About Health & Medicine

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.

*30/41/5*

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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Whenever Cheryl Allard goes to the gym, she abides by her 10-minute rule: Use one machine for 10 minutes, then move on to something else. This strategy helped her beat the boredom that nearly ended her exercise program. It also helped her lose 100 pounds.

Cheryl began working out in 1997 after finding out that she had high blood pressure. At the time, she weighed 265 pounds. “I was chubby even as a child,” recalls the 50-year-old sewing machine consultant from Chicago. “My parents lived in England during World War II, when food was rationed. They had the mindset that food was never to be wasted. I was raised to clean my plate.”

As Cheryl got older, the pounds kept piling on. “I tried every diet under the sun to slim down,” she says. “Once, I even lost 40 pounds, but they all came back.”

Then, Cheryl’s husband persuaded her to get a physical. “I hadn’t been to our family doctor in years, and my husband kept bugging me to go,” she explains. “I went just to keep him quiet.”

But Cheryl was the one left speechless after her doctor handed her a prescription for blood pressure medication. “That got me motivated to lose,” she says. “I didn’t want to be taking pills for the rest of my life.”

Cheryl went to a nutrition counselor, who helped her revamp her eating habits. She also joined a local gym, where she started using the aerobic-exercise equipment. “I felt self-conscious at first because of my size,” she says.

Over time, her self-confidence grew—as did her boredom. Even though she varied her workouts, they seemed to drag on and on. But she knew that she couldn’t stop exercising.

So she decided to add some variety to her workout routine. Rather than spending all of her time on one piece of equipment, she’d stay on for just 10 minutes, then switch. “I can do anything for 10 minutes,” she says. “Even though I detest riding that bike, I do it, knowing that it’s only going to be for 10 minutes.” Usually, she ends up using four or five different machines.

That did the trick. Cheryl found herself looking forward to her workouts so much that she started going to the gym 6 days a week.

It the years since, Cheryl has continued to eat sensibly and exercise regularly. And it shows: Her weight has held steady at 165

Within a year of launching her weight-loss program, she took off pounds.

In the years since, Cheryl has continued to eat sensibly and expounds. Even better, her blood pressure has returned to a healthy level, and she was able to stop taking her medication. “When my son got married not too long ago, my relatives flew in from England,” she says. “They were commenting on how much weight I had lost and how good I look. More important to me, though, is that I feel great!”

WINNING ACTION

Go for 10, then switch. Cheryl is doing what the experts call circuit training, and it has more benefits than just beating boredom. By using different machines, you work different muscles, trimming and toning your entire body. You can ask a personal trainer to create a circuit for you, or you can come up with your own, as Cheryl did. Use treadmills, upright bikes, recumbent bikes, stairclimbers, rowers—whatever aerobic machines your gym has available. Stay on one machine for 10 minutes, then move on to the next.

*99\89\8*

“You know, Dr. Fox,” a patient said to me, “this visualization and affirmation stuff sounds suspiciously like positive thinking.”

Yes and no. Positive thinking is saying it, either out loud or in your mind. I combine that with seeing it and feeling yourself already being, doing and having all the good things you desire.

The combination of affirmations, visualization and positive thinking mobilizes the endorphins and other biochemicals to help give you the good feelings, enthusiasm, energy and health you need to be a success. Perhaps the greatest medical discovery ever made is the realization that we can change our lives by changing our thoughts. We don’t fully understand this process— not yet—but we know it works. »

Most people fail in life because they’ve predisposed themselves to failure; they’ve stuffed their minds full of “I can’t,” “it won’t work,” “impossible,” “it’s too hard,” “I’m not good enough.” All these thoughts are negative affirmations, or negations, as I call them. Negations are just as powerful as affirmations are. Negative thinking cripples the mind as surely as polio cripples the body. But there’s a cure for negative thinking: positive thinking.

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In one of my previous books, The Beverly Hills Medical Diet, I introduced an exercise I called wogging: a combination of walking and jogging. I explained how I wogged through Beverly Hills in the morning or evening, alternately walking one block and jogging one block, past the beautiful homes and shops.

I’ve added a new step to my routine since then: skipping. That’s right, skipping, just like a child. Sure, skipping may sound a little silly, but that’s what helps make it so effective. First of all, when you’re skipping you’re using and toning muscles you don’t use when you walk—the muscles you use to hop. More important, however, is the fact that skipping is fun. It’s childish, it makes me smile and I get a smile from people watching me. And all that smiling makes me feel great. As we’ve learned, feeling good about yourself is good medicine for your “doctor within.”

