Health and medical information

• Breast feeding. Research has shown that smoking cigarettes may contribute to inadequate breast-milk production. Nicotine has also been found in the breast milk of mothers who smoke, although the effect on the baby is not yet fully understood.

• Long-term growth. Studies of long-term growth and development give evidence that children of mothers who smoked in pregnancy may have slight but measurable deficiencies in physical growth and intellectual development up to 11 years of age. Infants of parents who smoke are also more susceptible to chest infections, bronchitis and pneumonia than are the children of non-smokers.

The act of breathing in other people’s smoke has been labelled ‘passive’, ‘involuntary’ or ’second-hand’ smoking. Many non-smokers experience nose, throat and eye irritation from passive smoking; and there is evidence that long-term exposure may be harmful even to normal, healthy adults. Non-smokers dislike the smell of tobacco smoke in their clothes and hair following exposure.

The smoke from the burning end and from the mouthpiece of the cigarette is more irritant than the smoke which is breathed out. Since pipe and cigar smokers tend to inhale less than cigarette smokers, the contribution of their smoke to atmospheric pollution may be greater than that of cigarette smokers.

• Non-smokers who report recent exposure to smoke have been found to have nicotine concentrations in their saliva and urine which overlapped those of smokers who had smoked up to three cigarettes before sampling.

• Carbon monoxide (CO) levels in air heavily contaminated by tobacco smoke can exceed those permitted in industry for an eight-hour exposure. The amount absorbed by the non-smoker increases with the period of exposure.

• Recent research found that non-smokers who worked for twenty years with smokers, but who were not exposed to cigarette smoke at home, had sustained measurable lung damage similar to that in smokers who did not inhale.

A Japanese study has shown that the non-smoking wives of cigarette smokers developed lung cancer at higher rates than non-smoking wives of non-smoking husbands. The study followed up 91,540 non-smoking wives for fourteen years. The lung-cancer mortality rate of those married to men who smoked twenty or more cigarettes a day was twice as high as that of women who were married to non-smokers.

In another study, in Greece, it was found that for non-smoking women the relative risk of lung cancer associated with having a husband who smokes was an estimated 2.4 for women whose husbands smoked less than twenty cigarettes a day and 3.4 for those whose husbands smoked more than this.

Young children can be harmed by passive smoking. Infants under a year in age run twice the risk of developing a serious chest illness if both parents smoke. Also, children of parents who smoke have more upper respiratory infections than do children of non-smokers.

Since the early 1970s the proportion of adult cigarette smokers (over 16) in Great Britain has been decreasing. Between 1972 and 1982 the proportion of adult male smokers fell by over a quarter and that of women by about one fifth. Smokers have been a minority in the adult population since 1976. It has been estimated that there are about 16-17 million adult smokers in the population of Great Britain, and nearly 10 million ex-smokers. Between 1980 and 1982 about one million people gave up smoking.

Since 1978 men have been smoking on average fewer cigarettes per week, although they smoke slightly more now than in 1972.

• Cigarette sales in the UK have been declining steadily since 1974.

• There is a link between cigarette smoking and socio-economic group, showing a continuing trend for more smokers (men and women) in manual than in non-manual groups but in 1982 smokers were, for the first time, a minority in every socio-economic group.

• In England and Wales alone about 95,000 people are killed by smoking each year. It has been estimated that out of 1,000 young men who smoke in the UK, 1 will be murdered, 6 will die in road accidents and 250 will die prematurely as a result of their smoking. Most die from one of the three main diseases associated with cigarette smoking: lung cancer; chronic bronchitis/emphysema; and coronary heart disease. Lung cancer is caused almost entirely by smoking. In 1981 about a third of the total deaths from lung cancer were in people aged under 65. Although deaths from this disease are declining among men, they are rising among women.

• More than two-thirds of all smokers want to give up.

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Improving consultations

Start by writing down any information you need prior to the appointment. Your questions should also be written down and added to during the consultation.

Repeat information back to the doctor to make sure that you have heard and understood everything correctly. Ask for diagrams and illustrations to help you understand the information the doctor provides.

Take a friend or partner or relative along for moral support; it is important that family and friends be informed about your disease.

During the appointment take notes if necessary and ask the doctor to write down any instructions.

Although difficult at times, try to control your emotions when talking to your doctor as this will make it easier to understand the information and take notes.

Realistic expectations

It is reasonable to expect your doctor to ask if you understand vital aspects of your proposed treatment regime and for that information to be expressed in terms that you understand. To achieve this, your doctor first needs to establish your level of knowledge on both the technical and medical aspects of the disease.

It is not reasonable to put doctors on a pedestal and to accept all their advice without question. Let your doctor know what your expectations are – different women will have different needs and expectations.

