About Health & Medicine

A laparoscopy is a relatively safe and simple minor operation, performed under a general anaesthetic, in which a telescope-like instrument known as a laparoscope is inserted into a small cut near the navel.

Nowadays, laparoscopy is a fairly common operation which is used to diagnose a range of gynaecological conditions, including endometriosis and pelvic inflammatory disease. It is also used to treat a variety of gynaecological conditions, including drainage of simple ovarian cysts, and to perform sterilisation operations.

A laparoscope is a long thin telescope-like instrument approximately 30 centimetres long. It has a lens at the end which magnifies and lights up the pelvic organs and allows a gynaecologist to look for the presence of endometrial implants and cysts in the pelvic cavity. It can also be used to remove samples of tissues for testing, to perform minor surgery, to perform laser surgery and to take photographs.

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There are also numerous ‘tricks’, psychological or otherwise, that you can use to good effect to help you feel less hungry or make a smaller portion of food just as satisfying as a larger one. Researchers have found that the following ideas work well for most people, enabling them to adhere more easily to a restricted diet:

Drink a full glass of water half an hour or so before every main meal. The water makes you feel fuller when you begin to eat, so reducing your appetite.

Serve your food on plates smaller than those you normally use. The smaller plate will make a slimmer’s portion appear bigger than it really is, so deceiving your brain into believing that you’re having a larger meal than you are. Extending the same principle, try eating with a cocktail fork. This will force you into eating more slowly – the more slowly you eat, the more filling the food will seem to be.

Another useful ‘psychological’ tip in the same vein is to select food that is low in calories but which takes up a lot of room on your plate. Studies have shown that we eat what looks like the amount of food we think we want, subconsciously judging portions by the space they occupy. This means that choosing low-calorie foods, such as salads, that fill a lot of space on your plate can provide you with the illusion that you’re eating more.

Perhaps a rather extreme tip, but one that he swears is truly most effective, comes from an American slimming expert who suggests that you can make yourself eat less by making your food look unattractive by shining a green light on it.

Some more eminently practical suggestions that you can use to train yourself to eat less:

Much as you may hate to throw away good food, do not save leftovers from meals. Stashing away leftovers in the fridge, say the experts, is unconscious plotting to provide yourself with snacks between meals.

Keep foods that are low in calories in easily accessible places in your cupboards or fridge while placing high-calorie foods where they’re difficult to get to.

In so far as this is practicable, eat alone instead of in the company of others. Studies have determined that people eating on their own consume fewer calories on the average than those having a meal as part of a group. Additionally, those eating alone also spent less time at the table, thereby reducing the length of time during which they could have been tempted into having an extra helping.

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The diagnosis of depression has always been – and continues to be – made largely on the basis of a person’s subjective history. Although a skilful clinician will see traces of depression in a person’s face, observe sluggishness or agitation in the body’s movements and hear the slow cadence in the voice, it is the depressed person’s own story that will carry the day in making the diagnosis. A few decades ago there was great optimism that a laboratory test for depression could readily be found. No such luck. For better or worse, in your recollections of how you have been feeling and your accurate take on your present mood you hold the key to determining whether or not you are depressed. What the skilled clinician does is to organize these recollections and evaluate whether or not they meet modern diagnostic criteria for depression.

I remember well, before modern systems of diagnosis had been developed, how the question of diagnosis would be debated in teaching hospitals. A patient would be interviewed and there would be discussion to and fro as to the exact diagnosis. Finally the professor would opine as to whether he (and yes, it was almost always a man) thought that the patient was depressed or not. And his opinion would prevail because he was the boss. Well, clearly that was a most unsatisfactory state of affairs. For clinical, research and, more recently, insurance purposes, it became necessary to define depression.

The latest diagnostic classification system is called DSM-IV, a handbook referred to by insurance companies and others to determine a person’s clinical diagnosis. Each diagnosis is given a specific code number. The diagnosis for many psychiatric conditions, including clinical depression (referred to officially as major depressive disorder), was reached by the so-called Chinese menu approach. In Chinese restaurants, the fixed-price menus permit you to have a certain number of items from Column A, a certain number from Column B and so on. That’s how it is with the DSM-IV criteria for major depressive disorder, which I have modified and listed below. It is worth checking whether you meet the criteria for major depressive disorder. It is important to remember that these are strict criteria.

