Pharmacy News

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.

*28/41/5*

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.

*43/35/5*

John Bradley always loved being outdoors. As a youngster growing up in northern Maine, he spent many more summer nights sleeping outside than in. His days were filled with work on his family’s potato farm, fishing, swimming, canoeing, and hiking in the woods.

Now age 45, John still finds joy in the great outdoors. It not only relaxes him but it also helped him lose 30 pounds.

John, who ran his own farm for more than 20 years before becoming a student at the University of Maine, had a weight problem | for most of his life. He ate too much of the wrong kinds of foods, and despite his active lifestyle, it showed.

“My family always kept a lot of sweets around the house,” he says. “And I had a special fondness for french fries and Coke. I drank Coke all the time.”

Every now and then, John would diet and lose some weight, only to regain it. By age 40, he reached 220 pounds. “I realized that slimming down wouldn’t get any easier as I got older,” he says. “And I knew that I’d be a lot healthier without the extra pounds. So I made up my mind to get rid of them for good.”

John paid more attention to his food intake, eliminating fried foods, desserts, and high-calorie snacks. He kept an eye on his portion sizes, too. For exercise, he began doing situps, working up to 100, five times per week. But what really made a difference, he says, were his nightly nature walks.

Every evening after dinner, John, sometimes accompanied by his wife, would step out his backdoor and head for the old logging roads that cut through his 270-acre farm. He’d wander the roads for an hour, sometimes two, observing nature in all her glory. He’d spy bears and their cubs; coyotes; moose; and deer. “Even when I walked alone, it was never lonely,” he says. “I might see muskrats or beavers or trout in my stream. But I knew I’d almost always see something.”

John so enjoyed his nature walks that he never really thought of them as exercise. Yet in combination with his improved eating habits and his sit up regimen, they got him down to a healthy 190 pounds in about 6 months. He’s been holding steady since 1996.

“If I wasn’t active, I’d gain weight quickly,” John says. “But the exercise that I do is a pleasure. I’m always glad to get outdoors. It’s where I feel best. It’s the place where I most love to be.”

WINNING ACTION

Pursue your exercise through your passion. One of the best ways to stick with your exercise routine is to find an activity that you look forward to. If the traditional choices such as running, biking, and swimming don’t interest you, ask yourself what does. Bird watching? People watching? Karate Swing dancing? Anything that gets you moving can help you slim down and shape up.

*97\89\8*

Affirmation for Happiness

Many of the patients I see, regardless of their symptoms, are unhappy. I give them this happiness affirmation:

I really like myself. I am a worthwhile person. I am fantastically happy, and I have great happiness.

Affirmation for Serenity

We could all use serenity, especially the stress seekers who are always running at top speed. Say to yourself:

I am calm-, serene and have peace of mind. All my thoughts are loving and happy. My positive thoughts give me strength and confidence, happiness and peace. I have the energy, time, money and wisdom I need right now to make my world a happy place.

Affirmation for Success

Affirmations for success are especially helpful for stress phobics and others who feel frustrated at work, school or life in general:

I am now happily successful. I see myself continually achieving more success, step by step, overcoming all obstacles. I see and feel myself to be a successful person. I give myself the power and permission to be a success.

Affirmation for Self-Respect

Along with success affirmations, this affirmation for self-respect is important for stress phobics, who have so much self-doubt and so little love for themselves:

I truly like myself. I am an interesting, energetic man/woman who is respected and admired. I radiate positive, friendly feelings to everyone I meet or talk to.

The point is not to become an egomaniac but to recognize the good qualities you have. You can be proud of yourself without being egotistical.

*145\80\8*

Use your heart to determine whether you’re walking rapidly enough. Count your heartbeats by feeling your pulse at your wrist, your temples or on either side of your neck.

Count the number of times your heart beats in ten seconds. Multiply that number by six to get your heart rate per minute. The goal is to walk briskly enough to keep your heart beating at 70 to 80 percent of your maximal attainable heart rate. The 70 to 80 percent range will vary according to your age. Check your pulse a couple of times during your walk, and again when you finish, to make sure you’re pacing yourself just right.

If you think daily walking would be boring, who says you have to walk by yourself? Years ago I took brisk evening strolls with my young children. We’d start from our house and walk all the way down the hill, then over to the shopping center. It was about a two-mile walk. Then I’d call my wife to bring the car and drive us back up the hill. (I would tell her the kids were too young to walk up the long, steep hill. The truth was I was too lazy.)

