Antidepressants Blog

A very distressing—and far too typical—letter came us recently from a woman in Ohio, written on the eve of her twenty-sixth birthday. Karen described her tangled history with endometriosis, beginning with her final decision: the prior week, she wrote, she had signed a document giving her doctor the right to perform surgery to “clean up the endometriosis and save as much of my organs as possible.” Her letter went on to detail her story:

For two years she had suffered from cramps, bleeding, and intense abdominal pain. One afternoon a cyst ruptured as she was driving to work. Miraculously, she got herself out of the car and Ragged down a good Samaritan who took her to a hospital, where she was given emergency surgery.

At this point, Karen did not know she had endometriosis. After surgery, her doctor put her on tranquilizers for her continuing pain; then he followed up with hormone treatments to quell her menstrual cramps. She subsequently had two miscarriages and her doctor ran some tests on her, including a laparoscopy (the surgical procedure that enables doctors to see into the pelvic area). It was then finally that he discovered endometriosis!

“My doctor was very comforting.” Karen said in her letter, “and I’ve always trusted him. He said there was a slim chance that I’d need a hysterectomy, but he’d try to save what he could. Of course, I heard the words I wanted to hear: he’d save me. I woke up from surgery and he told me the news. He hadn’t saved anything and he’d given me a hysterectomy. That ended it for my ever having children and I wasn’t yet twenty-six years old! I felt as if I’d been butchered, like a human sacrifice! But if he said I needed a hysterectomy, who should I believe? He also said that, in another month, I would have to go on estrogen supplements since he had removed both my ovaries, too. Was he wrong? What would you do?”

This woman’s castration was presented to her after the fact as the only answer to her problem. Her surgery was needless. Had she seen a specialist in endometriosis, we feel certain that she could have had a chance at recovery. Touting her doctor may have given her a measure of comfort, but this was not enough. As we see it, when her doctor operated, he did not have the expertise to understand that the internal bleeding was caused by endometrial masses. Doctors who do not have a trained eye can miss the condition in its earliest stages, even when it is literally at their fingertips. They may mistake it for something else—an infection or even cancer. This doctor’s choice of treatment – complete hysterectomy—harks back to what was common practice over a decade ago for such “far-gone” cases. That this physician subsequently prescribed hormones in the form of estrogen replacement so soon after surgery indicates another gap in his knowledge.

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Hypnosis is essentially a state of mind, one which is usually induced in one person by another. It is attained by strict attention to either an object or to the repetitive spoken word. It results in a state of mind in which suggestions are not only more readily accepted than in the awake state, but are also acted upon much more powerfully than under normal conditions. Under hypnosis, one has access to the unconscious mind without the barrier of criticism normally presented by the conscious state. The actions and behaviour of a hypnotized subject may be compared with those of a person suffering from temporary absent-mindedness. Absent-mindedness is a state of mind that may come on suddenly and unexpectedly. It lasts for an indefinite period and then passes off equally suddenly. In such a state a person may start to do a job, and will do it just as efficiently and as thoroughly as in his normal state of mind. Yet when the absent-mindedness suddenly terminates, he will look and say ‘Good heavens, when did I start doing this?’ The state of the hypnotized person is, in many respects, similar to that of the absent-minded person, the basic difference being that under hypnosis a person’s receptiveness to suggestion is tremendously enhanced. However, at no time is there loss of control. Your personality is always there, but maybe likened to an ‘observer’. Techniques for painless childbirth are essentially hypnosis techniques. Acupuncture is also a form of hypnosis, although other factors may also be involved.

Two specific aims of hypnotherapy are ego-strengthening and symptom removal. Under hypnosis it is relatively easy to instil in a subject a sequence of simple suggestions designed to

remove tension, anxiety and apprehension, and to gradually restore the patient’s confidence in himself and in his ability to cope with his problem. Once this has been accomplished, one may successfully modify or remove specific symptoms, such as itching. The patient under hypnosis may also be guided, reassured, persuaded, and if necessary, reconditioned.

Depending on the nature of the patient’s problem, the patient may then be taught the technique of self-hypnosis, and in certain circumstances, can be given a code word which, when recalled under appropriate circumstances, will facilitate the self-induction of a hypnotic, relaxed state. Some patients prefer the use of a tape-recording made for them by the therapist, which they can use when circumstances demand it.

