Herbal Health

Summary of main points.

• Sustainable strategies of eating a low-fat diet and maintaining appropriate activity levels are required for long term management of fat stores.

• Fad diets are not sustainable, exploit the vulnerabilities of the overweight and are counter-productive.

• Criteria can be applied to these diets to assess their validity and sustainability.

Long term management of fat stores requires people to develop sustainable strategies in eating a low-fat diet and maintaining appropriate activity levels. The ad libitum approach to low-fat eating has been shown to be the most effective and easiest to follow over the long term. The rationale and techniques for doing this have been discussed in previous chapters. One disadvantage of this approach, however, is that it takes longer for success—even though this is likely to be more sustainable over the long run. Hence, there is still often a desire by many for a ‘quick fix’. ‘Diets’ offer this. Fad diets offer it even more convincingly. The most popular diets promise faster and seemingly effortless ways of losing ‘weight’, contributing to sporadic, and often counter-productive, efforts in weight management.

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Every woman should be aware that a second opinion is her right and she should never be made to feel guilty about wanting one.

A second opinion will give you peace of mind so it is essential that you get this from a specialist well-versed in the treatment of endometriosis and one who is well up on the latest research and technology. It is important that the doctor giving the second opinion is not in the same practice as the first doctor.

When should I get a second opinion

If you are unable to communicate with your doctor or you are uneasy about your doctor’s attitude, approach and explanations then you should seek a second opinion.

You should also obtain a second opinion if you are unsure about the type of treatment recommended, or if your doctor says there is nothing wrong with you.

If you do not feel that adequate tests and evaluations have been carried out or you wish to consult a doctor who has expertise in one particular aspect of the treatment of endometriosis — such as laser therapy or infertility — then seek a second opinion.

A second opinion is important for women who:

Have been recommended a hysterectomy.

Are told by their doctor that nothing further can be done to treat their disease.

Need reassurance that the treatment suggested by their first doctor is appropriate.

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Primolut N is a hormonal drug occasionally used to treat endometriosis. It is also sometimes used to treat a variety of other conditions including abnormal uterine bleeding, amenorrhoea (absence of periods) and PMS (premenstrual syndrome).

Primolut N is a progestogen (a synthetic progesterone) derived from the male hormone testosterone. Its chemical name is norethisterone. It is manufactured by Schering and sold in the form of white 5 milligram tablets.

How Primolut N works

It is thought that Primolut N eradicates endometrial implants by suppressing ovulation and interfering with the growth of the misplaced endometrial cells, causing them to slowly waste away Most women will stop ovulating and menstruating during their course of Primolut N.

Dosages of Primolut N generally used

Gynaecologists usually recommend 5 to 20 milligrams of Primolut N per day (one to four tablets per day) for four to nine months.

Side effects of Primolut N

The more common side effects are depression, weight gain, malaise, lethargy and tiredness, acne, vaginal bleeding, decreased libido and nausea.

How effective is Primolut N

There are no reliable figures on the effectiveness of Primolut N for the treatment of endometriosis.

Primolut N, pregnancy and breastfeeding

Primolut N should not be used during pregnancy as progestogens derived from testosterone can cause abnormalities in the developing foetus.

The use of Primolut N while breastfeeding is not recommended, as small amounts of progestogens have been found in the milk of mothers taking them and the effect on the child is not known.

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Probably the oldest form of medicine, herbalism – also known as ‘herbal medicine’ – has a history going back at least 3,000 years. First developed in ancient China, herbalism is based on the therapeutic uses of various plant parts – root, bark, stem, flowers, leaf, and even seeds – in different preparations, either for internal or external use as teas, potions, juice extracts, bath additives, salve, lotions, and ointments.

Throughout the ages there has always been a strong association between herbal remedies and back problems of all kinds. Modern herbalists believe that medicines are not just only a means of treating illness, but are also a way of restoring the body’s balance to its normal state, disease or pain being viewed by them as ‘abnormal states’. Of course, this approach means that a given disorder may not always be treated by the same herbal preparation, as deciding what the right treatment is in a given case will also take into account several other factors, including the patient’s general health, disposition, and even personality. However, in making their choices, practitioners are guided by pharmacopoeias – these being comprehensive listings of remedies that have proven themselves useful in specific conditions – and some of these have origins going back more than 6,000 years, having been first formulated when the Chinese started classifying and cataloguing herbal cures.

