It is also important to take plenty of exercise to burn off the excess calories and to strengthen your bones. The more bones and muscles are used, the stronger they grow, so from your middle years onwards the new buzz-words in your life should be ‘mechanical loading’, which means giving your bones plenty of work. As you use your muscles, the bone-building osteoblasts respond by building more bone; exercise is also thought to stimulate the production of calcitonin, thereby slowing the activity of the bone-dissolving osteoclasts. We have only as much bone as we need, and nothing will cause the skeleton to become stronger than it needs to be for your lifestyle. No amount of calcium tablets will compensate for ‘mechanical loading’ of the bones and muscles.

Exercise is something most of us do much less of as we get older, which is a pity, as it:

• helps to build up bones

• is good for the heart

• reduces depression and stress

• improves muscle tone and co-ordination, so reducing the risk of falling (which is one of the main causes of fractures)

• is an effective form of weight control

• improves sleep

All these things become more important after the menopause, so try to build some regular exercise into your life. If you have already had an osteoporotic fracture, you should take advice from your specialist or from a physiotherapist about what form of exercise you should and should not be taking. If you have no sign of this disease, then you should be having plenty of exercise that loads the bones and muscles. Swimming and yoga are very good for all the other aspects of your life, but as they do not put any strain on bones you would need to include some other forms of exercise as well, such as tennis, dancing, brisk walking, aerobics, fitness training, etc.

Just a word of caution: forget the old maxim ‘If it isn’t hurting, it isn’t working’; after about the age of 35 this is a harmful philosophy, so listen to your body, and when it says ‘stop’, then stop before you do some damage you will regret.

*72\42\4*

My sex life has deteriorated since having a hysterectomy a year ago, partly bemuse I find it difficult to get interested in sex. I don’t feel comfortable talking to my surgeon about this and I’m wondering who else could help.

Loss of interest in sex after hysterectomy may be due to reduced levels of sex hormones. This may, for example, result in less lubrication of the vagina making intercourse more painful for you. Loss of libido may also be due to feelings of depression caused by anxiety at losing the uterus and exhaustion due to the combined stresses of the condition for which you had the hysterectomy, the operation itself and the associated anaesthetic. Coincidental factors, such as relationship problems with a partner, reduced self-esteem or sexual difficulties that are unrelated to hormone levels, may be another source of difficulty. For instance, you and your partner may have drifted into a pattern of having sex which does not please you and which you are now rejecting, or your partner may have a medical condition which is making the achievement of erection more difficult for him. A general practitioner, endocrinologist, gynaecologist, psychiatrist or sex therapist may be able to help. Your doctor should be able to sort out who is best situated to provide this help, even if he or she cannot diagnose the cause of your problem.

Will I still menstruate after a hysterectomy?

No, menstruation will no longer occur. Whatever sort of hysterectomy you have will necessarily result in removal of the uterus complete with its inner lining, the endometrium, which is responsible for menstruation.

*84\198\4*

Highway hypnosis. Since hypnosis is not sleep, what is its relationship to sleep? When a person is driving a long distance on a highway, his eyes are focused only on the highway; he cannot look at anything beyond the highway for more than a few seconds. His eyes and his attention have to come back to the highway all the time. His awareness of the surroundings becomes narrower and narrower. This affects the content of his thoughts, which also become narrower. Although he is in a fully awake state, his awareness is submaximal and is continuously constricting to a narrower span. During this period of extremely limited awareness, it is as if he is in a trance state. He is dissociated from the awareness of his surroundings. Highway hypnosis is very dangerous. Eventually, if he does not pull over and stop driving, he will most likely fall asleep and lose control of the car.

After driving a period of time on a highway, a person goes into highway hypnosis, and very often highway hypnosis leads to sleep.

Hypnosis can lead to sleep. With the invention of the EEG machine, we now know that hypnosis does not equate with sleep. Schwartz, Bickford, and Rasmussen in 19SS reported that hypnosis and the awake state have identical EEG patterns. But typical sleep patterns on the EEG can be brought about in hypnotized individuals by means of appropriate suggestions. Hence, although hypnosis and sleep are two different states, given the appropriate suggestions of heaviness, tiredness, and sleepiness, one can pass from the hypnotic state to the sleeping state easily.

