Health related information and news from around the world.

Painkillers

A local anesthetic may have been injected, as a nerve block or into the wound during your operation, to reduce the pain as you regain consciousness. Its effects should last for about 6 to 8 hours. After this, and while you are still in hospital, you will be able to have pain-killing tablets or injections if necessary. Do ask for these injections if you need them, although following lumpectomies at least, regular oral analgesic tablets such as aspirin, paracetamol or Nurofen will probably be enough. Make sure you have some of these tablets at home for the next few days. Painkillers should be taken regularly (every 4 to 6 hours, or as indicated on their container) so that their effect does not wear off before you take the next dose. A dose as you go to bed may help relieve any discomfort and allow you to get a good night’s sleep.

If you have had auxiliary lymph glands removed, your armpit may be sore for a few days, and possibly numb for several weeks or months.

Getting out of bed

Effective pain control enables you to get out of bed and to move around with ease soon after your operation. Movement and exercise are important to avoid deep vein thrombosis and to keep your bladder and lungs working properly.

You should be able to get up and walk about as soon as the anesthetic effects wear off. Once you are fully mobile, you will be able to remove your anti-embolism stockings if you have been wearing them.

Bra padding

Before you leave hospital, you will be fitted with,-a temporary pad to put in your bra if you have lost a part or the whole of your breast. The pad will give some shape to your affected breast, and will also help to protect your wound. It can be worn at night if desired. Once the wound has healed, a more permanent prosthesis will be fitted if you want one.

Shoulder movement

While in hospital, you will only have limited shoulder movement until any drains have been removed, after which your range of shoulder movements should gradually return to normal within 2 to 4 weeks with gentle exercising. You may be visited by a physiotherapist on the day after your operation so that your degree of shoulder movement can be assessed. You will also be advised about exercises to help you regain the normal range of movement of the arm and shoulder on your affected side, and may be given a leaflet explaining how to do them.

There are some very simple exercises you can do while still in hospital to help to relieve some of the stiffness in your arm and shoulder, for example using your good arm to assist your affected arm with upward and sideways movements, and trying to brush your hair with your elbow resting on a table. Once you are at home again, you should try to exercise your arm and shoulder while carrying out your normal daily routine, for example while dusting and doing light housework.

Although the muscles in the chest wall are now not usually removed during a mastectomy unless absolutely necessary, they can become weakened by under-use after this operation, and exercises to help regain muscle strength are also important.

Discomfort following a mastectomy may also cause you to change your posture, for example by leaning towards the side of discomfort or bending forward. You should try to be aware of this tendency and avoid it if possible as good posture is important so that back pain does not become a problem.

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Use of X-rays, CT scans or ultrasound in diagnosis

CT scans (computerized tomography) and ordinary X-rays are of no value in the diagnosis and monitoring of endometriosis. Ultrasound can have a role in some situations.

Ultrasound involves the use of high frequency sound waves to create an image or picture of the body on a screen or film. Over the last decade it has been used increasingly in the diagnosis and management of a number of gynecological and obstetrical conditions, including the detection of ovarian cysts and determining the age and size of a foetus in early pregnancy.

Ultrasound has a limited role in the diagnosis and monitoring of endometriosis. At present, the machines used are not sensitive enough to detect small implants and adhesions. They can only detect cysts greater than two centimeters in diameter and determine their size and location. Ultrasound cannot determine the nature of a cyst nor can it distinguish it from other types of cysts or conditions.

Ultrasound should not be used as a substitute for laparoscopy to diagnose endometriosis. Its use is limited to confirming the existence of a cyst felt during a pelvic examination and determining its size and location prior to surgery. In some circumstances ultrasound may be used to help monitor the change in the size of a cyst after a laparoscopic diagnosis has been made.

Use of hysteroscopy or D&C in diagnosis

A hysteroscopy is a procedure where a telescope-like instrument is inserted into the uterus through the vagina and the cervix. It enables the gynecologist to examine the inside of the uterus.

A D&C (dilation and curettage) involves dilating or opening the cervix with a series of rods of increasing thickness until the opening of the cervix is dilated to about one centimeter in diameter. A thin spoon-shaped instrument, known as a curette, is inserted into the uterus and some of the lining is gently scraped off” and later examined.

Hysteroscopy and a D&C have no role in the diagnosis of endometriosis as they do not allow the gynecologist to examine the pelvic cavity.

