Health news blog

The many processes of hunger and appetite regulation have been brought together in the form of the ’satiety cascade’. The schematic representation of the eating process provides us with a means of linking the above factors to provide more information about how hunger and appetite work together to regulate eating behaviour.

While this cascade emphasises the physical factors, the psychosocial factors also help to determine both the size of the meal (satiation) and the length of time before we next eat (satiety).

The stages involved in satiation and early and late satiety have been described as sensory, cognitive, postingestive and postabsorp-tive. In real life, these stages will overlap and their effects can combine to affect eating behaviour.

Sensory effects—are stimulated by the flavour of food. We are not sure how different people react to different sensory factors, but we do know that taste is a stronger predictor of energy consumed from foods than their perceived ‘fillingness’. Fast food manufacturers seek to create a ‘bliss point’ where their foods have maximum sensory desirability.

Emotional and cognitive effects—are the eater’s feelings and knowledge about the properties and effects of food Men and women may react differently, for example, in reaction to stress.

Women are perhaps more likely to react with increased appetite, whereas men may decrease their food intake.

Postingestive effects—reflect gastrointestinal signals, i.e. how full the stomach gets, how quickly it empties, the release of hormones to signal ‘fullness’ and the stimulation of physiochemically specific receptors along the gastrointestinal tract.

Postabsorptive effects—include nutrient, hormonal and metabolic signals, plus the possible effects of these on neurotransmitter function. This feedback mechanism probably gives the brain information on the body’s energy stores.

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Ask your doctor for information — if she or he has not got any ask her or him to get some for you.

Look for relevant books in the library.

Go to a good bookshop that specialises in health topics.

Contact your nearest Endometriosis Association. They will have heaps of pamphlets you can read and will give you advice if required.

Avoid feeling isolated

Talk to your doctor about any concerns that you have.

Don’t push your parents away — give them the information to read and tell them how you feel.

Explain your disease to your friends.

You may even want your teachers to know about endometriosis.

Talk to other young people who have endometriosis so you can gain mutual support by contacting your nearest Endometriosis Association.

Don’t bottle up your feelings

If you are angry get it out of your system — it’s OK to shut yourself in a room and yell or hit a punching bag. Try not to let the pain overpower you

Don’t take too many painkillers.

Try blotting out the pain by imagining yourself enjoying life without pain.

Resist making endometriosis an excuse for something you do not want to do. But if you are genuinely not well, don’t hesitate to explain why you cannot do it.

When you are feeling well — go for it — enjoy life!

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A repeat laparoscopy, also sometimes known as a second-look laparoscopy, is performed some time after a diagnostic laparoscopy in order to monitor the progression of your endometriosis. It is most commonly performed for one of the following reasons:

Following a course of hormonal treatment

Continued infertility following surgery

Recurrence of symptoms

Persistence of symptoms following an apparently normal laparoscopy.

Following hormonal treatment

A repeat laparoscopy at the end of a course of hormonal treatment enables your gynaecologist to see exactly how effectively the treatment has eradicated your endometriosis. The location and size of your implants and cysts can be charted and compared to the chart that was made during the laparoscopy performed before your hormonal treatment began.

If the repeat laparoscopy showed that the treatment had eradicated your endometriosis then nothing further needs to be done for the time being. If it showed that the treatment had only been partially effective then it might be worthwhile considering a continuation of the same treatment. If it showed that the treatment had been ineffective you will need to consider some other form of treatment.

Infertility

If you have had surgery in order to improve your chances of conceiving, a repeat laparoscopy may be recommended if you have not conceived within six to twelve months of the surgery. In thus situation the laparoscopy will be performed to determine whether or not any adhesions have developed that may be reducing your chances of pregnancy.

Recurrence

A repeat laparoscopy is advisable if you have a recurrence of your symptoms following a period of remission, particularly if you are contemplating any treatment. You really need to know that the symptoms are due to endometriosis and not some other condition. In addition, it is advisable not to undertake any hormonal treatment unless you know that you definitely have endometriosis.

Normal laparoscopy

A repeat laparoscopy may be advisable if you have had a persistence or worsening of symptoms that may be due to endometriosis, despite the fact that you have previously had an apparently normal diagnostic laparoscopy. It is now recognised that, in the past, a proportion of women with endometriosis were incorrectly diagnosed as not having endometriosis because their gynaecologists did not recognise their atypical implants or because they had microscopic endometriosis.

