Antidepressants Blog

A physical examination usually involves:

testing a specimen of your urine

taking your blood pressure

examining your breasts

examining your abdomen

a pelvic examination (sometimes also known as an internal or a vaginal examination).

The purpose of the pelvic examination is to try to determine whether there are any indications that you may have some endometrial implants or cysts present. Sometimes, the pelvic examination will suggest the presence of endometriosis but often nothing abnormal will be found, especially in the early stages of the disease.

Knowing what is involved in a pelvic examination will help to relieve any anxiety that you may have and help you to relax and therefore make the examination more comfortable for you and easier for the doctor. Ask your doctor to explain the procedure to you before she or he begins.

It is best if you empty your bladder just before the examination as a full bladder will make it difficult for the doctor to perform the examination satisfactorily.

During the pelvic examination you will usually be asked to lie on your back with your legs spread apart, knees bent and feet together.

While the doctor is examining you it will help if you tell him or her when you can feel any pain or discomfort. A pelvic examination may cause a little discomfort but it should not be painful. If the examination does cause pain ask your doctor to stop for a moment to allow the pain to subside while you relax again. After the examination has been completed ask the doctor to describe what he or she felt.

The doctor will begin by examining the external genitalia, which includes the vulva, clitoris and labia, for any signs of inflammation, irritation or infection.

The doctor will then insert an instrument, known as a speculum, that holds the sides of the vagina apart to examine the vagina and the cervix. The doctor may also take a Pap smear or a sample of any unusual discharge using a cotton swab or a wooden spatula. Once a thorough examination has been made the doctor will remove the speculum and perform a bimanual pelvic examination.

In the bimanual examination the doctor inserts two gloved fingers into your vagina and places the fingers of the other hand on your lower abdomen in order to feel the outline, shape, size and location of the pelvic organs between his or her hands. The doctor will also feel for any nodules, lumps, growths, enlargements or areas of tenderness.

During the examination the doctor may be able to feel nodules of endometriosis in the Pouch of Douglas, on the utero-sacral ligaments or in the recto-vaginal septum. It may also be possible to feel if the ovaries are enlarged, which may indicate cysts on the ovaries. The doctor will also be able to feel if the uterus is lying in the normal position or if it is stuck in a retroverted position.

Occasionally, the doctor may feel that it is necessary to perform a recto-vaginal examination if you are complaining of symptoms involving the bowel. This examination is similar to a bimanual pelvic examination but the index finger is inserted into the vagina and the middle finger into the rectum. The fingers of the doctors other hand are placed over the lower abdomen to help outline the organs and feel for any enlargements or growths.

If a pelvic examination does not indicate anything abnormal and if it was not performed near the time of your period it may be worthwhile having another examination just before, or during, your period when the endometriosis is most active thus making the implants more tender, larger and easier to feel.

*34\83\2*

Originating in ancient India, yoga involves spiritual, mental and physical discipline for the unification of the mind and body. Its physical aspect, a series of postures or asanas, is now widely practised around the world and is popular as a means of managing stress, building strength and maintaining physical flexibility.

Many people with medical conditions such as heart disorders, or diseases of the respiratory system like asthma and bronchitis, will benefit from regular yoga practice as will those with muscular or nervous disorders. Some postures are designed to tone and stimulate internal body organs and glands. There is no high impact aspect to yoga nor any sense of extreme aerobic exertion. Rather, strength is built through muscle control, balance and body awareness. Breathing is very important as the embodiment of the life force or prana. Like T’ai-chi, many of the postures are derived from the movements of animals and birds.

Yoga requires little equipment although a lot of people like to work on a rubber mat. Belts and frames are sometimes employed to maintain postures without straining the body. Your clothing need only be loose and comfortable. As with most physical and mental disciplines, it is recommended that you seek ongoing instruction from a qualified teacher. Select a school with an emphasis on the aspect of yoga which most interests you. Hatha yoga concentrates on physical discipline while Raja yoga places more emphasis on controlling the mind. Bakti is the devotional aspect of yoga.