The time I spent walking with my children was great. We talked about baseball, medicine, history or whatever else was on our minds. They would tell me the latest jokes from school. Our walks were always enormous fun.

I’ve exercised with my family, friends, patients and business colleagues. While exercising I’ve chatted, conducted business, given medical advice, caught up with old friends and talked through ideas for books and articles with my son and coauthor, Barry.

And when I’m walking alone I use the time for sightseeing and mental relaxation. Sometimes I’ll include streets such as Rodeo Drive in my exercise route. That gives me a chance to window-shop. Other times I’ll walk in the park or among the beautiful houses of Beverly Hills. Walking is an exercise that leaves you free to think, see, hear, talk and laugh all you like.

*103\80\8*

Nutritional deficiencies can attack your immune system directly, or they can launch a two-stage attack by way of the mind. Lack of nutrients, especially the B vitamins, can lead to such personality changes as depression, irritability, nervousness, anxiety and moodiness. As a group, the B vitamins are especially important for maintaining a positive outlook on life.

As we learned earlier, there are physical and chemical links between mind and body. What kind of thoughts will an anxious, depressed, irritable mind generate? The kind that harm the “doctor within” and the immune system. That’s why it’s important to take in plenty of the nutrients that will keep you happy.

Nutrition profoundly influences your immune system, both by direct action and by way of the mind.

*60\80\8*

Government and industry claim that there are “safe” levels for various toxins in the body. That idea is patently absurd. Five to 40 years may pass before chemicals and particles you were exposed to at work, home or school are expressed as a disease. To be safe, I say that any amount is too much. Any risk we take of harming our “doctor within” is too great.

This much we do know: worldwide chemical pollution of our air, food, water and environment is reflected in the chemical pollution of our bodies. For example, house and industrial painters, who have worked for long periods in confined spaces and inhaled paint fumes, may suffer from a chronic brain syndrome characterized by fatigue, headaches, dizziness, depression, irritability and memory impairment. Being on guard against the obvious toxins isn’t enough. Hobbies such as sculpting, welding and painting, for instance, expose us to various toxins. Common household cleaners are potentially toxic. You may be unwittingly exposed to asbestos in school, at your workplace, even in your own home.

I couldn’t figure out what was wrong with the attractive 45-year-old woman who came to me complaining of frequent colds, irritability, nervousness and forgetfulness. “And those are only the major problems,” she explained. “I also have dizziness, insomnia and sometimes pain in my stomach.”

The laboratory studies I ordered showed that her immune system was out of whack, but not in any of the usual ways. She didn’t have AIDS, EB virus, CMV or any other standard immune-system diseases.

As is my custom, I reviewed all her old medical records. There was nothing in the many documents that suggested an answer to her current problems. She worked in a defense plant, making parts for a new, top-secret bomber. Perhaps she had inhaled a chemical at the factory?

“No,” she said, “there aren’t any chemicals where I work. We have good ventilation, too, so even if there were chemicals, I wouldn’t breathe in a lot of them.”

“Well,” I continued, “what exactly do you do at work?”

“I run a big machine that stamps out metal,” she explained. “But it’s almost entirely run by computer. I don’t have to touch the machine itself, just the contol board. Except when I clean it.”

“How do you clean it?” I wanted to know. She told me that she poured fluid out of an unlabeled can onto the machine and, using her bare hands, rubbed the fluid in to get the grease off of the machine. That was the clue I needed. Suspecting there might be a toxic chemical in the cleaning fluid, I ordered a battery of toxicology tests to be run. The laboratory found large amounts of chloroform in her blood, plus trichloroacetic acid and trichloroethanol in her urine. It turned out that the cleaning fluid contained trichloroethylene, a very dangerous but widely used industrial solvent. Exposure to this chemical, along with other chemicals and their break-down products, can depress the immune system and cause mental depression and such abnormalities of the central nervous system as confusion and un-coordination. In animals, this chemical has even caused liver cancer.

Happily, when she adopted my Immune For Life program and transferred to a different part of the factory—and got away from the cleaning fluid—most of her symptoms disappeared, and her immune-system tests returned to normal. As a special precaution, I had her get rid of the cleaning fluids and other chemical concoctions in her home.