Although herbalism has helped many people suffering from chronic conditions such as sciatica or back pain, a note of caution is in order: herbal preparations can be just as powerful – and therefore potentially also as toxic – as modern day drugs. This means that these remedies have to be prescribed and used with the greatest of care as they can lead to serious side-effects. It is essential therefore that herbal remedies should be prescribed by and used under the supervision of a suitably qualified medical herbalist.

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In depressed people the most frightening ideas do not generally come from fear of the outside world but result from turning the darkened lens of depression towards the interior and finding it to be full of self-doubt, self-criticism, guilt, recriminations about the past and grim predictions for the future. All of these thoughts are not only symptoms of depression but, according to the cognitive theory of depression, developed by Dr Aaron Beck and others, can actually propagate the depression and make it worse. Based on this theory, these researchers have developed a psychotherapeutic approach to depression called cognitive therapy, which has actually been shown to be as effective as anti-depressant medications in some studies of mild to moderate depression.

Cognitive therapists have developed a way of breaking down depressive thinking into its different components and showing how once you recognize these specific types of depressive thoughts, you can actively work to overcome them. For example, these therapists have accurately recognized the tendency of depressed people to engage in what they refer to as ‘all or none thinking’. So a depressed person may regard a project that was not a dazzling success as a total failure. Most ventures in life are not total successes or failures but some mix of the two. A positive attitude enables a person to enjoy those elements of the mix that are successful while learning from the failed elements, and then to move on to the next project. This is very hard for the depressed person, who is likely to expend valuable time and energy obsessing about, and magnifying, the failure. The depressed person has difficulty modulating responses to all sorts of stimuli.

Several other specific distortions of the depressed mind are also worth noting. One is overgeneralization. A depressed person who makes an error is quite likely to think, ‘You see, nothing I ever do succeeds.’ Cognitive therapy would seek to challenge this distortion by encouraging the depressed person to find areas in life where he or she has clearly succeeded. Overgeneralization is commonly seen following rejection. A depressed person is likely to take a single rejection as a sign that nobody will ever accept him or her. A healthier approach would be to accept that rejection is part of life and that a single rejection does not necessarily mean that others will follow. Excessive sensitivity to rejection can affect people at any age or stage of life, whether it be the child looking for a friend in the playground, the adolescent calling someone for a date, or the adult applying for a job or submitting a manuscript or proposal to a publisher or grant agency. Nobody enjoys being rejected, but we can develop ways of putting it into perspective and recognizing that further efforts might well be rewarded with acceptance. After being rejected a depressive person might avoid taking new initiatives for fear of further rejections, thereby greatly diminishing the likelihood of future success. Once again, the depressed person’s intellect can be recruited to help understand that this type of thinking is a costly distortion that can be corrected with proper guidance and systematic efforts.

One of the most painful aspects of overgeneralization is that it gets projected into the future. T will never succeed/ ‘No one will ever love me’ or T will never find happiness’ are common distortions of this type that greatly add to feelings of sadness and pessimism. Such distortions have been labelled ‘fortune-telling’ by cognitive therapists, a term that conveys the sense of assurance that a fortune-teller might offer about the future when plain sense indicates that there are too many imponderables to make such predictions with any degree of reliability. This can be pointed out by a skilful cognitive therapist repeatedly to good effect. Allied to this magical depressive tendency to fortune-telling is ‘mind-reading’, a process by which the depressed person thinks and talks as though he or she can read what is in another person’s mind. So a depressed person might say ‘She didn’t want to come on a date with me because she thinks I am too dull and nerdy/ or an unsuccessful applicant may say ‘He didn’t accept me for the job because I’m not qualified.’ The cognitive therapist will point out that other possible explanations for these outcomes abound. The girl who declined to go out on a date with you may already be committed to someone else; the prospective employer may have an inside candidate in mind for the job, and so on. Bearing in mind these alternative possible explanations empowers the rejected person, who is then more easily able to pursue other possibilities. In contrast, depressive thinking tends to paralyse the thinker, increasing his or her sense of powerlessness and reducing enthusiasm for making further efforts, which might be more successful.

In summary, it is important to recognize and address frightening thoughts, more technically known as depressive distortions.

Fortunately, treatment strategies have been developed to tackle such thoughts and these work if they are implemented diligently and systematically. For those interested in learning more about cognitive therapy, I provide references to further relevant reading in the Bibliography and Further Reading chapter.