*82\69\2*

Depression cuts into a person’s ability to function so that some of the failure that they perceive does have a basis in reality Mental processes slow down and it is difficult to concentrate, to focus or to get things done. Work inevitably suffers; chores remain undone; things get botched up, leaving you with feelings of failure and inadequacy, many of which may be exaggerated but some of which may be true. It is easy to forget how competent you have been at other times and how much you have accomplished before. All these things seem insignificant when you are depressed. Dr Kay Redfield Jamison, in her wonderful memoir An Unquiet Mind, describes the difficulties in thinking she experienced during one of her depressions as follows:

Everything – every thought, word, movement – was an effort. Everything that once was sparkling now was flat. I seemed to myself to be dull, boring, inadequate, thick brained, unlit, unresponsive, chill skinned, bloodless, and sparrow drab. I doubted, completely, my ability to do anything well. It seemed as though my mind had slowed down and burned out to the point of being virtually useless. The wretched, convoluted, and pathetically confused mass of gray worked only well enough to torment me with a litany of my inadequacies and shortcomings in character, and to taunt me with the total, the desperate, hopelessness of it all.

This description of severe depression conveys many aspects of a depressed person’s thinking. In the years that followed the depression described above, Dr Jamison went on to succeed enormously as a psychologist, researcher and writer, but such a future is unthinkable when you are in the depths of a depression. It is important to realize how misleading the conclusions reached in a state of depression can be. Nevertheless, when you are depressed, the difficulty in thinking and functioning is real and has its consequences. Failure that occurs in the context of some of the symptoms of depression described here should therefore be considered a tell-tale sign of depression in its own right.

Failure occurs in the workplace, but also in personal dealings. Relationships require a capacity to attend to another person and an ability to feel engaged with that person, both of which are sorely impaired in depression. Others may well feel put off, and withdraw in response to the reclusiveness of a depressed person.

If you find you have been failing at work or in your personal relationships in a way that has not always been typical for you, and this has been going on for more than a few weeks, consider the possibility that you may be clinically depressed.

*55\75\2*

Synthetic chemicals are found throughout the environment, but especially in home janitorial supplies. To rid the house of unnecessary air pollutants, start by looking under the sink. One can usually find there an accumulation of chemical products of all kinds: paints, solvents, laundry and dishwashing detergents, waxes and polishes, insect sprays, turpentine, shoe polish, and so forth. Whatever is not absolutely necessary should be dispensed with. Essential items, such as detergents, should be transferred to glass bottles with tight-fitting caps. One should save bottles for such a purpose. All questionable items should be stored outside, in places such as a garage or storeroom.

The same rule applies, naturally, to any other area in which toxic products accumulate. Conduct a careful house search, cleaning out drawers, broom closets, hobby areas, and medicine chests. It is amazing how much dangerous junk piles up in a house over the years, silently polluting the environment. One should be careful, however, not to allow any of these items to spill as they are being disposed of, or this may precipitate an acute attack of symptoms in susceptible people.

The human nose is an extraordinary instrument. Ecology patients tend to be either acutely sensitive to smells, or, conversely, lacking in the sense of smell altogether (in advanced cases). If you have a good-to-excellent sense of smell, you can identify noxious smells in the house by going out for a brisk walk in an area with fairly clean air and then returning to your house to perform a quick “sniff” test. If something has an offensive odor, get rid of it. Do not wait a day, or even a minute, since the nose will quickly adapt to the ill-smelling item. After being exposed for a short while, one can no longer fully smell the offending odor. Many patients report a cleaner feeling in the air after they have rid their homes of these hidden pollutants.

Several engineers and otherwise qualified experts now make “house calls” to inspect the homes of patients for chemical contaminants. They bring not only their expertise, but exceptional ability in “sniffing out” danger spots for patients, based on their own chemical-susceptibility problems. (The organizations listed in Appendix C can provide names of such experts.)

*106\110\2*

Until some time early in this century, pewter was made by mixing tin with lead, the British Medical Journal (291:1701) reports. Although the risk of lead poisoning from old pewter dishes is minimal, pewter tankards, mugs, or cups are much more dangerous because, if used repeatedly, their fluid contents dissolve a lot of lead. Since modern pewter vessels contain no lead, they can be used without risk.

Nonetheless, the Western Journal of Medicine (143:357) reports, modern pottery colored with lead-containing pigments may not be safe, even if the covering glaze appears to be intact, since it often becomes scratched off or cracked. Furthermore, even some glazes contain lead. People who color pottery or paint with lead-containing pigments (such as cinnabar) are also at risk and must wash their hands before touching their mouths or handling food.

