About Health & Medicine

PREVENTIVE MEASURES AGAINST HEART ATTACKS

•     Eat more fish oils. Studies of people who consume large amounts of fish (notably the Japanese and the Eskimos) show that they have very low heart-disease rates. Both groups have low blood-fat levels, high levels of high-density lipoproteins (the good, helpful kind) and a reduced tendency for their blood to clot. These people also have a high level of a particular type of fatty acid called eicosapentaenoic acid (EPA). This and its close relative, DHA, are found in fish, fish oils and the fat of marine animals. Many research groups have now looked at the role of fish-oil supplements and found that various risk factors for heart disease can be altered beneficially. The main advantage appears to be that the blood becomes less sticky and so less likely to form clots. This must reduce the risk of heart attacks because they are so often triggered off by a clot in one of the arteries that supply the heart. It is especially encouraging to find that the higher the blood fats before taking fish oil, the more they are affected by the treatment. So far there do not seem to be any drawbacks to taking fish-oil supplements-for example, the blood does not go on getting thinner and thinner. So, by increasing your fish consumption and possibly taking a food supplement of EPA, you can almost certainly reduce your chances of having a heart attack.

•     Eat more magnesium-containing foods. Recent work suggests that it is brief spasms of the coronary arteries rather than clots that trigger a significant number of heart attacks. It appears that a deficiency of magnesium could be behind this problem. Eat more fruit, whole grains, vegetables and pulses to enrich your diet with magnesium.

•     Make friends and be sociable. Social isolation has been found to be a factor in heart attacks, according to a study of 4,000 men in the US. The most sociable people had fewest heart attacks. In parallel with this an Israeli study found that men who had a good sex life were much less likely to have a heart attack. There is also evidence that loving care reduces the arterial disease that makes a heart attack more likely by narrowing the coronary arteries.

•     Control your diabetes if you have Type I (insulin-dependent diabetes) and cure it if you have middle-age onset diabetes. Diabetics have a very much increased risk of having a heart attack and this preventive measure is very worth while.

•     Don’t take the contraceptive pill if you have a history of heart disease in the family. It is not known why women have so much less heart disease than men-the hormonal differences are not an adequate explanation-but taking the Pill definitely raises the risk unacceptably for susceptible women, especially after the age of 35.

•     The weather, particularly the invasion of cold fronts and rapid falls in barometric pressure, has been linked to admissions to hospital with heart attacks. Things you can do to prevent heart attacks occurring in these circumstances are to avoid exposure to cold, especially the combination of vigorous exercise and cold. It is no coincidence that so many men die from heart attacks every year shifting snow from in front of their homes. The use of a light face-mask helps maintain temperature and humidity and can be a useful preventive.

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WEIGHT LOSS: TYPES OF GROUP THERAPY

Psychoeducational and Cognitive-Behavioral Group Therapy

We heard about many cognitive-behavioral techniques. The same principles can work in a group setting as well.

Groups provide a natural forum for patients to learn the facts about eating disorders. Food diaries can be looked at in groups. Another advantage of groups is that they give patients an opportunity to share strategies for improving unhealthy eating and reworking outmoded patterns of thinking and feeling.

Family Support Groups

Family groups, often led by a social worker, involve members of anywhere from five to ten families of eating disorder patients. Families learn how to be more supportive of their child, how to set limits, and how to handle problems that crop up. In sessions, people share experiences and trade advice, giving each other much-needed emotional support in the process. Many participants report feeling much less shame and guilt following a course of therapy.

Other Types of Groups

These include creative therapy, such as movement or dance therapy, to help patients get in touch with their bodies, and art therapy, where patients draw or sculpt to express their feelings about their bodies, their relationships with others in their family, and so on. In psychodrama groups, patients act out scenes, playing different roles to carry on conversations or demonstrate feelings. This strategy helps a patient uncover her feelings and bring them into the room, where they then take on a life of their own. Women’s issues groups focus on concerns relating to sexuality and the role of women in society. Finally, there are self-help groups that offer emotional support, socialization, and hope.

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STIMULATE YOUR DETERMINATION: SHE LOST THE WEIGHT AND GOT HER DREAM JOB

Phyllis Schmoyer wanted to be a telephone operator, just like her big sister. So shortly after graduating from high school in 1944, she applied for a job at the same company where her sister worked.

