Herbal Health

Prolonged disuse of bones from immobilisation in bed may lead to an increased loss of calcium from the bones, and so they become thinner and more fragile.

Elderly women may sustain fractures of bones from even simple injuries. A common fracture in women is a break in the radius, the major bone of the forearm. A fracture of this bone, just above the wrist, is called a Colles’ fracture.

A fall may result in a fracture of the neck of the femur or thigh bone. This can occur in both elderly men and women, but is far commoner in women. Crush fractures of the vertebral bodies of the spine are not uncommon in elderly women.

These can follow from carrying heavy weights and one cause is from grandmothers lifting and carrying grandchildren.

Elderly women who carry heavy loads from the supermarket can also suffer a crush fracture of the vertebra, usually affecting the bones of the thoracic or chest spine. These fractures cause considerable pain, but require no specific treatment beyond rest.

The deformity from wedging of a crushed vertebra leads to the prominence of the upper back which has been called the “widow’s hump”.

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The small and medium-sized arteries are affected and it involves most organs. In half the cases, there is an acute onset with fever, aching in the limbs and abdominal pain.

While this also is thought to be an auto-immune disease, some researchers believe it to be a hypersensitivity reaction to infection, particularly to recent infection with the streptococcus germ. This is the common cause of tonsillitis and the skin disease, impetigo.

Rheumatic fever, which affects the joints and sometimes the heart, and acute nephritis, an inflammation of the kidneys, are believed to be hypersensitivities to the streptococcus.

Cortisone can relieve the acute symptoms of polyarteritis but does not appear to alter the course of the disease.

There are a number of other collagen disorders, perhaps the most important of which is Giant Cell Arteritis.

This is a sub acute inflammation of the larger arteries and the temporal artery which lies in the scalp is the most commonly affected.

This form of collagen disease affects the elderly, usually at around 70. There is often a slow, insidious onset, with fever, tiredness and weight loss. The temporal artery may become thickened, easily felt and tender. While this is the most noticeable feature, many other arteries of the body may also be affected.

Early recognition is important, as the retinal arteries which supply the eyes may be involved and this can impair vision.

Cortisone is most effective in this condition. Early treatment results in settling of the inflammation with relief of symptoms, and can save the sight.

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A doctor is often faced with a parent who is concerned that his or her child seems to bleed or bruise easily and there is said to be a relative with a bleeding tendency.

In the past, tests to check whether there was some serious underlying disorder were somewhat complicated.

Doctors now know that a thorough history of the child, how the problem has presented itself, plus a history of the family, can give most of the clues.

A few simple blood tests as well, should be enough for the family doctor to be able to reassure the parents that no real problem exists.

True haemophilia or haemophilia A, which was present among many descendants of Queen Victoria, is due to an absence of factor VIII in the blood. This deficiency is inherited, but is sex linked. It is carried by females and may appear in their sons.

Haemophilia B, or Christmas disease, is due to a lack of factor IX and is also sex linked in inheritance.

Correct diagnosis as to whether a bleeding disorder is present, will lead to the proper treatment if it is needed.

Purpura is a form of bleeding tendency which, in most cases, is acquired rather than inherited, and is usually temporary.

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Firstly, you are entitled to know that the procedure is experimental or unproven. You must be told the reason for the research and exactly what it would involve for you in terms of inconvenience, risk, possible side effects, and financial cost. You must know what the alternative standard procedures or treatments are and be assured that they are not known to be better than the research procedure or treatment. You must be assured of confidentiality— that you will not be identified by name in records going to other centres or when research results are published. You must have the opportunity to ask questions and get answers you can understand. You must be told that, whether or not you agree to take part in the research, you will still be treated by the same practitioner to the best of his or her ability. After entering the research study, you are entitled to withdraw at any stage and still receive treatment from the same practitioner if you wish. You are entitled to take time and consult with others if you wish before deciding whether or not to take part in the research. You must be assured that any adjustments or changes to treatment will be made in your own individual interest. This means, for example, that if the treatment is clearly not helping you or is producing unpleasant or dangerous side effects, it will not be continued.

