Comprehensive men's sexual health information, tips and news about men's sexual health.

Are operations such as appendicectomies, hysterectomies and tonsillectomies being done excessively in those private practices based on fee-for-service.

The allegation is worrying many doctors, politicians and the public, and peer review has been suggested as the answer.

This means that an individual doctor’s work would be reviewed by his fellow practitioners and compared with what is generally accepted as right and proper.

Operation figures reflect not only what the doctor considers necessary but also what the patient demands.

In this modern age, many people are not prepared to tolerate chronic symptoms which, perhaps, their parents were prepared to put up with because of a fear of operation or anaesthetic.

For example, appendicitis is common and the standard English textbook recommends that early diagnosis and prompt removal of the appendix is the ideal. If this be done, it may be that a number of “normal” appendices are removed.

The appendix comes off the caecum or first part of the large bowel. It is present only in humans, some anthropoid apes and the wombat.

*203/71/1*

About a year ago, Dr. Obama received a letter from an Oklahoma woman who cold an odd tale of pain and suffering due to endometriosis. To his surprise, Mrs. Petersen’s account was not about her daughter, her sister, mother; aunt, or a friend. Rather, the unsuspecting victim of this insidious disease was her husband, George.

“How could a man develop endometriosis?” she asked. “How did nature go so wrong in George’s case?” Since neither she nor her stricken husband could justify the problem rationally—men, after all, do not menstruate—Mrs. Petersen wondered if perhaps like might have been somehow responsible for his plight. Of course, she was not to blame, since endometriosis is net transmitted sexually, nor is it a contagious disease in any way. Endometriosis is a rarity in men, and how it occurs among them may enlighten us in treating women.

George Petersen’s bout with endometriosis unfolded in this astonishing letter. He was only forty years old when the first symptoms appeared. George was in generally good health, except for frequent and severe headaches, brought on, they thought, by stress; be had also succumbed to chronic bladder problems. ‘Our doctor said George had an enlarged prostate,’ Mrs. Petersen wrote, ‘and be never really felt at his best for nearly two years. It seemed like a terribly long time for us. Finally, he was told he had cancer of the prostate. It scared us, but at least we knew what was going on, terrible as it was.’

George was assured that the recovery rate was high, she said, especially if the cancer was caught early. He agreed to the treatments that were advised, including a form of estrogen, which was supposed to shrink the tumor. About a year after George discontinued estrogen treatments, sharp abdominal pains began to plague him. George feared the cancer had returned, or worse, that perhaps it had spread from his prostate to other organs. He avoided medical care for a few months, until he collapsed one night in extreme pain.

“He managed to use the bathroom and urinated blood.” Mrs. Petersen wrote. “This was a mournful night for us, since we feared the worst. Dr Obama got George to a hospital and his doctor operated on him the following day.” In surgery the doctor saw that the cancer was under control, but that there were many spots of endometriosis around his bladder! This is what caused him such crippling pain, along with other irritating symptoms.

George was probably born with dormant cells that, under the right conditions, developed and behaved as if they were endometrial tissue. He experienced the identical symptoms that women have with the disease, we know that estrogen is a factor in the growth of endomctriotic tissue in women. If George stays off estrogen treatments, the endometriotic cells should shrink and the disease not recur.

To many scientists, this man’s unique reaction and sensitivity to the hormone validates the embryonic theory of why endometriosis could develop in some individuals but not in others.

*27\43\4*

Warts are small, hard swellings which sometimes appear on the skin and the mucous membranes. There are many different types of warts, all of them caused by the Papova virus; there is the common wart, usually on the fingers, and most unsightly; the plane or flat wart, often on the back of the hand or on the face; the plantar wart, on the soles of the feet, sometimes known a papilloma or verruca; and the venereal wart, which is confined to the anal or genital areas.

Warts are caused by infection of abraded skin by the human wart virus (Papova virus). They spread most rapidly under warm, moist conditions, at sites of trauma. It is estimated that about one quarter of all warts spontaneously disappear within six months. The mechanism of spontaneous resolution is not fully understood, but is certainty related to the resistance or immune response of the person. The development of immunity is related to the person’s make-up, and to the amount of virus present, which varies in warts of different kinds. Plane and plantar warts, which contain little virus, are the most persistent and difficult to cure.

There are many ways of treating warts. This multiplicity indicates that there is no one effective treatment for all warts. The aim of treatment must always be to remove the wart without hazard to the patient, with minimal discomfort and absence of scarring. Effective treatment not only destroys the wart but activates the immune system winch hopefully will prevent further infection.

