Pharmacy News

Many of the symptoms of endometriosis are also the symptoms of other conditions — particularly other gynaecological conditions — and therefore endometriosis is easily confused with them. These include pelvic inflammatory disease (PID), irritable bowel syndrome, ovarian cysts, appendicitis, ectopic pregnancy and occasionally cancer.

Pelvic inflammatory disease

Pelvic inflammatory disease, often known as PID, refers to any infection of the pelvic organs including the ovaries, fallopian tubes, uterus and cervix. Symptoms may include painful menstrual cramps, pain during or after intercourse, bleeding between periods, painful bowel movements or urination, generalised pelvic pain, lower back pain, nausea, fatigue, slight temperature and infertility.

PID is the condition which is most commonly confused with endometriosis when the diagnosis is made without the use of a laparoscopy because the symptoms of the two conditions are so similar. However, PID is caused by bacteria and it can be successfully treated with antibiotics. If antibiotic treatment fails to relieve the symptoms, further investigations should be carried out.

Irritable bowel syndrome

The term irritable bowel syndrome is sometimes used to describe a range of bowel symptoms when no other diagnosis can be found. The symptoms may include chronic lower abdominal pain which may be relieved by a bowel action, bouts of diarrhoea and constipation, flatulence (wind), straining to have bowels opened, bloated abdomen, chronic backache, lethargy, nausea and heartburn.

Many women are diagnosed as having irritable bowel syndrome before endometriosis is finally diagnosed.

Simple ovarian cysts

A cyst is a growth that contains fluid and is enclosed by a membrane. There are many types of ovarian cysts, the most common are follicular and luteal cysts. A follicular cyst is a fluid-filled cyst which has developed from an ovarian follicle that has continued to grow and enlarge. A luteal cyst is one which has developed from a corpus luteum which has enlarged and become filled with fluid or, occasionally, blood.

The symptoms of ovarian cysts include abdominal pain on the affected side, pain with intercourse, abdominal swelling, fullness or discomfort and irregularities in the menstrual cycle. If the cyst is large it may put pressure on the adjacent organs, such as the bowel or bladder, which in turn may cause some discomfort with bowel movements or when passing urine.

Many follicular and luteal cysts disappear within a few weeks as they are reabsorbed by the body. If the symptoms persist, a laparoscopy is the only way to distinguish between an ovarian cyst and an endometrioma.

Acute appendicitis

Acute appendicitis is an inflammation of the appendix and the symptoms include sudden and severe right-sided abdominal pain, nausea and vomiting, malaise and a raised temperature.

The symptoms of acute appendicitis are sometimes confused with those experienced by a woman with endometriosis where a large cyst, usually an endometrioma, has burst.

Ectopic pregnancy

An ectopic pregnancy occurs when a fertilised ovum implants itself in an abnormal location outside the uterus, usually within a fallopian tube, and continues to develop. Because the fallopian tube cannot expand to accommodate the developing foetus the tube eventually ruptures. The symptoms experienced when an ectopic pregnancy ruptures a fallopian tube include severe left or right-sided abdominal pain, nausea and/or vomiting, vaginal bleeding and internal bleeding which can lead to shock.

The symptoms of a ruptured ectopic pregnancy may sometimes be confused with those experienced by a woman with endometriosis who has a ruptured large endometrial cyst. A diagnostic laparoscopy is necessary to determine the correct diagnosis.

Cancer

The two main forms of cancer that may possibly be confused with endometriosis are ovarian cancer and rectal cancer. The symptoms of ovarian cancer include pelvic pain, weight loss, weakness and anaemia, while the symptoms of rectal cancer include constipation, bleeding from the rectum and backache.

However, ovarian and bowel cancer are very rarely confused with endometriosis. If there is any possibility that you may have cancer, diagnostic tests will be carried out quickly and thoroughly.

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Live yoghurt contains ‘friendly’ bacteria which form lactic acid in milk, suppressing the growth of harmful bacteria. Some of the bacteria which are used to make yoghurt are Lactobacillus acidophilus, Lactobacillus bulgaricus and Streptococcus thermophilus. The bacteria in many yoghurts are still alive, but are kept dormant by refrigeration. However yoghurts which have been pasteurised or otherwise treated by heat, no longer contain live organisms.

