O-date, no treatment has been developed that is effective for all women with endometriosis because little is known about the causes of the condition. However, many different approaches have been tried.
In general, the treatments aim to relieve the symptoms and, where desired, improve the chances of conception by eradicating as many endometrial implants, cysts and adhesions as possible.
The main options available for the management of endometriosis are:
Observation
Symptomatic management
Hormonal treatment
Surgical treatment
Combined treatment
Alternative therapies
Observation
Observation or a ‘wait-and-see’ approach involves no active treatment. Rather, as the name suggests, it simply involves a period of observation and monitoring. Such an approach should still involve regular visits to your gynaecologist to monitor any possible progression of your endometriosis and its symptoms.
Some gynaecologists believe that a period of observation is the most appropriate form of management for young women who have minimal endometriosis with no significant symptoms. Others believe that it is inappropriate because they believe endometriosis should be treated as it usually progresses.
A period of observation may be the most appropriate form of management if a woman decides that she does not want to have active treatment, particularly if she has minimal or no symptoms.
Symptomatic management
Symptomatic management for endometriosis involves treating only the symptoms — usually the pain — without attempting to treat the underlying disease.
It usually involves the use of various analgesic or anti-inflammatory drugs if the pain is intermittent, or a range of pain management techniques if the pain is chronic and ongoing.
Symptomatic management may be appropriate if a woman decides not to have treatment or if she has symptoms that have not responded to previous treatments.
Symptomatic management may also be used as an adjunct to conventional or alternative treatments in order to relieve ongoing symptoms.
If you decide to have only symptomatic management you need to be aware that it will not treat your endometriosis in any way and that in fact your endometriosis may progress.
Hormonal treatments
The hormonal treatment of endometriosis uses drugs to treat the condition. In general, hormonal treatments aim to eradicate the endometriosis by suppressing the menstrual cycle and preventing the growth and development of the endometrial implants and cysts.
Surgical treatments
In general, surgery for endometriosis aims to remove as many endometrial implants, cysts, endometriomas and adhesions as possible and to repair any damage caused by the disease. In the case of a hysterectomy, surgery aims to cure the disease by removing the uterus and sometimes the ovaries as well.
Combined treatment
Combined treatment is the use of a course of hormonal treatment before, or after, surgery to enhance the effects of the surgical treatment.
Alternative therapies
A variety of treatments are used by alternative therapists. Each therapist uses a combination of treatments, although the actual treatments used for each individual will usually depend on an assessment of her problems.
*46\83\2*
It’s a fact that many highly-stressed individuals simply refuse to accept that they may be more stressed than is good for them; this denial, of course, allows them to ignore the situation and just carry on as before. But there is no question that all of us, no matter how much we may like to think that we’re always totally in full control of our emotions, are to a greater or lesser degree susceptible to stress, either because we over-react to events or because we have a low stress tolerance level in the first instance.
Although a little bit of undue stress now and then may not do a great deal of harm, ongoing undue stress at a high level certainly will eventually exact a price to be paid in overall poorer health, whether this manifests itself as back pain or any one of a dozen other conditions whose incidence is at least partly linked to stress or worsened by it.
Doctors, of course, have many ways of determining whether someone is overstressed, but there is also a very simple and remarkably accurate way of finding this out for yourself and that is to just ask yourself whether you’re under undue stress. If ‘yes’ is the answer that immediately springs to your mind in response to this self-questioning, then it is most likely that this will indeed be so. Equally, should your own self-assessment suggest that you’re not particularly stressed, then that, too, is most likely to be the correct conclusion.
Naturally, how much stress you’re under usually varies considerably from day to day, week to week, month to month, and year to year. Just because you’re not feeling stressed at a given moment doesn’t necessarily mean that your body isn’t nevertheless paying a price for previous times when you might have been under a great deal of pressure.
Because stress is seldom constant in its intensity, many people fail to come up with either a clear-cut ‘yes’ or ‘no’ answer when they ask themselves whether they’re stressed, instead saying things like, “Well, I do get stressed now and then, but I can cope with it and it doesn’t bother me” or “No, I’m pretty sure that I’m not under great stress – well, perhaps now and then things do get on top of me.”
