Health News Blog. Lots of resources and information

During the past decade, research has suggested three main reasons for the widespread neglect of the signs of heart disease in women: (1) physicians may often be gender-biased in their delivery of health care, tending to concentrate on women’s reproductive organs rather than on the whole woman; (2) physicians tend to view male heart disease as a more severe problem because men have traditionally had a higher incidence of the disease; and (3) women decline major procedures more often than men do. Here are other possible explanations for the diagnostic and therapeutic difficulties encountered by women with heart disease:
-    Delay in diagnosing a possible heart attack
-    The complexity involved in interpreting chest pain in women
-    Typically less aggressive treatment of women who are heart attack victims
-    Their older age, on average, and more frequent comorbidities (other diseases/problems)
-    The fact that women’s coronary arteries are often smaller than men’s, making surgical or diagnostic procedures more difficult technically
-    Their increased incidence of postinfarction angina and heart failure
Although there is much debate about whether women have actually been ignored by past research concerning cardiovascular diseases, at least one study points out that the differences in treatment of suspected acute cardiac ischemia in men cannot be applied directly to women. More important, at least one study suggests that these differences may reflect overtreatment of men rather than under-treatment of women.
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The top of the vagina may be narrowed or shortened as a result of the hysterectomy and any scar in that area may take as long as three months to lose its tenderness and become flexible. Occasionally the hysterectomy itself leads to a prolapse of the bladder, rectum or vagina. Further surgery is then needed to reposition and anchor the organs so that they do not collapse downwards.

Various problems can occur with an abdominal scar, especially if a woman has previously had several abdominal operations (for example, Caesarean sections). The scar may be itchy or sore and the woman may think it looks unsightly. Some physiotherapists use ultrasound to soften the scar tissue and ease the soreness. The sound waves that are generated during ultrasound have a mechanical shaking effect which stimulates blood flow and cell activity in the hardened areas. Sometimes it is possible to reposition the scar or combine a number of scars during further surgery. Bruising and swelling at the site of an incision may also pose problems. The area may be drained or left to resolve itself, a process that can take several months.

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Exercise

Exercise is also highly beneficial, as it can help alleviate period pains by increasing circulation to the pelvic region. Exercise can also reduce stress and it is well known that exercise releases brain chemicals called endorphins which make us feel calmer, happier and more alert.

Exercise alone has been shown to have a very positive effect on people suffering from depression, stress, anxiety and insomnia and it is now often recommended as part of the treatment for these problems. Stress can have a direct effect on fertility so it is important to find ways of dealing with it.

Exercise can also have a direct effect on controlling oestrogen. A fascinating study, reported in the US Journal of the National Cancer Institute, showed that women who exercised for around four hours a week had a 58 per cent lower risk of breast cancer and those who routinely exercised for between one and three hours a week had a 30 per cent lower risk.169 Regular exercise seems to modify a woman’s hormonal activity in a beneficial way. We know that extremes of exercise alter the menstrual cycle dramatically – many women athletes, for instance, don’t have periods at all. So moderate routine exercise may suppress the production (or overproduction) of hormones, reducing a woman’s exposure during her lifetime. Some breast cancers are oestrogen-sensitive so it makes sense that if the hormone levels are more balanced then the risk of developing breast cancer will be lower. This knowledge is also valuable in other conditions where excess oestrogen may be a problem (e.g. PCOS, fibroids and endometriosis).

Herbs

Herbs can have a tremendous impact on these three conditions. If your problem is long-standing, it may be worth asking a medical herbalist for a private consultation.

• Agnus castus (vitex/chasteberry) is one of the most important herbs for female hormone problems. It stimulates and normalizes the function of the pituitary gland, which controls and balances the hormones in the body. Agnus castus works by restoring the balance, whether it is a hormone deficit or an excess.

• Milk thistle is an excellent herb for the liver and a number of studies have shown that its use can result in an increase of new liver cells to replace old damaged ones. Silymarin is the collective name for the substances found in milk thistle that produce this beneficial effect.

• Dandelion also helps cleanse the liver, the major organ of detoxification, which gets rid of accumulated ‘old’ female hormones.

Essential fatty acids

Our bodies produce beneficial prostaglandins from essential fatty acids. These prostaglandins help reduce period pains and they also have an anti-inflammatory effect which is especially beneficial for endometriosis sufferers.

