Health related information and news from around the world.

The advantage of weight is that it is a simple, accurate and reliable measurement. For individuals, significant changes in weight over the long term usually reflect significant changes in body composition.

Over the years, several attempts have been made to establish a series of ‘ideal weight’ measures as a goal for people to aim for. One of the first of these, the ‘Broce Index’, was estimated in kilograms by taking 100 away from height (in cm). In other words, a person 180cm tall might be expected to have an ‘ideal weight’ of 180-100=80kg. Ideal weights for height have also been developed over the years (beginning in the late 19th century in the US) based on actuarial, or death statistics. More recently, ideal measures of body mass index, skinfolds and fat distribution have been used (see below). However, scientists have yet to agree on a measure of ‘ideal’, and now generally accept that a variety of the measures discussed below have to be combined.

*58\186\4*

‘Jimmy suddenly ran this very high fever,’ Jane said on the phone. ‘I’m awfully worried. He is hot and clammy and looks pale and listless. What’s more, he wants to pass his urine every few minutes. When he does, he squeals as if it’s hurting him. Jimmy hardly ever complains… He is always a happy little chap,’ Jane went on. ‘I think he must have some sort of infection in his bladder…’

Soon afterwards I visited young Jimmy. Certainly, he rarely complained and was usually a bright happy lad. But today he was pale and obviously unwell. He had been off his food for about 24 hours, and his temperature had suddenly shot up, leaving him feeling very miserable. He was sweating profusely, and just before I arrived he had been vomiting slightly—also unusual for Jimmy. Passing his urine was definitely painful, and this immediately suggested an infection in the bladder or kidney region. When I gently prodded below his navel, in the so-called supra-pubic region, he winced. ‘Hurts,’ was all he would say, then he quietly shed a few tears. Similarly, pressure in the lower part of his back, just over his kidneys, was also quite uncomfortable.

‘We shall have a specime of urine checked out,’ I said to Jane. ‘This will tell us exactly the nature of the germ causing the trouble. It will also indicate the best treatment to give. Antibiotics are usually very satisfactory, but a sensitivity test will give us the exact result and indicate the most suitable treatment.’

Treatment

To begin with, doctors often prescribe one, of the ‘broad spectrum’ antibiotics, even before the results of investigation are received. This may start the patient quickly on the path to recovery. Many excellent varieties are now available and the urinary system is very receptive to them.

Also, keeping the patient in bed for a few days, until he feels and looks better and his temperature has come back to normal, is a good idea.

Plenty of fluids are advisable, for this flushes out the dead germs and general toxins, not only from the system but from the urinary tract in particular. It also replaces the fluids lost from perspiring and sweating.

Powders and granules given in fluid to ‘alkalinize’ the urine are often used, and this is claimed to help. Paracetamol will often reduce fevers and make the patient feel more comfortable and it reduces aches and pains which commonly accompany urinary infections. However, if there is vomiting, the more that is introduced into the stomach the worse the patient feels, so the less the better. Sucking chipped ice or cold drinks are often acceptable, and frequently retained.

Most infections in children affect the bladder region, but they are usually brought under control rapidly. Sometimes, especially if there are recurrences, it may indicate that the kidneys and upper parts of the urinary system (the ureters) may also be infected. It may be necessary to have further and more complete investigations carried out after the child has settled down and the acute bouts are brought under control.

Tests on thousands of children, especially those of school age, shows that many individuals carry around small numbers of germs in their bladders, even though symptoms are not present. Sometimes these can suddenly get out of control and an acute attack supervene. Some doctors believe that all urinary infections, however mild, should be treated.

It is a very important system, and disorders here can lead to more serious ones in later life. It is worth keeping a close check for symptoms and reporting any abnormality promptly to the doctor, for treatment or further investigation.

*82\87\2*

Childhood hyperactivity is currently a controversial and emotive topic. Rather than a symptom (as many suppose), it is a syndrome embracing a number of symptoms.

The symptoms include hyperactivity (excessive movements), a short attention span, being impulsive and being easily distracted. Sometimes learning difficulties and other nervous system signs are also present. From the point of view of the teacher or parent, hyperactivity is most likely to be the main symptom which leads to a visit to the doctor.