DSM-IV Criteria for Major Depressive Disorder

A Five (or more) of the following symptoms have been present for two solid weeks. This is different from your usual functioning. At least one of the symptoms must be either (1) depressed mood or (2) loss of interest or pleasure.

depressed mood most of the day, nearly every day, either experienced by yourself or observed by others

markedly diminished interest or pleasure in all, or almost all, activities, most of the day, nearly every day

significant weight loss when not dieting, or weight gain, or decrease or increase in appetite nearly every day

sleeping too much or too little nearly every day

being agitated or depressed to such a degree that others could notice it – not just internal feelings of restlessness or being slowed down

fatigue or loss of energy nearly every day

feelings of worthlessness or excessive or inappropriate guilt nearly every day – more than just feeling guilty because your depression doesn’t enable you to function adequately

decreased ability to think or concentrate, or difficulty making decisions, nearly every day

recurrent thoughts of death (not just fear of dying), recurrent ideas of suicide or attempting or planning suicide

AND

B These symptoms cause significant distress or impairment in your social, occupational or other important areas of functioning.

AND

C The symptoms are not directly due to the physical effects of medications, drugs or alcohol, nor the result of a medical condition, such as underactive thyroid functioning.

Now, many people who feel quite depressed do not exactly fit into the DSM-IV criteria for major depression. The diagnostic schema allows for these types of depression as well. These include briefer depressions that occur premenstrually (premenstrual dysphoric disorder), milder depressions (minor depressive disorder), and recurrent depressions that can be very severe even though they may last for only a few days at a time (recurrent brief depressive disorder). The good news is that all of these depressions, as well as those that accompany medical conditions or may be associated with drugs and alcohol, may be helped by the same treatments that are helpful for major depression.

One diagnosis, which has its own code in DSM-IV, is dysthymic disorder, a milder form of depression that causes a great deal of misery because of its chronic nature. I have modified the DSM-IV criteria for dysthymic disorder and have listed these below.

DSM-IV Criteria for Dysthymic Disorder

A depressed mood for most of the day, for more days than not, either experienced by yourself or observed by others, for at least two years

AND

B presence, while depressed, of two or more of the following:

poor appetite or overeating

insomnia or sleeping too much

fatigue or low energy

low self-esteem

poor concentration or difficulty making decisions

feelings of hopelessness

AND

C during the two-year period, you have never been without the symptoms in A or B for more than two months at a time AND

D the symptoms are not due to the direct physical effects of medications, drugs or alcohol or to a general medical condition, such as underactive thyroid functioning.

As you read through the criteria, it will become obvious that they are somewhat arbitrary. What if you were free of symptoms for two-and-a-half months? Does that mean that you are not dysthymic or wouldn’t benefit from treatment? Although systematic diagnostic schemas have been useful for standardizing diagnoses for research and other purposes, the seasoned clinician and the clued-up patient should realize that diagnosis is not a precise science and not get too hung up on whether someone exactly meets the criteria or not before deciding on whether and how to treat.

It is clear that when we are dealing with depression in all its forms, we are dealing with a continuum, with happy normal mood at the one end and serious depression at the other and all sorts of gradations in between. The same treatments that help the more severe forms of depression will generally also help the milder forms and vice versa. The most important determinants of whether or not you seek and receive treatment are therefore how bad you feel and whether you are willing to reach out for help.

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Once the home oasis is established, it is possible to attempt to make changes in the workplace as well. If the patient is self-employed, this is usually fairly easy to arrange. If he or she works for someone else, it may require some argument to convince an employer to make changes for the patient’s benefit. Sometimes it is easier to seek a transfer within a company or even another job which is less harmful to one’s health.

In some cases, however, employers have been impressed enough with the change in an employee’s health, including increased productivity, to voluntarily make ecologic changes in the workplace. After all, it is in their long-range interests, too, to have more productive employees. In some cases, employers have eventually come in as patients after seeing this method bring about improvements in the life of an employee.

