Information on popular complementary and alternative medical topics
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Archive for March, 2009
What is a carrier?
The body’s immune system doesn’t always completely eliminate HBV: 5 per cent of infected adults still carry the virus in their blood six months after they first became ill, even though all symptoms have cleared up. These people are called hepatitis В carriers, and can pass on the infection to others. Half of them will get rid of the virus and become non-infectious over the next two years. The rest remain infected (and infectious) and are at risk of developing complications such as chronic liver disease, cirrhosis and cancer of the liver later in life. A person may become a carrier without having developed symptoms after becoming infected.
How common is hepatitis B?
It is estimated that, worldwide, there are around 300 million carriers of HBV. It is mainly the carriers, especially those who don’t know they’ve ever been infected, who keep spreading hepatitis B. The number of people infected by HBV varies in different parts of the world. The prevalence of hepatitis В also varies between different population groups within a country. In Australia, chronic carriers of the infection are most commonly found among homosexual men, intravenous drug users, Aborigines and migrants from Southeast Asia.
How is hepatitis В diagnosed?
Present and past infection and the carrier state can be diagnosed by a simple blood test that may be performed on request by any doctor, public hospital or sexual health clinic for anyone who thinks they may have ever been at risk.
If you develop jaundice and the other typical symptoms of hepatitis, you will be offered a test for hepatitis В along with other blood tests to try to find the cause of the symptoms and to see how much your liver function has been disturbed. You’ll be advised to have further blood tests after the jaundice has faded and until liver function is normal again, and, if your hepatitis is caused by HBV, to see whether you’ve become immune or a carrier.
The blood tests are very reliable. The diagnosis is only likely to be missed if hepatitis В causes mild symptoms or none.
How can hepatitis В be prevented? Spread can be prevented by avoiding contact with body fluids of infected persons or carriers, particularly blood and sexual secretions. Good hygiene and staying with one sexual partner make wise precautions.
Sexual and other close contacts of people with hepatitis В should ask their doctor whether they need a vaccination for post-exposure or for permanent immunity.
If babies are exposed to HBV at birth, treatment can be given to help prevent them from becoming carriers.
Hepatitis В vaccination
Vaccination to give permanent immunity against hepatitis В is now available: three injections, two a month apart and the third six months later. It is advisable for all sexual and close contacts of carriers and for sex workers, health workers and others at risk of contact with other people’s body fluids.
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To understand incontinence we must know something of the normal control of urination. The bladder is a muscular t that drains to the outside through the urethra. Urine produced by the kidneys flows through the ureters into the bladder, where it is stored. Urine only escapes when pressure inside the bladder is greater than the pressure that keeps the urethra closed. Most of the time the urethra is compressed and kept closed by its sphincter and the pelvic-floor muscles that support it. A sphincter is a muscular cuff that acts like a rubber band or valve when it’s contracted to close off the tubular organ it surrounds.
When the amount of urine in the bladder reaches about 400 ml (though the amount varies from person to person and in certain circumstances), its muscle wall begins to stretch. Nerve endings in the muscle tell you that your bladder’s full and you feel the urge to pass urine. In childhood you slowly learn to consciously control this urge until it’s convenient to urinate. When you feel you want to go but must wait a while, your sphincter muscle and the pelvic-floor muscles tighten their hold around the urethra to help you hold on.
When you decide that it’s the right time to empty your bladder (which is usually when you’re seated on the toilet), you consciously release control and a series of muscle activities begins:
• the muscles that keep the urethra closed relax
• the muscles in the bladder wall contract so that urine is pushed out through the urethra
The most common causes of incontinence in women are things that upset the balance or strength of the muscles that keep the bladder outlet closed, and the muscles that cause the bladder to empty. The two types that commonly affect women are stress incontinence and urge incontinence, or a combination of both.
Incontinence can also result from anything that affects the nerves controlling urination such as spinal injury and some other nerve disorders such as strokes, multiple sclerosis and Parkinson’s disease.
Myra’s story
Myra is 55 years of age. During a recent routine checkup, she mentioned that she had put on more weight than she liked since her menopause at the age of 51 years. ‘I suppose it’s because I’ve had to give up my tennis,’ she said. Knowing that she was a good player who really enjoyed a game with her friends, I asked ‘Why?’. ‘Oh, bladder problems,’ replied Myra, blushing. ‘I’ve had a bit of a weakness for ages, but until I was about 50 I could control it pretty well. In the last few years it’s really got the better of me. Now, every time I serve or run for a return, I wet my pants. It’s so embarrassing. I’ve heard about the operations but I’d prefer not to have surgery, so I guess I’ll just have to put up with it.’