Yoghurt is often recommended for its nutritional properties: it is a good source of protein, calcium and other minerals and A and B vitamins. Because yoghurt also contains lactose, the calcium is readily absorbed by the body. Yoghurt stimulates the synthesis of lactase, so that some people with a lactose intolerance are able to eat it without ill effect.

The inclusion of yoghurt in the diet is useful in preventing the proliferation of toxic intestinal bacteria which are often introduced into the body by contaminated foods. There are substances in yoghurt which have an antibiotic effect in the gut, reducing the concentrations of pathogenic bacteria such as E. coli so that a balanced concentration of friendly bacteria is encouraged. As a result, yoghurt may be beneficial in treating diarrhoea and other digestive disorders.

In the treatment of thrush or Candida, live acidophilus and bifidus bacteria can help to recolonise gut flora which have become unbalanced by the fungus. The lactobacilli in live yoghurt are the same which normally inhabit the vagina, so when these have been killed by some cause, such as a course of antibiotics, yoghurt inserted into the vagina for a few days, either with a spoon or a plunger, is often of benefit.

Orotic acid, a substance found in some yoghurts, interferes with the synthesis of cholesterol in the liver. Inclusion of acidophilus and bifidus yoghurts in the diet is therefore recommended in the prevention of heart disease.

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Just as depression tends to cast a grey pall over everything in your world and in yourself, so there is an irresistible tendency to project that gloomy view into the future. The depressed person will always find something to be pessimistic about. And as with one’s view of the present, these gloomy predictions are often without any reasonable basis in reality. And even when there are problems in a person’s life, there are many different ways to look at one’s future. A person with cancer, for example, may have a very optimistic and upbeat view of the future, whereas a depressed person in perfectly good physical condition may be full of gloomy predictions about his health. In fact, in one research study patients who had suffered from both cancer and depression were asked to rate which of their two conditions involved greater suffering. They rated depression as the more painful of the two conditions. In summary, there is not generally a very close correlation between the realistic prospects for a person’s future and how a depressed person is likely to view it. Pessimism is a cardinal symptom of depression.

If the future seems bleak and gloomy to you and this has been going on for more than a few weeks, consider the possibility that you may be depressed.

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Plastic has become increasingly common, one might say all-pervasive, since the end of World War Two. The chemically susceptible person, however, should try to avoid unnecessary exposure to plastics wherever possible. The sources of plastics are explored in Chapter 6. As a simple preventive measure, one should go through one’s house and make all obvious and necessary changes.

For example, many lamps now have plastic shades. As the light bulb heats up, the plastic begins to give off odors and fumes which can have a marked effect on mental and physical well-being. It is necessary, in such cases, to replace the plastic shades with shades made from glass, metal, or natural fabric. In the kitchen, plastic bowls and dishes should be replaced by ceramic, glass, or wooden ones. Wrap foods in aluminum foil instead of plastic wrap and use glass or metal containers instead of plastic refrigerator ware.

The degree to which one must make such changes obviously depends on the severity of the problem. Some people are able to tolerate the harder plastics, while others find they must make a clean sweep through the house in order to feel reasonably well. It is beyond the scope of this book to discuss every aspect of this large problem, although books listed in the “Suggested Reading” should be of help with the practical details.

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While petting frogs is a harmless childhood activity, handling toads can be dangerous, the New England Journal of Medicine (314:1517) reports, since the skin of some types of toad secretes a poison which, when conveyed to the mouth, causes drooling, convulsive seizures, and serious disturbances of the heart rhythm. The Colorado River toad is the most toxic toad in North America and well-known as the cause of neurological problems and even death in animals that pick it up by mouth.

Now, according to the Journal, a young boy who played with a toad of this type required intensive care in a hospital for over seven days before he began to recover from paralysis, seizures, and difficulty in breathing, and probably would have died without such treatment.

Accordingly, while it is quite safe for children to play with frogs, don’t let them ever even touch a toad. Telling frogs and toads apart, however, may not always be so easy.

