Archive for May 8th, 2009

SKIN CARE: SUN SCREENS

Since the skin lacks adequate natural defence mechanisms against the damaging effects of UV radiation, total sun avoidance, the wearing of protective clothing, or the application of sun screens is necessary to protect it The latter is obviously more acceptable, and as people have become more conscious of the dangers associated with sun exposure, there has been greater awareness and use of these products.

A sun screen is a product intended for application to the skin to reduce the intensity of UV radiation reaching it. It should be easy to apply, form a thin invisible film, and resist removal by perspiration and swimming. Most importantly, it should be a broad spectrum screen, which absorbs both UVA and UVB radiation. It used to be thought that UVB radiation was the only wavelength to cause burning and permanent sun damage. So these wavelengths were the first to be screened out. However, it is now clear that both UVA and UVB are the cause of premature skin ageing and skin cancer. Therefore, newer preparations known as broad spectrum preparations are the ideal sun screens for Australian conditions. Furthermore, it should be made quite clear that a tan does not protect the skin from cancer-producing wavelengths even though it may prevent sunburn. Sun screens should be applied to dry skin, preferably half to one hour before sun exposure, and be reapplied if sweating is profuse or swimming frequent. The best chemical combinations currently available are those containing either the aminobenzoates or cinnamates, which preferentially absorb UVB, and benzophenone, which absorbs UVA.

The Health Departments and Anti-Cancer Councils in Australia classify sun screens by relating them to the percentage of UVB wave lengths which they screen from the skin. Most products from the United States and Europe, however, are labelled according to their Sun Protection Factor or S. P. F. This value is essentially an indication of how much the period of sun exposure can be prolonged without risking severe sunburn. An S.P.F. of 4 would mean that the product will allow the user to enjoy the sun four times longer than would be possible without protection. For the average individual this would mean an exposure of 40-60 minutes. Since the various products available for the Australian market vary greatly with respect to their S.P.F., the level of protection should be specified in order to simplify the consumer’s choice. Furthermore, it should be made clear that the broad spectrum preparations, although fewer in number, are the ideal choice for Australian conditions.

The only totally effective method of preventing sunburn and the more severe permanent signs of skin damage is to completely avoid the sun. A more satisfactory solution is to apply an effective sun screen preparation every morning as part of one’s daily grooming, along with such routines as hair combing and teeth cleaning. This is necessary in Australia and other sunny climates because of the cumulative effect of the sun from birth onwards. It is the number of hours of exposure to the sun, rather than the intensity of any single exposure, which is the crucial factor with regard to the onset of premature ageing and the formation of skin cancer.

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THE MENOPAUSE: HOT FLUSHES AND NIGHT SWEATS (PART 1)

Hot flushes and night sweats belong in a category of symptoms that doctors call ‘vasomotor symptoms’, that is they are concerned with the blood vessels dilating and constricting, and with the flow of blood through these vessels. The symptoms are harmless, but most women greatly dislike having them, and find them uncomfortable, embarrassing and unpleasant. They may also affect a woman’s ability to cope at work and at home, and she may even avoid social contact for fear of feeling ashamed.

The typical hot flush starts as an unpleasant sensation of heat in the face, neck or body. If it starts in the face or neck, it will probably spread down to the main part of the body; if it starts there it will spread up to the face. Often the face becomes red, and sweat appears; but many women find, to their surprise, that, despite the feelings of great heat in their face, there are no outward signs at all, and nobody has noticed.

Flushes may occur at intervals from several each hour, to just a few times each month, usually in the days leading up to the start of a period. There will be times when flushes occur frequently, and times when they do not occur at all. Each flush may last for a few seconds, or for up to half an hour, or more, but most last for about three minutes. After a flush, you may feel sweaty, then cold, and you may seem to be endlessly taking clothes off and putting them on again to get comfortable. Flushes can occur at any time of the day or night, and may be accompanied by heart palpitations, dizziness and feelings of faintness. In America, they are called ‘hot flashes’, but this is a less appropriate name, as it suggests something that comes and goes very rapidly. The British term ‘hot flush’ describes more accurately the feeling of heat that builds up and dies down slowly.