Naturally, we all hope that advances will be made in cancer research. Taking part in research could be an experience which makes you feel better about yourself. You would be justified in feeling that, in this way, you could use your illness positively to help future patients. However, it is still most important to be fair to yourself and to put your own immediate interests first. Don’t agree to participate in research unless you feel good about it and know exactly what you are agreeing to.

These rights are not so special or extreme, are they? They should sound familiar because, basically, they are the same sorts of rights as should apply in all treatment situations.

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As mentioned on page 36, this is a new form of ‘no-bleed9 HRT produced in response to the high drop-out rate among women who have not had a hysterectomy and who don’t want to have regular withdrawal bleeds. Although there has not yet been very much published data on it, it is increasingly being prescribed in the expectation that women will be willing to stay on HRT for longer. Different brands should be available soon. The brand currently available is livial, and the manufacturers, Organon, describe it as having ‘combined progestogenic, oestrogenic and androgenic properties’, that is, it works in the same way as progestogens, oestrogens and androgens work. By taking a combination of these hormones in tablet form on a continuous basis (rather than by taking progestogen for just 10—12 days each month), it is hoped that eventually bleeds will stop, though this may take up to a year, doesn’t work in all cases, and can produce irregular bleeding in the meantime. (If you continue to get a withdrawal bleed on ‘no-bleed’ HRT, your doctor may feel it is appropriate to prescribe a one-off dose of progestogen to clear the lining of the uterus, which should prevent further bleeds.) This type of HRT helps mood changes and loss of libido, as well as other symptoms of the menopause. More long-term research is needed before its effectiveness against osteoporosis is known for certain, but a ‘no-bleed HRT’ is definitely a step in the right direction. If you would like to take HRT for its benefits, but really cannot face the return of monthly ‘periods’, why not ask your doctor about this new form? It is only recommended for women at least 12 months past their final period.

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Surgeons gain access to, and remove, one or more of the reproductive organs in a number of ways. This is the basis for another method of classifying hysterectomy.

If the reproductive organs are accessed through the vagina, the operation is called a vaginal hysterectomy. This approach may be considered when:

• a woman has a prolapse and her uterus, bowel or bladder has already started to intrude into her vagina

• there are fibroids that are small enough to enable the uterus to be pulled down and out through the vagina

• the ovaries are to be left intact.

Vaginal hysterectomy is unsuitable when the uterus is very large or contains one or more sizeable fibroids. It is more difficult to perform than abdominal hysterectomy and should always begin and end with a laparoscopic inspection of the pelvis. This helps ensure that any abnormalities, such as ovarian cysts, are identified prior to surgery and alerts the surgeon to any bleeding that has occurred during the operation. Bleeding must be contained or the patient will form large blood clots in the pelvis which may lead to adhesion formation and infection. Removal of any clots will involve another trip to the operating theatre and an extra two to three days in hospital.

The debate among doctors about the relative merits of abdominal and vaginal hysterectomies is ongoing. Proponents of the vaginal approach argue that it involves less post-operative pain, is less costly and requires a shorter hospital stay. Some research has suggested it may be safer than the abdominal approach, resulting in fewer deaths and a lower complication rate but analysis of Australian hospital data indicates that this is not necessarily so. Nevertheless it is argued that the vaginal approach could be used for most hysterectomies if appropriate training programs for doctors were available.

In contrast, doctors who favour the abdominal approach claim that the types of complications more likely to affect women having a vaginal hysterectomy are a cause for concern. They claim post-operative infection and large blood losses necessitating transfusions are more common with the vaginal approach; and they suggest that there is an increased risk of damage to other pelvic organs due to the confined space in which the surgery is performed. Repairing this damage entails further surgery. They also say that vaginal hysterectomy is more likely than abdominal hysterectomy to result in a vaginal prolapse, where the upper part of the vagina collapses inwards. The upshot is that at present in the US, UK and Australia, about 25% of hysterectomies are performed vaginally.

