Health News and Information

The modem focus of eating plans for sustainable fat loss is a decrease in total dietary fat and an increase in the proportion of complex carbohydrates, followed in importance by a decrease in total energy intake. When assessing diet plans, these basic criteria need to be kept in mind. It is also important for health professionals providing advice to those seeking fat loss to know just how this is best achieved and to have an understanding of how popular diet plans manipulate the facts. The following is a review of some general diet plans.

Very low-energy diets. These are often available through clinics, where the diet supervisor (usually someone untrained in nutrition) provides some monitoring designed by a medical practitioner. These diets usually provide a formula feed of less than 800kcal/day, which is less than the usual range needed for the resting metabolic rates of most adults. The physiological effects of these diets are less than for fasting, but still carry risks and require medical supervision. The low-carbohydrate content of the formula stimulates the production of ketones which are thought to be responsible for the appetite suppression experienced. The hunger is intense upon reinstating carbohydrate in the diet. These diets should only be administered to morbidly obese people fulfilling strict selection criteria and within the context of a long term management plan.

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If you picture the uterus as an organ that is essentially static in the abdomen, think again. The combination of elastic tissue and muscle in the supporting ligaments of the uterus is organised to enable rapid adjustment to the altered position and size of its neighbouring organs, the bladder, bowel and vagina. When the bladder or rectum is full, the uterus moves accordingly. In addition, the uterus lifts out of the way with the entry of the penis into the vagina during sexual intercourse. In this position, the uterus may contract during orgasm. When a woman lies on her back, the uterus hugs the rear of the pelvis; if she rolls onto her stomach, it moves towards her belly button; and when she stands, the uterus drops down a centimetre or two, a movement that is accentuated if she has a prolapse and the ligaments do not provide strong support for the uterus.

Displacement of the uterus also occurs if there is a lump or growth in a neighbouring organ. For example, a lump in the vagina pushes the uterus upwards. On the other hand, if there is a growth in the bowel the uterus is pushed forwards, and in the bladder, backwards. The uterus is also able to rotate around the point where the cervix meets the rest of the body. A forwards rotation is called anteversion, and a backwards rotation, retroversion. Some women find these movements uncomfortable if they occur during sexual activity or when a doctor is examining their uterus to see if its ability to move is restricted in any way. In most cases women are largely unaware of these movements, although they may account for some of the pelvic ‘twinges’ or abdominal pain that is sometimes experienced.

For the uterus to contract successfully—which occurs during menstrual bleeds, childbirth and, in perhaps a third of women, during orgasm — the muscle tissue of the uterus and of the surrounding ligaments must work harmoniously. Women do not have conscious control over these contractions; this is exercised by nerves and hormones. Some aspects of uterine function are under dual control of both hormones and nerves, while others are influenced mainly by one or the other.

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Another possible explanation of why we need to sleep is perhaps a psychological one. When we are sleeping, we all dream. Dreaming has a restorative function. We act out and experience some of our frustrations and anger during dreams. When we wake up the next morning, we have forgotten our dreams. This forgetting is important, as it allows us to forget our frustration and anger at the same time. Dreams are like a psychological filter, filtering out the worries that accumulate during the day. Sleep laboratories have demonstrated that when we are dreaming all the big muscles of the body are totally relaxed. This may be the only time that the body muscles are ever completely relaxed.

Another recent discovery in dream study is the occurrence of a male erection, which is discussed in chapter 8 on Sex and Dreams. It has been observed that whenever a man dreams his penis is erect, no matter what sort of dream he is having. This dream erection occurs in all age groups and this to be important for the proper development of the penis. Hence, at least for men, dreams are very important.

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This is one of the most common causes of anxiety in women of childbearing age. The unmarried woman who has let herself be led into a foolish sexual experience without proper contraceptive precautions inevitably experiences severe tension. Her anxiety is often sufficient to inhibit her next menstrual period. She sees this as proof that her worst fears are confirmed, and desperation and self-loathing may easily drive her into precipitate action.

The married woman who fears pregnancy usually says that she does so because it would be financially embarrassing or would interfere too much with her social life. However, on close questioning it frequently turns out that there is much more to it than this, and that the fear is really based on a deep-seated fear of childbirth which developed when she was a girl as a result of foolish talk on the part of her mother or elder sister. That this fear is in fact neurotic is shown by the fact that these women are in no way reassured by completely adequate contraceptive measures, and their intimate life with their husband leaves them cold and in constant tension.

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People with recurrent depressions can be divided into unipolar and bipolar categories. Those with recurrent unipolar depressions suffer only from periods of low mood, separated from one another by normal periods. In contrast, those with bipolar depression experience periods of exaggerated energy and activation as well as depressions. During their activated periods, known as manic or hypomanic (less than manic) episodes, these individuals need less sleep, think and talk more quickly and are more sped-up than normal. Sometimes they are elated but at other times quite irritable and angry, especially when they feel blocked, frustrated or thwarted by those around them, who appear to them to be moving at a snail’s pace. The question here is whether a bipolar person can safely use St John’s Wort during a period of depression.