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One aspect of human nature is to search for causal links between events. The onset of epileptic seizures in a previously healthy child or adult results in great heart-searching in the family, and raking over past events in an attempt to find some reasons. Yet it has to be admitted that the most careful medical assessment of past events or current state allows a paediatrician or neurologist to assign a cause or causes of epilepsy in only a minority of subjects, and then often on the basis of circumstantial evidence.

Take head injury, for example. If a child is known to have cut her head falling in the playground, and then has her first seizure two weeks later, many parents will link the two events, and attribute the onset of epilepsy to this minor head injury on no basis other than coincidence in time. A minor head injury at work followed some weeks later by a first seizure unfortunately may lead to litigation between employer and employee, as the latter holds that he ‘was perfectly all right before the accident’. The association of events in time is, however, no evidence of cause. Severe head injuries may, however, result in the development of epilepsy, so-called

post-traumatic epilepsy. Somewhere in the continuum of mild to moderate to severe head injuries there must be a zone where there is reasonable doubt as to whether epilepsy was or was not caused by the injury.

The same arguments apply when assessing the effects of a difficult birth and the possible relationship of that to the subsequent development of epilepsy. There is no doubt that a very difficult labour, especially if the baby is small, may cause significant brain damage, severe learning difficulties, cerebral palsy, and epilepsy may result. However, after many difficult or prolonged labours the child develops perfectly normally and twins are no more likely to develop seizures than single births. It used to be thought that forceps or breech deliveries might be blamed for the subsequent development of epilepsy. However, a follow-up study of all children born in one week showed that epilepsy was no more likely to develop after such births than after normal unassisted deliveries. It is now known that in many children born with cerebral palsy or severe learning difficulties there are problems in cerebral development that precede birth. Although sometimes these may be visible on scanning, in other cases the abnormality is no more than a subtle disorder of organization of the developing nerve cells visible only microscopically in tissue obtained at surgical operation or after death. These may, however, be sufficient to cause seizures.

Having given these warnings against uncritically linking life events and the development of epilepsy, what are the factors which can be said, with a fair degree of confidence, to cause epilepsy? The causes are different at different ages. Some causes, such as a structural congenital brain abnormality may cause seizures in the neonatal period, and the abnormally organized brain may cause seizures throughout life, as is indicated by the long continuing arrow. Other causes occur only at one age, and their effect then ceases. Metabolic disturbances in the neonatal period, such as hypoglycaemia, are examples of this.

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AND TREATMENT

Signs and symptoms

Close observation will determine if your child is having trouble breathing or if the child is actually getting many full breaths of air in and out. Hyperventilation syndrome is never accompanied by cough or fever. There is no abnormal sound during breathing. Children who tend to hyperventilate may have repeated attacks.

Home care

It is important to remain calm and to reassure the child. Have your child breathe into a large paper bag held loosely over the mouth and nose. This will allow the child to re-breathe the exhaled carbon dioxide. Look for such causes as intolerable pressures or anxieties in the child’s surroundings – at home, at school, or in relationships with friends.

Precaution

• Hyperventilation syndrome can develop as a result of rapid, prolonged, forced deep breathing, which has become a party stunt in some circles. Encourage other kinds of games.

Medical treatment

A doctor will treat an acute attack the same as you would at home. Treatment of the underlying causes of hyperventilation depends upon investigating and analyzing possible sources of stress and emotional upset in your child. Psychiatric counseling may be advised for severe cases.

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What is it?

Drowning occurs when a person’s lungs become affected by water so that he or she cannot breathe. It is often fatal. Although only a few hundred people drown each year in all western countries almost all are preventable. Three-quarters of all drownings occur in inland waters (lakes, streams, brooks and ponds), and domestic paddling pools are a real hazard. Three-quarters of those who drown are males.

Although the lives of many are saved because they can swim the ability to swim is not enough to prevent drowning. Many people who drown had no intention of going anywhere near water.

What causes it?

• Ignorance or disregard of danger. Water can be much deeper than it looks and conditions in open water cannot be compared with those in a swimming pool. Even a confident swimming-pool swimmer can find such water a surprise.

• Access to danger is a constant problem. Fences are broken, warning notices pulled down, and home pools unfenced.

• Poor supervision. Young children should never be left alone near water-they can drown in a couple of minutes and in a few inches of water.

Prevention

• Never let young children out of your sight when you are near water or deep mud.