Dream state before sleep? David Foulkes, a US scientist, made a detailed study of the mental state of people falling asleep, and distinguished different phases. The first step is the loss of control over the flow of thought Thoughts begin to wander and go their own way. In the sleep laboratory, if the subject is awakened and questioned just before the appearance of a sleep pattern on the EEG, he reports that he has lost his orientation in time and space and is no longer aware of the reality of life around him. It is as if he is in a dream state resembling that of REM stage sleep, and sometimes it is impossible to tell them apart However, the EEG recording does not indicate any REM sleep and there is no rapid eye movement.

*86\174\4*

The little boy is playing. He falls and skins his knees, He screams. In an instant his whole being is overwhelmed with pain. For him there is only pain, his whole body, his whole world. Mother seizes him and holds him to her, kissing him on the cheeks. In a moment his distress is calmed and the pain passes, the sobbing dies down and he returns to his world of reality, and inquires about the thing he was playing with. Mother has quieted his distress, and the pain of his skinned knees does not disturb him unduly. Remember that this comes about by her kissing his cheeks rather than attending to the injured knees.

You may say that this is all very well for a child, but I am an adult, and I do not react like this. Perhaps so. But we adults react to pain with distress, only we do so slightly differently. We stop ourselves screaming; but the pain is still there. In a way we scream inwardly, and while this is happening, like the child, we feel consumed by the pain.

We can get some insight into this by comparing different cultural reaction to pain. The- Anglo-Saxon tradition is to present a stiff upper lip in the face of pain or disaster, on the other hand Southern Europeans have an accepted tradition of giving vent to their feelings. Such a woman in childbirth may scream when she experiences pain, and give full vent to her distress; her Anglo-Saxon counterpart may lie there silent, but tense and blanched, and in obvious distress. Both are suffering severe pain because the element of distress has got out of hand whether it is openly expressed or not. Another woman may be led to relax in her mind. Then there is no distress. And because there is no distress there is little discomfort.

*108\57\2*

Q. We hear so much about the endoscope these days. What is it, and what does examination entail?

A. The endoscopes suddenly swirled across the medical horizon in the late 1960s, and during the 1970s became the most widely used form of investigation by the gastro-enterologists, the doctors who specialise in disorders of the G.I. system. Indeed, they have revolutionised diagnosis and treatment.

The principle is very simple. The endoscope is a long, flexible solid tube made of fibreoptical material. This is pliable and can turn and twist and be bent into many different positions and directions. At the far end there is a light. At the near end, there is an eye piece.

The doctor places the tube down the patient’s throat, into his stomach and duodenum, or lower bowel if desired. The light illuminates the area. When viewing through the eye piece, the doctor can see by direct vision, the inside part of the organs under examination. The image is perfectly clear, despite the number of turns and twists the tube makes.

Q. Therefore, diagnosis is perfectly clear to the doctor?

A. Precisely. He can see if there is an ulcer on the walls of the stomach or duodenum. He can gain a good idea if there are other disease processes present also. What is more, if there is a lesion that is suspect, small instruments located on the side of the endoscope may remove small sections. This is called a biopsy, and is invaluable for an ulcer, specially of the stomach, which in fact may be an early stomach cancer. These are later examinated by the pathology experts and an exact diagnosis made. The amount of information that is yielded may be phenomenal.

Q. Is the procedure painful, and is it given under anaesthetic?

A. The process is not painful. It may be a little bit uncomfortable, and a general anaesthetic is not given. Usually food is restricted for the twelve hour period immediately preceding the examination. When you arrive, you may be given a fluid to gargle and swallow. This is aimed at partially anaesthetising the back part of the throat to make the examination less irritating. You may be given a mild sedative or tranquilliser to settle the nerves, and make you feel a bit lightheaded and sleepy. But you usually are not rendered unconscious. Later, you may have only a hazy recollection of what took place. However, about 40 minutes later, you will feel okay, with no ill effects. The throat may be a little bit uncomfortable.

Q. Does it take long?

A. In all, the examination itself takes about 20 minutes. The endoscope is about as thick as a pencil, and you will ‘swallow’ this. The end in your stomach has a light, and a wiping system a bit like a windscreen wiper in the car, which keeps the tip clear so the doctor can see clearly. The flexible fibres carry the picture around bends and corners to the viewing piece at the doctor’s end.