Unfortunately there are as yet no published studies on the use of St John’s Wort in the treatment of bipolar depressions. We do, however, know two important facts about the treatment of bipolar depression with other anti-depressants: (1) All anti-depressants that work in the treatment of unipolar depression also work for bipolar depression; and (2) All anti-depressants are capable of inducing hypomanic or manic episodes in patients with bipolar depression. Based on these observations, I would expect St John’s Wort to be an effective anti-depressant in bipolar depressions. I would also caution anyone with a tendency to develop hypomanic or manic symptoms to be sure to use the herbal antidepressant only under the close supervision of a doctor, and on no account to experiment with its use on your own. In addition, in most bipolar patients it is customary to use a mood stabilizer such as lithium carbonate or valproic acid before adding an antidepressant, to guard against the development of a hypomanic or manic episode. For those of you who are wondering why one should be so careful to prevent the development of a hypomanic or manic episode, I should mention that they can be extremely disruptive and destructive to a person’s life. Even though a mild hypomanic episode may not be harmful, when the process reaches its extremes it can cause the breakup of a marriage, the loss of a job, serious financial reversals and physical injury to the affected person.

I should emphasize that, to my knowledge, there has not been a single report to date of a manic episode induced by St John’s Wort and that there is no greater reason to be concerned about the herbal remedy in this regard than about any other effective anti-depressant. Even so, it is good to be aware of the potential risk, especially if you have a history of hypomania or mania. One of my patients who has experienced recurrent depressions and mild hypomanias in the past is on a maintenance dose of lithium carbonate to stabilize his moods. When he developed a mild depression I started him on 600 mg of St John’s Wort per day. A week later he rang me to say that he was feeling ‘too good’ and waking up in the early hours of the morning. I interpreted this as possible evidence of hypomania and suggested that he cut back to 300 mg a day, which turned out to be just the right amount for him. Once you are aware of the possibility that hypomania can develop with the use of any anti-depressant, you are forewarned

and better able to deal with the symptoms should they arise.

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The pathways of chemical metabolism in the newborn are very unstable and vast changes in the serum concentrations of various substances can occur. A blood glucose concentration sufficiently low (hypoglycaemia) to cause seizures, for example, cannot be induced in older children or adults by starvation, or indeed by any means other than the injection of insulin. However, severe hypoglycaemia resulting in seizures may be seen in the newborn, particularly in premature infants, or in babies born to diabetic mothers.

Seizures due to a low serum calcium are also fairly frequent in the newborn period. One cause is early feeding with cow’s milk, which is very rich in phosphates, and which results in increased renal excretion of calcium and subsequent low levels of calcium in the blood.

In later stages of life, other acquired metabolic disorders may cause seizures. Chronic renal failure used to be one of the more common causes, but dialysis and successful transplantation of kidneys has reduced the frequency of seizures due to this cause.

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Mrs. L.M. of New Mexico writes: “Too Good To Be True? That’s What I Thought!!!

“Rheumatoid arthritis hit my right knee about 40 years ago, caused from climbing a mountain. Since then, every time I overstressed my knee, it became worse.

“I am now 70 years old and have through the years developed arthritis in my hands and wrist. Also have arthritis as well as scoliosis in my back.

“I love to walk for exercise, but could not do that any more. My wrist and thumbs were so bad I could hardly comb my hair and wait on myself.

“After the fifth day of taking CMO, I was so surprised that the swelling had all gone from my knee and I could rise from my chair much easier, climb stairs, and walk down an incline without the pain.

“It has been one month since I took CMO. My hands are much better and continuing to improve. I wasn’t expecting relief for my back, but to my surprise the pain is mostly all gone. Thanks to my friends for introducing me to CMO.”

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Signs and symptoms

The symptoms of influenza are sudden chills, a sharp rise in body temperature to 38.9°C to 41.1 °C, flushing, headache, sore throat, a hacking cough, redness of the eyes, and pains in the back and limbs. Young children may vomit and have diarrhea. Fever lasts three to four days and is followed by days of weakness and fatigue during which the child is susceptible to other illnesses.

Secondary bacterial complications are responsible for many of the serious outcomes of flu, and their presence is suggested by: the return of high fever after the child’s temperature has been normal for three or four days; progressive worsening of the cough, changing from dry and hacking to loose and productive; formation of pus in the eyes; rapid breathing and shortness of breath beyond that expected from the fever; severe earache; stiff neck; confusion; and extreme weakness, exhaustion, or collapse.

In isolated cases, flu cannot be diagnosed with certainty by physical exam. During an epidemic, the disease is diagnosed by similarity to other cases.