• Empty paddling pools after use.

• Keep swimming pools fenced off and covered in the winter.

• Never leave a child alone in a bath while you go away to answer the phone, or the front door.

• Fence off garden ponds and check that a child can’t get into water butts.

• Never change or remove warning notices to do with water.

• Leave life-buoys alone in their proper place-you never know when they will be needed.

• Always wear a life-jacket when boating, even if you are a strong swimmer.

• Never fool about near, or run around, swimming pools.

• Never dive into the shallow end of a pool.

• Learn to swim really well and confidently.

• Look before you jump into a pool.

• Ensure that cess-pit covers are safe from small children.

• Beware of home-made rafts and boats-they usually sink quickly and are very dangerous.

• Don’t play in or around gravel-works, excavations or reservoirs.

• Keep off frozen reservoirs and lakes.

• When at the seaside find out the times of the tides and be sure you don’t get trapped.

• Never swim immediately after a heavy meal.

• Don’t sleep on inflatables – you could drift out to sea.

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Imaginary double blind crossover trial

Suppose our imaginary substance, which we wish to test for its effectiveness in the treatment of rheumatoid arthritis originates in the ocean. Perhaps we might call our substance ‘Seapower’.

We must first indicate some of the main properties whit we believe our substance to have. Let us say it is taken in the form of a pill and that it is a slow-acting preparation taking, perhaps, six weeks on average before beneficial results become evident. After this the patient’s condition improves steadily and the final condition lasts for several months at least without any further treatment. We are instructed to undertake a double blind crossover trial to see if the substance ‘Seapower’ can demonstrate its effectiveness in an objective clinical way.

The principle upon which our trial results will be judged involves a comparison between the change in the condition the patients whilst on the ‘active substance’ (‘Seapower’) and that whilst taking placebo. If there is no significant change between these two sessions of treatment, even if the patient on ‘Seapower’ is markedly better at the end of the trial, we shall be forced to consider that this product is ineffective. If there is a significant difference between the active and placebo conditions of the patients, then we can consider that ‘Seapower’ is effective. We shall now carry out the trial and see why this procedure is completely unsatisfactory for our purpose.

It should be emphasized that these criticisms do not apply to a properly designed double blind trial without any crossover.

Setting up the trial

First of all we must collect a number of suitable patients. We will try to pick those with a reasonable variation in degree and duration of suffering with rheumatoid arthritis to give a wide scope for our assessment. Let us say that we are lucky and manage to group together thirty patients (who seem to be of suitable temperament) within a manageable area.

Sufficient ‘Seapower’ pills, and similar-looking placebo pills, are prepared to allow each patient to have, say, eight weeks on each (this period is based on the average period of six weeks which it takes our substance to become effective). By allowing the extra two weeks, those patients who react more slowly will have a chance to benefit before being taken off the treatment. We prepare our active and placebo pills in such a manner that the only way of identifying which ones patients are receiving is by a code system. The code system is locked away.

We now decide on the various factors relating to patient condition which we will measure and set up the paperwork for this system. One more decision we make is to allow all our trial patients to be weaned off any other therapy they may be on over a period of three weeks preceding the starting date îf our trial. The patients are allowed to take pain-killing tablets but not those based on salicylates (aspirin, etc).

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Replacement prostheses

If you have been treated under the NHS, you can request a new prosthesis when your existing one begins to show signs of wear, is damaged, or if you gain or lose enough weight to make a significant difference in the sizes of your breasts.

If there is a breast care nurse at your hospital, she will be able to arrange a fitting for you to choose a replacement. If you were previously fitted by an appliance fitter, contact the hospital appliance department for advice – you may need the authorization of your GP, consultant or breast care nurse, and the appliance fitter will be able to advise you about what to do.

Bras

An underwired bra will put pressure on the silicone of a permanent prosthesis which could cause it to split. Underwired bras should therefore be avoided, perhaps except for the odd special occasion.

Bras worn with prostheses should be able to hold the breast shape in place and prevent it slipping about, but otherwise there is no restriction on the type of bra which can be worn.

Your breasts should be accurately measured and you should make sure that your bra fits well. It may be worth asking at a large department store if there is staff experienced in fitting women following breast surgery.

If necessary, you can ask the breast care nurse or appliance officer about having a pocket fitted to your bra in which to insert your prosthesis. This service is usually available on the NHS.

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