“At first, I was told that I couldn’t be hired because it was against company policy to employ more than one person from the same family,” recalls the 73-year-old Pottstown, Pennsylvania, woman. “But when I pressed the issue, I was told that I was too heavy.” At the time, she carried 168 pounds on her 5-foot-5 frame.

“Back then, telephone operators sat very close to one another,” she explains. “Because I was overweight, I would have taken up more than my share of space.”

Phyllis, who had never been too concerned about her weight, suddenly had a very compelling reason to slim down. “I really wanted that job, so I began doing things that I thought would help me get rid of the extra pounds,” she recalls. “I stopped sitting around like I had done all during high school, and I started walking everywhere.” She also tried to eat better, cutting back on both the candy bars that she loved and the rich food that was served in her home. “My parents were Pennsylvania Dutch, so I was accustomed to heavy meals with lots of fried foods,” she says.

Sure enough, the pounds came off—40 of them in all. Triumphant, Phyllis returned to the phone company to reapply for an operator position. This time, she got the job.

Though more than 50 years have passed, Phyllis has maintained her trim figure. “I stay active, and I watch what I eat,” she says. “I think that my weight got to where it was supposed to be in the first place, and it has pretty much stayed there.”

Looking back, Phyllis is convinced that taking off those 40 pounds made a world of difference for her. “If I hadn’t lost the weight, I probably wouldn’t be alive today,” she says. “Heart disease runs in my family, and as heavy as I was, I may have gotten it, too. I truly believe that slimming down saved my life.”

WINNING ACTION

Make slimming down high stakes. If you have trouble sticking with your weight-loss program, maybe you need to up the ante a bit. Maybe you’ve been toying with the idea of changing jobs or going back to school or signing up for an African safari. Make that your incentive to slim down.

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WHAT SHOULD YOU KNOWABOUT HRT

- I’ve decided to try HRT after discussing my situation with my doctor. Is there any particular time after menopause when it’s best to start?

If you are having menopausal symptoms that interfere with your quality of life, you can start on HRT at any time. If the main reason for HRT is your worry about a high risk of osteoporosis or heart disease in the future, it’s best to start on it within about twelve months of your menopause. It’s also acceptable to begin at any time after the menopausal years. For example, a woman in her late sixties whose bone density is found to be critically low can start HRT to prevent any further loss of calcium from her bones.

- My periods are getting less regular and I’m wondering whether there’s any sense in starting HRT before they finally stop. Could I avoid menopausal symptoms by doing this, for example?

This is not recommended, because many women don’t develop any significant menopausal symptoms and are not at risk of heart disease or osteoporosis, the other main reason for having HRT Another reason why we don’t normally offer HRT before menopause is that women could end up with persistently high levels-of oestrogen, and we don’t know the effects of this yet.

- How long should I stay on HRT?

That depends on why you are having it. If it’s to control symptoms, you’ll probably need HRT for between two and ten years, depending on how long the symptoms last. If it’s for protection of your bones, heart and blood vessels, your doctor will probably recommend that you stay on HRT until your late sixties or early seventies, or for the rest of your life.

- When should I stop HRT for symptom control?

When you feel comfortable about it. If you don’t want to go on any longer because it gives you side effects, or you feel well and are reluctant to continue taking pills, using patches or whatever, it’s a good idea to see how you get on without them. If you do stop HRT, the dose of hormones should be gradually reduced.

- Should I take my HRT pills at the same time each day?

Yes. This seems to give better control of symptoms and reduces the likelihood of spotting.

- Will I need to change the type of HRT I’m on, or the dosage, as time goes by, even though it seems to suit me well?

No. Once a hormone format is found that suits a particular woman’s needs, she is usually advised to stay with that format unless an alternative is developed that is likely to suit her better. Your dosage will probably also remain unchanged unless you have unwanted side effects at some stage.

- Can I use a hormone-based vaginal cream if I’m already using an oestrogen patch?

A vaginal cream used twice a week together with a patch may be called for if vaginal dryness is particularly troublesome and the oestrogen patch on its own does not do the trick.

- Do I need to remove my HRT patch when I shower or swim? Patches are designed to withstand the sorts of activities you describe, but if you find there is a problem, remove it from your skin and replace it on its original backing while you shower or swim. When you’ve dried off, put it back on again.

- Is there any evidence that HRT reduces the risk of bowel cancer?

Several studies suggest that oestrogen confers substantial protection against bowel cancer, while at least one other well-designed study has not reproduced this finding. Various groups of researchers are currently attempting to come up with a conclusive answer to this important question.

