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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NERVOUS SYSTEM PAIN

Among the most severe of all chronic pain syndromes is trigeminal neuralgia or tic douloureux. This condition, known in some alarmist literature as ’suicide pain’, is an affliction of a sensory nerve in the face.

Even a puff of wind, or a slight brushing touch, can set off a bout of severe pain. The pain is classically described as being fleeting in nature, occurring like lightning strikes — each one being as agonising as the others.

Although its cause is as yet unknown, it has been treated in the past by neurosurgical procedures which include lifting the nerve off from the artery thought to be causing compression on the nerve.

More damaging procedures such as alcohol injections of the nerve and a collection of nerve cells which control it, have been used, sometimes effectively, but sometimes leaving one side of the face totally numb.

Treatments Medications include the anti-epileptic drugs Tegretol and Dilantin. More recently, another anti-epilepsy medication, Ri-votril, has been successfully used in pain clinics in Australia and throughout the world.

Antidepressant drugs such as Prothiaden, Anafranil and Tolvon have also been used to modify the pain experience and to control the understandable depression that is caused by this most devastating of pain problems.

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CULTURAL ASPECTS OF PAIN: LOOK BEFORE YOU LEAP

Surgeons also sometimes play a game which is seemingly interminable: ‘If in doubt, cut it out’. Alternatively: ‘A chance to cut is a chance to cure’.But, there are also many surgeons who agree with those medical schools that teach that surgery is an admission of defeat and should only be seen as a last resort.

Before submitting to the knife, you should be certain the doctor has satisfactorily answered the following questions:

1. Why is the operation necessary?

2. What are the risks of complications, including death?

3. What are the risks without surgery? Are there alternative methods of treatment?

4. What are the chances that the surgery will achieve its aim? Surgery can never be undone. While a surgeon may cite a 75 per cent success rate, the other 25 per cent of failures sometimes develop long-standing problems that did not exist before!

The following poem is taken from The Pain Game by Dr C. Norman Shealy: There was a crooked man Who walked a crooked style He saw an orthopaedist Who sinisterly smiled. Ahah! I have the answer, Your problem is quite clear I diagnose a bulging disc We’ll remove it, have no fear. The surgery was ended The doctor got his fee And now the disc that was removed Is causing pain around the knee. So that crooked man who still had Pain and strife

Became another victim of a well-intended knife.

Information important for understanding

Closely allied with the ‘It’s all in your head!’ game is the implication, sometimes spoken quite frankly: ‘You’re too stupid to understand!’ Trading on this basis, doctors can excuse many of their own failures. They will fail to explain to a patient the risks of surgery or any other treatment, or the alternatives available.

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PHYSICAL EXAMINATION

Physical examination, and further questioning, usually leads to the impression that the complaint of pain is excessive compared with the physical findings and that emotional factors have significantly contributed to the pain — the presence of which medical treatment cannot offer a reasonable expectation of cure.

Common denominators are often lack of relief from medication and often depression, addiction and decreased ability to function normally as a result of over-medication. Frequently, there is also disability beyond that justified by the physical findings and the contribution of psychological and social factors for the reinforcement and perpetuation of pain behaviour is overlooked.

People often tend to over-value their pain. That is, the pain plays a central part in how they relate to themselves or others. In such cases, the pain controls the person rather than the reverse! Manipulation of others happens more often than most doctors would like to admit. Histories reveal that the patient has often succeeded in manoeuvring physicians into attempting ill-advised medical treatments or surgical procedures.

All this can be very tricky for the physician trying to make a diagnosis and decide the correct treatment. Often the presence of medical illness unrelated to pain is overlooked because of the patient’s restricted focus on the pain complaint. Most patients convey a sense of urgency, complain of distress and disability, and expect that the illness will be named and a definitive treatment started. Little pain management can be achieved until both patient and physician exchange the patient’s expectations, or desires for pain relief, for that of a mutual goal of rehabilitation.

After all, effective pain management involves an unwritten contract between patient and therapist.

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THE ESSENTIAL BACKGROUND — THE HISTORY OF PAIN

.fain exists in all age groups and is common to almost all humanity — affecting the psyche or mind as well as the soma or body.

It cuts across the boundaries of culture, heritage, socio-econom-ics and language. Pain has always been attended by controversy as it is symptomatic of many diseases and its problems involve many disciplines in medicine and philosophy. Its presence or absence has formed the basis for some philosophic systems, and has been the inspiration for much of the world’s literature.

