Mens Health Blog. Medical Blog

Radiotherapy

Radiotherapy is used as an adjuvant to surgery following radical or local mastectomy if malignant cells have spread to the auxiliary lymph nodes. The radiation treatment is aimed at the breast and the remaining lymph nodes under the arm, above the collar bone, and along the breastbone.

Radiotherapy can also help to alleviate the pain of extensive breast cancer which cannot be cured, particularly where there is spread of cancer to the bones. It may be the treatment of choice for women who are unfit for surgery and for those in whom secondary tumours have developed in the bones and skin. The X-ray beam can be directed onto the tumour itself, making it shrink and helping to relieve any pain it was causing. If radiotherapy causes the breast tumour to shrink enough, a mastectomy may be feasible later.

Radiotherapy is given externally, or, more rarely, via an internal implant of radioactive material.

Chemotherapy

This treatment is used increasingly as an adjuvant to surgery, for all forms of breast cancer as well as for advanced cancer, for widespread metastases, and for extensive local invasion such as ulceration or fixation of the tumour to the overlying skin.

Chemotherapy is given after surgery, either alone or in conjunction with radiotherapy when cancer has spread to the lymph nodes in the armpit as it can reach any malignant cells which may be hidden in other parts of the body.

Chemotherapy agents, such as 5-fluorouracil, cyclophosphamide and methotrexate, are anti-cancer drugs which act directly on cancer cell growth and division. However, they have potentially harmful side-effects and their use needs to be carefully monitored.

For extensive breast cancer, chemotherapy and/or radiotherapy may be given first. If the tumour shrinks sufficiently, the smaller lump can then be removed surgically.

Hormone therapy

The most commonly used drug for hormone therapy is an anti-oestrogen agent called tamoxifen. It has proved over the last 20 years or so to be an effective treatment, particularly for tumours which contain oestrogen receptors, as it acts by suppressing the effects of oestrogen on breast cancer cells.

Other drugs have been used for hormone therapy, such as stilboestrol for women who are well past their menopause, but these can cause side-effects such as vaginal bleeding and masculinisation.

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Tags: Cancer

Endometriosis is a condition in which endometrium (the lining of the uterus) is found in locations outside the uterus. It can occur in menstruating women at anytime from puberty to menopause. This misplaced endometrium is most commonly found on the ovaries, the ligaments supporting the uterus and the Pouch of Douglas. It can cause a wide range of symptoms including period pain, pelvic pain, painful intercourse, bowel problems and infertility.

Endometriosis has probably been around for as long as the human race. The first mention of the characteristic symptoms of endometriosis has been found in ancient Egyptian scrolls which date back to the year 1600 B.C. The first reference to endometriosis in medical literature appeared in 1860. But it was not until 1921 that an American doctor, John Sampson, first gave an accurate description of the disease and named it endometriosis.

Endometriosis is the second most common gynaecological condition affecting women in their menstruating years and it is responsible for up to one-quarter of all the abdominal surgery performed by gynaecologists. It is also one of the leading causes of infertility in women over the age of 2 5 and it is thought to affect approximately 30% to 40% of infertile women. It is impossible to determine how common endometriosis is because some women do not have any symptoms and many women with the condition are undiagnosed. Gynaecologists believe that endometriosis probably affects approximately 10% to 15% of women at some stage during their menstruating years.

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Tags: Women’s Health

These are more difficult to cost out. Immunization against the infectious diseases such as polio, rubella, measles, diphtheria, mumps, whooping cough and smallpox has been of interest to governments all over the western world because these diseases are highly contagious, cause a provable disruption to society and are relatively easily prevented. Although any one of these diseases causes very little risk of serious life-long impairment or fatality to any single individual, an epidemic affecting perhaps hundreds of thousands of people really does cost society a lot of money. The costs for society of preventing these illnesses are small yet the benefits are great. However, the benefits to society in the case of certain immunisable diseases, unless a very large proportion of the population is immunized, can be small. This applies especially to diseases in which there is considerable ‘herd immunity’. After this crucial point is reached there is really not much point spending yet more money immunizing the last 10 per cent of the population.