When you try this self-test and find that your own answer sounds a bit like those above, then most experts would suggest that you are indeed at least partly affected by stress. And, if you’re having back problems, then the chances are that somewhere along the way stress has made a considerable difference to how much these have affected you. If so, it follows logically that reducing or controlling your stress level in the future is likely either to reduce your back problems or at least make them more bearable.
*52\124\2*
Some of the most helpful things you can do to live an anti-depressant lifestyle involve taking control of your life wherever possible. One well-known animal model of depression, developed by Martin Seligman, is learned helplessness. In this model, rats in cages are given electrical shocks at random until, presumably realizing that there is nothing they can do to prevent these shocks, they simply give up and lie down, resigned or, perhaps, depressed. Life may feel like that to some people. At work, you may be faced with one difficult situation after another. Your boss may be constantly disgruntled or repeatedly abusive. Similarly in marriage or a relationship it sometimes feels as though you just can’t win. No matter what you do or say you land up in trouble with your partner. These are topics of satire, but in reality are not very funny. For example, in the highly successful comedy series Fawlty Towers, the unfortunate innkeeper, Basil Fawlty, is always falling foul of his wife Sybil. On one occasion Sybil harangues him about his gambling. When, later in the episode, she checks on whether he has been betting on the horses again (which he has) he responds, ‘No dear, that avenue of pleasure has been closed off to me.’ In depression, where avenues of pleasure are already closed off to the depressed person, it is particularly important that extra sources of unhappiness be tackled or avoided.
*67\75\2*
What about the words used to describe epileptic seizures? The word ’seizure’ is that most commonly used by neurologists for all types, but, depending upon the manifestation of the seizure, they may call them convulsions. Often they will use the words employed by their patients—for example, fit, turn, attack or dizzy spell. People who have two types of seizure often call them ‘big ones’ and ‘little ones’. As long as the patient and the doctor find themselves talking about the same events, this is perfectly acceptable.
The word seizure is really too sudden and violent a word to describe the minor distortions of consciousness that may be the only manifestation of some types of epilepsy such as absences, but we do not have a better word to cover all types.
Sometimes in correspondence and conversation doctors employ the words ‘epileptiform’ or ‘epileptoid’. In our experience, doctors who use such terms are skating round the subject and avoiding frankly stating that their patient has had an epileptic seizure. The only justification for such a term might be the description of attacks called anoxic seizures in which a few jerks of the limbs arise during a profound faint, in which the blood supply to the brain is briefly insufficient. Apart from this example, and strokes, which used to be called apoplectic seizures, by common usage in English-speaking countries a seizure now means an epileptic event.
*6\188\2*
Troublesome dryness of the skin can occur as the result of daily bathing or showering, especially in older people. The skin, particularly that over the lower legs, feels itchy and appears white, rough, scaly, even cracked, so that it may bleed and become red and infected.
The best way to deal with this common problem, the U.S. Pharmacist (13#12:24) advises, is to first soak the skin in warm (not hot) water for about 10 minutes. After this, the skin must be thoroughly dried with a towel and then, and only then, it should be immediately covered with a film of ointment or cream. The soaking gives time for the water to penetrate into the deepest layers of dry skin and the thin layer of ointment or cream then acts as a barrier to prevent the water from evaporating away. However, since water and oil don’t mix, the surface must be completely dried before ointment or cream can be properly applied. Without the soaking, a cream or ointment cannot do much good.
Since ointments are more oily than creams, they form a more lasting water-retaining barrier. However, because ointments are stickier and less easily washed off, creams are more popular, especially during the day. With creams, though, one must be prepared to soak the skin more often.
Containing still less oil, or even none at all, lotions, although soothing, are almost useless for treating skin that is already excessively dry. They may provide some help, of course, in preventing normal skin from becoming dried out. Gels, which usually contain some alcohol, may actually dry the skin.
Cutis (37:384) recommends that we add Alpha Keri oil to our bath water. Those who preferred showering to sitting in the tub got the same benefit from Alpha Keri oil by rubbing it on the skin immediately after drying. Other bath oils probably have the same effect.