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A bed that’s too small is obviously not going to promote a good night’s sleep nor help provide your spine with the rest it needs to recuperate as much as possible from the previous day’s exertions.

When considering the size of your bed, take the following into account:

People don’t just lie in one position all night, but instead are almost continuously on the move. Research has shown that during a night’s sleep, most people toss and turn as many as 60 or 70 times – and your bed has to be large enough to allow for these movements without you ending up partly out of it.

On the average, we are now both taller and heavier than we were, the UK population having grown upwards and outwards in the past 30 years. Women have gained an extra 1.05kg (more than two pounds) in weight and 1.75cm (more than half an inch) in height. Men have put on an extra 3cms (more than an inch) in height. As we have changed, so have our bed requirements. While these increases seem minimal, they are nevertheless large enough to spell the difference between a bed that’s barely big enough and one that’s just too small for comfort.

The NBPA offers this advice: “A standard 4′6″ double bed only gives each person 2′3″ of space to sleep in – no more than a baby has in a cot! If you do suffer from a back problem, a squeezed and cramped night’s sleep on a bed that rates amongst the smallest standard size in Europe will not help.”

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In a recent article, the eminent doctor and author Sherwin Nuland writes about the deficiencies of modern medicine in which the doctor treats the disease but not the patient who is suffering from the illness. Being ill is a lonely and scary condition and, of all illnesses, depression must surely be one of the loneliest and scariest. A good doctor should be a source of comfort to you in your illness and in the recovery process. You would do well to invest the time and energy in finding a doctor who is not only technically competent but is also able to play this critical role.

Choosing a Doctor

I can’t emphasize enough how important is the choice of a doctor. I am often astonished by how some highly discriminating people, who are careful in the selection of their barber or hairdresser and will go to great lengths to buy the right car at the right price, will take pot luck with whatever doctor is in their neighbourhood. I always like to go to doctors recommended to me by other doctors, figuring that if you’re in the trade yourself, you know the wheat from the chaff.

Credentials are of some value in choosing a good doctor, but sometimes doctors trained at the best places can also be conceited and closed to new ideas. In seeking a doctor, find someone who is clever, up-to-date, sympathetic, open-minded and not too impressed with his or her own opinions. Find someone who will take the time to listen to you and really hear what you are saying. Finally, keep an eye on your doctor. Even the best doctors are only human, can make mistakes and don’t always think of all the possibilities. Even if you are in treatment with a good doctor, you still have some responsibility to use your wits to be sure that you get the best possible care.

Extricating Yourself from an Unsuitable Doctor

A good doctor should not only keep up with the literature but also be open to learning new things. Ignorance is human and often forgivable; it is, after all, a treatable condition. Closed-mindedness, however, is hard to treat and if your doctor is not open to new information, that is a real problem since medicine is constantly changing and new diagnostic and treatment approaches are regularly being developed. It can also be very distressing to end up with a doctor who, rightly or wrongly, reflexively dismisses your point of view, as illustrated by the following cautionary tale.

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One of the ways in which events can go wrong is when a nerve cell loses some of its inputs from other cells because of damage to these other nerve cells. If inhibitory terminals are lost, then the cell will become over-excitable, and begin to switch on, or fire inappropriately, driving other nerve cells with which it is connected on the downstream side to similar activity. This may result in more and more nerve cells being incorporated into the abnormal pattern of discharge.

The biological background of an epileptic seizure is therefore an abnormal discharge of nerve cells in the cerebral hemispheres of the brain. The normal, quiet, and integrated function of nerve cells is interrupted as they are forced through the contacts they make with and receive from others into a paroxysmal discharge. Different types of seizure are a reflection of different patterns of paroxysmal discharge. If the seizure discharge spreads throughout large areas of the brain, then consciousness may be lost. If the discharge of nerve cells is confined to the temporal lobe of the brain (more or less above and in front of the ears), amongst those cells concerned with memory, the paroxysmal discharge may result only in a distortion of memory so that the sufferer perceives that he or she has experienced ongoing events before—the phenomenon of deja vu.

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About 1-2 percent of the population exhibits a failure of pigmentation in patches of the skin which, as a consequence, appear unnaturally white. While in a few cases, the lack of pigmentation is generalized, the white patches are usually only a few inches across and occur on the parts of the body that are most exposed. The face (especially around the mouth and eyes), neck, chest, armpits, elbows, and knees are most affected.