Many penal codes are based on the notion of inflicting pain, both mental and physical on the transgressor. Even the word ‘pain’ has similar roots to the Greek word for penalty.

Pain is no ordinary sensory experience. It has several attributes which differentiate it from the sensations of touch, smell, taste, etc.

One is the emotional aspect of real or threatened pain; another is the subjective experience of pain, which makes it a unique experience different for each individual.

Pain is not always experienced as noxious, and in some aberrant behaviours it is sought for pleasure and recreation. Pain is a perceptual behaviourial state of the whole animal.

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CLASSICAL ALLERGIC DISEASES: ASTHMA WITHOUT ALLERGENS

Asthmatics who are constantly exposed to their allergen – as is the case with house-dust sensitivity – are likely to have bronchi that are highly ‘irritable’, because of the inflammation in the membranous linings. The late-phase reaction, described in the box below, plays a large part in producing this state of chronic sensitivity. Once it has developed, all sorts of irritating stimuli can then spark off an asthma attack. Common irritants include smoke (cigarettes, bonfires etc), factory fumes, infections, very cold air and sulphur dioxide.

Becoming emotional or afraid can have the same effect as these airborne irritants, as can strenuous exercise. It was the ability of the emotions to bring on an asthmatic attack that led to the idea of asthma being largely ‘psychosomatic’.

Eating large amounts of the food additive monosodium glutamate, can also provoke an asthma attack, according to Dr David Allen, a respiratory specialist from Royal North Shore Hospital in Sydney, Australia. He believes that MSG -common in Chinese cooking, packet soups and other convenience foods – has an effect on the central nervous system which triggers off the attack. Similar claims have been made for diets that are high in salt, although how salt in food might contribute to asthma is unknown.

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MAIDENHAIR TREE (GINKGO BILOBA) – GENERAL INFORMATION

Some people over the age of seventy have registered a notable improvement in health after only 4—6 weeks when they have taken a double dose of the tincture three times a day (the normal dose is 15-20 drops three times a day). Relief is even more certain when a low-protein diet, but one that is rich in vital substances, vitamins and minerals is also followed. Although scientists believe that ginkgo flavone compounds are responsible for this plant’s diverse effects, other yet undiscovered substances in the plant must also be given some credit for these benefits.

It is possible to normalise high blood pressure after just a few weeks of taking Ginkgo biloba, probably because the blood’s viscosity will be favourably affected. We do not know of any other plant remedy that is as beneficial for the brain, central nervous system and vascular system. Moreover, it is interesting to note that the tincture produces a welcome secondary effect, the stimulation of the kidneys and pancreas. Improved blood circulation and supply of oxygen ensure that the cells of the central nervous system are better nourished, hence more efficient. Furthermore, the circulation in the skin, therefore the functioning of the finest capillaries, will be promoted. When Hypericum is taken at the same time, ten drops on an empty stomach every morning before breakfast, this will influence the circulation even more. Anyone over the age of fifty would do well to take Ginkgo drops for a few months, since various body functions can thus be improved. For when there is better blood circulation, the entire body will benefit from a general cleansing process. The use of this remedy in daily alternation with Vinca minor has also given very good results.

Vascular constriction caused by nicotine can also be favourably influenced – but one has to stop smoking. Circulatory disturbances in the arms and legs, even diabetic vascular damage, will diminish.

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HOW A GOOD HERBAL REMEDY IS DEVELOPED – COMBINING REMEDIES

The purpose of combining remedies is to enhance the effect of one through the addition of another. If a calcium deficiency is to be treated, it will be necessary to make sure that there is not a deficiency of silica at the same time. If there is, the patient must take both minerals. Supposing he also suffers from night sweats and at the same time wants to get rid of a bad cough; for the first, sage (Salvia) would be needed and for the second, extract of pine buds or lance-leaf plantain (also known as ribwort, or Plantago lanceolata) would be the indicated remedy.

It will be clear, therefore, that in order to cure different illnesses, the doctor can choose a suitable combination of remedies, but he must be careful that the individual remedies are compatible. There are some that vitalise the body, while others have a relaxing effect. As a rule, a knowledge of pharmacology is required to be able to choose and combine remedies correctly. Still, even in former times, when physicians were not so well trained and informed as they are today, they hit upon remedies by accurate observation and careful analysis of their findings. They were successful in discovering effective combinations, with one remedy increasing the effect of another, so that the action of the combined ingredients was greatly improved. However, if the combined remedies do not complement one another, not being compatible, the total effect can be reduced rather than enhanced.

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