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Emergency symptoms: Apply emergency treatment immediately.

Important: A child with heatstroke who does not revive within minutes after treatment is in danger and requires immediate emergency care.

Symptoms: feeling that lungs and muscles are “on fire”, dry mouth, breathing difficulty, dizziness, nausea blurred vision, hot, dry skin, high fever, absence of sweating.

Emergency treatment

1.     Call for emergency help and begin first aid.

2.     Remove the child’s clothing and lay the child down, feet higher than head, in a shady area.

3.     Pour cold water over the child’s body; rub the body with ice, then fan the child to promote evaporation.

4.     When the child is conscious and his or her body temperature is normal, give plenty of fruit juices to replace fluids and minerals lost during dehydration.

5.     Watch the child closely and repeat treatment if the symptoms recur.

Precautions

-    Heatstroke can be fatal if not treated immediately.

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

-    Strenuous exercise within one week of an attack of heatstroke increases the possibility of another attack.

-    Susceptibility to heatstroke is increased by: lack of water; excessive sweating; vomiting or diarrhea.

-    Salt tablets are not helpful in preventing heatstroke.

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For the past 50 years or so, we’ve been killing ourselves with a silent bang. It’s a little-known fact that suicide is the ninth leading cause of death in this country and the fifth leading cause among men ages 25 to 44.

There is no simple answer for why men commit suicide, says John L. McIntosh, Ph.D., professor of psychology at Indiana University in South Bend, who works with the American Association of Suicidology in Washington, D.C.

Nearly 95 percent of people who kill themselves are suffering from a psychiatric illness-most often depression – in the months before they commit suicide. Yet, it often goes undiagnosed, says Matthew Nock, research coordinator for the American Foundation for Suicide Prevention (AFSP) in New York City.

To be fair, detection is difficult because men often don’t let on that they’re in trouble, at least not in obvious ways, Dr. McIntosh says. Men also may have underlying biological tendencies for self-destruction that we just don’t understand yet, say suicide researchers. For one, men have lower levels of the brain neurotransmitter serotonin than women. And not only are people with low levels of this mood-governing chemical prone to depression but also research suggests that their suicide risk is 10 times that of people with higher levels.

And that’s not the only chemical connection. Very low cholesterol levels-less than 160 milligrams per deciliter-have also have been linked to elevated suicide risk in men. Researchers in Paris found that of more than 6,000 men they studied, those with low cholesterol levels were more than three times more likely to commit suicide during the four-year study than those with normal cholesterol levels.

Drinking and drug use seem to add mental anguish all their own, says Dr. McIntosh. Alcoholism is a factor in 30 percent of all completed suicides. And cocaine ranks right up there with depression and alcohol abuse as a primary risk factor.

Personal loss, particularly of a wife or a job, is another leading factor. For every rise in the divorce rate (measured as one extra divorce per 1,000 couples), there is a 35 percent increase in male suicide rates. And men without jobs commit suicide twice as often as men who have them.

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Non-steroidal drugs

Non-steroidal drugs, other than the salicylates, are used as anti-inflammatory, analgesic or anti-pyretic agents. Some have a combination of more than one of these properties. In general, the way in which these drugs work is not known, although it is possible to demonstrate the relative efficacy of one versus another by special trial procedures.

These drugs are usually marketed under trade names which derive from either their generic or chemical name. Considering them in general, it is fair to comment that most of the non-steroidal anti-inflammatory drugs take effect fairly quickly, usually within a few hours of consumption. It would also be fair to say that the effects are not long lasting, unless the drug is being taken regularly.

Side-effects of such preparations range from the usual gastric irritation and indigestion, with or without severe ulceration, to impaired vision, depression, skin rashes, loss of hair, impaired liver function, impaired kidney function, respiratory distress and changes in mental attitudes such as depersonalization. In rare cases bone marrow depression can also occur. One further aspect of many of these preparations is that they are not suitable for use with children.

