Few treatments are as effective as oestrogen, but if oestrogen is not for you, then what else can you do? Firstly, try not to let your doctor prescribe tranquillisers, sedatives or anti-depressants; they don’t relieve die hot flushes and night sweats, and they may make you feel much worse.

Controlling or preventing hot flushes is not easy, but some things make them worse, so:

• try to cut down on smoking, coffee and alcohol

• avoid hot spicy foods

• try to avoid stress

• ask your doctor if any tablets you are taking could be making the flushes worse

• wear cool, loose clothing made of natural fibres, especially in hot weather

• have a tepid shower whenever possible

• if you decide to stop HRT, do it as slowly as possible, and not during hot weather or times of stress

‘I stopped taking HRT to see if my ovaries would start working again without it, but they didn’t, and the hot flushes came back. So I went back on the HRT and feel much better now. I am 52.’

‘I bought some special “calcium tablets for women” from the health food shop for my flushes, but they didn’t help at all.’

The first of the two women quoted above doesn’t understand that once ovaries have stopped ‘working’ after the menopause, they won’t start up again. And the second has been misinformed about calcium tablets; they will help your bones, but not hot flushes.

Herbal remedies can sometimes help hot flushes; instead of just buying something over the counter at the chemist or health food shop, you might get a remedy that is more appropriate for you if you visit a medical herbalist or an aromatherapist. A homoeopath may also prescribe a suitable remedy. Bear in mind, though, that these remedies are not oestrogen, so will not prevent osteoporosis; however, many women And that alternative medicines can help other aspects of coping with the menopause.

Unlike vaginal and bladder problems, and osteoporosis, hot flushes will eventually pass for almost all women. They can be embarrassing and uncomfortable, and they may make you want to disappear into a hole in the ground, but they don’t last forever. If you are lucky, they will be over in about two years or even less, and if these are your only symptoms you may well feel that HRT is not necessary for you; if you are one of the unlucky ones, the hot flushes may still be with you in 20 years, and HRT may be the only effective solution.

*65\42\4*

Smoking endangers heart health, as well as having a detrimental effect on our bones. If you are a twenty-cigarette-a-day smoker, you will suffer more from atherosclerosis (narrowing and plugging of arteries) than comparable non-smokers. You also have double or triple die risk of sustaining a crippling or fatal heart attack than someone of the same age, family history and activity level who does not smoke. Giving up smoking effects a rapid improvement in the health of the heart. Twelve months after quitting your risk of sudden death from heart attack is almost half that of persistent smokers and, after five years, this risk is almost identical to that of non-smokers.

Dangerous blood clots (thrombosis), which may lodge in any part of the body, can occur after surgery. Risk factors for thrombosis include being overweight and heavy smoking. If a hysterectomy, myomectomy, or endometrial resection is not urgent, it should be deferred in women who are overweight and who smoke until they have taken off excess kilos and quit smoking.

Surgeons can also help prevent thrombosis during major surgery, such as hysterectomy, by artificially stimulating the calf muscles to contract during the operation. This does no harm. Another technique is to inject an anticoagulant, such as heparin, to reduce the clotting activity of the blood. This has the disadvantage of increasing the amount of bleeding that occurs during surgery, but is generally considered preferable to the formation of a blood clot.

Women having any form of surgery should be able to recognise the early signs of thrombosis in the legs or a blood clot (embolus) in the lungs. The middle of the calf may become tender at rest or sore when moved, or the ankle may swell. An embolus in the lung may cause pain on breathing, a dry cough, shortness of breath, and soreness or pain in the chest If any of these symptoms occur, it is important to tell your doctor or nurse promptly. An early diagnosis nearly always averts further problems.

Paradoxically, there is some evidence to suggest that women who smoke are less likely to have a hysterectomy. The reasons for this are unclear but it may be related to the suppression of oestrogen by some of the toxic components of cigarette smoke. It is presumed that smoking keeps the oestrogen required for fibroid growth under control.