However, increasing evidence is accumulating which suggests that, from the child’s point of view, it is the disorder of attention which is the most important. The two do not necessarily go hand in hand, for the level of physical activity often bears little relationship to the child’s difficulty in learning or with his nervous system disabilities.

The frequency with which the disorder occurs is variable. In school-aged children in primary school, estimates have varied from 4-10 per cent. However, behavioural patterns of children which caused parents and teachers to seek medical help are far more frequently encountered. In one survey reported in the Medical Journal of Australia, restlessness occurred in 50 per cent of boys and 28 per cent of girls.

These sorts of figures are causing considerable concern in countries like the United States, where medication of supposedly hyperactive children is getting out of hand.

It is well-established that boys are affected more commonly than girls, and the ratio of nine to one is frequently reported.

Many other terms are used to describe these children, for the complexity of the disorder is being realized by doctors and psychologists. The terms ‘learning disability’ and ‘minimal brain dysfunction’ (MBD) and ‘hyperactivity’ are now commonly used. Doctors tend to use the term ‘MBD’ in the medical literature (particularly in American medical literature, although ‘hyperactivity’ seems more common in Australia). ‘Learning disability’ and ‘hyperactivity’ are used widely by educators and psychologists.

Symptoms

A great deal of controversy exists over what constitutes a hyperactive child. The dividing line between normal and abnormal is difficult to establish, as the range of figures of complaints indicates.

Although physical hyperactivity may be a symptom of certain disorders which can be clearly distinguished, it may be a symptom of some other disorder. Because of the implications of treatment, correct diagnosis is necessary, although it may be difficult. It may require special investigation and psychometric tests. For instance, there may be mental retardation (anywhere from borderline to severe); perceptual disorders (relating to the ability to hear and see); psychological disorders (anxiety states, psychoses); neurological disorders (such as lead poisoning or the use of certain drugs); and acute medical disorders (for example, chorea or thyroid excesses). Finally, there may be cultural differences: what is socially acceptable in one society may be attributed to some pathological disorder in another.

Many of these causes may be totally unrecognised by parents or teachers. For example, a child with borderline retardation may react with restlessness and lack of co-operation when his parents indicate excessive expectations of him.

Cause

There are many theories on the cause of the syndrome. Some claim it is a genetically determined developmental abnormality resulting from a low nervous system arousal. It tends to run in families. Parents producing hyperactive children can describe similar problems in their own childhood.

Others believe the condition is ‘psychogenic’. There may have been a poor social relationship between mother and child early in life. This may have resulted from early separations, or more commonly from emotional distancing resulting from maternal disturbances. This can commonly occur in the time immediately following birth, and is manifest as a depression, which may persist undiagnosed. The child reacts to this with an increasing aggression and a diminished capacity to develop internal controls on aggression and impulsiveness.

Another group claims hyperactivity is due to ‘minimal brain damage’. Damage is slight for general intelligence to be noticeably impaired or for there to be gross nervous system signs of impairment. This damage might occur prenatally or in the postnatal period. Giving weight to this are abnormal brain tracings (EEGs) that are found in up to 50 per cent of these children.

Treatment

Diagnosis of hyperactivity is no simple matter. If a parent or teacher suspects that a child may be suffering from the syndrome and can identify some of the suspect symptoms (some are quite obvious, others are not), then take the child to the doctor. In turn, your family doctor may refer the child to a doctor who specialised in this particular field. Further tests are necessary to clearly establish the correct diagnosis, as has been explained.

If the child is diagnosed as hyperactive, then specialised therapy may be indicated. As an ongoing process, this must be under the general supervision and guidance of persons with the necessary knowledge and expertise in the field, usually child psychiatrists.

The Feingold Diet: A theory which has gained wide credence and support is the one put forth by Dr. Ben Feingold, an allergist who claims certain ‘small sized molecules’ occurring in some natural foods and in some artificial colours and flavours have an adverse effect on brain cells of children afflicted with the syndrome.

