Mens Health Blog. Medical Blog

A man in Oregon wrote to Dr Obama after Elizabeth, hit wife, asked him to read about endometriosis. Jonathan, a twenty-seven-year-old administrator at a large company in Texas, was searching for an answer that made sense, Elizabeth seemed to be suffering terribly, and it was getting worse. What he read about endometriosis seemed to correlate with Elizabeth’s symptoms and life-style. He hoped Dr Obama might assist him further.

His letter is a touching one. It is a love note for Elizabeth as well as a sad tale of all-too-common experiences with misdiagnosis and improper treatment of the “career woman’s disease.” It goes, in part, this way:

“I’m writing at a point of desperation in my wife’s life. She has learned after five years of pain that she has endometriosis. Elizabeth has seen twenty doctors since 1982, when they began having chronic pain in her vulva following an abortion. Doctors couldn’t find any condition that corresponded to her pain and either dismissed her as neurotic or prescribed creams that irritated the area.

“Then, a few months ago, a general practitioner diagnosed endometriosis based on her symptoms: painful urination, history of bad menstrual cramps, and abdominal pain. We heard that Danocrine would help over other treatments, but he insisted she take Norlutin. A synthetic progesterone, which created terrible side effects. Elizabeth then went to a top gynecologist on whom she’d pinned all her hopes. He told her that she had problems ‘accepting a normal sex life’ (we’ve been unable to make love for months because intercourse was so painful for Elizabeth) and that nothing else was wrong with her!

“I’m not a doctor, but I think I’ve unearthed every available medical journal on endometriosis. I feel pretty confident that Elizabeth has this disease and no other.

“I never would have believed how a woman can suffer and still be ignored by those with the power to heal if 1 had not seen it myself. This is why I’m writing a letter like this. Please give our problem your attention. We trust your opinion and hope you can answer us, no matter how briefly. What should we do next?”

Endometriosis can dramatically alter the daily rhythms of a woman’s life, and Elizabeth is a good example of this. Often, intimate relationships change when pain becomes a demanding third party. In these cases, coping with the disease not only requires fortitude of spirit but needs the understanding of others.

Of the many points Jonathan raised in Elizabeth’s case, the most significant was his description of two of the three symptoms (the “triad”) that most typify endometriosis: a history of bad menstrual cramps and dyspareunia (or painful intercourse). The third, infertility! is, in my opinion, a good probability for Elizabeth, although getting pregnant is not relevant to her now. Although a laparoscopy; or “Band-Aid procedure,” performed by a good diagnostician can help reveal the truth about Elizabeth’s condition, it’s a fairly good bet based on her symptoms that she has endometriosis and that a laparoscopy is not necessary in her case. As mentioned earlier, a standard suction abortion is rarely responsible for the onset of the disease. A badly performed abortion, however, may have caused some damage to the uterus. The doctor might have accidentally wrenched it in some way, tearing it slightly so that endometriotic tissue spread to the cervix and vagina. It is worth noting that the disease very rarely implants itself and grows in the vagina. However, during an internal examination a doctor can see very small brown-black (“powder burn”) spots of endometriosis on the cervix.

Unless there were actual lesions or indication of infection, we would say that the pain an Elizabeth’s vulva was not due to a localized problem, but radiated down from another source. Most likely, the pain originated in pelvic organs inflamed with actively growing endometriotic tissue. Such growths would alto account for frequent urination, since the bladder is commonly involved in this “glue-stick” disease.

Partnership of any kind, but especially partnership in health care, requires harmonious goals. You and your doctor must be able to exchange information freely and decide on the wisest course of action.

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Comments (0) May 08 2009

An itch is one of the commonest complaints relating to the skin. Frequently it is unaccompanied by any visible causative disease. Although everyone knows what an itch is, it is nevertheless difficult to define. The most widely accepted definition might be: ‘that unpleasant sensation which provokes the desire to scratch. Itching is an important symptom of many diseases of the skin, and also of internal disorders. It also warrants attention because of the further damage to the skin that would be caused by continued scratching.

Although itching has been extensively studied, its causes are ill understood. However any discussion of itching must refer to the physiology, so that the limitations of treatment may be understood. Itching, then, is a disagreeable sensation produced by the action of stimuli of a harmful nature on the skin surface. It is a signal of actual or potential danger to the skin. The purpose of the reflex action of scratching is to remove the causative agent from the body surface.