*79\198\4*

What is hypnosis? The story of hypnosis started a few hundred years ago. The first record of the use of hypnosis on patients has to be that of Dr Franz Mesmer. He graduated from medical school with honours in 1765. He practiced first in Vienna and later in Paris. Pierre Janet, in his book Psychological Healing, gave the following description of Mesmer’s method of practice. Mesmer used an elaborate apparatus. In the centre of a hall, which was filled with the sound of ceremonial music, he placed a large oak tub, Mesmers famous ‘baquet’. This was filled with water, iron filings, and powdered glass. It had a lid pierced with holes and coming up through the holes were iron rods. The patients, who were completely silent and expected something to happen, would join hands and apply the iron rods to those parts of their bodies afflicted with the ailment. Mesmer, the great magnetizer, in a silken robe of lilac colour, would then appear with a long iron wand in his hand. He would pass slowly in front of his patients, fixing his eyes on them and passing his hands on their bodies or touching them with his magnetic wand. These patients, because of his great name, were expecting something to happen. Some did not feel anything, but some felt uneasy, some went into a trance, and some, especially young women, fell down on the ground and went into convulsion. This was supposed to be therapeutic, and after a few of these ceremonies, and payment of enormous fees, many patients declared that they had been cured of many of their ailments.

Magnets were supposed to be full of supernatural power in those days, and the ceremony provided the suitable environment for most of these patients to go into a trance state. Mesmer knew nothing about hypnosis, nor did he know why some of his patients got better. It was later discovered that patients with hysterical or psychosomatic symptoms would improve if they went through cathartic experiences or acted out some of their buried, unconscious, primitive wishes. We now describe a person in a trance as a person being mesmerized, and mesmerism is somehow equated to hypnotism.

*81\174\4*

Pain may arise from injury to our body cells. This is known as organic pain. More accurately it arises from the stimulation of nerve fibres as a result of injury to the body tissues. However, some organs of the body, such as the brain itself, are not supplied with pain nerves, and these organs can be cut or otherwise injured without causing any pain at all. In other instances. due to the complicated anatomical arrangement of the nervous system, the pain is not felt in the diseased part but is felt is some other area.

On the other hand, pain may arise in any part of the body as a result of the operation of psychological mechanisms within the mind, and in the complete absence of any physical disease or injury, This is known as functional pain.

It is important that we do not consider a person suffering from functional pain as imagining that he suffers pain. This is not so. He does suffer pain. Furthermore, functional pain may be very severe, and there is nothing in the quality of functional pain which automatically distinguishes it from organically determined pain. Although we can often tell one kind of pain from the other by the way in which it comes about or by the patient’s reaction to it, we cannot always distinguish the two by the actual nature or severity of the pain.

*103\57\2*

Q. What causes these erosions to take place in a healthy person?

A. The basic cause is too much acid and pepsin in the gastric fluid. At all times, a continual battle is going on in the stomach. On one hand, glands in the walls are actively producing acid, which in turn allows production of pepsin, and these two liquids commence digestion of the food. This means it is broken down into its basic component parts which will allow it to be absorbed by the blood stream further down in the intestinal canal. On the other hand, the mucosal lining has to resist the action of these chemicals on itself, for it is also subject to being digested — a case of the body actually devouring itself! Normally, the two remain in a fairly stable equilibrium, and no harm occurs; food is broken down, and the stomach wall remains intact.

Q. Do ulcer patients produce too much acid and pepsin?

A. In most cases, probably all, the answer must be ‘Yes’. Often this is not so with stomach ulcers, but it has been found that in many cases of duodenal ulcer, acid production is three times that of normal. Imagine that hot burning acid being present in three times the normal volume. We have already pointed out the extremely strong burning nature of hydrochloric acid — as every plumber who solders knows — and this may act for hours on the lining of the intestine. No wonder that little craters and holes develop.

In a particular disorder called the Zollinger-Ellison syndrome, acid production is stimulated to incredibly high levels and as much as eight times normal acid production occurs. Little wonder these patients suffer from serious ulcers.

Q. If there is no acid present, does that mean no ulcers?

A. The reverse holds true. Excess acid and there is a high risk of ulcers. No acid, so called achlorhydria, and there is no chance of an ulcer developing.