*196\143\2*
Signs and symptoms
High blood pressure has been called the “silent disease,” because it often has no symptoms. Symptoms, if they occur, can include headaches, pounding heartbeat, shortness of breath during exercise, and flushing of the face. Accurate diagnosis can be made only by taking careful blood pressure measurements with instruments that are the correct size for your child’s size. If the blood pressure is high on the first reading, the doctor will check it several times at return visits to make sure that the first reading was accurate.
Home care
There is no home treatment for high blood pressure. The condition must be diagnosed and treated by a doctor. All children should have an annual physical examination. High blood pressure in child-hood is curable, but it can be dangerous if it is not treated.
Precaution
• Be sure the doctor checks your child’s blood pressure during each annual checkup.
Medical treatment
Your doctor will give the child a complete physical examination, including measuring the blood pressure, palpating the arteries in the groin, and examining the eye for changes in the blood vessels in the back of the eyes (where effects of high blood pressure may be recognized early). The doctor will also examine the child’s heart, abdomen, and genitals.
It takes complicated laboratory investigation to check for all of the many possible causes of high blood pressure. Except for rare cases, all the causes of high, blood pressure can be successfully treated or cured by medications, changes in diet, or surgery. However, the condition frequently requires the child to be hospitalized for tests and determination of treatment.
*113/84/5*
To balance your blood sugar, you need to follow three golden rules:
1. Eat complex carbohydrates regularly.
2. Avoid refined foods, especially sugar.
3. Reduce foods and drinks that are stimulants.
1. Eat Complex Carbohydrates Regularly
You need to eat foods that give a slow rise in blood sugar and keep a constant level for about three hours. Then you need to eat again, to prevent the level from dropping. Spacing food at three-hourly intervals in this way maintains a good balance.
And the best foods for this are complex carbohydrates. They give a slow release of energy because it takes time for the digestive tract to break them down into simpler substances that the body can use.
To help maintain a steady blood sugar level, aim to eat complex carbohydrates as part of your main meals and also regularly during the day. You do not necessarily need to eat large amounts. Sometimes just an oatcake between meals can be enough to keep eating urges at bay.
If you find the symptoms associated with low blood sugar level are greatest first thing in the morning or you wake during the night, heart pounding, and cannot get back to sleep, then it is very likely that your blood sugar level has dropped overnight and adrenalin has been released. Eating a small, starchy snack, like an oatcake, one hour before going to bed and, if possible, one hour after getting up, will help to alleviate these symptoms.
2. Avoid Refined Foods, Especially Sugar
Simple carbohydrates, with the exception of fruit, are all refined foods and should be avoided. Although fruit contains fructose (fruit sugar), which is a simple sugar, the fibre content of the fruit is a complex carbohydrate which slows the digestion rate. So fructose is acceptable when taken in the whole fruit, like an apple, but not when used in the refined form of powdered white fructose bought in boxes.
Pure fruit juice can also cause a rapid change in blood sugar level because it is not buffered by the fibre that is normally present in the fruit. It is therefore better to dilute fruit juice in water to make it less concentrated.
Sugar seems to be everywhere, even in unexpected places. And, by the way, the ‘brown-is-best rule’ doesn’t apply to sugar. All colours do the same damage to your blood sugar balance!
A can of cola may contain up to eight teaspoons of sugar, as may a pot of fruit yogurt. Most of the convenience foods and drinks we buy are laden with it. Sugar is also in savoury foods, such as baked beans and mayonnaise. Did you know that tomato ketchup has just 8 per cent less sugar, weight for weight, than ice cream, and that the cream substitute used for coffee is 65 per cent sugar (compared to 51 per cent for a chocolate bar)?
Indeed, sugar is added to practically everything, as it is an inexpensive bulking agent. Even some toothpastes contain sugar but, as toothpaste is not a food, sugar does not have to be included on the ingredients list.
Sugar is just ‘empty’ calories. This means that it contains no nutritional value so you can happily cut it out and lose nothing but weight. You may be tempted to replace sugar with artificial sweeteners – don’t. You are simply substituting an alien chemical which your body then has to deal with, giving it extra work, to do. Nobody really knows what havoc these chemicals may cause when introduced into our own bodies’ delicately balanced biochemistry.
