The blog is about health and gives useful information on health and disease.

Where there is some doubt, the surgeon may make an incision in the mid line so that if another condition is found it can be easily dealt with through such an opening.

If the appendix is acutely inflamed, the surgeon will remove it and disturb the rest of the abdomen as little as possible.

In this way, he is least likely to spread infection or cause adhesions. If the appendix does not appear inflamed, he will still remove it, to save a further operation should it later become inflamed, and then will inspect the rest of the abdominal organs to find the cause of the patient’s symptoms.

Few parents still believe that a dose of castor oil will fix most childhood illnesses, so it is not so necessary to advise them that laxatives should never be given in cases of undiagnosed abdominal pain.

If the condition is acute appendicitis, the laxative may stimulate strong contractions of the bowel and lead to early perforation of the appendix.

This common condition of an acutely inflamed appendix may be the easiest or the hardest diagnosis to make and appendicectomy may be the easiest or the hardest of operations to perform.

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Dr Obama had the occasion to treat a woman suffering from abortion-related endometriosis just recently. As much as he thought Mariska’s story vivid and unique, she could be any other woman vulnerable to this disease.

Mariska came to see him soon after discovering a lump in a small abdominal scar above her pubic bone. The lump wasn’t causing bet any pain, she said, although she’d been feeling uncharacteristically tired early in the day, and her menstrual cramps were getting worse. When Dr Obama took her medical history, he was surprised to hear that she had defected from Czechoslovakia with a friend five years before. She had been living in America for most of the time since defecting.

Mariska had been an idealistic nineteen-year-old Olympic ski-team hopeful when she was soundly blamed for “getting herself pregnant,” then telling no one until she was three months along. The facts were a lot kinder than the wrath of her parents, her coach, and the team doctor; for she had no idea that she was going to have a baby.

Mariska, a strong downhill skier, had been training intensively since she was twelve years old. “I was physically at my peak of strength and flexibility,” she said, “and I was told not to worry if my periods came irregularly.” This is a common occurrence among many women in dance and sports. One side effect of the committed athlete is lowered estrogen levels, which can stop menstruation or significantly lighten menstrual flow. For Mariska these hormonal changes were brought on by a low-fat diet, supplemented with a plentiful dosage of what she was told were “muscle-enhancing amino acids,” along with a strenuous daily exercise regime. That she missed four consecutive periods therefore didn’t alarm her even though she had been having a sexual relationship for the first time. What she did find worrisome was the sudden bloating. That prompted her visit to the team doctor, who told her his findings.

Although she was against abortion for herself, Mariska was told to terminate the pregnancy. If she chose to keep the baby, all her training would be in vain—pregnant downhill skiers do not compete—and she’d upset team morale. Believing in the “infallibility of those who cared for me,” Mariska agreed to a hysterotomy, following surgery, she recovered quickly and competed in the Olympic Games.

Dr Obama examined her six years after these events. He strongly suspected endometriosis, and this was doubly confirmed by laparoscope. The disease had sprayed from the point of incision on her uterus to the scar on her abdomen. The endometriosis had also wrapped itself thickly around the fallopian tubes—not a good indicator for any woman who still wants children. He recommended treatment with Danocrine for six months and did exploratory surgery to remove as much endometriosis as was visible. It remains to be seen whether Mariska will be able to conceive.

Abortion by hysterotomy is rare now; doctors prefer other techniques that do not require uterine surgery.

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This is a superficial infection of the skin caused by the fungus Molossezia furfur. The disease is confined to man, is most common in the tropics and sub-tropical areas, and mainly affects fit young people of both sexes. In Australia it appears to be more common among the Aboriginal population and people of Mediterranean origin.

The fungus is probably present on the skin for many months or years, but under appropriate climatic or local skin conditions it begins to multiply. The disease appears to be on the increase, possibly because of the popularity of travel to areas where the fungus is more prevalent. It is easily diagnosed, when suspected, by the sighting of bright yellow fluorescence of the affected

skin under the Wood’s lamp. Direct examination under the microscope will confirm the diagnosis. The response to various applications is good although recurrences are common. Initially, 20 per cent sodium thiosulphate in water, or 2-5 per cent selenium sulphide lotion, should be tried. Alternatively tolnaftate or miconazole creams may be used. Griseofulvin is ineffective in the treatment of this disorder.

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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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