Common warts are probably best treated, at least initially, with local applications of either formalin, salicylic acid, cantharadin, or combinations of these. This treatment has the advantage of being painless and can be done at home. If they prove resistant, then cryotherapy is the next choice. This entails freezing the wart, either with carbon dioxide snow at — 79°C or liquid nitrogen at — 196°C. It is frequently necessary to repeat this treatment three or four times with, ideally, no longer than a three-week interval between treatments. Occasionally, warts may be resistant to cryotherapy, or too large for freezing to be effective. Patients then have the option of undergoing diathermy with curettage under local anaesthesia. This is sometimes known as ‘burning the warts out’. The disadvantage of this form of treatment is that it is rather painful and occasionally leaves scars. Curettage or ‘spooning out’ of the wart, without diathermy, is frequently more effective.

Plane warts are usually responsive to local applications. Since they commonly occur on the face, this is also a more appropriate mode of treatment. Various preparations may be used.

including topical 5-Fluorouracil, a preparation used for some skin cancers and solar keratoses. If they persist, then cryotherapy is the logical and only other mode of treatment.

Plantar warts are frequently most difficult to treat. Once again local preparations containing salicylic acid and/or formalin, either in a paint or in a paste, are the most beneficial. If progress is slow, cryotherapy is the best alternative. Both diathermy and curettage, and superficial X-ray therapy, may be effective. However, there is a high incidence of recurrence and scarring. The scar may be more painful than the preceding wart, and more persistent!

Genital warts usually respond well to podophyllin paint. This type of preparation is really only useful in moist areas, and therefore rarely effective on other types of wart. The applications may have to be multiple, and should ideally be carried out at weekly intervals if necessary. Occasionally cryotherapy may be required. Diathermy and curettage requires a general anaesthetic, and is therefore a last resort.

Unusual and controversial forms of treatment include immunotherapy, where a persons own wart extract is injected into the warts. Also, D.N.C.B. (dinitrochlorbenzenel has been used to stimulate a person’s immunity, so as to enhance the natural rejection process. Similarly, smallpox vaccination has been tried. Treatment based on psychotherapy and on hypnosis both have their proponents. More recently the anti-cancer drug, bleomycin, has been injected into warts.

These are but a few of the many forms of treatment available for this very common infection.

*54\44\4*

An increase in dietary fibre will occur as fat-containing foods are replaced by food containing more carbohydrate. Methods for Increasing dietary fibre:

- Use wholegrain bread and cereals such as brown rice, wholemeal spaghetti and other pasta, wholegrain breakfast cereal, wholegrain crispbread, oatmeal or wheatmeal biscuits, wholemeal flour and other wholegrain cereal foods.

- Eat at least three pieces of fruit and four serves of vegetables each day.

- Eat the skins on fruits and vegetables e.g. potatoes in their jackets and the skins peaches, etc.

- Add one tablespoon of bran or wheatgerm to prepared breakfast cereals.

- Add dried beans, dried peas, brown rice or lentils to soups and casseroles.

- Thicken soups and casseroles with bran or wholemeal flour.

Implications.

1. Dietary fibre intake (from both soluble and insoluble sources) should be increased to a level greater than 30 grams per day.

2. Increased consumption of fluids may be necessary with extra fibre.

3. Inform clients that they may experience greater flatulence from extra fibre.

4. Select foods with resistant starch as they provide similar benefits to fibre.

5. People with diabetes should choose foods with a low GI to reduce fluctuations in blood glucose.

6. The use of foods high in sugars may need to be limited by some clients.

7. Encourage the consumption of a wide variety of unprocessed plant foods, including fruits, vegetables, wholegrain cereals, legumes, pasta and rice.

8. Clients should be encouraged to eat more wholemeal or wholegrain bread (with low-fat spreads and toppings) per day.

9. Read food labels for starches and fibre.

10. Choose foods labelled to indicate a higher fibre content.

*107\186\4*

My endometriosis was diagnosed in January 1986 when I was 33 years old. I had sought medical attention when I had been unsuccessful in conceiving after 18 months. Apart from painful periods (always), which were getting heavier and a few odd aches and pains that I’d attributed to heavy lifting at work (nursing), I didn’t have any other problems.

When told I had moderate endometriosis, I was amazed as I didn’t think I had anything wrong.

Over the next two years I had three laparoscopics and two laparotomies as well as courses of Danazol, Duphaston and Provera. The drugs proved ineffective as my endometriosis is apparently very tenacious.

In July 1986, my specialist asked if we had considered going on the IVF programme, as he felt the endometriosis was preventing the eggs transferring from the ovaries into the fallopian tubes.

I said ‘No’, as I thought that was for people who were desperate for a child. It dawned on us that we were desperate! The waiting list was 22 months long, so we put our names down.