A good example of how to work out what is worth doing in the public health arena was the different ways in which German measles vaccine was used in the US and the UK, when it was first licensed in 1969. In the US children between 1 and 12 were inoculated whilst in the UK only girls between 11 and 14 were offered the vaccine. The benefits of the programme were defined to include the saving of the costs that would have been incurred in the treatment of the disease and its complications had it not been prevented. Work loss was also taken into account. The direct costs were the expenditure on the vaccine, its administration and the treatment of vaccine complications. By 1972 it was obvious that giving the vaccine had economic advantages at any age but that the most cost-effective way of using it was to offer it at the age of 12 to girls only, rather than to all children at age 6 or younger, as had been done in the US.

This raises an interesting general point in that it would be ideal to be able to prevent many diseases -whether they are communicable or not-yet as a society that already spends so much on health we have to be highly selective about what we spend money on. However rich a society its resources are not endless, and starting a preventive programme means shifting priority from other preventive programmes, acute care or even from non-health activities. This puts a considerable burden on those who are planning to introduce preventive programmes because they have to be able to justify what they do in terms of value for money. Unfortunately, the crisis-intervention sort of medicine we are all used to has rarely been subjected to such rigorous scrutiny-often with dire results.

Another example of the value of public health measures in the preventive field is the fluoridation of water to prevent tooth decay. Governments, whether local or national, tend to support water fluoridation because it is by far the cheapest way of ensuring that vulnerable people get enough fluoride. Cost-benefit analyses have shown that the fluoridation of water saves up to twenty to forty times its cost by dramatically reducing the incidence of tooth decay.

Environmental control of air and water pollution is the nearest we come in this century to the environmental problems faced in the last. A great deal of evidence has been accumulated to show that a reduction in air pollution would lead to a significant reduction in illness and death rates in urban areas. Using current costs for reducing air pollution there is no doubt that the benefits would outweigh them.

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Tags: General health

Ask Lisa Gardiner about her favorite weight-loss weapon, and she’s likely to show you her toothbrush. After all, it helped her take off 25 pounds in just 6 months.

After two pregnancies, Lisa, of Ballston Spa, New York, was eager to slim down. But caring for her newborn twin daughters and 3-year-old son didn’t leave her much time to plan nutritious meals or stick with an exercise routine.

Lisa believed that if she could just control her after-dinner noshing, she’d take a significant bite out of her fat and calorie intake. So she fell back on a little trick that she had used to lose 20 pounds in college.

Instead of heading to the kitchen right after dinner, Lisa would head to the bathroom and brush her teeth. “It was my signal that my time to eat was over for the day” she says. “If I felt the urge to snack, I just reminded myself that I had already brushed my teeth.”

This simple strategy helped Lisa, age 35, slim down for the second—and, she’s determined—last time in her life.

WINNING ACTION

Try the toothbrush trick. After dinner, brush your teeth. This simple task sends a message to your brain that you’re done eating for the day. What’s more, the toothpaste alters the flavor of food. If you were to eat something after brushing, it wouldn’t taste very good. What’s more, your teeth and your smile will thank you!

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Tags: Weight Loss

Chemical tinkering with the hydrocortisone molecule has produced drugs such as prednisolone. This suppresses inflammation but has very little effect on the excretion of salt by the kidneys, so it will not cause water retention.

Unfortunately, these are not the only bad effects of corticosteroids. Because they suppress inflammation, which is a valuable part of the body’s fight against disease, they tend to make infections more likely. Viruses and fungi, in particular, are likely to flourish.

If corticosteroids are taken over a long period of time, the adrenal glands’ natural activity is suppressed. Stopping the drug leaves the body without corticosteroids which can lead to collapse in the worst cases. This means that corticosteroids taken by mouth should never be stopped abruptly if they have been taken for more than a few weeks. The glands must be given time to recover their natural level of activity, by gradually reducing the dosage. Even after as little as two weeks, corticosteroids should be withdrawn gradually, by halving the dose each day, to avoid a flare-up of the original problem.