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Blood pressure goes up with age in most people in most populations that have been studied, but one study reports thirteen small populations where this does not occur and a major study in Kenya in the 1930s found that high blood pressure was hardly ever seen. A study of 1,000 post-mortems in Kenya in 1936 found that only 36 of the deaths were the result of heart disease and there were no cases of high blood pressure. Ii the early 1940s one doctor found 2 cases of high blood pressure over four years-most of those were salaried and prosperous. At this time strokes and angina were still considered to be very rare and serious hypertension was not seen in East Africa until 1953.

Today, hypertension has become a very common disease in East Africa and a review of deaths in hospitals there found that hypertension was responsible for ‘something like 40 t 60 per cent of the heart disease hospital diagnoses’. By 1978 it was the second commonest cause of death among the urbanized Bantu. Research has implicated many factor in this dramatic story but apart from the stresses of urbanization (which are difficult for quantify and are arguably not much greater than the stresses of tribal life), the amount of sail a population eats seems to be crucial. An analysis of the Kikuyu diet in 1930 found that salt was never added to food. The vast majority of the diet was unrefined starch in the form of carbohydrate (72 per cent of calorie: consumed); the rest was made up of fat (9 per cent) and protein (19 per cent). Salt intake started to rise in the 1920s and 1930s, first in urban areas. In places where diets were supervised by Europeans salt use was common.

Western man consumes 6-18 g of sodium (as common salt) daily. Primitive hunter-gatherer man consumes about 0.6 g daily. A recent study of such peoples found that their blood pressure does not rise with age.

Ethnic groups who do not add common salt “to their food have lifelong low blood pressure and no exceptions have been found to this rule. A part of this might be explained by different sensitivity to dietary salt. Genetically controlled salt sensitivity varies considerably both in animals and in man. It is now suggested that most people can tolerate a daily intake of up to about 4 g of salt but that above this level an increasing proportion of salt-sensitive subjects develop blood pressure with age. Above 6-8 g almost all salt-sensitive people will develop blood pressure with age. It is interesting that although fat people so often have hypertension in the West, obesity itself is not the cause-it is the high salt intake that so often goes with the obesity.

This knowledge has led to many trials of low-salt diets to alleviate hypertension. One major study found that reducing salt intake to 3 g daily was as effective in lowering blood pressure as drugs prescribed to another group for the same purpose. Many centers now claim to achieve normal blood pressure in their patients within a few weeks of putting them on a low-salt diet (4 g a day or less) and many people can then stop taking drugs entirely.

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Kathy Brown is 50 pounds lighter because she stopped carrying cash.

In 1994, at age 40, Kathy weighed 185 pounds. And she knew why: She just couldn’t resist those fast-food drive-thrus around her hometown of Atlanta. In fact, there were few days when Kathy didn’t hit one fast-food joint or another. The greasy breakfasts were her favorites, though she ate more than her share of cheeseburgers and fries, too.

Disillusioned by gaining so much weight, Kathy decided that her fast-food feasts had to end. But giving up what had become an almost daily event wouldn’t be easy. “I knew my weakness, so I had to figure out a way to overcome it,” she says. Her solution was to leave all of her cash at home. She had her bank cards and credit cards to cover other expenses, but no money for the drive-thru.

With fast foods all but gone from her diet, Kathy had to find something to fill the void. Vegetables and bread became her new dietary staples, supplemented by smaller amounts of fruits, dairy products, and other proteins. “I never used to eat vegetables, never. I didn’t even eat lettuce,” she says. “Now, I eat all kinds of vegetables. My problem was that I had never tried them, so I assumed that I didn’t like them.”

These days, a typical meal for Kathy is stir-fried vegetables sprinkled with soy sauce and served over rice, with a baguette on the side. When she craves the convenience of fast food, she reaches for a low-fat frozen entree, instead.

By improving her eating habits, Kathy was able to trim 50 pounds from her 5-foot-5 frame. She’s so confident of her ability to maintain her healthy weight of 135 pounds that she has even relaxed her fast-food ban. She treats herself to whatever she wants, but only once every 2 weeks—on payday.

WINNING ACTION

Detour around the fast-food route. Kathy found a unique way to break herself of the fast-food habit. In addition to traveling without cash (you may want to have some on hand in case of an emergency), you have a couple of other options. When you drive to and from work, use a route that doesn’t pass through the local fast-food district. And stock your glove compartment with nonperishable low-fat foods—pretzels, dried fruit, small boxes of cereal—to tide you over in case you get hungry.

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