He has put forth proposals that limitation of these foods (simply by dietetic restriction) yields positive benefits to the children.

The Feingold method has attracted considerable criticism, but its following is enormous. Doctors themselves are in disagreement, and medical journals regularly print fiery articles either supporting or denouncing the system.

It seems relevant that many parents with hyperactive children frequently follow the system on their own account, and often report favourable results. Probably they all cannot be right; neither can they all be wrong. The truth of the matter is still unknown. More clinical trials under strict, closely supervised conditions are necessary before the final word is given.

‘From my private practice, of 72 families I have instructed and supervised to date, 62 found sufficient change to continue adherence to the diet to date, from 4 to 20 months. A difficult diet is less difficult to manage than a difficult child, and it is surely preferable that a child be “set apart” because of his diet than because of his behaviour,’ is typical of the reports appearing in medical magazines in support of the routine. This excerpt came from the Medical Journal of Australia from a doctor in Queensland.

But others are just as convincing in the opposite direction. ‘The diet costs averages $120 per week per family,’ an MJA editorial states. ‘The results suggest that on objective tests, no changes of any kind were observed—physical, behavioural or cognitive—and in school children neither were there any parental or teacher reports of behavioural change.’

‘The diet was not designed for use in normal households,’ another correspondent says. ‘To place this treatment in perspective, the Feingold diet is no more difficult than many other dietary regimes commonly used in medical therapy, for example, diabetic, or gluten free diets.’

The book by Dr. B.F. Feingold which started the controversy on the diet is entitled Why Your Child is Hyperactive, (Random House, New York, 1975). No doubt many parents are already trying out his suggestions on their own.

In 1980 another detailed book which examined the Feingold system in detail came off the press. It is entitled Food Additives and Hyperactive Children by Dr. C.K. Connors (Plenum Press, New York, 1980).

Parents who would like more information are coming together to pool their knowledge and ideas. The National Association of Hyperactivity’s address is P.O. Box 100, Narrabeen, Sydney, NSW, 2101. But whatever routine is considered, medical supervision by a medical practitioner specially versed in this difficult field is recommended.

*33\87\2*

Viral and bacterial infections can cause pneumonia, a condition in which one or both lungs become inflamed. Bacterial pneumonia is generally regarded as more serious than viral pneumonia, although both can be very dangerous to the young and the elderly. Viral pneumonia is often the result of chickenpox or measles.

A cough and shortness of breath are the first symptoms of pneumonia, accompanied by fever and sweating. Acute lobar pneumonia, which affects only one lobe of one lung, causes a dry cough. The sufferer may cough up blood. In the case of bronchopneumonia, usually affecting both lungs, there are sudden chest pains and the sufferer coughs up yellow, green, or brown sputum, sometimes containing blood.

Pneumonia can be a serious condition and a doctor should be consulted if it is suspected. However, some complementary therapies prescribed by qualified practitioners can be helpful. Herbal expectorants can be used to loosen the phlegm, including mullein and thyme. Echinacea, garlic and large doses of Vitamin C and Vitamin A may be recommended to boost the immune system against infection. Fruit or vegetable juice fasts may be recommended, followed by diets which exclude foods which increase mucus production such as dairy products and sweet foods.

*32\69\2*

Fiona is a 60-year-old social worker and mother of three grown children who has been troubled by depression and mood fluctuations for years. Her depressive symptoms have often seemed more physical than emotional. During her depressions she would become fatigued, her arms and legs would feel heavy, her eyelids would begin to droop and she would feel ‘rather sad and tired’, wanting to sleep much of the time. To some extent these problems might have been related to a condition of adrenal failure, known as Addison’s disease, from which Fiona suffers. The steroid replacement that is necessary to control her medical condition has been partly responsible for causing Fiona’s mood swings. Because of these mood variations she has never been able to rely on her ability to cope and has chosen not to work at her profession.

Fiona had been on Prozac (20 mg per day) for six or seven years. Although she credits Prozac for lifting her out of her depression, it left her with a ‘dazed view of the world’. Things did not feel ‘quite real’. Her mind was not clear and she would forget things. Her reactions were delayed and it was hard to keep up with a conversation even though she had previously been an extrovert.