*6\61\2*

As already noted briefly, sciatica can be experienced in a number of ways. Most typically it manifests itself as one or more of the following sensations, with some sufferers having more than one kind of sciatic pain or discomfort:

A pain that sufferers describe as ‘aching’, ‘stinging’, or even ‘burning’, this either following a specific course, such as along

the back of the leg, or restricted to one specific area, such as the upper part of the thigh.

A cramping pain, as though the muscles in the affected leg are contracting involuntarily. ‘Cramping’ sciatica is also often marked by spasms.

Less specific – and also usually less severe – pains, including feelings of numbness, or experiencing ‘pins and needles’, these once again being experienced either over a fairly large area or concentrated within a much smaller one.

Because it’s only too easy to mistake some of the pains or feelings of discomfort that arise from ‘mild’ sciatica for something else – for example, pins and needles or cramp may happen because you’ve been sitting too long in the same position, especially if your legs were crossed – it often takes some time before a sufferer comes to the conclusion that his symptoms are due to something specific and are more than merely the kind of odd sensations most of us experience now and then, dismissing them from our mind once they disappear seemingly of their own accord.

For many, however, the onset of sciatica is only too obvious as its pain is so intense that it is virtually crippling during its worst moments. A bad attack of sciatica can be so disabling that even the smallest movement, such as getting in or out of a chair, or even sneezing or coughing, brings on agonising distress. Acute sciatica can usually, but not always, be linked to some recent incident or event that provoked it.

The specific underlying causes of sciatica are examined in the next chapter in which we also look at the ‘greater picture’ of back pain in general.

*4\124\2*

Of late, vitamin A has been much in the news as a drug that reduces the incidence of certain cancers. Accordingly, for the sake of fair balance, we felt that our readers should be told about a recent report in the Western Journal of Medicine (137:429).

A young woman visited her doctor because dryness of the eyes made it uncomfortable for her to wear her contacts. She also complained of a sore tongue and gums, cracking of the skin at the corners of the mouth, and generalized itching and dryness of the skin. She also had a continuous headache, felt nauseated, and had frequently vomited during the previous seven days. Devoted to jogging, she nevertheless had had to give it up because of severe pains in her bones.

On being questioned in the hospital, this lady (a health food store employee) admitted taking 25,000 units of vitamin A daily (five times the “recommended daily allowance”) for several months. Tests showed abnormally high vitamin A blood levels that, among other things, had disturbed her liver. All of these signs and symptoms were typical of toxicity due to excess of vitamin A.

Treatment with intravenous fluids normalized this woman’ s blood levels of vitamin A in about a week. Had she taken vitamin A in excess for much longer, however, early death from liver failure would have become inevitable. The lesson, then, is to take only enough vitamin A to avoid deficiency and bolster resistance against cancer, the recommended daily allowance (RDA), but do not take it in excess.

*212\143\2*

Symptoms

Sudden abdominal pain; cramping pain; diarrhea; vomiting

Home care

Apply mild heat to the abdomen.

Treat constipation by changing the child’s diet or with a glycerin suppository.

Precautions

-    Do not try to relieve stomach pain by giving a laxative or placing ice on the stomach.

-    If you cannot diagnose the child’s pain as being due to a cause such as constipation, digestive tract upset, or emotional stress, take the child to the doctor.

-    If the stomach pain is accompanied by fever and painful urination, the child should see a doctor.

-    If pain is accompanied by a fever and a cough, see a doctor.

-    If any stomach pain persists or gets worse, consult a doctor.

-    Severe, crampy stomach pain accompanied by blood or mucus in the stool requires a doctor’s attention.

-    Be concerned if the stomach pain causes the child to bend forward while walking.

-    Severe pain that follows injury to the abdomen or lower chest may indicate internal injury and requires a doctor’s attention.

The abdomen contains the stomach, small and large intestines, liver, spleen, pancreas, kidneys, urinary bladder, gall bladder, and organs of reproduction. Disease or injury involving any of these organs can cause abdominal pain and, consequently, a “stomachache” can test the diagnostic ability of a parent or a doctor. Fortunately, almost all stomachaches in children are caused by one of four problems: constipation; acute digestive tract upset (caused by viruses, bacteria, or improper diet); emotional stress; or urinary tract infection.