It is not reasonable to have unrealistic expectations of what your doctor can achieve. For instance, the disease may not always respond to the best treatment available so it would be unfair to get angry with your doctor. Remember, doctors do not have all the answers to endometriosis – or anything else for that matter. They, too, can get frustrated with the lack of ‘cures’.

Making the right decision

Start by evaluating your doctor’s recommendations in the light of your own needs. If you want advice and guidance but also want to make your own decisions about treatment, then let your doctor know.

Trust

No doctor wants to feel that her or his credibility is being challenged but, equally, no woman should ever feel intimidated.

Let your doctor know that you respect her or his opinion but expect open and mutual communication and trust. You should trust your doctor’s level of knowledge just as the doctor should have respect for your judgements.

Confidentiality is also important and you must feel that information is confidential to both you and your doctor.

Your doctor needs to be able to trust that you have followed the treatment plan you both have agreed upon.

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Aching feet are hardly a subject for high-tech medicine and more often than not elicit a laugh rather than sympathy. After all, no one ever died of them. However, when your feet hurt you hurt all over and aching feet can make the most easy-going person irritable and tense. Painful feet in turn can cause back pain, knee problems and even stress and fatigue because of the abnormal postures your body takes up. All of this will make you less likely to want to play games and to take exercise and the cycle continues.

Almost eight out of ten people have aching feet at one time or another, according to surveys-in fact it is the third most common medical complaint. But why is the foot so vulnerable to aches and injuries? For a start it is a very complex structure of 26 bones, 56 ligaments and 38 muscles. This means there is a lot to go wrong-and the heavy punishment our feet take can accentuate problems that in other parts of the body might go unnoticed. By the age of 35 the average person will have walked 45,000 miles and the ball of the foot may be subjected to a force of 200 lb all the time and far more on running and jumping. Being furthest from the heart the feet have the poorest circulation of the body and this reduces with age as the arteries supplying the lower limbs narrow. Most of us wear shoes which immobilize the feet to a great extent and as a result the foot’s muscles are in a pretty poor state a lot of the time.

The greatest single cause of aching feet is poor footwear. Under constant pressure from tight or ill-fitting shoes, the skin of the foot becomes hardened and forms corns. Shoes which are too tight can cause ingrowing toenails or a painful thickening of the nail of the big toe.

Women have by far the greatest number of foot problems (about 85 per cent, according to several experts), mainly because of the style of women’s shoes. High heels make the body slide forwards, and to rebalance it a woman has to alter her whole posture. This takes the form of sticking her buttocks and her stomach out. The higher the heel the more the weight of the body is thrown on to the ball of the foot and a woman with a wide forefoot will end up with corns, bunions and hammer toes when her foot is jammed into a pointed shoe. High heels, if worn all the time, can also shorten the Achilles tendon at the back of the heel and leave the wearer open to injuries.

Platform shoes can cause painful bleeding under the big toenail and tight boots can actually cut off the circulation. Bunions (an inflammation of the joint where the toes meet the foot) are often caused by shoes that force the big toe into an unnatural angle.

The way people walk reflects the way they feel. Depressed people walk sloppily with a shuffling gait, and the stresses that this can put on the feet can cause problems. Though plantar warts (verrucas) are caused by a virus, there is a school of thought that says that they only occur when the individual is emotionally run down or stressed.

With the current vogue for walking and jogging an increasing number of individuals are suffering from a condition called plantar fasciitis. In this the thick band of fibrous tissue that runs the length of the sole linking the heel to the ball of the foot becomes inflamed. Sometimes the insertion of the fascia pulls away from the heel bone and a bony spur forms. These heel spurs are themselves very painful but the increased pulling of the tissue away from the bone that often accompanies fasciitis is the most common source of foot pain among adults who exercise. The earliest signs of fasciitis are a bruised sensation in the heel which won’t go away or pain in the sole as you get out of bed in the morning.

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In meditation, as in any relaxation technique, the first requirement is to let the relaxation process happen. It means not only letting go of our thoughts, feelings and emotions, but letting go of our control. As I have already discussed in chapter three, our need to be in control of ourselves and our environment is one of the major factors in the perpetuation of the disorder. Letting go of this control is essential to recovery.

Some of us find the prospect of letting go in meditation quite fearful. It can be too frightening even to think about it. We may think that by letting go we will lose control, and all our worst fears will come true. This is not the case. By letting go we are actually gaining control, not losing it.

Sometimes we may experience a ’surge’ attack during meditation. If this or other types of attacks happen in meditation, the secret is to let them happen. Not to fight them, but let them come. We keep our mind focused on our meditation technique. Although this may seem frightening as you read this, in actuality it isn’t frightening. When you let the attack happen and keep focused on your meditation, the attack will move through your body and disappear as quickly as it came. This is taking back the power.