It is thought that a wide variety of stimuli and noxious agents may liberate chemicals in the skin which then act on peripheral nerves, eliciting the itch sensation. These chemicals include histamine, bradykine, protease, and prostaglandins. Throughout the skin there are many itch receptors. On the forearm these points lie approximately one millimetre apart. However they are more closely set in areas about orifices such as the mouth or anus. The small skin nerves then carry the impulses to the spinal cord, from where they are transmitted via the pain fibres to the brain. It is not yet understood how scratching relieves itching, but possibly it disturbs the rhythm of the impulses travelling towards the spinal cord. Scratching may also simply damage the nerve fibres which are conveying the itch.

Possible causes of itching.

1. Physical and chemical spicules, e.g. fibre glass, wool, detergent, proteases, e.g. nettles, Rhus tree drugs, e.g. opiates, quinidine.

2. Skin diseases Obvious e.g. eczema, tinea, bites. Not obvious e.g. scabies, hives, winter itch, parasitophobia.

3. Internal diseases or conditions.

Metabolic disorders, e.g. diabetes, thyroid disorders, liver disorders, kidney disorders, blood disorders, pregnancy, cancer, parasitic infestation iron deficiency.

4. Psychological disorders. Primary, secondary.

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Comments (0) May 08 2009

Nowadays, we think we know all there is to know about sex, having babies, contraception, and all that. Yet we seem to know so little about the menopause. Why don’t we talk about it more, compare notes, learn from each other? We do about most other things.

Talking about the menopause is something that most women have just never done. We talk about other aspects of our lives, but not this one. As a result, a conspiracy of shame and silence has drifted down the generations, expressed in such phrases as: ‘It’s her time of life’, ‘She’s going through the Change, poor old thing’, ‘Take no notice of her, she’s just having a hot flush’. Say no more, nudge nudge, wink wink.

Now, however, at last, compared with their predecessors, women reaching the menopause could be the lucky ones, the ones who know about it and are well informed. They can recognise hot flushes and other symptoms for what they are: the body’s response to a fall in the level of the female hormone oestrogen – simply that. They are not something shameful; nor do they mean we are suddenly old. After all, who wants to feel old at 50? It will be another 30 years before you need even to start worrying about that, so don t wish it on yourself now.

Part of the problem is that, until fairly recently, the majority of women didn’t live long enough to experience the menopause. Until reliable birth control became readily available, women who bore children tended to spend the majority of their married lives in a state of pregnancy or breast-feeding until their early forties. A combination of continuing pregnancies and the hazards of childbirth, as well as poor sanitation and inadequate health care, meant that, even at the start of the twentieth century, most women were dead by about fifty. So it is hardly surprising that so little was known about the menopause, let alone talked about.

Those who did survive to the menopause never made much of a fuss about it. They used a bit of self-medication, herbal remedies handed down through the generations, or exciting dietary supplements like ‘two sheep’s ovaries a day sandwiched between unleavened bread’, or ‘one tankard dairy of the urine of a she-goat’, and waited for it to pass.

Today, we often feel the menopause is just another illness to be treated by visits to the doctor and by medication. We hear the term ‘deficiency disease’, that is we are deficient in oestrogen. Yet most women still don’t really know what the menopause is, when it might happen, what to expect, and what can be done to ease their passage through it.

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Comments (0) May 08 2009

There are several sites for cancer that prompt women to consider a hysterectomy. Cancer of the cervix, also called cervical cancer, develops in cells that line the cervix. The abnormal changes usually occur over a period of years, although in some women the changes seem to happen much faster. Abnormalities of the cells of the cervix, thought to be precursors of cervical cancer, used to be called dysplasia; but nowadays the term cervical intraepithelial neoplasia (ON) is used.

Cervical cancer is diagnosed in about 1100 Australian women each year. Although most diagnoses are made in women aged over fifty-five, it seems that increasing numbers of women in their twenties and thirties are now being affected. Tell-tale signs include bleeding between periods in pre-menopausal women, bleeding after sexual intercourse or at any time after menopause, and a smelly vaginal discharge.

Screening for cervical cell abnormalities that could develop into cancer is available using the Pap smear technique. A small sample or biopsy of cells from the cervix is obtained using a special brush and a fine wooden spatula. The cells are smeared onto a piece of glass and then sent to a laboratory for examination. From the appearance of the cells, it is possible to identify cancer at a stage early enough to permit its complete removal and cure. Australian health authorities recommend a Pap smear every second year from the time women start to be sexually active.