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Summary of main points. Fat in food is a mixture of saturated, poly- and mono-unsaturated fatty adds, with different proportions in different foods.

• While saturated fats have the most detrimental effect on health, all fats and oils are currently thought to increase body fat.

• Reduction of fat should be the primary goal of any fat loss program, within a balanced diet.

• Client education should involve:

— assessment of dietary fat intake for obvious as well as hidden fats

— analysis of food choice and food preparation methods

— recommended food selection and preparation for dietary fat reduction

— information on how to read food labels and ingredient lists

— explanation of nutritional claims about fat in foods.

• Reducing fats in the diet is the single most important factor for fat loss.

The nutritional issues are intended to highlight the nutritional mediating component considered in the model of obesity (i.e. fat/energy intake).

As such, we will consider dietary fat and how to reduce it in detail in this chapter, then the alternative; increasing dietary carbohydrate and fibre. Reducing fat intake is regarded as an important part of a healthy eating pattern.

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Tai Chi was developed in China generations ago and consists of a series of slow, dance-like steps.

Using correct breathing, controlled stretching and gentle artistic movements, and it is a graceful way of keeping fit without much effort.

According to the Chinese this art of gentle relaxation and controlled body movements increases the body’s tolerance against disease and illness and helps rejuvenate the whole person.

It claims to relax the mind and body, improve circulation, loosen stiff joints and tone up muscles.

If you find vigorous exercise difficult or painful then you may like to try this gentle form of exercise.

Yoga

There are many different varieties of yoga, the most familiar in western countries being Hatha which involves physical postures that balance and harmonise the body systems. It is believed that yoga stimulates your natural powers and therefore gives you greater control over your well-being.

Yoga postures — known as asanas — flex the joints, stretch and tone the muscles and improve the body’s circulation.

The maintenance of slow and rhythmic breathing while the postures are being performed helps relieve body tension and therefore increases the effectiveness of the body positions.

Asanas should never be strained but should be practised slowly and gracefully.

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Dysmenorrhoea means painful periods. It is the most common symptom of endometriosis. In a recent survey of women with endometriosis by the Endometriosis Association, 81% of the women had experienced dysmenorrhoea.

According to medical textbooks there are two types of dysmenorrhoea: primary and secondary.

Primary dysmenorrhoea is said to be the ‘cramping’ type of dysmenorrhoea that typically affects teenagers. It usually begins a year or two after the onset of menstruation and tends to lessen by the age of 2 5, or after childbirth. The pain usually begins with the menstrual flow and lasts for only one or two days. It is often accompanied by nausea, vomiting, diarrhoea, dizziness and fainting. This type of dysmenorrhoea is generally believed by the medical profession to have no relationship to endometriosis.

Secondary dysmenorrhoea is the ‘grinding’ or ‘boring’ type of menstrual pain which is usually due to an underlying condition of the reproductive organs. According to the medical profession it typically appears in women who are in their 20s and 30s. This is the type of dysmenorrhoea that is generally believed to be associated with conditions such as pelvic inflammatory disease (PID), fibroids and endometriosis.

The pain of dysmenorrhoea due to endometriosis may be mild, moderate or severe and may be described as constant, deep inside, sharp, stabbing, knife-like, nagging, aching, burning, throbbing, dull, boring or cramping. It may be located in the centre or on one or both sides of the abdomen. The pain may radiate into the vulva, pubic bone, lower back, rectum, buttocks, groin or thighs. It may be more severe when using the bowels or passing urine, and may be accompanied by nausea, vomiting, and diarrhoea and/or constipation.

The pain may begin one to several days before the start of the period, gradually becoming more severe, particularly once the menstrual flow begins. The pain may last for the first one to two days or continue throughout the entire period. Usually the pain is most severe on the first or second day. It has been reported that the pain worsens and peaks at the end of the period although this pattern is not common.

It is not known precisely what causes the dysmenorrhoea associated with endometriosis but it is probably due to several reasons. One is that the bleeding from the endometrial implants causes irritation to the surrounding tissues. Another possibility is that the pressure resulting from the swelling of the implants and cysts causes pain in the immediate area in much the same way that a boil causes pain. It is also possible that the release by the endometrial implants of chemicals known as prostaglandins causes pain. Irritation to neighbouring organs, such as the bowel or bladder, by the implants of endometriosis can also lead to pain in those organs.

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