It may take some time for people to gain the confidence to begin to let go of their control. Other people are able to let go within meditation immediately, and as they let go they can meditate naturally and easily. This is the beginning of full recovery. It is a very important step, because meditation teaches us that it is all right to let go of the control we are trying so hard to maintain. As we let go of this control we realise our major fears don’t come true, and as our practice continues over time we begin to understand why they never will.

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In an effort to help us relax, many of us are prescribed tranquillisers. However, this does not teach us management skills. While we need to be able to control our disorder, our need to be in control prevents us from relaxing. Relaxing means letting go of this dysfunctional control. In letting go, we gain a much more healthier way of control.

Relaxation doesn’t mean curling up with a book or watching television. If it were that simple, we wouldn’t have the disorder in the first place. Establishing the discipline of practising a relaxation technique may appear inconvenient to some people, despite the extraordinary inconvenience of their disorder, but recovery is worth the effort.

The main relaxation techniques are various forms of progressive muscle relaxation, and meditation. Progressive muscle relaxation is a step-by-step technique which teaches us to tense, then relax the major muscle groups in our bodies. If practised successfully, our minds also begin to relax. As our minds relax we may find ourselves meditating.

Meditation techniques work in the opposite way. If our practice is successful our minds relax first, then our bodies relax easily and effortlessly by themselves.

Meditation is over five thousand years old and while we use meditation as a relaxation technique, it is also the oldest cognitive technique in the world. Besides enabling us to access deep levels of relaxation, meditation teaches us how to be aware of and control our thoughts.

The next chapter outlines two meditation techniques. I used meditation because I found it was simpler and easier for me, during the years I had panic disorder/agoraphobia. This is also true for many people I have worked with over the years. This doesn’t mean progressive muscle relaxation doesn’t work—it does, and I have known people who find it easier. It is an individual choice.

Much of our recovery depends on our commitment to lower and keep down our levels of anxiety and panic. Practising a relaxation technique is a proven natural way to do this.

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Bill

Bill walked from his manager’s office. He knew the day would come-when he would be found out and today was that day. He had been caught drinking during working hours in the bar of the hotel, a few doors down from the office. He had been a regular visitor to the hotel, as he made his daily courier rounds to the head office, a few blocks away. Having a drink was the way he had found to help him cope with the panic attacks and perpetual anxiety. Bill had a regular routine. A drink before going to work, one during his morning round, two at lunch, one on the afternoon round and two before he drove home. He felt he had at least one thing in his favour. The manager didn’t know about his anxiety problem. Bill thought that having a drinking problem was much more socially acceptable than having an anxiety problem. What Bill didn’t know was that his manager also had the same anxiety disorder!

Patricia

The prescription lay on the table. Will she or won’t she have it filled? Years ago Patricia had been given a similar medication. She had never liked the thought of taking it, but the panic attacks and the anxiety finally convinced her she had to do something. It had helped for a while, but over time she found she had to keep increasing the dose for it to have any effect. Finally she decided enough was enough, and slowly withdrew from the medication. Patricia had learnt to cope with the panic attacks and the anxiety, but over the last two months they had become more and more intense. She didn’t want to take the medication, but as no one could suggest any other way of controlling the disorder she felt as if there were no alternative.

Robyn

Robyn looked at her mother in silence. It was no use, her mother was never going to understand that Robyn’s panic disorder was a legitimate condition and that Robyn was not just being ’stupid’. Her cousin also had panic disorder/ agoraphobia and had committed suicide a month before. No one had known until after his death exactly what had been wrong with him. He had never told anyone outside his immediate family. Yet Robyn’s mother still would not be convinced. She told Robyn that the family was not the type to have this sort of problem and that she had better ‘pull herself together’ and stop being so ridiculous.

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The extent of the disabilities people suffer through the disorders mean that we, as a community, lose the many and varied talents of these people. Not only is there a horrific personal cost, there is also an enormous socio-economic cost to the community.

In 1980 the economic cost of panic disorder, calculated in terms of employment losses, disability benefits, financial support and health care costs, was estimated at US $1 billion (Sheehan et al. 1980). A survey in the United Kingdom placed the economic cost of panic disorder, calculated solely on the basis of absenteeism, at £3 billion per year (Phobic Trust NZ 1991).

After speaking with over 12 000 people with an anxiety disorder, I have no doubt in my mind we are the most medically tested group of people in the country. In an effort to find out what is wrong we may see a number of doctors and specialists. We can undergo a range of medical tests including cardiographs, brain scans, testing for ulcers, numerous blood tests, not once but at least twice if not three, four or more times. As our symptoms can be unremitting we may regularly seek professional help either through our doctor or by attending the casualty department of our local public hospital.

