BREAST LUMPS: GOING HOME AFTER OPERATION

Some time after your operation you will be visited on the ward by a hospital doctor to check that all is well.

Before you are discharged from hospital, the nursing staff will need to be sure that you will be able to manage. If you do not have help at home, and you are concerned about managing on your own, do tell one of the nurses before your operation so that some arrangement can be made for you. For some people, such as students who are returning alone to student accommodation, or elderly women who live on their own, a longer stay in hospital may be necessary until they are better able to cope.

By the time you are discharged from hospital you should have only slight pain or discomfort, your wound will be healing, and any drains will have been removed.

Driving

You should not drive yourself home after your operation, and should probably avoid driving for at least 2 weeks. Your car insurance is likely to be invalid for at least 48 hours after a general anesthetic: you may feel all right, but your reactions in an emergency would be slower than normal.

Even if you have not had a general anesthetic, do not drive until you are sure you can make an emergency stop without being hindered by pain from your wound. If you are in any doubt, your GP will be able to advise you about this.

Discharge letter

Before you leave hospital you will be given a letter to take to your GP’s surgery. This will contain a report of the operation and anything your GP may need to know about your treatment, and should be delivered as soon as possible – on your way home from hospital if this is feasible. The letter may be posted to your GP if you leave hospital before it has been written.

Follow-up clinic visits

Before you leave the hospital, nursing staff will arrange your next clinic visit – within a week or two of your operation. Time will be allowed for the results to be received from the examination of your breast tissue which always follows an operation on the breast.

If the stitches in your wound are non-absorbable, these will either be removed at the clinic visit or, if nursing staff think your wound will have healed sufficiently beforehand, you will be asked to make an appointment at your health centre or GP’s surgery so that they can be removed there.

Although the anxiety you and your family will feel while you await this next visit to the clinic is well understood by the nursing and medical staff, they must be sure that the results from the laboratory will have been received first.

Visit from the breast care nurse

If your hospital has a specialist breast care nurse, she will visit you on the ward before you leave. Do tell her if you are concerned about anything, or if there is anything you do not understand. She may be able to arrange a date to visit you at home if you would like her to do so, and will probably continue to see you as often as necessary, either at home or in her clinic.

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WOMEN’S HEALTH: CONDITIONS CONFUSED WITH ENDOMETRIOSIS

Many of the symptoms of endometriosis are also the symptoms of other conditions – particularly other gynecological conditions – and therefore endometriosis is easily confused with them. These include pelvic inflammatory disease (PID), irritable bowel syndrome, ovarian cysts, appendicitis, ectopic pregnancy and occasionally cancer.

Pelvic inflammatory disease

Pelvic inflammatory disease, often known as PID, refers to any infection of the pelvic organs including the ovaries, fallopian tubes, uterus and cervix. Symptoms may include painful menstrual cramps, pain during or after intercourse, bleeding between periods, painful bowel movements or urination, generalized pelvic pain, lower back pain, nausea, fatigue, slight temperature and infertility.

PID is the condition which is most commonly confused with endometriosis when the diagnosis is made without the use of a laparoscopy because the symptoms of the two conditions are so similar. However, PID is caused by bacteria and it can be successfully treated with antibiotics. If antibiotic treatment fails to relieve the symptoms, further investigations should be carried out.

Irritable bowel syndrome

The term irritable bowel syndrome is sometimes used to describe a range of bowel symptoms when no other diagnosis can be found. The symptoms may include chronic lower abdominal pain which may be relieved by a bowel action, bouts of diarrhea and constipation, flatulence (wind), straining to have bowels opened, bloated abdomen, chronic backache, lethargy, nausea and heartburn.

Many women are diagnosed as having irritable bowel syndrome before endometriosis is finally diagnosed.

Simple ovarian cysts

A cyst is a growth that contains fluid and is enclosed by a membrane. There are many types of ovarian cysts, the most common are follicular and luteal cysts. A follicular cyst is a fluid-filled cyst which has developed from an ovarian follicle that has continued to grow and enlarge. A luteal cyst is one which has developed from a corpus luteum which has enlarged and become filled with fluid or, occasionally, blood.