Symptoms of lead poisoning from such sources include mood changes, headache, aching of the limbs, constipation, and bouts of colicky abdominal pain. Since lead poisoning is quite common, anyone having these symptoms should ask a doctor to check them over with this cause in mind.

*184\143\2*

Symptom: Tiny pink or red eruptions each surrounding a skin pore on the cheeks, neck, shoulders, in skin creases, and in nappy area.

Home care:

Keep the child as cool as possible, preferably in an air-conditioned room.

Cool baths and careful dusting with corn flour or baby powder help relieve discomfort.

If the rash is on the face, rest the child’s lace on an absorbent pad placed in the crib.

Be careful not to overdress the child.

Use prickly heat powders during warm weather.

Precautions:

-    Use powder carefully; if a baby inhales large amounts of powder, lung inflammation can occur.

-    Overdressing a baby is a frequent cause of heat rash; the baby need be dressed no more warmly than you dress yourself.

-    The use of detergents and bleaches on bed linens and clothing may aggravate heat rash.

-    Avoid using bubble baths, water softeners, or oily lotions on a child with heat rash.

Heat rash is a mild skin condition caused by temporary blockage of the sweat gland openings on the skin. Heat rash, also known as prickly heat or miliaria, is the most common of all rashes in children of any age. Almost all babies get heat rash during hot weather. Heat rash can even occur in cold weather if your child is overdressed either during the daytime or nighttime. Fair-skinned children (redheads and blonds) get heat rash more frequently than other children, and they suffer the most from it.

*101/84/5*

The Hard-Hat Zone

When Joseph B. Strauss designed and engineered America’s second-largest bridge across the Golden Gate Strait, he was determined that this San Francisco project would be the safest in bridge-construction history. Local safety equipment manufacturer Edward W. Bullard developed the first “hard hat,” workers were fed a special diet to prevent dizziness, and a safety net was suspended below the floor of the bridge from end to end. That net saved a total of 19 men, proving that safety measures worked. Then in 1937, a few months before the bridge was to open, a section of scaffold carrying 12 men fell and ripped through the safety net, killing 10 of them-proving also that construction was, is, and likely always will be inherently dangerous.

Today, falls remain a leading cause of death and disability at construction sites. In one year alone, it’s common to have more than 40,000 disabling falls. When those falls happen from roofs, scaffolding, or other temporary platforms, workers often don’t get back up. Making matters on the construction site even worse are vehicular accidents and electrocutions, which account for almost as many fatalities as falls.

With more than 309 deaths in 1995-or a rate of 39-5 for every 100,000 workers-being a construction laborer ranks as the sixth deadliest occupation in the United States. No doubt, we’re always going to need bridges and buildings, but we need to keep our construction workers safe. Here’s what experts recommend.

Strap on protection. There is no shortage of products on the market to help prevent a construction worker’s fall. “Some fasten the workers to a stable part of the construction site. Some work like a seat belt and ‘catch’ the worker should he suddenly slip.” But according to some safety professionals, many of the daredevils in these fields don’t want to wear them. For example, roofers have actually fought to be exempt from fall-protection regulations because they maintain that the equipment contributes to falls rather than preventing them.

Work along the curve.

“Being new on a job increases your chances for getting hurt”. “The newness of the work, the lighting, and the conditions all put you at risk when you start a job, no matter what your age. It’s best to be aware of that and respect your learning curve.”

White-Collar Woes

If you’re among the legion of button-down desk jockeys or other non-laborers in the workforce, you don’t have to worry much about death by toppling trees or by falling hundreds of feet from scaffolding. Your coworkers are another story. One in three workplaces has been the site of a violent episode. Every day two or three workers are fatally shot at work.

Assaults and violent acts comprise 20 percent of fatal occupational injuries. When they happen at work, your employer takes a certain amount of responsibility for them and they are logged as occupational “intentional deaths” – the safety industry’s word for not being an accident. Right now, getting shot is the biggest risk for some white-collar workers.

Though this occupational risk seems more out of the victim’s control than, say, strapping on a safety belt, that doesn’t mean that you’re helpless from preventing these events from occurring. For example, I can remember back in the 1970s, anybody could just walk into the federal building where I worked. But circumstances have changed. Now we have employee identification and access cards to restrict entrance of potential perpetrators of violent acts in the workplace.