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SEXUALITY AND EMOTIONAL GROWTH: EMILLY’S AND NADIA’S STORIES

This was the case until a few years ago for Emily, a sixty-two-year-old who suffered from chronic back pain. Initially she was very concerned to protect her back, and she put sex off limits. But with support and reassurance from various health practitioners, she experimented and found enjoyable ways to have sex with her partner. In particular, she chose times when she was warm, well rested and feeling sexy, and with plenty of pillows available to support her back.

For Nadia, who was plagued by intermittent heavy bleeding in her mid-forties, the problem was finding a time when she could have sex enjoyably. ‘I had never felt like sex during my monthly bleeds, but at least they previously lasted only four or five days. This stage was much worse because I was bleeding for fifteen days without a break and I felt so ugh! My husband didn’t mind having sex while I was bleeding, but I just couldn’t come at it.’ Since Nadia’s menopause at the age of forty-eight, she and her husband have resumed the satisfying sex life they enjoyed in earlier years.

that those who have neither a desire for nor interest in sex, or who have deliberately chosen a lifestyle in which sexual activities play little or no part, have every right to their decision. On the other hand, those older people who enjoy sex or want to enjoy it should be given the information and treatment they need if problems arise.

In attempting to put the presence or absence of sexual intimacy into some sort of general framework of midlife relationships, Hathorn and Bates identified a significant obstacle. ‘One of the major problems was that our interest was in both men and women, yet it seems that most of the well-known developmental theorists of the past have focused only on men. It is as if woman were an afterthought and had to be “fitted in” to men’s cycle of growth

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HRT AND MNOPAUSAL SYMPTOM CONTROL: ENERGY LEVELS

ENERGY LEVELS. Women at midlife sometimes claim that their get up and go has got up and gone. They can’t raise the energy to pursue activities they have enjoyed for years. Such a woman is Bronwyn, whose youthfulness comes from an appetite for adventure that was unquenchable until menopause hit. ‘I don’t have flushes and I generally feel OK, except that I don’t have any energy. I’m working near to home but I find it harder than ever to get up in the morning, and to get moving. The worst thing is that I just want to rest on my days off, instead of visiting friends or taking off for the bush. I haven’t been able to look my hiking boots in the eye.’

If this is your scenario too, it is important — before allowing a doctor to reach for the prescription pad — to establish that your loss of energy has a physical origin and is not explained by job frustration or dissatisfaction, or the need for new challenges in life. Once you are satisfied that there is a physical basis to the problem, it is essential to have a check on your general health, diet, activity levels and lifestyle stresses before even considering HRT. Some women do find that energy levels respond to HRT. It is unclear to what extent this is due to an effect of HRT in settling other symptoms such as night sweats and sleeplessness; a feeling of wellbeing induced by HRT’s action on the brain and other body tissues; or a placebo effect activated by a doctor’s interest in and support of his or her patient.

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THE A TO Z OF HRT: INDEPENDENT STUDIES

Women’s acceptance of oestrogen was helped along by the statements of medical authorities such as Dr Robert Greenblatt, a leading endocrinologist who was president of the American Geriatrics Society. In 1974 Dr Greenblatt claimed that about three-quarters of menopausal women were acutely oestrogen-deficient, and he advocated oestrogen therapy for them all, even in the absence of symptoms. A year later, with prescriptions for oestrogen exceeding 26 million in the US alone (it was the fifth most frequently prescribed drug), and worldwide sales of Premarin surpassing $USioo million in value, controversy erupted.

Two independent studies by reputable US research teams, both published in the New England Journal of Medicine in 1975, reported a link between postmenopausal oestrogen therapy and cancer of the endometrium (the lining of the uterus), the risk increasing with the duration of therapy and its dose. The researchers found that women who had a uterus and used oestrogen preparations without any other sex hormones, such as progestogens (synthetic forms of progesterone), for longer than six months had an increased risk of endometrial cancer -five to ten times greater than was normal for their age.

There followed a period of widespread concern and scientific reappraisal, during which progestogens were teamed with oestrogen, the aim being to protect the endometrium of all women with an intact uterus from the increased risk of endometrial cancer. Subsequent studies have confirmed that progestogen achieves this protection.

