Herbal Health

What is it?

There are basically two important types of skin cancer. The non-malignant type is the more common and is seen in fair-skinned people who expose themselves excessively to sunlight. It is easily treated and does not kill. The malignant type is called a malignant melanoma and is a killer. Skin cancers are most common on the face and other areas where the skin is exposed to the sun. Any skin damage that does not heal properly should be seen by a doctor. Also, should a pigmented patch of skin you have had for years start to become more pigmented, be suspicious and seek advice. One type of skin cancer starts as a pale, pearly, raised, translucent nodule that slowly enlarges and then ulcerates. The next most common type is a small, raised area or patch that can be reddened or darkened and hard. A common site for this latter type is on the lower lip.

What causes it?

Researchers at the University of Arizona (a very sunny site) found that the incidence of the malignant form of skin cancer jumped 34 per cent over a ten-year period. Since 1960 until the present day the incidence of the non-malignant type has also risen by a startling 500 per cent. Nearly half of all the tumours were found in people aged between 50 and 69. Malignant melanoma is rising in incidence at a rate of 5 per cent per year in the US.

Other researchers have found that pale-skinned, easily burned people with an estimated lifetime sun exposure of more than 30,000 hours have a twenty times greater risk of developing skin cancer than a comparable group with less than 10,000 hours of sun exposure. More than 200,000 cases of skin cancer occur in the US annually though the incidence is much less in the UK because there is less sun. Northern climates have less sun and so less cancer of the skin. For every 265 miles you go closer to the equator the incidence of skin cancer doubles.

Another form of skin change caused by sunlight is the breakdown of the normal connective, elastic tissue called collagen. This produces premature ageing of the skin and is a reason why Californian women so envy the skin of English women.

Prevention

• Use a sunscreen preparation if you are in the sun a lot.

• Be guided by the general rules for preventing sunburn.

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Endometriosis is a chronic disease that will require ongoing treatment and investigations by a qualified specialist. It is important that you choose your doctor carefully.

If you are buying a car you would not take the first one you see, so why should shopping around for a doctor be any different?

Road test the doctor, ask questions, talk to other women. Your health is worth the effort. You should be encouraged to be involved in your health care and to make informed decisions about treatment and surgery.

Many women are surprised to learn they have a chronic illness, so they are usually in a state of shock when treatment options for their endometriosis are discussed.

You need a doctor who understands the emotional as well as the physical aspects of the disease and who can provide counselling and support.

For those women who have had little contact with the medical profession, or for teenagers who are not ready to be assertive or demanding with an adult, challenging your doctor or seeking a second opinion can be difficult.

Where do you start? How do you know if the doctor you have selected will be the best for you? How do you take control?

Many women have asked these questions before so do not feel you are in any way inadequate or foolish for being afraid to question your doctor. After all, they are professionals experienced in the treatment of gynecological problems so it is not uncommon to feel that your doctor knows best and should not be questioned.

Many women say they do not feel confident enough to seek a second opinion. Others may feel they should not waste their doctor’s time by asking questions. These feelings are also common but also learn to trust your own judgment. It should be possible for you and your doctor to work together. If the treatment schedule mapped for you is not what you expected, discuss the options with your doctor. Consider all the options and make sure you are happy with what has been planned.

Unfortunately, women frequently complain that they feel embarrassed that they may ask a ’stupid’ question. It is essential to overcome this. Many doctors incorrectly assume their patients understand what their illness is, how it developed and how it may be treated. And it can be confusing when doctors use medical terminology – with which only they can be expected to be familiar. For instance, a doctor may talk about ‘patent tubes’. What is really being said is that the fallopian tubes are functioning and normal.

Obviously it would be easier if doctors used a language that their patients understood, so do not feel embarrassed to ask for an explanation – even though it can be a normal tendency to sit back and pretend you know what the doctor is on about!

Remember, it is your health, your body, so it is up to you to take control and be assertive.

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Most families now have a car and many have two. Of all our everyday activities, driving is one of the most dangerous, killing 5,599 people in 1984 in Great Britain and injuring a further 319,000. The cost to the nation of all these accidents is 2,650 million pounds. The fact is that by adopting some fairly commonsense preventive measures much of this illness, suffering and financial cost could be avoided. Here are the top twenty guidelines for safe driving drawn up in the UK by the Royal Society for the Prevention of Accidents.