The symptoms of ovarian cysts include abdominal pain on the affected side, pain with intercourse, abdominal swelling, fullness or discomfort and irregularities in the menstrual cycle. If the cyst is large it may put pressure on the adjacent organs, such as the bowel or bladder, which in turn may cause some discomfort with bowel movements or when passing urine.

Many follicular and luteal cysts disappear within a few weeks as they are reabsorbed by the body. If the symptoms persist, a laparoscopy is the only way to distinguish between an ovarian cyst and an endometrioma.

Acute appendicitis

Acute appendicitis is an inflammation of the appendix and the symptoms include sudden and severe right-sided abdominal pain, nausea and vomiting, malaise and a raised temperature.

The symptoms of acute appendicitis are sometimes confused with those experienced by a woman with endometriosis where a large cyst, usually an endometrioma, has burst.

Ectopic pregnancy

An ectopic pregnancy occurs when a fertilized ovum implants itself in an abnormal location outside the uterus, usually within a fallopian tube, and continues to develop. Because the fallopian tube cannot expand to accommodate the developing foetus the tube eventually ruptures. The symptoms experienced when an ectopic pregnancy ruptures a fallopian tube include severe left or right-sided abdominal pain, nausea and/or vomiting, vaginal bleeding and internal bleeding which can lead to shock.

The symptoms of a ruptured ectopic pregnancy may sometimes be confused with those experienced by a woman with endometriosis who has a ruptured large endometrial cyst. A diagnostic laparoscopy is necessary to determine the correct diagnosis.

Cancer

The two main forms of cancer that may possibly be confused with endometriosis are ovarian cancer and rectal cancer. The symptoms of ovarian cancer include pelvic pain, weight loss, weakness and anemia, while the symptoms of rectal cancer include constipation, bleeding from the rectum and backache.

However, ovarian and bowel cancer are very rarely confused with endometriosis. If mere is any possibility that you may have cancer, diagnostic tests will be carried out quickly and thoroughly.

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PREVENTIVE MEDECINE: OBESITY

It is impossible to be sure what proportion of the western world is obese but current estimates suggest that about 30 per cent are ‘clinically’ overweight. That obesity increases one’s chances of suffering from diabetes, heart attacks, gall-stones, hiatus hernia, cancers of all kinds, painful feet, arthritis of the hips and knees and several other conditions is now beyond dispute. It shortens life and reduces the quality of life for countless millions of people. Obviously obesity is a terrible health and social problem.

In the 1920s obesity was rare in African rural peoples and a 1960 study suggested that low body weights were lifelong in rural Zulu men. There is now overwhelming evidence that in certain ways the control mechanism of body weight somehow breaks down in an affluent society. Individuals in primitive societies have a kind of automatic regulator which controls the amount of effort they spend searching for food and the amount of food they consume. According to one world expert, ‘Supermarket Man has no such automatic facility.’

An adult man, wherever he lives and however he eats, who eats 1 per cent more energy every day than he expends accumulates 1 kg of fat per year. At 30 such a man would weigh 30 kg (66 lb) more than someone who had been in good energy balance for a lifetime. Obesity is a real hazard to hunter-gatherers because it slows them down, affecting their ability to catch prey and to escape animal predators. So in survival terms it pays the hunter-gatherer to keep slim. Such peoples get their food mainly from plants, and individuals spend 2-3 hours a day gathering food, three-quarters of which is supplied by women and children gathering and one quarter by men hunting. Many hunter-gatherers live long enough to become obese but they do not do so. In one study of such a group 7 per cent of the men were over 65 but they were all slim.

The first agricultural revolution, in about 10,000 BC, changed things radically for most of the world’s population as man began to farm cereals and to store food. The diet of today’s peasant agriculturalist has changed little since this time. Although food shortages occur in developing rural peasant communities, resulting mainly from population density and poor soil fertility, competent scientific observers say that even where the population is not dense, the soil is fertile and there are two harvests a year, body weight remains low throughout adult life.