Home care

The prescription for home care is: bed rest during the height of the fever and

paracetamol, not aspirin, for fever and pains. You should encourage the child to drink a lot of fluids. Keep the child isolated from the rest of the family, and don’t let the child return to school or work until fully recovered. This will lessen the child’s chances of getting another disease while his or her resistance is lowered by the influenza.

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As with so many things about birth, prevention is better than cure-so how can you ensure that you have the least possible chance of having to have an episiotomy?

• Decide well in advance that you will not have an episiotomy except for one of the very specific medical reasons that you have been able to discuss well ahead of time at an ante-natal visit, or if your experienced midwife is fairly certain that you will have a bad tear if you do not have one. Get the staff to write it in on your notes, and ensure that your husband or partner understands your feelings precisely. Then it will be understood that the midwife or obstetrician will have to justify the episiotomy to you before doing it. This should dramatically reduce the likelihood that you will have one as a matter of routine. Of course, ideally you should choose a unit where episiotomies are done rarely and only for good medical reasons, but such units are rare.

• Practice pelvic-floor muscle and perineal stretching exercises during pregnancy.

• If you arrange in advance to labour in an upright position of some kind, and to keep changing position as you feel best, it will probably reduce the likelihood of your needing an episiotomy.

• If you do end up on your back because it is deemed obstetrically necessary, ask the midwives to hold your legs so that your knees are only a foot or so apart, not widely apart as in lithotomy stirrups. This will reduce the stretching of the perineal tissues and so reduce the likelihood that an episiotomy will need to be done.

• It is worth learning perineal massage, even from quite early on in pregnancy. In this the woman lies flat on her back on the floor or on a bed with the soles of her feet flat together. Her husband or partner then uses his fingers, well lubricated with vegetable oil or baby oil, to massage the whole of the lower vulva and the area between the vagina and the anus. It is this area that stretches so much during the birth of the baby, and a supple, relaxed perineum is far less likely to tear or to need an episiotomy than is an unprepared one. This form of massage can easily develop into sexual foreplay as the man inserts his fingers into the vagina until, towards the end of pregnancy, the woman will be able to take four fingers quite easily. Don’t forget that from quite early on in pregnancy a woman’s vagina becomes more relaxed and will, by twelve or fourteen weeks, be able to take two or three fingers easily. Using sweeping movements around the lower vagina, the man can often feel the deep pelvic muscles relaxing as pregnancy progresses, and the woman will learn to relax her perineum and sense the stretching of her perineal tissues in a controlled, loving setting before the real thing takes place in the labour ward.

The idea early on is to stretch the woman’s vulval opening to the point where she complains of tingling or pins and needles, or simply says it’s enough. The man then holds his fingers in this position for some time until the stretching sensation passes. Over subsequent sessions the couple can gradually increase the amount of vaginal stretching until the woman can easily take four fingers. Any woman who has had this kind of perineal preparation is unlikely to need an episiotomy, especially if she gives birth in an upright position. When it comes to experiencing the strange bursting sensations as the baby’s head stretches her vulva during the last stage of labour she will not be alarmed or think she is going to burst open (as many unprepared women fear) because she will have experienced similar (though less intense) sensations.

Some American midwives use perineal massage as the baby’s head comes down the birth canal, massaging the tight, whitened and thinned areas of the vaginal opening with oil as the baby’s head emerges. They also massage the pelvic muscles to relax them via the vaginal walls. Such midwives rarely use episiotomies however big the baby.

• It can also be a useful preparation for the birth to master pelvic exercises, and they can be of considerable value after the birth of the baby too, to both you and your partner. Here are three ways of exercising your deep pelvic muscles. Do any or all of them, several times a day, perhaps while driving the car or watching TV.

Start off by sitting on the lavatory and, while passing urine, stop in mid-flow. Start and stop; learn to control the stream at will. The muscles you are using are the deep pelvic ones that you will need to be aware of, both during the birth and afterwards when you are getting back to normal. Once you have conquered this to your satisfaction, start on the exercises proper.

1. Tighten and relax your pelvic muscles, holding them in a tightly contracted position for several seconds and then relaxing them. Try to increase the length of time you can hold the muscles contracted.

2. Tighten and relax the muscles quickly, in a sort of fluttering way, gradually increasing your control.

3. Pull up your entire pelvic area as if your vagina were a pump drawing up water and then force the ‘water’ out of the ‘pump’. This exercise uses some abdominal as well as pelvic muscles.

If you put a finger or two inside your vagina (or get your partner to do so) you can gauge how well you are progressing with your muscle control. Early on it may well feel flabby and rather weak, but after a few weeks the muscles will be so powerful that they will feel as if they could squeeze your fingers off.

These exercises are also very useful post-natally to get your pelvic muscles back to strength after being stretched by the baby coming down the birth canal.

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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.

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