Myra’s story is like that of many women who suffer some pelvic-floor damage during childbirth but don’t develop troublesome symptoms until after the menopause. If she had been doing pelvic-floor exercises since her first baby was born, it’s unlikely that she’d have had these problems. She commenced pelvic-floor exercises the next day and decided to start hormone replacement therapy. Three months later she was playing tennis twice each week without fear of accidents, and had lost 4 kg.
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WOMEN’S BODIES: HIRSUTISM: TYPES AND CAUSE
Author: admin
There are two types: ‘simple’ hirsutism and hirsutism with virilisation (obvious evidence of masculinisation).
‘Simple’ hirsutism
This is growth of varying amounts of terminal hair on ‘male’ sites in women who] have no other signs of masculinisation. One or many sites may be affected, beginning around puberty.
Why does simple hirsutism occur in some women and not in others if all women produce some male hormones after puberty? Many factors may be responsible, including how much male hormone is produced, how it is circulated and used in the body, and increased sensitivity to androgens of the hair follicles id the sites affected. All of these factors ten to be controlled by our genes, which explains why the tendency to simple hirsutism runs in some families and races. It is
common in southern Mediterranean and Middle Eastern women, variable in Caucasians and rare in Asian women.
Hirsutism with virilisation
This is always associated with an excess of male hormones. The onset may be before (rarely), during or after puberty. Male-pattern hair growth is usually much more pronounced than in simple hirsutism (but a diamond-shaped or ‘male’ pattern of pubic hair growth is normal for many women and is not regarded as a sign of virilisation). Other symptoms and signs of virilisation include missed or scanty periods, subfertility, acne, deepening of the voice, altered body shape and increased masculinity, shrinkage of the breasts, male-type baldness and an enlarged clitoris. The excess hormone may come from overactivity or hormone-producing tumours of the ovaries, adrenal glands or pituitary gland, or from drugs (mainly anabolic steroids and the anticonvulsant phenytoin; less commonly synthetic progestogens with masculinising properties; rarely corticosteroids).
After the menopause some women gradually develop hirsutism with features of virilisation. This happens because the body continues to make androgens but these are no longer counteracted by oestrogens from the ovary. The unopposed Meet of even small amounts of androgens may have a masculinising effect.
Finding the cause
It’s important for any woman worried by hirsutism to see a doctor, first, to rule out the possibility of excess androgen production or drug-induced hirsutism and, second, because medical treatment can also help simple hirsutism.
Your doctor will want to know when the condition was first noticed, how rapidly it developed, your family history, if you are on medication, your menstrual history, and of any other health disorders. The physical examination will include looking for signs of virilisation, a general examination, and a pelvic examination to look for abnormalities of the ovaries. A blood sample for measuring hormone levels is usually taken. A common cause of hirsutism with or without virilisation is polycystic ovaries; therefore pelvic ultrasound examination may be suggested at this stage. If there is any evidence of increased androgens, you’ll probably be referred to an endocrinologist (specialist in hormone disorders) or gynaecologist for further investigations and treatment.
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WOMEN’S BODIES: PREMENSTRUAL SYNDROME (PMS)
Author: admin
The premenstrual syndrome describes a wide range of symptoms that trouble some women from one to ten days before menstruation. The symptoms vary from woman to woman and also in the same woman from one cycle to the next.
The most common symptoms are abdominal bloating, breast enlargement and tenderness, and mood changes. Other physical symptoms include fluid retention leading to weight gain and swelling of the feet, ankles and hands; skin disorders; hot flushes; headache; pelvic discomfort; backache; changes in bowel habit (often constipation); bladder irritability.
Nervous symptoms are often called premenstrual tension (PMT) and include irritability, aggression, anxiety, depression tearfulness, lethargy, insomnia, change in appetite, food cravings, thirst, change in libido, loss of concentration, and co-ordination leading to clumsiness and increased risk of accidents.
Even a single symptom can be distressing. Sore breasts can disturb walking running and can affect your game at sp they can hurt when you play the piano o| violin and when you brush your hair; can make you flinch when your toddler jumps onto your lap and when your partner embraces you. Mood changes make you respond to people and situations in a way that’s just not ‘you’ and that you’ll feel regretful or ashamed about, and it’s no comfort to blame PMS when you’ve offended someone. What is responsible for these unwanted changes in your body and mind?