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‘Apnoea’ means not breathing. Sleep apnoea is the inability to breathe whilst asleep. The frequent attacks of sleep apnoea disturb sleep profoundly. Because sufferers do not have enough sleep at night, they feel tired all day and have no energy to do anything. They are unable to concentrate at work, and lose interest in sex and other things they enjoyed before. This is another common cause of excessive daytime sleepiness, and is now studied extensively in sleep laboratories. As a result, this condition is now believed to be more common than was previously believed. It is estimated that over 1 per cent of the adult population is suffering from sleep apnoea.

Sleep apnoea becomes more frequent as we grow older. The typical sufferer is a man over forty years of age who is grossly overweight and has high blood pressure. His sleeping partner invariably complains that he is snoring every night. A keen observer may be able to report that the sufferer snores very heavily, then wakes himself up, takes a few deep breaths, and falls back into snoring again. This may happen many times throughout the night In fact people suffering from sleep apnoea do not have any real sleep. They keep waking up throughout the night. However, in the morning, they may not remember that they have been waking up frequently, but somehow have the feeling that they have not slept. They also fall asleep very easily in the daytime, at the most inappropriate times. Many road accidents involve people who have sleep apnoea.

This condition is caused by obesity; in particular, the accumulation of fat around the throat. During sleep, air is sucked into the lungs, creating negative pressure around the surroundings of the throat and the tongue, which leads to a reduction in the diameter of the throat. This reduces air flow into the lungs. In normal people this reduction in the diameter of the throat is minimal, and may create only a snoring sound. Snoring results from the vibration of the palate, which is the roof of the mouth, as air is blowing across it. The flute and other woodwind instruments work on the same principle. In some obese people the air passage is narrowed far more than in normal people because of the accumulation of fat around the throat. This causes an even greater reduction in the flow of air to the lungs and results in obstructive sleep apnoea.

The condition is made even more severe during REM sleep. In REM sleep the muscles of the body are almost paralysed. Hence the muscles in the throat become flaccid and the diameter of the opening is further reduced. Because there is a reduced air flow into the lungs the person is virtually suffocating; this subsequently reduces the amount of oxygen circulating in the brain.

For normal people, the blood oxygen level during sleep stays above 90 per cent, but for sufferers of sleep apnoea this may go down to 40 per cent at times. Whenever the brain is deprived of oxygen, the body is signalled that all is not well, and the person wakes up immediately. After taking a few deep breaths, the brain regains its oxygen supply and the body feels that all is well. The person falls back into sleep, and snores again. Further cycles of waking and snoring then follow. This snoring/waking cycle repeats itself many times throughout the night. Normal people may also have occasional attacks of apnoea, but less than four times in one hour. People with sleep apnoea have as many as 30 attacks in one hour, and each attack of apnoea may last as long as three minutes. Because there is not enough air going into the lungs, and consequently less oxygen is circulating in the blood, these people may suffer from high blood pressure and irregular heart beats. It is thought that many heart attacks and strokes are triggered during these attacks of sleep apnoea.

Professor Colin Sullivan at the University of Sydney devised a nasal mask which can be worn during sleep. Air is pumped through the mask to ventilate the lungs by an electric pump. This device is now available commercially and is called continuous positive airway pressure, commonly known as ‘CPAP’, which is pronounced as ‘see-pap’. Besides this, there are other ways of helping sufferers of sleep apnoea. Weight reduction in the obese is very important, as this is sometimes the main cause of sleep apnoea. Tablets can also be given to reduce the time spent in REM sleep, as sleep apnoea is worse during REM sleep. Some sufferers may consume an excessive amount of alcohol or may be heavy smokers. Giving up drinking and smoking will definitely help. Plastic surgery of the soft palate and the oral cavity is sometimes very successful.

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EXERCISES-DIFFICULTIES IN ATTAINING PHYSICAL RELAXATION

The difficulties in attaining relaxation of the body are not great. But I think it wise to mention various difficulties that different people have experienced. Then if you find that you have similar problems you will at least know that others have also experienced them, and have overcome them without too much trouble.

