When you have your laparoscopy you will be in hospital for one or two days. An increasing number of hospitals are now doing laparoscopies as a day procedure, which means that you will be admitted early in the morning and discharged later the same day.

After you have been admitted to the ward a medical history will usually be taken, your pubic hair may be shaved and the anaesthetist will probably visit you. You will also be given a consent form so you can sign your permission for the operation. You may already have signed the consent form when you discussed the operation with your gynaecologist at an earlier visit.

Before the operation you will not be allowed to eat or drink for at least six hours, and you will be asked to shower and empty your bladder not long before you are due to go to the operating theatre. About an hour before the operation you may also be given an injection, often referred to as a pre-med or a pre-medication, that may make you relaxed and sleepy and will probably make your mouth feel dry.

The operation will be performed under a general anaesthetic and it usually takes 20 to 60 minutes depending on the severity of your endometriosis and whether or not any treatment is done at the time.

When you go into the operating theatre you will be given the general anaesthetic which is injected into a vein in your hand or arm. A tube will be placed in your throat and connected to a machine that breathes for you. You will then be positioned on the operating table so that your head is tilted downwards and lies below the level of your hips. This position is necessary so that the bowel falls away from the pelvic organs and a clearer view can be obtained when the laparoscope is used. A tube may also be inserted into your bladder to drain the urine.

You will be given a pelvic examination and then a D&C will be performed if it has been scheduled. During the D&C your cervix will gradually be opened with a series of instruments, known as dilators, and the lining of the uterus will be scraped off.

An instrument known as a cannula will then be inserted into the opening of your cervix. The cannula allows the gynaecologist to gently move the uterus around during the operation.

A small cut of two to three centimetres will then be made just below, or in the fold of, your navel and a needle inserted. Approximately two to six litres of carbon dioxide gas will then be slowly pumped into your abdomen through this needle. The gas causes the organs in the abdomen and pelvis to lift and separate from each other so that they can be seen more clearly. The needle will then be removed and the laparoscope inserted into the cut.

The gynaecologist will usually make a second small cut just above the pubic hairline so that an instrument, known as a probe, can be inserted and used to move the internal organs around as necessary. Still another cut may be made midway between the navel and the pubic hairline to remove samples of tissue or drain fluid from any cysts.

The gynaecologist will then carry out a thorough inspection of the entire pelvic cavity for traces and signs of endometriosis — in the obvious and the not so obvious places. The probe inserted through the pubic hairline cut and the cannula in the cervix will be used to lift and move the uterus and ovaries around so that their undersurfaces can be clearly viewed.

The gynaecologist will be able to see any implants of endometriosis ranging in size from pinhead-sized spots to large cysts and endometriomas as well as any adhesions and areas of inflammation. If classical endometrial implants and cysts are visible their appearance will usually be sufficient for the gynaecologist to make a definite diagnosis of endometriosis immediately. If atypical implants are present, or if there are no obvious visible implants, it may be necessary to remove one or more tiny samples of tissue, known as a biopsy, from any suspicious areas for later examination and testing under a microscope.

If fertility problems exist, dye may be passed through the tubes to see if they are blocked.

When the examination has been completed and the details recorded, the laparoscope and other instruments will be removed and the carbon dioxide gas will be forced out of the abdomen in much the same way that one deflates a rubber ball. The cuts will then be stitched or stapled and you will be taken to the recovery room and soon afterwards back to your hospital room.

*40\83\2*

Although the above seems like a simple enough question that should evoke an equally simple answer, the truth is that, as is so often the case, experts do have widely differing views. What’s more, what is a good and comfortable bed for one person is not necessarily so for the next, as what suits best does vary greatly from individual to individual. To take two extreme examples, even today many Japanese still sleep on traditional futons, thin strips of flock-filled bedding which are unrolled on the floor at bedtime, while there is a great vogue for waterbeds in many other parts of the world. The contrast between the two sleeping arrangements could hardly be greater – ranging from the sleeper being almost directly in contact with the hard floor to lolling about in the deep moving trough of a waterbed. Yet both methods have their keen proponents who would argue strongly the merits of their choice. The truth is that neither sleeping arrangement is per se the right one – the fact that both are acceptable for many people just shows that the human body can adapt to and accept a wide range of sleeping conditions.