Many questions about PMS remain unanswered. What causes it? Why do some women suffer regularly while others notice symptoms only sometimes or never? How can it be treated? Since PMS first described in 1931, researchers have been trying to answer these questions.
After 60 years we’re not much wiser. The results of research have been mixed and conflicting.
Is PMS a real disease?
All women who have ever experienced any premenstrual changes (and is there anyone among us who has never noticed a few facial spots, some different breast sensations, or a tendency to drop plates?) know that their symptoms are real. But because there is no precise definition of PMS, and because it is rarely associated with changes that can be seen or measured, doctors have often been baffled and disconcerted when women consult them about premenstrual symptoms. The disorder has often been put in the ‘too hard’ basket: doctors are inclined to dismiss and ignore things they can’t understand. Women have often felt that their very real symptoms have been discounted or belittled.
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Long-term lack of oestrogen leads to changes in many systems of the body that make them more liable to degeneration and disease. After the age of about 60, most women who don’t have hormone replacement will have some signs of health deterioration due to a lack of oestrogen, though the degree of disability varies greatly.
Muscular aches, weakness and stiffness may be due to reduced muscle tone and joint ageing, which are accelerated without oestrogen. Osteoporosis can lead to crush fractures of spinal vertebrae resulting in dowager’s hump and increased risk of other fractures, especially of the hip and wrist. Deterioration in the cardiovascular system can lead to angina and heart attack.
Some symptoms that start around the menopause become worse with the years. Dryness and thinning of the vaginal lining and genital skin are progressive and sex may become painful or impossible.
There may be loss of scalp hair, excessive hair growth on the upper lip and chin, and sometimes deepening of the voice. These changes (and acne-like skin eruptions) are caused by male hormones that are produced by the ovaries in small amounts throughout adult life; before the menopause their effects are cancelled out by oestrogen. After the menopause male hormone production declines very slowly, so that for some years there is a relative excess of androgens.
Much of the past 30 years of research into the menopause and its consequences has been aimed at preventing or reducing menopausal problems and finding means to help older women enjoy better health -about time, too. This branch of health care was previously entirely neglected.
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WOMEN’S BODIES: PREGNANCY. ANTENATAL CARE
Author: admin
Since it was introduced early this century modern antenatal care has made a huge contribution to the health of mothers babies. Australia was one among the first countries to provide antenatal services. Few Australians today will have heard of any woman who has died as a result; pregnancy or childbirth, largely thank antenatal care plus improved management of labour, the availability of blood transfusion and antibiotics, and bet social conditions that ensure healthier pregnant women.
There are two broad divisions of antenatal care: education and pregnancy supervision.
Education
Today most maternity and district hospitals provide many opportunities for you to get the best out of pregnancy: talk, films and question sessions for parents; nutritional advice; tips on how to relieve pregnancy symptoms; exercise classes; preparation for childbirth; breastfeeding know-how; baby-care information. Most women attend as many sessions as they can during the first pregnancy, and just the exercise classes for subsequent pregnancies.
If you live in a remote area you may have to rely more on reading to learn how to look after yourself during pregnancy and prepare for delivery, with occasional visits to antenatal classes.
The purpose of pregnancy supervision is to discover any problems so that they can be corrected if and as soon as possible. Not every problem is preventable or treatable, but early detection usually improves the outcome for mother and baby. For most of this century pregnancy supervision has been provided mainly by doctors, though today you’re more likely to meet a team that also includes mid-wives, physiotherapists and nutritionists, as well as the many experts who perform the routine and other tests that have become part of pregnancy supervision.
Which doctor?
Most women see the family doctor for confirmation of pregnancy. If you live in the country, your doctor is likely to supervise your pregnancy and deliver your baby. If you live in the city, you’re likely to be referred to a hospital or a private obstetrician for antenatal care and delivery: few city GPs deliver babies these days. You can also go directly to a public hospital antenatal clinic for confirmation of pregnancy and antenatal care. You don’t need a referral, but it’s a good idea to ring for an appointment.
It’s very important that you feel happy with your doctor and other antenatal attendants. You must have faith in their competence, feel at ease with them and be able to ask questions freely. If you’re not satisfied, find someone else.