Zinc and vitamin B6 are also important for the correct metabolism of fatty acids and their conversion to beneficial prostaglandins (PGE1 and PGE3). However, certain prostaglandins (PGE2) can have a negative effect in large amounts. They are highly inflammatory, and can cause swelling and pain and also thicken the blood.

In a 1998 study, women with endometriosis were asked to eliminate caffeine, to control blood sugar (and the over-excretion of insulin), and to supplement with essential fatty acids. The doctors found that by making these simple dietary changes, the women experienced a significant decrease in their symptoms. The control of blood sugar is also central to the dietary treatment of PCOS.

To ease fertility problems naturally, you need to:

• eliminate caffeine

• reduce or eliminate saturated fats

• eliminate alcohol

• get your weight within a BMI of 20-24.

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Relaxation techniques are now used extensively for the control of chronic pain. Many women with endometriosis coupled with chronic pain have forgotten how to relax. It is not a new skill but one that needs to be re-learnt. It will take time and practice, but once mastered it will not only give relief from pain but will also offer a general improvement in your total well-being.

Pain is a vicious cycle. It causes fear, tension, stress and anxiety which leads to muscles tightening, which in turn aggravates the pain. An increase in blood pressure and heart rate may also occur. More energy is used up when a woman is anxious and tense and this may lead to feeling drained and exhausted.

If the cycle of pain, tension, more pain and exhaustion can be broken, then it should eventually result in a reduction of pain.

Most people develop tension throughout their lives as a reaction to some type of stress. You need to learn how to release your tension and develop the ability to relax. There are several ways of developing relaxation skills. Here are two examples of relaxation techniques that you may like to practice.

Controlled breathing

This is one of the oldest and simplest relaxation techniques. With this method you can relax tense muscles, slow your heart rate and lower your blood pressure.

Choose an area where you will be alone and undisturbed for about half an hour. Find a spot where you can sit or lie in a well supported, comfortable position.

Close your eyes and try to relax your body. Now take a breath slowly and deeply through your nose and out through your partly-closed lips. Concentrate on the rhythm of breathing in and out and feel your tension begin to melt away. Try to maintain this slow, deep, rhythmic breathing for fifteen minutes. It is recommended that this breathing technique be performed daily to gain maximum relief.

Progressive muscle relaxation

If your muscles are tense and tight as a direct consequence of your pain then muscle relaxation can be helpful.

When practicing muscle relaxation you should again choose an area where you will be undisturbed for about twenty minutes.

Start by taking slow deep breaths and then concentrate on curling up your toes and tightening them as hard as you can. Maintain this tension and tightness in your toes and feet for about ten seconds. Then relax the feet completely and you will notice how the toes uncurl and your feet become heavy. Feel the contrast between when your muscles are tense and when they are relaxed.

Gradually move up your body, systematically tensing and relaxing the muscles of your legs, thighs, buttocks, abdomen, shoulders, arms, hands, neck, jaw and face.

As you continue to work through this regime you will again notice the contrast between muscle tension and relaxation; with practice you will be able to relax your muscles when they tighten in response to pain.

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A regular exercise programme is essential. This does not mean setting yourself something you cannot possibly achieve, like jogging round the block in the cold. This is boring. You only need to look at the faces of people doing it. It also can be dangerous during the middle years.

For some reason many women do not feel that regular exercise is part of their scene. But regular outdoor activity could be golf, tennis, gardening, or anything that keeps you out of doors and in action, and in addition gives you a regular, uplifting, outside interest that makes you feel good and allows you to see people.

Don’t put it off just because it is bad weather; a true saying is that there is no bad weather, only bad clothes for it – buy a good jumper.

Housework no longer provides exercises to the same extent as it once did. Instead of scrubbing and washing, we have labour-saving devices. Use the time saved for exercise that is more fun.

Your appearance will improve. Well-toned muscles make you walk well and feel good, prevent stiffening of the joints and make you look years younger. You are never too old; you should continue exercising to any age if your doctor considers your health allows it.

Regular exercise helps you to lose weight. If your food intake is not balanced by output and exercise, the result is surplus weight around your body – another reason for regular exercise. A regular exercise programme should be done daily. Time must be set aside for it, and remember, however many calls on your time from your children, your partner or your grandchildren, you have to see you set the time aside and do it.

The most important exercises are for your middle and your pelvic floor at this stage. Back and shoulder exercises are also important. They take, at the most, ten minutes a day.