Naturally, some polluted workshops are almost beyond repair for the ecology patient. In such cases, patients can take their health grievances to their unions or to the appropriate government agencies for adjustment.

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Thanks to their bitter taste, potato stems and leaves are rarely eaten. This is fortunate because all parts of a potato plant except its root tubers (the potatoes) contain the potent poison, solanine. High concentrations of solanine are produced in the shoots of potatoes; and the potatoes themselves, as well as their shoots, become loaded with solanine a few days after they begin sprouting.

Vomiting and diarrhea, sometimes accompanied by mild fever, appear four to 14 hours after ingestion of sprouting potatoes. Large amounts of solanine can cause coma, convulsions and circulatory collapse, from which some people never recover. According to the Quarterly Journal of Medicine, the diarrhea and vomiting last for about a week, while mental confusion and hallucinations may persist for several more days after physical recovery. People already weakened by heart disease, alcoholism, or malnutrition, etc., are the most likely to be fatally affected.

Two points worth making are that mild solanine poisoning may be the unrecognized cause of institutional diarrhea outbreaks and that no amount of cooking can remove solanine from potatoes once it has been formed. So, be on the safe side, and throw away any potatoes that are beginning to sprout.

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Signs and symptoms

The onset of heatstroke is signaled by a feeling that lungs and muscles are “on fire.” The child may have a dry mouth, difficulty in breathing, dizziness, nausea, and blurred vision. However, the most characteristic signs of heatstroke are extremely hot, flushed, dry skin; high fever; and the complete absence of sweating, which usually leads to unconsciousness.

Home care

If you suspect that your child has heatstroke, call immediately for emergency-help and then begin first aid. Remove the child’s clothing and place him or her in a shady area. Place the child in a reclining position with the feet higher than the head. Pour cold water over the child, rub the body with ice, then fan the child to promote evaporation which will lower the body temperature. Continue this treatment until the child is conscious and the body temperature is back to normal. Then give fruit juices, which will replace minerals as well as fluids lost during dehydration. Watch the child carefully, and if the symptoms recur repeat the treatment process. If the child does not revive within minutes emergency care is essential.

Precautions

• Heatstroke can cause brain damage or death if not treated correctly and promptly. A child with heatstroke who doesn’t revive within minutes requires emergency care immediately.

• Heatstroke occurs most often when both temperature and humidity are high.

• Strenuous exercise within one week of an attack of heatstroke may lead to another attack.

• Lack of water, excessive sweating, vomiting, and diarrhea increase the child’s susceptibility to heatstroke.

• Taking salt tablets can increase rather than lessen a person’s risk of getting heatstroke.

Medical treatment

If a child with heatstroke does not revive in minutes, injections of special intravenous fluids will be required.

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In 1995, more than 21,500 people were murdered in America. That’s about 8 out of every 100,000 people. Homicide is the second leading cause of death among all young people ages 15 to 24. What’s more, 77 percent of the people killed in 1995 were men.

Yet the reality is that violent crime is on the decline. During the past five years or so, violent crimes such as assault and battery have dropped about 12.4 percent. The murder rate itself has dropped 13 percent. So why do we still feel so unsafe?

Ask most cops how to cut down on homicide and they’ll give you two words: “gun control.” Eight out of every 10 murders are committed with a gun, most often a handgun.

Contrary to the message sent by the John Waynes and Dirty Harrys out there, packing your own heat is not the solution to gun violence, says Hubert Williams, president of the Police Foundation in Washington, D.C. “The great majority of people who get guns are not trained to use them, and that doesn’t just mean how to fire them,” says Williams, who was a police director in Newark, New Jersey, for 11 years. “Your chance of getting shot by someone who has a gun on you is much higher if you have a gun, too. Plus, too often the perpetrator doesn’t have a weapon until he gets his hands on yours.”

And that’s not even considering how risky it is just to have a gun in your house. A firearm in your home is 40 times more likely to hurt or kill you or a family member than it is to stop a crime, says the National Crime Prevention Council (NCPC), in Washington, D.C.

There are better ways to protect yourself against gun violence, says Williams. Here’s what he recommends.