If your workplace seems vulnerable to outside invasion, safety experts suggest that your employer install a security system, especially if your job involves handling money. Employers often take these suggestions seriously.

*110/36/5*

RHEUMATIC FEVER

Bursitis

Bursitis is the name given to the situation where an inflammatory condition of the bursae exists. The bursae are’ closed sacs’ which are lined with a special membrane and which facilitate the movement of muscles and tendons over bony surfaces. Housemaid’s knee is possibly one of the most commonly known forms of bursitis but there are others which affect areas such as the elbow or the heel. There are several causes for the various types of bursitis, ranging from too much kneeling in the case of housemaid’s knee, through direct injury and the introduction of organisms in septic bursitis, to abnormal deposition of calcium around the rotator tendons in calcareous tendinitis (bursitis of the shoulder).

Tennis elbow

Tennis Elbow is a condition not truly named because it is not restricted to tennis players. Any occupation which involves frequent and repeated extension of the wrist can bring on this condition. It is, again, an inflammatory condition with associated pain and restriction of flexibility. Whilst the affected region is principally the elbow, the problem can involve the muscles on either side, depending on the cause. For instance, if the condition occurs after playing tennis or squash, the outer side of the elbow would be the region most likely to be affected. If it occurred after, say, golf or cricket, then probably the inner side would take the strain and be the one to be affected.

Psoriatic arthritis

Psoriatic arthritis is a form of the disease in which two conditions exist. The first is psoriasis, which is an inflammatory condition of the skin, and the second has features which are very similar to rheumatoid arthritis. The two conditions are believed to be associated and not merely coincidental. It is also quite probable with psoriatic arthritis that heredity may be a significant feature in its occurrence.

Rheumatic fever

Rheumatic fever is a different kind of disease altogether and we have some knowledge of its causes. This condition may result in an attack on many organs of the body. If the heart is the organ affected, then the results may be fatal. If the particular area attacked by the fever involves connective tissue or an articular function, the arthritic association becomes apparent.

Fortunately with the development of better health and sanitation standards throughout the world the incidence of this disease should decrease. This is because rheumatic fever occurs as the result of infection by bacteria of the type known as the Streptococci. It should be pointed out that not all infections by Streptococci result in rheumatic fever. Only a certain group of these bacteria are effective and even then there may be other factors, besides the presence of these pathogenic organisms, which are necessary for the condition to develop. Although Streptococcal infections can occur even amongst the best regulated populations, the probability of any bacteriological infection is reduced with good hygiene and public health standards.

*4/48/5*

Once a diagnosis has been made the gynecologist should mark the size and location of all your implants, cysts, endometriomas and adhesions on a drawing or prepared chart of the reproductive organs. If you have any endometrial implants or cysts located outside the pelvic cavity, such as on the bowel or cervix, the gynecologist will make a note of the location of those implants and cysts somewhere on the chart. Similarly, if any other conditions, such as pelvic inflammatory disease, are found these will also be noted.

Because of the progressive and recurrent nature of endometriosis it is important that an accurate chart of your endometriosis be made at the time of your diagnostic laparoscopy. The chart will provide a record of the initial extent of your endometriosis that can be compared at a later date with the charts made during any subsequent laparoscopics so that an accurate assessment can be made of the progress of your condition.

The information gained from the laparoscopy and the chart is then used to rate the extent and severity of your condition. There are several formal classification systems which have been developed, the most widely known being a system developed by the American Fertility Society. These classification systems generally allocate a certain number of points to each implant or cyst depending on its nature, size and location and the total number of points is then used to classify the severity of the condition.

For example, according to the American Fertility Society’s classification scheme, a woman with a four centimeter endometrioma on one ovary, some adhesions on both ovaries and implants in the Pouch of Douglas would score a total of 30 points (20 + 2 + 2 + 6) which would be defined as moderate endometriosis (16-40 points).

However it appears that few gynecologists in Australia use any of the formal classification systems. Their classification of the disease is usually based on their visual impression gained from the laparoscopy.

The four categories most commonly used to classify endometriosis are minimal, mild, moderate and severe. The terms stage I, stage II, stage III and stage IV are also used occasionally. A brief description and diagram of a typical example of each category is shown in Fig.9 on p.56.