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Knowing the survival time of sperm and ovum, we can work out that the fertile period may extend from seven days before until 24 hours after ovulation. Each cycle has two infertile phases: the first phase lasts from the first day of menstruation until about seven days before ovulation and the second infertile phase lasts from 24 hours after ovulation until the first day of the next menstruation. You can use this knowledge to assess when you are fertile by noting various changes in your body during the menstrual cycle and knowing what these changes mean.
• Changes in cervical mucus and the cervix tell you that the fertile period has begun and that ovulation is approaching.
• A rise in basal body temperature pi further changes in cervical mucus tell you that ovulation has occurred and that the second infertile phase has begun.
There are thus several ways you can use fertility awareness, depending on which changes you concentrate on and observe in your body. These methods are known as the rhythm (calendar), the temperature, the mucus (ovulation, Billings) and the symptothermal (combines mucus am temperature) methods.
The rhythm (calendar) method
The rhythm of your menstrual cycles is observed to calculate your most likely time of fertility, based on the knowledge that ovulation usually occurs around two weeks before the next period starts. But because even women with the most regular cycles can sometimes ovulate early or late, the rhythm method got a bad reputation for its high failure rate. Now that we have more reliable methods of fertility awareness, the rhythm method is no longer recommended. However, just for the record I’ll describe how the calculation was done.
• First, the length of menstrual cycles was rioted for a minimum of six months. For women whose cycles varied widely, observation of 12 cycles was advised.
• From the length of the shortest cycle during the observation period 20 days were subtracted. This marked the first day of the fertile phase by allowing 14-16 days for the length of time after ovulation plus 6-4 days for sperm survival time.
• Eleven days were subtracted from the longest cycle (which allowed for the shortest time from ovulation to menstruation) to find the last day of the fertile phase.
Thus, for example, if your cycle varied from 27 to 30 days, the time of abstinence would be from the 7th to the 19th days, but if your cycle varied from 21 to 35 days you would need to avoid coitus for 24 days from the first day of menstruation. This amount of abstinence is not acceptable to many couples.
If you intend to use temperature, mucus or cervical changes, it’s best to learn the method from a teacher properly trained to observe and interpret these signs.
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Can the Pill be taken continuously?
Yes, and some women choose to take the Pill this way when they realise that the only purpose of the week off is to produce a withdrawal bleed. A scheme that was successfully tried in Scotland is 12 weeks (four 21-day packs) of hormones followed by a week off. This results in four withdrawal bleeds per year instead of the usual 13, and reduces the frequency of symptoms that some women experience during the Pill-free week, such as headaches.
Is missing the break between cycles harmful?
Almost certainly not. However, because all studies on safety of the Pill have been done on women taking a week off after each 21 days of hormones, it’s impossible to give an absolute ‘No’ to this question. In theory ill effects are extremely unlikely. Some women have reported spotting or a feeling of bloatedness after some months without a break.
Can you use the Pill to time bleeding?
Yes. If you want to miss or postpone bleeding so that it doesn’t coincide with a sporting or other event in your plans, just go on to the next pack without taking the week off or the dummy tablets. This is straightforward if you’re taking a monophasic Pill. However, if your Pill is biphasic or triphasic, you must go on in the next pack with the same-coloured hormone pills as those that you were taking at the end of the last pack. (If you take the dummies or lower-dose -different-coloured – tablets at the beginning of a triphasic or biphasic cycle, bleeding will occur.) Stop the Pill 24-72 hours before it’s convenient to have your withdrawal bleed. Start a new pack within seven days (it doesn’t matter if it’s less than seven) and put aside the part-used pack as ‘spares’.
If you manipulate withdrawal bleeds in this way, the important thing to remember is never to have more than seven days’ break from the hormone tablets.
Why can’t all women take the Pill?
Oral contraceptives can aggravate some conditions. Your doctor will take a full health history before prescribing the Pill. Other methods of contraception will probably be suggested if you have or have had any of the following:
• high blood pressure, heart attack, stroke, blood clot in the lung or leg
• acute or chronic liver disease •jaundice or severe skin itching during previous pregnancy
• certain types of cancer
• abnormal vaginal bleeding of unknown cause (though the Pill may be used to treat certain types of irregular bleeding after diagnosis)
• severe diabetes
• certain types of migraine
• systemic lupus erythematosus Non-hormonal contraception may be advised if you’re a heavy smoker.