Other less frequent causes of a stomachache are appendicitis, pneumonia, infectious mononucleosis, and hepatitis.

*199/84/5*

Drugs may be absorbed by mouth, by injection, by inhalation, or by contact. They may be well accepted, or they may cause intolerance or allergy. Intolerance is an exaggerated response to a large quantity of a drug, while allergy is sensitivity to the drug regardless of the quantity used.

Allergy to a drug assumes one of these forms:

a.     A local inflammation and itching (for example, at the site of a penicillin injection)

b.     A fixed reaction caused by swelling and itching which appears in the same place each time the drug is used ñ Hives

d.     Anaphylaxis

e.     Serum sickness

Drug allergy is usually less severe in children than in adults; drugs sensitize when first used, but open the door to dangerous reactions later on. A good example of this is anaphylaxis caused by a second injection of penicillin.

Anaphylaxis

This is a dangerous allergic reaction which may occur after an allergy injection, a bee sting, the eating of allergenic foods, an injection of horse serum, or an injection of penicillin. The symptoms may be shock, hives, congestion in the nose, or asthma. To prevent anaphylaxis, a careful history (to avoid a potential allergen) should be taken by the child’s allergist.

A child who has had a slight reaction to penicillin should avoid its use. In case it is imperative to use it, it is much safer to have it taken by mouth than by injection. Furthermore, injections of penicillin are to be given in the arm and not in the buttocks, so that a tourniquet may be placed above the place of the injection to slow down the passing of the injected material into the circulation (in case of a reaction).

The treatment of anaphylaxis consists of:

a.     An injection of adrenalin to relax the spasm of the bronchi and to diminish the secretions of the mucus glands

b.     An intravenous injection of calcium gluconate

ñ     Monitoring of the blood pressure so that another injection of adrenalin can be given if it becomes necessary

d.     Hospitalization

*26/99/5*

Luteinising hormone (LH) controls the development and release of the egg from the ovary. Women who have high levels of this hormone in the first half of their menstrual cycle seem to have a greater risk of miscarriage. In addition, women with polycystic ovary syndrome (PCOS) have raised levels of LH.

Progesterone is the hormone which maintains the pregnancy during the first few weeks. After the egg has been released from the ovary, the ruptured follicle then develops into the corpus luteum which produces progesterone. If the egg is not fertilised, after 14 days the corpus luteum withers, progesterone levels fall and a period occurs. If the egg is fertilised and the embryo implants successfully and starts to produce another hormone hCG (human chorionic gonadotrophin) then the corpus luteum gets the message to continue producing progesterone. Without sufficient levels of progesterone, the pregnancy cannot continue, and that is why anti-progesterone drugs are now used to terminate an early pregnancy without the need for an operation.

Because of this obvious link between progesterone and maintaining pregnancy, many doctors give progesterone as injections or pessaries to prevent a miscarriage. But Professor Lesley Regan, in her excellent book Miscarriage, states that ‘Injections of hormone, in the early weeks of a pregnancy at risk, may prolong the miscarriage but they cannot reverse it. Low progesterone levels in early pregnancy are the result rather than the cause of miscarriage.’

After the egg has been fertilised, the womb (endometrium) lining will also stay thick where the embryo will implant and develop. If the womb lining is inadequate, then the embryo will not ‘hold on’ and a miscarriage will occur. It is possible to have good levels of progesterone and yet have a thin womb lining, perhaps because the womb lining is not responding to the levels of progesterone. Other doctors, however, do give progesterone to women with a history of recurrent miscarriages and they have gone on to have a successful pregnancy.

Ultrasound can also be useful for those women with a history of recurrent miscarriages, as it can often pick up an indication of corpus luteum failure before any drop in progesterone level is seen in the blood. This is where the use of progesterone can be beneficial.

There are so many factors that govern the efficient functioning of the cycle that it is not always easy to identify cause and effect. Every part of the cycle is dependent on what went before so we may not be able to ‘fix’ problems in the second half of the cycle without looking at what has gone wrong in the first half. By going back to the basic foundations of health and getting yourself back into balance, you have a much better chance of maintaining a pregnancy without the need for hormones or other drugs.

*101/73/5*