•     Keep your vehicle in good condition with frequent inspection and regular servicing.

•     Ensure that you are fit and alert before driving. Do not drive after drinking and be sure that medicines will not affect your ability to drive.

•     Maintain your observation well ahead and plan your approach to hazards. Use mirrors frequently.

•     Handle your vehicle with positive precision and aim for the smoothest possible drive.

•     Give clear and early signals for all manoeuvres. Help other road users to understand your intentions.

•     Always think ahead and exercise caution. If in doubt-don’t.

•     Assess speed carefully to take account of all conditions. Avoid sudden changes of speed or direction on slippery surfaces.

•     Never drive so fast that you cannot stop safely in the distance you can see to be clear.

•     Remember the additional hazards of driving at night. Adjust your speed accordingly.

•     Know the problems which a truck driver faces and make due allowance when such vehicles are manoeuvring.

•     Traffic legislation has been developed to improve safety for all. Do not break the law.

•     Be considerate of the comfort and safety of your passengers. Ensure that children are properly restrained and drive as you would wish to be driven. Remember that the law says you as the driver, and your front-seat passengers, must wear seat-belts at all times.

•     Know and understand signs, signals and road markings all have valuable information for the driver.

•     Remember that 95 per cent of the accidents are caused by human error. Always maintain maxi concentration on the task in hand.

•     Always drive within the limits of your capability and within the limits of your vehicle.

•     Park in such a way as to cause minimum inconvenience and danger to other road users.

•     Learn some basic first aid so that you know what to do if you an accident.

•     Maintain courtesy on the road. Be considerate towards the needs and problems of other road users.

•     Take a pride in your driving, but remember that all drivers have room for improvement.

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Meditation is an integral part of Eastern religions and forms the basis of some Christian traditions. This gives rise to the many myths surrounding meditation. As a consequence some people are unsure of meditation and are concerned about practising it. Therefore it is important for these issues to be discussed. If we have doubts about meditation because of our religious background, we need to speak to our minister or priest and be guided by our own feelings of what is right for us.

Meditation is like so many of the other Eastern techniques and disciplines we have adopted, such as various martial arts, tai chi and yoga. In India the word ‘yoga’ is a generic name for a multitude of meditation disciplines. The word ‘yoga’ was originally defined as ‘the way to go’, but more recently it has been defined simply as ‘union’.

We associate yoga with the practice of gentle physical and breathing exercises. This form of yoga is derived from a very strict meditation discipline called ‘hatha yoga’. The West has adapted hatha yoga to its needs by stripping it of all its religious and ascetic practices. This form of yoga is now an accepted part of our Western lifestyle.

Other forms of meditation from the Eastern traditions have also been adapted. The comprehensive and intricate visualisations of various deities have been replaced with images of beaches or forests, the devotional ‘gazing’ has been replaced with flowers or candles, and the sacred mantras have been replaced with everyday words.

There is nothing mysterious in these techniques. The strict adherence and disciplines required for their religious and philosophical aspects have been stripped away, leaving their bare essence, techniques for relaxation. Learning to meditate does not mean we have to change our religion, our lifestyle or our diet. The only thing which will change will be our response to stress and anxiety.

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Many people were, and still are, being given a graded exposure program as treatment for their agoraphobia. Along with medication this may be the only other form of treatment people have received. Graded exposure does not cover the many strategies used in CBT and is simply exposure to situations and/ or places we avoid.

The question many people with panic disorder/agoraphobia ask is, ‘exposure to what’? Many graded exposure programs treat the avoidance behaviour in panic disorder as though it was the situation or place which triggered the attack. Much to their confusion, people who have panic disorders without any form of avoidance behaviour have been, or are given, a graded exposure program.

The rationale behind graded exposure programs is that when people put themselves into avoided situations/or places and stay in that situation or place, then the anxiety and/or panic attack will peak and slowly ebb away. In other words the person will habituate to the anxiety and panic attack in that situation or place. As many people say, even though the panic attack does subside, if they are not directly frightened of the situation/or place why would the anxiety ‘ebb away’ when it has never done so before.