Much has been learned from this saga, particularly the need for constant review of present knowledge, and a commitment to ongoing research of the menopause and ageing. What we can say with confidence is that in recent years there has been a resurgence of interest in HRT, together with an acceleration of research and clinical trials using therapies of different dosages in different patient groups, and the development of new ways to administer it. One of the biggest challenges now facing the medical research community is to identify women who need HRT and those who don’t. Women themselves should at the same time be analysing their experience of menopause in the light of their own medical history, weighing up the evidence, and making their own judgement.

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THE SYMPTOMS OF FOOD INTOLERANCE: CROHN’S DISEASE

This is a serious bowel disorder that produces patches of inflammation in the intestines, mostly in the second part of the small intestine (the ileum) or the large intestine (the colon). These patches have a characteristic appearance under the microscope. They may heal themselves in time, and some patients recover after just one or two attacks of Crohn’s disease. Others suffer recurring attacks throughout their lives. As they heal, the inflamed areas may develop scar tissue that narrows the intestine, making passage of food difficult. In terms of actual symptoms, Crohn’s disease produces diarrhoea, and cramps or more generalized pain in the abdomen, especially after eating. There is usually a general feeling of malaise and, sometimes, a slight fever. If left untreated, there is weight-loss and the health deteriorates because nutrients are not absorbed properly. Other symptoms, such as joint pains and mouth ulcers, often go with Crohn’s disease.

Despite intensive study, doctors still have no clear idea of what produces Crohn’s disease. The damaged areas of intestine, when studied under the microscope, contain a great many immune cells – it is these that produce the inflammation. The obvious explanation is that some infectious agent attracts them there – but there is no evidence that Crohn’s disease is infectious, and the fact that the disease mostly affects people in their twenties makes an infection unlikely. However, some researchers believe that they may now have found an infectious agent – a slow-growing bacterium related to the one that causes tuberculosis. Attempts to show that this bacterium really does produce Crohn’s disease are now in progress.

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NATURAL SLEEP – THE INTERPRETATION OF DREAMS

The general interpretation of dreams as practised by private individuals or by psychologists usually goes too far. It is interesting, however, that you may find an answer to some problem you have been looking for in vain while awake, the reason being that the rested brain is able to draw more logical conclusions. Some researchers and inventors have even found the solutions they were seeking while asleep and dreaming. The solutions were proved to be correct on subsequent examination of all the details involved.

According to God’s inspired writings in the Bible, the Creator revealed his purposes on several occasions in the form of prophetic dreams way back in antiquity. On the other hand, dreams can also be inspired by magic, metaphysical powers that are neither in harmony nor accord with the Almighty. Dreams have always had an important place in ancient cultures, as can be clearly seen from Daniel’s reports about King Nebuchadnezzar of ancient Babylon, as recorded in the Bible. However, the memorable dream in question, telling of a mighty tree, came in fact from God Almighty, and the King’s magicians and interpreters of dreams were unable to understand its meaning. No one but Daniel himself, with God’s help, succeeded in presenting the correct information to the frightened ruler. A similar thing happened to the Egyptian pharaoh in the time of Joseph. In that case, too, no one but Joseph knew the divine dream’s interpretation.

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THE INFLUENCE OF CORRECT BREATHING ON ILLNESS – INTRODUCTION

A slim figure can be obtained or retained by correct breathing. A ’spare tyre’ will disappear more quickly if, at the same time, attention is given to the diet. Even if one is careless with the diet, correct breathing alone will ensure a 50 per cent success rate in achieving a good figure.

Anyone suffering from enlarged adenoids may do so because of faulty breathing, since it can lead to the formation of these growths of lymphoid tissue. On the other hand, correct breathing, day and night, will prevent them and even make existing ones recede.

Some people lose their sense of smell. For them we recommend a diet of natural foods, for a time perhaps even raw food, and correct breathing exercises. This combination can slowly bring back the sense of smell. Indeed, no illness or disease exists that will not benefit from correct breathing techniques.

If women would but breathe properly, most of their abdominal complaints, tumours and growths could be prevented. Confinements would be much easier because nervous congestions would disappear. Tight clothing, belts and tight-fitting elastic girdles should be avoided if abdominal breathing is to be unrestricted. It is preferable to exercise the abdominal muscles to maintain their elasticity, rather than to control their shape by girdles that restrict and only serve to weaken the muscles. As soon as such an artificial contrivance is removed, the muscles which have been kept in place by pressure alone will again bulge out and the whole purpose of maintaining a pleasing appearance will be defeated.

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