Fiona’s GP wondered to what degree her problems with thinking were due to the Prozac, and brought her off the medication in order to find out. She soon became depressed again, at which time he started her on St John’s Wort (500-750 mg per day). Within two weeks her mood picked up. Her thinking was clearer and she was able to read again. She rates the anti-depressant effect of the St John’s Wort on a par with that of Prozac, but she feels that she is now ‘part of the world again’. With her newfound clarity she has restarted therapy and is contacting old friends and having lunch with them. She has even initiated ‘play groups for adults’, where friends come over simply to do fun things like painting or throwing medicine balls around. These get-togethers remind her of the ‘co-operative games of the 1960s’. T never got to play them then,’ she observes, ‘and I want to play them now.’

*8\75\2*

A slightly different kind of problem was presented by Karen Black. She complained, not just of hyperactivity and restlessness, but of headaches, stomachaches, skin rash, and a peculiar “spaced out” feeling in her head much of the time.

Her history provided a good clue: the symptoms became much worse after the family had moved so that she had to travel for a long time to get back and forth from school. In retrospect, this may have been due to an increased exposure to exhaust fumes. She developed stomachaches and an itchy rash under her armpits. A perceptive doctor advised her to stop wearing synthetic garments, and the rash went away, but the stomach problem and other symptoms persisted.

The family moved again, and now Karen developed a headache whenever she rode in the family car. Her teachers complained that she was in a world of her own, and before the end of the fifth grade the family had to remove her from school entirely and seek home instruction for her.

Because there was a strong family history of allergies, Karen was taken to a clinical ecologist. He diagnosed her as allergic to a variety of foods, including apple, chicken, grape, milk, peanuts, and rice, all of which made her feel “spaced out” on the provocative test.

To get a more definitive answer, Karen was referred to me. Upon fasting, she underwent withdrawal symptoms which, as I shall explain more fully below, are typical for those suffering from this syndrome. On the fourth day of the water fast, she felt sick to her stomach and threw up. Soon, however, she felt better—better, in fact, than she had in a long time.

Deliberate test feedings revealed a very serious allergy to cane, chicken, peanuts, corn, grapes and raisins, beef, milk, wheat, lobster, and peas, and lesser reactions to lamb, yeast, apples, and cherries.

Eating these foods would bring on her old symptoms, including periods of anger or tiredness. She complained of being “spacey” and “down,” although this alternated with irritable periods.

Smelling chemicals made her angry, tired, dull, and almost catatonic. Two consecutive meals of commercial foods contaminated with the “normal” amounts of chemicals made her tired, irritable, with episodes of staring vacantly into space.

The testing was quite successful, and Karen was like a new person upon leaving the hospital. Unfortunately, she went back into a house which was ecologically harmful for her. It had brand new carpeting with a foam rubber pad, both of which are often the source of adverse reactions among those with the chemical-susceptibility problem. What is more, the family’s furniture had been put into storage several months before and appeared to have been fumigated—a common practice among storage companies. All of these factors combined to make Karen’s recovery less complete than it could have been.

Hyperactivity and related syndromes are a growing problem in the United States. Rather than dealing with this problem at the level of environmental causation, orthodox medicine prefers to perpetuate the problem through the use of drugs. Of the 750,000 children seen for “minimal brain dysfunction” (another term for hyperactivity) in 1978, 212,000 were put on medication, and about 75 percent of them, or nearly 120,000 on methylphenidate hydrochloride (Ritalin Hydrochloride).

A child psychologist recently complained that labeling a hyperactive child as in need of drugs eliminates the necessity of discovering the underlying problem which is causing his behavior problems. While the psychologist probably had in mind psychological causes, the same can be said, even more emphatically, about the chemical and environmental causes of this disorder.

*61\110\2*

In recent years, energy policy has become a prominent topic of debate. What is almost never taken into account is the long-term harmful effects of petrochemical fuels on susceptible individuals.