Trying to correct avoidance behaviour without working on the cause means limited success, which can be destroyed by the next panic attack.

Most of these programs insist people stay in the situation or place until the anxiety and panic attack subsides and this is also one of the main complaints from people with panic disorder. It seems illogical to stay in a city mall (or any other place) for hours on end in an effort to reduce anxiety. Many are chronically anxious day-in, day-out, and are also experiencing ongoing panic attacks. As people say, if they were going to habituate to the anxiety and the panic attacks they would have already done so, irrespective of where they were.

To compound the issue and the confusion, many panic disorder clients are asked to list their secondary fears and a graded exposure program is built around them. In some cases the list of fears included specific fears which pre-dated the attacks and have no bearing on the disorder, yet they are incorporated or become the main feature of the exposure program. This little known but crucial fact has also been noted by researchers. One such study showed, ‘half the simple (specific) phobias in panic disorder had childhood onset and half had onset associated with the onset of panic disorder’ (Argyle et al. 1990).

The new categories of panic attacks demonstrate quite clearly the spontaneous panic attack is triggered by internal cues not external ones. In panic disorder, treatment needs to be aimed at these internal cues.

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The third category of avoidance behaviour is not known or realised by almost anyone who does not have the disorder. It is the avoidance of situations and/or places because of feeling generally unwell most of the time.

As well as suffering the symptoms of anxiety and panic attacks, our level of overall fitness deteriorates rapidly. We begin to experience a general sense of feeling unwell. Some people compare this to ongoing ‘flu-like’ symptoms. We are also continually exhausted, as the anxiety and panic attacks consume all our energy. Going out, going to work or doing the normal day-to-day things around the house mean not only trying to keep the anxiety and panic attacks at bay, but also trying to overcome the feeling of being unwell and the all-consuming fatigue.

Alcohol

The use of alcohol is another control and some people will go on to develop an alcohol dependence. Both men and women use it, although it appears to be the major control used by men.

Many people with the disorders feel it is more socially acceptable to have an alcohol problem than to admit to having an anxiety disorder. The symptoms of a hangover can also perpetuate the anxiety. We misinterpret these symptoms as a warning” of an impending panic attack, so we have another drink in an effort to control it.

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Part of the overall problem in understanding the severity of the disorders lies in the word ‘anxiety’. Everyone has been anxious at one time or another, and it is through our own experience of anxiety that we judge those who experience anxiety disorders.

Our own anxiety may not have affected us to any great extent. If it did we were able to do something about it, or it passed of its own accord and was no longer a problem. We have extreme difficulty in accepting that a person with an anxiety disorder experiences anything different from our own anxiety. So it is quite natural for us to say or think ‘pull yourself together’, or to ignore that there really is a problem.

There is a marked difference between the ‘normal’ experience of anxiety and that of an anxiety disorder. People cannot ‘pull themselves together’, because they do not know what is wrong with them. They do not recognise the symptoms as anxiety. If it was purely the experience of anxiety, people would recognise it and they would be able to address the problem. It is this difference which is highlighted by the fact that even now, some health professionals are still unable to recognise, let alone, diagnose or treat these disorders.

The symptoms of anxiety can be quite varied, with any number of symptoms being experienced at the same time. The most common ones are a rapid or pounding heartbeat,

‘missed’ heartbeats, chest pain, an inability to take a deep breath, a feeling that breathing will stop altogether, choking sensation, dizziness, giddiness, feeling faint, nausea, pins and needles, diarrhoea, trembling hands and/or legs, dry mouth, sweating, fatigue, loss of concentration, loss of libido. Dissociative symptoms can include depersonalisation, derealisation, visual disturbances such as intolerance to light, stationary objects appearing to move, tunnel vision and/or audio disturbances, where everyday noise seems louder than normal.

For many people with an anxiety disorder the symptoms are their constant companion. Not just for a few minutes or hours at a time, but ongoing sometimes for months or years. To confuse the issue further, people can experience different symptoms and sensations in their anxiety and panic attacks (Arthur-Jjnes 1994).