It is important to remember that the classification system only rates the extent and severity of your endometriosis and your classification does not necessarily bear any relationship to the severity of your symptoms. Minimal or mild endometriosis can cause severe symptoms while severe endometriosis can sometimes cause no symptoms.

*26/41/5*

Not so long ago, biologists conceived of the brain as a kind of computer, a machine that generates and processes electrical signals. New discoveries forced us to revise that model. We now think of the brain more in terms of a chemical factory. Chemical “messengers” travel across the gap between nerve endings, and when they reach the proper receptors they trigger electrical signals.

Without the presence of a neurotransmitter, an electrical impulse comes to a biological dead end-its message can’t get through. Too much or too little of a given chemical can also affect the rate and the clarity with which the signal is carried. That’s why we speak of chemical imbalance as the cause of a number of mental and physical disorders.

Sitting within the skull, the brain is enmeshed in an intricate network of blood vessels. Before blood can reach the brain, it must pass through a kind of filter known as the blood-brain barrier. This barrier acts, quite literally, as a bodyguard, preventing potentially harmful molecules carried in the blood from gaining access to the brain. For example, the blood-brain barrier will not permit certain drugs to enter the brain and wreak biological havoc.

Blood contains the red cells, which transport vital supplies of oxygen to nourish the brain cells and keep them functioning, and the white cells of the immune system, responsible for protecting the body from invaders. These cells are suspended in plasma, the fluid portion of blood made up of water, minerals, glucose, fats, proteins, and other substances.

The exact composition of plasma is determined in part by the types and amounts of food you eat. Following a meal, the chemical makeup of plasma changes. For example, if you’ve eaten a large steak, the presence of certain amino acids-the building blocks of protein-may increase. When blood containing this particular plasma mix reaches the blood-brain barrier, the different amino acids compete with each other to squeeze through the openings in the filter. Like shoppers clawing their way to reach a K-mart blue light special, only a few can get through.

Different chemical mixtures trigger the manufacture of different neurotransmitters. Let me give you an example. (Bear in mind, however, that not all the facts are in on this intricate process.)

Eating carbohydrates stimulates the pancreas to release insulin, in turn lowering the blood levels of most amino acids. The amino acid tryptophan is unaffected by this process. More tryptophan enters the brain, since there is less competition at the blood-brain barrier from other amino acids. In the next step of the process, tryptophan is converted to a powerful neurotransmitter called serotonin. The higher the tryptophan level, the more serotonin the body can make.

Serotonin circulates in the blood, eventually reaching a certain part of the hypothalamus. When the serotonin level is high enough, it triggers a message that speeds to the other parts of the brain. The message reads something like: “Stop eating carbohydrates now and look for food with other nutrients.” Thus it may be that the specific foods you have already eaten may lead to cravings for other types of foods.

Experiments have shown just how powerful these neurotransmitters can be. For example, animals who normally eat a balanced diet will turn into voracious carbohydrate-cravers, even to the point of endangering their health, if their brains are flooded with certain chemicals that stimulate carbohydrate ingestion.

There are actually three main groups of neurotransmitters involved in the regulation of appetite: the monoamines (of which serotonin is one), the amino acids, and the neuropeptides.

At this point let me introduce the term macronutrients, a word that refers to the major components in food. The three types of macronutrients are carbohydrates, proteins, and fats. Each of these supplies a different type of energy to the body. A balanced diet contains a healthy mix of all three macronutrients. As a rule, animals and most humans will seek out foods that, over the course of time (say, a day) will supply the macronutrient blend their bodies need.

Macronutrients affect the production and release of neurotransmitters. As we saw in the above example, carbohydrate consumption may lead to increased serotonin levels. Similarly, sweet or fatty foods lead to production of certain neuropeptides.

Like a biological traffic cop, the hypothalamus directs all this activity, and it’s a particularly busy intersection. Signals coming from the brain affect the diet, while diet in turn affects the signals heading for the brain. Should something go wrong, a neurotransmitter disturbance might trigger an abnormal pattern of eating. This in turn might worsen the already existing neurotransmitter disturbance, causing more abnormal eating, and so on.

Such findings underscore how chemical messengers spark specific behavior. Controlling the balance of these chemicals through medications might ultimately enable us to bring abnormal eating patterns under control.

*41/35/5*