Even in Britain, where the overwhelming majority of people favour what might be called ‘ordinary’ beds consisting of a base and mattress, there is wide variation in what people find comfortable. Experts, however, agree that to play its part in easing or preventing back pain or sciatica, your bed should meet the following criteria:

It must provide ‘good’ support for the whole body and so prevent the spine from sagging.

It must be of a height that makes it easy to get into and out of bed. The height is also of importance when it comes to making the bed or changing bedding – a low bed means there will be more bending over than with a comparatively high one.

It must be large enough to allow plenty of room for movement during the night. Naturally, if you share your bed it should then be big enough to provide adequate space for two.

Let us now look at these key points in greater detail.

*45\124\2*

The voice on my answering machine says, T am calling to cancel my appointment for tomorrow. I am just too upset to come in and talk about it.’ This is the paradox of severe depression. It is a downward spiral. You feel so bad you have no wish to seek assistance nor any hope that it will help. You become more isolated and depressed. Work and relationships suffer, compounding the problem, and so it goes. You can be helped but you have to get to the doctor if this is to happen. And sometimes, if you can’t manage to do so yourself, a loved one or friend must take you there. Often this takes relatively little work on the friend’s part, but what a difference it can make!

Someone rings me to ask me to ask to see his friend, who is very depressed and needs help immediately. I am closed to new referrals, I say, but something in the friend’s voice changes my mind. If someone has a friend who cares so much for him, somehow that makes me care more too. I become involved, recruited to be a member of the team and help the friend out of his depression. Two months later the friend is completely well (on Lustral, incidentally, not St John’s Wort. It was too acute and serious to warrant my trying the herbal anti-depressant, though, in future, as we learn more about the herb it may become a first-line treatment even for more serious depression). Serious depression can cost a person his or her life. It can wreak havoc with relationships and jobs. It is a medical emergency – and it is treatable. So it is clearly a reason to seek out medical help without delay. And if you have a friend or loved one who is severely depressed, do go the extra mile or two to connect him or her with a good doctor. It is really worth the trouble and effort to do so.

*61\75\2*

It is important for anyone undertaking this program of prevention to maintain a constructive point of view. These problems are predominantly physical and external in origin, yet to the extent that psychological factors come into play, it is important to maintain a positive attitude. The necessary changes in lifestyle should be made of one’s own free will, since no one such as a parent, spouse, or business associate can really make such important decisions for another person. At some point they must be self-motivated. Second, the patient should not be excessively sorry for himself. Anyone can learn to live a relatively healthy life in a less polluted environment. Despite the temporary difficulties, life can be made simpler and more enjoyable for the susceptible person. The aid and comfort of patients who have brought their own problems under control can be of great assistance.

These suggestions are offered as proposals for improving your health by changing the physical environment. They are not a panacea. Some people may need intensive care by a clinical ecologist or even temporary hospitalization before any real improvement is seen. For the most part, however, following these ten suggestions can make a big dent in a longstanding health problem, ward off any future cumulative chemical exposures, and help one to have a happier, safer, and more carefree existence.

*113\110\2*

Common in Florida from early February through late August every year, outbreaks of ciguatera fish poisoning occur after ingestion of certain types of ocean fish, especially grouper and snapper. Beginning two to 30 hours after a meal, this illness usually starts with diarrhea and vomiting, which may cause such severe dehydration that hospitalization for intravenous fluid treatment becomes necessary. Some victims first complain of itching, with weakness and aching of the legs and thighs. Sooner or later, nearly everyone experiences reversal of temperature sensations (cold fluids in the mouth feel hot), hypersensitivity of the teeth, and sensations of burning in the palms and soles. Although many ciguatera fish poisoning victims may continue to feel weakfor many months, fatalities have not been reported.