Treatment, which, the American Family Physician (33#5:137) reports, is often unsatisfactory, includes repeated exposure to ultraviolet light after the patient has been given psoralen, a drug that sensitizes skin and makes it more reactive to sunlight. Before this, however, the eyes must be examined by an expert since the retina may also be involved in this pigment disturbance and could be injured by the psoralen-light reaction. Some parts of the skin may pigment more deeply and permanently than others in response to treatment. Skin that does not darken can be hidden with cosmetics or, alternatively, the surrounding skin can be lightened with

Eldoquin or Artra creams to blur the edges of the patches and make them less noticeable.

It is essential that anyone with patches of de-pigmented skin be seen by a dermatologist, since there are other conditions, including some types of poisoning and serious infection, that resemble vitiligo but that urgently need very different treatment. Moreover, anyone with vitiligo should undergo very careful medical examination, because in some cases there is an associated major illness, such as an autoimmunity (in which the tissues attack themselves), diabetes, thyroid disease pernicious anemia, myasthenia gravis, or melanoma. The relationship with melanoma is intriguing since a melanoma is a cancer of pigment-producing skin cells. However, having vitiligo does not mean that one is likely to develop a melanoma; the reverse is true and about 20 percent of melanoma patients also have vitiligo. Furthermore, the occurrence of vitiligo in someone who has had a melanoma removed sometimes heralds the development of recurrent melanoma tumors elsewhere in the body (i.e: in the liver).

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Symptoms

Oral herpes: multiple painful ulcers of mouth membranes or eyeballs, painful, red, swollen gums, swollen lymph nodes in neck, fever, fever blisters near the lips.

Genital herpes: painful ulcers and blisters on genitals.

Home care

For oral herpes give aspirin or paracetamol to relieve pain, and have the child eat bland foods.

An older child can rinse the mouth with a mild salt solution or be treated with triamcinolone or local anesthetic ointments.

Apply antibiotic ointment to fever blisters to prevent cracking and lessen the possibility of further infection.

For genital herpes, warm soaks help relieve inflammation and pain.

Precautions

-    In the case of herpes of the eyeball, consult an eye doctor promptly.

-    If a baby contracts herpes, get prompt medical attention.

-    Keep adults or children with herpes isolated from babies.

-    A pregnant woman with genital herpes can infect her child as the infant passes through the birth canal during delivery.

Herpes simplex is a highly contagious disease caused by herpesvirus hominis types 1 and 2. It is commonly known as canker sores (when it occurs in the mouth) or fever blisters (when it appears near the mouth). The infection is transmitted by direct contact with an infected person.

The type 1 infection (oral herpes) is common before the age of four but can occur at any age. Once contracted, the virus continues to live in the body for months or years, sometimes for the person’s lifetime. When the person’s resistance is lowered, (for instance by fever, sunburn, exhaustion, or emotional stress), the “sleeping” virus is reactivated.

Infection with the type 2 virus is genital herpes and, like oral herpes, it is contagious and often recurrent. It is usually transmitted sexually when the lesions (blisters) are present. A baby born to a mother with genital herpes can contract the disease while passing through the birth canal during delivery. In this case there is a 50 percent chance that the infant will be severely damaged or die.

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Your ability to conceive is significantly affected by what you weigh. You can make some very simple changes here to increase your fertility.

Calculating Your Body Mass Index (BMI)

Being the right weight for your height is very important. The easiest way to measure this is by means of the Body Mass Index (BMI) which identifies the percentage of body tissue which is actually fat. The amount of fat is important for fertility because we produce oestrogen from fat cells.

Your BMI is the ratio of your height to your weight and is calculated as follows: BMI = your weight in kg divided by the square of your height in meters. For example, if my weight is 63.5kg (10 stone) and my height is 1.68m (5ft 6in), my BMI is 63.5 – 1.68 X 1.68 = 22.5.

What does your BMI mean?

Under 20: underweight

20—25: normal

25—30: overweight

30-40: obese

Over 40: dangerously obese

A BMI of 30 would indicate a person around 16kg (2 1/2 stone) overweight.

What is Underweight?