If surgery is planned, ask your doctor whether you should stop the Pill beforehand. If you have emergency surgery, make sure that your doctor or the hospital bows that you’re taking oral contraceptives. The combined Pill should not be used during breast-feeding, but the mini-Pill may be used.
In some conditions the Pill may be less effective. These include:
• certain chronic bowel disorders that may reduce absorption of the hormones
• illnesses such as epilepsy and tuberculosis and some fungal skin conditions, which need treatment with drugs that can reduce the effectiveness of the Pill.
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WOMEN: PREGNANCY IN ADOLESCENCE
Author: admin
An unplanned pregnancy in your teens is usually a disaster. Out of each hundred Australian women under the age of 20 who conceive, less than five will be married or plan to become pregnant. Even though effective contraception is easy to get these days, nine out of ten adolescent girls risk pregnancy from their first sex. Once sex becomes regular, nine out of ten are taking precautions.
Are there any adolescent girls these days who don’t know about contraception? Why do they take the risk? There seems to be a block against using it the first time, based on a heap of myths and notions including the following.
• ‘It can’t happen the first time’ (one in five teenage girls become pregnant during the first month of risking it).
• Tm too young to get pregnant’ (not after you’ve started periods, and sometimes even before).
• ‘I don’t want to appear to be anticipating sex – “nice girls don’t”.’
• ‘Contraception takes the spontaneity and pleasure out of sex’ (a teenage pregnancy takes more out of your life).
• I’m too embarrassed to ask for contraception’ (how would you feel about admitting you’re pregnant?).
• ‘Contraceptives can be harmful, and I they’re too expensive’ (contraception is very rarely harmful, and having a baby or an abortion is very expensive).
• ‘My parents might find the contraceptives at home’ (I hope most would prefer this to finding out that you’re pregnant).
Be prepared. You can get condoms from pharmacies and many supermarkets, and other contraception from your doctor or a Family Planning Centre.
If you do become pregnant, what will you do? There’s the choice of:
• marrying or setting up home with the father
• having the baby and bringing it up as a single parent
• having the baby and giving it for adoption (this rarely happens these days)
• having an abortion.
Often all the options are bad. Marriages forced by pregnancy have the highest divorce rate; being a young single parent is usually very tough; abortion may be against your beliefs. Pregnancy counselling services will give you information to help with your decision.
You may dread breaking the news to your family. You will certainly have to tell them if you continue the pregnancy. If you decide on abortion you may not need to confide in your parents, but it is in the best interests of family relationships if you do. Parents often hit the roof at first, but it’s rare for them not to come round after they’ve cooled off, offering you support in whatever decision you make.
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The growth spurt and budding of breast in early puberty are soon followed changes in the other reproductive organs.
In childhood all that can be seen of the external genitals are the rather flat, undeveloped outer lips of the vulva, and the genital cleft between them. Around the age of 10 to 11 you will notice some downy, pale hair appearing on the outer lips (labia majora). Over the next few years this pubic hair becomes thicker, coarser, curler and often darker, and extends to cover the outer surfaces of the labia majora and to meet in the middle over the pubic bone so that the vulva can no longer be seen.
While pubic hair is growing, fat is deposited over the pubic bone so that this region protrudes more and is called the mons veneris (Latin for ‘hill of love’!). The labia majora enlarge in width and length. The inner lips (labia minora) grow, and may partly protrude from between the labia majora – sometimes on one side more than the other. They often develop an irregular edge and a rather wrinkled surface.
The membrane covering the labia minora and the inner surfaces of the labia minora changes from the pale pink, rather shiny appearance of childhood to dull red, and becomes moistened by fluid draining from the vagina. You may notice a small clear or white stain with a characteristic sweetish smell on your underpants. This is normal, as long as the discharge isn’t yellowish, bad smelling or itchy.
The clitoris, which lies beneath a ‘hood’ of skin where the labia minora meet in front, also enlarges. The genitals become much more sensitive to touch, especially the clitoris and the labia minora. You will notice exciting and enoyable sexual feelings stimulated by the lightest touch and sometimes just when you think of sex. This is normal.
The growth of pubic hair is controlled by hormones from the adrenal gland. Its pattern of growth (amount, colour, where it grows) is controlled by the genes you inherit. The development of the rest of your genitals is controlled by oestrogen from your ovaries. By the mid to late teen years, genital development has reached adult stage.
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