The larger and more mature fish, according to the Journal of the American Medical Association (244:254) are more likely to cause ciguatera poisoning. For this reason, Floridians have learned to avoid big specimens of grouper and snapper during the season of risk. Since frozen fish can be stored for many months and is trucked all over the country, avoid grouper or snapper unless you are in Florida and can be certain that it has been freshly caught during safe months of the year.

*190\143\2*

Signs and symptoms

First symptoms are fever, malaise (body discomfort), headache, and sometimes signs of a common cold. The key symptoms are a marked loss of appetite (often with nausea, vomiting, and upper abdominal pain) and the onset of jaundice (yellowed skin, yellowed whites of eyes, dark amber urine, and light-colored stools).

Jaundice lasts two to four weeks, followed by one to two months of diminishing fatigue. The liver often is enlarged and tender. Specific diagnosis (A type or  type) depends upon blood tests and must be made by a doctor.

Home care

If symptoms of hepatitis appear, isolate your child from friends, school, or work to lessen the chance of spreading the disease. Then call your doctor. Hepatitis must be diagnosed and treated by a doctor. Your doctor will give you specific instructions for caring for the child at home and will probably recommend rest, liquids, and a low-fat diet that is easy to digest.

Precautions

• If your child is exposed to hepatitis, call your doctor. The child and other family members should be given preventive gamma globulin or hepatitis  immune globulin injections as soon after exposure as is practical and before symptoms appear.

• If you are caring for a child with hepatitis B, remember that this form is now known to be contagious (contrary to past beliefs). Practice good hygiene, particularly careful hand washing, to avoid spreading the disease.

Medical treatment

Your doctor may hospitalize your child for treatment. Tests are also available to determine when hepatitis  is no longer contagious.

*107/84/5*

Farmers give their cattle antibiotics to speed their growth as well as hormones to increase the supply of milk per cow. A generation ago, an individual cow would produce approximately 9 liters (2 gallons) of milk per day; now it yields 56 liters (12 gallons) per day. These hormones must surely end up in the milk. At a time when you are trying to boost your fertility you don’t want excess hormones coming from outside, as it is crucial that your own and your partners hormones are within the normal range.

So, if you are buying dairy products, again buy organic in order to reduce your intake of chemicals and hormones. Organic dairy produce is available in most supermarkets.

Of all dairy foods, yogurt containing the culture Lactobacillus acidophilus, which is a natural inhabitant of our gut, is the most beneficial. When yogurts are heat treated they lose their original culture so no benefit is gained from eating them. Buy natural yogurt that is ‘live’ and organic. This can be marketed in different ways, so read the labels carefully. ‘Bio’ usually means ‘live’, and ‘bio’ yogurts will contain a culture like Lactobacillus. Avoid fruit yogurts which can have very high sugar content.

Taking Lactobacillus acidophilus as a supplement (available in capsule form from all good health food shops) can also be beneficial, as it lowers the level of the enzymes which reabsorb ‘old’ hormones. Each month your body should eliminate all the hormones it doesn’t need. But, unfortunately, it sometimes reabsorbs some of them, creating an imbalance. This imbalance can affect your fertility so anything that helps your body to excrete more efficiently is useful.

Margarine versus butter

Hydrogenated vegetable oil is listed in the ingredients of most margarines and also many fast foods, crisps, biscuits and crackers. The process of hydrogenation changes the essential unsaturated fats contained in the food into trans-fatty acids which have been linked to problems with absorption of essential fats and an increased risk of heart attack.