When flushes occur at night, they are called ‘night sweats’. Typically, a woman will wake from sleep to find she is drenched in sweat and has to get up to change her night-clothes, and perhaps even the bedding. Night sweats cause greatly disturbed nights and lack of sleep, for the woman suffering them and perhaps also for her partner who may find himself woken several times in the night as she gets up to wash and change into something dry. Repeated broken nights cause fatigue, loss of concentration, irritability, and a general sense of lethargy.

The underlying cause of a hot flush is a falling level of oestrogen. This is not the same as a low level: girls before puberty and men have low levels of oestrogen, but they don’t suffer hot flushes; women get them when the level of oestrogen in their body has been high and then starts to fall. Women who lose their oestrogen suddenly, as when they have both ovaries removed, tend to get flushes that are particularly troublesome. If the decrease in oestrogen is gradual, the symptoms will be less severe. In most cases, once the body has adjusted to its final low level, the flushes will end.

It is thought that the falling level of oestrogen throws the body’s heat-controlling mechanism into confusion, and the ‘thermostat’ becomes set too low. The result is that the body thinks it is suddenly too hot, so it dilates the blood vessels and sweats to cool itself down. The dilated blood vessels produce redness and a sensation of heat in the skin, but although the skin itself may become several degrees warmer than normal, the body’s underlying temperature remains unchanged. Even if the skin hardly becomes warm at all, the woman will still feel hot – usually uncomfortably and embarrassingly so.

Flushes can be triggered by several things – or by nothing. Common causes of a flush are: anxiety, hot weather, moving from a cold room to a hot one, drinking tea, coffee, alcohol or hot drinks, or eating spicy food. However, most flushes don’t seem to be triggered by anything. As smoking reduces oestrogen, smokers tend to find flushes more troublesome than non-smokers do.

If you get hot flushes, you may feel freakish, and wonder if everyone is staring at you. In reality, the chances are that no one will notice, and, far from being a freak, 75 per cent of women going through the menopause get hot flushes, just like you. Of that number, 80 per cent still have them a year after they first appeared, 25 per cent still have them five years later, and for an unfortunate 5 per cent, they continue indefinitely.

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HYSTERECTOMY: ‘WATCHFUL WAITING’

For some women, coping with difficult menstrual bleeding or painful periods without drugs or surgery is an option worthy of serious consideration. The rationale for a ‘watchful waiting’ approach hinges on the well-established finding that oestrogen plays a major role in the growth of fibroids and endometriosis. When oestrogen output by the ovaries decreases after menopause, these conditions tend to become much less worrying. Many women are therefore prepared to give the watchful waiting approach a try if their period problems are bearable and they are nearing menopause.

Julia experienced intermittent, heavy and painful bleeding due to fibroids for two-and-a- half years before her menopause and considered having either a myomectomy or a hysterectomy during this difficult time. Looking back some years later Julia was pleased that neither procedure was ultimately necessary.

There are many reasons for difficult-to-manage bleeding patterns apart from fibroids. Lauren had lengthy menstrual bleeds in her late forties that were different from anything she had experienced previously. During them, spotting was typical on the first few days, then there were several days of heavy bleeding which resembled the heaviest bleed of former periods, followed by a handful of days when the bleeding tapered off. Managing the blood loss was tiresome because it went on for so long and Lauren was also concerned about the possibility that something was seriously amiss. Medical investigations including a hysteroscopy did not reveal any suspicious lumps or growths and showed that she was not anaemic. Doctors said changes in her sex hormone levels, consistent with an Impending menopause, were to blame for her symptoms. In order to sort out whether Lauren’s blood loss was excessive, it was suggested she record what her bleeding was like. ‘Keep a diary of how many days it lasts, how many and what sort of sanitary pad or tampon you use, whether pain occurs and when,’ her doctor said. ‘Then we’ll discuss the findings.’