If a food or drink is described as ‘low sugar’ or ‘diet’ it will usually contain an artificial chemical sweetener such as saccharin or aspartame. They are also found in some non-diet crisps, ice lollies, sauces, pot noodles and some over-the-counter medicines so it’s worth checking labels carefully.
3. Reduce Foods and Drinks That are Stimulants
Sugar, smoking and caffeine in tea, coffee, chocolate and caffeinated soft drinks, are all stimulants and cause a fast rise in blood sugar level, followed by a quick drop. Avoid them whenever possible. Or, even better, cut them out of your diet completely. Replace with herbal teas and grain coffee, spring water and diluted pure fruit juices.
Do:
• Eat plenty of unrefined complex carbohydrates, including whole-wheat bread, whole meal pasta, potatoes, brown rice, millet, oats and rye.
• Eat fruit and drink diluted pure fruit juice.
• Always eat breakfast – porridge oats are good.
• Eat small, frequent meals no more than three hours apart.
• Reduce, and preferably avoid, stimulants including tea, coffee, chocolate, smoking and canned drinks that contain caffeine.
Don’t:
• Eat refined carbohydrates. Avoid ‘white’ in general. Remember that white flour is in many foods, like cakes, biscuits, pastries and white bread.
• Eat sugar or foods containing it, including chocolate, sweets, biscuits, pastries and soft drinks.
• Replace coffee with decaffeinated coffee (as it contains two other stimulants, even when the caffeine is removed).
• Eat convenience foods, as they are likely to contain refined carbohydrates, sugar and high levels of fat and salt.
*37/73/5*
We all know how war kills you with a bang. We’re now beginning to understand how it kills you with a whisper. PTSD is one way. But researchers from the Carolina Population Center at the University of North Carolina at Chapel Hill also have found that combat veterans from World War II were more likely to experience physical decline and death during the first 15 years after the war than those not involved in combat.
“War is such an incredibly disruptive event,” says study author Glen H. Elder Jr., Ph.D., of the Carolina Population Center, “especially when you’re mobilized during your late twenties and early thirties like many soldiers were during World War II. This disruption, combined with returning and never really talking about the experience, seems to have had adverse consequences for their physical health, perhaps through an impaired immune function. In our studies, late mobilization and exposure to combat are predictive of declining physical health. There is more cancer and heart disease in the lives of these men.”
Echoing those findings, a 50-year study of 152 World War II veterans found that 30 out of 54 veterans who saw intense fighting contracted chronic illnesses and died by the time they were 65. Sixteen of those veterans had complained of symptoms of PTSD. And the rates of disease and death were significantly lower among veterans who had not seen much combat.
Because Vietnam occurred earlier in the soldiers’ lives, Dr. Elder isn’t able to draw parallels between World War II veterans and those who served in Vietnam. “The disruption occurred when they were younger, but the war had psychological consequences all of its own,” he says.
*124/36/5*
Is it all in the mind?
The question of psychological response, the ‘placebo effect’, needs dealing with fairly comprehensively because it always crops up with new medical treatments. Yes, some of the results described could be due to psychological influence; but in such cases they would be unlikely to last for more than a few weeks at the most. The proper answer to the question heading this paragraph is therefore, no. The beneficial effects produced by mussel extract are not of a psychological origin. That some psychosomatic influence may help the working of the treatment, any treatment in fact, is not doubted. Psychosomatic therapy in the form of a placebo is used by medical practitioners quite frequently where it is thought that this type of therapy will help a patient.
A placebo is a substance used in medicine (primarily in trial work) that does not have any pharmacological effect on the disorder. It is often in the form of a sugar pill or coloured water. The idea is that in a trial, some patients are administered a pharmacologically active substance and some a placebo which looks like the active substance but which is known to have no effect. A comparison of the patient’s progress on active and placebo then gives an ‘objective’ assessment of the effect of the active substance and rules out psychosomatic response.
Where the placebo is used in general practice it is done as a straight psychological treatment. The patient believing that the pills or liquid are something which will help the ailment, can be influenced into feeling and becoming better. This effect of psychosomatic influence is well known and is valuable.