So I would recommend using moderate amounts of organic butter (most supermarkets now sell it) or unhydrogenated margarine (obtainable from health food shops) rather than ordinary margarine. Although margarine is manufactured from polyunsaturated fats it is made into a solid form through hydrogenation. Because these trans fats are not natural in such high levels and have a plastic-like quality, your body has great difficulty getting rid of them. Why put yourself under extra pressure to deal with a substance that you do not really need to eat? It’s better to make things easy for your body so that it functions efficiently and, in doing so, has the resources to heal itself and increase your fertility.

Semen is rich in prostaglandins which are produced from essential fatty acids so it is also important for men to avoid trans fatty acids. It is thought that the prostaglandins help to make the sperm motile and are crucial for their survival.

Health risks of saturated fats

1.     Becoming overweight

The more saturated a fat becomes, the harder it is to digest. So it ends up being stored in the body. Butter, coconut oil and palm oil are the saturated fats most easily assimilated by the body, so they are less harmful. Fat from beef, lamb and pork are the hardest to digest because they are hard at body temperature. And being overweight reduces fertility.

2.     Blocking nutrients

Saturated fats also interfere with your body’s absorption of the essential fatty acids which are vital for health and fertility. Trans fatty acids, often contained in fried foods and in margarines under the name ‘hydrogenated fats’, are the biggest culprit and should always be avoided.

*30/73/5*

Drive your car into a tree and it’s an act of stupidity. Put a patch of ice under your tires and suddenly it’s God’s fault. Though scientists hate the phrase “act of God,” everyday folks have been blaming not-so-everyday disasters like twisters, blizzards, and floods on random acts of the divine since Noah picked up his first two-by-four. The government has officially recognized acts of God as a public health concern since the 1600s. Insurance companies use the phrase to describe just about any major disaster. But the fact is that most of us are still as unprepared for sudden disaster as the folks who didn’t make it onto the ark.

“A lot of people have some of the things they need for a crisis, but since they never really think it’ll happen to them, they aren’t prepared to the extent they should be,” explains Nina Johnson, disaster manager at the American Red Cross, Lehigh Valley Chapter, in Bethlehem, Pennsylvania. “And that can cause big problems when disasters strike.”

Hurricanes, tornadoes, snowstorms, and the like kill about 245 people each year, according to National Safety Council statistics. “And though these events are often unexpected, that doesn’t mean that they have to be unanticipated,” says Mary Hudak, public information officer for the Federal Emergency Management Agency in Atlanta. The state and federal governments have great systems in place to help you out in times of crisis, but to survive, you need to educate yourself about your risk and be well-prepared. That means being able to survive 72 hours without assistance, and often electricity. Here’s what you need to know.

Winter Storm Warning

Just two blizzards-the first in March 1993, the second in January 1996-combined to claim the lives of 300 people in the eastern United States. And the majority of those who die in winter storms are men over 40. With the National Weather Service’s ability to predict storms well in advance, there’s really little excuse for letting Old Man Winter knock you out for the count. Next time, take these steps.

Take warning. “The most important thing is to listen to the watches and warnings,” Johnson says. “Watches mean that a storm could happen. A warning means that it will. A blizzard warning means that it’s going to be big. Watches change to warnings very quickly, so when you hear a watch, make sure that you stock up on the essentials like food, diapers, bottled water, and anything else you need.”

Get off the road. Seventy percent of ice- and snow-related winter deaths happen in cars, according to the American Red Cross. If you must go out, the organization recommends carrying a disaster supply kit in your car and filling your gas tank frequently to keep the fuel lines from freezing. If you get stuck, stay with your car. Just run the engine for 10 minutes every hour with the dome light on for visibility; crack a window to let some air in, and tie a bright cloth to your antenna.

Take shelter. Seventy-five percent of people who die from cold exposure are men. Stay inside, if possible. If you must go out, wear many loose-fitting layers of clothes, covered by a tightly woven, water-repellent coat. Cover your mouth with scarves to protect your lungs from the cold air, says Johnson.