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One intriguing aspect of illness is that it can often be ‘cured’ – at least temporarily – by any form of medical attention. A medical investigation or injection can work wonders, and a course of tablets is almost as good. This phenomenon is known as the placebo effect placebo being a Latin word that means ‘I shall be pleasing’.

Research shows that over a third of people in pain get relief from inert

tablets that they believe to be painkillers. Headaches, migraine, insomnia, epilepsy and rheumatoid arthritis are among the conditions that are susceptible to placebos.

In some cases, the symptoms may have been psychosomatic in origin, which would account for the good effect of the placebo. It may be that the patient feels gratified by someone taking his or her illness seriously, or it may simply be the power of suggestion – because they feel they are being offered a cure, they actually begin to get better. In other cases, there may be a mixture of organic illness and psychosomatic illness behind the symptoms – the two can coexist, one feeding on the other. Again, the placebo could be powerful because it meets some psychological need for attention and treatment.

With diseases such as rheumatoid arthritis, it is less obvious how the placebo effect works. However, the immune system plays an important role in rheumatoid arthritis, and this may provide a clue. A new form of treatment, or a new and more enthusiastic doctor, may act as a morale-booster which has a beneficial effect on the immune system – the sort of effect that the psychoneuroimmunologists are currently studying. Placebo effects are also seen in allergy, perhaps for the same reason.

A characteristic feature of the placebo effect is that it does not last all that long: it is usually only a matter of weeks, and two to six months is about the most that can be expected. If a patient responds to a new treatment and is still well after a year, it is unlikely to be a placebo effect.

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Anytime a patient notices a suspicious mass in his testicle, I suggest that he visit a urologist, who will do a sonogram of the mass to determine the exact site and whether the mass is hard or filled with fluid. If the urologist has any doubt, he will perform a biopsy. If the testicle is not cancerous—which is usually the case—it will be left in place.

If you have a cyst on the epididymis, your doctor will probably choose to leave it alone. If it continues to grow, however, it will eventually cause pain. At that point, your doctor will probably want to remove it surgically.

If the lump turns out to be cancerous, your doctor will need to treat it immediately by removing the entire testicle. This procedure is called an orchiectomy and is performed if the cancer has not spread beyond the testicle. Again, since only one testicle is usually affected, the other testicle will be left in place, meaning that your fertility will not be impaired. If your doctor feels that the cancer has spread, however, he will recommend that you also be treated with radiation or chemotherapy; this will result in sterility.

One of my patients is a 37-year-old man whom I diagnosed 10 years ago with testicular cancer; he was unmarried at the time. Before he was treated with surgery and radiation, he decided to have his sperm frozen so he would be able to father a child in the future, since the treatments would render him sterile. He also had a small testicular prosthesis placed into his testicular sac for cosmetic reasons.

Today, he’s been cancer free since the surgery; he needs only an annual blood test and physical exam. He hasn’t yet married, but his semen is intact if he needs it to become a father.

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Changing your diet or your medication will often correct chronic diarrhea.

If you think you have lactose intolerance, try eating some ice cream or drinking a large glass of milk. If you begin to have diarrhea an hour or two later, and you also feel pain and bloating in your abdomen, you probably have a lactose intolerance. You should then eliminate dairy products from your diet as much as you can. This, however, can be a problem, since you still need to get some calcium in your diet, especially if you are a woman. Fortunately, you can take calcium supplements, 1000 milligrams a day for premenopausal women and 1500 milligrams for postmenopausal women daily. You can also buy a lactose-free milk such as Lactaid in the supermarket or add Lactaid drops to your milk or take pills whenever you eat or drink foods that contain lactose.

If you have a gluten intolerance, your doctor will take an X ray of your small intestine to show the typical pattern of gluten malabsorption. An endoscope may also be used to take a biopsy to confirm the diagnosis. One of my patients came to me a few years back complaining of chronic weight loss, and we gave him every test in the book and came up empty-handed. Then I ordered an X ray of his small intestine, which immediately showed all the signs of gluten malabsorption. With the help of a dietitian, we changed his diet to avoid all gluten, and he recovered quickly.

If you have an intolerance to gluten, a gluten-free diet is easy to achieve, even though gluten is found in almost all bread products and cereals. You can eat rice cakes and buy gluten-free products at the health food store.

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