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Stomach, back and buttock exercises

1 Lie on your back and raise your straight legs 90° to the rest of your body and slowly lower them (figure 8.1)

Figure 8.1

2 Raise both your upper body and your straight legs so that you look like a ‘V perched on your tailbone. Slowly lower (

3 When you are in the ‘V position above, open and close your straight legs several times

4 Lie on your back, lift one leg at right angles to your body, and, while it is still straight, bring it across your body and down to touch the hand of the opposite outstretched arm. Then do this to the other side

5 Roll on your tailbone in the pivoted position. Between each of these, have a rest and rotate your feet first round one way and then the other. Then take four deep breaths before you start again.

Shoulder shrugging exercises Shrug your shoulders up and down, up and down, and then rotate your arms backwards and forwards. This helps to strengthen the shoulder girdle and stop pins and needles which so many menopausal women complain of in bed, due to sagging of their shoulder muscles. Chest exercises With your hands outstretched in front, clasp your hands and press them firmly together so that you feel your pectoral muscles contracting.

Remember, do these exercises every day and you will be surprised. In a matter of weeks your figure will alter dramatically.

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Worth mentioning is a rare condition called a molar pregnancy or, to give its full name, a hydatidiform mole.

This rather unpleasant sounding condition occurs in about one in 750 pregnancies in Australia. (It is more common in some other areas, like South-east Asia and Mexico.) What happens is that a fertilised egg may start off doing the right things, heading down to the uterus and implanting, but when it comes to dividing up into a placenta, sac and embryo, things go wrong. The embryo rarely develops, but what happens is that the chorionic villi, which usually go towards making up part of the placenta, overgrow. The overgrowing villi form cysts, creating a mass within the uterus, which enlarges more rapidly than a normal pregnancy would.

If a woman has a molar pregnancy, she may have exaggerated symptoms of pregnancy (such as marked morning sickness) and may have bleeding in early pregnancy. This is because the abnormal molar tissue produces increased levels of pregnancy hormones, and has a tendency to bleed. When she is examined, her uterus would generally be larger man it should be for the gestation of her pregnancy. An ultrasound would be performed, which would confirm the lack of a foetus, and the presence of this abnormal tissue. The treatment required is to remove the abnormal tissue, and this is done by a D and C.

Follow up is needed to ensure that all the molar tissue has been removed. Regular measurements of the level of HCG (the hormone measured in routine pregnancy tests) will monitor the regression of the condition. In most cases treatment will have been adequate. It is recommended that women wait eighteen months to two years before becoming pregnant again. There is usually no problem in subsequent pregnancies.

There is a tiny (3 to 5 per cent) chance of the molar pregnancy developing into a more serious condition, a form of cancer called choriocarcinoma (which fortunately usually responds well to treatment); another reason regular follow up is routine.

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Telling a woman with an unplanned pregnancy that she should have used contraception is not very useful. If she did use contraception, then it has obviously failed. If she didn’t then she has probably already told herself she should have. (Contraception is the responsibility of two people, not just one.) Making her feel worse about the situation is pretty mean.

If a couple want to have sex and avoid getting pregnant, then they should use reliable contraception. Unfortunately not everyone knows a lot about it, so getting reliable information is important. Many women, particularly younger women, do not actively associate pregnancy with having sex. Sometimes it takes a pregnancy, or a pregnancy scare to help them realize. It is a pretty dramatic way to learn.

Some women are probably very fertile. Just as we understand some women have problems getting pregnant, there are some who get pregnant more easily than the average woman.

Having been involved in the care of many women who have had unplanned pregnancies, my own feeling is that prevention is definitely better than cure. I am sure many women who have had abortions would agree. However, we are fortunate that if, despite our best efforts, we do become pregnant, and continuing the pregnancy is not a possibility, we have access to safe, legal abortion and support.

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The ultimate test for HIV infection and AIDS is a positive blood test. A sample of blood is sent to a laboratory where they test for evidence of HIV ‘antibody’. Antibody is the stuff that the body makes when it has tried to fight a particular bug. For example, if you have had chicken pox it would be possible to find antibody to the chicken pox virus in the blood stream. If there is HIV antibody in the blood it will prove that the body has been in contact with that particular virus, and that person is said to be ‘antibody positive’. We do not yet have a blood test which identifies the presence of the actual bug; we can only identify the antibodies to it. We know that with HIV this means that the person not only has antibodies to the virus, but also active, infective virus floating around the blood stream.