Work lightly. “All the snow does not have to be cleared from your sidewalks within one hour after a snowfall,” Johnson says. Cold weather puts a strain on your heart, so regardless of your age or physical condition, you can have a heart attack while shoveling snow. Take frequent breaks.

*117/36/5*

The experimental and clinical trial work which forms the basis for the answers which follow has been done using mussel extract produced by McFarlane Laboratories of Auckland, New Zealand. This company is believed to be the only one producing the pure extract.

To avoid the use of trade names under which this extract is marketed it will be referred to throughout as mussel extract. In all cases this reference specifically means the extract from the New Zealand Green-Lipped Mussel.

So far, it is not clear just how the extract works. However, as a result of research work, several features of this substance have been discovered. These features, which relate to its possible way of working in human and animal patients, are very interesting in both a medical and biological way. The research work has been conducted in animals and humans and has been carried out at research laboratories, university medical schools, drug company establishments, hospitals, clinics and even private homes right across the world — in Australia, New Zealand, Japan, United States of America, Germany, Switzerland, Holland and the United Kingdom.

One of the first interesting features to be noted was that any attempts to refine or fractionate (split up into components) the product resulted in a loss of the activity. In other words, trying to find out if the activity against arthritis was involved with any specific component or group of components by separating the ingredients stopped the product from working. This is an interesting and important feature in that it suggests that the activity is due to a combination of two or more of the ingredients, or perhaps ingredients involved in more than one group, working together. If this is the case, then it would make the production of a synthetic version of this product not only very difficult but also improbable.

This aspect is one which is not unusual in a natural substance that has therapeutic effects. It is quite reasonable to accept that combinations of compounds or ingredients in a substance of natural origin may be so unique or so complex that all our present technology may fail in attempts to duplicate them. It may also be true to say that it could well be these unique combinations which cause or give the therapeutic effect. Thus we have the situation here of a substance which is effective therapeutically in the form of a ‘crude’ extract, to use a pharmaceutical term, but which loses its effectiveness upon being split up or refined.

During experimental work with the mussel extract preparation on animal subjects it became evident that this substance worked in a manner which was different from that of the usual anti-arthritic drugs. In very generalized terms, the mussel extract gave different results in trials with animal subjects to those produced by synthetic drug preparations.

The results were such that it might just be that the extract is attacking the cause rather than the effect of arthritis! The expression ‘might just be’ has to be emphasized because as yet no definite proof exists to clarify the possibility. What could stimulate such a dramatic thought?

It is based on the speculation that, as the standard anti-inflammatory treatments are known only to attack the effect of the disorder, i.e., the inflammation, and as the extract does not appear to attack inflammation directly, then it may be that the mussel extract is penetrating below mere symptoms to the cause itself. The results which provoked this line of reasoning came about through trials using rats in which inflammatory conditions ’similar’ to those found in arthritic conditions are created in the animals by various means. The important fact is that these are inflammatory conditions, and they respond to treatment by anti-inflammatory drugs, but they are not of arthritic origin. They do not respond to treatment with the mussel extract, which suggests that the extract does not possess direct anti-inflammatory properties. However, inflammatory conditions which are of arthritic origin do respond to treatment with the mussel extract, which suggests that the anti-inflammatory properties of the extract are secondary and, that it might be working on the origin of the inflammation rather than on the inflammation itself.

A feature of the mussel extract which might add weight to these suggestions is that the pain and discomfort associated with rheumatoid and osteo-arthritis are relieved in subjects taking this product. It does not seem that any analgesic properties are present in the extract and therefore it might be postulated that the cause of the pain is being removed. If these factors are, in due course, proved to be true, then a very important step forward in the treatment of arthritic disorders will have been demonstrated. Just consider the significance of the difference between treating these conditions by reducing or removing the cause compared with just masking the pain and discomfort by palliatives. Not only would the disease be relieved effectively, but its progression and resulting deterioration of the afflicted person might also be stopped.