The most common difficulty in learning to relax is undoubtedly the simple reluctance of many people to try it. I have had so many people say to me, “I really did not think that this would be any good for me, but you talked me into trying it, and now I am already feeling much easier in myself.”

Another difficulty, as I have pointed out, is the simplicity of the procedure. Some people find it hard to believe that anything so simple and so natural could help them when they have already tried dozens of tablets and injections without effect. Do not forget that you too, by the very

culture that surrounds you, have been at least partially conditioned into this pattern of thinking.

Restlessness may be a difficulty. We sit down ready to start, and we immediately find we want to move about. We fidget. We move a leg and then an “arm. Then we are aware that our clothes are uncomfortable, and we move again. Restlessness like this is only an initial difficulty. If you have this trouble, make yourself as comfortable as you can. Use cushions; lie on a soft bed—anything that appeals to you as making you comfortable. Then do your relaxation; but do it only for a very short period—two or three minutes. After that have a rest and a stretch, and then do it again. Soon the phase of restlessness will pass, and then you can move into doing the exercises in more uncomfortable positions.

The feeling of physical discomfort in some part of our body may cause difficulty in relaxation. We become aware of our leg. It is uncomfortable. It is beginning to hurt, and we feel we want to move it. At this stage, instead of moving it, concentrate on relaxing more completely. In spite of the discomfort we bring ourselves to let go more completely. We do this. We let ourselves go through the discomfort, as it were. The discomfort passes, and we relax more easily.

Sometimes a trembling of the muscles makes relaxation difficult. This is only a worry at the very start, and it soon passes. It is most common in the eyelids and the muscles around the eyes. In fact, some trembling of the eyelids would seem to be the general rule in the initial phases, and is of no consequence at all.

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The fourth rule of vital nutrition is that your food should be as poison-free as possible. This is easier said than done, however, in this poisoned world of ours. And if you feel that “poisoned world” sounds rather alarmist, I will add that it is almost impossible these days in the United States and West-European countries to obtain foodstuffs that are free from poisonous residues or additives. Fruits and vegetables contain residues of various poisonous insecticides, waxes, bleaches, and artificial colorings. Fresh meats contain residues of hormones used to speed up animal growth and antibiotics to prolong meat s shelf life. Processed meats, bread, cereals, canned and processed foods are loaded with some of the nearly 1,000 different chemicals now used by the food processing industry in this country—and many of them have never been tested for their possible toxicity! Much recent research shows that the toxic effect of chemicals is multiplied by the effect of other chemical agents consumed simultaneously.

There is a growing movement in the United States to produce poison-free, organically grown foods. They are often available in health food stores. Every effort should be made to obtain such foods. Poisons in foods are, perhaps, the greatest menace to American health today.

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If a drug is to be taken reliably and regularly, a patient must be informed fully about that drug. A plan of the proposed management and possible side-effects of the anti-epileptic drug must be discussed with the patient (or family) at diagnosis and at the outset of treatment. In the children’s seizure clinic at the Royal Liverpool Children’s Hospital (Alder Hey) and at St. Bartholomew’s Hospital, families are provided with a drug information sheet with written details about the drug. Included is information about:

• its preparation (e.g. tablet, capsule, or liquid);

• the method of administration;

• the dosage regime;

• its possible interactions with drugs bought over the counter in chemist’s shops as well as with other prescribed drugs; and

• its side-effects.

Advice is also given regarding what to do about doses which are forgotten, missed, or vomited.

Written information is in addition to, rather than a substitute for, oral advice. Patients often do not remember, or may misunderstand, much of what is said to them by doctors in a busy hospital clinic or surgery. This is particularly relevant with regard to adverse events or side-effects. Unexpected side-effects may distress or annoy patients (and their families) and thus adversely affect whether they will continue to take the drug, with its potential benefits. Patients should also be warned that different, or additional drugs may be needed depending on the specific epilepsy syndrome and their initial response to treatment. Well-informed patients and families are more likely to use their drugs with discretion and obtain the benefits which modern drugs can offer.

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