In general, applying corticosteroids locally lie where they are needed) is preferable to taking them by mouth or injecting them, because it reduces the dose needed and thus minimizes side-effects. This means applying the drug in creams or ointments for eczema, inhaling it for asthma, or injecting it directly into an affected joint for rheumatoid arthritis. Some of the drug still gets into the bloodstream however-for example, it can be absorbed through the skin. Children with eczema who are smothered in high-dose corticosteroid cream by their parents can develop Cushing’s Syndrome, although this is now very rare as doctors are more aware of the dangers.

Corticosteroids are valuable weapons in the fight against many diseases, but must always be used with some caution. The doctor’s instructions, as regards the amount and timing of the dose, must be followed exactly.

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Tags: Allergies

Sublingual therapy is approached in exactly the same way, the neutralizing dose being determined by a series of injections. But the mixture of extracts for home use is supplied as drops, one of which is placed under the tongue. There is rapid absorption into the bloodstream from this area, and it bypasses the liver, so the extract is not broken down rapidly. The effect of drops is not as long-lasting as that of a subcutaneous injection – the treatment has to be repeated every few hours. However, they are useful for inhalant allergies, or reactions to substances that are “only encountered occasionally, because the drops can be used only when needed. Sublingual therapy has been successfully used to treat patients with allergic reactions to house-dust mite and pollen. It is also claimed to be effective for patients sensitive to synthetic chemicals, where industrial alcohol is used instead of an extract. The question of using mixtures of extracts for neutralization is a difficult one. The trials of this technique have all involved solutions containing single food extracts. Yet some practitioners use up to 70 food extracts in a mixture. Whether the method still works under these conditions is uncertain.

There is also concern over the possible dangers of this technique to patients with violent allergic reactions. It is theoretically possible for such a person to suffer anaphylactic shock when injected intradermally with their allergen, and this could be fatal. However, this technique has now been widely used for many years, and no fatal (or even near-fatal) reactions have occurred. Nevertheless, anyone who has experienced immediate and violent allergic reactions to food (or other allergens) should be carefully assessed before such treatment begins.

Finally, it is claimed that the provocation-neutralization method can be used as a diagnostic test, to determine which foods are the culprits and avoid the need for an elimination diet. These claims are rejected by the majority of doctors because they feel the test is too unreliable. Detailed trials show that there are often positive reactions to extracts of foods that do not provoke symptoms when eaten (false positives). Occasionally foods that cause symptoms will not produce a positive wheal (false negatives).

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Tags: Allergies

Before embarking on an elimination diet, some understanding of how foods can cross-react with one another is necessary. Foods derived from two related plants (or two related animals) will have similar proteins. They do not have to look like one another to be alike chemically – our own proteins are 99 per cent the same as those of the chimpanzee and the gorilla, our nearest living relatives. In the same way, the potato and the tomato may look quite different, but the plants they come from are closely related.

If you are allergic to one sort of food, you may show a reaction to food from a related source, because the IgE antibodies that bind to the first protein will also bind to a similar related protein. Cross-reactions also seem to occur in food intolerance, although the mechanism is not understood in most of these cases.

Biologists use various methods to work out how closely two animals or plants are related. Having done so, they express these relationships by grouping creatures together in a hierarchical scheme – very closely related creatures belong to the same species, related species belong to the same genus (plural genera), related genera belong to die same family, related families belong to the same order, and so on. There are often further subdivisions within each level, such as the subfamily and the tribe, which are subdivisions of the family.

How is this sort of classification scheme relevant to food sensitivity? Practical experience of thousands of patients suggests that they can cross-react to related foods, although they do not always do so. It also seems, from this collected experience, that the family level in biological classifications is a useful one in deciding which foods will cross-react – although sometimes one has to look at higher or lower levels to understand the cross-reactions that are seen. For example, all cereals are grasses, and belong to the grass family, Gramineae. Some food-sensitive people react to all cereals – to all members of the family. But others react only to wheat or maize, the two most commonly eaten cereals in the West. Many who react to wheat also react to rye and barley, and sometimes oats. If one looks at the classification of the Gramineae, one finds that wheat, rye, barley and oats all belong to the same subfamily, the Pooidae, and wheat, rye and barley are in the same tribe, the Triticeae. Maize is in a different subfamily, and rice in a different subfamily again, so there is less likely to be a cross-reaction between wheat and these cereals. This nicely explains the observation that wheat-sensitive folk are more likely to tolerate rice than any other commonly eaten cereal.