Lauren’s diary confirmed that her blood loss was heavy and prolonged and a number of possible medical therapies were discussed as well as the option of watching and waiting. After talking with friends who had negotiated similarly difficult bleeding, Lauren decided to try a non-medical approach for a few more months. In particular, she started experimenting with dietary changes, including some herbal products, and the use of highly absorbent ‘overnight’ sanitary pads when the bleeding was heaviest. Her boss, who had herself been through similar difficulties some years earlier, was supportive and understanding. Lauren bled profusely at night on several occasions and found it reassuring to have a mattress protector in place as well as a towel beside her bed in case of flooding. After several months her periods dwindled then stopped.

An increasingly common cause of bleeding in the post-menopausal age group is hormone therapy. Sometimes there is no apparent reason why such problems affect one woman and not another. Occasionally the explanation seems to be pre-existing fibroids or the use of an oestrogen implant as part of post-menopausal hormone therapy. It has been noted that implants cause severe uncontrollable bleeding in some women, presumably because they deliver larger amounts of oestrogen than other hormone therapy formulations, for some of the time at least.

Another possible cause of bleeding is cancer of the endometrium in post-menopausal women who have used oestrogen therapy (in pill, patch or implant form) without added progestogen for several years. Even after oestrogen is no longer taken, the risk of cancer of the endometrium persists. It is important to seek medical advice promptly if this possibility applies to you.

The decision about whether to watch and wait or to try medical treatments or surgery depends on many factors including the amount of bleeding and its effect on daily living, the ability to cope with such difficulties, general health, the rate of change in conditions like fibroids, and the probable time to menopause. Situations in which watchful waiting is generally considered to be inappropriate include rapid fibroid growth resulting in a significant and measurable increase in the size of the uterus during a six-month period, bowel or urinary obstruction, and symptoms which make life seem hardly worth living.

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DREAMS—PSYCHOLOGICAL FILTER

We are now going to explore the use of dreams from another angle. But first let us recapture some of the facts about dreams and REM sleep. When a person is sleeping in the sleep laboratory, if he is awoken immediately after the REM sleep he will nearly always be able to recall his dreams vividly. But if he is awoken five minutes after the cessation of REM sleep, he will have only a vague recollection of the dream. If he is awoken ten minutes after the REM sleep, he will have difficulty in remembering any dream. It is quite normal to forget our dreams, and some people can never remember their dreams and believe that they never dream at all. Most of us wake from our dreams in the morning and still have our dreams fresh in the mind. However, when activities of the real world set in, the dream details disappear. As the day continues, you normally cease to think of your dreams—your mind is occupied with real tasks and real problems. Hence forgetting our dreams is normal and healthy.

Once, on waking in the morning, my wife Patricia tried to tell me about an interesting dream. However, by the time we were having breakfast and discussing the day’s work ahead of us, she had totally forgotten the contents of the dream. Patricia manages my clinic and is also a registered nursing sister. Unless we make a conscious effort to remember a dream, such as writing it down, it vanishes from memory. Just stop for a moment and think. Can you remember the dream you had the night before?

While we are dreaming we act out and experience some of our unconscious wishes and desires. Some of these desires may be very wicked and sometimes even immoral, and some of these desires may be too ambitious or even against the law and can never be fulfilled in real life. The dreams seem to satisfy our wishes and desires and let us experience them as if they are real and as if our dreams have come true.

Once these desires are satisfied, they are meant to be forgotten, so that the mind will no longer be disturbed by these desires and we can get on with our normal daily lives. In this theory about dreams, we are not encouraged to remember dreams or to analyze them. Dreams are perhaps a psychological filter and are used to dispose of our accumulated unconscious desires that may disturb our normal daily activities. After all, nature has designed dreams in such a way that most dreams are forgotten the next morning. Dreams are used to balance out our inner psychic life.

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