Pastoral peoples plant no crops but raise animals and eat meat, blood and milk. Studies show that their blood cholesterol levels remain low despite the high intakes of animal fat and cholesterol, and that obesity is rare.

The second agricultural revolution started in Europe towards the end of the eighteenth century and crop rotation and fertilizers, together with better machinery and animal husbandry, changed western eating habits totally. The upper classes became wealthy; meat, butter and milk could be consumed throughout the year; and sugar intake went up, as did that of alcoholic drinks. Obesity suddenly became extremely common in the upper social classes, towards the end of the seventeenth century and even more so in the eighteenth century. Portraits of even quite young people of the time show double chins.

With the coming of the Industrial Revolution in the nineteenth century the production of goods and wealth really took off. This enabled radical changes in the production, storage and transport of food. Dietary fibre began to be milled out of bread-the staple diet of the masses. Salt, sugar and fat intakes rose and the consumption of starchy foods fell. Fruit and vegetable intakes rose steadily. People got less exercise, as machines began to do the work. Slowly food became so plentiful, even for the masses, that people began to eat snacks between meals as well as regular meals-themselves a luxury for many until 200 years before.

So why is obesity so common in the West and hardly ever seen in non-westernized peoples? The main answer is that our food has radically changed in character-it is not simply that we eat too much of it, as was previously thought. Over half the energy in the food of a hunter-gatherer or peasant agriculturalist comes from high-starch foods. Such a diet eaten even ‘to excess’ does not cause obesity, partly because it is almost impossible to eat an excess, so bulky and filling is it. At least two-thirds of the energy in a western diet comes from fibre-free fats and sugars and low-fibre cereal products. Undoubtedly, there are other factors in the production of obesity but, looking at populations overall, food is undoubtedly at the heart of the problem. That westernized people can slim by adopting a high-fibre (rich in unrefined carbohydrate) diet is no longer in doubt; and the observation that slim, rural dwellers in non-westernized countries can be made obese very quickly on a western diet is not easy to refute.

It seems that food intake stops when we feel we have had enough and that we feel satisfied sooner on foods rich in dietary fibre – i.e. unrefined carbohydrate foods. It is simply so easy to over-consume refined foods that have no appetite-controlling capacity that we in the West eat ourselves to obesity.

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FEED YOUR BODY RIGHT: SAVE NOW, SPLURGE LATER

Mary Adams longed for a way to enjoy the goodies at parties and holiday dinners without exceeding her 1,200-calorie-a-day limit. “I read that the average Thanksgiving dinner has more calories than I eat in an entire day,” says the 48-year-old Denver resident, who was restricting calories to slim down her 286-pound frame.

Friends suggested that she try snacking on something before special eating events, but Mary doubted that would work for her. She feared that she’d eat beforehand and then indulge anyway, doubling her potential for gaining, rather than losing, weight. So she came up with the idea of banking calories.

“I realized that if I ate only 300 calories during the day, I’d have 900 left for dinner. I could eat what I wanted and not go over my calorie goal,” she explains. “The trick was to find foods that would fill me up on the fewest calories.” So she started checking her calorie counter for filling but low-cal foods. Among her choices were light J bread, light cereal, tiny graham crackers, carrots, celery sprinkled *i with chili powder, sugar-free Jell-O, and lots of water. ?

Like someone squirreling away money from every paycheck to buy an expensive coat or a new stereo system”, Mary saves up calories so she can splurge on food at special events. “When my office “* planned a big holiday dinner, I saved 100 calories a day for 10 days,” she says. “I was able to go to the dinner, sample all the great foods, and not worry about overindulging!”

Since establishing her personal calorie account in 1998, Mary has dropped 112 pounds. And she plans on using calorie banking to get to her 135-pound goal. She’s banking on making it.

WINNING ACTION

Save, save, save, then splurge. While this tactic may not work for everyone, Mary found her own way to enjoy party foods without ruining her weight-loss efforts. As I say in my Ten Commandments of Weight Loss on page 1, slimming down doesn’t have to mean giving up on all of the fun. You just have to find a way to do both. Give Mary’s method a try to see if it works for you.

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