Unfortunately this can be to no avail. Without a diagnosis and appropriate treatment many people become so disabled through the disorders they are forced to give up their jobs and rely on social security benefits. Others may refuse a job promotion or may need to take a lower paid position in an effort to cope with their disorder.

The cost to the community through these disorders is still not acknowledged, let alone addressed. Health care costs are soaring, yet many of the costs could be lessened through understanding and relevant treatment. Anxiety disorders and the secondary conditions are treatable. People can recover and resume normal lives. Greater awareness and understanding within the health professions and the general community will lessen both the personal and monetary costs.

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It will be clear from Table 1, that many of the symptoms seen in psychosomatic illness are also features of food intolerance. Indeed, ‘opponents’ of food intolerance would maintain that most supposed food intolerance is psychosomatic illness. But doctors specializing in the treatment of food allergy and intolerance would disagree. They see innumerable patients who have been told that their symptoms are psychosomatic or ‘all in the mind’ by one doctor or another. Yet a high proportion of these patients respond to an elimination diet. They get better when foods are eliminated from the diet – and they stay better, which is the important thing.

A diagnosis of psychosomatic illness or hypochondria is very largely a diagnosis of exclusion – it requires all other possibilities to be excluded first. With many patients suffering vague, multiple symptoms, food intolerance must be regarded as one of those possibilities. Unless steps are taken to ‘eliminate it from the enquiry’ – and that must mean a diagnostic diet – then there is no sound basis for saying that a patient’s symptoms are psychosomatic.

Things are not necessarily done in this order, however, and for good reason. Many of those attending the doctor’s surgery with physical symptoms, such as headache or diarrhoea, actually have serious emotional, sexual or family problems that they want to discuss with the doctor, but find it difficult to start on such sensitive topics. Family doctors are trained in the art of discovering what the patient has really come to see them about. If you have symptoms that you think may be caused by food intolerance you should not feel affronted if the doctor’s initial questions seem rather personal and irrelevant to the aches and pains being suffered. Answering the questions calmly and reasonably will do much to convince the doctor that your problems are not psychosomatic.

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If you have a family history of prostate cancer, get regular checkups and tests for BPH, including a digital exam of your prostate by your physician. The use of a screening test, such as a ptostatic-specific antigen, or PSA, test, is still controversial, and its results are unproven.

Whenever I feel a hard nodule in a patient’s prostate, I refer him to a urologist, even if he has no signs of urinary problems. The urologist will use a sonogram to check for cancer and will take a biopsy—which is a totally safe procedure—if he strongly suspects the presence of cancer. The biopsy is done either in the urologist’s office or in the hospital on an outpatient basis.

If you have an enlarged prostate with no signs of cancer, taking 5 milligrams of Proscar once a day for at least six weeks can help keep your symptoms manageable. Also, your doctor may suggest that you take Hytrin, a mild antihypertensive medication that can have the immediate benefit of reducing the effect an enlarged prostate has on urinary retention. You’ll usually start a regimen of Hytrin with a dosage of 1 milligram each day and slowly build it up to 5. Unlike with intestinal cancer or breast cancer, there’s not much you can do to lower your risk of prostate cancer, such as changing your diet.

A great deal of evidence shows that men who have prostate cancer do extremely well, even when it has spread. The most common therapy uses the hormone estrogen; what’s curious is that a form of cancer that only men get is treated with a female hormone, while breast cancer is typically treated with tamoxifen, a form of male hormone. The side effects of hormone treatment for prostate cancer include a loss of sexual desire and an increase in breast size.

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If your doctor determines that you have diverticulitis, you will need to be hospitalized. In addition, you will not be able to eat solid food or drink liquids for several days, since you will need to rest the bowel to clear up the condition. You will be given intravenous antibiotics and fluids, and a CAT scan will be done with a modified barium enema. This will serve two purposes. First, it will empty out your intestines, which will allow them to rest. Second, the barium will enable your intestines to show up on an X ray so that your doctor can examine the diverticula and determine if the infection is limited to a few diverticular pockets or has spread to form an infectious abscess. When your fever and pain disappear after about five days, you will be able to drink liquids again, and within a few days you will be able to eat solid food.

In most cases, surgery is not necessary to treat diverticulitis; only when an abscess has formed will surgery be considered. And, contrary to popular opinion, diverticulitis is not a preindication of cancer.

To prevent a recurrence of diverticulitis, you will need to exercise regularly and follow a high-fiber, low-fat diet, since a diet that’s high in fat slows the bowel transit time, as does a diet low in fiber, which aggravates the diverticula. The combination of exercise, high fiber, and low fat seems to speed up the bowel transit time and helps to eliminate the problem. You should also avoid eating nuts, seeds, popcorn, and foods with an indigestable hull such as corn.

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