The odors of various hydrocarbon fuels such as coal, gasoline, and natural gas can be a source of chronic illness for certain people. Prolonged exposure to such odors or even to their undetected fumes can result in a full spectrum of diseases.

Some of the worst practices of the past are now gone. In the old days, for instance, when coal was delivered by chute to the basement of one’s house, kerosene was often sprayed on the coal to control dust. It slowly gave off fumes, contaminating the basement or dwelling.

Today, fuel oil and natural gas have replaced coal and wood in most areas. These can give rise to their own set of problems, however. Old oil tanks, for instance, may leak and give off fumes which are almost imperceptible to those who have lived in the house for a while. With oil, there is always the danger of an overflow while the tanks are being filled. If a basement floor has been flooded with fuel oil, the odor tends to remain for several months or even years, despite the best cleanup efforts. This has caused numerous problems for susceptible individuals; in a few cases they have been forced to abandon their homes entirely.

Most fuel-oil installations, whether furnaces or space heaters, give off a characteristic odor. Although they tend to smell worse when they are actually operating, there may be enough odor coming from them even when they are shut down to cause reactions in highly susceptible patients.

Natural gas is advertised as the “clean fuel.” This may be so from the point of view of visible or smog-producing residues, but for the chemically susceptible individual this gas may be the worst form of fuel.

In the early part of this century, most cities were supplied with artificial gas derived from coal. Especially after World War Two, with the completion of a national gas line network, most cities switched to natural gas. From the point of view of chronic disease, it does not really matter whether artificial or natural gas is used, since both can cause problems for those with the chemical problem. Natural gas, however, is delivered at much higher pressures than the artificial product. This, in turn, can cause a serious problem of leakage if the pipes were originally constructed for the transmission of artificial gas. In Chicago, for instance, joints and turns in the old gas line become potential or actual sources of leakage. Gas, being lighter than air, tends to rise from the basement or kitchen into the rest of the house. The greater the amount of piping and the number of outlets, and the more pilots and other automatic devices on gas appliances, the greater will be the probability of leaks.

Perhaps one of the most surprising aspects of this gas problem is the incredible sensitivity of some people to its presence. Merely shutting off a gas range is not enough to bring relief to such patients. The gas stove must be completely removed from the premises. This is because even a non-working range continues to give off odors from the gas which it has absorbed over the years.

In the course of my practice, I have directed almost 3,000 patients to remove their gas kitchen ranges because I found these people to be susceptible to chemical odors and fumes. This decision was not taken lightly or on the basis of blind hunch but after scientific tests, such as those conducted in the Ecology Unit. To date, none of these patients has complained that the changeover was not worth the cost or trouble.

In many cases, in fact, when the range was removed for the benefit of one member of the family, other members of the family also reported an improvement in health. A gas range was removed from the home of one patient, a girl with persistent headaches. Her mother, who was not a patient, reported an unsuspected benefit, however. While cooking with gas, she had often become highly irritable. She would scream at the children or anyone else who came into “her kitchen.” Since she frequently had a kitchen knife in her hand when she started screaming, this frightened the children and created a bad atmosphere at dinnertime. With the removal of the gas range, her temper tantrums quickly subsided. What had appeared to be a potential “mental” problem was solved simply by removing a hidden environmental pollutant.

In cases in which actual removal of the gas range has been impossible, certain halfway measures have proven useful. They have included increased ventilation of the kitchen; installation of a kitchen door, which is kept closed during the time the stove is on, keeping fumes from reaching the rest of the house; or disconnection of the stove, without actual removal. For many people, such measures are beneficial; for the seriously ill, however, there is no substitute for complete removal of the offending appliance.

*31\110\2*

In popular usage, dysentery is taken to mean any severe form of diarrhea. More accurately, dysentery is an infection of the intestinal tract caused by one of several specific bacteria. Dysentery causes diarrhea, but dysentery is a distinct disease.

The germs that cause dysentery are salmonella and shigella bacteria. (Typhoid bacteria are a type of salmonella.) Dysentery may also be caused by amoebas (amoebic dysentery). Some doctors consider cholera to be a form of dysentery.