Steroidal drugs

Another type of therapy is that using steroidal drugs. Usually steroidal drugs would be one of the last forms of therapy to Û tried on any patient. The dangerous effects of treatment with, and withdrawal from, these particular drugs are well known. It is also important that the clinician treating any patient with corticosteroid therapy is familiar with the various facto relating to that particular patient’s general condition before commencing. Use of corticosteroids in arthritic treatment usually produces a rapid and dramatic response. The person begins to feel much better in general and their arthritic condition shows a significant improvement. The mechanism of the anti-inflammatory and anti-rheumatic activity of the corticosteroids is not yet understood, but their effect is known to be palliative and not curative.

It would be reasonable to assume that, as a result of what has just been said about the beneficial effects of these preparations that they would be in widespread use. Unfortunately they possess some very unpleasant side-effects and therefore are only used as a last resort.

Probably the most hazardous effect of the steroids is that the anti-inflammatory effect is non-discriminating. This means that it can and does have an anti-inflammatory effect on the inflammation which is the body’s natural defense mechanism against some infectious agents. In addition to this, other side effects include a protein-wasting effect; a linear-growth impairing effect in children; a quite significant impairing o: wound healing capacity; a generalized osteoporosis effect (increasing porousness of the bones); ulcer development; development of syndromes such as rounding of the face; fattening around the waist; disorders of the eyes; menstrual disorders; depression and insomnia.

This is not a complete list, and of course, not all people who are treated with steroidal drugs will develop or experience these effects.

When these factors are considered together with the tact that, generally speaking, steroid therapy does not remain effective for long, and withdrawal from this therapy has unpleasant effects, it is easy to see why use of it is, generally made with great reluctance.

Before leaving the subject of drug therapy in the treatment 0f rheumatoid arthritis, gold therapy should receive at least brief mention.

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For a number of years researchers have sought ways to diagnose and monitor endometriosis that would avoid the need for a laparoscopy. Various methods have been tried, including examining the blood and endometrium for the presence of antibodies and testing for a substance known as the CA-125 antigen. Other methods are still being investigated. So far, most of the tests tried have been unsuccessful because they have not produced consistent and accurate results, especially in the early stages of the disease. Work is continuing and it is likely that a reliable test will be developed in the future. In particular, work on the CA-125 antigen looks promising but it is likely to be several years – at the earliest – before this or any other tests are fully developed and available for general use.

CA-125

CA-125 is a substance known as cancer antigen 125 which is produced by the endometrium and is found in the blood. It was discovered while researchers were trying to find a test for ovarian cancer.

Researchers found although it was present in extremely high levels in some women with ovarian cancer, raised levels were also found in some women with a range of gynecological conditions, including endometriosis, adenomyosis, pelvic inflammatory disease, unexplained infertility and during pregnancy and menstruation. In an attempt to find a reliable blood test for endometriosis researchers have been investigating the levels of CA-125 in women with endometriosis. They have found that the levels in women with minimal and mild endometriosis are no different to those found in women in general but the levels in women with moderate and severe endometriosis are generally significantly higher.

Unfortunately, the CA-125 test is not yet sufficiently accurate to replace laparoscopy as a general test for the diagnosis of endometriosis because the levels are not raised in all women with endometriosis and because the levels are raised in a range of conditions other than endometriosis.

It may soon be useful as an aid for the diagnosis of endometriosis and could be used to help decide who needs a laparoscopy. For example, if the gynecologist only vaguely suspects that a woman has endometriosis he may decide to perform a laparoscopy if the CA-125 levels are raised, but not if the levels are normal.

For now, the most useful role of the CA-125 test appears to be in monitoring the progress of the disease after a definite diagnosis has been made. The levels of CA-125 appear to rise as the disease worsens and fall as the disease improves. Therefore, it may be possible to use repeated CA-125 tests to help determine the real effectiveness of drug treatment or to determine whether or not the underlying disease has worsened, improved or recurred, thereby avoiding the need for repeat laparoscopics.

The CA-125 test offers the most promise as a diagnostic test for endometriosis but further work is necessary before it will be accurate and reliable enough to be used by gynecologists for the diagnosis and monitoring of endometriosis.

