Pharmacy News

There is considerable scientific backing for the health benefits of a diet with a high proportion of starches. National health targets suggest that carbohydrates should provide about 55-60 per cent of daily energy. Unfortunately, carbohydrate intake in most Western countries has declined this century with the increased consumption of fat. Fibre intake in most Western countries averages only about half the national target of an achievable 30g per day.

The first idea that fibre could protect against certain diseases appeared in I960, when researchers observed that the degenerative illnesses common in affluent societies were rare in rural Africa where diets were high in unrefined plant foods. Subsequent studies confirmed the health properties of fibre and it is now considered to have a role in protection against chronic diseases such as cardiovascular disease, colorectal cancer, and the management of constipation and diabetes. The specific benefits depend on the type of fibre. Foods high in insoluble fibre reduce transit time (i.e. shorten the time for food to pass through the GIT), soften stools by holding water and increase stool volume. In contrast, foods high in soluble fibre have little effect on bowel transit but appear to slow the rate of carbohydrate absorption due to their gel-forming ability. This helps to reduce rapid fluctuations in blood glucose and insulin among people with diabetes.

The combination of the effects of different fibres (including resistant starch), the SCFAs produced and a diet low in fat are all thought to protect health, so it has been difficult to credit any one factor. Nutritionists therefore recommend a diet low in fat with a variety of foods containing all types of starch and fibre.

A low intake of carbohydrate in any form appears to be linked to obesity on a population level because, by default, it is a high-fat diet. The claim that carbohydrates, whether as sugars or starches, are fattening’ is a myth. However, it is prudent for some individuals who are obese and who consume large quantities of sugars, to moderate their intake as a second level of priority after decreasing fat.

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Just because you have endometriosis does not necessarily mean that it is the only cause of your inability to conceive.

Most doctors will want to do a number of tests to check that everything else is as it should be.

First, you will be asked to have your hormone levels assessed. This is usually done as a blood test where the levels of progesterone will be measured. If these are abnormal, oestrogen, prolactin, testosterone, follicle stimulating hormone (FSH) and luteinising hormone (LH) levels will be measured as well.

The results of the test can take up to four weeks. Your doctor will tell you at what stage in your cycle the test should be done. Usually, it will be collected one week after your expected ovulation (for example, if you usually ovulate on day 14 then your blood test will be done on day 21).

The next test most women have to undergo is the tedious process to establish a basal body temperature chart. Once told to do this test your morning cannot possibly start without sticking the thermometer under your tongue — do not drink, go to the toilet, get out of bed or even talk before doing this!

Once the temperature has been noted it is then marked on the chart at the appropriate day in your cycle and the pattern is observed.

Like playing dots and dashes, you then draw a line joining the dots and this should indicate when ovulation is due. Intercourse is then timed to coincide with ovulation.

If ovulation has occurred your temperature will normally rise by about one degree. If your temperature remains high after the due date of your period this may be the first indication that you are pregnant.

If your basal body temperature chart shows that you are ovulating but still have not conceived your doctor may want to perform other tests. These may include:

Hysterosalpinogram

An hysterosalpinogram is an X-ray where dye is injected through the cervix to check that both tubes are functioning and that the internal structure of the uterus is normal. The procedure lasts approximately ten minutes.

Your doctor may say that this test will be a little uncomfortable. It is, but thankfully most hospitals will inject you with a sedative before the test is carried out and you should experience little more than some ‘cramping’ pains.

This test is becoming less frequent as most doctors feel that a laparoscopy provides a more accurate picture.

Post-coital test

A post-coital test allows your doctor to observe sperm within the cervical mucus after intercourse. You will be asked to have intercourse (at home) four to twelve hours before the test and this is usually done mid-cycle as the mucus is then clear.

It is similar to a smear test and carried out to make sure that the live sperm are penetrating the mucus and that the mucus is not ‘hostile’. Do not panic if your doctor says your mucus is ‘hostile’. IVF-related procedures mean that the sperm and egg can be fertilised outside the womb and transferred back into the fallopian tube, by-passing the cervix.

The Kremer test

The Kremer test is similar to the post-coital test except that you are not asked to have intercourse. Instead, specimens of mucus and sperm are collected and tested together at regular intervals over six hours. This test will help pinpoint if the problem lies with the sperm or the mucus.

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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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