Anything under a BMI of 20 is considered underweight and could make it difficult for you to conceive. This is one of nature’s protective mechanisms. The theory is that if we do not have enough fat stores our bodies think we are starving. Since it is not appropriate to become pregnant when food is short, ovulation or menstruation stop. (This is why women of the Bushmen tribes only ovulate at a certain time of year when food is plentiful.) When our weight gets back to normal (because we have stopped dieting and/or reduced the amount of exercise we take) we start ovulating and menstruating again. Our bodies assume that food is now plentiful and we become fertile again.

And even short-term dieting can have an effect. For example, healthy women who were put on a diet of 1,000 calories a day for just six weeks showed hormonal disruption in that short time. Progesterone, the important hormone which maintains pregnancy, dropped significantly and so did their oestrogen levels.

The good news is that getting back to the right weight really does boost your fertility. One study showed that nearly three-quarters of women with unexplained infertility managed to conceive naturally once they stopped dieting and returned to a normal weight.

If you get your weight back up to normal quickly it is still advisable to wait at least four months before trying to conceive. You will almost certainly have some vitamin and mineral deficiencies because you have been restricting your food intake. The four-month wait before getting pregnant is vital because otherwise, if you have been undernourished, you are more likely to have a low birth weight baby.

As we have seen, the current popularity of no-fat or low-fat foods and diets has some serious implications for fertility. Dieting in this way may deprive you of the nutrients that are essential for the proper functioning of your reproductive system. Just how serious an effect this can have was demonstrated by one study which showed that only 27 per cent of the women on a fat-restricted diet were actually ovulating.

To improve your fertility you should aim for a BMI within the normal range of 20-25, the optimum being 24.

Food should be eaten regularly and you should never skip meals. Apart from ensuring that you are well-nourished, regular meals are important to maintain your hormonal balance.

What is Overweight?

A BMI of over 25 is considered overweight and it can reduce your fertility. However, just losing a small amount of weight, say 10 per cent, can be enough to improve your hormone profiles, make your periods more regular, stimulate ovulation and increase your chances of pregnancy.

In fact it has been suggested that changing a woman’s diet should be the first move if she is overweight and failing to conceive. And research shows that even women with normal ovaries gain positive improvements in their hormone balance as they lose weight.

However, once you are pregnant, dieting is positively harmful. This is because, when you diet, your body gets rid of toxins and waste products. This is usually a good thing but if you are pregnant then the toxins can go straight into the developing baby.

For this reason, you must aim to lose any excess weight before you get pregnant. If you are already pregnant, then it is fine to change the quality of your food (by buying healthier foods such as organic vegetables, changing to organic free-range eggs, eliminating sugar, etc) but you still need to eat a good variety of food and not skip meals.

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You’re on the seventh hole, and you hear thunder in the distance. What do you do? None of the other players looks concerned, and this is your first day off in months. So you decide to play on. It’s the smart thing to do, right?

Wrong. No one, not even a golfer, is immune to lightning. Lightning kills about 100 people a year, and injures hundreds more, says Michael Cherington, M.D., clinical professor of neurology at the University of Colorado School of Medicine and founder of the Lightning Data Center at Centura Health, both in Denver. Men are four times as likely to get jolted as women, perhaps, in part, because they don’t come in out of the rain. He recommends several ways to lower your risk.

Pick up the signals. Darkening skies, sudden drops in temperature and increasing wind are all pretty good signs that a storm is coming and you ought to head for cover.

Use your ears. If you can hear thunder, you’re close enough to get zapped. You can measure how far away the storm is by counting seconds between the flash of lightning and the thunder-every five seconds equals roughly one mile-but just seek safe shelter immediately.

Follow an 11:00 a.m. curfew. If you’re hiking high altitudes like the Rocky Mountains, get down below timber-line by 11:00 A.M., Dr. Cherington says. “Most strikes occur after this time during the day.”

Seek safe shelter. The safest place during a storm is inside a safe shelter. When indoors, stay off the phone, out of the shower or bathtub, and away from appliances.

Stay away from single trees. If you’re on a golf course or any other open area, do not seek refuge under an isolated tree. The inside of a closed car or van is a relatively safe place to be. If a vehicle or safe shelter is not nearby, run into a forest rather than under a single tree. If you’re outside and you feel your hair starting to stand on end, a lightning strike is imminent. “Get into a catcher’s position, crouching on the balls of your feet, lower your head, and cover your ears,” says Dr. Cherington. “This is a very bad situation that’s best avoided.”

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