*13/48/5*

Anyone who has ever been on a diet knows it is extremely difficult to keep weight off once it is lost. Sure, she might shed a few pounds in the first weeks or so but, try as she might, that weight almost invariably returns. When it does, the person usually blames the diet or, more typically, herself. “It’s my fault,” she wails. “I have no willpower. I’m a failure-a washout.”

When I hear such remarks from a patient, I tell her as emphatically as I possibly can: “It is not your fault.” And I proceed to tell her about a scientific discovery that has revolutionized the way we think about body weight.

Simply put, that discovery-known as the set point model-has revealed that each person is biologically programmed to reach and maintain a body weight that falls within a certain, relatively narrow range. Within that range, body weight is strongly guarded against either increasing or decreasing substantially.

For the individual, the actual weight range is not a matter of personal choice or aesthetic preference, nor is it a response to cultural pressure. It is part of our genetic, physiological destiny (with perhaps some influence from the way we are fed in infancy). Just as we have no control over whether our eyes will be brown or blue, we have no choice over the body weight that our DNA says will be right for us.

The human body is an organic system that takes in and expends energy. Like the coal that stokes the furnace, food in the form of calories provides energy. Metabolism determines the rate at which our bodies convert the food into energy.

Normally, the metabolic rate represents a balance between intake and expenditure. If we consume roughly two thousan calories a day, we will usually burn off roughly two thousand calories a day. Such burning occurs actively, through work or exercise, or passively, through sweating or regulation of body temperature. The very act of thinking burns calories. Even when we are sitting or sleeping, we are burning energy at a certain rate. Our metabolic balance is controlled by interaction among a number of different factors, including hormones and their receptors in the cells, neurotransmitters, diet, amount of exercise, our genetic inheritance-even the temperature of the air around us.

The set point model, supported by much scientific evidence, shows that metabolism tries to reach and hold a certain weight level. Some people are naturally skinnier and others are naturally heavier. The set point model implies that different body weights are appropriate and healthy for different people.

A person biologically programmed to weigh 160 pounds is healthy and normal at that weight. If she suddenly dropped thirty pounds, her metabolism would react as though the body were in a state of siege-which, in a sense, is what starvation is. Her metabolism would slow down tremendously-by as much as a whopping 30 percent-to help conserve energy. Her body would take the few calories it gets and use them more efficiently until it returned to its higher weight. Conversely, someone who should weigh 100 pounds and who balloons up to 140 will experience an acceleration of metabolism, a cranking up of the physiological furnace in an effort to burn off the unwanted weight.

You can see the vicious cycle. A person decides to diet-say, by cutting down her food intake by 20 percent. She loses some weight. Her body senses the change and reacts as though it is in danger of starvation. Her metabolism then drops as the efficiency by which her body converts food to body weight increases.

Thus, although the dieter eats less food, her metabolism also decreases. A recent study on a group of women found that after nine weeks of dieting they had lost an average of 3 percent of their original weight. Yet their consumption of oxygen-which the body uses to burn energy and which thus fuels metabolism- dropped by a substantial 17 percent.

When weight rises beyond the set point range, the body burns off energy-by raising body temperature, for example. Conversely, loss of too much weight triggers a kind of biological blackout. The person will feel fatigued and may begin to sleep more. Body temperature may drop to conserve calories. As we have seen, anorexics often complain of feeling cold.

Menstruation also stops. There is genetic wisdom-I’m tempted to call it “bio-logic”-behind this development. A starving woman can’t spare the energy needed to build another human being. In the interest of survival of both the mother and her future children, the reproductive system shuts down.

By undergoing this radical energy-conservation program, the body struggles to push weight back up to the right level for this particular person. But when her weight starts to rise again-as it inevitably will-the dieter begins to panic. She may take even more drastic steps to lose weight, triggering further metabolic disruption. And so on.

*47/35/5*