I continued treatment and went back to work to save up for IVF. The long wait didn’t necessarily worry me as I believed I would conceive naturally and wouldn’t need IVF, so I figured the longer we waited the better our chances.

When the letter came after 18 months saying that it was our turn, I had to face reality. I was angry and scared, firstly because we couldn’t conceive naturally and secondly because this was our last hope and its low success rate meant we were likely to remain childless.

Before starting the programme, there were a number of requirements. I had to record the first day of my menstrual cycle for the previous six months, check rubella (German measles) immunity and have had a Pap smear within the last two years.

We had to attend a counselling session, be screened for Hepatitis B and the AIDS virus and checked for sperm antibodies. My husband also had to have had two semen analyses done in the previous six months.

Having met these conditions, I phoned in at 9.45am on Day 1 of my period in February 1988. The treatment cycle proceeded approximately as follows:

Day 4: I started taking Clomid tablets twice daily for five days. We attended the clinic for an interview and paid $1000 for non-rebatable fees. We were asked to sign consent forms stating what we wanted done with any extra eggs that may be collected (we were allowed a maximum of four to be put back). The choices were to donate them to someone else or to allow their use for research or to be disposed of. We could also direct them to be fertilised and frozen for our future use, or for any resulting embryos to be donated to someone else or to research or to be disposed of. We hadn’t expected to have to decide all of this on the spot and found it confusing and rather traumatic.

My husband was shown how to take my blood and give me injections. We were given the necessary equipment, etc. (anyone can take blood and give the injections). Day 5: My husband gave me my first morning injection, HMG (human menopausal gonadotropin) which is a follicle stimulating hormone. We both survived! Day 6: Attended the clinic between 7am and 7.30am for blood tests for oestrogen, luteinising hormone and progesterone levels. I saw the doctor on duty and he ordered the appropriate quantity of HMG, and I was given the injection. I found having a well-padded behind an advantage for all the injections.

Day 7: Clinic for blood tests, injection and consultation with doctor. The amount of HMG was calculated from the previous day’s blood tests which were graphed. Each day the doctor showed me my graph and discussed how I was progressing and answered my many questions. Day 8 & 9: Clinic as usual. In the evening my husband gave me another HMG injection.

Day 10: Clinic as usual, and also had an ultrasound scan to determine the number and size of my follicles. In the evening my husband took my blood (a nervous experience for both of us).

Day 11: Clinic as usual, plus took in previous night’s blood sample. In the evening, my brother-in-law (a vet!) took my blood as my husband was at night school. He said I was easier than an animal as I didn’t have to be shaved first! At 12.45am my husband took my blood and gave me an injection of HCG (human chorionic gonadotrophin). The timing of this injection was given to me by the clinic and is important because ovulation follows within the next 36 hours and enabled operating theatre scheduling. Day 12: Took previous evening’s blood samples to clinic. At 5pm admitted to hospital.

Day 13: My husband attended the hospital between 10 am and 11am to provide a semen sample in the privacy of Room 8′. As my tubes were open and normal it had previously been agreed that I have a GIFT (gamete intra fallopian transfer) procedure, which had a slightly higher success rate. I went to theatre at 12.30pm where six eggs were collected during a laparoscopy. These were then washed — as was my husband’s semen — and then the four best-looking eggs and a quantity of the semen were placed in my fallopian tubes. I remained at the hospital until 7pm and I was then allowed to go home.

I then had to wait two weeks before having a pregnancy test and it really dragged. Although there were no restrictions on activity (within reason), I just crept around, almost too scared to cough.

As each day passed without my period (despite checking each time I felt the slightest twinge), I couldn’t help becoming a bit optimistic although I tried hard not to be.

I was glad I hadn’t committed myself to doing anything or being anywhere during and immediately after the treatment cycle as I slept a lot. The travelling and the stress of being on time at the clinic, together with all the hormone injections, really exhausted me.

I went to the clinic in the morning for my pregnancy test (by blood test) and had to ring up at 3.45pm for the results.

I couldn’t believe it when I was told that my test was positive. I repeated my name and asked the sister if she was sure she had the correct results. I waited until my husband came home from work to tell him rather than ringing him as I had waited years to see the look on his face. After this wonderful news, we didn’t mind the numerous extra bills.

I had to have weekly blood tests for hormone levels at the clinic until I was eight weeks pregnant. I then had an ultrasound scan to ensure that everything was normal and to check the number of babies — in our case just one.

After an almost uneventful pregnancy, I gave birth to a normal, healthy boy.

*97\83\2*

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.

*38\83\2*

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.

*43\124\2*

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.

*59\75\2*

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.

*111\110\2*

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.

*188\143\2*