Dysentery is the result of eating or drinking food, milk, or water that is contaminated with these specific bacteria or amoebas. It also may be contracted from someone who has the disease or is a carrier of dysentery. (A carrier is a person who has the germ in the body but is healthy.) Complications that may develop from dysentery include arthritis, meningitis, and perforation (ulcers) in the intestines.

Signs and symptoms

The major symptom of dysentery is diarrhea. The diarrhea is often severe and is commonly bloody. The child may have a prolonged high fever (39.4°Ñ to 40.6°C). The child may also be extremely weak and exhausted. Any persistent diarrhea should be suspected of being dysentery, especially if it is severe or bloody.

Home care

Do not attempt to treat dysentery on your own. Whenever diarrhea is severe and bloody, see your doctor. Dysentery must be diagnosed by a doctor and often requires treatment with specific medications.

While waiting to see the doctor, give the child plenty of clear liquids. Liquids are needed to replace those being lost from the diarrhea. Extra liquids will help prevent dehydration (a serious loss of body fluids). Clear liquids that are the most helpful include tea, water, flavored gelatin water, and commercial mineral and electrolyte mixtures.

Limit or eliminate solid foods from the child’s diet. Especially avoid foods with roughage, fruits (except bananas and apples), vegetables, butter, fatty meats, and peanut butter. Do not give the child milk, since milk may further aggravate diarrhea.

Precautions

• Always report severe or bloody diarrhea to your doctor.

• If any diarrhea lasts more than two or three days, call your doctor.

• The younger the child, the more easily dehydration can occur with diarrhea. Infants can become dehydrated rapidly (within 12 to 24 hours after diarrhea begins).

• Do not give anti-diarrheal medications to children, since side effects are common and can be dangerous.

• When traveling, carefully choose sources of food and water. Avoid sources where sanitation may be poor.

• If you suspect dysentery, isolate the child and dispose of stools carefully.

• Practice good hygiene in your own home. Wash hands after treating an ill member of the family. Wash hands carefully before cooking and eating.

Medical treatment

A culture of the stools (with microscopic examination for amoebas and other parasites) confirms the diagnosis. Cultures of the blood and urine are sometimes performed, as well as tests for specific antibodies in the blood.

If dysentery is diagnosed, your doctor may hospitalize your child for treatment and isolation. Specific antibiotics for treating dysentery are available, although they are not always necessary. Diagnosed cases of dysentery must be reported to health authorities.

*56/84/5*

Sex is healthy. Admittedly, that’s hardly a novel notion. But in an age when you have to find ways to make sex “safe,” a little reminder of sex’s essentially salutary nature never hurts.

Keep in mind, though, that “healthy” is one thing, “medicinal” is another. True, intercourse does have its direct health benefits. It is, after all, exercise (though it comes in well below golf and sawing wood on the calorie-burning charts). It has an analgesic effect, reducing pain for several hours after the fact, most encouragingly for sufferers of arthritis. And there’s evidence that ejaculations on a steady, regular basis make for a healthier prostate.

But sex, as far as anybody knows, doesn’t cure cancer. It won’t prevent heart disease. We’d love to report that sex will fend off diabetes forever. But that, as a certain jowly ex-president once said, would be wrong.

Still, it’s wrong only in its overstatement, not in spirit. Sexual fulfillment is a player in the disease-fighting game, not because it cures anything directly but because it’s a morale-booster.

Sex is a motivator and a powerful one, according to Aaron Vinik, M.D., Ph.D., director of research at the Diabetes Institute in Norfolk, Virginia. “The contact that sex provides keeps you functioning and involved,” Dr. Vinik says. “Sexually inactive people become what I call slothful – apathetic and inactive.”

Apathy and inactivity are invitations to disease; they’re the antithesis of the disease-free lifestyle. To defy disease, you need to exchange those two losers for a couple of winners: inspiration and action. A lusty sex life is part of that motivational mix.

“A lot of the depression and withdrawal you see in people with illnesses is because of a loss of sexuality,” Dr. Vinik says. “Sex is important to feel whole, to have a healthy outlook, to maintain vibrancy.”

*64/36/5*

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.

*42/39/5*