Wogging is easy. Begin with 50 paces of brisk walking. Then shift to a comfortable jogging pace for the next 50 steps. Now skip for 50 paces with a broad smile on your face, and you’re ready to start another wogging cycle with brisk walking. When you’re new to wogging, you may have to take it easy on the skipping. Skipping is a lot of fun, but it takes quite a bit of energy to skip for more than a short distance. You may want to start by skipping slowly, or only skipping 20 or 30 paces, building up to 50 paces as you get stronger. Make sure to wear good-fitting, well-padded exercise shoes for wogging.

Wogging is a happy exercise. I enjoy wogging around the high school track, where the regular joggers often stop me to enquire about my unique exercise. Other times you’ll find me wogging through Beverly Hills. I wonder what the tourists on Rodeo Drive must think about the man they may have seen walking, jogging and skipping down that ritzy street?

*105\80\8*

But Dr. Fox,” some patients complain, Food is so much fun! It’s my only enjoyment in life.” I answer that food and eating should always be pleasurable, but food and eating are not, and should not be, the sole enjoyment in life. Life has a great deal else to offer: love, friendship, beauty, nature, knowledge, humor, exploration, the joy of nurturing, the excitement of pursuing a goal, the thrill of physical activity and sport, the satisfaction of quiet contemplation.

Food can be, and should be, a sensual delight. Ironically, most of us don’t know what food tastes like. We know the taste of fat, sugar and salt, in all their many combinations, but we are largely unfamiliar with the taste of real food.

The Immune For Life philosophy is that food is a very pleasurable necessity of life. It tastes great and gives you a comfortable, full feeling in your stomach. But food is also the raw material our “doctor within” uses to build health, happiness and longevity. That means we must eat good-tasting foods that also boost our “doctor within.”

Choose your foods from the abundance of great-tasting fresh fruits, vegetables, whole grains and whole-grain breads, rolls and pastas that are available. Low-fat fish is delicious, as is fish that is high in omega-3s. Small amounts of nonfat or low-fat poultry and dairy products add even more variety. With spices, herbs and small amounts of nuts and seeds, you can create innumerable taste sensations.

The first step is to decide that you want to live young and healthy to a very old age. Then make a point of discovering all the wonderful tastes the Standard American Diet overlooks. Be adventurous. Try eating vegetables raw or lightly steamed, not boiled to death or hidden under mounds of butter and sauce. Learn what food, all by itself, without a bunch of salt, sugar and fat, really tastes like. Find out how much zest garlic, ginger, herbs and spices add to food.

The recipes that follow will give you an idea of the different ways to prepare healthy foods. Some I created, and others were given to me by my patients, friends and family. I encourage you to experiment until you figure out exactly what you like and how you like it prepared. Feel free to add or subtract ingredients, alter the instructions or invent your own dishes. Super Food cooking isn’t the type of gourmet cooking that requires precise measurements and timing. In fact, on many recipes I simply say “spice to taste,” because I want you to turn cooking into a discovery process.

*62\80\8*

To make matters worse, thanks to at least three medical fallacies, our physicians often harm our “doctor within”. One of these is the idea that health is an either/or situation, with nothing in between.

We physicians tend to see a patient as either healthy or diseased. If the person is sick, treat the disease. If there is no recognizable disease, then there is nothing to treat. It seems so very simple, but it’s not.

Health isn’t an either/or state. It ranges from the best to the worst of health. Imagine a HEALTH LADDER. If you’re standing on the top of the ladder, you have vibrant health. Standing on the lowest rung, you have a serious disease, such as cancer. We don’t jump from the top of the ladder to the bottom, or the bottom to the top. Health and disease do not appear out of thin air. We climb up or down, step by step, passing through the various stages of disease and health.

With VIBRANT HEALTH you feel great at any and every age. Not only do you feel physically fit, you’re happy as well. Your emotional and spiritual health are excellent.

One rung down is FAIR HEALTH. In this condition you don’t feel bad, but you don’t feel great either. You’re a little tired, and perhaps you have a vaguely dissatisfied feeling about life. Still, you’re not sick, so, your doctor usually can’t help you.

Next comes the SYMPTOMS rung. Symptoms are the problems you begin to notice, such as shortness of breath, fatigue, headaches, backaches and chest pain. Standing on the SYMPTOMS rung, you feel run down and unenthusiastic about life.

A step below symptoms is the SIGNS rung. Signs are the changes in your health and/or body that we doctors can actually measure. Elevated blood pressure, irregular heart rhythms and abnormal blood counts are signs. Now you have something your doctor can treat, often with pills and injections. From the SIGNS rung, it is still possible to scramble back up the HEALTH LADDER.