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Tags: Allergies

The foods that are most likely to cause problems are those that you always eat in large quantities or hinged on during pregnancy, those you have a craving for, and, paradoxically, those that you actively dislike but eat because they ‘do you good’. You should also be suspicious of foods that are known to be potent allergens. Apart from milk, these are: eggs, peanuts, other nuts, wheat, chocolate, fish, oranges and other citrus fruits, chicken and beef. If you eat a lot of any of these foods, then add them to your list.

Anything with a drug-like action, such as coffee, tea, wine (especially red wine), beer, spirits or other drugs, is also a prime suspect, especially in the case of colic. Try cutting out all these drug-like items, plus cow’s milk, for two weeks and see if the baby improves. Eat extra protein from other sources and take a calcium supplement, which your doctor can prescribe.

If there is no improvement, then you should try eliminating all the other suspect foods that you have listed. Avoid them for two weeks, but substitute other foods that will fulfil your nutritional needs. Remember to cut out all the ‘hidden’ forms of foods, especially with ubiquitous foods such as milk, eggs and wheat. Read the labels on packaged foods carefully and see p292 for some of the synonyms used, as these can be deceptive. Avoid all restaurant or takeaway food during this time as it is difficult to know what you are eating.

If you have cut out more than two or three foods, and your baby gets better, then you will probably wish to test the foods to see which ones were the cause of the trouble – often it will just be one food. Wait until the baby has been well for about a week, and then reintroduce each food in turn, beginning with those least likely to cause trouble, and testing cow’s milk last. Eat a normal-sized portion of the food to be tested, every day for a week. If the baby remains well, discontinue that food and go on to test another one, again eating it every day for a week. Make a note of which foods cause symptoms and which do not. When all have been tested, those that produced no symptoms in the baby can become part of your normal diet again.

It is possible that the baby will remain well, and not respond to any of the foods – a brief period of avoidance can sometimes clear up the sensitivity. If this happens, continue with your normal diet, but be careful not to eat too much of any one food.

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Tags: Allergies

In the case of asthma, it is the effect of histamine on the smooth muscles of the bronchi that produces the symptoms. These vital tubes, which carry air to the lungs, go into a spasmodic contraction. How the allergens reach the airways, and the types of allergens involved, will be dealt with in Chapter Three. The way in which mast cells cause other allergic reactions, such as hay-fever and perennial rhinitis, will also be described there.

As one might expect, people with these allergic disorders tend to have a higher level of IgE in their blood than others. But there are a few whose IgE levels are normal. Conversely, there are quite a large number of people who have high levels of IgE, and give positive skin-prick tests to common allergens (see box), but who display no symptoms. Perhaps these symptom-free individuals have fewer, or less accessible, mast cells than others, making them less susceptible to high IgE levels. Or perhaps the mechanisms behind allergy are more complex than they appear, and IgE is only part of the story.

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Tags: Allergies

The medicinal use of Petasites goes back to the Middle Ages, or even earlier. The more we study the plant the more impressed we become with its good effects on a whole range of complaints, and the therapeutic spectrum of its active substances.

Petasites has a wide range of applications as an analgesic (a pain-relieving drug) and excellent results have been reported in connection with its use for headaches, migraines, menstrual cramps, toothache, painful wounds and many other aches and pains. It is at its most effective when taken in tablet form as Petadolor. This remedy provides temporary or complete relief from pain, and has also been known to cure the underlying problem.

Considering the fact that many people swallow chemical analgesics almost without thinking and become dependent upon them, it is understandable that doctors and patients alike appreciate the availability of a nontoxic and nonaddictive pain-killer.

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Tags: Herbal