Toxic chemicals are everywhere. There’s asbestos in our buildings, mercury in the fish we eat, pesticides in our beef and potentially harmful and hormones in our chicken. The DDT that was banned long ago is still in our drinking water and meats. Processed foods are full of potentially toxic substances. The air we breathe can be toxic. Even wallpaper contains pesticides. In our society, it’s very hard to avoid toxic chemicals and environmental pollutants. That’s why we must do everything we can to protect and strengthen our “doctor within.”

*16\80\8*

A third factor that influences medical trials is the type of patients a particular doctor sees. To take one example, a consultant gastroenterologist working in a large hospital will see a wide range of patients with persistent diarrhoea, who have been referred by their family doctor. These patients will vary in all sorts of ways, including their own ideas about their illness. Some may think that particular foods cause their symptoms but most will have no clue at all why they are ill. An allergist, on the other hand, will not see many patients with diarrhoea, but those he does see will probably have been referred by their family doctor because they believe their symptoms are caused by ‘allergies’ to food. Experience shows that such patients have often tried some form of self-diagnosis, or alternative therapy, without success.

A proportion of the allergist’s patients may be people with psychosomatic problems, who have latched on to diet as an explanation for their symptoms because they find the label psychosomatic’ unacceptable. Despite their lack of success in identifying dietary triggers for their symptoms they are unwilling to give up. Of course, the first group of patients – those seen by the gastroenterologist – may well include some with psychosomatic problems, but they are probably fewer than in the group seen by the allergist.

When referring patients, family doctors take account of the consultant’s views, and, it must be said, their own personal preferences. A ‘difficult’ patient whose diarrhoea is accompanied by a patently neurotic personality is likely to be referred to a consultant whose main interest lies in psychosomatic causes. Another patient with much the same bowel symptoms, whom the family doctor believes to be mentally well-balanced, will probably be referred to a consultant who is more interested in physical causes. This again biases the ’sample’ of patients that a particular consultant sees, and tends to reinforce medical prejudices.

Neither of these two groups of patients is a representative sample of everyone in the country with persistent diarrhoea. A survey which showed that a third of ‘apparently healthy’ people suffered some form of bowel disorder also discovered that the majority had not sought medical treatment. So the statistics produced by any medical study are not necessarily applicable to the population at large.

*104\180\8*

It’s common for doctors to receive a flat monthly fee for every patient under their care. Under this arrangement, known as capitation, the cost of lab tests, procedures and other care comes out of the doctor’s pocket. If the doctor orders an $80 X ray, $80 is deducted from his paycheck.

Frequently, HMOs give bonuses and assess monetary penalties according to how much the doctor spends. For example, many HMOs reward doctors who limit the number of patients they hospitalize or who minimize referrals to expensive specialists. Using a technique known as “economic credential-ing,” managed-care plans terminate doctors who spend too much on patients.

To further limit costs, HMOs set up barriers to care. Under most managed-care plans, you can’t see a specialist without being referred by your primary care doctor. Visits to the emergency room require pre-authorization. And it can take weeks—even months—to get an appointment.

Given these new realities, here’s how to protect your interests. If you’re thinking of joining an HMO or are already enrolled, learn as much as you can about the plan. Read the membership materials carefully. If possible, talk to current and former members about their experiences with the HMO in question.

*83/47/1*

what to look for: Whole wheat is typically the first ingredient, but it could be whole oats, whole rye or millet.

typical nutritional data per slice: 90 calories, 1 g fat, 3 g fiber, 180 mg sodium.

good brands: Arnold Natural 100% Whole Wheat… Oroweat 100% Whole Wheat…Stroehmann Dutch Country 100% Whole Wheat.

important: Some “wheat” breads are made with enriched wheat flour. Enriched means that after the grain was refined, only five nutrients that were removed in the refining process were added back in—thiamin, riboflavin, niacin, iron and folic acid. However, fiber, magnesium and other vitamins and minerals are not restored to the flour.

RYE…

what òî look for: Whole rye should be the first ingredient.

typical nutritional data per slice: 100 calories, 0.5 g fat, 3 g fiber, 200 mg sodium.

good brands: Rubschlager 100% Rye, Rye-Ola Black Rye… Genuine Bavarian Organic Whole Rye.

*74/47/1*