The reasons that the definite statement can be made that the treatment with mussel extract is not psychological in effect are several. First, the results would not be lasting. With such a painful condition as arthritis a psychosomatic or placebo effect would probably wear off after four to six weeks at the very most. With the extract treatment the results are long lasting. Second, animals are unlikely to respond to a psychological stimulus, especially when they do not even know in most cases that they are receiving any medication. Animals respond very well to mussel extract. Finally, clinical studies are carried out in a way that is designed to eliminate as far as possible any emotional influences of the trial patients. In clinical studies the extract demonstrates excellent results.
Can this substance be obtained from other shellfish?
Naturally, the discovery of the anti-arthritic effect of an extract from the New Zealand Green Lipped Mussel led to the theory that other types of mussels or shellfish may also possess the same property. This does not seem to be the case, however, and apparently only this one species of mussel can lay claim to these particular therapeutic powers. This should not surprise us. Some species of marine organisms, similar in many ways, differ because of geographical distribution; sometimes the same species growing in waters of the same ocean, but in different regions, can vary in certain characteristics. One obvious influence is the diet to which a particular group is exposed: another is environment, including, of course, the composition of the water.
Therefore, it may not only be that other species of mussels do not posses this particular activity, but possibly even the same species grown in other areas may not do so. This last factor has not yet been established, but it is not an unreasonable assumption.
*19/48/5*
The process of treatment begins at the first moment of contact. Because such contact usually comes by phone, treatment can start before the doctor and the patient have even met face-to-face.
As a doctor, I try to plant the seeds of success during those first, critical moments. If I create an atmosphere of trust, of caring, then there’s hope. If my tone is judgmental or threatening, then the process may be doomed.
The next step is to meet with those involved. If the patient herself asked for help, then the first appointment is with her; when the parents make the call, I may ask to see them first. In other cases it may be best to see everyone at the same time.
The initial evaluation may take one or more meetings. However, if the situation is life-threatening and the patient needs to be hospitalized, I don’t wait.
Every situation is different. If in your search for help you don’t feel the caregiver is responding to your needs, discuss the problem with him or her. If you are still not satisfied, keep looking.
The Initial Assessment
I perform a complete assessment of the problem before the patient and I agree on a plan for treatment. Too many professionals say, in effect, “Welcome to our facility, here’s how we’ll treat you, now tell me all about your problem.”
Typically I start by asking, “How may I help?” Patients often seem surprised that I play the role, not of adversary, but of collaborator on a joint project-as indeed I am.
The patient’s initial response is most revealing. Here are some examples drawn from recent cases:
“You can’t help me. My parents are the ones with the problem.” This comment is typical of anorexics, who feel they aren’t sick at all and have come just to get people “off their backs.”
“My father called me fat, so I started losing weight.” People with low self-esteem are very sensitive to such remarks. One fifteen-year-old patient, inspired by the Olympics, demonstrated a gift for gymnastics. When her coach said she might do better if she “lost a little weight,” she began to diet. Unfortunately, she focused on weight loss at the expense of everything else. If starvation had been an Olympic event, she would have qualified for a medal.
“/ look in the mirror and I get scared. I want to find some peace inside.” Some patients know they are hurting themselves and want help in stopping. Especially in anorexia, the more distress the patient feels, the more motivated she is to get treatment.
Follow the Leader
In conversation I follow my patient’s lead. Following someone’s concerns, hopes, and resistances is more productive than a mechanical, by-the-numbers interrogation.
Sometimes when I ask, “How can I help?” she replies, “You can’t help. I don’t want to be here.” I may then say, “Well, someone is concerned enough to insist that you come here. Maybe we need to look at what’s going on in your life that makes you feel you need to starve yourself almost to the point of death.” Or she may say, “I don’t think you can help-nothing has worked so far.” I might then ask, “What have you previously tried?” and explore why other efforts have failed. And because words mean different things to different people, I would explore what she means by certain terms. Does “desperate,” for example, mean “confused” or “suicidal”?
Many times, the most telling clues come from something a patient avoids saying, or hesitates over. If a patient tells me something is none of my business, I’ll respect that. But later, when we’ve established a higher level of trust, I may ask again.
Trust is crucial. It takes time to build trust, to demonstrate concern and show that my intention is to heal, not to harm. When I show a patient that I accept her feelings as valid-although I don’t necessarily accept her way of dealing with those feelings-I send the message that the patient herself is worthwhile.
*53/35/5*