Over 400000 women in the State of Victoria, Australia, had a Pap smear during 1990, but seven out of ten women considered to be most at risk of cervical cancer did not come forward for testing. Of every ten smears done, eight were completely normal or showed insignificant changes. Less than four in every 100 smears showed CIN changes and only one in every 2000 was suggestive of possible cancer. If the results of a Pap smear raise concerns or if a woman experiences any unusual bleeding or cervical discharge, the cervix is examined for suspicious-looking tissue using a magnifying instrument called a colposcopy. A biopsy is usually taken and the tissue sample removed from the cervix is sent to a laboratory for microscopic examination. If the examination indicates severe CIN or pre-invasive cancer, any areas of the cervix which look abnormal are treated by cryosurgery (which destroys tissue by freezing), diathermy (which achieves the same end using an electric current), or else by heat or by laser. Diathermy or electrocoagulation entails using an electric current to produce points, loops or small balls of heat that burn the tissue while also closing blood vessels. Lasers are high-density beams of light energy that can cut tissue precisely and, at the same time, close off blood vessels. All these techniques have a high cure rate, and they do not interfere with a woman’s sex life or prevent her from having children in the future. Occasionally, a procedure called conisation is performed in which a cone-shaped sample of tissue about a centimetre thick is removed from the cervix using a scalpel, diathermy or laser. Once again, it is rare for the technique to damage a woman’s sex life or impair her ability to have children. If, however, there is any evidence that the disease has spread inside or beyond the cervix, a hysterectomy should be discussed. Radiation therapy or chemotherapy may also be suggested in a bid to ensure the complete destruction of cancer cells.

Although scientists do not know the exact cause of cervical cancer, there appears to be an association with sexual activity. Research suggests that certain strains of the human papilloma virus (HPV), which may be transferred during sexual contact, are involved in the disease process.

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Comments (0) May 08 2009

In 1953, Dr Natheniel Kleitman, Professor of Physiology at the University of Chicago, made a major discovery about the nature of sleep. He was studying sleep in small babies, and made round-the-clock observations of them. He noticed recurrent rapid movement of the eyeballs beneath the eyelids of these babies. The eyeballs moved for a few minutes, then rested. This recurred nearly every boar. He then started to investigate if this also occurred in adults. He was joined by William Dement, a medical student at that time. They started the first electrical measurement of eyeball movement during sleep. They attached electrodes to the skin at the corners of the eyeballs to pick up potential changes when the eyeballs moved. This kind of eye movement recording is called an electro-oculogram or EOG. Dr William Dement is now the director of the Sleep Disorder Centre at Stanford University, California, and also the Professor of Psychiatry in its medical school. He remains a world authority on sleep.

Kleitman and Dement observed that, when a person is sleeping, there is rapid eye movement in both eyes and this recurs periodically about four to five times each night. If these people are awakened during one of these periods of rapid eye movement, 95 per cent report that they are dreaming, compared with 7 per cent at other times of awakening. The duration of the dreams they recall appear to correlate with the length of the period of the rapid eye movement. This rapid eye movement sleep is now abbreviated to REM sleep. REM is pronounced like the word ‘gem’.

During REM sleep, the person is dreaming, his mind is active, and his eyes are moving rapidly back and forth under closed eyelids. The EEG recording is very similar to that of the awake state, like a very irregular saw tooth, and nothing like that of the four stages of sleep described previously. Contrary to what we expect, when the person is dreaming his body is not moving at all, but is in complete relaxation—paralysed. Some people call this REM sleep the paradoxical sleep. This is because the mind is active and dreaming, but, paradoxically, the body is totally inactive and motionless. It is thought that this complete body rest during REM sleep is essential for the refreshing feeling the person feels in the morning. This is because no matter how tense a person is, during REM sleep his muscles are all relaxed It is also thought that this complete body paralysis during dreaming prevents the dreamer from acting out his dream physically when he is asleep. It looks like there is some form of jamming mechanism that disconnects the brain activity from the muscular system of the body.

Michael Long, in a 1985 edition of National Geographic, reported that, in Minneapolis, at the Hennepin County Medical Centre, a Dr Mahowald and a Dr Schenck interviewed over 30 people who somehow bypassed this jamming mechanism during REM sleep and acted out their dreams. This is of course extremely dangerous, but fortunately also extremely rare. During dreaming all sorts of fantasies, angers, and frustrations are acted out. Those people with no jamming mechanism can endanger not only themselves but also those sleeping beside them. It was reported that some of these violent dreamers beat their wives up repeatedly, smashed windows, punched holes in the walls, and displayed remarkable strength and agility. Fortunately most of us have this jamming mechanism which prevents us from acting out our dreams; otherwise our beds would look very different, with restraining belts to lock our bodies and limbs to the bed, to prevent us from running wild destroying things in the house when we are having a nightmare.

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Comments (0) May 08 2009