diagnosis which means that only one bout of surgery, one hospital stay and one recovery period are needed.

It is not possible to compare the results of laparoscopic surgery with other forms of treatment as there are no reliable figures available at present. The impression of many gynecologists is that laparoscopic surgery relieves the symptoms in many cases and it restores fertility in some cases.

Risks and complications of laparoscopic surgery

The risks and complications of laparoscopic surgery are the same as those associated with a diagnostic laparoscopy except that there is the additional risk of damaging organs during cauterization.

*46/41/5*

Educational therapy, sometimes known as psycho-educational therapy, involves teaching people the facts they need to overcome their disorder. It is not always a substitute for psychotherapy but can be a very helpful adjunct to it.

Some of the best work in this field has come from eating disorder specialists at the University of Toronto. They recently conducted an important piece of research comparing the effectiveness of different treatments in reducing the symptoms of bulimia. Amazingly enough, they found that for the healthiest 40 percent of the bulimia patients, educational therapy-in the form of a short lecture course-was as effective as a much longer treatment involving individual cognitive-behavioral therapy. The lecture course gave information about bulimia as well as self-care strategies to help the patients learn how to return to normal eating habits. The findings of this research suggest that it makes sense to begin treating bulimia patients with educational therapy and reserve costly, time-consuming individual therapy for those who don’t get better after learning the facts about their disease.

I can think of few other illnesses in which there can be such a dramatic therapeutic response after taking the simple step of learning the facts. In the next few pages, let’s review some of these facts as they might be covered in a course of educational therapy.

Our society keeps turning up the pressure to be thin. As a result many women resort to severe dieting. Our bodies, however, operate under biological rules. Each of us has a certain predetermined weight range-the set point range-that our bodies fight to maintain. For many people, this range is higher than what society says is the “ideal standard” for beauty.

Excessive or constant dieting robs the body of the food it needs to maintain the weight it prefers. The body then turns up the volume on the “hunger” signals. The result: bingeing.

Some people then try to undo the damage by purging, which leads to a vicious cycle. The woman binges with less guilt, since she knows purging will protect her from gaining weight. And she binges because it’s easier to vomit with a full stomach. Purging also keeps the body in a constant state of semi-starvation and dehydration. The cycle leads to anxiety and depression, which the woman then attempts to relieve through further eating.

After prolonged disruption, a person’s body may lose its ability to control eating. A woman must then relearn what it means to feel hungry, how to eat properly, and when to stop eating. She also has to learn to feel comfortable and not feel anxious when her body returns to its natural set point weight range.

But how does she know what that range is? In other words, what should her “goal,” or target weight, be? That’s something educational therapy can show her. First, the weight should be such that she can maintain it easily. She should be able to stay at that weight without resorting to extreme dieting, which as we have seen promotes bingeing. Secondly, the goal should be an individualized weight, not one derived from statistical charts.

Actually, the best goal is really a “no-goal.” By that I mean the woman should stop thinking in terms of weights and numbers and concentrate instead on learning better habits. Through psycho-education, she learns how to eat reasonably, exercise regularly, and develop ways of coping with stressful feelings without using food as self-medication.

Reaching this no-goal, however, usually occurs at the end of therapy. There are lots of steps in between, some of which involve setting up concrete objectives and working to achieve them. For example, an anorexic needs to know how much weight she has to regain. Her target should be neither too high nor too low, and should be a range rather than a precise number. As a rule, I ask patients to reach roughly 90 percent of the stable highest weight they had prior to the onset of their disorder. Each patient is different, but many find they can reverse starvation and maintain a reasonable weight without subsequently feeling the urge to binge and purge.

*70/35/5*

Jeanann Pock isn’t what you’d call a morning person. But with a little help from legendary football coach Vince Lombardi, the Zionsville, Indiana, woman found a way to resist the snooze alarm. She ended up losing 85 pounds as a result.

In 1992, Jeanann was a 22-year-old college graduate about to embark on a career in university public affairs. At 5 foot 2 and 200 pounds—she gained about 20 pounds in each of her last 3 years of college—she wondered whether she would be able to meet the demands of her new job. “Being overweight made everyday activities so much more tiring than they used to be,” she explains. “I made up my mind to slim down.”

Armed with information from the university library, Jeanann began trimming the fat from her diet and walking on a daily basis. She planned her walks for first thing in the morning so she’d be certain to fit them into her schedule. The trouble was that she had a hard time getting up early. At 4:45 A.M., all she wanted to do was snooze.

At about that time, Jeanann happened to be reading What It Takes to Be Number One, a book by legendary football coach Vince Lombardi. She was struck by one particular passage, in which Lom-bardi wrote, “Winning is not a sometime thing; it’s an all-the-time thing.”

His words provided the motivation that Jeanann needed. “I understood that to succeed at weight loss, I had to win every little battle along the way—including my morning skirmishes with my alarm clock,” she says. “I had to think like a winner to be a winner.”

From that point on, Jeanann had a new morning ritual. Rather than hiding her head under her pillow to block out her alarm clock’s ring, she repeated to herself Lombardi’s words. And then she asked herself, “Do I really want to be fat?” That got her out of bed and into her running shoes.

It also kept her weight-loss program on track. “After all, a winner doesn’t give up when she’s halfway to the finish line,” Jeanann says. Within a year, she got rid of all 85 unwanted pounds. She has maintained her weight at a healthy 115 pounds ever since.

WINNING ACTION

Give yourself a pep talk. All of us have moments when we need a little extra push to help us stick with our weight-loss programs. At times like these, having some sort of personal slogan can help. Think of a quotation, a song lyric, or a prayer that gives you inspiration and strength. If you can’t come up with one, create your own affirmation. For example, “My body is getting stronger, slimmer, and healthier every day.” You can repeat your slogan to yourself whenever you need to, or you can make it part of a daily ritual, as Jeanann did. It can help you get over the bumps on the road to weight-loss success.

*125\89\8*