The problem with the blood test is that it will generally take up to three months after infection for the antibodies to show in the blood. This means that the infective virus particles may be in the blood, but the tell-tale antibody isn’t. It means that a person may feel well, be antibody negative on a test, but be infected and able to infect others. This period of being infective, and antibody negative is referred to as the ‘infective window’ or ‘window period’.

It is recommended that people have two tests, at least three months apart, with no ‘high-risk activity’ (doing things likely to put you at risk of catching the bug, outlined later) between tests if they want to be sure they are not infected. This makes sense, as it allows for the window period. Some researchers and clinicians have recommended allowing for a six-month window period, as it may take longer for some people to develop antibodies.

Actually having this blood test performed can be a very stressful event, not just because most people are afraid of needles, but because a positive result, no matter how unlikely, is for most people such a devastating prospect.

Contrary to the belief of some people, blood is not routinely tested for HIV whenever a blood test for anything else is taken. Guidelines for the handling of HIV testing have been suggested for Australian doctors, because the nature of the disease means that extra concerns about confidentiality and other ethical issues are raised. In Australia, doctors who order the test should do so at the request, or at least with the permission, of the patient. It should not be undertaken without a discussion of the test, its limitations, and what the consequences of a positive and negative result would be. The result should be given, in person, only to the person who was tested, and the result should remain confidential. Many insurance companies now request HIV results for insurance policies, and this is only done with written authorisation from the patient.

The stage of the disease (where along the line from ‘infected and well’ to ‘terminally ill’) in a particular person is worked out by a number of classifications doctors use. The stage of the disease is usually monitored by testing the numbers and function of certain white blood cells, and clinical findings.

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The condom. This useful little article is experiencing a renaissance. It fell out of favour when the more convenient, less obtrusive oral contraceptive pill took to the streets. However, recent events, such as the advent of AIDS (acquired immune deficiency syndrome), and the apparent explosion of PID (pelvic inflammatory disease), have bolstered the popularity of this strange little rubber thing.

The condom is a very thin, strong latex sheath. It is designed to fit over an erect penis, catch the ejaculate (the semen) in a little reservoir at the tip, and be removed and thrown away. Various success (or failure) rates have been reported. The failure rate of a contraceptive method is usually expressed as ‘per 100 women years’. This means how many women would be expected to get pregnant if 100 women were using the method for a year. The failure rate for condoms has been found to be between four and fifteen pregnancies pet 100 women years (about 85 to 96 per cent effective). There is an enormous variability depending on the users, so true failure rates are difficult to assess.

Problems can arise when the condom is not put on early enough. As mentioned previously, there are plenty of sperm hanging around eagerly prior to ejaculation, like barflies around opening time. Not everyone reads the instructions carefully before putting the condom on (admittedly, it can detract from the atmosphere a little). But if the condom breaks, a panicky trip to the doctor for the morning-after pill certainly doesn’t do heaps for the atmosphere either.

There is a little nipple-like bit on the tip of the condom. This is to catch the ejaculate. If the air is not fully squeezed out of the tip before the condom is rolled onto the penis, a pocket of air may be trapped inside, which heats up and expands during intercourse. Add to this a couple of millilitres of semen and the condom may burst, no matter how carefully it may have been tested.

Another trap for young players is removal of the condom. This should happen before the penis gets flaccid (floppy) again, and care should be taken not to spill semen. The condom should be held onto the base of the penis while the penis is being removed from the vagina so the condom doesn’t slip off. The effectiveness of the condom as a contraceptive is improved by the use of a spermicidal cream, jelly or foam. There are many on the market, but they should only be used in conjunction with a barrier method, not on their own, as they are NOT effective alone.

If using a lubricant, it is important to use a water-based one, such as K-Y Jelly, and not an oil-based product, such as Vaseline or baby oil, as these weaken the latex and make the condom less effective, and more likely to break. Putting on a condom does not necessarily need to be an inconvenience; imaginative couples can easily incorporate it into foreplay.

The benefits of the condom as a contraceptive are obvious. However, the function of the condom as a germ-catcher makes it an even more useful device. As well as stopping sperm, it can decrease your chances of catching viruses (like herpes and AIDS), bacteria (like gonorrhoea and chlamydia), and other miscellaneous bugs (like syphilis and trichomonads). There are many brands of condom on the market now, with a tantalizing selection of names and promotional promises. All Australian condoms must conform to Australian standards, but if used incorrectly, or not used EVERY TIME, you might as well be wearing it on your nose (not a recommended function).

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