Take up the arts. “If I had to name one effective form of self-defense for almost everybody, it would be the martial arts,” Williams says. Not just because they teach you how to throw a kick or a punch, but because you learn a mental discipline that teaches you how to handle potentially violent conflicts without getting hurt. You also learn to develop the presence of mind to sense dangerous situations before you get into them, he says.

Take a Stand. To keep guns from the hands of folks who shouldn’t have them, continue to support laws like the Brady Bill that require background checks for purchasing a firearm. The Bureau of Justice Statistics reported that since the Brady Bill took effect in 1994, 173,000 illegal handgun sales – meaning sales to someone with a criminal record – have been blocked.

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If the ocean can help relieve the symptoms of arthritis in a better way than some other remedies, and various other treatments, then the details of how and why should be presented right away. If this treatment is so good, then it has to be made known to the world and be used wherever possible. Why is it not already widely known?

In fact, this treatment is being widely used in several countries throughout the world. It is being used by specialists in the rheumatology departments of hospitals, by general practitioners working cither independently or in group-operated clinics, and by the ordinary person in the street, who can simply purchase it over the counter of the chemist or local health food store.

The treatment consists of taking a daily dosage of an extract from a shellfish grown in New Zealand waters. It is effective in relieving the symptoms of both rheumatoid and osteoarthritis in subjects of any age group without the disadvantage of dangerous side-effects. The extract is normally in the form of dry powder. This may be encapsulated in hard gelatin capsules similar to the type commonly used with antibiotics, or it may be in tablet or granular form.

The daily dosage may be required for a period ranging from as little as three weeks to as long as eighteen weeks. The shellfish is the New Zealand Green-Lipped Mussel which is scientifically identified by the name Perna canaliculus. Results using this treatment have been excellent. There have been cases of very elderly people crippled for many years, who have had such relief from pain, together with restoration of mobility, that they have recommenced outdoor activities that had been given up long ago.

There have also been cases of very young children of school and even pre-school age suffering from attacks of severe rheumatoid arthritis who have been able to resume their normal activities in full following treatment with this substance. Not all cases are dramatic of course. Some are simply like the panel-beater who can work a full day again after previously having to give up after an hour or two because he could not grip his tools; or the professional pianist playing again after having to give up work because of arthritis in the fingers. These are just everyday cases but they are certainly dramatic as far as the person involved is concerned.

The symptoms relieved by this treatment include relief from pain, increase in freedom of movement and, in some cases, the disappearance of distorting features. Quite obviously there will be many questions which we would like to have answered. For instance does it work for everyone and are there any side-effects? Probably the best way to cover this aspect is to take questions most likely to be asked and then answer them in detail.

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For the majority of women with endometriosis the initial decision regarding treatment is whether to have hormonal or surgical treatment. Ideally, you should make this decision yourself in consultation with your gynecologist.

The reasons for selecting a particular treatment vary widely and will depend on a number of factors including:

• extent and severity of the endometriosis

• size and location of the endometrial implants

• extent and location of any adhesions

• nature and severity of symptoms

• duration of any infertility

• desire for future childbearing

• age

• whether or not related problems exist

• success of previous treatments

• your preferences

• the preferences and practices of your gynecologist.

If you have minimal to moderate endometriosis, hormonal treatment is usually recommended. In contrast, if you have severe endometriosis you are more likely to have surgical treatment although hormonal treatment may still be appropriate if you do not have any large cysts.

If you have any adhesions or endometriomas greater than two centimeters in diameter, these can only be removed surgically as hormonal treatment has no effect on adhesions or large endometriomas.

Some women choose hormonal treatment rather than surgery because they do not want to have their lives totally disrupted for several weeks while they recover from an operation. Others choose hormonal treatment because they feel that it is a less drastic form of treatment or because they do not like the idea of having surgery. Some women do not want surgery because they do not want to take the risk of developing adhesions which surgery can cause.

Some women choose surgery because they do not want to delay trying to conceive for another six to nine months while they are having hormonal treatment. Others may have already experienced intolerable side effects from previous hormonal treatment and would rather try surgery. Others simply do not wish to use drugs or are concerned about the possible long-term effects of hormonal treatment.