After the test, when you ‘come to’, you may feel a bit drowsy, but generally within 40-60 minutes you are back to normal. If a working person, you usually only require a day off duty. Ideally do not plan to drive your car for the remainder of the day — just to be doubly sure of safety.

Q. Is this test safe during pregnancy?

A. Unlike x-ray examinations, there are no risks to the foetus during an endoscopic examination. However, if you are breastfeeding, or taking medication, it is wise to tell the examining doctor about this.

Q. What happens after this examination?

A. As with the results of the x-ray, these are relayed back to the referring physician, and the patient will then be placed under the appropriate therapy.

However, unlike the x-rays, which are taken by a radiologist, a doctor who spends all of his time in taking and interpreting x-rays, the gastro-enterologist who performs the endoscopy is a specialist in the field of the G.I. system. Therefore, he will often commence treatment once he has made the diagnosis. This may be instituted at once, for the patient is still with him, and after the diagnosis is confirmed, it is often convenient to proceed with therapy.

Q. Is it necessary or desirable to have other tests carried out?

A. Before the advent of the endoscope, various other tests were available, for checking acid levels, but these are now rarely used, and then only for specific conditions. The endoscope has revolutionised diagnosis of ulcers, as well as other bowel disorders. Now it forms a vital part of the doctor’s investigations, and an increasing number of these tests are being performed — usually to the patient’s benefit.

*11\61\2*

Once you’ve made an appointment to see your doctor, it’s a good idea to spend a few minutes beforehand jotting some down quick notes about how your symptoms developed, so as to have the answer to any questions you may asked readily at hand. For example, try to recall when you first noticed any symptoms. Was the onset sudden or gradual? Did the pain go after a while, then keep coming back? Can you remember any particular incident that may have triggered its start? Are there some activities that you know will bring on the pain? What about things that make it worse or better? Also try to be clear in your mind about the exact site or sites of the pain, the path it may follow, and whether what you experience is best described as an aching, burning, searing, or tingling sensation. Naturally, if you also have back pain of any kind, then make similar notes about that as well.

During your consultation, your doctor – after having heard your account of your symptoms – will examine you. Just how thorough that first examination will be depends greatly upon whether the diagnosis in your case is a fairly obvious one. In most instances of simple sciatica, the doctor will quickly form a pretty accurate impression of what the cause of the trouble is, and, unless the symptoms are very severe, probably recommend that the first approach to be tried is a few days of rest, together with analgesics to control the pain. It is a standard principle of medicine that when several different treatments are possible, the first thing to try is the least invasive one. There are several good reasons for this:

If the simple approach does the trick, all’s well and good, and the patient will have been spared the risk of possible side-effects that more energetic approaches frequently entail; and

As explained in greater detail farther below, many instances of sciatica and back pain are essentially self-limiting; and

Even tests and investigations can carry their own risks of side-effects.

*9\124\2*

Softening of children’s bones with permanent bowing of the legs, (“bandy legs”), medically known as rickets, was fairly common before World War II. With the discovery that rickets is caused by vitamin D deficiency, bandy legs have become rare.

Now, with rickets a thing of the past, physicians are beginning to see an illness due to vitamin D excess called hypercalcemia, a high concentration of calcium in the blood. Symptoms of hypercalcemia include weakness, nausea, vomiting, thirst, frequent urination, and distaste for food. Left untreated, hypercalcemia can produce kidney stones and kidney damage with high blood pressure.

According to the Lancet (1: 229), people vary in the amount of vitamin D excess they can tolerate without getting hypercalcemia, and it may not be safe for everyone to take a tablet containing vitamin D every day. The elderly who are not eating well and all growing children probably can benefit from taking a multi-vitamin tablet (containing vitamin D) every day, but well-nourished adults usually get enough vitamin D from their food, unless they are on a diet.

*217\143\2*

Signs and symptoms

The onset of strep throat is sudden. It begins with a headache, fever up to 40°C, sore and red throat, vomiting, abdominal pain, and swollen lymph nodes in the neck. If the infecting organism is rash-producing and the child is not immune, he or she will develop a rash within 24 to 72 hours. The rash is typical of scarlet fever, with fine, slightly raised red spots resembling coarse red sandpaper. It appears on the base of the neck, in the armpits and groin, and then on the trunk and extremities. The child’s face is flushed, but the lips are pale. When the rash subsides in three to 20 days, the skin flakes and peels.