When you’re down to the MEASUREABLE ILLNESS rung, you have an easily identifiable illness such as colitis, tumors, ulcers or diabetes. Now your physician is excited; he or she can bring out a full arsenal of drugs, surgeries, CAT scans, angiograms, nuclear magnetic resonance scans and dialysis.

SERIOUS ILLNESS is the next rung down the ladder. By now your health is nearly gone, and your life is in danger. Serious illnesses include heart disease, cancer, uncontrolled diabetes and strokes. These are the kinds of problems the medical system is geared to deal with. But even if a doctor manages to “cure” you, chances are you’ll never be really healthy again.

Below the SERIOUS ILLNESS rung is DEATH.

If you view health and disease as an either/or situation, you’re operating under a serious misconception.

Where do we stand on the HEALTH LADDER? Well, most of us are in average health. That puts us on the SYMPTOMS or SIGNS rungs, bad places to be.

*18\80\8*

Rheumatoid arthritis is a disease in which the joints become painful, swollen and warm, due to internal inflammation. There are characteristic changes in the level of certain factors in the blood that help to confirm die diagnosis. Contradictory results from different trials are often due to a failure to diagnose rheumatoid arthritis properly. This disease should not be .confused with other forms of joint pain, which are more transient and do not produce the same sort of changes in the blood, or damage to the joint – it is well known that joint pains of this type can be due to allergic reactions to food. What is at issue is whether foods can ever be a factor in true rheumatoid arthritis. In the two studies described here, all the patients involved were diagnosed as cases of rheumatoid arthritis by a standard set of tests.

Dr Gail Darlington, a consultant rheumatologist at Epsom District Hospital in Surrey, carried out one such trial, with the help of Dr John Mansfield, a private practitioner with many years’ experience of elimination diets. Dr Norman Ramsey, an experienced medical physicist, helped with the assessment of changes in the patients’ symptoms.

This was a reasonably large-scale study with 53 rheumatoid arthritis patients involved, and 44 actually completing the trial. They all underwent a two week ‘wash-out’ period, when the medicines they had been taking were withdrawn, and they all received paracetamol instead, plus a dummy tablet that they were told was a ‘new drug’. This sort of treatment is known as a placebo. Placebos play an important part in scientific trials.

*106\180\8*

Since its introduction in 1967, coronary artery bypass graft (CABG) surgery has enabled thousands of people to survive severe coronary artery disease.

Coronary artery disease (atherosclerosis) occurs when fatty deposits form in the coronary arteries, restricting flow of oxygen-rich blood to the heart. Over time, atherosclerosis may lead to a form of chest pain called angina…or to heart attack.

In bypass surgery, doctors reroute blood flow around arterial blockages, using blood vessels grafted from another part of the body, usually a leg.

The procedure has become so common that people tend to forget just how serious it is.

One surgeon slices open the chest, cracking the breastbone (sternum) to reach the heart, while another “harvests” the arteries or veins to be grafted. The heart is stopped for several hours as doctors attach the grafts.

Bypass surgery generally requires a hospital stay of four or more days, plus a one-month convalescence.

Bypass surgery is often the best therapy for heart disease, but it is not the only approach, other options to consider…

*85/47/1*

Common foods can cause headaches, fever, visual disturbances, confusion and a dangerous rise in blood pressure when eaten by individuals taking a prescribed antidepressant.

self-defense: Avoid tyramine-containing foods while taking a monoamine oxidase (MAO) inhibitor—even for several weeks after you stop taking the drug. Tyramine-containing foods include avocados, bananas, bologna, broad beans, aged cheese, caviar, chicken liver (stored), miso soup, meat concentrate (in gravy), pepperoni, pickled herring, salami, summer sausage, soy sauce, wines (Chianti and vermouth) and yeast extract (marmite).

Peanuts are easily aspirated into the lungs…and peanuts are one of the most common—and dangerous—foods to which one may develop an allergy.

most at risk: Those from high-risk families—where both parents or one parent and a sibling are food-allergic. Even trace quantities can trigger an attack in peanut-allergic individuals.

example: A boy began wheezing when ajar of peanut butter was merely opened nearby.

helpful: Alert teachers and other caregivers to the food allergy…have the child wear a MedicAlert bracelet (call 888-633-4298 for information)…older children should be taught to use spring-loaded syringes of epinephrine to ward off attacks after inadvertently ingesting a food to which they are allergic.

*76/47/1*