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Physical aspects of anorexia nervosa

Some of my anorexia patients tell me that they rarely feel hungry. They are so good at starving themselves, they say, because they’ve trained themselves to suppress hunger.

I’ve dealt with enough patients to know that’s not always the case. These people may be frequently hungry. Their illness is such that they must stand guard at all times lest hunger overwhelm them and they give in to the urge to eat even a mouthful of food.

Their claim that they don’t experience hunger may be in part a product of selective inattention. They don’t want to be hungry; therefore, eventually, they fool themselves into believing that they aren’t. They convert a hunger pang into a signal that they must work harder at being thin, through exercise or some other means. In part, however, their starvation may biologically decrease their perception of hunger.

Hunger denial isn’t present in all anorexics, though.

A patient named Jackie often remarked that yes, she did indeed feel hungry-a feeling she began to display as a kind of badge of valor. I once heard her remark to a fellow patient, “I could eat a horse- but of course I won’t.” Later, during a therapy session, I probed a little deeper into what she meant. Jackie replied, “If I can keep from eating even though my appetite is so huge, I know I’m succeeding in my quest to be thin. That success makes me feel very proud.”

Jackie thus revealed that she believed her extreme hunger (and her ability to resist it) marked her as a skilled soldier in the fight against fat. She actually cultivated her hunger because being aware of it helped make her feel thinner.

Some anorexic patients report that their efforts to starve themselves spring from their fear that they will eat beyond the point of fullness. For these individuals, a full stomach becomes a source of horror. If they eat enough to feel even a little full, they panic. They fear they have gone over the edge, that they have lost all control.

I treated a sixteen-year-old patient named Zoe, who had been anorexic for three years. Long after she began to improve, Zoe was still terrified that she might eat too much. Over the course of her illness, she said, “I think I’ve lost the ability to know how much food is enough.” Zoe’s satiety feedback loop had malfunctioned. It took months of treatment for this patient to relearn correct eating behavior.

Laboratory studies on anorexia patients often reveal that the hypothalamus isn’t functioning the way it should. Less clear is whether a defect in the hypothalamus causes the anorexia, or whether the effects of starvation have in turn affected the hypothalamus. Without going into detail, suffice it to say that, to different degrees in different patients, starvation and loss of body weight disrupt endocrine functions ranging from the thyroid to the liver to the reproductive organs.

These endocrine changes in anorexia occur along several body networks. Amenorrhea, loss of interest in sex, and reduction in breast size are all symptoms related to the pathway connecting the hypothalamus and the pituitary gland with the reproductive organs.

Other pathways link the hypothalamus to the nerves regulating blood pressure and heart rate, or to the body engines that turn our sleep cycles on and off.

There may even be a physiological network that governs one’s ability to perceive the body accurately. If so, disturbance of body image, one of the key symptoms of anorexia, may result from abnormalities in the neurotransmitter system.

At some point, the anorexic’s illusion that hunger doesn’t exist becomes a reality. In the terminal stages of the illness, hunger does indeed disappear. Without sufficient food, the body withers. The stomach shrinks, as does the small intestine. The ability of these organs to function shrinks as well. The stomach pumps out less digestive acid, and is thus less able to break down what little food is available. Eventually the stomach muscles may atrophy and lose their ability to pass food into the small intestine, a medically serious condition known as gastric dilatation.

Physical aspects of bulimia nervosa

Laboratory tests on bulimics reveal various endocrine abnormalities. Most of these, however, reflect the impact of bulimic behavior-bingeing and vomiting-on the body. They are the effects of the disorder, not the cause.

As we know, the act of vomiting depletes the body of essential fluids and chemicals. The passage of stomach acid up through the esophagus and out the mouth can burn or deteriorate the lining of the throat and causes tooth erosion. Loss of certain minerals threatens the ability of muscles to function properly. The heart is at high risk of developing an irregular rhythm or of stopping altogether. Affected by fluid imbalance, perhaps made worse by the use of diuretics, the kidneys malfunction. Menstruation becomes irregular, or stops altogether, due to changes in the body’s ability to manufacture and secrete hormones. The list-a sad one-goes on.

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