The diagnosis of a strep throat cannot be confirmed without a throat culture that isolates streptococcus organisms. However, cultures are only 90 to 95 percent reliable. The diagnosis of scarlet fever is based on the appearance of the rash.

Home care

The only home treatment recommended is to give aspirin or paracetamol to relieve fever and pain. A streptococcal infection should be treated by your doctor.

Precautions

• Infants are immune to the scarlet fever toxin for four to six months if their mothers are immune. The infants are not immune to a streptococcal infection, which may be very serious but may not produce typical symptoms. Consequently, keep infants away from groups of children, some of whom may be carriers of the streptococci bacteria.

• If one child in your family has a streptococcal infection, your other children should receive a throat culture whether they are sick or not.

• Follow the full course of antibiotic treatment prescribed by a doctor, giving your child all the medication prescribed even if the child seems to be well before all the medicine is finished.

Medical treatment

Strep throat is diagnosed by means of a physical examination and the results of a throat culture. Penicillin (or another antibiotic for those who are allergic to penicillin) is usually prescribed for ten days to cure the streptococcal infection. Antibiotics prevent rheumatic fever and may prevent inflammation of the kidneys. A child who develops complications may have to be hospitalized.

*204/84/5*

What is stress? Sky-rocketing interest rates. An unfaithful husband. Problems with the tax-man. Children on drugs. An impossible boss. An unwanted pregnancy. If you believe that such matters are stress, we are not on the same wavelength in understanding what stress is all about.

‘I know what stress is. I can feel it.’ No. You don’t feel stress. What you feel is some malfunction of your body due to the anxiety which has been caused by stress.

Well, what is stress?

As I see it, stress is the disharmony of brain function that arises when our brain is unable to integrate all the information it receives.

Looked at in a more homely way, stress is the disparity between the adverse circumstances of our life and our ability to cope with them.

There are always two sides to stress. On the one hand there are the problems, and on the other hand there is the coping.

If we have some practical problem and if it is of considerable magnitude, our coping will be so much the more difficult. If the impulses arriving at our brain reach such a level of intensity that our brain cannot sort them out and integrate them, our brain function becomes disorganized.

This produces the various bodily and mental malfunctions which we recognize as the symptoms of stress.

Often there is some major problem which initiates the bulk of the disturbing impulses to our brain. But the main problem always operates on a background of lesser problems which contribute their share of disturbing impulses, and so add to the effect of the major problem.

Of course, the magnitude and severity of the major problem will play an important part in determining whether it will generate sufficient nervous impulses to disturb the harmony of our brain function. But the magnitude of the problem by itself does not produce stress. There is always this other factor. Our coping.

Coping with the nervous impulses arising from a major problem occurs at two levels. There is the practical level. What can we do in terms of practical reality towards putting things right? Then there is the other level of coping. What can we do to make it easier for our brain to integrate the flood of messages it is receiving?

In many life situations, the major problem is an event which is quite outside our control. So for practical purposes, our main way of avoiding stress is learning ways of helping our brain integrate the flood of impulses coming to it.

We are living beings. Over countless generations we have evolved a whole host of compensatory mechanisms to help us if we come under strain from one source or another. In strenuous exercise our heart rate is increased and so is the rate and depth of our breathing. We have similar restorative mechanisms to help us if our brain is over-taxed by a flood of nervous impulses from our problems. Those few fortunate people among us who have unconsciously learned to call upon these inner resources enhance the coping power of their brain, and suffer little stress. In this way they come to experience a dimension of life that eludes most of us.

*1/98/5*

A positive skin test may mean that the allergy is caused by the allergen used in testing; by an allergen that may cause allergy at a future date; by an allergen which has caused allergy in the past; or by an allergen which is similar to the one causing the positive test. Or it may mean that the positive skin finding is a casual one which is not related to the allergy in question. Therefore, extreme care must be exercised in diagnosing an allergy on the basis of skin test interpretations.

If the allergic history and skin tests are not conclusive, the Rast test may be used. This test works on the principle of an allergen reacting with its specific antibody in the blood serum of an allergic patient. It is safe, convenient, accurate, time-saving, and less traumatic than skin testing, but it is costly and not always available.

After the allergic history and the skin or Rast tests have been done, all the positive findings should be recorded in the following summary which must be kept in the physician’s records and should also be kept by the school nurse, the camp doctor, and the child’s parents.

*32/99/5*