Kylie’s story

I started menstruating at the age of 13. For the first 12 months everything was fine, but I then started to develop acute pain in my right side. I went to my GP who referred me to a surgeon and I was then rushed to hospital to have my appendix removed. Strangely, my appendix was quite normal. I felt well for three months, but then the pain started up again. After having an ultrasound, I was admitted to hospital with a suspected ovarian cyst. A laparoscopy was performed, but everything appeared normal. I was sent home, having been told that it was quite normal to suffer some discomfort when having a period.

For the next year I tried to put up with the pain because I was sure the doctors would tell me it was ‘all in my head’. After another bout of severe pain my GP referred me to another specialist who ordered a barium enema. He said that I had an irritable bowel and to eat more fibre. Unfortunately, this made no difference to the pain. My GP then thought that perhaps I was suffering from pelvic inflammatory disease – a course of antibiotics made no difference. My mother wasn’t happy with the doctor’s explanations and so took me to another GP who immediately suspected I may have endometriosis even though I was only 17 years old. He sent me to a gynecologist who immediately performed a laparoscopy and diagnosed endometriosis.

During the laparoscopy the gynecologist ‘burnt off’ all the endometrial deposits that he could find. He explained to me that because there could still be microscopic endometrial deposits in the pelvis, I was to take Provera 30 milligrams a day for nine months. I am now pain free and have just finished the course of tablets. I am looking forward to starting university next year and enjoying life.

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Brain chemicals do more than regulate behavior. They also determine our moods. An imbalancetoo much or too little of a given substance-can produce symptoms of mental disorder ranging from depression to the abnormal elation and hyperactivity known as mania.

As we have seen, the incidence of depression in relatives of eating-disordered people is higher than the rate found in the general population. Researchers have long been intrigued by this apparent connection between eating disorders and affective disorders (mood disorders, such as depression and mania). Is it possible that both types of illnesses arise from a common source?

We don’t yet have all the evidence we need to answer this question with confidence. However, there is no doubt that disruption along certain neurochemical pathways can lead to disturbed moods of varying severity.

Consider, for example, some of the fairly common syndromes in which feelings of depression play a part. The first, and most widely known, is PMS-the premenstrual syndrome. Symptoms of PMS include sudden mood swings, irritability, anxiety, feelings of hopelessness, difficulty concentrating, sleep disturbance, food cravings, and physical problems such as headaches or joint pain.

Another illness that has received considerable publicity in recent years is SAD, or seasonal affective disorder. With the onset of winter and its shorter days, people with SAD begin to feel depressed, hopeless, and lethargic. The illness is particularly troubling because during the summer these same people are lively, outgoing, and energetic. The contrast can be confusing, not just to the patient, but to family, friends, and co-workers as well.

Less familiar is the syndrome known as CCO, or carbohydrate-craving obesity. The name is self-explanatory: Patients with this condition overeat carbohydrates to the point of severe, health-threatening obesity. A variant of this illness is a form of bulimia in which patients, usually mildly obese women, engage in severe bingeing, often involving carbohydrate-laden foods, but with little or no vomiting.

These conditions share certain symptoms, including depression, lethargy, difficulty concentrating, and periodic bouts of overeating leading to weight gain. People with these disorders seem specifically to prefer carbohydrates above all other foods. One of my patients, who as it turned out had SAD, described herself as a “bread and pasta fiend” in the winter, while in the summer she ate more protein.

Bouts of depression in SAD, as its name suggests, appear in a cycle determined by the changing seasons. PMS strikes regularly every month (though it is worse for some people during the winter months). CCO, however, seems to trigger abnormal eating virtually every day, most often in the late afternoon or early evening. It’s this regular rhythm-seasonal, monthly, daily-that caught the attention of investigators concerned with the ways our bodies change over the course of time.

We now know that many of our bodily functions operate on what is known as a circadian cycle. Circadian means “about a day.” The word refers to the fact that many natural functions- sleep, hunger, sexual arousal-are not discrete events but rhythmical processes that continue over a period of approximately twenty-four hours, with peaks and valleys that occur at different times. As a rule, these processes are regulated by the hypothalamus.

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